1/86. The emotional face of harm.Nonmaleficence refers to the maxim Primum non nocere, "Above all, do no harm." Nonmaleficence is an important ethical principle, especially in the face of advanced technology and other superordinary or extraordinary therapeutic interventions available to patients today. Chronic illness poses challenges in balancing the benefits with the burdens of therapeutic intervention. A discussion of nonmaleficence as a principle to consider in chronic conditions is presented.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/86. Managing pain and comorbid depression: A public health challenge.Many millions of Americans suffer chronic medical conditions complicated by both depression and pain. chronic pain disorders may be classified as being caused by one or more mechanisms, such as nociceptive (inflammatory), neuropathic (peripheral and central), and myofascial, each associated with a complex substrate of neurophysiologic changes. Specific treatment approaches have been developed for different pain mechanisms. Because all pain sensation is personal and subjective, all pain is affected to some degree by emotional states, and, therefore, by psychosocial factors. Major depression commonly complicates chronic pain and adds to impairment and disability. There is evidence that patients with depression occurring after the onset of chronic pain have the same rates of affective disorders in family members as in the general population, and significantly lower rates than in families of patients with major depression alone. This suggests that it is the stress of living with chronic pain, not personal or family predisposition, that causes depression in these patients. Optimal treatment includes treatment of both pain and depression, together with a focus on symptom control and functional restoration.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
3/86. Asymptomatic chronic anterior posttraumatic dislocation in a young male patient.We report an unusual case of chronic anterior glenohumeral dislocation in a young active patient. The diagnosis was not made until 4 years after the initial injury occurred. X-ray evaluation and magnetic resonance imaging showed an anterior dislocated humeral head that was locked anteroinferior of the glenoid as a result of a large Hill-Sachs lesion. Passive and active range of motion was surprisingly normal, and the patient had no pain and no limitation in his activities of daily living. A chronic dislocation of the glenohumeral articulation has been defined as a joint that has been dislocated for at least several days. It is generally accepted that the longer the dislocation persists, the more the difficulties and complications of reduction increase. In most of the patients the persistence of an unreduced chronic dislocation is a very difficult problem. This condition is mostly seen in elderly patients and in those with limited general mental status. We report a case of a young male patient with only minor clinical symptoms.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
4/86. To die young, to die old management of terminal illness at age 20 and at age 85: case reports. death and dying in a 20-year-old woman.An effort was made to provide emotional support during the terminal phase of leukemia in a 20-year-old woman. Notable were the patient's own ways of coping and the responses of her family and the hospital staff. She first denied and then recognized her own dying. Her anger was prominent, and she withdrew from objects toward the end. The intense stresses in the doctor-patient relationship, transference, countertransference, and reality factors are described.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
5/86. A conservative management protocol for calcific tendinitis of the shoulder.OBJECTIVE: This paper presents a management protocol for calcific tendinitis and describes its effective application in 2 cases of calcific tendinitis of the supraspinatus tendon in middle-aged women. CLINICAL FEATURES: Two patients presented to a chiropractic clinic with previously diagnosed calcific tendinitis of the supraspinatus tendon. Both patients complained of chronic pain and tenderness in the shoulder region and had a limited range of shoulder motion as a result of the pain. Radiographs demonstrated calcific deposits in the region of the supraspinatus tendon. INTERVENTION AND OUTCOMES: Both patients were admitted to a treatment protocol involving approximately 20 sessions of phonophoresis (driving of medication into tissue by ultrasound) with Movelat cream followed by cross-friction massage to the supraspinatus tendon and range of motion exercises. A second set of radiographs was requested. The calcific deposits, clearly seen on the previous radiographs, were no longer visible, and symptoms were resolved. At 4-month follow up, both patients continued to be symptom-free. CONCLUSION: The result of these studies indicates that the management of calcific tendinitis falls within the scope of chiropractic practice and supports the use of a trial period of conservative management in cases of calcific tendinitis before consideration of surgical treatment.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
6/86. Partnership in education: an example of client and educator collaboration.This article describes one education strategy designed to assist nursing staff in the process of "learning to surrender" the service providers' need to direct client decision-making. Using the health promotion principle of "client as expert," a nurse educator and a client with advanced multiple sclerosis co-present an inservice class about the importance of personal empowerment and environmental mastery for maintaining physical and psychological well-being in the face of a chronic disorder. This collaborative strategy provided the client a forum from which to share his personal experience and professional knowledge to influence attitudes and provide valuable information to nursing staff in a long-term care facility. Collaborating with the client to bring information to nursing staff is one means to foster a climate of client empowerment, influence staff perceptions and communicate the unique experiences of the client.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
7/86. Transference and dream in illness: waxing psyche, waning body.In times of change, crisis, and illness, the excited points of an individual's personal history are reactivated within the transference and may also be noted by observing countertransference. When there are anomalies in the emotional and imaginal circle of the therapeutic relationship, there is occasion for repetition and/or a transformative opening. In some cases, there is simultaneous treatment of severe developmental fixations and compulsions, and issues of individuation. Images may emerge both from the personal field and from the collective and archetypal imagination. These may be expressions of interpersonal experience, intrapsychic dynamics, and physical as well as psychic state.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
8/86. Intemittent obstruction of the upper airway during sleep causing profound hypoxaemia. A neglected mechanism exacerbating chronic respiratory failure.An obese patient with a ten year history of respiratory failure presented with insomnia and marked daytime somnolence. Respriatory failure had been attributed to obesity, respiratory centre insensitivity to carbon dioxide, and to diffuse airways obstruction. To investigate the possible role of episodic apnoea with frequent nocturnal arousals, continous recordings were obtained during sleep of arterial oxygen saturation, oesophageal pressure and the motions of the rib-cage and abdomen/diaphragm. Repeated episodes of hypoventilation and profound hypoxaemia were found which were due to intermittent obstruction of the upper airway rather than to cessation of breathing efforts. During the episodes of hypoxaemia, values of arterial O2 tension fell to as low as 24 mmHg. Episodic hypoxaemia was relieved but not abolished, by the use of a collar, designed to hold the mandible forward. Previous reports indicated that recognition of intermittent obstruction of the upper airway during sleep and treatment by a permanent tracheostomy, resulted in a significant long-term imporvement of pulmonary and cardiac function and relief of insomnia and day-time somnolence. When tracheostomy is inadvisable, as in the present patient, it is hoped that similar long-term benefits will result from a supportive collar.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
9/86. EMDR: a new treatment for trauma and chronic pain.EMDR (eye movement desensitization and reprocessing) is a new psychological treatment for trauma that is capable of facilitating rapid and permanent reduction in distressing thoughts and feelings (Carlson et al. 1998,Wilson et al. 1995). In addition to reduction of psychological distress, the method leads to more adaptive attitudes and functioning. The utility of the method also appears to extend beyond trauma with positive results reported in the treatment of addictions, phobias, and pain (Henry 1996, Goldstein & Feske 1994, Grant 1986). As a treatment for pain EMDR offers a method of facilitating permanent changes in how pain is experienced somatically and emotionally. knowledge and understanding of the principles underlying EMDR can also provide a guide for more effective interventions by pain specialists.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
10/86. counseling and educational interventions for women with genital human papillomavirus infection.Human papillomavirus (HPV) genital infection is a sexually transmitted disease that affects a large proportion of college-aged women. In addition to the distressing medical aspects of HPV infection, sometimes including lengthy and painful treatments, symptom recurrence, a lack of a definitive cure, and its potential for malignant transformation, HPV also results in significant emotional and psychosexual sequalae for the patient. Concurrent with the range of negative emotions experienced by the patient is also a knowledge deficit regarding the disease, its prevention, and its management. This combination of factors within the young women afflicted with this disease often precludes them from effective adherence to their treatment and follow-up plan of care, which are both essential elements in managing this chronic condition. Clinicians who are treating patients with HPV infection must address not only the medical aspects of the disease, but the psychosocial needs as well. This case report describes a newly diagnosed young women with HPV infection and discusses the necessary psychosocial and educational interventions that should be provided to all female patients who are diagnosed with HPV infection. Inclusion of these interventions can reduce the emotional stress that occurs with the diagnosis and can augment a patient's coping skills, thereby serving to improve adherence to the treatment plan and promote a greater sense of empowerment and wellness for the patient.- - - - - - - - - - ranking = 0.75keywords = motion (Clic here for more details about this article) |
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