Body, Mind & Spirit Articles and Latest News

Therapy response evaluation with positron emission tomography-computed tomography.

Semin Ultrasound CT MR. 2010 Dec;31(6):490-5

Authors: Segall GM

Positron emission tomography-computed tomography with F-18-fluorodeoxyglucose is widely used for evaluation of therapy response in patients with solid tumors but has not been as readily adopted in clinical trials because of the variability of acquisition and processing protocols and the absence of universal response criteria. Criteria proposed for clinical trials are difficult to apply in clinical practice, and gestalt impression is probably accurate in individual patients, especially with respect to the presence of progressive disease and complete response. Semiquantitative methods of determining tissue glucose metabolism, such as standard uptake value, can be a useful descriptor for levels of tissue glucose metabolism and changes in response to therapy if technical quality control measures are carefully maintained. The terms partial response, complete response, and progressive disease are best used in clinical trials in which the terms have specific meanings and precise definitions. In clinical practice, it may be better to use descriptive terminology agreed upon by imaging physicians and clinicians in their own practice.

PMID: 21147376 [PubMed - in process]

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Clinical judgement and the medical profession.

J Eval Clin Pract. 2010 Oct 25;

Authors: Kienle GS, Kiene H

Objectives  Clinical judgment is a central element of the medical profession, essential for the performance of the doctor, and potentially generating information also for other clinicians and for scientists and health care managers. The recently renewed interest in clinical judgement is primarily engaged with its role in communication, diagnosis and decision making. Beyond this issue, the present article highlights the interrelations between clinical judgement, therapy assessment and medical professionalism. Methods  Literature review and theory development. Results  The article presents different methodological approaches to causality assessment in clinical studies and in clinical judgement, and offers criteria for clinical single case causality. The article outlines models of medical professionalism such as technical rationality and practice epistemology, and characterizes features of professional expertise such as tacit knowledge, reflection in action, and gestalt cognition. Conclusions  Consequences of a methodological and logistical advancement of clinical judgment are discussed, both in regard to medical progress and to the renewel of the cognitive basis of the medical profession.

PMID: 20973873 [PubMed - as supplied by publisher]

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Urofacial (ochoa) syndrome: can a facial gestalt represent severe voiding dysfunction?

Ren Fail. 2009;31(7):589-92

Authors: Derbent M, Melek E, Arman A, Uçkan S, Baskin E

Urofacial (Ochoa) syndrome is a rare autosomal-recessive disorder that features an unusual “inverted” facial expression, such that patients appear to be crying when they smile. This syndrome also involves serious urinary tract disorders, though the diagnosis may be missed because of variability of these problems and failure to recognize the characteristic facial grimacing. The urinary issues usually result in enuresis, urinary tract infection, and hydronephrosis, and some severely affected patients become hypertensive and progress to end-stage renal disease. Early diagnosis is very important for management of urinary problems and best prognosis in these patients. We report the first published case of urofacial syndrome in Turkey. The patient was diagnosed at 16 years of age, after having been followed with the diagnosis of recurrent urinary tract infection and vesico-ureteral reflux. Physicians should keep this syndrome in mind for any patient who presents with dysfunctional voiding, particularly in countries with high rates of consanguineous marriage.

PMID: 19839856 [PubMed - indexed for MEDLINE]

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Hunter syndrome in an 11-year old girl on enzyme replacement therapy with idursulfase: brain magnetic resonance imaging features and evolution.

J Inherit Metab Dis. 2010 Jan 6;

Authors: Manara R, Rampazzo A, Cananzi M, Salviati L, Mardari R, Drigo P, Tomanin R, Gasparotto N, Priante E, Scarpa M

Mucopolysaccharidosis type II (MPS-II, Hunter disease) is a X-linked recessive disorder. Affected females are extremely rare, mostly due to skewed X chromosome inactivation. A few papers outline MPS-II brain magnetic resonance imaging (MRI) “gestalt” in males, but neuroradiological reports on females are still lacking. We present an 11-year-old girl affected by the severe form of MPS-II who was followed up over a time span of 8 years, focusing on clinical and brain MRI evolution. In the last 2.5 years, the patient has been treated with enzyme replacement therapy (ERT) with idursulfase (Elaprase, Shire Human Genetic Therapies AB, Sweden). On brain and cervical MRI examination, abnormalities in our patient did not differ from those detected in male patients: J-shaped pituitary sella, enlargement of perivascular spaces, brain atrophy, mild T2-hyperintensity in the paratrigonal white matter, diffuse platyspondylia, and mild odontoid dysplasia with odontoid cup. Brain atrophy progressed despite ERT introduction, whereas perivascular space enlargement did not change significantly before and after ERT. Cognitive impairment worsened independently from the course of white matter abnormality. Despite a profound knowledge of genetic and biochemical aspects in MPS-II, neuroradiology is still poorly characterized, especially in female patients. Spinal and brain involvement and its natural course and evolution after ERT introduction still need to be clarified.

PMID: 20052546 [PubMed - as supplied by publisher]

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[Reason and emotion: integration of cognitive-behavioural and experiential interventions in the treatment of long evolution food disorders]

Nutr Hosp. 2009 Sep-Oct;24(5):614-7

Authors: Vilariño Besteiro MP, Pérez Franco C, Gallego Morales L, Calvo Sagardoy R, García de Lorenzo A

This paper intends to show the combination of therapeutical strategies in the treatment of long evolution food disorders. This fashion of work entitled “Modelo Santa Cristina” is based on several theoretical paradigms: Enabling Model, Action Control Model, Change Process Transtheoretical Model and Cognitive-Behavioural Model (Cognitive Restructuring and Learning Theories). Furthermore, Gestalt, Systemic and Psychodrama Orientation Techniques. The purpose of the treatment is both the normalization of food patterns and the increase in self-knowledge, self-acceptance and self-efficacy of patients. The exploration of ambivalence to change, the discovery of the functions of symptoms and the search for alternative behaviours, the normalization of food patterns, bodily image, cognitive restructuring, decision taking, communication skills and elaboration of traumatic experiences are among the main areas of intervention.

PMID: 19893873 [PubMed - indexed for MEDLINE]

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Hypotension and shock in the preterm neonate.

Adv Neonatal Care. 2009 Aug;9(4):156-62

Authors: Schmaltz C

While the methods of establishing and maintaining organ perfusion differ from one clinician to the next, the underlying physiological rationale remains constant. The gestalt for correcting circulatory compromise is generally performed in a stepwise manner; first ensuring that the vasculature is filled, then administering medications to tighten the vasculature, and lastly, compensating for an immature vasculature. This stepwise approach is reflected in the pharmacological interventions of providing fluid boluses (filling the pump), giving catecholamines (tightening the pump), and starting hydrocortisone (compensating for an immature pump). While the stepwise management approach may be familiar to some nurses, it is important to understand the evidence-based rationale that supports clinical decisions. This article will outline physiology unique to the neonate, clarify terminology that surrounds hypotension and shock, and explore various methods for the treatment of circulatory compromise in the preterm neonate.

PMID: 19696569 [PubMed - indexed for MEDLINE]

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Couples Counseling in Alzheimer’s Disease: Additional Clinical Findings from a Novel Intervention Study.

Clin Gerontol. 2009 Apr 1;32(2):130-146

Authors: Auclair U, Epstein C, Mittelman M

This article describes the clinical findings of a study designed to assess the benefit of counseling for couples, one of whom is in the early stage of Alzheimer’s disease (AD). We previously reported our findings based on the first 12 couples that enrolled in the study. Based on the treatment of 30 additional couples, we have refined our treatment strategy to include concepts of Gestalt Therapy and Transactional Analysis and identified prevalent issues of concern to this cohort. The study design has remained as described in the earlier article (Epstein et al., 2006), and has proven to be appropriate to meet the goals of this intervention as indicated by our clinical experience and feedback from the participating couples. Case vignettes demonstrate how to conduct the sessions so that the experience of each member of the dyad is validated, while acknowledging the differential impact of the disease on them.

PMID: 19865591 [PubMed - as supplied by publisher]

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Early neuropsychological signs of childhood adrenoleukodystrophy (ALD).

Brain Dev. 2009 Aug;31(7):558-61

Authors: Kaga M, Furushima W, Inagaki M, Nakamura M

OBJECTIVE: To identify the very early signs of childhood cerebral adrenoleukodystrophy (CALD) in asymptomatic boys. Methods: Subjects were 8 neurologically and radiologically asymptomatic CALD patients. They were chosen from 22 ALD patients before hematopoietic stem cell transplantation (HSCT) treatment. Wechsler Intelligence Scale tests and other neuropsychological tests were performed. Their IQ data were compared with those of symptomatic ALD children with apparent brain lesions. RESULTS: All asymptomatic CALD showed normal FIQ. PIQ was significantly lower than VIQ in 2 patients. Occipital lesioned patients often showed normal VIQ with low PIQ. Gestalt Closure in The Kaufman Assessment Battery for Children and Constancy of Shape in the Frostig Developmental Test of Visual Perception seemed to be effective for detecting visual cognitive dysfunction in asymptomatic CALD whose difference of VIQ and PIQ was within the normal range. CONCLUSIONS: Follow-up of asymptomatic ALD boys with neuropsychological tests along with previously reported neurophysiological tests may help in determining the timing of therapeutic intervention. Neuropsychological abnormalities seemed to precede the appearance of clinical and MRI alterations.

PMID: 19497692 [PubMed - indexed for MEDLINE]

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Maintenance of gains following experiential therapies for depression.

J Consult Clin Psychol. 2009 Feb;77(1):103-12

Authors: Ellison JA, Greenberg LS, Goldman RN, Angus L

Follow-up data across an 18-month period are presented for 43 adults who had been randomly assigned and had responded to short-term client-centered (CC) and emotion-focused (EFT) therapies for major depression. Long-term effects of these short-term therapies were evaluated using relapse rates, number of asymptomatic or minimally symptomatic weeks, survival times across an 18-month follow-up, and group comparisons on self-report indices at 6- and 18-month follow-up among those clients who responded to the acute treatment phase. EFT treatment showed superior effects across 18 months in terms of less depressive relapse and greater number of asymptomatic or minimally symptomatic weeks, and the probability of maintaining treatment gains was significantly more likely in the EFT treatment than in the CC treatment. In addition, follow-up self-report results demonstrated significantly greater effects for EFT clients on reduction of depression and improvement of self-esteem, and there were trends in favor of EFT, in comparison with CC, on reduction of general symptom distress and interpersonal problems. Maintenance of treatment gains following an empathic relational treatment appears to be enhanced by the addition of specific experiential and gestalt-derived emotion-focused interventions. Clinical and theoretical implications of these findings are presented.

PMID: 19170457 [PubMed - indexed for MEDLINE]

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[Study of Morita therapy–including an experience in participating a joint study program for young psychiatrists from Japan and Korea]

Seishin Shinkeigaku Zasshi. 2009;111(2):214-20

Authors: Hirahisa N, Nakamura K, Nakayama K

PMID: 19466766 [PubMed - in process]

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