Severe chronic active Epstein-Barr virus infection is a rare, debilitating, nonneoplastic, inflammatory disorder for which there is no definitive treatment. We describe a Caucasian child who initially presented with clinical and histopathologic features consistent with inflammatory bowel disease, for whom additional investigations led to the diagnosis of severe chronic active Epstein-Barr virus infection.

Biopsy, Needle↗

PubMed2005

Therapy and support services for people with long-term stroke and aphasia and their relatives: a six-month follow-up study.

OBJECTIVE: To evaluate the impact of attending an aphasia therapy centre on quality of life and communication skills in people with stroke and aphasia and their relatives. DESIGN: Before and after study, six months duration. SETTING: Community-based aphasia therapy centre in the United Kingdom. PARTICIPANTS: Thirty-eight men and women with aphasia following a stroke, and 22 of their relatives. Mean time since stroke was 33 months (SD 24.1). INTERVENTIONS: A range of group therapies for people with aphasia and their relatives and counselling for individuals and couples. OUTCOME MEASURES: Quantitative outcome measures were ratings of quality of life and communication for people with aphasia, and relatives' independent ratings of communication and coping with caring. Qualitative outcomes were perceptions of quality of life and communication skills using semi-structured interviews. RESULTS: Improvement was detected on all outcomes at six months. There were significant changes from baseline on the quality of life measure, mean difference 0.14 (95% confidence interval 0.02, 0.26); and the communication measure assessed by people with aphasia and their relatives, mean difference 12.8 (4.0, 21.5) and 9.7 (3.6, 15.7) respectively. The changes on the coping with caring measure were not significant, though the direction of change was positive. Qualitative interviews revealed a similar pattern of benefit in terms of increased levels of self-confidence and changes in lifestyle and levels of independence. CONCLUSIONS: The results suggest that this therapeutic approach has an impact on quality of life and communication for people with aphasia and their relatives.

Adaptation, Psychological↗

PubMed2005

Sex, medicine and the Tudors.

Explore the source record for details and available documents.

Contraception↗

PubMed2005

Canadian Helicobacter Study Group Consensus Conference: Update on the approach to Helicobacter pylori infection in children and adolescents--an evidence-based evaluation.

As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of 14 topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The goal was to update guidelines based on the best available evidence using an established and uniform methodology to address and formulate recommendations for each topic. The degree of consensus for each recommendation is also presented. The clinical issues addressed and recommendations made were: population-based screening for H. pylori in asymptomatic children to prevent gastric cancer is not warranted; testing for H. pylori in children should be considered if there is a family history of gastric cancer; the goal of diagnostic interventions should be to determine the cause of presenting gastrointestinal symptoms and not the presence of H. pylori infection; recurrent abdominal pain of childhood is not an indication to test for H. pylori infection; H. pylori testing is not required in patients with newly diagnosed gastroesophageal reflux disease; H. pylori testing may be considered before the use of long-term proton pump inhibitor therapy; testing for H. pylori infection should be considered in children with refractory iron deficiency anemia when no other cause has been found; when investigation of pediatric patients with persistent or severe upper abdominal symptoms is indicated, upper endoscopy with biopsy is the investigation of choice; the 13C-urea breath test is currently the best noninvasive diagnostic test for H. pylori infection in children; there is currently insufficient evidence to recommend stool antigen tests as acceptable diagnostic tools for H. pylori infection; serological antibody tests are not recommended as diagnostic tools for H. pylori infection in children; first-line therapy for H. pylori infection in children is a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics (clarithromycin plus amoxicillin or metronidazole); the optimal treatment period for H. pylori infection in children is 14 days; and H. pylori culture and antibiotic sensitivity testing should be made available to monitor population antibiotic resistance and manage treatment failures.

Adolescent↗

PubMed2003

Using co-teaching as a means of facilitating interprofessional collaboration in health and social care.

In this paper we report the findings of a collaborative enquiry on our experience as tutors co-teaching interprofessional collaboration to a multidisciplinary group of undergraduates. We have different professional/academic backgrounds and the student group included health and social work professionals alongside a number of non-professionals. Our data included our perceptions of the co-teaching experience collected by means of our reflective diaries and reflective conversations during planning and after teaching sessions. We also collected data on student perceptions elicited by means of student evaluations and a student focus group discussion. The data illuminate the process of using co-teaching to role model shared learning and collaborative working within the classroom and highlight the importance of carefully planning co-teaching interaction, including the use of humour, tension, different knowledge bases and styles of debate. The deliberate use of the interactions made possible by coteaching enabled us to create an active learning environment that facilitated the teaching of collaboration. Drawing on our experience, we discuss the considerable potential of using co-teaching to role model collaborative working for multidisciplinary student groups.

Attitude of Health Personnel↗

PubMed2003

Liposome-encapsulated oxymorphone hydrochloride provides prolonged relief of postsurgical visceral pain in rats.

Adequate pain control is necessary for optimal postsurgical recovery and humane treatment of laboratory and companion animals. Opioid drugs are currently the most potent analgesic agents available in human and veterinary medicine. Long-acting formulations of opioid drugs confer several important advantages over standard pharmaceutical preparations, especially for use in animals. A long-acting formulation of oxymorphone hydrochloride was produced by encapsulation into liposomes. Liposome-encapsulated (LE) oxymorphone was tested in a rat model of visceral postoperative pain. Rats were given one subcutaneous injection of LE oxymorphone (1.2 or 1.6 mg/kg of body weight) or standard oxymorphone (0.3 mg/kg) at the time of intestinal transection or resection. A single administration of LE oxymorphone hydrochloride was as effective for relief of postoperative pain in rats (P = 0.18), as were multiple (q4 h or q8 h) injections of 0.3 mg/kg of the standard pharmaceutical preparation. The rats given LE oxymorphone prior to intestinal resection also had significantly higher body weight at three and seven days after surgery than did rats that were given standard oxymorphone. In conclusion, LE oxymorphone was effective in treating visceral pain associated with intestinal surgery in rats. On the basis of body weight gain, rats treated with LE oxymorphone had improved recovery outcome, compared with rats treated with repeated injections of standard oxymorphone.

Abdominal Pain↗

PubMed2002

No pain, no gain: clinical excellence and scientific rigour--lessons learned from IA morphine.

The effectiveness of intra-articular (IA) morphine in arthroscopic procedures of the knee joint was analysed in all randomised and controlled trials that included injections of morphine and placebo into the knee joint, and where the data were analysable. Sensitivity of the studies and effectiveness were analysed for three different periods: immediate (0-2h), early (2-6h) and late (6-30h). Sensitivity for each period was assumed if pain intensity was at least 30% of the maximum of 100 on the visual analogue scale in the placebo group. Six different doses (1-10mg) of IA morphine were compared with placebo. The injections were made at the end of surgery, before the arthroscope was removed from the joint. In the immediate period 7/15 sensitive trials were positive, in the early period 8/12 sensitive trials were positive and in the late period 10/13 sensitive trials were positive. Most positive studies had used higher doses (3-5mg) compared with negative studies that had mainly used 1mg. Two studies using patient controlled analgesia consumption of analgesics as an outcome were also positive. The only sensitive study of four dose-response comparisons indicated that 5mg of IA morphine was more effective than 1mg. The only sensitive study of three cross-route comparisons showed no difference between 5mg of IA and 5mg of intra-muscular morphine. All insensitive trials, including placebo (except two individual comparisons), cross-route and dose-response comparisons, were negative. The analysis of sensitive studies indicates that 5mg of IA morphine injected into the knee joint provides postoperative pain relief for up to 24h. A minimum of 30% of the maximum possible pain intensity is needed for an analgesic effect to be detected in a study.

Analgesics, Opioid↗