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PubMedDate not supplied

Monitoring, reentry, and relapse prevention for chemically dependent health care professionals.

Monitoring and reentry programs for chemically dependent health care professionals are increasingly being recognized as important components of recovery efforts targeted at this population. Such monitoring and preventive programs should incorporate certain eligibility requirements, patient-monitoring program contracts, recovery maintenance activities and adjuncts, work-site assessments and reentry recommendations, random body fluid analysis, relapse management, and clear explanations of financial responsibility. Monitoring and reentry programs need to be fully integrated within the spectrum of resources available to health care professionals.

California↗
PubMed2004

Uric acid, phosphate and oxalate stones: treatment and prophylaxis.

Medical treatment for the most commonly encountered types of renal stones is described. Nowadays treatment for uric acid stones is well-defined: alkalinizing urine is easy with drugs that are sufficiently active and well enough managed. Relapse is avoided in a high percentage of patients. Medical treatment of phosphate or calcium stones is a more open question as results are far from satisfactory compared with intra- and extra-corporeal approaches which are often minimally invasive and well accepted by both patient and urologist. Relapses are not easy to control because prophylactic measures such as changes in lifestyle and diet are never activated or because they are adopted for a brief period of time. Water therapy is examined, with the choice of water depending on the type of stone, together with drug therapy. Drugs such as citrate, with or without magnesium, and thiazides are considered excellent for curing renal stones and relapses. Although medical therapy has a limited role in many types of stones, its use is decisive in some others.

Calcium Oxalate↗
PubMed2006

The role of lifestyle modification in dysmetabolic syndrome management.

Lifestyle modification should be the primary therapeutic intervention in individuals with the dysmetabolic syndrome, given the fact that obesity, unhealthy diet, and physical inactivity are primary underlying risk factors for its development. Most individuals with the dysmetabolic syndrome need to lose weight through dietary changes and increases in physical activity. Modest weight losses may significantly improve all aspects of the syndrome. Because individuals differ in their lifestyles, tailoring interventions to meet the specific needs of each person will maximize the chances of success. Assessment of the individual with the dysmetabolic syndrome involves quantification of obesity, diets and dietary patterns, physical activity, emotional problems, and motivation. To help individuals make lifestyle changes, a number of behavior modification strategies have shown good efficacy. These strategies include a tailored problem-solving intervention, involving goal-setting, self-monitoring, stimulus control, cognitive restructuring, stress management, relapse prevention, social support, and contracting. The frequency of self-monitoring is an especially important strategy for continued success. Research studies have clearly demonstrated the power of lifestyle modification for long-term behavioral change. Lifestyle modification appears effective in delaying or preventing the development of the dysmetabolic syndrome.

Cognitive Behavioral Therapy↗
PubMed2003

Research advances in the understanding and treatment of addiction.

The likelihood of developing an addictive disorder is a function of multiple simultaneous, pharmacologic, genetic, and environmental variables, such as the pharmacology of the drug, the route of administration, the personality of the individual, and the availability of the drug. There is increasing evidence that long-lasting changes in the brain result from the progression of casual user to addict. Moreover, the course of the progression of addiction is similar to that of other chronic diseases. In this paper, strategies for effective treatment of addiction, including long-term relapse management and new pharmacological therapies such as naltrexone and acamprosate, are discussed.

Acamprosate↗
PubMed2006

[Rupture of the renal artery aneurysm in a patient with symptoms of a systemic connective tissue disorder--A case review].

The renal arteries aneurysms are relatively rare, however, their rupture has a high mortality rate. The authors present a case-review of a 38-year old female, hospitalized with a pain in the left lumbar region, lasting for 24 hours, which spread into the mesogastrium and the left groin. Upon angiographic examination, the left renal artery aneurysm was detected. Embolization was conducted, aiming to save the kidney, however, it proved unsuccessful and was complicated by a rupture of the aneurysm. Consequently, urgent nephrectomy was completed. Prior to the procedure, massive haemorrhaging from the right groin following angiography, was managed. Relapsing haemorrhaging from the right groin and development of a major retroperitoneal haematoma, complicated the postoperative course and required repetitive postoperative revisions. The accidental finding of a minor aneurysm of the lienal artery, the patient's constitution, her anamnestic data and the complicated course of hospitalization, suggested the systemic connective tissue disorder. Furthermore, the authors discuss contemporary diagnostic and therapeutic approach to the renal arteries aneurysms.

Adult↗
PubMed2005

Multiple sclerosis: diagnosis and the management of acute relapses.

Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system that may result in a wide range of neurological symptoms and accumulating disability. Its course is unpredictable resulting in a changing pattern of clinical need. Diagnostic criteria for multiple sclerosis require objective evidence for dissemination in space and time. The diagnostic and management process should follow good practice guidelines with the person at the centre of the process. Appropriate support and information should be available from the time of diagnosis. Continuing education is key in enabling the person to actively participate in their management. In the event of an acute relapse the person should have direct access to the most appropriate local service. Provided medical causes have been excluded, corticosteroid treatment to hasten the recovery from the relapse should be considered. Management of an acute relapse should be comprehensive addressing any medical, functional, or psychosocial sequelae.

Adolescent↗
PubMed2004

Management of violent behaviour in acutely relapsed schizophrenics.

The management of aggressive behaviour has always been a critical issue in psychiatry. Finding measures that can be used to accurately predict the likelihood of assaultative behaviour and thus ensure timeous appropriate pharmacological management remains a dilemma. The study objective was to investigate the naturalistic, pharmacological management of inpatient aggressive behaviour in a group of 50 schizophrenic subjects with a view to determine: (1) whether a presenting history of recent violence lead to altered pharmacological management and (2) whether the NOSIE could be regarded as a useful assessment tool with regards to inpatient behaviour management. No significant difference could be demonstrated between the 2 subsets of subjects (history of violence vs none) with respect to total doses of medication administered. No statistical correlation could be found between the total NOSIE score and the dose of psychotropic medication used. The relationship between a subset of NOSIE-items and the total dose of medication was more complex and a clear linear relationship could be demonstrated for a total score of 0 to 5. In this particular ward setting a presenting history of recent violent behaviour did not influence the administration of medication and neither could the clinical judgement employed by the nursing staff to manage inpatient behaviour be captured by the NOSIE. However, a five-item subset of the NOSIE with questions relating to aggression and irritability warrants further scrutiny in this regard.

Acute Disease↗
PubMed2000

Managing Indolent Lymphomas in Relapse: Working Our Way Through a Plethora of Options.

The front-line management of stage IV indolent non-Hodgkin's lymphoma has ranged from the watch-and-wait approach to intensive experimental regimens such as high-dose chemotherapy and bone marrow transplant. With this broad spectrum of regimens to choose from the decision has become a challenging exercise for both patients and oncologists. With the recent introduction of new agents such as rituximab, fludarabine, and combinations based on these, the management of relapsed cases can be similarly confusing. More aggressive approaches such as high-dose chemotherapy with autologous bone marrow transplant and more recently allogeneic bone marrow transplant have also been used. Recently the technique of "mini-allo transplants" has been introduced. It utilizes a less myelosuppressive conditioning chemotherapy regimen based on fludarabine which is immunosuppressive enough to allow engraftment of the donor marrow. Since it is less myelotoxic it is better tolerated, and this has allowed us to significantly extend the age cut-off for allogeneic transplants. All these advances provide us with a more extensive armamentarium, but at the same time they confront physicians with new challenges in choosing from a large and continuously growing therapeutic menu. In this review of the alternative therapies a panel of three expert hemato-oncologists each discuss their approach to the management of a 49-year-old patient with a relapsed indolent follicular lymphoma. Dr. Horning discusses the traditional alternatives available for this patient such as standard chemotherapy combinations or the watch-and-wait approach in Section I. In Section II, Dr. Kaminski reviews the different therapeutic monoclonal antibody options such as rituximab, Bexxar (Iodine-labeled anti-CD20) and Ytrium-labeled anti-CD20 antibody. Allogeneic transplants are increasingly more popular for the treatment of indolent lymphomas because they can provide an immune-mediated graft-versus-lymphoma effect. In Section III, Dr. Richard Champlin reviews various transplant options including autologous, allogeneic and mini-allogeneic transplants.

Journal Article↗
PubMed2005

Implementing a self-management model of relapse prevention for psychosis into routine clinical practice.

This paper describes an implementation project to incorporate an evidence-based, structured model of relapse prevention into routine clinical practice at the Community Mental Health Team in Reading, Berkshire. This project has currently reached the end of the pilot stage, which this paper reports in details. It is proposed that clinicians will adopt Smith's Self-Management Training Manual for individuals with psychosis as a clinical tool for working with patients who have schizophrenic-form disorders or bipolar affective disorders with psychosis. Effects of the proposed change are considered from the viewpoint of the clients and families/carers, the clinicians and the service. The process of transition and its impact on members of the multidisciplinary team is examined. It includes an audit of Care Programme Approach (CPA) forms and a staff survey, which give background information on the needs for improvement and staff development initiatives. A pilot study incorporating the structured relapse prevention work into the local community mental health team is also underway. The method of evaluation and dissemination to the wider team and service settings across the organizational boundaries is reviewed with implications for practice drawn. This paper aims to describe the background and development of this ongoing development project whilst focusing on the current pilot stage. Ongoing work will be carried out in addressing and reporting the outcomes of the full project in future papers.

Aftercare↗
PubMedDate not supplied

Laparoscopic adnexectomy of a persistent ovarian tumor in a girl with acute lymphoblastic leukemia relapse.

The management of children with acute lymphoblastic leukemia (ALL) relapse and an ovarian tumor remains controversial. The authors report about a 4-year-old girl who developed a late bone marrow and cutaneous relapse of her pre-B-cell ALL and revealed an enlargement of her left ovary (4 x 3 x 2 cm). Chemotherapy (ALL-REZ-BFM pilot-protocol 2002) achieved effective remission, but the ovarian mass depicted no regression. Laparoscopic adnexectomy was performed and the tumor could be extracted in a specimen-bag through a 12-mm umbilical incision. Histology detected no viable lymphoblasts, but a fibrotic enlargement due to previous cellular infiltration. The authors conclude that in children with ALL relapse and an ovarian tumor, malignant infiltration as well as local response to chemotherapy can be judged only by surgical excision and histopathologic examination. Laparoscopic oophoradnexectomy is a valuable management option in these children.

Adnexa Uteri↗
PubMed1981

Surgical management of chronic relapsing pancreatitis.

Chronic relapsing pancreatitis is a syndrome usually associated with chronic alcohol abuse, and is characterized by pain in the upper abdomen and back, weight loss, and disturbances in function of the endocrine and exocrine pancreas. A surgical attack on this disorder can be traced to the turn of the century, when experimental work suggested the feasibility of operations of the pancreas. In 1911 Link performed pancreatostomy for this disease and achieved an excellent long-term result. Later, partial or total pancreatectomy was introduced in the management of this condition. With pathologic evidence of pancreatic duct dilatation, attempts at retrograde drainage of the duct into the gastrointestinal tract were introduced in the 1950s, with encouraging results. The recent advent of diagnostic modalities capable of more precise definition of ductal anatomy allows more discriminate application of the two major surgical approaches of resection and internal drainage. In this review, the literature concerning this interesting subject is surveyed and the favored diagnostic and surgical methods are assessed.

Alcoholism↗
PubMedDate not supplied

Management of chronic relapsing pancreatitis in adolescents.

Chronic relapsing pancreatitis in adolescence is a most uncommon clinical problem and has received minimal separate recognition in the literature. Adolescence is an age when the causes of the disease, which may operate from birth, overlap with the major etiological factors in the generality of pancreatitis in adult life. A personal series of 32 patients with pancreatitis, aged 11-20 years, is reported. Twenty-four followed a chronic relapsing course. There was, therefore, a marked reversal of the normal preponderance of acute over chronic relapsing cases. Those with underlying biliary disease, and the group in whom no etiological factors could be identified, ran an unexpectedly severe and troublesome course. This, coupled with the reversal of the acute versus chronic disease ratio, raises the question as to whether adolescent pancreatitis is a distinct subgroup in the overall spectrum of this disease.

Adolescent↗