Interactive wound dressings. A practical guide to their use in older patients

The properties of an ideal wound dressing do not change with the introduction of new types of wound dressing, but the range of effects on wound healing increases. The number of dressings available is enormous, and the choice between them is often bewildering. Because there is still no ideal dressing for all wound types, it is necessary to get to know a few well, and to avoid switching to new therapies solely on the basis of anecdotal reports. The adoption of novel dressings should be based on scientific evidence. At present, dressings are still chosen on the basis of local traditions and personal empirical experience, together with evidence from the few double-blind, placebo-controlled trials that have been performed. In the management of ulcers, a particular wound management plan should not be changed if the ulcer being treated is decreasing in size and the patient is comfortable. The dressing should be chosen with care. The type of chronic ulcer and its appearance, the amount of exudate and the presence or absence of pain all assist in the selection of an appropriate wound dressing product. Quality-of-life aspects are important. In the elderly, good quality of life may not necessarily require complete ulcer healing, although this is naturally desirable. Dressing changes should be minimised and the ulcer should be kept moist and the surrounding skin dry. The high cost of interactive dressings is a potential disadvantage of their use. However, if the wound can be re-dressed at longer intervals and if healing occurs more quickly, their use may be cost effective and associated with less pain and a better quality of life.     

A practical guide to when (and how) to withdraw antiepileptic drugs in seizure-free patients

Most patients with epilepsy will become seizure-free on antiepileptic drugs (AEDs) within a few years of diagnosis. More than 60% will remain so when the medication is withdrawn. After assessing the risks and benefits for the individual patient, withdrawal may be considered by the physician and informed patient or parent if the patient meets the following profile: normal neurological examination, normal IQ, normal electroencephalogram (EEG) prior to withdrawal, seizure-free for 2 to 5 years or longer, and no juvenile myoclonic epilepsy. AEDs can be safely withdrawn in the seizure-free patients over the course of 6 months, possibly even faster, especially in children.     

Web-conference supervision for advanced psychotherapy training: A practical guide.

The advent of readily accessible, inexpensive Web-conferencing applications has opened the door for distance psychotherapy supervision, using video recordings of treated clients. Although relatively new, this method of supervision is advantageous given the ease of use and low cost of various Internet applications. This method allows periodic supervision from point to point around the world, with no travel costs and no long gaps between direct training contacts. Web-conferencing permits face-to-face training so that the learner and supervisor can read each other's emotional responses while reviewing case material. It allows group learning from direct supervision to complement local peer-to-peer learning methods. In this article, we describe the relevant literature on this type of learning method, the practical points in its utilization, its limitations, and its benefits. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Using liquid levodopa in the treatment of Parkinson's disease. A practical guide

Many patients with Parkinson's disease develop both involuntary movements from and a critical dependency on, levodopa therapy as their disease progresses. This results in a narrow therapeutic window in which blood concentrations of levodopa can achieve optimal control of parkinsonian symptoms. The short half-life of levodopa, combined with loss of intraneuronal storage capacity for levodopa as the disease progresses, results in patients experiencing marked motor fluctuations complicated by medication-induced dyskinesias. When given in tablet form, the dosage of levodopa (which is usually combined with a decarboxylase inhibitor such as carbidopa or benserazide) often cannot be titrated adequately, and the drug may become unpredictable in its ability to relieve parkinsonian symptoms. A solution of levodopa and carbidopa, stabilised using ascorbic acid, offers a means of delivering a titrated amount of levodopa at regular intervals. Solutions pass through the stomach faster than solids, affording more rapid symptomatic relief in some patients with Parkinson's disease.     

Review of The therapeutic dialogue: A theoretical and practical guide to psychotherapy.

Reviews the book, The therapeutic dialogue: A theoretical and practical guide to psychotherapy by Sohan Lai Sharma (1986). Sharma has taken on the Herculean task of reviewing the whole of the available literature on psychotherapy, organizing it, and using the data to try to instruct the student therapist in the ways of a fundamentally eclectic, existential-humanistic model of psychotherapy. While I appreciate this effort, and wholeheartedly agree with this as the correct and necessary course for the future survival of psychotherapy, the way has already been more compellingly articulated by such writers as Jung, Rank, Rogers, Perls, R. D. Laing, Szasz, and May. Regrettably, though well-intentioned, Sharma's book lacks the requisite elegance, style, depth, and dynamism needed to help spark the essential resurrection of real psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A guide to therapy with families with a chemically dependent parent.

Presents an inclusive therapeutic outline for working with families with a chemically dependent adult. Topics discussed include the characteristics of families with chemically dependent members, the family's dilemma when approaching treatment, and family treatment and aftercare. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Raising the OH profile: a practical guide

Positive strategies can be used to enhance the profile of an occupational health department within an organisation. Jack Lamport Mitchell offers practical advice on how to become involved in decision making and planning procedures within the management structure.     

Protein chemical shift analysis: a practical guide

Proper protein chemical shift analysis requires careful experimental measurements and the implementation of standardized referencing procedures. In this article we outline the steps necessary to ensure proper chemical shift referencing and the selection criteria for choosing appropriate "random coil" amino acid chemical shift values for predicting, comparing, and assigning 1H, 13C, and 15N resonances in proteins. By making use of these standardized conditions we demonstrate how several recently developed methods, namely homologous assignment techniques and empirical chemical shift contour maps (or hypersurfaces), can significantly improve the accuracy of chemical shift prediction for 1H, 13C, and 15N nuclei. In addition to illustrating the potential utility of chemical shift prediction, we also outline procedures for identifying secondary structure elements through heteronuclear chemical shift analysis and further demonstrate how empirical shift contour maps can actually be used to refine, and more importantly generate, reasonably good three-dimensional protein structures.     

A practical approach to implementing theraplay for children with autism spectrum disorder.

Theraplay is a counseling approach that uses elements of play therapy to help children build better attachment relationships with others through attachment-based play. This article describes a practical approach for implementing Group Theraplay with children with Autism Spectrum Disorder (ASD), particularly those that are mainstreamed in a kindergarten classroom setting. The approach uses resources that are already in place in schools today, such as mental health professionals (e.g., school counselor, social worker, etc.) and teachers. Foundational Theraplay assumptions, therapeutic goals, empirical support, and implementation guidelines are provided. Comparative effectiveness research examining the use of Group Theraplay with this population in this setting versus the use of alternative therapeutic approaches is needed. To help guide future research in this needed area of outcomes investigation, several assessment instruments appropriate for clinical research use with this population are suggested. Ethical and cultural implications pertinent to the application of Group Theraplay for children with ASD also are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Keeping a reflective practice diary: a practical guide

We report a case of idiopathic retroperitoneal fibrosis presenting with duodenal obstruction. A 55-year-old man suddenly developed severe epigastric pain and was admitted to our hospital. On abdominal computed tomography (CT), a large retroperitoneal mass was found. Hypotonic duodenography showed obstruction of the third portion of the duodenum. He was diagnosed as idiopathic retroperitoneal fibrosis and was treated with prednisolone. The patient improved dramatically. He has been well for twelve months without any further treatment.     

A guide to strategic planning

Strategic planning is a new concept in general practice. Underneath all the jargon, however, it is simply a label for the planning and evaluation processes that most organisations have used in the past. The aim of this paper is to demystify strategic planning as it applies to newly formed Divisions of General Practice.     

Average causal effects from nonrandomized studies: A practical guide and simulated example.

In a well-designed experiment, random assignment of participants to treatments makes causal inference straightforward. However, if participants are not randomized (as in observational study, quasi-experiment, or nonequivalent control-group designs), group comparisons may be biased by confounders that influence both the outcome and the alleged cause. Traditional analysis of covariance, which includes confounders as predictors in a regression model, often fails to eliminate this bias. In this article, the authors review Rubin's definition of an average causal effect (ACE) as the average difference between potential outcomes under different treatments. The authors distinguish an ACE and a regression coefficient. The authors review 9 strategies for estimating ACEs on the basis of regression, propensity scores, and doubly robust methods, providing formulas for standard errors not given elsewhere. To illustrate the methods, the authors simulate an observational study to assess the effects of dieting on emotional distress. Drawing repeated samples from a simulated population of adolescent girls, the authors assess each method in terms of bias, efficiency, and interval coverage. Throughout the article, the authors offer insights and practical guidance for researchers who attempt causal inference with observational data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)