Sandtray and solution-focused therapy.

Both solution-focused (SF) and sandtray therapies have been shown to have effective healing properties. SF, a primarily verbal therapy, uses carefully worded and timed questions and comments that solicit the clients' already existing strengths and resiliencies to solve the current and future problems. Sandtray therapy relies primarily on nonverbal communication through the use of carefully selected miniatures within the confines of a sand tray to facilitate clients' healing and strengthen internal resources. Because these therapies at first appear to be so different, it is not surprising that their combined application is rarely mentioned in the literature. Yet, similarities between the two therapies do exist and may be combined to provide an empowering and brief experiential therapeutic journey. A brief background and theoretical orientation to SF therapy is provided, accompanied by illustrations of the merger of these two approaches. Also discussed are similarities between SF and sandtray therapies and the advantages of combining them in work with children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent advances of immune therapies for demyelinating neuropathies

Most of acquired demyelinating neuropathies are caused by immune-mediated processes. Therefore, we can treat these neuropathies to control underlying immune abnormality. We review the recent therapies and show possible strategies in the future. (1) Recent therapies Guillain-Barré syndrome should be treated quickly and intensively in the first week of the disease with plasmapheresis (PP). Intravenous immunoglobulin (IVIG) is as effective as PP. IVIG is under phase 3 clinical trial in Japan. Chronic inflammatory demyelinating polyneuropathy (CIDP) is treated with corticosteroids, PP or IVIG. Corticosteroids or PP is the first choice. For severe or resistant cases, combined therapy or immunosuppressants, such as cyclophosphamide pulse therapy, should be considered. Polyneuropathy with IgM-MGUS (monoclonal gammopathies of undetermined significance) is treated with PP, immunosuppressants or these combinations to decrease serum IgM, especially for cases with anti-MAG antibody, because the autoantibody induces demyelination by itself. (2) Future strategies Immunopathogenesis may differ among cases with Guillain-Barré syndrome or CIDP. The best therapy will be chosen individually, according to appropriate immunologic tests. In CIDP, immunomodulation therapies, that are similar ones in multiple sclerosis, will be considered to maintain improvement.     

Providing the right stuff: feeding children with chronic renal failure

The progressive loss of renal function in children with chronic renal failure (CRF) has a negative influence on their nutritional status and statural growth. Supportive therapies with 1-25 dihydroxy-vitamin D3, recombinant erythropoietin and growth hormone have significantly improved the biochemical and clinical features but the success of these therapies is largely related to an appropriate diet, with adequate protein/caloric intakes. Children more than adults have minimal protein requirements to avoid malnutrition and growth impairment FAO/WHO and RDA recommendations save as guidelines for a correct diet in children with CRF. Following these allowances leads to a "normoproteic" diet, with a protein intake which is often half the unrestricted one in Western European countries, but which is still likely to be not enough to protect against renal deterioration. Indeed the European Study Group for Nutritional Treatment of CRF in children failed to show a significant effect of diet on the mean decline of glomerular filtration rate over two years.     

The immunological aspects of systemic enzyme therapy in the combined treatment of recurrent nephrolithiasis

BACKGROUND: Despite the popularity of complementary therapies with the public, knowledge and use of these therapies among doctors appear limited. However, studies show that physicians and medical students are positive toward complementary therapies and have a high level of interest in learning about them. METHODS: The attitudes of medical students toward complementary therapies were examined using a questionnaire distributed to 800 first-, third-, and fifth-year medical students at two universities in Melbourne, Australia. RESULTS: The survey revealed that whereas Australian medical students were positive toward complementary therapies, their self-reported knowledge was low, with 56% having no knowledge of the principles of complementary therapies. Attitudes toward different therapies were found to vary widely, with students having little knowledge of chiropractic and naturopathy, the two therapies most commonly used by Australians. Students consistently scored meditation, massage, and acupuncture the highest with regard to knowledge, perceived usefulness, intended patterns of referral after graduation, and desire for education in the undergraduate degree. CONCLUSIONS: When the medical course included some tuition on complementary therapies, students were more positive toward them. A single lecture on complementary therapies was found to have significant impact on medical students' views. Medical students have a high level of interest in complementary therapies that is not being satisfied by their undergraduate curricula.     

Unconventional therapies for cancer: 3. Iscador. Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative

Unconventional therapies (UTs) are therapies not usually provided by Canadian physicians or other conventionally trained health care providers. Examples of common UTs available in Canada are herbal preparations, reflexology, acupuncture and traditional Chinese medicine. UTs may be used along with conventional therapies (complementary) or instead of conventional therapies (alternative). Surveys have shown that many Canadians use UTs, usually as complementary therapies, for a wide range of diseases and conditions. Reliable information about UTs is often difficult to find. Your doctor may be unable to give you specific advice or recommendations, since UTs are often not in a physician's area of expertise. However, he or she will usually be able to provide some general advice and help supervise your progress. For your own health and safety, it is important to keep your doctor informed of the choices you make. This document is intended to (a) provide you with questions to consider when making your treatment choices, (b) help you find information about UTs, (c) help you decide whether a specific UT is right for you, and (d) provide tips to help you evaluate the information you find.     

"Cancer-related fatigue: A systematic and meta-analytic review of non-pharmacological therapies for cancer patients": Correction to Kangas, Bovbjerg, and Montgomery (2008).

Reports an error in "Cancer-related fatigue: A systematic and meta-analytic review of non-pharmacological therapies for cancer patients" by Maria Kangas, Dana H. Bovbjerg and Guy H. Montgomery (Psychological Bulletin, 2008[Sep], Vol 134[5], 700-741). The URL to the Supplemental Materials for the article is listed incorrectly in two places in the text. The incorrect listings appear on p. 704 (in the last two lines of the third paragraph) and on p. 705 (in the third and fourth lines of the first paragraph in the second column). The correct URL for the Supplemental Materials is http://dx.doi.org/10.1037/a0012825.supp, which is provided on the first page of the article beneath the abstract. (The following abstract of the original article appeared in record 2008-11487-005.) Cancer-related fatigue (CRF) is a significant clinical problem for more than 10 million adults diagnosed with cancer each year worldwide. No "gold standard" treatment presently exists for CRF. To provide a guide for future research to improve the treatment of CRF, the authors conducted the most comprehensive combined systematic and meta-analytic review of the literature to date on non-pharmacological (psychosocial and exercise) interventions to ameliorate CRF and associated symptoms (vigor/vitality) in adults with cancer, based on 119 randomized controlled trials (RCTs) and non-RCT studies. Meta-analyses conducted on 57 RCTs indicated that exercise and psychological interventions provided reductions in CRF, with no significant differences between these 2 major types of interventions considered as a whole. Specifically, multimodal exercise and walking programs, restorative approaches, supportive-expressive, and cognitive-behavioral psychosocial interventions show promising potential for ameliorating CRF. The results also suggest that vigor and vitality are distinct phenomena from CRF with regard to responsiveness to intervention. With improved methodological approaches, further research in this area may soon provide clinicians with effective strategies for reducing CRF and enhancing the lives of millions of cancer patients and survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fibromyalgia and chronic fatigue: the holistic perspective

Fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS) are not new conditions, but they are receiving more attention as more research is conducted. These two conditions are primarily women's health problems. In some instances, there may be a genetic predisposition for these conditions. The impact of FMS and CFS can be devastating both physically and emotionally. The treatment plan must be interdisciplinary and holistic and include alternative therapies if the client and family are to be truly supported and helped in coping with these chronic conditions.     

Transport and mode of action of nucleoside derivatives used in chemical and antiviral therapies

Nucleoside analogues used in cancer and anti-viral therapies interfere with nucleotide metabolism and DNA replication, thus inducing their pharmacological effects. A long-awaited goal in the understanding of the pharmacological properties of these molecules, that is the molecular characterization of nucleoside plasma-membrane transporters, has been achieved very recently. These carrier proteins are encoded by at least two gene families and new isoforms remain to be identified. Direct demonstration of translocation of these drugs by nucleoside transporters has already been provided and most of them can inhibit natural nucleoside transport, probably in a competitive manner. The expression of these genes is clearly tissue-specific and might depend on the differentiated status of a cell. This is relevant because the sensitivity of a cell to a drug can depend on the type of nucleoside carrier expressed, and the drug itself might modulate nucleoside carrier expression. In this article, Mar?al Pastor-Anglada, Antonio Felipe and Javier Casado discuss recent studies on the regulation of nucleoside carrier expression and of the molecular determinants of substrate specificity. Better knowledge of these will contribute to an improved design of therapies based on nucleoside derivatives.     

Trends in dental computerization in Oklahoma practices

Sixteen people with multiple sclerosis (MS) responded to a semi-structured questionnaire about their experiences with alternative therapies. No definition of alternative therapies was provided. Physical therapy, counseling, nutrition, and massage were the most frequently used alternative therapies. Other therapies included acupuncture, occupational therapy, aquatic therapy, Therapeutic Touch, yoga, passive exercise, and removal of mercury alloy tooth fillings. Almost two thirds of the respondents reported seeking an alternative health practitioner because traditional physicians offered no cure for MS. Just under one third of the respondents stated that the quality of their lives was improved by alternative therapies.     

MRI studies of multiple sclerosis: implications for the natural history of the disease and for monitoring effectiveness of experimental therapies

The use of magnetic resonance imaging (MRI) in multiple sclerosis (MS) has increased in our understanding of the natural history of the disease course and has provided and important tool for the analysis of new experimental therapies. Studies using MRI as well as pathological studies of MS indicate that the first event in the development of a new MS lesion as seen on T2 weighted images is disruption of the blood brain barrier (BBBD) which can be demonstrated by areas of increased signal on T1 weighted images done after the administration of gadolinium DTPA. When GdDTPA enhanced MRIs are used to monitor disease activity in patients with mild relapsing remitting MS, a considerable degree of disease activity is observed in clinically stable patients. These findings indicate that MS is an active and progressive disease in most patients even during the earliest phases of the disease and before significant clinical disability has occurred. MRI is also an important tool in evaluating new therapies. Using simple baseline vs treatment designs evidence for an effect of a new treatment on MRI parameters such as Gd-DTPA enhanced measure of BBBD can be achieved using a small study cohort and over a short duration. Together these advances should lead to more rapid progress in the understanding of MS and in identifying new treatments.     

Atrial fibrillation: overview of therapeutic trials

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia treated by physicians, and a plethora of therapeutic trials deal with selected aspects of its management. This overview attempts to categorize and summarize the available studies. A key to management of AF is a clinical classification schema that provides a framework for application of the available treatment modalities. Such a classification is provided. Antithrombotic trials have demonstrated the remarkable efficacy of warfarin and more modest effect of acetylsalicylic acid for prevention of stroke; these data are summarized. Cardioversion to restore sinus rhythm is an important aspect of management of AF, particularly of persistent and new onset AF. In this review pharmacological cardioversion is emphasized. The data concerning the use of various drugs for pharmacological cardioversion are reviewed. Many, but not all, agents have been shown to have efficacy in this regard, but efficacy with drugs is lower than that with electrical cardioversion and, in the case of amiodarone, may be delayed. For recurrent AF, the two major rhythm management approaches are maintenance of rhythm and heart rate control. Trials of pharmacological and nonpharmacological therapies for these purposes are reviewed and summarized. Management of AF is an active area of research, and the present review is intended as a foundation upon which new information can be added.     

Innovative therapy for chronic myelogenous leukemia

Innovative therapies for chronic myelogenous leukemia (CML) have focused mainly on combining autologous transplantation with another modality of therapy for purging of the graft or treatment of the patient after transplant. Of the three categories of innovative therapies, two are based on studies that demonstrate the bcr/abl gene rearrangement in the pathogenesis of CML, whereas the third is based on the observation that allogeneic disparity is important to maintain remissions in CML. The rationale and data supporting these innovative approaches are reviewed in this article and future strategies are discussed.     

Choice of renal replacement therapy

Renal replacement therapies (RRT) for acute renal failure patients consist of continuous or intermittent methods. Continuous renal replacement therapies (CRRT) are used in 54% of centers. Determinant for the choice of the continuous versus intermittent method is the clinical status of the patients. Those who are hemodynamically unstable, who receive a large fluid intake, who are anuric, who present with severe and persistent metabolic disorders such as acidosis or hyperkaliemia, and who are in respiratory failure, are preferably treated with CRRT. Once the patient has improved, he can be switched to intermittent RRT (IRRT). Thus CRRT and IRRT are complementary approaches. Dialysis material should be biocompatible; the RRT method used should guarantee stable hemodynamics. Coping with these two requirements reduces the time duration of renal recovery, diminishes the need for catecholamines and may improve the survival rate.     

Heterogeneity in susceptibility to metronidazole among Helicobacter pylori isolates from patients with gastritis or peptic ulcer disease

Combination therapies that include metronidazole (MTZ) are the most successful therapies used in eradicating Helicobacter pylori. In this study, the prevalence and the relevance of heterogeneity in susceptibility to MTZ among H. pylori populations of 156 patients were evaluated. The results of this study show that 37 patients (24%) were infected with MTZ-resistant H. pylori (MIC > or = 8 micrograms/ml). Furthermore, 33% (52 of 156) of the patients were found to be infected with H. pylori populations heterogeneous for their susceptibility to MTZ. The reassessment of the MICs of MTZ for these 52 H. pylori populations revealed MTZ resistance in 28 of them, increasing the number of MTZ-resistant H. pylori populations among the 156 patients to 65 (42%). Out of 20 isolates, 2 (10%) heterogeneous in their susceptibility to MTZ also appeared to be heterogeneous at the genome level as determined by randomly amplified polymorphic DNA fingerprinting. In conclusion, the results show the limitations and risk of possible misinterpretations when only a single colony, picked from the primary H. pylori populations isolated from patients, is analyzed for its susceptibility to MTZ.     

Current and future therapies for HCV infection: what should the end point for treatment be?

Based upon all of the available data relating to the natural history, chemical course, and response to therapy of HCV, the following recommendations are made: 1) The primary end point for HCV therapy should be HCV clearance from all tissue sites, eg plasma, liver and others 2) Therapy should be provided for patients with early infections as they have the best chance of achieving a virologic response 3) Therapy should be offered to patients with cirrhotic disease, as prevention of hepatic decompensation and degeneration to hepatic cancer is possible 4) End stage decompensated disease should be treated, particularly if liver transplantation is being considered, in an effort to either eliminate or ameliorate disease recurrence 5) Combination therapies are preferable to monotherapy as they enhance the likelihood of a therapeutic response. Some of these include agents that reduce the frequency of IFN-induced untoward events (NSAIDs) 6) The approach to HCV infection should be to view it as an infectious disease. In this way, multi-agent therapy could be used to prevent the emergence of drug resistant mutants as well as to obtain earlier clearance of the infection than is possible with monotherapy.     

Counseling cancer patients about herbal medicine

More than half of all cancer patients now use some form of complementary/alternative medicine, yet the majority of these patients do not disclose this use to their physicians. Health care practitioners need to educate themselves about the complementary/alternative medicine products their patients are using. Eight herbal products (astragalus, essiac, Asian ginseng, Siberian ginseng, green tea, garlic, Hoxsey formula and iscador) commonly used by cancer patients are reviewed here and a list of recommended reference texts is provided. In addition, health care providers are encouraged to initiate discussions about complementary/alternative products and therapies with their patients so that they may help them make safe and informed decisions about these products. Not knowing what patients are taking is definitely a less desirable option.     

A biometric evaluation of the somatotherapies in schizophrenia.

"The purpose of this study is to examine the available analyzable data on the outcome of the shock therapies and psychosurgery in order to get an estimate of the effectiveness of these therapies in the treatment of schizophrenia, as it has been reported in the literature." In spite of the several limitations of these studies the following facts were revealed: in terms of immediate outcome, there is a distinct advantage for the treated groups vs. the untreated ones; in terms of long-range recovery the treated have generally not shown greater improvement over the untreated; specific therapies work better with patients whose illness is of short duration; and with better prognostic indicators the results of specific therapies would excel the outcome of the nonspecific therapies. 85-item bibliography. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interactions between non-immune host cells and the immune system during periodontal disease: role of the gingival keratinocyte

OBJECTIVE: The role of sympathetic blocks in pain therapy is examined in the light of changing concepts of pain pathophysiology. A critical review of the literature also sought to develop an evidence-based analysis of outcome studies to provide recommendations for appropriate applications of sympathetic blocks, together with ideas for further clinically based research. METHODS: A focus on the pathophysiology of neuropathic and inflammatory pain disorders was used to help redefine what contribution, if any, was provided by the sympathetic system, to chronic pain states. Validation of nerve block therapies based on historical practices and these newer concepts and outcome determinations has then been used to present an overview of clinical nerve block therapies as applied to the sympathetic nervous system. RESULTS: 1. Pain Diagnosis: A reclassification of reflex sympathetic dystrophy (RSD) to the new taxonomy of complex regional pain syndromes (CRPS) is supported, with evidence that only a questionable sympathetic contribution at the dorsal root ganglion level can be ascribed etiologically to this group of disorders. Sympathetic blocks can establish whether pains may be nonresponsive or variably responsive to such blocks, but are considered inappropriate in determining a clinical diagnosis. 2. Neuropathic Pain Therapy: (a) A critical review of the literature regarding the use of sympathetic blocks in the treatment of acute herpes zoster pain and in the treatment of postherpetic neuralgia found little support for the widely held view that sympathetic blocks reduced either the incidence of long-term reduction of pain in these disorders. Further attempts to reduce PHN by the combination of blocks with aggressive drug therapies during acute herpes infection are suggested. (b) CRPS (RSD) treatments are seen as evolutionary at present, with the role of sympathetic blocks being only part of a balanced pain treatment strategy aimed at getting patients activated under cover of good analgesia and improved function. These proposals come as consensus recommendations but are not substantiated by outcome studies. 3. Ischemic Pain: Permanent sympathetic block with neurolytic or thermocoagulation techniques provides up to 50% long-term improved blood flow and reduction of pain and ulceration for patients with advanced peripheral vascular disease. This is particularly appropriate at lumbar levels in which percutaneous techniques are safe when conducted with real time imaging control. CONCLUSIONS: Changes in the understanding of CRPS disorders and the role of the sympathetic nervous system in neuropathic pain has changed both the diagnostic and management strategies for these pain states. The sensitivity and specificity of response to sympathetic blocks in establishing their value at diagnostic aids will not be fully established without further clinical study. Further use of intravenous regional blocks or diagnostic intravenous infusions remains questionable. Preventive and therapeutic use of sympathetic blocks in herpes zoster pain remains open to well-controlled study.     

Gene therapy for hemophilia: feasible in principle but not yet clinically applicable]

The current treatment of haemophiliacs consists of injection of concentrates of blood clotting factors VIII (haemophilia A) and IX (haemophilia B). The inconvenience of the multiple injections needed, and the risk of transmission of infectious agents (HIV, hepatitis) prompted the development of alternative therapies. Gene therapy aims at introducing functional factor VIII and IX genes into the body cells of patients in order to make these cells produce the desired clotting factors. There are two strategies for gene therapy: (a) in the laboratory cells of the patient may be provided with the desired gene, followed by reintroduction of the cells that now produce factor VIII, into the patient (ex vivo strategy); (b) vectors with the desired genes may be injected into the patient in order to induce the modification (in vivo strategy) For both routes, the formal proof-of-principle has been acquired recently in animal experiments: cells modified by factor VIII or IX genes will produce adequate concentrations of the clotting products in plasma and will correct the bleeding tendency. Before the clinical evaluation and widespread application of the technology can be considered many technical problems have to be solved.