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Practice Today (practice + today)
Selected AbstractsEvaluating Cardiac Sources of Embolic Stroke with MRIECHOCARDIOGRAPHY, Issue 3 2007Asu Rustemli M.D. The evaluation of patients with stroke includes identifying its etiology in order to appropriately tailor therapy. Currently, the diagnostic work-up includes imaging of the brain, the arteries of the head and neck, the aorta, and the heart. Traditional methods of imaging include magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), duplex ultrasound, and transthoracic echocardiography (TTE) and/or transesophageal echocardiography (TEE). While echocardiography remains a cornerstone in the field of cardiac imaging, MRI is increasingly able to assess for the most common causes of cardioembolic stroke such as left atrial/left atrial appendage thrombus, left ventricular thrombus, aortic atheroma, cardiac masses and patent foramen ovale. This review will focus on the advantages and limitations of echocardiography and cardiac magnetic resonance (CMR) imaging in diagnosing patients suspected of having an embolic stroke and the role these modalities play in clinical practice today. [source] How best to fight that nasty itch , from new insights into the neuroimmunological, neuroendocrine, and neurophysiological bases of pruritus to novel therapeutic approachesEXPERIMENTAL DERMATOLOGY, Issue 3 2005T. Biró While the enormous clinical and psychosocial importance of pruritus in many areas of medicine and the detrimental effects of chronic ,itch' on the quality of life of an affected individual are widely appreciated, the complexity of this sensation is still often grossly underestimated. The current Controversies feature highlights this complexity by portraying pruritus as a truly interdisciplinary problem at the crossroads of neurophysiology, neuroimmunology, neuropharmacology, protease research, internal medicine, and dermatology, which is combated most successfully if one keeps the multilayered nature of ,itch' in mind and adopts a holistic treatment approach , beyond the customary, frequently frustrane monotherapy with histamine receptor antagonists. In view of the often unsatisfactory, unidimensional, and altogether rather crude standard instruments for pruritus management that we still tend to use in clinical practice today, an interdisciplinary team of pruritus experts here critically examines recent progress in pruritus research that future itch management must take into consideration. Focusing on new insights into the neuroimmunological, neuroendocrine, and neurophysiological bases of pruritus, and discussing available neuropharmacological tools, specific research avenues are highlighted, whose pursuit promises to lead to novel, and hopefully more effective, forms of pruritus management. [source] Elitism in psychoanalysis in the USA: narcissistic defense against cumulative traumas of prejudice and exclusionINTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES, Issue 1 2007Joann Ponder Abstract Psychoanalysts in the USA have been perceived as élitist and exclusionary. It is hypothesized that this behavior services as a narcissistic defense against feelings of marginalization and inadequacy, stemming from experiences of prejudice, loss, and exclusion in the past. It is further hypothesized that there has been an institutional and multigenerational transmission of cumulative traumas that originated with Freud and the European psychoanalysts. The roots and history of the narcissistic defense are examined, as well as its manifestations in American training and practice today. Copyright © 2006 John Wiley & Sons, Ltd. [source] Heterogeneity of violence in schizophrenia and implications for long-term treatmentINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2008J. Volavka Summary Aims:, Most patients with schizophrenia are not violent. However, persistent violent behaviour in a minority of patients presents a therapeutic challenge. Published treatment guidelines and most pharmacological and epidemiological literature on violence in schizophrenia treat overt physical aggression as a homogeneous phenomenon. The aim of this review is to address the subtyping of violent behaviour in schizophrenia, and to relate the subtypes to treatment. Method:, Literature describing subtypes of violence in schizophrenia and the treatment of this problem was reviewed. ,Schizophrenia', ,violence', ,aggression', ,hostility' and ,personality disorders' were the principal search terms describing behaviours. Generic names of individual atypical antipsychotics and mood stabilisers were used in treatment searches. Results:, There are at least three aetiological subtypes of violence in schizophrenia (i) that related directly to positive psychotic symptoms, (ii) impulsive violence and (iii) violence stemming from comorbidity with personality disorders, particularly psychopathy. Current treatment of violence in schizophrenia relies on antipsychotics and mood stabilisers. The evidence of effectiveness is relatively strong for clozapine, but inconsistent for other treatments. No systematic recommendations relating the treatment to aetiological subtypes of violence were found. Discussion:, The inconsistent effectiveness of the current treatments of violent behaviour in schizophrenia is due, at least in part, to the aetiological heterogeneity of that behaviour. We should not expect that any given pharmacological treatment will be equally effective in reducing violent behaviour caused by psychosis, impaired impulse control or personality disorder. Conclusion:, Violence in schizophrenia is aetiologically heterogeneous. This heterogeneity has therapeutic implications that impact clinical practice today and should be further explored in future studies. [source] A review of hand-washing techniques in primary care and community settingsJOURNAL OF CLINICAL NURSING, Issue 6 2009Sheree MS Smith Aim., This review seeks to identify the most effective hand-washing and hand-cleansing practice that could be used in primary care. Background., Healthcare associated infection is a major problem in the UK causing 5000 deaths every year. Current guidelines indicate expert opinion is the level of evidence for hand washing as an activity to reduce infection. Design., Systematic review. Method., Publications on hand-washing, hand-cleansing studies, policy and practice-based documents were sought by searching several databases. Terms used included hand washing, hand cleansing, hand hygiene, hand decontamination, infection control and primary care. Results., Few articles described the hand-washing technique in detail and some publications simply referred to either the European and British Standards or the Centre for Disease Control statement on hand washing. Major discrepancies in hand position and water flow direction were found. Several methodological problems were also identified and few studies were undertaken in primary care. Conclusion., This review has found a lack of evidence for hand-washing techniques being undertaken in practice today. Findings from hand-washing technique studies were inconclusive and methodological issues exist resulting in sparse reliable evidence. There is an urgent need to undertake methodologically sound studies of hand-washing techniques for use in the ever expanding scope of primary care practice. Relevance to clinical practice., Evidence for hand-washing and hand-cleansing techniques will inform healthcare professional practice, and contribute to the overall management of infection control in primary care. [source] 9.,Human Rights: Historical Learning in the Shadow of ViolenceAMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 1 2009Article first published online: 18 FEB 200, Richard T. Peterson This paper emphasizes the historical dimension of human rights understood as a social ethic. Rather than timeless principles, human rights and the universality proper to them emerge in a process of suffering, conflict, political assertion, and institutional change. We can understand them as historical yet also universal by seeing that human rights arise in processes of social learning that take place in an increasingly globalized world. Such learning often has advanced in the face of dramatic violence, for example, the bombing of Hiroshima. But the demands on a global social ethic today are not only a matter of responding to threats and acts of dramatic violence in isolation. Attention to the example of Hiroshima suggests that the problem of violence is bound up with other questions about the regulation of emerging technical powers in a context of inequality and social conflict. To what extent can an ethic centered on human rights provide an ethics that can inform effective responses to these problems? To consider the promise of human rights, we look more closely at the kind of social learning they involve and explore in particular the role of social movements in forging new identities and reciprocities along with normative claims proper to a global public sphere (the anti-apartheid movement provides an example). We go on to see that these political experiences can inform interpretations of historical experience that can inform a widened sense of historical possibilities, both those missed in the past and those that confront us today. While this argument may thicken our sense of the promise of a human rights ethic, it remains speculative, not least because of the limited effectiveness of these norms in practice today. We close with the suggestion that nonetheless a coherent ethical response is possible, one that in the wealthy parts of the globe might take the form of an ethic of democratic responsibility. This would both represent a distinctive kind of learning and perhaps contribute to a wider advance of human rights. [source] Parametricism: A New Global Style for Architecture and Urban DesignARCHITECTURAL DESIGN, Issue 4 2009Patrik Schumacher Abstract Though parametricism has its roots in the digital animation techniques of the mid-1990s, it has only fully emerged in recent years with the development of advanced parametric design systems. Patrik Schumacher explains why parametricism has become the dominant, single style for avant-garde practice today and why it is particularly suited to large-scale urbanism as exemplified by a series of competition-winning masterplans by Zaha Hadid Architects. Copyright © 2009 John Wiley & Sons, Ltd. [source] Saints and CEOs: an historical experience of altruism, self-interest and compromiseBUSINESS ETHICS: A EUROPEAN REVIEW, Issue 2 2003David Molyneaux At a time when social and ethical responsibilities of companies and CEOs are being increasingly emphasised, this paper examines conduct of social business in a different age and culture to discern features of enduring relevance for ethical business practices today. The personal correspondence of three fourth-century saints gives insights into their relationships and decision-making.Community expectations were those of sharing rather than of outright giving, with ,fusion of interest' prevailing over concerns for ,con?ict of interest'. Selected incidents show two entrepreneurial bishops, Basil and Gregory of Nyssa, struggling to balance tensions between 'liberality' and ,fairness'. They compromised, competed robustly for revenues and were vexed over limited budgets and resources for projects while their disapproving cousin, the academic Gregory of Nazianzus, criticised their worldliness. Their historical experiences suggest four pragmatic and possibly normative ways of blending altruism and self-interest for the overall advancement of bene?cial change. [source] | ||||||||||