Utilization of virtual learning environments in the allied health professions.

Multiple technology based tools have been used to enhance skill development in allied health education, which now includes virtual learning environments. The purpose of this study was to explore whether, and how, this latest instructional technology is being adapted in allied health education. An online survey was circulated to all Association of Schools of Allied Health Professions (ASAHP) member institutions and focused on three broad areas of virtual learning environments: the uses of, the perceived pros and cons of, and the outcomes of utilizing them. Results show 40% (17 of 42) of the respondent use some form of the technology. The use of virtual learning technology in other healthcare professions (e.g., medicine) demonstrates the potential benefits to allied health education.

Methadone deaths: risk factors in pain and addicted populations.

Methadone is highly effective in treating opioid dependence, and it is also used as an analgesic for second-line management of chronic pain. However, recent increases in methadone-related deaths have instigated controversy about the use of this medication. In this paper, we evaluate risk factors for methadone mortality in opioid dependent and pain populations and present guidelines for initiating methadone treatment in these two populations to minimize the risk of death. Early research with methadone-maintained patients revealed that methadone fatalities occur primarily due to respiratory arrest during methadone induction and in the context of polysubstance use. Recent reports of methadone deaths emphasize chronic pain populations, methadone-related QTc prolongation, and the possibility of inducing Torsade de pointes (TdP), a potentially fatal ventricular arrhythmia. Retrospective analyses of these deaths show that patients who develop TdP often present with multiple risk factors, including high methadone doses, use of other medications that cause QTc prolongation, and electrolyte abnormalities. To minimize fatalities, guidelines are presented for initiating methadone in opioid treatment and pain populations that consider the drug's pharmacology along with behavioral, medical and psychiatric risk factors.

ADHD: does parenting style matter?

Attention deficit hyperactivity disorder (ADHD) is a condition typically arising in childhood, which untreated, can have consequences reaching into adolescence and beyond. Effective pharmacological treatment is available and has become widespread in the West. Outcomes for both the child with ADHD and the parent may be influenced by the nature of interaction between them. The authors of this article aim to review published research examining the interaction between parents and their children with ADHD. A PubMed search was conducted of studies written in English between 2000 and 2007 with the keywords ADHD and parenting. Child ADHD elicits high levels of parental stress and maladaptive parenting. The presence of parental psychopathology is common and influences the parent's response to the child's ADHD symptoms. Optimizing parent-child interaction and parental psychiatric status may improve outcomes for both parent and child.

Addiction and chronic pain: diagnostic and treatment dilemmas.

Chronic pain and addictive disorders present significant medical and public health problems; both are underdiagnosed and inadequately treated. The cooccurrence of pain and addiction adds complexity to the assessment and treatment of both disorders. Research on the link between pain and substance use disorders (SUDs) has focused on the bidirectional relationship between chronic pain and opioid dependence. While chronic opioid exposure alters physiological responsivity to painful stimuli, chronic pain also modifies the rewarding effects of opioids. Although the relationship between alcohol and pain has been less studied, alcohol use disorders are also prevalent among chronic pain patients and are of high clinical interest. In both subgroups of patients, failure to alleviate chronic pain contributes to poor clinical and functional outcomes. This review discusses common evaluation and diagnostic dilemmas in treating this challenging population.

Alcohol dependence and suicidal behavior: from research to clinical challenges.

Epidemiological and clinical data suggest high rates of suicidal behavior in alcohol-dependent individuals. Suicide attempters are likely to be young, to be single or separated, and to have made prior attempts. They differ from non-attempters by higher levels of impulsive aggression, drug use, and psychiatric comorbidity, particularly personality and depressive disorders. Treatment-seeking, alcohol-dependent individuals often present with multiple risk factors. Early recognition of suicidal behavior is hindered, however, by insufficient data regarding the acute phenomenology of imminent risk. Similarly, little research is available to guide intervention efforts. Initial trials support the use of fluoxetine for the treatment of suicidal, alcohol-dependent persons with comorbid depressive disorders. Future studies may clarify the relative efficacy of various psychotherapeutic and pharmacological approaches to treating these patients.

Adult rat forelimb dysfunction after dorsal cervical spinal cord injury.

Repairing upper extremity function would significantly enhance the quality of life for persons with cervical spinal cord injury (SCI). Repair strategy development requires investigations of the deficits and the spontaneous recovery that occurs when cervical spinal cord axonal pathways are damaged. The present study revealed that both anatomically and electrophysiologically complete myelotomies of the C4 spinal cord dorsal columns significantly increased the adult rat's averaged times to first attend to adhesive stickers placed on the palms of their forepaws at 1 week. Complete bilateral myelotomies of the dorsal funiculi and dorsal hemisection, but not bilateral dorsolateral funiculi injuries, also similarly increased these times at 1 week. These data extend a previous finding by showing that a forepaw tactile sensory deficit that occurred in the adult rat after bilateral C4 spinal cord dorsal funiculi injury is due to damage of the dorsal columns. Averaged times to first attend to the stickers also decreased to those of sham-operated rats at 3 and 4 weeks post-dorsal hemisection with weekly testing. In contrast, a separate group of rats with dorsal hemisections had significantly increased times when tested only at 4 weeks. These data indicate that frequent assessment of this particular behavior in rats with dorsal hemisections extinguishes it and/or engenders a learned response in the absence of sensory axons in the dorsal columns and dorsolateral funiculi. This finding contrasted with weekly testing of grid walking where increased forelimb footfall numbers persisted for 4 weeks post-dorsal hemisection.