ABSTRACT
BACKGROUND AND STUDY AIM: Prior studies have suggested that music therapy can provide stress relief and analgesia. In this meta-analysis we focused on the effects of music therapy on patients undergoing gastrointestinal endoscopic procedures. MATERIALS AND METHODS: A literature search using the PubMed and Cochrane Library databases and a manual search led to the inclusion of six randomized controlled trials that examined the effects of music therapy on patients undergoing gastrointestinal endoscopic procedures. After data extraction, four separate meta-analyses were performed: in the three studies that did not use pharmacotherapy (group A), anxiety levels were used as a measure of efficacy; in the three studies in which pharmacotherapy was used (group B), sedation and analgesia requirements and procedure duration times were analyzed. RESULTS: A total of 641 patients were included in the analysis. In group A, patients receiving music therapy exhibited lower anxiety levels (8.6% reduction, P = 0.004), compared with controls. In group B, patients receiving music therapy exhibited statistically significant reductions in analgesia requirements (29.7% reduction, P = 0.001) and procedure times (21% reduction, P = 0.002), and a reduction in sedation requirements that approached significance (15% reduction, P = 0.055), in comparison with controls. CONCLUSIONS: Music therapy is an effective tool for stress relief and analgesia in patients undergoing gastrointestinal endoscopic procedures.
Subject(s)
Anxiety/therapy , Endoscopy, Gastrointestinal , Music Therapy , Stress, Psychological/therapy , Analgesia/methods , Conscious Sedation , Humans , Hypnotics and Sedatives/administration & dosage , Operating Rooms , Randomized Controlled Trials as TopicABSTRACT
INTRODUCTION: Prevention of venous thromboembolism and coronary events (with beta-blockers) during and after surgery is at the top of a list of safety practices for hospitalized patients, recommended by the Agency for Health Care Research and Quality (AHRQ). We wished to determine and improve adherence to clinical guidelines for these topics in our institution. PATIENTS, MATERIAL, AND METHODS: A prospective survey was conducted over several weeks on operated patients in a 1200-beds medical center (a teaching, community and referral hospital in Jerusalem, Israel). Eligibility for and actual administration of prophylactic treatment with anticoagulant and beta-blockers were determined. Following an intervention program, which included staff meetings, development of local protocols, and academic detailing by a nurse, the survey was repeated. RESULTS: In general, adherence to recommended anticoagulation prophylaxis was low, found in only 29% [95% confidence interval (CI) = 23-36] of eligible patients. After the intervention, adequate anticoagulation increased to 50% (95% CI = 40-59) of eligible patients (P < 0.001). Initiation of beta-blockers in preventing perioperative cardiac events was very low (0%, 95% CI = 0-5%) and did not increase after intervention. CONCLUSIONS: Adherence to guidelines for prevention of surgical complications was found to be low in our institution. A multifaceted intervention significantly increased use of prophylaxis for venous thromboembolism but not for coronary events. This differential response suggests that the success of a quality improvement project strongly depends on topic content and its phase of acceptance.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Hospitals, University/standards , Perioperative Care/standards , Postoperative Complications/prevention & control , Practice Guidelines as Topic , Thromboembolism/prevention & control , Venous Thrombosis/prevention & control , Adult , Aged , Chemoprevention , Guideline Adherence/statistics & numerical data , Health Care Surveys , Humans , Israel , Middle Aged , Perioperative Care/methods , Prospective Studies , Quality Assurance, Health CareABSTRACT
This brief provides an overview of how to identify, select, train and retain volunteers. The next issue will focus on costs (both hard dollar and staff time) associated with volunteer programs, as well as profiles of Medicare education and advocacy programs that have successfully integrated volunteers into their efforts. Additional information and sample materials can be found on the Center for Medicare Education Web site (www.MedicareEd.org).
Subject(s)
Medicare , Patient Education as Topic , Personnel Management/methods , Volunteers , Humans , United StatesABSTRACT
This brief is the second in our series on volunteers and focuses on costs associated with developing and maintaining volunteer programs. It also highlights lessons learned by two organizations that have successfully integrated volunteers into their operations. Additional information and sample materials can be found on the Center for Medicare Education Web site (http://www.MedicareEd.org).
Subject(s)
Costs and Cost Analysis , Medicare , Patient Education as Topic/economics , Volunteers , Humans , Medicare/economics , United StatesABSTRACT
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is an acronym that describes a seronegative syndrome of bone and joint lesions, frequently localized to the anterior chest wall, associated with variable dermatologic manifestations. Dermatologists should be aware of this entity, as early diagnosis can prevent unnecessary surgery and avoid prolonged ineffective antibiotic therapy. We report three new cases and review the literature.
Subject(s)
Acquired Hyperostosis Syndrome/diagnosis , Acquired Hyperostosis Syndrome/drug therapy , Acquired Hyperostosis Syndrome/physiopathology , Adult , Anti-Bacterial Agents/administration & dosage , Biopsy, Needle , Drug Therapy, Combination , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prognosis , Steroids/administration & dosage , Tomography, X-Ray Computed , Tretinoin/administration & dosageSubject(s)
Dental Care/psychology , Informed Consent , Patient Education as Topic , Video Recording , HumansABSTRACT
J774 macrophage-like cells express organic anion transporters that promote the efflux of fluoroquinolone antibiotics such as norfloxacin (NFX) from these cells. Gemfibrozil (GFZ) blocks organic anion transport in J774 cells, thereby facilitating the intracellular accumulation of NFX (Cao, C., H.C. Neu, and S.C. Silverstein. 1991. J. Cell Biol. 115:467a [Abstr.]). To determine whether GFZ enhances the efficacy of fluoroquinolone antibiotics against intracellular bacterial pathogens, J774 cells were infected with Listeria monocytogenes and incubated in medium containing a fluoroquinolone antibiotic in the presence or absence of GFZ. Intracellular growth of L. monocytogenes was evaluated by lysing J774 cells and assaying for colony-forming units of Listeria. GFZ intensified the bacteriostatic effect of 4 micrograms/ml NFX and rendered 8 micrograms/ml bactericidal for L. monocytogenes. GFZ had a similar potentiating effect when used in combination with 2 micrograms/ml ciprofloxacin (CFX). CFX plus GFZ was bactericidal for intracellular L. monocytogenes. Treatment of J774 cells with NFX plus GFZ markedly reduced the cytotoxic effect of the bacteria on these cells. Over 55% of cells treated with 8 micrograms/ml NFX alone were dead 16 h after infection, whereas only 5% of cells treated with 8 micrograms/ml NFX plus GFZ were dead at 16 h. Similarly, GFZ potentiated the ability of 2 micrograms/ml to protect J774 cells against the cytocidal effect of Listeria. NFX in combination with GFZ limited cell-to-cell spread of L. monocytogenes. In antibiotic-free medium, > 99% of J774 cells contained intracellular L. monocytogenes at 14 h after infection. NFX alone in the medium did not change this outcome. However, 4 micrograms/ml NFX plus GFZ decreased bacterial spread by approximately 40% at 24 h postinfection, and 8 micrograms/ml NFX plus GFZ prevented all spread beyond the initially infected cell population. These results suggest that GFZ could be used clinically to enhance the efficacy of fluoroquinolone and of other anionic antibiotics against bacteria that grow and/or reside within macrophages and/or other cells.
Subject(s)
Ciprofloxacin/pharmacology , Gemfibrozil/pharmacology , Listeria monocytogenes/drug effects , Macrophages/microbiology , Norfloxacin/pharmacology , Animals , Cell Line , Drug Synergism , Listeria monocytogenes/growth & development , MiceABSTRACT
About 1900, modern food selection and processing caused widespread epidemics of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a panhypovitaminosis B, i.e., a mixture of substrate beriberi and substrate pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse endemic disease. This would constitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modernized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by out diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w30EFA, is safe for primates. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.
Subject(s)
Beriberi/etiology , Fatty Acids, Essential/deficiency , Adult , Chronic Disease , Fatty Acids, Essential/metabolism , Female , Humans , Male , Middle Aged , Models, Biological , Oils , Structure-Activity Relationship , Vitamin B Deficiency/etiology , Vitamin B Deficiency/therapyABSTRACT
Pellagra was once a major cause of three behaviorally different mental disorders-schizophreniform, manic-depressive-like, and phobic neurotic - plus drying dermatoses, autonomic neuropathies, tinnitus, and fatigue. In this preliminary study all three of the corresponding present-day mental diseases are found to exhibit, statistically, the same pellagraform physical disorders but to ameliorate not so much with vitamins as with supplements of a newly discovered trace omega-3 essential fatty acid (w3-EFA), which provides the substrate upon which niacin and other B vitamin holoenzymes act uniquely to form the prostaglandin 3 series tissue hormones regulating neurocircuits en block. Since present-day refining and food selection patterns, as well as pure corn diets, deplete both the B vitamins and W3-EFA, the existence of therapeutically cross-reacting homologous catalyst and substrate deficiency forms of pellagra are postulated, the first contributing to the B vitamin deficiency epidemics of 50-100 years ago, the second to the more recent endemic "Diseases of Western Civilization" which express in certain genetic subgroups as the major mental illnesses of today.
Subject(s)
Fatty Acids, Essential/deficiency , Neurotic Disorders/drug therapy , Pellagra/drug therapy , Psychotic Disorders/drug therapy , Adult , Agoraphobia/drug therapy , Bipolar Disorder/drug therapy , Fatty Acids, Unsaturated/therapeutic use , Female , Humans , Linseed Oil/therapeutic use , Male , Schizophrenia/drug therapyABSTRACT
Based on the apparent existence of a second (choroid plexial) blood-brain barrier offering a new brain attack mechanism on the periventricular primary personality brain (Rudin, 1980) and which may be breached to produce the schizophreniform psychosis characteristic of systemic lupus erythematosus (Rudin, 1981), we here assess the evidence that viruses and exogenous peptides, including especially the glutens of cereal grains, may be the primary triggers for schizophrenia. Schizophrenia would then be supposed to result as one expression of gene-determined combined transport organ dysfunction with underlying basal laminar immunopathy at the tissue level and possibly a prostaglandin disorder at the chemical and membrane level in turn, finally disrupting neurotransmission in the periventricular limbic system. We conclude that the evidence warrants test of the hypothesis, including a clinical trial under national auspices employing an elemental diet, plasmapheresis, immunosuppression together with an antiviral regimen.
Subject(s)
Blood-Brain Barrier , Choroid Plexus/blood supply , Peptides/immunology , Schizophrenia/immunology , Antipsychotic Agents/therapeutic use , Celiac Disease/genetics , Celiac Disease/immunology , Dermatitis Herpetiformis/immunology , Genetic Markers , Glutens/immunology , Humans , Limbic System/immunology , Renal Dialysis , Schizophrenia/diet therapy , Schizophrenia/geneticsABSTRACT
Carr et al. (1978) and Rudin (1979) independently suggested tat systemic lupus erythematosus (SLE) might provide a model for schizophrenia since SLE is strongly associated with schizophreniform psychoses and exhibits only a covert CNS pathology revealed by immunofluorescent immune complex deposits in the choroid plexus. To carry the concept forward we here examine SLE employing the ideas developed in the preceding paper (Rudin, 1980) indicating that the choroid plexus is part of a second blood-brain barrier guarding the periventricular primary personality brain, the limbic system, and that the choroid plexus is also but one of a set of "transport organs" sharing common vulnerability to covert basal lamina immune complex pathology. In this context both SLE and schizophrenia are viewed as expressions of combined transport dysfunction syndromes, resulting from polygenic-induced sensitivity to exogenous peptides or viruses causing basal laminar immune complex disease, but exhibiting differing statistical expressions over the transport organ group due to difference in genes which elicit different transport organ sensitivities to different exogenous viruses or peptide antigens. Immune disease processes are briefly reviewed.
Subject(s)
Blood-Brain Barrier , Choroid Plexus/immunology , Lupus Erythematosus, Systemic/immunology , Schizophrenia/immunology , Antigens/immunology , Bipolar Disorder/immunology , Cell Membrane Permeability , Fluorescent Antibody Technique , Humans , Immune Complex Diseases/immunology , Intellectual Disability/immunology , Neurotic Disorders/immunologyABSTRACT
Schizophrenia and certain idiopathic neuroses and retardations may be caused by polygenic sensitization to exogeneous peptide antigens or viruses causing a covert immune complex basal lamina disease of the choroid plexus. This organ has the general structure and disease susceptibility of many other transport organs but acts as a second blood--brain barrier putting at risk to contamination and dysfunction the periventricular primary personality (limbic) brain now thought to be centrally involved in schizophrenia. Genetic variability selects different antigens and different target organs so that a complex statistical structure of disease expression can result over the transport organ group as well as between this group and the endocrines and exocrines. This leads to the concept of intra- and intercombined system diseases all of which may have a covert biphasic (hyper-hypo) time course. To this extrinsic combinatorial complexity may be added an intrinsic or neural combinatorial complexity resulting from the fact that the choroid plexus is threaded throughout the limbic system and subject to spotty disease characteristic of many immunopathies. In this way a wide range of behavioral disorders may arise as well as mental retardations if the process occurs during development. In this paper we discuss basic mechanisms. In the next paper of the series we examine systemic lupus erythematosus, the prototypical "combined transport dysfunction," as a model for schizophrenia. In the last paper we search for specific exogeneous peptide triggers for schizophrenia viewed as one expression of combined transport organ dysfunction. We conclude that immunofluorescent and virological surveys should be conducted in all mental illnesses as well as clinical trials of interferon therapy and elemental diets.
Subject(s)
Blood-Brain Barrier , Choroid Plexus/blood supply , Mental Disorders/etiology , Antigens/immunology , Humans , Immune Complex Diseases/immunology , Intellectual Disability/etiology , Limbic System/immunology , Lupus Erythematosus, Systemic/immunology , Mental Disorders/immunology , Neurotic Disorders/etiology , Schizophrenia/etiologyABSTRACT
Galucoma may be one of a set of "baropathic" disorders including tinnitus, Meniere's disease, arthritis and bursitis caused by transport dysfunction in the "tissue membranes" of the set of closed "tissue cells" envisioned by The Tissue Cell Theory of Metazoa and which result, in turn, from prostaglandin disturbances induced by primary or secondary essential fatty acid deficiencies possibly coupled with immunopathic effects.
Subject(s)
Arthritis/physiopathology , Glaucoma/physiopathology , Tinnitus/physiopathology , Basement Membrane/physiology , Cell Membrane Permeability , Humans , Lipid Metabolism , Melatonin/physiology , Melatonin/therapeutic use , Meniere Disease/physiopathologyABSTRACT
Schizophrenia and certain forms of idiopathic mental retardation may result from covert immune complex disease of the basal lamina of the choroid plexus, a process already known to cause covert transport dysfunction in similar structures of, for example, skin, bowel, kidney, and endocrines. Plexial attack could lead to cerebrospinal fluid contamination and then, via an "open" ependyma, to neurotransmitter dysfunction in the periventricular limbic brain. The immune complex mechanism implies polygenic induction, direct or autoimmune, of immune sensitivity to exogenous agents and is thus compatible with the genetic picture in schizophrenia. Candidate agents include viral coat peptides and cereal grain glutens. The glutens are known to cause immune complex skin and bowell disease variants, and some empirical evidence links them to schizophrenia. Only newer immunofluorescence methods can detect the pathology, which is otherwise silent. Systemic lupus erythematosus provides a model since it is a genetic immune complex disease strongly associated with schizophreniform psychoses, exhibits choroid plexial immunofluorescence but no central nervous system pathology by ordinary methods, and may be triggered by viruses.