By O. Aldo. University of California, Berkeley.
Empiricism was cialis black 800mg on line, at last, about to the dangers of idleness, and the need for patients play a role in psychiatric practice. Such an approach was now considered to be PSYCHIATRIC TREATMENT AND ITS more likely to restore reason than harshness EVALUATION: THE EARLY TWENTIETH or severity. CENTURY But although there was an increasing desire for caring to replace constraint in dealing with 3 In the 1920s Dr Henry A. Cotton proposed a the- the mentally disturbed, drugs such as corium, ory relating focal infection to mental disorders, in digitalis, antimony and chloral were still used particular the functional psychoses. According to to quieten patients, replacing physical fetters Dr Cotton: with pharmacological ones. And despite the best efforts of the advocates of the moral treatment The so called functional psychoses we believe approach, asylums housing the insane often today to be due to a combination of many remained depressing and degrading places until factors, but the most constant one is the intra- well into the twentieth century, as is illustrated cerebral, bio-chemical cellular disturbance arising by the following account of a visit by a newly from circulating toxins originating in chronic appointed psychiatrist in 1953 to the chronic foci of infection, situated anywhere in the body, ward of a mental hospital in Cambridge in the associated probably with secondary disturbance United Kingdom: of the endocrin system. Instead of considering the psychosis as a disease entity, it should be considered as a symptom, and often a terminal I was taken in by someone who had a key to unlock symptom of a long continued masked infection, the the door and lock it behind you. This led into a big Dr Cotton identified infection of the teeth and bare room, overcrowded with people, with scrubbed tonsils as the most important foci to be consid- floors, bare wooden tables, benches screwed to the ered, but the stomach and in female patients, the floor, people milling around in shapeless clothing. At the back of the infected tissue, all infected teeth and tonsils cer- ward were the padded cells, in which would be tainly and for many patients, colectomies. Addi- one or two patients, smeared with faeces, shouting tionally female patients might require enucleation OVERVIEW 237 of the cervix, or in some cases complete removal became popular in the 1930s and 1940s. Such treatment coma, for example, required patients to be given was, according to Dr Cotton, enormously suc- large doses of insulin which, by lowering the cessful with, out of 1400 patients treated, only blood sugar, induced a comatose state from which 42 needing to remain in hospital. According to Sargant and Slater,5 choses was not universally accepted, neither were the striking results said to have been obtained (reproduced with permission of Elsevier Science) by the removal of these infections. To achieve this laudable schizophrenics coming under observation, and it is if somewhat pious aim, Kopeloff and Cheney therefore important not to waste the treatment on planned their study in the form of an experiment. All members of one group received operative treatment for foci Perhaps the most severe of the physical therapies of infection in teeth and tonsils, while members was a lobotomy, where the brain was cut with of the other group received no such treatment and a knife. The operation was pioneered by Egas consequently could be regarded as controls. Evaluation of the effectiveness of entific limitations it did produce results (sum- the therapy was largely anecdotal, and even marised here in Table 15.
You will also need to know such details as length purchase cialis black 800 mg line, charts or tables, degree of original statistical analysis required, deadline for the article and other relevant conditions (such as will you get paid? Look in particular at the structure: most review articles (though not systematic reviews) move away from the traditional IMRAD structure and follow the structure for editorials and feature articles. In general they start off with a first sentence that should attract attention, go on to set up the question they are to address, develop an 115 THE A–Z OF MEDICAL WRITING argument that addresses it (one step per paragraph) and finally, at the end of the article, come to rest with the message. Be realistic about what you have been asked to do, which is to use your knowledge and skill to look at a topic, bring together the information you have found, and come to some kind of plausible conclusion. For major tasks (such as a thesis or a scientific paper) make sure that you celebrate as soon as you have finished. What happens later is, to some extent, beyond your control, though if all goes well you can have another celebration later (see effective writing; payoff). When you come back to the draft you will need to look at it in a number of ways, though not necessarily all at once. These are the big issues, such as is the message still there, is it in the appropriate place and is it still right for the audience (see setting the brief)? Also ask if the structure works (try the yellow marker test) and whether the tone is appropriate? Once you have carried out these tests, you can start looking at the micro-editing issues – checking facts, accuracy, grammar and style. It is important to get these right, but it is unhelpful to concen- trate all your resources on them. Sometimes the number will depend on the importance of the writing – a thesis will usually receive more attention than a letter home. The big problem for most people, however, is knowing when to stop rewriting: this is where deadlines are invaluable.
The person may experience profound respiratory depression generic cialis black 800mg with mastercard, pulmonary edema, hypo- cardiovascular collapse, generalized tonic-clonic seizures, glycemia, pneumonia, cellulitis, and other infections often and acute psychotic episodes. These can be prevented by accompany opiate overdose and require specific treatment gradually withdrawing the offending drug. CHAPTER 15 SUBSTANCE ABUSE DISORDERS 243 Signs and symptoms of withdrawal can be reversed im- CENTRAL NERVOUS mediately by giving the drug producing the dependence. SYSTEM STIMULANTS Therapeutic withdrawal, which is more comfortable and safer, can be managed by gradually reducing dosage over Amphetamines and Related Drugs several days. Clonidine, an antihypertensive drug, is some- times used to relieve withdrawal symptoms associated with Amphetamines and related drugs (see Chap. Except for the use of methylphenidate in nence from further opiate usage. Because this goal is rarely treating ADHD, however, the drugs are more important as met, long-term drug therapy may be used to treat heroin de- drugs of abuse than therapeutic agents. One method uses opioid substitutes to prevent with- drawal symptoms and improve a lifestyle that revolves around obtaining, using, and recovering from a drug. Methadone Amphetamine-Type Dependence has long been used for this purpose, usually a single, daily, Amphetamines and related drugs (eg, methylphenidate) pro- oral dose given in a methadone clinic. Proponents say that duce stimulation and euphoria, effects often sought by drug methadone blocks euphoria produced by heroin, acts longer, users. The user may increase the amount and frequency of ad- and reduces preoccupation with drug use. This allows a more ministration to reach or continue the state of stimulation. One normal lifestyle for the client and reduces morbidity and of the drugs, methamphetamine, may be chemically treated mortality associated with the use of illegal and injected drugs. Opponents say that methadone fects of amphetamines are similar to those produced by co- maintenance only substitutes one type of drug dependence caine and are largely dose related. In addition, a substantial percentage of those re- mental alertness, wakefulness, and increased energy. Large ceiving methadone maintenance therapy abuse other drugs, amounts may cause psychosis (eg, hallucinations and para- including cocaine.
When you review her chart cheap cialis black 800mg overnight delivery, it indicates she has right-sided hemiparesis, memory deficits, and dysphagia (difficulty swallowing). Reflect on: Outline appropriate assessments to determine if it is safe to give Ms. Zack can take medications orally, what precautions can you take to help ensure her safety? OVERVIEW GENERAL PRINCIPLES OF ACCURATE DRUG ADMINISTRATION Drugs given for therapeutic purposes are called medica- tions. Giving medications to clients is an important nursing • Follow the five rights consistently. The basic requirements for accurate drug adminis- effects, adverse effects, and any specific instructions tration are often called the five rights: giving the right about administration). These rights require knowledge of the name, dose, frequency of administration). Question the drugs to be given and the clients who are to receive them as prescriber if any information is unclear or if the drug well as specific nursing skills and interventions. This chapter is concerned with safe and accurate different dosage forms and concentrations; it is ex- medication administration. You explain that desirable interactions with other drugs and IV solutions). On exiting the room, you look at the room number and realize that you just gave medications to Mr. LEGAL RESPONSIBILITIES This promotes safer administration and reduces errors.
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