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Neuroscience Letters Oct 2020This study examined the effects of systemic administration of the TrkB receptor antagonist (ANA-12) during induction of morphine dependence on the severity of physical...
This study examined the effects of systemic administration of the TrkB receptor antagonist (ANA-12) during induction of morphine dependence on the severity of physical and psychological dependence and the cerebrospinal fluid (CSF) BDNF levels in morphine-dependent and withdrawn rats. Rats became morphine-dependent by increasing daily doses of morphine for 7 days, along with ANA-12 injection. Then, rats were tested for the severity of physical dependence on morphine (spontaneous withdrawal signs), anxiety-like (the elevated plus maze), depressive-like (sucrose preference test) behaviors after spontaneous morphine withdrawal. Also, the CSF BDNF levels were assessed 2 h after the last dose of morphine and day 13 after morphine withdrawal in morphine-dependent and withdrawn rats. We found that the morphine withdrawal signs were significantly higher in morphine dependent rats receiving ANA-12 on days of 5-7 after morphine withdrawal, also ANA-12 exacerbated overall dependence severity. While, the percentage of time spent in the open arms and sucrose preference were higher in morphine-dependent rats receiving ANA-12 than morphine-dependent rats receiving saline. Also, the ANA-12 injection decreased the CSF BDNF levels following morphine dependence, while increased it after morphine withdrawal. We conclude that the ANA-12 exacerbated the severity of physical morphine dependence but attenuated the anxiety/depressive-like behaviors in morphine-dependent and withdrawn rats. Also, ANA-12 injection was able to reverse the changes in the CSF BDNF levels. Therefore, ANA-12 is not more likely to complete treatment for opiate addiction.
Topics: Animals; Azepines; Behavior, Animal; Benzamides; Brain-Derived Neurotrophic Factor; Dependency, Psychological; Disease Models, Animal; Male; Morphine Dependence; Rats; Rats, Wistar; Receptor, trkB; Severity of Illness Index; Substance Withdrawal Syndrome
PubMed: 32860885
DOI: 10.1016/j.neulet.2020.135332 -
The Clinical Teacher Dec 2017Medical students traditionally learn physical examination skills as a rote list of manoeuvres. Alternatives like hypothesis-driven physical examination (HDPE) may...
BACKGROUND
Medical students traditionally learn physical examination skills as a rote list of manoeuvres. Alternatives like hypothesis-driven physical examination (HDPE) may promote students' understanding of the contribution of physical examination to diagnostic reasoning. We sought to determine whether first-year medical students can effectively learn to perform a physical examination using an HDPE approach, and then tailor the examination to specific clinical scenarios. Medical students traditionally learn physical examination skills as a rote list of manoeuvres CONTEXT: First-year medical students at the University of Minnesota were taught both traditional and HDPE approaches during a required 17-week clinical skills course in their first semester. The end-of-course evaluation assessed HDPE skills: students were assigned one of two cardiopulmonary cases. Each case included two diagnostic hypotheses. During an interaction with a standardised patient, students were asked to select physical examination manoeuvres in order to make a final diagnosis. Items were weighted and selection order was recorded.
INNOVATION
First-year students with minimal pathophysiology performed well. All students selected the correct diagnosis. Importantly, students varied the order when selecting examination manoeuvres depending on the diagnoses under consideration, demonstrating early clinical decision-making skills.
IMPLICATIONS
An early introduction to HDPE may reinforce physical examination skills for hypothesis generation and testing, and can foster early clinical decision-making skills. This has important implications for further research in physical examination instruction.
Topics: Clinical Competence; Curriculum; Education, Medical; Humans; Physical Examination; Problem-Based Learning
PubMed: 27933732
DOI: 10.1111/tct.12581 -
Chest May 2019Lobar atelectasis (or collapse) is an exceedingly common, rather predictable, and potentially pathogenic companion to many forms of acute illness, postoperative care,... (Review)
Review
Lobar atelectasis (or collapse) is an exceedingly common, rather predictable, and potentially pathogenic companion to many forms of acute illness, postoperative care, and chronic debility. Readily diagnosed by using routine chest imaging and bedside ultrasound, the consequences from lobar collapse may be minor or serious, depending on extent, mechanism, patient vulnerability, abruptness of onset, effectiveness of hypoxic vasoconstriction, and compensatory reserves. Measures taken to reduce secretion burden, assure adequate secretion clearance, maintain upright positioning, reverse lung compression, and sustain lung expansion accord with a logical physiologic rationale. Both classification and logical approaches to prophylaxis and treatment of lobar atelectasis derive from a sound mechanistic knowledge of its causation.
Topics: Acute Disease; Female; Humans; Male; Physical Examination; Point-of-Care Testing; Pulmonary Atelectasis; Sensitivity and Specificity; Severity of Illness Index; Spirometry; Tomography, X-Ray Computed; Ultrasonography, Doppler
PubMed: 30528423
DOI: 10.1016/j.chest.2018.11.014 -
Clinical Rheumatology Mar 2020To review the importance of physical examination in the diagnostic process of musculoskeletal conditions vis-a-vis the development of sensitive and powerful technologies... (Review)
Review
To review the importance of physical examination in the diagnostic process of musculoskeletal conditions vis-a-vis the development of sensitive and powerful technologies such as MRI and high-resolution ultrasound. Because the physical examination of the musculoskeletal system is an exercise of applied clinical anatomy, the authors tested, in one-to-one practical examinations, the basal knowledge of musculoskeletal anatomy of rheumatology trainees, rheumatologists, and other professionals of musculoskeletal medicine. The results of the authors' surveys were disappointing, with a correct response rate of 50 to 60% depending on the locales. To correct this deficit, the authors gave many active-learning, case-centered seminars throughout the Americas and some overseas that may have fostered an interest in the study of clinical anatomy. There was an increased interaction between anatomy departments and clinicians, and that daily use of clinical anatomy would make anatomy relevant, improve clinical skills, and probably reduce the overall costs of the health care system.Key Points• Knowledge of musculoskeletal anatomy is the basic diagnostic tool in the regional pain syndromes• Knowledge of musculoskeletal anatomy helps understand the musculoskeletal involvement in the regional and systemic rheumatic disorders• An active-learning methodology was used since 2006 to review the anatomy that is relevant for rheumatology trainees and practitioners of musculoskeletal medicine• A skilled, anatomy-based physical examination and a well-thought diagnostic hypothesis could reduce the use of expensive technologies that, being too sensitive, may lead the unaware clinician astray.
Topics: Anatomy; Clinical Competence; Curriculum; Education, Graduate; Humans; Musculoskeletal System; Physical Examination; Rheumatology
PubMed: 31446539
DOI: 10.1007/s10067-019-04725-9 -
Social Science & Medicine (1982) Sep 1998This paper presents a conceptual model of physical independence and dependence as it relates to adult onset, chronic physical illness and disability. Physical...
This paper presents a conceptual model of physical independence and dependence as it relates to adult onset, chronic physical illness and disability. Physical independence and dependence are presented as two separate, continuous, and multiply determined constructs, and illustrations are provided of situations where people can be independent, dependent, not independent, or experience imposed dependence. The paper also discusses potential determinants of physical independence and dependence, including different domains of disability, the role of subjective perceptions, demographics, the physical and social/political environments, personal resources, attitudes and coping resources, illness and efficacy appraisals, and the nature of the assistive relationship. The paper extends work on physical independence and dependence by synthesizing the findings from previous studies and incorporating the findings from other relevant areas of research into the area. It also expands on the concepts of physical independence and dependence, as well as their determinants, and relates independence and dependence to other outcomes of interest such as service delivery.
Topics: Activities of Daily Living; Adult; Caregivers; Chronic Disease; Dependency, Psychological; Disabled Persons; Health Services Needs and Demand; Humans; Models, Psychological
PubMed: 9690821
DOI: 10.1016/s0277-9536(98)00149-x -
American Journal of Alzheimer's Disease... May 2013Relating to Alzheimer's disease (AD), dependence has been defined as the increased need for assistance due to deterioration in cognition, physical functioning, and...
BACKGROUND
Relating to Alzheimer's disease (AD), dependence has been defined as the increased need for assistance due to deterioration in cognition, physical functioning, and behavior. Our objective was to evaluate the association between dependence and measures of functional impairment.
METHODS
Data were compiled by the National Alzheimer's Coordinating Center. We used multinomial logistic regression to estimate the association between dependence and cognition, physical functioning, and behavior.
RESULTS
The independent association with dependence was positive. Dependence was most strongly associated with physical functioning. A secondary analysis suggested a strong association of dependence with multiple impairments, as measured by the interaction terms, in more severe patients.
CONCLUSIONS
We find that dependence is simultaneously associated with physical functioning, cognition, and behavior, which support the construct validity of dependence. Dependence might be a more simple measure to explain the multifaceted disease progression of AD and convey the increasing need for care.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Cognition; Cognition Disorders; Databases, Factual; Dependency, Psychological; Disability Evaluation; Female; Humans; Logistic Models; Male; Middle Aged; Neuropsychological Tests; Outcome Assessment, Health Care; Reproducibility of Results
PubMed: 23512996
DOI: 10.1177/1533317513481092 -
Revista Espanola de Salud Publica Aug 2020Despite knowing that the practice of physical activity can positively influence the health of older people, there are variables such as the risk of dependency and the...
OBJECTIVE
Despite knowing that the practice of physical activity can positively influence the health of older people, there are variables such as the risk of dependency and the level of self-esteem that can mediate people´s quality of life. The objective of this study was to know the relationship between the risk of dependence and level of self-esteem in older people.
METHODS
515 seniors between 60 and 90 years old were interviewed. A single measurement was made, using different scales and validated questionnaires (Rosenberg personal self-esteem scale, Barber test and Modified Baecke PAQ questionnaire). Statistical analyzes (with the SPSS v. 23.0 program) descriptive, ANOVA, linear regression analysis and correlations were performed.
RESULTS
89.1% had dependency risk, 32.6% were physically active and 43.3% had low self-esteem. The level of physical activity practice showed significant differences (p<0.001) favorable to active people, who had a lower risk of dependence, better self-esteem and lower consumption of medications than sedentary ones.
CONCLUSIONS
The practice of physical activity helps reduce drug consumption, which improves the self-esteem of the elderly and decreases the risk of dependence.
Topics: Aged; Aged, 80 and over; Aging; Cross-Sectional Studies; Dependency, Psychological; Drug Utilization; Exercise; Female; Humans; Linear Models; Male; Middle Aged; Quality of Life; Risk; Self Concept; Spain; Surveys and Questionnaires
PubMed: 32852480
DOI: No ID Found -
Sports Medicine and Arthroscopy Review Jun 2014The shoulder is subject to tremendous stress during the throwing motion, which creates the opportunity for injury and disability. Understanding the potential causes of... (Review)
Review
The shoulder is subject to tremendous stress during the throwing motion, which creates the opportunity for injury and disability. Understanding the potential causes of injury in the overhead athlete can be challenging in and of itself; however, placing those diagnoses in the clinical context of an injured athlete can be even more challenging. In a world of advancing technology and increasing dependence on magnetic resonance imaging, the art of history taking and physical examination can be easily forgotten.
Topics: Athletes; Athletic Injuries; Biomechanical Phenomena; Humans; Physical Examination; Range of Motion, Articular; Shoulder Injuries; Shoulder Joint
PubMed: 24787723
DOI: 10.1097/JSA.0000000000000026 -
European Eating Disorders Review : the... 2011To examine associations among exercise dependence score, amount of physical activity and eating disorder (ED) symptoms in patients with longstanding ED and non-clinical...
OBJECTIVE
To examine associations among exercise dependence score, amount of physical activity and eating disorder (ED) symptoms in patients with longstanding ED and non-clinical controls.
METHODS
Adult female inpatients (n = 59) and 53 age-matched controls participated in this cross sectional study. Assessments included the eating disorders examination, eating disorders inventory, exercise dependence scale, reasons for exercise inventory, and MTI Actigraph accelerometer.
RESULTS
Positive associations were found among vigorous, not moderate, physical activity, exercise dependence score and ED symptoms in patients. In the controls, ED symptoms were negatively associated with vigorous physical activity and not correlated with exercise dependence score. Exercise for negative affect regulation, not weight/appearance, and amount of vigorous physical activity were explanatory variables for exercise dependence score in both groups.
CONCLUSIONS
The positive associations among exercise dependence score, vigorous physical activity and ED symptoms need proper attention in the treatment of longstanding ED.
Topics: Adolescent; Adult; Cross-Sectional Studies; Dependency, Psychological; Exercise; Feeding and Eating Disorders; Female; Humans; Inpatients; Motivation; Psychiatric Status Rating Scales; Surveys and Questionnaires
PubMed: 21584917
DOI: 10.1002/erv.971 -
American Heart Journal Jul 1998To explain why investigations of the measurement of central venous pressure (CVP) usually reveal a discrepancy between the clinician's estimate of CVP from physical... (Review)
Review
OBJECTIVE
To explain why investigations of the measurement of central venous pressure (CVP) usually reveal a discrepancy between the clinician's estimate of CVP from physical diagnosis and supine measurement with a catheter. Data from MEDLINE search, personal files, and bibliographies of textbooks on physical diagnosis and cardiology were used.
RESULTS
The most important reasons for this disagreement are the failure to standardize the external reference point used by the clinician to indicate "zero" venous pressure and the failure to recognize that venous pressure often depends on the position of the patient during examination. During physical examination clinicians tend to underestimate the CVP, as measured by a catheter in the same patient positioned supine, especially when the measured value is high. This occurs because the venous pressure of patients with heart failure, in contrast to that of healthy individuals, demonstrates an exaggerated postural fall when the patient is in the more upright positions that are necessary to visualize the elevated neck veins. The cause of this postural instability, increased venoconstriction from sympathetic tone, also helps explain two other physical findings of the jugular veins, the abdominojugular test, and Kussmaul's sign.
CONCLUSIONS
Clinicians should avoid making decisions about degrees of CVP elevation that are imprecise and difficult to reproduce. Instead, they should determine during physical diagnosis merely whether the CVP is elevated. Until further research is done, the best definition of elevated CVP is that of Sir Thomas Lewis-when the top of the external or internal jugular veins is >3 cm of vertical distance above the sternal angle, the CVP is abnormally high.
Topics: Animals; Blood Pressure Determination; Cardiovascular Diseases; Catheterization, Central Venous; Central Venous Pressure; Heart; Humans; Physical Examination; Posture; Reference Standards
PubMed: 9665212
DOI: 10.1016/s0002-8703(98)70175-9