Motion sickness is a common problem, with nearly 80% of the general population suffering from it at one time in their lives. People with migraine headaches or Ménière's syndrome, however, are more likely than others to have recurrent episodes of motion sickness. Researchers at the Naval Medical Center in San Diego, California, reported in 2003 that 70% of research subjects with severe motion sickness had abnormalities of the vestibular system; these abnormalities are often found in patients diagnosed with migraines or Ménière's disease.
While motion sickness may occur at any age, it is more common in children over the age of two, with the majority outgrowing this susceptibility.
When looking at why motion sickness occurs, it is helpful to understand the role of the sensory organs. The sensory organs control a body's sense of balance by telling the brain what direction the body is pointing, the direction it is moving, and if it is standing still or turning. These messages are relayed by the inner ears (or labyrinth); the eyes; the skin pressure receptors, such as in those in the feet; the muscle and joint sensory receptors, which track what body parts are moving; and the central nervous system (the brain and spinal cord), which is responsible for processing all incoming sensory information.
Motion sickness and its symptoms surface when conflicting messages are sent to the central nervous system. An example of this is reading a book in the back seat of a moving car. The inner ears and skin receptors sense the motion, but the eyes register only the stationary pages of the book. This conflicting information may cause the usual motion sickness symptoms of dizziness, nausea and vomiting.
Monday, October 20, 2008
Group therapy
A psychologist, psychiatrist, social worker, or other healthcare professional typically arranges and conducts group therapy sessions. In some therapy groups, two co-therapists share the responsibility of group leadership. Patients are selected on the basis of what they might gain from group therapy interaction and what they can contribute to the group as a whole.
Therapy groups may be homogeneous or heterogeneous. Homogeneous groups have members with similar diagnostic backgrounds (for example, they may all suffer from depression). Heterogeneous groups have a mix of individuals with different emotional issues. The number of group members varies widely, but is typically no more than 12. Groups may be time limited (with a predetermined number of sessions) or indefinite (where the group determines when therapy ends). Membership may be closed or open to new members once sessions begin.
The number of sessions in group therapy depends on the makeup, goals, and setting of the group. For example, a therapy group that is part of a substance abuse program to rehabilitate inpatients would be called short-term group therapy. This term is used because, as patients, the group members will only be in the hospital for a relatively short period of time. Long-term therapy groups may meet for six months, a year, or longer. The therapeutic approach used in therapy depends on the focus of the group and the psychological training of the therapist. Some common techniques include psychodynamic, cognitive-behavioral, and Gestalt therapy.
In a group therapy session, group members are encouraged to openly and honestly discuss the issues that brought them to therapy. They try to help other group members by offering their own suggestions, insights, and empathy regarding their problems. There are no definite rules for group therapy, only that members participate to the best of their ability. However, most therapy groups do have some basic ground rules that are usually discussed during the first session. Patients are asked not to share what goes on in therapy sessions with anyone outside of the group. This protects the confidentiality of the other members. They may also be asked not to see other group members socially outside of therapy because of the harmful effect it might have on the dynamics of the group.
The therapist's main task is to guide the group in self-discovery. Depending on the goals of the group and the training and style of the therapist, he or she may lead the group interaction or allow the group to take their own direction. Typically, the group leader does some of both, providing direction when the group gets off track while letting them set their own agenda. The therapist may guide the group by simply reinforcing the positive behaviors they engage in. For example, if a group member shows empathy to another member, or offers a constructive suggestion, the therapist will point this out and explain the value of these actions to the group. In almost all group therapy situations, the therapist will attempt to emphasize the common traits among group members so that members can gain a sense of group identity. Group members realize that others share the same issues they do.
The main benefit group therapy may have over individual psychotherapy is that some patients behave and react more like themselves in a group setting than they would one-on-one with a therapist. The group therapy patient gains a certain sense of identity and social acceptance from their membership in the group. Suddenly, they are not alone. They are surrounded by others who have the same anxieties and emotional issues that they have. Seeing how others deal with these issues may give them new solutions to their problems. Feedback from group members also offers them a unique insight into their own behavior, and the group provides a safe forum in which to practice new behaviors. Lastly, by helping others in the group work through their problems, group therapy members can gain more self-esteem. Group therapy may also simulate family experiences of patients and will allow family dynamic issues to emerge.
Self-help groups like Alcoholics Anonymous and Weight Watchers fall outside of the psychotherapy realm. These self-help groups do offer many of the same benefits of social support, identity, and belonging that make group therapy effective for many. Self-help group members meet to discuss a common area of concern (like alcoholism, eating disorders, bereavement, parenting). Group sessions are not run by a therapist, but by a nonprofessional leader, group member, or the group as a whole. Self-help groups are sometimes used in addition to psychotherapy or regular group therapy.
Therapy groups may be homogeneous or heterogeneous. Homogeneous groups have members with similar diagnostic backgrounds (for example, they may all suffer from depression). Heterogeneous groups have a mix of individuals with different emotional issues. The number of group members varies widely, but is typically no more than 12. Groups may be time limited (with a predetermined number of sessions) or indefinite (where the group determines when therapy ends). Membership may be closed or open to new members once sessions begin.
The number of sessions in group therapy depends on the makeup, goals, and setting of the group. For example, a therapy group that is part of a substance abuse program to rehabilitate inpatients would be called short-term group therapy. This term is used because, as patients, the group members will only be in the hospital for a relatively short period of time. Long-term therapy groups may meet for six months, a year, or longer. The therapeutic approach used in therapy depends on the focus of the group and the psychological training of the therapist. Some common techniques include psychodynamic, cognitive-behavioral, and Gestalt therapy.
In a group therapy session, group members are encouraged to openly and honestly discuss the issues that brought them to therapy. They try to help other group members by offering their own suggestions, insights, and empathy regarding their problems. There are no definite rules for group therapy, only that members participate to the best of their ability. However, most therapy groups do have some basic ground rules that are usually discussed during the first session. Patients are asked not to share what goes on in therapy sessions with anyone outside of the group. This protects the confidentiality of the other members. They may also be asked not to see other group members socially outside of therapy because of the harmful effect it might have on the dynamics of the group.
The therapist's main task is to guide the group in self-discovery. Depending on the goals of the group and the training and style of the therapist, he or she may lead the group interaction or allow the group to take their own direction. Typically, the group leader does some of both, providing direction when the group gets off track while letting them set their own agenda. The therapist may guide the group by simply reinforcing the positive behaviors they engage in. For example, if a group member shows empathy to another member, or offers a constructive suggestion, the therapist will point this out and explain the value of these actions to the group. In almost all group therapy situations, the therapist will attempt to emphasize the common traits among group members so that members can gain a sense of group identity. Group members realize that others share the same issues they do.
The main benefit group therapy may have over individual psychotherapy is that some patients behave and react more like themselves in a group setting than they would one-on-one with a therapist. The group therapy patient gains a certain sense of identity and social acceptance from their membership in the group. Suddenly, they are not alone. They are surrounded by others who have the same anxieties and emotional issues that they have. Seeing how others deal with these issues may give them new solutions to their problems. Feedback from group members also offers them a unique insight into their own behavior, and the group provides a safe forum in which to practice new behaviors. Lastly, by helping others in the group work through their problems, group therapy members can gain more self-esteem. Group therapy may also simulate family experiences of patients and will allow family dynamic issues to emerge.
Self-help groups like Alcoholics Anonymous and Weight Watchers fall outside of the psychotherapy realm. These self-help groups do offer many of the same benefits of social support, identity, and belonging that make group therapy effective for many. Self-help group members meet to discuss a common area of concern (like alcoholism, eating disorders, bereavement, parenting). Group sessions are not run by a therapist, but by a nonprofessional leader, group member, or the group as a whole. Self-help groups are sometimes used in addition to psychotherapy or regular group therapy.
Underlying depression and less cognitive flexibility could be warning signs
A recent study showed that health-care costs go up another $2,500 for each patient with delirium following surgery, because of longer hospital stays, higher death rates and the need sometimes to admit patients to long-term care. The annual national cost may reach as high as $152 billion a year, Monk said.
"When you look at the increase in the aging population, this is going to be more of a problem," she added.
Dr. Arnold Berry, a professor of anesthesiology at Emory University School of Medicine, Atlanta, said the impact of the problem is already clear, considering that about 12 percent of the U.S. population is 65 or older and this group accounts for one-third of expenditures on surgery.
The Duke study of 100 patients, averaging 65 years of age, found that 16 percent experienced post-operative delirium after they'd received general anesthesia for non-cardiac surgery. Specific percentages can be as high as 50 percent or more for patients having surgery following a hip fracture, Monk noted.
The two pre-surgery tests -- the Geriatric Depression Scale-Short Form and the Trail Making Test -- can be administered by nurses and other health-care personnel in as little as 15 minutes, Monk said. The finding that these tests are effective screening tools could lead to further research to identify measures to prevent or reduce post-operative delirium, she said, adding that current interventions are limited.
For example, further research might show that treating depression in older patients prior to elective surgery reduces their likelihood of post-operative delirium, she said.
Monk is scheduled to present the study's findings Oct. 20 at the American Society of Anesthesiologists' annual meeting, in Orlando, Fla.
Emory's Berry, who leads a group of anesthesiologists interested in geriatric issues, said Monk's findings are "one piece to a big puzzle." Because of changes in the aging brain, it's difficult to determine how much the stress of surgery and how much anesthesia add to the risk of post-operative delirium, he said.
The Duke study identifies screening tools that could spur more research into ways of dealing with both factors as they relate to post-op delirium, Berry explained. He said he doesn't plan to add the screening tools used in the Duke study to his pre-operative work-ups -- at least not yet.
"They are something that's promising, but I think most people would wait until it has undergone peer review and has been published," he said.
Monk said the study has been submitted for publication.
In a related study, Canadian researchers reported last month that people who take cholesterol-lowering statin drugs -- such as Crestor, Lipitor, Pravachol and Zocor -- are more likely to suffer delirium after surgery. That finding was published in the Canadian Medical Association Journal.
"When you look at the increase in the aging population, this is going to be more of a problem," she added.
Dr. Arnold Berry, a professor of anesthesiology at Emory University School of Medicine, Atlanta, said the impact of the problem is already clear, considering that about 12 percent of the U.S. population is 65 or older and this group accounts for one-third of expenditures on surgery.
The Duke study of 100 patients, averaging 65 years of age, found that 16 percent experienced post-operative delirium after they'd received general anesthesia for non-cardiac surgery. Specific percentages can be as high as 50 percent or more for patients having surgery following a hip fracture, Monk noted.
The two pre-surgery tests -- the Geriatric Depression Scale-Short Form and the Trail Making Test -- can be administered by nurses and other health-care personnel in as little as 15 minutes, Monk said. The finding that these tests are effective screening tools could lead to further research to identify measures to prevent or reduce post-operative delirium, she said, adding that current interventions are limited.
For example, further research might show that treating depression in older patients prior to elective surgery reduces their likelihood of post-operative delirium, she said.
Monk is scheduled to present the study's findings Oct. 20 at the American Society of Anesthesiologists' annual meeting, in Orlando, Fla.
Emory's Berry, who leads a group of anesthesiologists interested in geriatric issues, said Monk's findings are "one piece to a big puzzle." Because of changes in the aging brain, it's difficult to determine how much the stress of surgery and how much anesthesia add to the risk of post-operative delirium, he said.
The Duke study identifies screening tools that could spur more research into ways of dealing with both factors as they relate to post-op delirium, Berry explained. He said he doesn't plan to add the screening tools used in the Duke study to his pre-operative work-ups -- at least not yet.
"They are something that's promising, but I think most people would wait until it has undergone peer review and has been published," he said.
Monk said the study has been submitted for publication.
In a related study, Canadian researchers reported last month that people who take cholesterol-lowering statin drugs -- such as Crestor, Lipitor, Pravachol and Zocor -- are more likely to suffer delirium after surgery. That finding was published in the Canadian Medical Association Journal.
Be Involved in Your Health Care
1. The single most important way you can help to prevent errors is to be an active member of your health care team.
That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.
Medicines
2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.
At least once a year, bring all of your medicines and supplements with you to your doctor. "Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.
3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
This can help you avoid getting a medicine that can harm you.
4. When your doctor writes you a prescription, make sure you can read it.
If you can't read your doctor's handwriting, your pharmacist might not be able to either.
5. Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.
What is the medicine for?
How am I supposed to take it, and for how long?
What side effects are likely? What do I do if they occur?
Is this medicine safe to take with other medicines or dietary supplements I am taking?
What food, drink, or activities should I avoid while taking this medicine?
6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?
A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.
7. If you have any questions about the directions on your medicine labels, ask.
Medicine labels can be hard to understand. For example, ask if "four doses daily" means taking a dose every 6 hours around the clock or just during regular waking hours.
8. Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you're not sure how to use it.
Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.
9. Ask for written information about the side effects your medicine could cause.
If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.
Hospital Stays
10. If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.
Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
11. If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands.
Handwashing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.
12. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home.
This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.
Surgery
13. If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done.
Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.
Other Steps You Can Take
14. Speak up if you have questions or concerns.
You have a right to question anyone who is involved with your care.
15. Make sure that someone, such as your personal doctor, is in charge of your care.
This is especially important if you have many health problems or are in a hospital.
16. Make sure that all health professionals involved in your care have important health information about you.
Do not assume that everyone knows everything they need to.
17. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can't).
Even if you think you don't need help now, you might need it later.
18. Know that "more" is not always better.
It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.
Medicines
2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.
At least once a year, bring all of your medicines and supplements with you to your doctor. "Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.
3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
This can help you avoid getting a medicine that can harm you.
4. When your doctor writes you a prescription, make sure you can read it.
If you can't read your doctor's handwriting, your pharmacist might not be able to either.
5. Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.
What is the medicine for?
How am I supposed to take it, and for how long?
What side effects are likely? What do I do if they occur?
Is this medicine safe to take with other medicines or dietary supplements I am taking?
What food, drink, or activities should I avoid while taking this medicine?
6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?
A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.
7. If you have any questions about the directions on your medicine labels, ask.
Medicine labels can be hard to understand. For example, ask if "four doses daily" means taking a dose every 6 hours around the clock or just during regular waking hours.
8. Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you're not sure how to use it.
Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.
9. Ask for written information about the side effects your medicine could cause.
If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.
Hospital Stays
10. If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.
Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
11. If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands.
Handwashing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.
12. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home.
This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.
Surgery
13. If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done.
Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.
Other Steps You Can Take
14. Speak up if you have questions or concerns.
You have a right to question anyone who is involved with your care.
15. Make sure that someone, such as your personal doctor, is in charge of your care.
This is especially important if you have many health problems or are in a hospital.
16. Make sure that all health professionals involved in your care have important health information about you.
Do not assume that everyone knows everything they need to.
17. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can't).
Even if you think you don't need help now, you might need it later.
18. Know that "more" is not always better.
It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
Wednesday, August 27, 2008
Twenty Dollars
A well-known speaker started off his seminar by holding up a $20 bill. In the room of 200, he asked, "Who would like this $20 bill?" Hands started going up. He said, "I am going to give this $20 to one of you, but first, let me do this." He proceeded to crumple the 20 dollar note up. He then asked, "Who still wants it?" Still the hands were up in the air. "Well," he replied, "what if I do this?" He dropped it on the ground and started to grind it into the floor with his shoe. He picked it up, now crumpled and dirty. "Now, who still wants it?" Still the hands went into the air. "My friends, you have all learned a very valuable lesson. No matter what I did to the money, you still wanted it because it did not decrease in value. It was still worth $20." "Many times in our lives, we are dropped, crumpled, and ground into the dirt by the decisions we make and the circumstances that come our way. We feel as though we are worthless; but no matter what happened or what will happen, you will never lose your value." "Dirty or clean, crumpled or finely creased, you are still priceless to those who love you. The worth of our lives comes, not in what we do or who we know, but by ...WHO WE ARE." "You are special — don’t ever forget it."
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