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Objective This study examined the perception and experience of hospitalized palliative care eligible patients receiving massage therapy from specially trained massaged therapist. Design Twenty hospitalized palliative care eligible patients received three differing doses of massage therapy from specially trained massage therapists. Patients were interviewed about their experience and perception related to the massage. Open-ended data were collected and analyzed using a grounded theory approach. Setting 912-bed tertiary hospital center in Washington, DC. Results Participants generally perceived the hospital-based massage experience positively. Participants noted how the massage experience provoked reflection on the overall hospital experience in two ways: first, as a reference point to the inpatient environment itself, and second, in terms of how massage reduces this distress and creates a sense of peace, at least temporarily. Conclusion The data collected in these semi-structured interviews showed that massage therapy can uniquely ameliorate some of the most pervasive challenges to quality of life for hospitalized patients affected by chronic and serious illness.

Today’s health care landscape requires expert nursing care for clients with dementia. Unfortunately, most nursing students dislike providing dementia care. Lack of students’ self-efficacy may account for some of the negativity surrounding dementia care, and learning activities to increase self-efficacy may be one means for increasing positive feelings. The purpose of this article is to describe and evaluate a clinical learning activity designed to increase the self-efficacy of students in meeting the psychosocial needs of clients with dementia. The experience involved 39 baccalaureate nursing students and included the implementation of a therapeutic activity in a long-term care setting. Evaluation involved discussing the activity before and after implementation, observing the students perform the activity, administering a survey before and after the activity, and completing a clinical log addressing the major objectives. Evidence from the evaluation suggests that the experience promoted increased self-efficacy in students.

Falls are a common cause of serious injury and injury-related death in the older adult population, and may be associated with multiple risks such as age, history of falls, impaired mobility, balance and gait problems, and medications. Sensory and environmental factors as well as the fear of falling may also increase the risk of falls. The purpose of this article is to review current best practice on screening fall risks and fear of falling, fall prevention strategies, and fall prevention resources to assist gerontological nurses in reducing falls by their older adult clients.

A 56-year-old man was referred to the neurology service by his general practitioner for further management of his migraine. His symptoms had begun 6 years earlier with a fairly sudden onset headache on waking with associated nausea, vomiting, photophobia and neck stiffness. He was admitted to hospital under the general internal physicians; a CT brain scan was normal. He declined a lumbar puncture. He improved over 3 days and was discharged with a presumed diagnosis of viral meningitis. However, shortly afterwards he began to experience stereotyped headaches, which continued over the ensuing 6 years, about three attacks per week, with up to 2 weeks between attacks. He described the attacks as beginning with ‘lights floating’ in front of his eyes; he couldn't clearly recall if this was monocular or not. He also volunteered a description of ‘white patches floating in front of my vision’. These progressed in intensity over 20 min and then improved, always within an hour. This was then consistently followed by an evolving, throbbing headache, generally focused retro-orbitally on the left, frequently extending posteriorly to the vertex and occiput and also on occasion involving the right side. It would worsen over around 30 min to a severe throbbing pain during which he would lie or sit still. There was associated profound nausea, frequently with vomiting, photophobia and phonophobia. Typical headache duration was around 4 h, with a maximum of 7 h. The only triggers he recognised were coitus, when he would get an attack shortly after orgasm, and ‘artificial light’. There were no additional features, in particular any red eye, tearing, rhinorrhoea or nasal stuffiness. Between these attacks he was entirely headache free, with no systemic, neurological or visual symptoms. There was a background of …

Editor,—Sympathetic ophthalmia with deafness has been reported rarely.12 We describe one such case and explore a hypothesis whereby genetic susceptibility may be associated with cross reactivity of antigens derived from common neural crest tissue. ### CASE REPORT A 72 year old woman who had previously undergone a left trabeculectomy had a fall in which she sustained a Colles fracture and a left total hyphaema. By 14 days the blood had cleared sufficiently to reveal that she had expelled the entire left iris into the trabeculectomy bleb, with extensive dispersion of uveal pigment into the subconjunctival space. She was also found to have dislocated the lens, and had sustained a choroidal detachment (confirmed by ultrasonography). A non-granulomatous anterior uveitis was noted in the left eye at this time. The initial visual acuity was light perception in the left eye and 6/12 in the right eye. On the 25th day after the original injury, she experienced pain and blurring of vision in her right eye, with the simultaneous onset of …

Polygraphic tracings of 13 normal infants were recorded in a morning sleep at 1 and 2 weeks of age and 1, 2, 3, 4, and 6 months of age. A vibrotactile stimulus graded at 25, 50 and 100 Hz (frequency) and amplitudes of 1, 2 and 3 mm (intensity) was used, each combination being applied twice at 30 s intervals to the hand of the sleeping infant during active sleep (AS) and quiet sleep (QS). The results were analysed as percentages of failure to arouse (FTA) in relation to the number of stimulus trials, the criteria for FTA being the absence of a response in heart or respiratory rate, electroencephalogram, or chin electromyogram. The percentages of FTA from QS did not change significantly from 1 week to 6 months of age, irrespective of frequency or intensity. The percentages of FTA from AS fell sharply and significantly from 1 week to 2 months of age (P less than 0.001). At 3 months of age there was a significant increase followed by a significant decrease at 4 months of age, both changes showing a significant difference at P less than 0.05. Apart from the first week of age, the numbers of FTA from QS were greater than from AS for all stimulus trials. It is concluded that there is an arousal deficit in QS from 1 week to 6 months of age and the temporary deficit in AS at 3 months of age could explain the peak incidence of SIDS at this time.

Morphometric analyses of the right ventricular papillary muscle, as well as measurements of right ventricular pressure and weight, were carried out in the rat during the development and recovery of hypoxic pulmonary hypertension. Animals were divided into hypoxic and normobaric control groups. The hypoxic rats were placed in hypobaric chambers for 1, 2, and 3 wks; and after 3 wks exposure, subgroups of hypoxic rats were allowed to recover in normoxia for 1 to 9 wks. Hematocrit (HCT) and right ventricular systolic pressure (RVSP) were measured prior to sacrifice. The heart was perfused, and the right ventricle (RV) was separated from the left ventricle and septum (LV+S) and weighed. The papillary muscles were dissected and processed for ultrastructural morphometry. Results showed that HCT, RVSP, and RV weight increased in the rats during the hypoxic exposure and then gradually returned to control levels after 3 to 4 wks of normobaric recovery. The papillary muscle of the hypoxic rats showed increased volume density of interstitium, increased diameter and cross sectional area of the cardiac myocytes, reduced volume density of mitochondria, and reduced mitochondria to myofilament ratio. During normoxic recovery, these morphometric indices returned toward control values at various periods of time ranging from less than 3 wks to 9 wks. The results indicate that the adaptive ultrastructural changes of the papillary muscle in RV hypertrophy paralleled the RVSP changes, and also demonstrate the reversibility of these changes in ambient oxygen.

Partial nasal obstruction was performed during a morning of quiet sleep (QS: non-REM) and active sleep (AS: REM) at ages 1 week, 2 weeks, 1, 2, 3, 4 and 6 months on 12 normal infants, 15 subsequent siblings of victims of the Sudden Infant Death Syndrome (SIDS) and 12 infants admitted for investigation of infant apnoea (‘near-miss’ SIDS). In all three groups the numbers failing to arouse after 240 s (FTA-240) in QS were significantly greater than those in AS. After 2 months of age all groups showed a decrease in the number FTA-240 in AS, whereas in QS the number did not change significantly. Subsequent siblings of SIDS had a significantly higher number FTA-240 in QS than controls. There was no significant difference in FTA-240 in QS between controls and infant apnoeas, although there was a trend for this to be higher in subsequent siblings of SIDS than infant apnoeas. It was concluded that arousal from AS is more marked than from QS, that after 2 months of age the ability to arouse from AS increases, and that in relation to SIDS, QS is the sleep state in which the infant is less able to arouse. Furthermore, subsequent siblings of SIDS differ from normal infants in their ability to arouse from QS.