By R. Roland. College of Saint Scholastica.

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The strongest predictor of abnormal imaging was an abnormal motor exami- nation (odds ratio: 18 discount endep 25mg on line. The MR findings in 186 of 274 consecutive patients who underwent temporal lobectomy for intractable epilepsy were retrospectively reviewed (moderate evidence) (Table 11 discount endep 50mg line. MRI sensitivity and specificity in temporal lobe epilepsy Item Sensitivity (%) Specificity (%) Reference Hippocampal lesion 93 83 Lee et al. Magnetic resonance imaging detected 121 hippocampal/amygdala abnormalities (sensitivity and specificity of 93% and 83%, respectively) and 60 other abnormalities in the remainder of the temporal lobe (sensitivity and specificity of 97% and 97%, respectively). Increased signal of the hippocampus on T2-weighted images had a sensi- tivity of 93% and specificity of 74% in predicting mesial temporal sclero- sis (Fig. Forty-two temporal tumors were detected with a sensitivity and specificity of 83 and 97%, respectively. The sensitivity of CT and MRI in temporal lobe pathology was recently reported by Sinclair et al. All patients underwent temporal lobectomy for intractable epilepsy, hence providing histopathology as the reference stan- dard. Magnetic resonance imaging found abnormalities in 27 cases (64%) and CT scan in 12 of 39 cases (31%). Magnetic resonance imaging was clearly more sensitive than CT in the detection of pathology. The MRI sensitivity in demonstrating the epileptogenic zone determined by EEG (a weak standard reference) was investigated in a level III study (limited evidence). The weakness of the reference standard is in part com- pensated by the number of cases.

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Walkers used fewer medications and had a Deconditioning generic endep 10 mg without a prescription, which usually can be traced to excessive 108 27% decrease in arthritis pain discount endep 50 mg overnight delivery. A longer randomized bed rest in the home or institution, is a common geriatric trial in patients with osteoarthritis using either an aerobic phenomenon. With modern medical therapies, there are or a resistance exercise program showed improvements few diseases for which absolute bed rest is indicated. Following hospitalization, some elders with osteoarthritis to prevent deconditioning and patients may be unable to return home because of decon- promote independence. The Arthritis Foundation has an ditioning, in spite of having had their admitting diagnoses 110 extensive array of educational materials for patients. Therefore, the mainstay of treat- Joint replacement surgery is being used increasingly ment is prevention. In the acute hospital, patients should in older populations, and rehabilitation is very impor- have orders for regular out-of-bed activities, be encour- tant following these procedures. The cornerstones of aged to walk to diagnostic studies if possible, and be arthritis rehabilitation are the use of adaptive equipment taught bed and chair exercises if activities are limited. In and training in joint protection and energy conservation some cases, group exercise programs may be better tol- techniques. If patients do not stress their cardiopulmonary or muscular systems, the presence of deconditioning may go unnoticed. This disorder can be recognized by a rise in Conclusion the resting heart rate or an exaggerated blood pressure response to exercise, decreased muscle power, decreased Rehabilitation should be considered in all geriatric endurance, and fatigue during simple activities of daily patients with functional losses. Measurements of a person’s "capacity" for exer- vided to older persons has the potential for enhancing cise should be based on the expected demand in the functional abilities or limiting disabilities. One does not need to tion approach can be adopted in any care setting, achieve total cardiovascular fitness to improve skills in including the acute hospital.

They have the capability to construct solutions that can enhance their lives order endep 25mg mastercard, but have lost sight of these abilities because their problems emerge so large to them that their strengths are crowded out of the picture purchase 25mg endep otc. The solution-focused therapist ardently adheres to the belief that a simple shift in focus from what is not going well to what the clients are already doing that works can remind them of, and expand their use of, their re- sources (Berg & Miller, 1992; de Shazer, 1985, 1988, 1991, 1994; O’Hanlon & Weiner-Davis, 1989). Like the Constructivists who believe in the notion of no true reality, solution-focused therapists believe that they should not impose what they think is normal on their clients. They disagree with the Structuralists’ claims that symptoms are a sign of some underlying problem (e. They focus only on the complaints clients themselves present, and help the clients reexamine the ways they describe themselves and their problems. Due to individual dif- ferences, therapy is highly individualized (Berg & de Shazer, 1993; Berg & Miller, 1992; de Shazer, 1994; O’Hanlon & Weiner-Davis, 1989). THERAPEUTIC CONTENT, PROCESS, AND TECHNIQUES The goals and contents of therapy revolve around resolution of the client’s presenting complaints. To do that: Efforts are made to create an atmosphere in therapy where the individuals are helped to reorient themselves from focusing on their problems to recog- nizing and utilizing their strengths to resolve their problems. Better goals can get you out of your stuck places and can lead you into a more fulfilling future. Much of the work for SFT lies in the negotiation of an achievable goal (Berg & de Shazer, 1993; Berg & Miller, 1992). Instead of changing personality and psychopathology types, SFT therapists help clients construct well-defined goals (Berg & Miller, 1992; de Shazer, 1991; Walter & Peller, 1992). Instead of having negative goals such as "I will get rid of my depression," the goals should be positive.