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By N. Hamid. James Madison University. 2018.

In general cheap toradol 10mg visa back pain treatment videos, no serious side effects were noted cheap toradol 10mg pain treatment alternative, but hepatotoxicity and thrombocytopenia have been reported with valproic acid use in other disorders. Clonazepam is a long-acting benzodiazepine that has been used to treat chorea with some success. Benzodiazepines act on the GABAA receptor–chloride ion channel complex and increase the frequency of ion channel opening, acting as indirect GABA agonists. Case reports document improved chorei- form movements at relatively low clonazepam doses, 1–5 mg=day. Tolerance may develop after a period of months, necessitating dose escalation or a drug holiday. Drugs That Increase ACh Large aspiny cholinergic interneurons within the striatum innervate GABAergic MSSN and tend to counterbalance the influences of dopamine and glutamate. Trials of cholinergic precursors, such as choline and lecithin, for chorea have been limited and results modest. Reports dating back to the 1970s suggest that tetrabenazine may be helpful in selected patients with chorea. Tetrabenazine acts by preventing the presynaptic release of dopamine, so-called monoamine depletion, as well as blocking dopamine receptors on postsynaptic terminals. Tetrabenazine treatment in 5 pediatric patients with chorea significantly improved movements in 80%, although high doses (up to 275 mg=day or 25 mg=kg=day) were often necessary (Chatterjee). Medication was continued for at least several months and side effects commonly reported in adults, such as depression, parkinsonism, hypotension, acute dystonic reaction, and neuroleptic malignant syndrome, were not present. Tetrabe- nazine is not approved for use in the United States, but can be obtained from Canada for selected cases. Reserpine, another dopamine-depleting agent, is effective for chorea in some patients. Reserpine is longer acting than tetrabenazine and side effects may include hypotension, depression, and parkinsonism. Dopamine antagonists including the typical neurolep- tics haloperidol, pimozide, and chlorpromazine have been efficacious in treating chorea. Early case reports describe rapid improvement of abnormal movements within a few days, using low doses of haloperidol, from 0. Other authors have suggested that pimozide may have a lower risk of inducing neuroleptics side effects, such as sedation, parkinsonism, weight gain, school phobia, hepatocel- lular dysfunction, leukopenia, and tardive dyskinesia. Carbamazepine has also been used to treat chorea, but its mechanism of action is unknown. Some authors have postulated that it stimulates cholinergic pathways and others have implicated structural similarity to tricyclic antidepressants and phenothiazines. Surgical Therapy Surgical approaches for the treatment of chorea are unproven. Deep brain stimula- tion (DBS) of the thalamus and pallidotomy have been performed in a small number of cases with mixed results. Chorea in Children 137 Therapy in Sydenham’s Chorea Since treatment is symptomatic and not curative, the decision to initiate therapy in patients with SC is based on the degree of patient disability, whether due to chorea, behavioral, or psychiatric symptoms. Numerous neuropsychiatric problems are seen in association with SC, including emotional lability, irritability, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and psycho- sis, and specific therapy may be required to address these issues (see appropriate chapters). Studies in patients with SC have shown improvement of chorea with the use of anticonvulsants. In limited trials, there were no significant differences between val- proic acid and carbamazepine in the time to clinical improvement, time to complete remission, duration of therapy, or recurrence rates. Other therapies have included neuroleptics, such as haldol and pimozide. In most patients, chorea improved dra- matically and the duration of therapy, although variable, ranged from 3 to 6 months. Immunomodulatory therapies, such as corticosteroids, plasmapheresis, and intravenous immunoglobulin (IVIG), have been used to treat SC. Case reports and retrospec- tive reviews of corticosteroid therapy in SC suggest that they may shorten the time to recovery. These data, however, should be interpreted with caution, because there were few studies and these were retrospective or uncontrolled. A prospective, uncon- trolled trial of intravenous methylprednisolone followed by oral prednisone for refractory SC was just published (Cardoso). Several patients with recalcitrant SC have received IVIG or plasmapheresis ther- apy, the latter resulting in fewer recurrences of chorea.

Instead of returning to the pediatrician toradol 10mg without a prescription pain sacroiliac joint treatment, Elise took her daughter to an audiologist cheap 10 mg toradol with visa pain management for osteosarcoma in dogs, who discovered that Lourdes had a significant hearing loss. This 198 Diagnosing Your Mystery Malady explained a lot, such as why she wasn’t “listening” to the teacher or her par- ents and seemed inattentive, as well as why her vocabulary wasn’t expand- ing in either Spanish or English. Lourdes was worse in the backseat of the car because she couldn’t read her mother’s lips, whereas when she was engaged in direct eye contact and conversation, she became communicative again. Since these symptoms started when Lourdes became sick, Elise took her daughter to an ear, nose, and throat doctor. He found that both of her middle ears were full of fluid—the remnants of the cold that Lourdes caught after beginning nursery school. Once they placed drain tubes in Lourdes’s eardrums (tympanic mem- branes), her hearing improved dramatically. Her vocabulary caught up to her age level, and Lourdes returned to being the bright, inquisitive, and well- behaved child she once was. Without solid research on the Internet and a step-by-step analysis, Lourdes’s mother would not have been able to get the help her daughter needed as quickly as she did. Case Study: Justin Justin was a nine-year-old who had just earned his first badge as a Cub Scout. After he attended scout camp that summer and achieved his second badge, he informed his parents he intended to work toward becoming an Eagle Scout. His parents were pleased and hoped his five-year-old brother would follow in his footsteps. One morning, Justin’s brother told his parents that Justin was not sleeping and was walking around the house during the night. Justin’s folks began to worry that there was something going on at school that their son was not talking about. When they confronted him, he denied anything unusual was happening there. One day Justin began to complain that he had tingling in his hands and feet. Sometimes he wet his pants, and other times he went for long periods without urinating at all. Again, his parents took him to the pediatrician, but the doctor could find nothing wrong. He referred Justin to both a urologist and a neurolo- gist at the local children’s hospital. Neither of these specialists could deter- mine the cause of Justin’s problems, although after numerous tests, the neurologist did find that he was indeed suffering from impaired short- and long-term memory, which accounted for his forgetfulness. She also docu- mented evidence of numbness and decreased sensory perception. Now Justin’s parents were worried sick and begged the neurologist to do something. She put Justin on a regimen of multivitamins and screened him for diabetes and thyroid problems. Not only did the boy’s symptoms not improve, but he was also in a foul mood all the time and becoming less and less motivated to do anything. He wouldn’t even attend Boy Scout meet- ings, the one thing he’d always loved. Fortunately for Justin, his mother and David’s mother, Hilary, shared a carpool. Noting Justin’s frequent absences, Hilary inquired about his health and his mother confided in her. Hilary told Justin’s mother about how she’d solved David’s mystery malady using the Eight Steps. She bought a notebook, listed Justin’s symptoms in detail, and com- pleted all the steps until she reached Step Five (past and present mental or physical problems).

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If you’re dealing with very sensitive informa- tion which you know could be called upon by a court of law cheap 10 mg toradol otc muscle pain treatment for dogs, you will need to inform your participants that you would be obliged to hand over the information buy generic toradol 10 mg phantom pain treatment. OVERT AND COVERT RESEARCH Overt research means that it is open, out in the public and that everyone knows who you are and what you are doing. Covert research means that you are doing it under cover, that no one knows you are a researcher or what you are doing. In my opinion covert research should be kept to a minimum – there are enough journalists and television personalities doing this kind of undercover, sensationalist work. Covert research In the past researchers have justified their covert work by 148 / PRACTICAL RESEARCH METHODS saying that it has been the only way to find out what goes on in a particular organisation that would not otherwise let a researcher enter. Such work has been carried out within re- ligious cults and within warring gangs of young people. However, this type of research can have serious implications for the personal safety of the researcher and the people with whom she comes into contact. It can also give research a bad name – other people may read about the work and be- come suspicious about taking part in future projects. Overt research I believe researchers should be open and honest about who they are and what they’re doing. People can then make an informed choice about whether they take part in a project. It is their prerogative to refuse – nobody should be forced, bullied or cajoled into doing something they don’t want to do. If people are forced to take part in a research project, perhaps by their boss or someone else in a position of authority, you will soon find out. They will not be willing to participate and may cause problems for you by offering false or useless information, or by dis- rupting the data collection process. Wouldn’t you do the same if you were forced to do some- thing you didn’t want to do? This means that not only should you be open and honest about who you are and what you’re doing, but so should those who open the gates for you, especially those who are in a position of authority. HOW TO BE AN ETHICAL RESEARCHER/ 149 EXAMPLE 14: STEVE It was the first project I’d ever done. I wanted to find out about a new workers’ education scheme in a car factory. One of my tutors knew someone in charge of the scheme and that person arranged for me to hold a focus group in the factory. This meant that the person in charge of the scheme chose the people for the focus group. I was really pleased because it meant I didn’t have to do a lot of work getting people to come. Of course I soon found out that he’d chosen these people for a particular rea- son, and he’d actually told them that they had to attend, that there was no choice involved. When I turned up to hold the group, no one had been told who I was and what they were doing there. When I started to introduce myself some of the workers looked a bit uneasy and others just looked plain defiant. It was only after the group that I spoke to someone who said that they’d all thought I was a ‘spy’ for the company and that some had decided to give the ‘company line’ on what the scheme was all about, whereas others had decided not to say anything. She said that really they didn’t believe a lot of what had been said, but none of them dared say anything different as they thought I was going to go straight to management with the results. I felt that the information I collected wasn’t very useful in terms of my research, but it was useful in terms of getting an idea about employer-employee relations. If you are relying on someone else to find participants for you, it is important that you make sure that that person 150 / PRACTICAL RESEARCH METHODS knows who you are and what you’re doing and that this in- formation is then passed on to everyone else. A useful way to do this is to produce a leaflet which can be given to any- one who might be thinking about taking part in your re- search. This leaflet should contain the following information: X Details of who you are (student and course or employ- ee and position). X Information about who has commissioned/funded the research, if relevant. X Information about the personal benefits to be gained by taking part in the project. This section is optional, but I find it helps to show that people will gain person- ally in some way by taking part in the research.

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