Systematic Relaxation Training and the Process of Methadone Detoxification

This study examined the completion and noncompletion of methadone detoxification of two groups of subjects enrolled in a heroin treatment program. Twenty-six subjects who had been addicted to heroin for a minimum of two years and were receiving methadone were randomly assigned to an experimental and control group. The experimental group was assigned a series of relaxation training sessions. Each subject, at the outset, was receiving 18-22 mg of methadone daily. Two counselors conducted the relaxation training which began at the 18-22 mg dosage level. Completion of methadone detoxification was defined by the following criteria. (1) The subject ceased to ingest methadone after reaching a plateau of between 1-5 mg of methadone within 20 weeks of being at a dosage of 18-22 mg. (2) The subject did not use a narcotic during the last two weeks of detoxification and the first two weeks of absstinence as verified by urinalysis of three monitored urine specimens per week. In the experimental group, nine subjects completed detoxification, four subjects did not. In the control group, two subjects completed detoxification and eleven did not. The study showed that a significant relationship existed between the experimental group receiving relaxation training and the completion of methadone detoxification. The results of this study showed that relaxation training may help manage certain side effects of methadone detoxification and that relaxation training may raise the probability of an individual completing methadone detoxification

Systematic Relaxation Training and the Process of Methadone Detoxification

This study examined the completion and noncompletion of methadone detoxification of two groups of subjects enrolled in a heroin treatment program. Twenty-six subjects who had been addicted to heroin for a minimum of two years and were receiving methadone were randomly assigned to an experimental and control group. The experimental group was assigned a series of relaxation training sessions. Each subject, at the outset, was receiving 18-22 mg of methadone daily. Two counselors conducted the relaxation training which began at the 18-22 mg dosage level. Completion of methadone detoxification was defined by the following criteria. (1) The subject ceased to ingest methadone after reaching a plateau of between 1-5 mg of methadone within 20 weeks of being at a dosage of 18-22 mg. (2) The subject did not use a narcotic during the last two weeks of detoxification and the first two weeks of absstinence as verified by urinalysis of three monitored urine specimens per week. In the experimental group, nine subjects completed detoxification, four subjects did not. In the control group, two subjects completed detoxification and eleven did not. The study showed that a significant relationship existed between the experimental group receiving relaxation training and the completion of methadone detoxification. The results of this study showed that relaxation training may help manage certain side effects of methadone detoxification and that relaxation training may raise the probability of an individual completing methadone detoxification

Family Stresses After Pediatric Heart Transplantation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73984/1/j.1751-7117.1989.tb00572.x.pd

Construction of an instrument for the measurement of educational philosophy

Thesis (M.Ed.)--Boston Universit

Delivering Public Services: Locality, Learning and Reciprocity in Place Based Practice

Policymakers across myriad jurisdictions are grappling with the challenge of complex policy problems. Multi-faceted, complex, and seemingly intractable, ‘wicked’ problems have exhausted the repertoire of the standard policy approaches. In response, governments are increasingly looking for new options, and one approach that has gained significant scholarly interest, along with increasing attention from practitioners, is ‘place-based’ solutions. This paper surveys conceptual aspects of this approach. It describes practices in comparable jurisdictions – the UK, the EU and the US. And it explores efforts over the past decade to ‘localise’ Indigenous services. It sketches the governance challenge in migrating from top-down or principal-agent arrangements towards place-based practice. The paper concludes that many of the building blocks for this shift already exist but that these need to be re-oriented around ‘learning’. Funding and other administrative protocols may also ultimately need to be redefined

Clinical and hemodynamic follow-up of left ventricular to aortic conduits in patients with aortic stenosis

To assess the long-term results of left ventricular outflow tract reconstruction utilizing an apical left ventricular to aortic valved (porcine) conduit the clinical and hemodynamic data were reviewed from 24 patients who had placement of an apico-aortic conduit. Eighteen of the patients are asymptomatic and taking no cardiac medications. Three patients were reoperated on, one patient 1.5 years after his original operation for subacute bacterial endocarditis and two patients 3 to 4 years after their original operation for severe conduit valve insufficiency. None of the patients is taking anticoagulants and no thromboembolic events have occurred. Postoperative catheterization has been performed 1 to 1.5 years (mean 1.2) after repair in 15 of 21 patients. The rest left ventricular outflow tract gradient has decreased from 102.5 ± 20 mm Hg preoperatively to 14.8 ± 9.9 mm Hg postoperatively (probability [p] < 0.001). Some degree of conduit obstruction was demonstrated by catheter passage in 11 of the 15 patients. In these 11 patients, the obstruction occurred at three distant sites: at the egress of the left ventricle in 9, at the porcine valve in 5 and at the aortic to conduit junction in 1. Isometric exercise in five and supine bicycle exercise in six patients increased the left ventricular outflow tract gradient by 2.5 ± 1.1 and 20.8 ± 11.8 mm Hg, respectively, despite an increase in cardiac index of 1 ± 0.3 and 3.7 ± 0.4 liters/min per m2, respectively. The data suggest that a left ventricular to aortic conduit is an effective form of therapy for severe left ventricular outflow tract obstruction

Potential for reversibility of pulmonary vascular obstructive disease in children after cardiac transplantation

Patients with pulmonary vascular obstructive disease (PVOD) are usually not considered candidates for orthotopic cardiac transplantation, because the normal donor's right ventricle may be unable to function because of an acute increase in afterload, especially in the postischemic situation of the arrested and transported donar heart. The accepted guideline is that pulmonary vascular resistance (PVR) must be 8 Wood units (mm Hg/liters/min) or lower during maximal medical management.1,2 Patients whose PVR is between 4 and 8 Wood units are marginal candidates. Combined heart-lung transplantation or heterotopic cardiac transplantation is generally believed to be necessary when the PVR is 8 units. However, among children with a variety of congenital defects, PVOD is often reversible after correction, especially when correction is performed at a young age. This was the case in the patient described herein whose cardiac transplantation was successful despite a PVR of nearly 13 Wood units.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25979/1/0000045.pd

Association of Pediatric Heart Transplant Coronary Vasculopathy with Abnormal Hemodynamic Measures

Objective.  Transplant coronary artery disease (TCAD) is the limiting factor to long‐term cardiac allograft survival; however, presymptomatic diagnosis remains challenging. To that concern, we evaluated the association of abnormal catheter‐derived filling pressures with TCAD in pediatric heart transplant (HTx) recipients.Design, Patients, Outcome Measures.  Data from 52 presymptomatic pediatric HTx patients were analyzed. Catheter‐derived right ventricular end‐diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) were recorded. Biopsies were collected to verify the absence of rejection.Results.  TCAD was diagnosed an average of 8.3 years post‐HTx in 20 (38%) patients, six of whom died and four of whom underwent retransplantation. Catheter‐derived pressure measurements showed that RVEDP was elevated in TCAD compared with non‐TCAD patients (9.5 ± 6.0 vs. 5.4 ± 4.7; P= .005), as was the PCWP (12.9 ± 5.7 vs. 9.1 ± 5.7; P= .012). Results from logistic regression analysis showed RVEDP > 10 mm Hg or PCWP > 12 mm Hg was associated with TCAD (OR = 5.2; P= .010).Conclusions.  In this series, elevated ventricular filling pressures measured during routine surveillance catheterizations were associated with angiographic TCAD. Recognizing the association between elevated RVEDP/PCWP and TCAD may prompt earlier diagnosis and treatment of this potentially lethal process.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111940/1/j.1747-0803.2010.00470.x.pd