Acta neurologica Belgica
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Action research is a form of research that enables practitioners to investigate and evaluate their own work. It is increasingly used in health care research; it is a research strategy in which the researcher and practitioners from the setting under study work together in projects aimed at generating new knowledge and simultaneously improving practice. ⋯ Ethical problems are discussed as are questions of rigour The article shows that action research can be used to bridge the gap between theory and practice by generating knowledge fitting the particular circumstances in the practical setting, thereby avoiding problems of implementation of research findings due to lack of fit or lack of motivation. Action research lastingly increases the capacities of practitioners to solve problems encountered in practice.
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Acta neurologica Belgica · Sep 2008
ReviewThe Glasgow Coma Scale--a brief review. Past, present, future.
The Glasgow Coma Scale (GCS) was introduced in 1974 aiming at standardizing assessment of level of consciousness in head injured patients. It has been used mainly in evaluating prognosis, comparing different groups of patients and monitoring the neurological status. However its use expanded beyond the original intention of the scale and certain limitations were identified. ⋯ Moreover, future trends and implications are considered. The key concept in all articles reviewed is that even though GCS is not a perfect tool and other coma scales have been proposed, it seems destined to be incorporated in clinical decisions regarding coma for many years to come. Nonetheless, deep knowledge of its proper applications on one hand and limitation of its misuse on the other is essential to benefit both health care professionals and their patients.
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Carotid endarterectomy effectively reduces stroke in patients with TIA or minor stroke and a high-grade carotid stenosis. Carotid endarterectomy is also beneficial in male asymptomatic patients younger than 75 years with high-grade stenosis. ⋯ The few trials that have been performed up to now show either inferior results or suggest equivalence. Before accepting carotid stenting as a mainstream treatment for carotid stenosis, this therapy should be as critically evaluated as carotid endarterectomy was in the 1980s and 1990s.
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There is increasing evidence that stress and depression may play a crucial role in the aetiology and pathophysiology of fibromyalgia (FM). We first review recent studies on the possible role of life stress, including childhood trauma, in FM. ⋯ We put forward the hypothesis that chronic stress/depression may contribute to a dysregulation of neuro-endocrine, immune and central pain mechanisms in FM. Finally, we discuss some future directions, including the use of new conceptual models, research topics and strategies, as well as potential implications from recent studies in affective disorders for the treatment of FM.
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Epidemiological studies suggest that medication-overuse as defined by the International Headache Society is extremely common in patients with chronic daily headache. If all medication-overuse produces medication-overuse headache (MOH) in headache patients, it would be the third most frequent form of headache, after tension-type headache and migraine. ⋯ Here, we summarize available data on MOH, including clinical features, drugs used in withdrawal, as well as withdrawal strategies that have been described in the literature. We also include a detailed description of an in-patient and out-patient withdrawal procedure, reflecting personal experience and opinion of the authors.