Clinical Trials

One can increase the value of statistical clinical study with a control group received a placebo, and the characteristics of this group should be as close as possible to those contained in the treated group (age, sex, and duration and the nature and severity of the disease, etc..) .. You can also disguise the nature of the treatment (drug or placebo) to the examiner, and the patient. This is known as a randomized, double-blind, placebo-controlled study. Determines the size and statistical power and the duration of study needed to get the correct results. Such clinical trials prove conclusively.

The results of the meta-analysis and more convincing. This type of study is to analyze the effectiveness and safety of treatment, based on the combined results of several clinical studies designed according to scientific protocol properly.

Monitoring Patients

To be meaningful, must provide evidence through monitoring the group of patients in the study of the available open the doctor and patient alike know that the drug administered.

Schedule a test, and treated and observed in the patients in the near future (prospective study) provide the strongest evidence that the ex-post evaluation of a group of patients in the past (retrospective test) treatment. Studies in the open, and there are a number of factors, the results seem in many cases cheaper than they make in reality. First, there will be biased in favor of improved references, and the results of treatment. Then there is the placebo effect: that the patient gets better, because he wants to heal, and that participation in clinical trials assured. Finally, there is a bias by excluding patients who stop treatment or who deteriorate and then the examiner the impression that the well-established that most of his patients, and data are received at the end of the day, especially on issues of response to treatment.

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Effectiveness of a Medicine

For the treatment of choice or therapeutic method to prevent and must be based on a symptom of the disease or on objective data to prove its safety and effectiveness are based.

However, there are several levels of evidence. Only to be confirmed by a neighbor on the effectiveness of a medicine (evidence) is very weak evidence. The same statement from a large number of people are certainly more weight, but is still far from conclusive evidence that a particular approach has its supporters, although its usefulness is questionable goal.

The fact that treatment will be used for many years, even centuries, is not conclusive evidence of their effectiveness. Just think of the bloodshed, which was practiced thousands of years ago, but we now know to be dangerous and even deadly, because it weakens the already sick patient. However, since a long time this practice is effective and was used widely since ancient times to the twentieth century.

The Last Point

This last point is important because many drugs that act on the nervous system or immune system, including potentially serious side effects. Difficulty in MS is that, as is often remissions almost complete in the early stages of the disease, and that the intervals between outbreaks varies greatly (these intervals 30 years in some cases exceeded), it is very difficult to know what If the improvement of the clinical situation, which lasted for several years because of the effect of treatment or the occurrence of natural remission.

The minutes of the study double-blind placebo-controlled clinical study designed to provide a solution to this problem, both in medical and surgical care and rehabilitation for the treatment of "alternative". Another problem is the enormous cost pressure in the treatment of some new drugs. Economy is becoming increasingly important in the evaluation of therapeutic, and in spite of the discussions that were raised by the institution.

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Choice of Treatment

So far, we have evaluated the progress made in treatment, to change the course of the disease. But breakthroughs have been equally important in the last decade in the treatment of neurological symptoms and rehabilitation. Is the development of new drugs and new methods of management of drug-old. Has been confirmed by controlled studies on certain aspects of the rehabilitation of the nervous system also the effectiveness of this method in the treatment of MS

Evidence of the effectiveness and choice of treatment

As with other serious diseases, the clinical phenotype is highly variable, and there are two main problems in MS, which affects all aspects of treatment. First, the effectiveness of treatment is difficult to determine, it is not easy to prove that the potential beneficial effects for the treatment of a greater chance of having side effects.

Stress, Approach

Here, we must stress the very problem that the success of these approaches in the past few years. Clinical studies have shown that it is possible, in the course of the disease by two categories of drugs currently approved, or at least change in some countries: in the beta interferons and acetate glatiramer. We now know that this treatment is effective in part, is no longer justified, morally, to provide a large scale and over long periods of placebo-controlled clinical studies so far have been necessary to shed light on the effectiveness of new drugs.

While it may be of shorter duration studies are justified morally, but will not be useful to study chronic disease such as MS. Another strategy would be to compare the new therapy to treat the list, but such a study would provide results much more difficult to interpret and will be more expensive than the trials and placebo-controlled. Therefore, we must develop a new approach to clinical trials, and this is exactly the goal of international cooperation, carried out under the auspices of the International Federation of Multiple Sclerosis.

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Effectiveness of Treatment

This applies in particular to a form of MS through the relentless progress without setbacks and clear and specific products and is characterized by remissions, but also applies to other forms of MS. In addition, it is increasingly clear that the white matter that appear normal on the abnormalities in brain MRI, and often contains the structure of the chemical composition.

These developments have led to the discovery of new therapeutic strategies for more than 80 new drugs that are in the beginning of the 21 evaluation of a century.

We have already stated on the significant progress that MRI technology has enabled us to judge ourselves better, and the effectiveness of treatment to reduce disease activity. However, it is very difficult to determine the exact nature of the relationship between the activity of MS, for example, using magnetic resonance imaging, and to see a physical disability associated with the disease. Therefore, the clinical criteria must still play a role in evaluating the effectiveness of treatment. This evaluation was conducted double-blind clinical trials already in the large, placebo-controlled.

Techniques of Magnetic

The use of certain techniques of magnetic resonance have a better understanding of how to develop provided the lesions. Usually preceded by a new strain that rupture of local blood-brain barrier, which is associated with inflammation. Can be observed demyelination (which is the characteristic phenomenon of the disease MS) at the same time almost. After about a month, to ease the inflammation and the healing process gets under way, and what about the clinical remission. Over time, however, there are in most cases the accumulation of neurological deficits by the onset of disability.

We have found recently that the element of non-recovery of the deficit is mainly due to complete degeneration of nerve fibers, and these observations have important therapeutic implications.

As expected, showed the emergence of new technologies and better, and the unexpected complexity of the disease. For example, we now know that the lesions of MS do not have the detection of infections.

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Traditional Therapy

Internet is often the first place people go to for information. So, this is evidence not only in the form of traditional paper published, but also on the website of the International Federation of Multiple Sclerosis. Thanks to a copy on the Internet, and the reader can easily access the updates until the release of the new printed version.

The development of knowledge about MS is partly a result of breakthroughs in various medical specialties, the most important undoubtedly those made in the techniques of MRI (magnetic resonance imaging [MRI], and NMR spectroscopy [SRM]).

Investigations have shown in magnetic resonance in a series that disease activity ten times more common than previously thought, simply on the basis of the frequency of relapses. This observation has to check the development of ways to be suitable for effective treatments to reduce the number of new lesions in the central nervous system (CNS).

Alternate Therapy

In the last decade of the twentieth century, saw the way we see the Alternate Therapy (MS) major changes. From the viewpoint of a neurologist, and we better understand the mechanisms behind the damage to the nerves, and the onset of symptoms, although we are still significant gaps. These developments have enabled us to new therapeutic approaches, including the first steps is to put inconclusive.

For the first time, has changed our ability to influence the course of MS outlook for people with this disease. It is hoped that can be adjusted from the progression of the disease, and can alleviate the symptoms and new treatments that appear more effective than currently available soon.

With the dramatic increase in the volume of information available for MS, including the Internet, and more involved with the disease in care. It is therefore important to ensure a comprehensive directory and is accessible to the current treatment options, where she has to offer will find information about the relative effectiveness of these.

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Breath Sample: Know the limits

The peace officer may require the driver to provide a breath sample using an approved instrument when it has reasonable grounds to believe that the ability to conduct the person was impaired or driving it faster than allowed by law. Usually, this test is administered at the police station.

Anyone who refuses, without reasonable cause, to provide a breath sample pursuant to the order of a peace officer may be convicted for refusing to obey the order to provide a breath sample. The person convicted is liable to the same penalty as that would have been imposed if she had been convicted of impaired driving.

The peace officer may ask the person who is unable to provide a breath sample because of his physical condition to provide a blood sample. A doctor or other qualified professional can take the blood sample. Refusing to provide a blood sample is also a criminal offense.

Limit imposed by law

The person whose blood alcohol exceeding 80 mg of alcohol per 100 ml of blood is guilty of an offense (BAC over 80 mg). Most of the time a breath sample to determine blood alcohol. In some situations, a blood sample will be crucial.

Any person whose BAC is above the limit set by law will be convicted even if his behavior is not that of an intoxicated person and even if it is not clear that his impaired . The punishment for this type of crime is the same as the punishment for driving while intoxicated.

The peace officer may order the driver to provide a breath sample on a screening device "approved" when it has reason to suspect the presence of alcohol in the body of the person. This test is usually done on the roadside.

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Impaired Driving

The concept of impaired driving applies when driving a motor vehicle, including a car, truck, boat, snowmobile, aircraft or train, while the ability to operate the vehicle is impaired by influence of alcohol or drugs.

A person can be convicted of impaired driving when there is proof beyond reasonable doubt of his disability. The evidence could show by example that the person was driving very slowly or too fast, not driving it straight, she was unable to perform simple physical tasks, she had difficulty speaking, she had red eyes, she smelled of alcohol. Any person whose capacity is impaired by alcohol can be charged and convicted of impaired driving, his alcohol level is above or not the "limit imposed by law".

Another place you can see

Another place you can see, these attacks are the mass fainting in the factories of the Free Trade Zone, where the majority of workers are girls. The press often reports on incidents where the number of girls admitted to the hospital are sometimes more important, because fainting. It is called mass hysteria.

The management of a person, these problems include a thorough examination to clarify what the person of "good" or fainting attack meant and assessment of his depression and / or anxiety. Reinsurance person shows that all tests are within normal range.

These patients should be education about mental health, panic attacks and fainting due to a reaction time because of unresolved bereavement or separation.

Cognitive behavior therapy techniques, relaxation and slow breathing exercises with these pastors.

Sometimes drugs with anti-depressants and anxiolytics are useful.

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Keep An Open Mind

It is very important to keep an open mind to other diagnoses that the patient will be followed.

There is a strong association with stress and is "fit" and it is therefore important to obtain confirmation of the story distinguish this form of "adaptation" by a physical cause.

Major depression due to unresolved grief as a family death or separation can cause seizures, dizziness and fainting. A person can suffer from anxiety and panic as fear of heights or crowds of people fainting.

In Eastern European countries fainting spells are common in Funeral Service and schools, especially in girls schools.

Helping Teens

Teenagers are often accused of being behind many acts of violence. However, some measures could prevent the passage to the act. Thus it is recommended:

* They offer creative activities, including arts (drama, music ..) to express themselves.

* Give them access to temporary accommodation when they want to temporarily separate from their parents during a crisis.

* Better care for children who suffer the penalties of law.

* And of course to help parents who express a need.

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School: better support

School: better support

For authors, the problem of school violence goes beyond the classroom. This aggression is often the result of other factors, including family ... But within the school, the report provides several concrete actions, which include examples:

* Provide better education for citizenship in schools;
* Find alternatives to the Disciplinary Board, developing mediation in particular;
* Extending the operations "open school" during the holidays, which enable to change the ratio of children with their school;
* Adapt the rules to situations encountered;
* And of course, provide targeted training on violence issues for educators and teachers.

In parallel, the establishment of health points to listen, open evenings and weekends could afford childcare by professionals.

Better listen to children and parents

Better listen to children and parents

In Violence its report, the Task Force proposes several actions to improve support for parents. From the outset, pregnancies should be better supervised. A home easier for pregnant women should be considered in order to detect situations of distress. It also seems important to increase the places of listening, such as green houses (reception initiated ). As the report points out, this listening can prevent violence by providing answers to the anxiety, loneliness, lack the emotional ... The authors stress the importance of increasing the number of childcare places and enhance the training of professionals . In addition, it should perhaps reassess the age of school entry, as some children are greeted at the age of two years, which may expose them to a form of violence too early (read our article: School: the last little too stressed out!).

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