Minimally conscious state Health Dictionary

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Minimally Conscious State: From 1 Different Sources

(MCS) a disorder of consciousness distinct from *persistent vegetative state (PVS) and locked-in syndrome (see vegetative state). Unlike PVS, patients with MCS have partial preservation of conscious awareness although the level of awareness frequently fluctuates over time.

Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Minimally Invasive Surgery

Surgery using a rigid endoscope passed into the body through a small incision. Further small openings are made for surgical instruments so that the operation can be performed without a long surgical incision. Minimally invasive surgery may be used for many operations in the abdomen (see laparoscopy), including appendicectomy, cholecystectomy, hernia repair, and many gynaecological procedures. Knee operations (see arthroscopy) are also often performed by minimally invasive surgery.... minimally invasive surgery

Persistent Vegetative State

Long-term unconsciousness caused by damage to areas of the brain that control higher mental functions. The eyes may open and close, and there may be random movements of the limbs, but there is no response to stimuli such as pain. Basic functions such as breathing and heartbeat are not affected. There is no treatment to reverse the situation, but, with good nursing care, survival for months or years is possible.... persistent vegetative state

Advance Statements About Medical Treatment

See LIVING WILL.... advance statements about medical treatment

Anxiety State

See NEUROSIS.... anxiety state

Minimally Invasive Surgery (mis)

More popularly called ‘keyhole surgery’, MIS is surgical intervention, whether diagnostic or curative, that causes patients the least possible physical trauma. It has revolutionised surgery, growing from a technique used by gynaecologists, urologists and innovative general surgeons to one regularly used in general surgery, GYNAECOLOGY, UROLOGY, thoracic surgery, orthopaedic surgery (see ORTHOPAEDICS) and OTORHINOLARYNGOLOGY.

MIS is commonly carried out by means of an operating laparoscope (a type of ENDOSCOPE) that is slipped through a small incision in the skin. MIS now accounts for around 50 per cent

of all operations carried out in the UK. A small attachment on the end of the laparoscope provides an image that can be magni?ed on a screen, leaving the surgeon’s hands free to operate while his assistant operates the laparoscope. Halogen bulbs, ?breoptic cables and rod lenses have all contributed to the technical advancement of laparoscopes. Operations done in this manner include extracorporeal shock-wave LITHOTRIPSY for stones in the gall-bladder, biliary ducts and urinary system; removal of the gall-bladder; appendicectomy; removal of the spleen and adrenal glands; and thoracic sympathectomy. MIS is also used to remove cartilage or loose pieces of bone in the knee-joint.

This method of surgery usually means that patients can be treated on a day or overnight basis, allowing them to resume normal activities more quickly than with conventional surgery. It is safer and lessens the trauma and shock for patients needing surgery. MIS is also more cost e?ective, allowing hospitals to treat more patients in a year. Surgeons undertake special training in the use of MIS, a highly skilled technique, before they are permitted to use the procedures on patients. The use of MIS for hernia repair, colon surgery and repairs of duodenal perforations is under evaluation and its advantages will be enhanced by the development of robotic surgical techniques.... minimally invasive surgery (mis)

Persistent Vegetative State (pvs)

PVS may occur in patients with severe brain damage from HYPOXIA or injury. Patients do not display any awareness of their surroundings, and are unable to communicate. Sleep alternates with apparent wakefulness, when some re?exes (see REFLEX ACTION) may be present: for example, patients’ eyes may re?exly follow or respond to sound, their limbs can re?exly withdraw from pain, and their hands can re?exly grope or grasp. Patients can breathe spontaneously, and retain normal heart and kidney function, although they are doubly incontinent (see INCONTINENCE).

For a diagnosis of PVS to be made, the state should have continued for more than a prede?ned period, usually one month. Half of patients die within 2–6 months, but some can survive for longer with arti?cial feeding. To assess a person’s level of consciousness, a numerical marking system rated according to various functions – eye opening, motor and verbal responses – has been established called the GLASGOW COMA SCALE.

The ETHICS of keeping patients alive with arti?cial support are controversial. In the UK, a legal ruling is usually needed for arti?cial support to be withdrawn after a diagnosis of PVS has been made. The chances of regaining consciousness after one year are slim and, even if patients do recover, they are usually left with severe neurological disability.

PVS must be distinguished from conditions which appear similar. These include the ‘LOCKED-IN SYNDROME’ which is the result of damage to the brain stem (see BRAIN). Patients with this syndrome are conscious but unable to speak or move except for certain eye movements and blinking. The psychiatric state of CATATONIA is another condition in which the patient retains consciousness and will usually recover.... persistent vegetative state (pvs)

State Medicine (health Care Systems)

Major government schemes to ensure adequate health services to substantial sectors of the community through direct provision of services.... state medicine (health care systems)

Anxiety States

Acute or chronic, mild or severe.

Pathological anxiety is caused by a mood of fear, the resolution of which is usually psychological or spiritual. Apart from wise counselling it is sometimes necessary to give relaxants to reduce tension. Causes may be fatigue, low blood pressure, emotional exhaustion, autonomic imbalance, endocrine disturbance (hyperthyroidism, pre-menstrual tension), stress, conflict, schizophrenia, depression. Symptoms: dry mouth, increased sweating, fainting attacks, rapid heartbeat, shortness of breath. Prolonged consumption of strong tea, coffee and other caffeine drinks leads to a deficiency of Vitamin B1 which manifests as general anxiety, even agoraphobia.

Alternatives:– Passion Flower, German Chamomile, Lime Blossom, Skullcap, Oats, Cowslip, Damiana, Dogwood, Valerian, Wild Lettuce, Motherwort, Pulsatilla.

In cases of anxiety the heart is involved – whether physically or otherwise. A ‘heart sustainer’ may give the patient an unexpected ‘lift’ enabling him to cope.

Motherwort tea. Combine equal parts: Motherwort (heart), Balm (gentle nerve relaxant), Valerian (psycho-autonomic). 1-2 teaspoons in each cup boiling water; infuse 10-15 minutes; 1 cup 2-3 times daily.

Powders. Formula. Motherwort 2; Passion Flower 1; Valerian half. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.

Tinctures. Combine, Oats 3; Hawthorn 1; Valerian 1. Dose: 1-2 teaspoons in water or honey thrice daily. Anxiety before menstruation. Evening Primrose Oil capsules. OR: Liquid Extract Pulsatilla BHP (1983) 3-5 drops, thrice daily.

Anxiety with obvious heart symptoms. Hawthorn 6; Valerian 1; Cactus 1; Holly 1; Hyssop 1. (Dr A. Vogel)

Bach Flower remedies: Rescue remedy.

Biostrath. Kava kava of special value.

Diet. Low salt, low fat, high fibre. Avoid alcohol, coffee, sugar and refined foods. Alfalfa tea for remineralisation.

Supplements. Vitamin B-complex, Magnesium, Zinc. 2-3 bananas daily for potassium.

Supportive: Relaxation technique: yoga, etc. ... anxiety states

Confusional State

An acute distressing symptom in elderly and very young people. ‘Lack of clarity in thinking.’ Mild brain failure. Temporary character-change and alteration in behaviour. Absence of classical symptoms of illness. Cannot formulate answers.

Diagnosis: dementia requires six months mental impairment, whereas acute confusional states may develop in a few days. Distinguish from Alzheimer’s disease.

Causes: Oxygen deficiency in the tissues (Vitamin E). Toxaemia (eliminatives). Delirium (nerve relaxants). Infections (Echinacea). Metabolism (Dandelion). Drugs (Ginseng). Hypothermia (Cayenne). Nutritional (Slippery Elm, thiamine).

Tea. Combine herbs, equal parts: Agrimony, Skullcap, Balm. 2 teaspoons to each cup boiling water; infuse 5-15 minutes. 1 cup freely.

Ginkgo: Favourable results reported.

Vitamins. B-complex. B12. Thiamine. E (1000iu daily). Minerals. Dolomite. Zinc. ... confusional state

Advance Directive, Decision, Or Statement

(in England and Wales under the Mental Capacity Act 2005) a legally recognized decision or statement by an adult with *capacity identifying any specific or general treatment the patient does not want in the event that he or she loses capacity. An advance directive or decision (formerly often called a living will) should be informed, made voluntarily, and must be valid and applicable to the medical situation that arises; at the extreme it can constitute an advance refusal of potentially life-saving treatment. It cannot, however, be used to demand future treatment and does not apply as long as the person retains capacity. An advance statement is a more general and less legally binding expression of the person’s values and views on the sort of treatment he or she may or may not wish to undergo. Directives and statements can raise ethical questions: for example, should life-saving treatment refused in advance nevertheless be given if it could restore the patient to a quality of life with which he or she was content before losing capacity.... advance directive, decision, or statement

Auditory Steady State Response

(ASSR) an objective test of hearing that measures the electrical activity in the auditory nerve and *brainstem following sound stimulation using a modulated continuous tone.... auditory steady state response

Hyperosmolar Hyperglycaemic State

(HHS) a state of extreme hyperglycaemia seen in type 2 diabetes accompanied by dehydration that can be severe, typically triggered by illness in a patient with type 2 diabetes or a patient with previously unknown type 2 diabetes. It was previously known as hyperosmolar non-ketotic hyperglycaemia (HONK). Emergency hospital treatment is required to control blood glucose levels and to treat the dehydration and the underlying precipitating cause. There is a significant mortality, especially in the elderly and patients with other disorders (e.g. vascular disease). While insulin is required as part of the initial emergency treatment, the patient often does not need insulin in the longer term, when well.... hyperosmolar hyperglycaemic state

Mental State Examination

(MSE) a full psychiatric examination of signs and symptoms, which takes place during a psychiatric interview and should apply only to signs and symptoms elicited at that time; it should not take into account historical information. The examination is usually divided into the following subheadings: appearance and behaviour, speech, mood, *affect, thought and perception, *insight, and orientation. Usually it also includes a *risk assessment.... mental state examination

Mini-mental State Examination

(MMSE) a brief 30-point questionnaire that is used to screen for cognitive impairment in the diagnosis of dementia. It is also used to estimate the severity of cognitive impairment and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document response to treatment. It tests functions including arithmetic, memory, and orientation.... mini-mental state examination

Mixed Affective State

a state of disordered mood that combines elements of *mania and *depression; it is a common feature of *bipolar affective disorder. Symptoms include overactivity, flight of ideas, depressed mood, and suicidal *ideation.... mixed affective state

Statementing

n. the provision by a local authority of a statement of *special educational needs for children attending school who have mental or physical disabilities severe enough to require extra help at school.... statementing

Statement Of Fitness For Work

a medical certificate that replaced forms Med 3 and Med 5 in April 2010 (see Appendix 8).... statement of fitness for work

Vegetative State

the clinical condition of unawareness of the self or the environment. The patient breathes spontaneously and has a stable circulation and sleep/wake cycles. It results from extensive damage to the cerebral cortex and thalamus while the brainstem and hypothalamus remain intact. The commonest causes are traumatic brain injury (e.g. road-traffic accidents) and cardiopulmonary arrest. Conditions that mimic the vegetative state include the psychiatric state of *catatonia and the locked-in syndrome, resulting from damage to the brainstem, in which the patient is conscious but unable to speak or make any movements of the body except for blinking and upward eye movements. See also persistent vegetative state.... vegetative state

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