Hospitals are still collecting ‘new long stay’ patients such as the young order 10mg buspirone with mastercard anxiety symptoms 3 days, single male schizophrenic with a history of violence or the middle-aged female with affective disorder or 3281 dementia buy buspirone online pills anxiety 9gag gif. New long stay patients cheap buspirone american express anxiety young child, defined as those cases needing longterm inpatient care and refractory to extensive rehabilitatory efforts, were accumulating at a rate of 0. Cognitively damaged patients are particularly difficult to rehabilitate and require high levels of support. The cases that were decanted first from institutions tended to do relatively well if their discharge was planned, but the remnant population was much more damaged, i. The population is getting older and this brings with it increasing levels of chronic morbidity and demands for total care. The mushrooming of nursing homes is paralleled by the increasing use of psychotropic drugs to contain behaviour because of the lack of other feasible alternatives. Psychiatrists are increasingly been ask to do something about elderly patients whose ‘depression’ or ‘paranoia’ or disinhibited behaviour is only one aspect of a multiplicity of organic disorders. It should be recalled that resources were scare because monies had been diverted into President Kennedy’s community mental health centres which catered for the less seriously ill. Rather than simply taking from better-funded areas, the lesser-funded areas require greater funding. Survey of Irish psychiatric services (O’Keane ea, 2003) (1 consultant/each of 32 catchment areas completed questionnaire) Over-stretched and developed on ad hoc basis Best developed in most affluent areas (negatively correlated with an index of relative deprivation, i. The College of Psychiatry of Ireland (Barry & Murphy, 3282 Poor outcomes are associated with patients’ perceptions of being ignored or disrespected. Whereas 74% of mentally ill Europeans receive no treatment, the comparable figure for diabetes in only 8%. A Gloomy View: Rhetoric or Reality in Relation to the Advancement of A Vision for Change. The Lie of The Land: Psychiatric Service Land Disposal & Failures and Delays in Capital Development of Community Based Mental Health Services. Proceedings of the Joint Conference of the Equality Authority and the Irish Medical Organisation. Evaluation of a Pilot Project for Home-Delivered Care for Patients with Acute Mental Illness in North Kildare. Position Statement on Psychiatric Services for Children and Adolescents in Ireland. Reconnecting with Life: Personal Experiences of Recovering from Mental Health Problems in Ireland. Code of Practice on Admission, Transfer and Discharge to and from an Approved Centre. Report of a Study Group on the Development of the Psychiatric Services (Trant S ea). Happy Living Here…A Survey and Evaluation of Community Residential Mental Health Services in Ireland. Report of the Inspector of Mental Hospitals for the Year Ending 31st December, 2003. Every treatment approach has its devotees and it is important to keep this in mind when evaluating evidence, e. The mind and brain are interdependent and neuroimaging shows brain changes after either psychotherapy or physical treatments. Behaviour therapy for anxiety disorders leads to attenuation of abnormalities on brain images in expected areas and activation of regions connected to positive interpretation of stimuli that otherwise lead to anxiety. Some patients simply want to gain greater control over their feelings, even if their symptoms survive, whilst others seek symptom removal. Supervision by an experienced and interested therapist offers the best teaching milieu. Greben (1981) defined psychotherapy as any form of treatment strategy wherein a trained individual associates with a person who is looking for help and who, by listening and talking to him, the therapist helps him. Fisk (1993) bemoaned the tendency of psychotherapists to identify with specific schools rather than with the whole field of psychotherapy. Undoubtedly, no matter what the technique employed, the personal skill of the therapist is highly relevant to outcome. The biggest problems with psychotherapy are poor availability (Guthrie & Sensky, 2007, p. He/she must experience pain born out of the individual interactions with patients, reminders of our own unresolved problems. His/her elders must not take flight into administration or academia, or give the example of defensive hostility towards patients. Personal and clinical maturity comes with time and interaction with real patients, who can be very demanding, as can their relatives. It is 3287 advisable to start reading psychotherapy with a broad-based text and to maintain a broad-based interest in the subject until the basic principles are well entrenched. Each has some goal (insight, behaviour change, symptom control, social competence, etc), a technique, (free association, sculpting, video feedback, etc), and a target of intervention (a symptom, family dynamics, interpersonal problems, etc). Their findings were very similar in both the eastern and northern regions of Ireland. They concluded that trainees expressed the wish for supervised exposure to psychotherapy and that their training to date was inadequate. In fact, there is little provision for psychotherapy within various public mental health and managed care services. Provision of psychotherapy by American psychiatrists has declined in favour of drug treatment. Bloch (1986, 2006) supplies a comprehensive reading list and no attempt to will be made to imitate him. Abreaction is the rapid release of emotionally charged material and may be aided by music, deep breathing, and by drugs such as sodium amytal. The repeated ventilation of emotion may desensitise the patient; this is classically seen in mourning (the social expression of grief). The therapeutic alliance is the working relationship that develops between therapist and client when trust has developed between them. It has its origins during infancy and is based on the bond of real trust between 3291 the child and his mother. A positive transference reaction might take the form of a requirement for the doctor to be omnipotent. What is required for effective progress is that the patient’s ‘mature, rational observing ego’ combines with the psychiatrist’s ‘analytic abilities’. They are useful for reaching many people who require training in novel treatments. Guided mourning in cases of abnormal grief reactions is a good example of how the act of focusing attention on a problem may facilitate natural healing processes.
She was diagnosed with Seropositive Rheumatoid Arthritis in Jul 2013 after a four years period of persistent and recurrent joint pain and swell- 258 ing involving both her ankles buy buspirone us anxiety pills, knees and elbow joints purchase buspirone 10 mg amex anxiety while sleeping. She was 1 Gulhane Military Medical Academy - Haydarpasa Research and also noted to have multiple bilateral joint contractures involving her Training Hospital buy buspirone canada anxiety eating disorder, Physical Medicine and Rehabilitation, Istanbul, shoulders, wrists and knees. She Material and Methods: A-40-yr man who was diagnosed ankylos- could hardly stand because of the bilateral knee pain. Cryotherapy ing spondylitis presented to our outpatient clinic due to the increase was also provided however this only improved her pain slightly. Her standing balance improved and Sulfasalazine (2,000 mg daily) and dicıofenac (200 mg daily) treat- by the 5th cycle of hydrotherapy, she was able to walk 5 rounds in ments were discontiniued because of their side effects. She progressed very well in the ab treatment (40 mg) was started every other week. Two days after hydrotherapy pool, walking independently under supervision of our the frst adalimumab application, patient presented to our outpatient therapist. There is no fever and there is no to her late presentation to hospital and hence to rehabilitation, this increased expectoration. There were also complaint of cough after young lady’s dream of walking again is still beyond expectations. Results: The reason of cough was considered Adalimumab and treatment was terminated. The patient had no complaint of cough in the control examination 257 2 weeks later. Tekin Introduction/Background: There are various musculoskeletal 1Gulhane Military Medical Academy - Haydarpasa Research and manifestations that may develop in a patient after chemotherapy. Training Hospital, Physical Medicine and Rehabilitation, Istanbul, These manifestations may be due to metastasis to musculoskeletal Turkey structures, paraneoplastic syndrome or immune reactions as well as adverse reactions to cancer specifc chemotherapy. It has been described in patients with some kinds of cancers antagonists is a well-established phenomenon. Ma- monoclonal antibody, and who unexpectedly developed psoriatic terial and Methods: A 39-year-old man presented with a 6 weeks skin lesions. Material and Methods: Case: A 37-year-old man who history of symmetric arthralgia on his bilateral hand and foot joints. Sulfasalazine (2,000 mg daily) and in- sis and treated chemotherapy, including palonosetron, doxorubicin, domethacin (75 mg daily) treatment was discontinued about a year cyclophosphamide, etoposide, vincristine. His last chemothrapy ago because of insuffcient antirheumatic effect and adalimumab was 6 weeks before. Physical examination revealed no swelling (40 mg subcutaneously) treatment was started every other week. According to her history, she had not received pruritic skin lesions of up to 10 cm in diameter as well as some pus- a regular treatment for 35 years but she have used lefunomide (20 tules on palms, arms and especially on both plantar area appeared. On Psoriasis pustulosa was clinically and histologically confrmed by examination there was no fever and swelling of hand, wrist or any a dermatologist. Ciclosporin A and topical treatment for was widespread bilateral rough rales by auscultation. Laboratory tests re- treatment is planned after becoming sure that the skin lesions are not vealed: White blood cell 11. Results: We performed three courses of steroid the severity of the symptoms in some patients, but which biological pulse therapy (methylpredonisolone 500 mg x 3 day/course) and agent would prove to be less harmful could not be predicted. Lefuno- mide was discontinued and methotrexate (10 mg/week) hydroxy- chloroquine (400 mg twice a day) and prednisone (4 mg/day) was 260 started. Kiralp1 1 Rheumatoid arthritis is known as a chronic systemic infamatuar dis- 1Gulhane Military Medical Academy - Haydarpasa Research and ease which effects periferic small joints. We presented a case who Training Hospital, Physical Medicine and Rehabilitation, Istanbul, has the diagnoses of these two diseases both. Her low back and hip pain had manifestations include bronchiolitis obliterans and crycoarytenoid increased in addition to the pain in the hand joints in the last 1 month. We present a case of a patient with pulmonary involve- On physical examination, bilateral wrists, 1. Lum- al and Methods: Case: A 70-year-old man with a 36-year history of bar range of motion was limited minimally in all directiond. Lumbar rheumatoid arthritis had been on methotrexate, sulfosalazine, and Schober test was measured as 4,5 cm and chest expansion was meas- prednisone admitted to our outpatient clinic. There was decreased left lung sounds by ausculta- matoid arthritis was diagnosed with ankylosing spondylitis in the tion. Laboratory tests revealed: erythrocyte sedimentation rate of light of these fndings and treatment has been revised. Chest X-ray showed decreased left tis is a rare situation, it should be considered in the diagnosis. Conclusion: There is 1 1 1 evidence of an association between pulmonary complications and E. Adalimumab is a humanized monoclonal antibody, it would Training Hospital, Physical Medicine and Rehabilitation, Istanbul, have the potential advantage of being less immunogenic. However, Turkey some authors have suggested that its use might induce pulmonary complications. Herein, we want to draw attention to successful Introduction/Background: Pulmonary involvement is one of the treatment of pulmonary involvement of rheumatoid arthiritis with extra-articular manifestations of rheumatoid arthritis and includes adalimumab but it should be kept in mand that it may also cause pleural effusion, parenchymal nodules, interstitial involvement, pulmonary complications. We present a case of a patient with pulmonary involvement of rheumatoid arthiritis and treated with pulse steroid therapy. All questions are about sleep and they were well understood by ment of Otorhinolaryngology, Ankara, Turkey, 3Ministry of Health patients which showed the face validity. Introduction/Background: The aim of this study was to investigate Pearson’s (r) Signifcance (p) the inner ear function in patients with psoriatic arthritis. Statistical comparisons between both groups were per- formed using chi-square test and Mann- WhitneyU test. Latif3 the evaluation of hearing frequencies of the patients between 4,000 1Ahvaz Jundishapur Univeristy of Medical Sciences - Ahvaz - Iran, and 6,000 Hz, a statistically signifcant difference was found relative 2 Physical Medicine and Rehabilitation, Ahvaz, Iran, Ahvaz Jundis- to the control group (p<005). When compared with 3 the control group, a statistically signifcantly difference was found Ahvaz, Iran, Ahvaz Jundishapur Univeristy of Medical Sciences at 3,000 and 4,000 Hz. Conclusion: Our study provides - Ahvaz - Iran, Health Research Center-Diabetes Research Center, strong evidence suggesting the necessity of monitorization of these Ahvaz, Iran patients regarding sensorineural hearing loss so as to take measures Introduction/Background: Median nerve involvement in wrist is against the development of hearing loss during early stage which one of the most common compression neuropathy which drives the may be another disability in patients with PsA which is itself a po- patients to musculocutaneus clinics such as orthopedy, neurology tential cause of severe disability. For estimating the amount of nerve injury, all the amounts of patients’ pain severity, 264 clinical and electrodiagnostic severity data were used by different researchers. The patients’ report of pain severity did Not show Introduction/Background: The aim of this study is to assess the va- correlation with electrodiagnostic severity. The electrodiagnostic severity was correlated with the consuming scale which assesses the sleep disturbance with 4 ques- clinical symptom severity at: p=0. The tom severity and the electro diagnostic severity were more reliable internal consistency (Cronbach’s alpha) was assessed for reliability. Face validity and construct validity (convergent and divergent va- lidities) were evaluated. Material and Methods: A total of 60 1 patients who fulflled the “Revised Criteria for the Classifcation of D. Sung 1Samsung Medical Center, Physical Medicine and Rehabilitation, Rheumatoid Arthritis 1987” were included in this study.
Medicine has effective technologies— technologies that link what the physician does with what happens to the patient cheap buspirone online visa anxiety feeling. Most of the research was designed to ascertain optimal conditions for the production of goods purchase 5 mg buspirone with visa anxiety symptoms in dogs. But the investigators discovered an anomaly—whatever they did buy buspirone 10 mg low cost anxiety 18 year old, 20 The Impact of Medicine production improved. W hen workers believed that m anagem ent cared, w hether by increasing or decreasing the lighting, for example, they tried harder. Some patients given placebos respond better to the null “treatm ent” than those given active drugs. In some studies, groups of patients given placebos had better treatm ent outcomes than groups treated with active medications. One of the dangers, then, of too rigorous an examina tion of medicine—requiring proof beyond a reasonable doubt—is that caring might be lost in the process. In procedures such as reduction of frac tures; treatm ent of infectious diseases such as diphtheria, tetanus, poliomyelitis, and tuberculosis; and surgery for re moval of pathenogenic organs, the physician truly heals. Medical care also heals when it utilizes therapies with which The Impact of Medical Care on Health Status 21 it has been entrusted. Penicillin, sulfa drugs, and antibiotics have expanded the capacity of the medical care system to treat and heal. The capacity to deal effectively with syphilis and tuberculosis represents a milestone in human endeavor, even though full use of this potential has not yet been made. And there are, of course, other examples: the treatment of endo- crinologic disorders with appropriate hormones, the preven tion of hemolytic disease of the newborn, the treatment and prevention of various nutritional disorders, and perhaps just around the corner, the management of Parkinsonism and sickle-cell anemia. There are other examples, and everyone will have his favorite candidate for the list, but the truth is that there are not nearly as many as the public has been led to believe. T he Papanicolaou test for cervical cancer has proven utility,39 and the means have been found to treat some forms of skin cancer. Paradoxically, some diseases that are both preventable and treatable continue to strike large num bers of people. Allen Chase in The Biological Imperatives40 lists a num ber of preventable diseases which either kill or debilitate large num bers of people simply because resources have not been allocated to their control. Included are hookworm disease, which afflicts approxim ately 600 million people; ascariasis, 22 The Impact of Medicine another worm infestation; schistosomiasis; trachom a, which causes irreversible blindness; and endemic goiter. T he fact that most of these diseases are ram pant in underdeveloped areas does not make them irrelevant. Even in the United States there are diseases that could be m ore effectively treated, or possibly even prevented. Edward Berk, Chairm an o f the D epartm ent of Medicine at the University of California at Irvine, m ore than half of the population o f the United States registers frequent complaints about digestion. Roughly 15 to 20 percent of all illnesses reported afflict the digestive tract—the stomach, intestines, biliary passages, liver, and pancreas. Because of nonspecific symptoms, many cases of peptic ulcer and gallstones, for example, re main undetected. Nevertheless, digestive disease ranks second only to circulatory disorders as a cause of workdays lost per year. And research funds are disproportionately spent in other areas, particularly those that have strong lobbies, such as cystic fibrosis and muscular dystrophy. Despite its limitations and despite its questionable priorities, the medical care system continues to grow and consume m ore and m ore resources. Some of the most trenchant thinking about the effectiveness o f medical care has been done by A. In Effectiveness and Efficiency,43 Cochrane concludes that the National Health Service has had little to do with improving mortality and morbidity rates. He acknowledges the effectiveness of some medications for some conditions; strikes a loud note for preventive measures such as im m uni The Impact of Medical Care on Health Status 23 zation and curtailm ent o f population growth and cigarette smoking; expresses doubt about some tried and true mea sures, including the pap sm ear and the coronary care unit; and, almost hesitatingly, argues that further developm ent of medical therapies should be deferred until definitive proof of their effectiveness is available. T o read Cochrane is to conclude with him that little of medical care is effective and that health will never be the exclusive product of medical care—there are too many other factors. W hen somebody gets the flu, the advice given by both the professional practitioner and the am ateur diagnostician is the same—wait it out. Several researchers have established the rarity of cancers, vascular disorders, and other degenerative diseases am ong primitive popula tions. Unique geographical and cultural factors affect both the incidence and control of certain dis eases. In the nineteenth century, at the height of the Industrial Revolution, thousands of migrants were compressed into urban industrial sinks. But despite the hum an loss, enorm ous in some cases, people in most affluent countries have adopted to urban conditions (and, of course, the conditions have been im proved as well). T o use a concrete example, the devas tating disease known as “consum ption” in the nineteenth century is now understood to have been pulm onary tuber culosis. Although the virulence of the bacilli is as great now as it was then, our adaptive response has come to blunt its 24 The Impact of Medicine severity. In short, both the types of disease and the patterns of disease reflect prevalent conditions in a given culture. To quote Rene Dubos: W ithout question, nutritional and infectious diseases account for the largest percentage of morbidity and mortality in most underprivileged countries, especially in those just becoming industrialized. Undernutrition, protein deficiency, malaria, tuberculosis, infestation with worms, and a host of ill-defined gastrointestinal disorders are today the greatest killers in these countries, just as they used to be in the Western world one century ago. In contrast, the toll taken by malnutrition and infection decreases rapidly wherever and whenever the living standards improve, but other diseases then become more prev alent. In prosperous countries at the present time, heart dis eases constitute the leading cause of death, with cancers in the second place, vascular lesions affecting the central nervous system in the third, and accidents in the fourth. Increasingly also, persons who are well fed and well sheltered suffer from a variety of chronic disorders, such as arthritis and allergies, that do not destroy life but often ruin it. Increased longevity, re ductions in m aternal and infant m ortality, and o th er related im provem ents are not owed to m edicine. Diseases associated with industrialization— largely infectious disorders— were tam ed in developed cultures. If anything, due to o u r incapacity to adjust to the stresses o f postindustrial society, health status is tapering. Jo h n Powles, in a paper on the ebbs and flows in health and disease patterns, sum m arizes the point: Industrial populations owe their current health standards to a pattern of ecological relationships which serves to reduce their vulnerability to death from infection and to a lesser extent to the capabilities of clinical medicine. Unfortunately, this new way of life, because it is so far removed from that to which man is adapted by evolution, has produced its own disease burden. John Cassel, a noted epidemiologist at the Uni versity o f N orth Carolina, has argued for m ore research focused on the relationship between disease rates and social phenom ena such as industrialization, stress, and congestion.
Most antihistamines are considered safe in the short term buy on line buspirone anxiety symptoms in 9 year old boy, although diphenhydramine has been associated with cardiovascular malformations discount 5 mg buspirone free shipping anxiety questions. Chloral hydrate is a pro-drug that needs to be metabolised to trichlorethanol to produce an hypnotic effect 5mg buspirone mastercard anxiety 2 days after drinking. It has a 841 Zammit ea (2009) found that women consuming over 21 units of alcohol/week were at risk of having adolescent offspring who experienced psychotic symptoms. Depression in pregnancy may respond to non-drug therapies such as environmental manipulation or cognitive therapy (if available). Each case is decided on its own merits, keeping in mind that 10% of pregnant women meet standard diagnostic criteria for depression and that relapse rates following discontinuation of medication are high. Ramos ea (2008) found no support for a connection between duration of antidepressant use in general during the first trimester of pregnancy and major congenital malformations diagnosed during the first year of life. It is probably safest to avoid breast-feeding premature babies if the mother is on psychotropics because of hepatic and renal immaturity. Some authorities are more inclined to stop breast-feeding if the mother is on high doses or 846 combinations of antidepressants. Oestrogens, which may help some cases of postpartum depression, should not be combined with breast-feeding. Interpersonal psychotherapy,(O’Hara ea, 2000) various brief therapies, and counselling (again, depending on availability) are effective alternatives to medication for postpartum depression. It should be recalled that schizophrenia itself appears to be associated with minor physical anomalies. Some tentative conclusions derived from a review of the salient literature are shown in the box. Some conclusions Interpreting statistics: Clinicians and their patients are bombarded with novel drug-risk information. P-value-based thresholds may not tell us anything about severity of the alleged adverse event and fail to provide guidance on safer treatments or factor in benefit from the indicted compound. Hasty reactions may lead to discontinuation of efficacious interventions whereas non-reaction might lead to ‘another thalidomide’! Pregnancy: Polypharmacy is best avoided and doses should be as low as is compatible with maintenance of health. Bupropion use during pregnancy does not appear to be associated with an excess of malformations. If used, it should be avoided during the first trimester, and levels 845 Buspar was withdrawn, December 2009. For people planning a pregnancy who are receiving anticonvulsants and who have never been on lithium it may be worth considering a trial of lithium during the non-gravid period. Serum anticonvulsant levels may drop during pregnancy and so should be monitored carefully. Multiple dosing of neuroleptics (instead of a larger once a day dose) is advised during pregnancy to avoid peak serum concentrations. General advice regarding antipsychotics is to have a drug-free interval around delivery, which necessitated changing to oral medication. The last depot injection can be given at week 28 of the pregnancy and a high potency agent is started on the date when the depot would have next been due. The dose is increased to rough equivalence with the depot and it is again reduced, starting 2 weeks before the expected date of delivery, the aim being to have the mother drug-free 2 to 3 days before onset of labour. Neuroleptics are rapidly reinstated (oral plus depot) shortly after the baby is born. Strong consideration should be given to giving folate supplementation to pregnant patients on atypical neuroleptics. First 847 trimester exposure to folic acid antagonists should be avoided as far as possible since they double the risk for congenital malformations and increase the risk for neural tube defects six times. Premature infants (immature P450 enzymes) or those with poor liver function are least likely to be able to handle drugs transmitted via mother’s milk and it is often decided to defer breat-feeding in such cases. High levels of bupropion in breast milk were devoid of adverse effects but data is very limited. Antipsychotics have limited data but probably safe (do not breast feed if on clozapine;[Howard ea, 2004; Kohen, 2005] one case of excessive sleepiness and one case of reversible agranulocytosis in infants breast fed by clozapine treated mothers: Dev & Krupp, 1995) – the older ones have more data than the newer ‘atypicals’; however, there is some data attesting to the safety of olanzapine in small numbers of offspring of breastfeeding mothers. Milk lithium levels are up to half maternal plasma levels - if used observe closely, especially infant’s fluid status. Valproic acid and carbamazepine (very cautious: breast milk levels are low) use require close monitoring because of the risk to the infant of liver problems and white cell toxicity, although only low levels appear in maternal milk. Viguera of Boston (2004) recommended breast feeding to bipolar patients on mood stabilisers. In cases of doubt, many clinicians advocate bottle feeding rather than leaving the mother’s (serious) mental disorder untreated. It should be noted that stress in later pregnancy has been correlated with preterm delivery. Progestogens inhibit the metabolism of many psychotropic drugs: therefore, stopping a contraceptive preparation may necessitate increasing the dose of a psychotropic, and pregnant women, who have elevated progesterone levels, may need lower doses of psychotropics during gestation, their dosage requirements increasing after delivery. Interestingly, although progesterone is widely used for postnatal depression there is no evidence that it works, and postnatal norethisterone may increase the risk of depression. Oestrogens on the other hand may relieve some severe cases of postnatal depression. Where available, psychotherapy may obviate the need for medication in selected cases. A morning walk or light therapy may help patients with seasonal affective disorder; and those with regular summer depressions may benefit from cooling and dark glasses. Where can I find answers, how do I go about it, and how do I measure level of evidence? Provide information to my patient in a sensitive and balanced fashion in order to elicit informed consent Monitor performance to enhance learning No one published research paper should be interpreted in isolation. A precise definition of the clinical problem is mandatory, as are an efficient search for the best available evidence, and a critical appraisal of the evidence. According to Geddes (1997), clinical practice lags behind research, although one can legitimately argue that much research lags behind clinical need and may not be applicable to clinical work. Also, sources of evidence vary greatly in quality (Kelly, 2002) and the message given out. Pathways Report – Experiences of Mental Health Services from a User-led Perspective. Health Services Intercultural Guide: Responding to the Needs of Diverse Religious Communities and Cultures in Healthcare Settings. De L’education d’un Homme Sauvage, ou Des Premiers Développements Physiques et Moraux du Jeune Sauvage de L’Aveyron. The effect of atypical antipsychotic drugs to improve cognition in schizophrenia: functional significance and mechanism of action..
I. Tom. University of Wisconsin-Parkside. 2019.