The psychologic effects of spontaneous abortion.

Although 14% to 18% of pregnancies end in spontaneous abortion, miscarriage is often not recognized as a significant occurrence. Women may experience grief reactions similar to those after the loss of a neonate. If the woman is not given an opportunity to deal with her grief, there may be continuing feelings of sadness, inadequacy and fearfulness as well as impairment in the relationships with her spouse and children. Methods of helping the couple during this time include acknowledging the significance of the loss, providing information, permitting the couple to see the fetus, if desired, and suggesting a memorial service. Some women may require individual or group therapy to deal with their feelings.     

The effect of thermic stress on the somatic reaction of rage and on rapid circling turns, in the cat.

An investigation was made of the effect of thermic stress on the somatic rage reaction and on rapid circling turns in cats awake and free to move in a behavioural cage. An increase in room temperature had a two-phase effect on the excitability of the nervous structures stimulated that is able to evoke the somatic rage reaction and rapid circling turns. The first phase, at room temperature 25 degrees-30 degrees C, was characterized by hypoexcitability; the second phase, appearing after longer periods of exposure and at temperatures above 30 degrees C, was characterized by the onset panting, hyperexcitability of the nervous structures stimulated and then by lowering of the somatic rage reaction threshold and a very significant increase in the number of circling turns. Experimentation on the action of cold external temperature on the excitability of structures involved in evoking the somatic rage reaction and rapid circling turns indicated an increase in their excitability, corresponding to an increase in spontaneous and evoked somatic motor activity.     

Managing erotic feelings in the physician-patient relationship.

In spite of prohibitions against the sexual involvement of physicians with their patients, erotic feelings sometimes arise in physician-patient relationships. The authors suggest that physicians can protect themselves and their patients from the harm that results from sexual involvement by establishing behavioural limits for their professional relationships, responding to patients'' sexual overtures in a firm but nonjudgemental manner, examining their own sexual feelings rationally, seeking consultation if necessary and terminating the relationship if sexual feelings are compromising patient care. The challenge for physicians is to acknowledge that sexual feelings can arise and to manage such feelings for the sake of their own and their patients'' well-being.     

Emotional Health of People with Visual Impairment Caused by Retinitis Pigmentosa

Purpose

To understand the emotional difficulties associated with living with the ocular condition Retinitis Pigmentosa, and to examine the functioning of a self-report instrument used to assess this construct.

Methods

The difficulty of goals and tasks in the emotional health domain of the Dutch ICF Activity Inventory were rated by 166 people with Retinitis Pigmentosa in a cross-sectional study. Demographic factors were also assessed.

Results

Responses to the 23 emotional health tasks were Rasch analysed and could be used to form either one 20 item overview scale with some multidimensionality, or three unidimensional subscales addressing feelings (4 items), communicating visual loss (5 items) and fatigue (7 items). The most difficult individual tasks related to communicating visual loss to other people, and dealing with feelings such as frustration, anxiety and stress. The use of mobility aids and female gender were associated with increased difficulty with emotional health, explaining 19% of the variance in the overview scale.

Conclusions

The emotional health domain of the Dutch ICF Activity Inventory is a valid tool to assess emotional difficulties arising from visual loss. Interventions to aid people with Retinitis Pigmentosa deal with emotional difficulties should particularly address communicating vision loss effectively to others and coping with negative feelings.     

The role of RAGE in the pathogenesis of intestinal barrier dysfunction after hemorrhagic shock

The receptor for advanced glycation end products (RAGE) has been implicated in the pathogenesis of numerous conditions associated with excessive inflammation. To determine whether RAGE-dependent signaling is important in the development of intestinal barrier dysfunction after hemorrhagic shock and resuscitation (HS/R), C57Bl/6, rage(-/-), or congenic rage(+/+) mice were subjected to HS/R (mean arterial pressure of 25 mmHg for 3 h) or a sham procedure. Twenty-four hours later, bacterial translocation to mesenteric lymph nodes and ileal mucosal permeability to FITC-labeled dextran were assessed. Additionally, samples of ileum were obtained for immunofluorescence microscopy, and plasma was collected for measuring IL-6 and IL-10 levels. HS/R in C57Bl/6 mice was associated with increased bacterial translocation, ileal mucosal hyperpermeability, and high circulating levels of IL-6. All of these effects were prevented when C57Bl/6 mice were treated with recombinant human soluble RAGE (sRAGE; the extracellular ligand-binding domain of RAGE). HS/R induced bacterial translocation, ileal mucosal hyperpermeability, and high plasma IL-6 levels in rage(+/+) but not rage(-/-) mice. Circulating IL-10 levels were higher in rage(-/-) compared with rage(+/+) mice. These results suggest that activation of RAGE-dependent signaling is a key factor leading to gut mucosal barrier dysfunction after HS/R.     

Avocado

EDITOR'S NOTE Journals teach and stimulate in many ways. They present new information. They raise questions. They emphasize. They also may affect patient care by affecting physicians' feelings. This paper has affected reviewers not necessarily by presenting new information but by edging into their consciousness, by stirring their sense of humanity, by giving a new approach to hopelessness and handicaps. It is about teaching and about caring."Avocado" is an adaptation of an address given at the Stanford University Class Day, June 1990. It is an excerpt from an unpublished novel, La Mollie and the King of Tears. Dr Islas is Professor of English at Stanford. He has dealt with his own chronic illness for 30 years.     

Sexual contact in the doctor-patient relationship in The Netherlands.

OBJECTIVE--To obtain data on sexual contact between doctors and their patients. DESIGN--Anonymous questionnaire with 17 items sent to all working gynaecologists (n = 595) and all ear, nose, and throat specialists (n = 380) in the Netherlands. RESULTS--Response rate was 74%; a total 64 doctors gave a reason for not completing the questionnaire. 201 (59%) male gynaecologists and 128 (56%) male ear nose, and throat specialists indicated that sexual feelings are acceptable in the doctor-patient relationship; 286 (85%) and 186 (81%), respectively, had felt sexually attracted to a patient at some time, as had 14 (27%) female gynaecologists. More than half (59%) of the doctors who indicated that sexual feelings are unacceptable in the doctor-patient relationship had experienced these feelings, and 91% of this group had a negative attitude towards these feelings. 4% of respondents in each group had had actual sexual contact with patients. Most gynaecologists were in favour of having more attention paid to sexual problems during training; having their professional society take an official viewpoint; subsequent public support of this viewpoint; and taking on an impartial counsellor for the patients as well as the doctors. CONCLUSION--Sexuality exists in the doctor-patient relationship. Gynaecologists have a higher risk of having sexual contact with their patients than do ear, nose, and throat specialists but compensate for this greater risk by a higher state of recognition and acknowledgement.     

Dose-finding based on efficacy-toxicity trade-offs

We present an adaptive Bayesian method for dose-finding in phase I/II clinical trials based on trade-offs between the probabilities of treatment efficacy and toxicity. The method accommodates either trinary or bivariate binary outcomes, as well as efficacy probabilities that possibly are nonmonotone in dose. Doses are selected for successive patient cohorts based on a set of efficacy-toxicity trade-off contours that partition the two-dimensional outcome probability domain. Priors are established by solving for hyperparameters that optimize the fit of the model to elicited mean outcome probabilities. For trinary outcomes, the new algorithm is compared to the method of Thall and Russell (1998, Biometrics 54, 251-264) by application to a trial of rapid treatment for ischemic stroke. The bivariate binary outcome case is illustrated by a trial of graft-versus-host disease treatment in allogeneic bone marrow transplantation. Computer simulations show that, under a wide rage of dose-outcome scenarios, the new method has high probabilities of making correct decisions and treats most patients at doses with desirable efficacy-toxicity trade-offs.     

Attention-deficit/hyperactivity disorder and alexithymia: a pilot study

Although the relationship between alexithymia and psychopathology has been studied extensively in adults, research is lacking on alexithymia in childhood psychopathology. The aim of this study was to investigate the relationship between alexithymia and attention-deficit/hyperactivity disorder (ADHD). The Italian version of the Alexithymia Questionnaire for Children was administered to a sample of 50 children with a DSM-IV diagnosis of ADHD, as assessed by means of the K-SADS PL, and to 100 healthy, age- and sex-matched children without ADHD. The total alexithymia score as well as the difficulty in identifying feelings (DIF) and externally oriented thinking factors were significantly associated with ADHD. The total alexithymia score, the DIF, and the difficulty in describing feelings factors were also significantly associated with symptoms of hyperactivity/impulsivity. No significant relationship between alexithymia and inattentiveness symptoms emerged. Results provide preliminary data on the relationship between alexithymia and ADHD. Findings point to an association between difficulty in identifying emotions and hyperactivity/impulsivity. Future studies conducted on larger patient samples, as well as longitudinal designs, are warranted to confirm our findings.     

Lifting patients in bed with and without a drawsheet: a comparative ergonomics study

Two techniques for lifting a patient in bed, namely with and without the use of a drawsheet, have been compared from an ergonomics point of view. Forty-two nurses of a Thai university hospital were studied before and after using each method by measuring back strengths and by using a questionnaire for feelings of fatigue and for musculoskeletal fatigue and pain. Decreases in back strength 10 minutes after and immediately after lifting with each method were found to be significant (90% confidence). The decrease 10 minutes after lifting was found to be significantly smaller with a drawsheet than without one (98% confidence). Immediately after lifting there was less difference between the two methods, which indicates that the use of a drawsheet reduced the recovery time and the decrease in back strength. Increases in feelings of fatigue from lifting with each method were also found to be significant (90% confidence), and the results indicate that the increase was lower with a drawsheet than without one. Musculoskeletal fatigue and pain immediately after lifting were more common without a drawsheet than with one. In conclusion, the lifting technique with a drawsheet is ergonomically superior and should be used by nursing personnel.     

The friendship model: a reply to Illingworth

Patricia M.L. Illingworth, in an article in the January 1988 issue of Bioethics, maintained that a friendship model of the physician patient relationship violates the autonomy of patients who do not want to be friends with their physicians and diminishes the autonomy of patients who seek such friendship based on "psychological oppression" stemming from internalization of feelings of inferiority. James contends in this reply that much of Illingworth's critique of the model was beside the point. He argues that trust between doctor and patient is a moral good in the therapeutic relationship and that this trust has enough similarities to trust between friends to make a model which develops these similarities well worth exploring.     

The LSD Syndrome—A Review

lsd (lysergic acid diethylamide) is a powerful bio-active substance related to serotonin in structure. Its actions generally affect autonomic, sensory and psychological functions. Autonomic stimulation is varied. Sensory responses are usually visual, involving heightened and distorted color perception and fusion of sensory impressions. Psychological responses include a feeling that a unique experience is occurring; feelings of depersonalization; pronounced fluctuation of mood; time and space distortions; autistic phenomena; fluctuation of aggressive drives (usually reduction); and spontaneous reoccurrence of the lsd experience.The subjective responses can be related to three basic phenomena: (1) expectation; (2) loss of characteristic modes of perceptual and cognitive patterning; and (3) hypersuggestibility.The major adverse reactions are: (1) chronic drug dependence including subsequent personality changes and depressive reactions; and (2) acute ego dissolution. These reactions usually occur in already emotionally ill people. Most of these users fall into two groups, those with unresolved identity problems and those with severe ego abnormality. The majority of adverse reactions are of the chronic drug dependence type and are usually seen in adolescents and young adults who have not negotiated the age-appropriate tasks of forming and integrating the various identities that are the composite of their life experiences.lsd helps alleviate these stresses via some of its psychological properties as discussed. It also provides a nidus for the formation of a subculture where goals for social, sexual and vocational achievement are lower and idiosyncratic modes of adaptation are better tolerated. A smaller group of users who have serious reactions such as psychosis, rage reactions, homicidal and suicidal ideation are usually found to have preexisting ego abnormality such as ambulatory schizophrenia, chronic impulse disorders and borderline states. Although adverse reactions most often appear to be related to pre-morbid psychopathology, this is not invariably so. Further, there is as yet no reliable method to determine who will have an adverse reaction and what the nature of that reaction will be.     

Healing and feeling: the clinical ontology of emotion

In the clinical setting, not enough attention is paid to the role that emotion plays. It is at worst ignored or avoided, isolating those who are suffering, at best treated as something to help another to endure. This is the result, in part, of an impoverished idea that views emotion as mere feelings. However, emotions are not just feelings, they are cognitive. If we look beneath the surface, emotions can provide information about values and beliefs, some of which may be false or unreasonable. When they are motivating decisions that seriously affect the lives of others, there is a moral obligation to ferret them out and correct or deal with them. Attention needs to be paid to the emotions of healthcare providers as well as to the emotions of patients and their loved ones, and more done to train healthcare providers to deal effectively and productively with emotion – their own and others'. A son tearfully requests everything be done for his dying father. He fears limiting treatment means his father will be ignored. A physician orders another course of chemotherapy because she cannot bear for this patient to die. The patient, fearing he will painfully suffocate to death, agrees. Paying attention to emotions and bringing to light the beliefs and values behind them can only enhance the care and consideration of all involved.     

Can different patient satisfaction survey methods yield consistent results? Comparison of three surveys.

OBJECTIVE: To examine the consistency of survey estimates of patient satisfaction with interpersonal aspects of hospital experience. DESIGN: Interview and postal surveys, evidence from three independent population surveys being compared. SETTING: Scotland and Lothian. SUBJECTS: Randomly selected members of the general adult population who had received hospital care in the past 12 months. MAIN OUTCOME MEASURES: Percentages of respondents dissatisfied with aspects of patient care. RESULTS: For items covering respect for privacy, treatment with dignity, sensitivity to feelings, treatment as an individual, and clear explanation of care there was good agreement among the surveys despite differences in wording. But for items to do with being encouraged and given time to ask questions and being listened to by doctors there was substantial disagreement. CONCLUSIONS: Evidence regarding levels of patient dissatisfaction from national or local surveys should be calibrated against evidence from other surveys to improve reliability. Some important aspects of patient satisfaction seem to have been reliably estimated by surveys of all Scottish NHS users commissioned by the management executive, but certain questions may have underestimated the extent of dissatisfaction, possibly as a result of choice of wording.     

Social Priming Increases Nonverbal Expressive Behaviors in Schizophrenia

Semantic priming tasks are classically used to influence and implicitly promote target behaviors. Recently, several studies have demonstrated that prosocial semantic priming modulated feelings of social affiliation. The main aim of this study was to determine whether inducing feelings of social affiliation using priming tasks could modulate nonverbal social behaviors in schizophrenia. We used the Scrambled Sentence Task to prime schizophrenia patients according to three priming group conditions: pro-social, non-social or anti-social. Forty-five schizophrenia patients, diagnosed according to DSM-IV-TR, were randomly assigned to one of the three priming groups of 15 participants. We evaluated nonverbal social behaviors using the Motor-Affective subscale of the Motor-Affective-Social-Scale. Results showed that schizophrenia patients with pro-social priming had significantly more nonverbal behaviors than schizophrenia patients with anti-social and non-social priming conditions. Schizophrenia patient behaviors are affected by social priming. Our results have several clinical implications for the rehabilitation of social skills impairments frequently encountered among individuals with schizophrenia.     

Glassy State and Seed Storage Stability: A Viability Equation Analysis

Dry seeds exist generally in a glassy (or vitrified) state.The high viscosity of the glassy state would be expected tohave a retarding effect on deteriorative reactions in the cytoplasm.Thus the glassy state may be considered to be a biophysicalbarrier for seed deterioration. The present study aims to testthe hypothesis that seed storage stability is associated withthe glassy state. With the equations derived from the seed viabilityequation, we have calculated the maximum temperature (Tmax)for long-term storage of corn, pea and soybeans. The Tmax forlong-term seed storage is found to be in a good agreement withthe glass transition temperature (Tg) in each instance, suggestingthat seed deterioration would be accelerated when seeds arenot in the glassy state. Experiments with soybeans given acceleratedageing show that the loss of glassy state is followed by a rapiddecrease in seed viability. These observations provide indirectevidence that the glassy state may play a significant role inseed storage stability.Copyright 1994, 1999 Academic Press Glassy state, seed longevity, storage stability, viability analysis     

The Efficacy of Dietary Fat Vs. Total Energy Restriction for Weight Loss

Objective : Dietary fat restriction is currently being promoted as a weight loss strategy. However, previous investigations suggest that fat restriction alone may not be more beneficial than total energy restriction for the treatment of obesity. The purpose of this project was to assess whether an energy-restricted or fat-restricted diet was more effective at promoting weight loss, improving eating behaviors, and reducing barriers to dietary adherence. Research Methods and Procedures : Eighty individuals (15 men and 65 women) were randomized into the two treatment conditions. Subjects were 120% to 140% of ideal body weight and 25 years to 45 years old. Treatment consisted of 24 weeks of dietary fat (22 g/day to 26 g/day) or energy restriction (4,186 kJ/day to 5,023 kJ/day), including behavior modification and exercise. Body weight change, dietary intake, eating behaviors, and barriers to adherence were measured at baseline and after treatment. Results : Results show that subjects in the energy-restricted condition lost over twice as much weight as those in the fat-restricted group (11.5 kg vs. 5.2 kg). Additionally, subjects in the low-energy condition had greater improvements in eating behavior scores, enhanced feelings of wellness, a greater distaste for dietary fat, and no more pronounced feelings of deprivation than did those in the fat-restricted condition. Discussion : An energy-restricted diet produces greater short-term weight loss than dietary fat restriction without many of the negative consequences commonly attributed to reducing energy intake.     

Management of foot injuries with free-muscle flaps

Transfer of a free-muscle graft with application of a split-thickness skin graft is one of many techniques available for reconstruction of the massive foot injury. The durability of such a reconstruction has been questioned. We have treated nine patients suffering from foot injuries with extensive soft-tissue loss. Each patient underwent reconstruction using a free-muscle transfer covered by a split-thickness skin graft. A mean follow-up of 33 months (range 17 to 48 months) is reported for these nine patients. Each patient is ambulatory. One patient developed an ulcer on the plantar surface, which was treated successfully by flap revision and skin grafting. We feel this technique provides a durable reconstruction for significant soft-tissue loss of the foot.     

早泄的诊疗进展

早泄是男性常见的一种性功能障碍性疾病,属于射精障碍,在男性病中有着相对较高的发病率。早泄严重的影响着患者的生活质量和性生活质量,渐渐的引起患者自信心的缺失,还在一定程度上影响患者的夫妻感情和关系,最终导致患者出现焦虑、紧张、恐慌等症状。这些不良的精神状态最终影响着患者的家庭生活和工作质量等。针对早泄的发病原因,其治疗方法也是多种多样的,治疗效果也不统一,有着很大的差异,新的治疗方法也越来越多。因此对于早泄的治疗有着重要的意义。本文对早泄的治疗进行综述。     

Mathematical analysis of the relative contributions of decreased production and increased peripheral destruction in idiopathic thrombocytopenic purpura and implications in splenectomy

We utilize a model of platelet concentration kinetics and bone marrow production based on three terms (a constant loss term, a random loss term and a higher order loss term) to compare a hypoplastic bone marrow patient and a patient with Idiopathic Thrombocytopenic Purpura (ITP) for the same platelet concentration. We compare this model to published data and show that in many ITP patients there is an overall decrease in platelet production. However, for almost all cases of ITP there is an increase in peripheral platelet destruction, even in those cases where total bone marrow production is less than that in a normal individual or is severely depressed. We are able to graphically depict the variable contributions of decreased production and increased peripheral destruction in patients with ITP and hence give insight into their relative contributions in a given patient. We apply a unique feature of our model, the newly postulated destruction term proportional to the platelet concentration squared (the higher order loss term), to explain cases of antibody negative ITP. Application of our model to data on patients splenectomized as treatment for ITP shows promise in predicting which patients are likely to respond.