Human endometrial cancers contain follicle-stimulating hormone receptors: a preliminary study

Prostaglandins, particularly PGE1, are now widely used in PAOD as they act on the balance of microcirculation and endothelial function. The Authors report their experience in 21 patients (19 males, 2 females; median age 64) treated with PGE1, 80 micrograms per day i.v. and subcutaneous heparin 0.2 ml twice a day and followed from September 1993 to March 1995. Twenty patients were affected by PAOD; in this group 8 (5 diabetics) were suffering from claudicatio intermittens, II from critical ischaemia, while 1 patient had thromboangiitis obliterans. One of the 8 claudicating patients did not complete the protocol because he underwent a femoropopliteal bypass, while the other 7 experienced a significant and stable improvement (two of these walk quite freely). Only 7 of the 11 patients with C.L.I. received a medical treatment alone; 4 had healing of necrotic ulcers and in the other 3 the treatment was stopped because of the onset of severe hypertension or because they were non-responders. In 4 patients with C.L.I. PGE1 was associated with a surgical revascularization procedure, and its role has to be better defined. From the analysis of the results reported treatment with PGE1 may be an important step in Fontaine class IIb patients, before planning a surgical approach. Also in most cases of C.L.I. it proved its efficacy, however, the initial therapeutic option (either medical or surgical) should be evaluated in each single case.     

The effect of lack of information on the undecided response in attitude surveys.

The "undecided" response in attitude inventory items may be selected because of actual neutrality, item ambiguity, lack of information, antagonism to the test procedure, or a need to "straddle." The major determiners are probably actual neutrality, "fence-straddling" attitudes, or lack of information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The moderator effect that wasn't there: Statistical problems in ambivalence research.

Ambivalence researchers often collapse separate measures of positivity and negativity into a single numerical index of ambivalence and refer to it as objective, operative, or potential ambivalence. The authors argue that this univariate approach to ambivalence models undermines the validity of subsequent statistical analyses because it confounds the effects of the index and its components. To remedy this situation, they demonstrate how the assumptions underlying the indices derived from the conflicting reactions model and similarity-intensity model can be tested using a multivariate approach to ambivalence models. On the basis of computer simulations and reanalyses of published moderator effects, the authors show that the frequently reported moderating influence of ambivalence on attitude effects may be a statistical artifact resulting from unmodeled correlations of positivity and negativity with attitude and the dependent variable. On the basis of extensive power analyses, they conclude that it may be extremely difficult to detect moderator effects of ambivalence in observational data. Therefore, they encourage ambivalence researchers to take an experimental approach to study design and a multivariate approach to data analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intramedullary cysticercosis cured with drug treatment. A case report

STUDY DESIGN: A report of a patient with cervical intramedullary cysticercosis is presented. OBJECTIVES: To report the first case of intramedullary. cysticercosis cured with drug management only, which supports the hypothesis that management with anthelmintics might be successfully used in this form of cysticercosis. SUMMARY OF BACKGROUND DATA: Intramedullary cysticercosis is a rare manifestation of neurocysticercosis. Every treated patient reported to date has undergone surgery, frequently necessary for diagnosis. Since the anthelmintics praziquantel and albendazole were shown to be effective in parenchymal brain cysticercosis, these drugs have been considered potentially useful in patients with intramedullary cysticercosis. Nevertheless, no case yet had been reported to be cared with only medical therapy. METHODS: The treatment of a patient who suffered multiple cysticercal reinfestations of the nervous system is presented. RESULTS: The patient received prolonged treatment with albendazole because of superimposed cerebral reinfestations. During this treatment, she suffered acute paraparesis, and cervical magnetic resonance imaging showed cyst-like lesions with linear gadolinium enhancement and perilesional edema, indicative of dying cysticerci and inflammatory host reaction. Dexamethasone was added, and progressive neurologic improvement followed with complete resolution of intramedullary lesions. CONCLUSIONS: A preoperative diagnostic suspicion of cysticercosis is important in patients with intramedullary cystic lesions because specific drug treatment is available. Treatment with anthelmintics, particularly albendazole, should be considered in patients with intramedullary cysticercosis before surgery. Corticosteroids may be added to the therapeutic regimen because this may reduce the perilesional edema and prevent neurologic deterioration during the course of anthelmintic treatment.     

A prospective study of bipolar disorder in children and adolescents from India

In the light of new opportunities for structural arrangements in Germany calling for higher co-operation between physicians in private practice, determinants for diagnostic and therapeutic co-operation need to be examined. In the present study, 130 general practitioners were asked in regard to four typical primary care indication groups whether they prefer to diagnose and treat the patients on their own or in co-operation with colleagues. This self-assessment was validated using the data from 2,069 physician-patient contacts: physicians preferring therapy in co-operation actually referred patients three times more often. Concerning both gastro-intestinal and rheumatic disorders, physicians' preferences for diagnostic and therapeutic co-operation are highly correlated (phi = 0.491 and 0.528 respectively); preferences for diagnostic and therapeutic co-operation across indications are not as strongly correlated (phi = 0.334 and 0.397 respectively). However, there is no general indication-independent attitude towards co-operation for individual physicians: Indication and type of services are two factors which--probably in addition to others--affect co-operation independently. We confirm earlier conclusions that the detailed analysis of provider and patient characteristics together with the actual patient management on a case by case basis is a powerful tool for health services research.     

Graphic ratings and attitude measurement: A comparison of research tactics.

This paper suggests that under certain conditions attitudes may be measured as validly and as reliably with a single "attitude report question" as with a multi-item attitude scale. 84 physicans responded to 8 Guttman scales, and also rated their attitudes on 8 comparable graphic rating scales. These data were factor analyzed, and the communalities used as an estimate of the minimal scale reliability. In general, the graphic rating scales proved as reliable as the Guttman scales. An examination of the interscale correlations showed that similar conclusions would be drawn from either technique. It is suggested that a single graphic rating may usefully substitute for a multi-item attitude scale when the attitude continuum is unidimensional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitude intensity and dissonant cognitions.

Balance and dissonance theory postulate that tension may be reduced by decreasing the importance of dissonant cognitions. 232 students at a southern university and 261 students at a northern university responded to 3 forms of an attitude scale toward integration. Attitude intensity was used as a measure of importance and was correlated with dissonance as measured by perceived discrepancy between Ss' attitude and those of their parents and close friends. The results suggest that: (a) individuals may markedly disagree with primary reference groups when these groups are perceived to be against the broader norms of his culture, and (b) dissonance may result in an increase as well as a decrease in attitude intensity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Forming attitudes that predict future behavior: A meta-analysis of the attitude-behavior relation.

A meta-analysis (k of conditions = 128; N = 4,598) examined the influence of factors present at the time an attitude is formed on the degree to which this attitude guides future behavior. The findings indicated that attitudes correlated with a future behavior more strongly when they were easy to recall (accessible) and stable over time. Because of increased accessibility, attitudes more strongly predicted future behavior when participants had direct experience with the attitude object and reported their attitudes frequently. Because of the resulting attitude stability, the attitude-behavior association was strongest when attitudes were confident, when participants formed their attitude on the basis of behavior-relevant information, and when they received or were induced to think about one- rather than two-sided information about the attitude object. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relational interpretations.

We review studies of relational interpretations as predictors of psychotherapy outcome and alliance. Investigations examining frequency of interpretations and outcome have yielded mixed findings. However, studies specifically of transference interpretations have converged toward the conclusion that high rates of transference interpretations can lead to poor outcome, particularly for patients with low quality of object relations. Several studies of the quality of interpretations have yielded consistent findings suggesting that relatively more favorable treatment outcomes are produced when therapists accurately address central aspects of patients' interpersonal dynamics. Few studies that have examined the relation between interpretations and the therapeutic alliance or tested the common clinical notion that interpretations have their greatest impact in the context of a positive alliance. Practice implications based upon this research literature are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating premature ejaculation in the multi-modal therapeutic framework: a single case study

Generally, premature ejaculation is caused by organic, psychological, interpersonal factors and lay beliefs. It is defined as a lack of adequate voluntary ejaculatory control with the result that a patient climaxes involuntarily. An ejaculatory control may be said to be established when the patient can tolerate high levels of excitement which characterise the plateau stage of the sexual response cycle without ejaculating reflexly. The most effective treatment for premature ejaculation so far is the stop-start exercises that aim to help patients tolerate a prolonged period of intense pleasurable arousal and to enjoy sexual sensation before ejaculation. However, the stop-start exercises would be more effective if they are employed in a multi-modal therapeutic framework. This is because cases of premature ejaculation differ in terms of the aetiology, pathological patterns, and the patients' personal characteristics and background. A case is presented to illustrate how the conventional stop-start exercises are prescribed in this multi-modal framework.     

A study of attitude change in the preretirement period.

2 separate sets of factors appear in preretirees' job attitude when they refer to their past experiences in middle age (30-55). Job-related factors provide satisfaction; context-related factors determine dissatisfaction. When sources of satisfaction were examined in the preretirement period, the dominant emphasis was on the context-related factors. This change of attitude was explained in view of the change of job structure. Choosing more attainable sources on the job, the context-related in case of preretirement, is more satisfying than choosing the ones which became more difficult to attain, the job-related factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical implications of research on brief dynamic psychotherapy II. How the therapist helps or hinders therapeutic progress.

In this second of a two-part article, we describe how the therapist's interpretations promote therapeutic progress. Any therapist behavior that is in accord with the patient's plan will be helpful to the patient, but interventions that are at cross purposes with the patient's plan will not be helpful. The implications of the plan concept for brief dynamic therapy are described and contrasted with other key technical, concepts such as transference interpretations, therapeutic alliance, and interpretive activity. The importance of understanding the patient's plan and intervening in accord with it are illustrated in several case vignettes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating self-care into nursing education

After external cardiac massage, 3-8% of patients present potentially dangerous liver lacerations. Here we discuss the case of a patient who presented a major haemodynamic instability following external cardiac massage and thrombolytic therapy. Falsely attributed to a cardiac complication, this was actually consecutive to a hepatic haemorrhage originating from liver lacerations caused by the cardiac massage. Haemodynamic stability was obtained by reestablishing blood volume and coagulation factors. Following this the patient evolved favorably. We discuss the importance of evoking the possible existence of abdominal lacerations after external cardiac massage and the therapeutic attitude which must be adopted towards these, particularly in the light of thrombolytic therapy used in interventional cardiology and its effect on these complications.     

Hysterectomy: improving the patient's decision-making process

Increasingly, patients are expecting to be more involved than they traditionally have been in medical and surgical decision making. The unilateral process of informed consent is evolving into one of informed collaborative choice. Hysterectomy is a procedure that is frequently performed when reasonable surgical and nonsurgical alternatives remain. When professional consensus as to the clear recommendation for hysterectomy is not present, patient choice is particularly important. Because more than 80% of health-care decisions, including those in which one of the choices is hysterectomy, are elective, gynecologists and other health care providers increasingly will need to develop more efficient and collaborative methods to integrate patient autonomy and choice into the decision-making process. There is mounting evidence that both clinical and nonclinical outcomes (satisfaction and cost) may be improved when properly informed consumers collaborate in making medical and surgical decisions. Legal liability for adverse outcomes may be decreased by increased patient participation in medical and surgical decision making. The era of managed care has created an agency problem stemming from the fact that consumers (patients) are concerned that necessary procedures and other treatments may be withheld because of cost considerations. Health plans and medical groups likely will be required to provide objective information about the options that consumers (patients) have when faced with choices, including decision making and hysterectomy. By incorporating patient expectations and preferences as part of the process of decision making, an ethically acceptable and effective method of "rationing by patient choice" may be feasible. Figure 3 is a graphic depiction of such a process of informed collaborative choice progressing from effective choices through efficient choices and then to the one providing the best value for an individual patient.     

Guilty by mere association: Evaluative conditioning and the spreading attitude effect.

Five experiments investigated the phenomenon that attitude formation is not confined to the co-occurrence of an attitudinal object with an evaluated experience. The pairing of a target with a (dis)liked person not only affects the evaluation of the previously neutral person but spreads to other individuals who are (pre)associated with the target (spreading attitude effect). Exps 1 and 2 provided evidence for the spreading attitude effect in appetitive as well as aversive evaluative conditioning. Exp 3 showed that the spreading attitude effect is a robust phenomenon resistant to extinction. Exp 4 demonstrated that attitude spread can be transferred to 2nd-order conditioning. Finally, Exp 5 supports the notion that the spreading attitude effect is not dependent on cognitive resources. Implications for social as well as applied psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical and CNS effects of oral and I.V. Thyrotropin-releasing hormone in depressed patients

Both oral and intravenous TRH produce systematic alterations in brain function of depressive patients as determined by scalp-recorded computerized cerebral biopotentials (computer EEG). The computer EEG (CEEG) profiles of both formulations are not only very similar to each other, but also resemble the CEEG profiles of psychostimulant compounds (Bio-availability). As in CEEG findings, TSH plasma levels also indicate that oral TRH is indeed an active compound. Although some "antidepressive" effects were observed after both formulations, they were not present in every patient, and it was not always the case after repetitive TRH administration, nor were the effects on depressed mood too impressive. On the other hand, in almost all patients certain behavioral effects of TRH were seen which related to "life instincts" and "life performance". The increase of interest, desire and drive for work, food and sex was one of the most striking findings, particularly after intravenous TRH. This may be responsible for the "antidepressive" effects of TRH in patients in whom depression may be the result of an inhibition of "instinctive" functions.     

Life-sustaining treatment decisions by rehabilitation patients: The uncontested high ground.

There are 3 categories of patients for whom decisions must be made regarding the appropriate level life-sustaining efforts to be used if life-threatening situations occur during rehabilitation. These are patients who (1) are suffering from a terminal condition, (2) had limited treatment "code status" or orders in the institution from which they are being transferred, or (3) have completed advance directives that express their convictions regarding certain life-sustaining procedures. The psychologist in the rehabilitation setting can assume a leadership role with the rehabilitation team, providing assistance to team members and patients with the task of delineating patient preferences for treatments toward the end of life. Here case examples (1 young adult male and 2 middle-aged patients; 1 female) with commentaries are used to bring relevant ethical guidelines from the "high ground" of abstraction to the practical application level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)