Medical sculpture: a valuable aid to patient rehabilitation

Silicone rubber is the most satisfactory material for cosmetic prostheses. It has a soft, lifelike texture, is easily worked and easily colored and is strong enough to withstand frequent application and removal. Examples of patients referred to the medical sculptor include those with congenital defects of one or both ears, loss of the nose or an eye and orbit due to cancer surgery, loss or absence of fingers or parts of the hand and those who have had radical breast surgery.     

Review of assumptions and problems in the appropriate conceptualization of effect size.

Estimation of the effect size parameter, D, the standardized difference between population means, is sensitive to heterogeneity of variance (heteroscedasticity), which seems to abound in psychological data. Pooling s2s assumes homoscedasticity, as do methods for constructing a confidence interval for D, estimating D from t or analysis of variance results, formulas that adjust estimates for inflation by main effects or covariates, and the Q statistic. The common language effect size statistic as an estimate of Pr(X??>?X?), the probability that a randomly sampled member of Population 1 will outscore a randomly sampled member of Population 2, also assumes normality and homoscedasticity. Various proposed solutions are reviewed, including measures that do not make these assumptions, such as the probability of superiority estimate of Pr(X??>?X?). Ways to reconceptualize effect size when treatments may affect moments such as the variance are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trimethylaminuria: the use of choline as an aid to diagnosis

Trimethylamine metabolism can be studied by means of choline loading. The value and some limitations of the method are illustrated by results obtained in normal subjects, a patient with the Fish Odour syndrome and his kindred.     

The notion of somatization: an artefact of the conceptualization of body and mind

In this review published data are used to determine the benefits and costs of antenatal screening for hepatitis B carriers to prevent the later occurrence of hepatoma and chronic liver disease in their offspring. In Britain, babies born to carrier mothers have a 25% risk of perinatal infection and of becoming carriers themselves (the risk is 82% if their mothers are positive for the e antigen and 10% if negative). The carrier state increases the risk of hepatoma an estimated 86 times and the risk of chronic liver disease 20 times. Life table analysis showed that there is an 11% lifetime risk in carriers in Britain of dying from hepatoma (which results in seven years of life lost on average) and a 7% risk of chronic liver disease (14 years of life lost). Neonatal vaccination reduces the risk of the infant becoming a carrier by about 90%. Perinatal transmission occurs in 38 of every 100,000 neonates in Britain. Antenatal screening of all women and vaccinating babies of carrier mothers would prevent perinatal transmission in 34 of the 38 children (90%), or 255 per year in Britain. Of these 34, 8.4 children would be Chinese in ethnic origin, 4.2 African, 11.5 South Asian (from the Indian subcontinent), 2.0 Caribbean, and 7.3 would be white. Six deaths in the 34 from hepatoma or chronic liver disease caused by hepatitis B would then be prevented. The direct cost in Britain of screening all women, irrespective of ethnicity, at their first pregnancy only, would be 1300 pounds for each year of life saved (undiscounted) or 2500 pounds if screening at every pregnancy. Screening just Chinese, Africans, and South Asians, at first pregnancy only, would cost 330 pounds for each year of life saved but would prevent only 64% of these deaths. Vaccinating the infants of carrier mothers is likely also to prevent horizontal transmission of hepatitis B in early childhood and prevent the carrier state developing in an estimated three extra children for each child protected from vertical transmission. When this is taken into account the number of deaths prevented increases fourfold, reducing the cost for each year of life saved by 75%. Screening all women at first pregnancy only is an acceptably cost effective policy in Britain (1300 pounds for each year of life saved), actually preventing 45 deaths a year from hepatoma and chronic liver disease (or about 180 deaths if those horizontally infected are included), at a total cost of 540,000 pounds a year. It has the advantage of being comprehensive, equitable, and easier to implement than a policy based on screening of high risk ethnic groups.     

The path to a clinical pathway: collaborative care for the patient with an ostomy

A colostomy and ileostomy clinical pathway was developed at a southeastern teaching hospital in 1990 in response to excessive lengths of stay and costs at our hospital compared with national data for this patient group. A multidisciplinary clinical pathway team was formed and charged with the development, implementation, and ongoing monitoring of the clinical pathway tool and its effect on the outcomes of the population of patients with colostomies and ileostomies. Through this multidisciplinary collaboration, length of stay and cost have been reduced while quality care indicators have been maintained. This article presents the sample pathway we developed and describes the pathway development process, documentation, the variance analysis process, and the outcomes achieved with implementation. A urostomy/urinary diversion pathway that was developed after variance analysis review of the colostomy and ileostomy clinical pathway is also presented.     

Witchcraft in histories of psychiatry: A critical analysis and an alternative conceptualization.

Histories of psychiatry have typically contended that those accused of being witches during the late medieval/early modern period were mentally disturbed. Specifically, they have argued that (a) a great upsurge in mental disorder occurred in the 15th century, (b) the mentally ill were considered to be witches, and (c) witches were obviously mentally disturbed because they confessed to bizarre and impossible happenings, exhibited localized analgesia, and were sometimes insensitive to torture. These contentions are examined and found wanting. The overriding sociopolitical factors that produced and sustained witch persecutions are outlined. Witch accusations, confessions, and purported insensitivity are conceptualized in terms consonant with modern social-learning and social-role theories. (168 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commentary: Progress and problems in the cognitive approach to clinical child psychology.

Comments on articles included in the special section "Meta-analysis and Psychotherapy" in the Journal of Consulting and Clinical Psychology. Problems related to preventive programs are discussed in light of the finding that early development in childhood tends to be fluid in many instances rather than fixed. Difficulties in accounting for psychopathology in terms of cognitive variables and developmental delay are presented. Advantages and disadvantages of having diverse approaches to cognition are noted. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trichotillomania: current issues in conceptualization and treatment

Trichotillomania is a little-known disorder with wider prevalence and more significant consequences than previously believed. While sharing similarities with obsessive-compulsive disorder, compelling differences from it have also been noted. This fact, coupled with recognized overlap with other obsessive-compulsive spectrum disorders, has resulted in the ongoing evolution of our conceptualization of this illness. While empirical evidence supports the use of behavioral treatment and pharmacotherapy, considerable research is still needed before we can promise highly effective interventions tailored to the individual hairpuller. This review will summarize the evidence supporting, as well as challenging, a hypothesized link with obsessive-compulsive disorder. Current treatment approaches will be reviewed, as well as evidence for their efficacy. Suggestions will be made for future directions in this field.     

The measurement of pressure and flow in the microcirculation: application to physiological and clinical problems

The analysis of hemodynamic phenomena at the level of microscopic blood vessels of diameters ranging from 10(-2)-10(-3) cm is currently based on direct measurements of plasma pressure and red blood cell velocity in in-vivo conditions. Pressure measurements are performed with active pressure measurement systems via cannulae with 1 mum tip openings. Flow measurements are deduced from optical transit time methods from data recorded by television. The technique provides both average and dynamic data. The latter is derived from signal processing of the direct measurements by means of active filters. These techniques yield data on low level signals related to the periodic action of the heart. This analysis provides information on the transit time of pressure and flow pulses through the microcirculation. These methods are currently utilized in routine physiologic investigations and as a means for studying the human skin microcirculation of normal subjects.     

Vancomycin susceptibility as an aid to the identification of lactobacilli

Malignant mesothelioma of tunica vaginalis testis is a rare tumour usually associated with hydrocele. Until now only one case has been documented, where a pre-operative diagnosis was made by cytological examination of hydrocele fluid. We report one more case with pre-operative diagnosis using hydrocele fluid cytology.     

Grounded theory: A promising approach to conceptualization in psychology?

Suggests that psychology suffers from an elaborate research technology that overemphasizes theory verification and impairs thinking and discovery. Grounded theory is advanced as an approach to research that can address this crisis of method in psychology. The grounded approach is illustrated in terms of its application to psychotherapy process research. The emphasis on theory creation that characterizes the grounded approach is examined within the history of induction and in terms of the constant comparative method of psychology research. The challenges to and limitations of grounded theory are discussed. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Carcinoma of the vulva in women: clinical and morphopathological problems

1. To investigate the relationship between the autonomic drive to the heart and heart rate variability, as evaluated by power spectral analysis, we studied the effect of clonidine (300 microg), a central sympatholytic agent, on heart rate variability. 2. Six healthy subjects (mean age 31 +/- 3 years) were studied in the supine and the sitting position (15 min each) on two different occasions, respectively, before and after clonidine administration. Using an autoregressive approach, the low frequency (LF) and the high frequency (HF) components of power spectral analysis were measured, and their ratio was calculated. Blood pressure was monitored throughout the study and plasma catecholamines were measured at the end of each period. 3. Before clonidine, assumption of the sitting position induced increases in LF, LF/HF ratio, blood pressure and plasma noradrenaline. Clonidine induced remarkable reductions in the normalized values of the LF component and the LF/HF ratio in both the resting and the sitting position (supine: LF = -68%, LF/HF ratio = -80%; sitting: LF = -23%, LF/HF ratio = -55%) without affecting the central frequencies of LF and HF components. Blood pressure and plasma catecholamines also significantly decreased after clonidine. 4. These results support the hypothesis that the LF component of HRV, expressed in normalized units, is an indicator of the sympathetic control of the heart. In addition, this component seems to be largely of central origin, because it is markedly reduced by the central sympatholytic action of clonidine.     

Subglottic stenosis in an HIV positive patient: an exceptional form of clinical presentation in Kaposi's sarcoma

The case of a 29-year-old HIV positive male patient suffering from a Kaposi's sarcoma exclusively located in the proximal third of the trachea and subglottic region is presented. The patient was found to have included an obstruction of the upper airway. A characteristic endoscopic appearance led to the final diagnosis. A combined treatment with Nd-YAG laser endoscopic resection and laringotracheal irradiation was performed. Pathological examination confirmed Kaposi's sarcoma.     

Current problems of occupational medicine in mining enterprises of the North

The article deals with causes of occupational diseases (including those due to complex factors) among miners in Far North and other regions of CIS. The authors present main principles for more healthy work conditions with considerations of climate surroundings.     

Analogies as an aid to understanding and memory.

Analogies from near and far knowledge domains were presented with three different scientific passages. A no-analogy condition served as a control. Ss who read passages with a distant domain analogy listed more facts in free recall and cued recall tests, and answered correctly more questions that required inferences or comprehension of a novel analogy. Before or after placement of the analogy was a nonsignificant variable. There were no differences between near-domain analogies and the no-analogy control conditions. These results are interpreted as support for the concept of structure mapping as the underlying process in the use of analogies. Results suggest that analogies from far domains promote comprehension of and memory for scientific text. (PsycINFO Database Record (c) 2010 APA, all rights reserved)