Doctors'' attitudes to fibromyalgia: a phenomenological study

BACKGROUND: Primary systemic amyloidosis is an uncommon disorder associated with the desposition of fragments of immunoglobulin light chains in a variety of tissues. Some patients present with peripheral neuropathy. The prognosis of these patients is not clear. METHODS: We searched the medical records of all patients seen at the Mayo Clinic between January 1, 1978 and December 31, 1994 with the diagnosis of amyloidosis. Twenty-six patients with sural nerve biopsy-proven amyloid neuropathy and a documented monoclonal protein in the serum or urine were studied. RESULTS: The most common symptoms that led to the diagnosis of primary amyloid neuropathy were paresthesias (81%), muscle weakness (65%), and numbness (58%). The median duration of symptoms before diagnosis was 29 months. Symptoms of autonomic neuropathy were present at diagnosis in 17 patients (65%). Other organs were involved in most patients. The monoclonal light chain protein detected was lambda in 18 patients (69%) and kappa in 8 (31%). The neuropathy was chronic, debilitating, and showed relentless progression. Twenty-two patients (85%) died (median survival 25 months) and 4 patients were alive at a median follow-up of 4.5 years. Progressive amyloidosis was the cause of death in most patients. Survival was significantly better in the patients with a serum albumin level >3 g/dL (median survival 31 months compared with 18 months; P <0.01, log-rank test). CONCLUSIONS: Patients with primary systemic amyloidosis in whom neuropathy is the dominant clinical manifestation often do not receive a diagnosis until years after the onset of symptoms. The prognosis is worse than previously indicated. Neuropathy does not improve with therapy.     

On memories of childhood abuse: a phenomenological study

OBJECTIVE: To explore the phenomenon of memories and reported recovered memories of childhood abuse, and to examine ways in which clients and therapists assess the veridicality of such memories. METHOD: Qualitative methodology utilizing phenomenological inquiry. Within the context of a wider study exploring perceptions of helpful and unhelpful factors in the therapeutic process, a sub-sample of 36 in-depth interviews with clients, therapists, and therapists who considered themselves to have been abused as children included a focus on abuse-memory experiences. Data were analyzed according to Grounded Theory principles. RESULTS: Participants described six types of abuse-memory experiences. The most frequently reported type was where abuse was known about but kept "out of mind." The six types can be collapsed into three main categories: (1) continual knowledge of abuse (69.5%); (2) unexpected abuse-memories recovered from a prior state of partial knowledge of abuse (16.5%); and (3) abuse-memories recovered from a prior state of no knowledge of abuse (30%). Independent corroboration of recovered memories was rare; and criteria which were reportedly used to assess the veridicality of such memories were problematic when viewed in the light of cognitive psychology research on memory processes. CONCLUSION: It seems that most people who were abused as children have always had continual knowledge of this, although it is often only much later than many connect problems in adult life with the consequences of such abuse. People also experience the recovery of memories of abuse about which they were previously unaware. There is a danger that the specific controversy surrounding "false memories" may become over-generalized contributing to increased public scepticism about the prevalence and negative impact of child abuse, and the potential effectiveness of appropriate therapeutic services.     

Adolescent process of coming to accept asthma: a phenomenological study

Health care team members in the clinical setting frequently comment that if adolescents would just accept their asthma and the need for continued treatment they would not experience so many problems. A review of the literature reveals researchers have not explored the process of acceptance or what effect acceptance may have in the lives of adolescents experiencing asthma. The purpose of this study was to identify the essential structure of the process of acceptance of chronic illness by adolescents experiencing asthma/reactive airway disease. Phenomenological design, method, and analysis within a life-span developmental framework guided this study. The sample consisted of 6 adolescents diagnosed with asthma who were identified by health care professionals as verbalizing and demonstrating acceptance of their chronic illness. The results have implications for diagnosing lack of acceptance and developing and testing interventions to facilitate acceptance.     

Self-care ability in a group of elderly Swedish people: a phenomenological study

The aims of this study were to describe self-care ability in a group of Swedish elderly and to elucidate the meaning of actualizing this self-care ability into self-care activity. Two different phenomenological methods were applied in the analyses of 11 self-reports written by home dwelling elderly in the community. The eidetic structure of self-care ability was twofold; it entailed, first, being present to the opportunity to act on certain perceived influences on the body and, second, alone or with support from somebody else to be able to bring about a change in attitude towards one's personal lifestyle or life situation. The meaning of actualizing this ability was interpreted as self-realization or self-transcendence.     

Child teacher relationship training: A phenomenological study.

This article examines the findings from a phenomenological study of 10 early childhood and Pre-Kindergarten teachers who participated in Child Teacher Relationship Training (CTRT). Results present the essence of the participants' largely affirmative experience of CTRT in regard to general applicability and interrelatedness between the CTRT model and the teachers' views on the importance of the child-teacher relationship. Implications for early childhood education and the impact of the child-teacher relationship are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aging and identity-in-the-world: a phenomenological analysis

This paper uses a criticism of "objectivistic" approaches to aging and identity as a vehicle for a phenomenological rethinking of those topics. This phenomenological approach to "identity-in-the-world" as it is experienced in everyday life leads necessarily to a theory of the temporal limits of that experience in the aging process; that is, a theory of identity, properly understood, is already a theory of aging. It is concluded that this approach overcomes the parallel problems of objectivism versus subjectivism and biologism versus sociologism, demanding a rethinking of conceptions of human nature that have predominated in social science.     

Fatigue in cancer: a phenomenological perspective

Experiments were conducted by using scrape-loading and dye transfer (SLDT) method to study the gap junction intercellular communication (GJIC) of Chinese hamster lung cells (V79), mouse fibrous cells (Balb/c-3T3), rat liver cells (WB) and human embryonal lung cells (2BS). We also observed the inhibition of the GJIC by TPA and the antagonistic effect of Curcumin derivatives on TPA. The results indicated that V79, WB, 3T3 and 2BS normal cells showed medium level of GJIC, and TPA could inhibit the GJIC to some extents. Curcumin derivatives (91022, 91022-S) could counteract the inhibition of TPA-induced GJIC. It was also found that human lung adenocarcinoma cell (A549) and GLC lacked GJIC, and 91022 could improve the GJIC of A549 cell. It may be related to its anticancer activity.     

The auditory hallucination: a phenomenological survey

A comprehensive semi-structured questionnaire was administered to 100 psychotic patients who had experienced auditory hallucinations. The aim was to extend the phenomenology of the hallucination into areas of both form and content and also to guide future theoretical development. All subjects heard 'voices' talking to or about them. The location of the voice, its characteristics and the nature of address were described. Precipitants and alleviating factors plus the effect of the hallucinations on the sufferer were identified. Other hallucinatory experiences, thought insertion and insight were examined for their inter-relationships. A pattern emerged of increasing complexity of the auditory-verbal hallucination over time by a process of accretion, with the addition of more voices and extended dialogues, and more intimacy between subject and voice. Such evolution seemed to relate to the lessening of distress and improved coping. These findings should inform both neurological and cognitive accounts of the pathogenesis of auditory hallucinations in psychotic disorders.     

Tracer flux ratios: a phenomenological approach

The kinetic behavior of tracer flows across epithelial membranes is examined and attention is called to the condition under which unidirectional tracer flows may be described by first order rate equations. It is shown that the first order nature of the tracer rate equation when combined with simple thermodynamic constraints on tracer flow yields a relation between the ratio of the unidirectional rate coefficients and thermodynamic driving forces. The form of this relation is examined for the case of simple diffusion and in the presence of coupled process.     

Conventional heart surgery with the fast-track-method: experiences from a pilot study

Early release after cardiac surgery can be promoted by implementation of a standard protocol for accelerated perioperative and early postoperative care, with optimal education and support of the patient playing a key role. We report on our preliminary experience with 100 selected patients who underwent a "fast track" protocol following coronary artery bypass (n = 61), valve replacement or reconstruction (n = 34) or closure of an atrial septal defect (n = 5) between 1996 and 1998. Surgery was performed through a midline sternotomy using normothermic or mild hypothermic cardiopulmonary bypass. Patients undergoing cardiac surgery with less invasive techniques were excluded from this study. The following criteria had to be fulfilled for early hospital discharge: sinus rhythm, temperature below 37.5 degrees C, stable haematocrit around 0.30, uncomplicated wound healing and complete mobilisation including stair exercises. Mean duration of the operation was 137 +/- 24 minutes and mean intubation time was 4.5 +/- 3 hours. Mean duration of hospitalisation from the day of the operation was 4.9 +/- 2.1 days. There was no early or late mortality in this group of patients and only 2 patients had to be re-admitted on postoperative day 10 and 14 because of atrial fibrillation in one and a wound healing problem in the other. Accelerated recovery and early hospital discharge is highly attractive in selected patients; in helps to promote early cardiac rehabilitation and the costs of the procedure can be substantially reduced. According to our experience and the most recent literature, this approach does not expose patients to higher mortality or morbidity. In addition, fast-tracked patients have shown a higher level of satisfaction. Under optimal cooperation between surgery, anaesthesiology and intensive care unit, the fast-track protocol can be applied in approximately 30% of overall adult cardiac surgery patients.     

Teacher beliefs about instructional choice: A phenomenological study.

We interviewed 36 practicing teachers, using phenomenological methods to examine what, when, where, and to whom teachers offer choice. Teachers participated in pilot, interview, and member-check phases. Our final results focused on the following main points: (a) Teachers believe that choice promotes learning and motivation; (b) choice is used in a number of ways; (c) teachers have a variety of reasons for giving choices; and (d) teachers imposed limits on classroom choice based on (e) student age, ability, and prior knowledge and (f) teacher experience, efficacy, and management style. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The hysterical personality disorder: a phenomenological approach

The background of the present study is a general uncertainty as to what comprises the essence of hysterical (histrionic) personality disorder. Using phenomenological methodology, phenomena observable in the 'classic' hysterical personality are analysed, described, named, and classified according to the basic functions of human experience and behaviour. The resulting psychopathological picture of the hysterical personality facilitates a differential diagnosis that is often decidedly difficult. The phenomenon of dissociation of the mental processes is demonstrated for the various basic functions. A specific feature of the disorder is shown which generates a dissociation of contents of the personality along a conscious-preconscious-unconscious continuum. It is concluded that dissocation is, in the final analysis, the prerequisite for a compromised and partial acting out of prohibited non-integrated elements, e.g. aggression, as a coping strategy.     

Ambulatory anal surgery: a feasibility study

Because of the current economic situation, ambulatory surgery has become a modus vivendi for the surgeon. The aim of this study is to examine the feasibility of anal ambulatory surgery and the results obtained over a period of 12 months. 141 consecutive patients underwent anal surgery: 108 on an ambulatory basis (77%) and 33 were admitted to the hospital (23%). The reasons for admitting the patients were the complexity of the operation in 19 (8 sphincteroplasty, 5 complex fistulae, 3 recto-vaginal fistulae...) emergency procedures in 9 and miscellaneous reasons in 5 patients. All 108 patients operated on an ambulatory basis could be discharged at the end of the day but two, one for urinary retention and another because he underwent a more extensive procedure than first planned. Three more had urinary retention; they were catheterized and discharged on the same day. The four patients (3 women and 1 man) developed urinary retention following spinal anesthesia. Three patients (2.7%) had to come back to the emergency room in the first 24 hours for bleeding from the operative site. One of them had to be transfused and reoperated for hemostasis. In conclusion, ambulatory anal surgery is feasible in a large proportion of cases (77%) with a low rate of complications (7.4%) and low rate of unexpected hospital admission (2.7%). In a specialized colorectal unit, 23% of patients required hospitalization for a longer stay.     

Providing nursing care for a patient with borderline personality disorder on an acute inpatient unit: a phenomenological study

The aim of the present study was to investigate any relationship between the level of oral hygiene and probing pocket depth reduction over time after periodontal treatment in sites with either vertical or horizontal destructions. The investigation was conducted as a retrospective study on a 3-year consecutive referral population of periodontitis-prone patients based on full-mouth oral radiographic examinations, probing pocket depth registrations and plaque scores. The analyses were performed on a final sample of 3064 sites in 107 patients with regression analysis after adjusting for dependence within the patient. Probing pocket depth was significantly less reduced over time in sites with vertical destructions compared to sites with horizontal destructions following non-surgical treatment. Furthermore, the difference in probing pocket depth reduction between vertical and horizontal defects following non-surgical treatment increased over time in sites with plaque compared to sites without plaque, thus reflecting the importance of the patient's plaque control, especially in sites with vertical destructions. However, the difference in probing pocket depth reduction between vertical and horizontal defects did not increase over time for surgically treated teeth, a finding which probably can be attributed to a more thorough debridement of vertical defects during surgery and/or osteoplasty/osteoectomy limiting the surface area upon which a long junctional epithelium can form, which may facilitate recurrence of a periodontal pocket.     

Anatomic basis of cleft palate and velopharyngeal surgery: implications from a fresh cadaveric study

The aim of this investigation was to examine the blood supply of the normal velopharyngeal musculature and its clinical implications. Detailed dissections were performed on each side of five fresh human adult cadaveric head and neck specimens (n = 10) following carotid artery injection with liquid neoprene latex stained with green pigment. The vascular network of the soft palate was situated within its glandular layer. The velopharyngeal muscles were supplied by the following four branches of the external carotid artery: (1) ascending palatine branch of the facial artery, which supplied the palatoglossus, palatopharyngeus, musculus uvulae, and the intravelar part of the levator veli palatini; (2) ascending pharyngeal artery, which supplied the superior constrictor; (3) the previously undescribed recurrent pharyngeal artery, which supplied the extravelar part of the levator veli palatini; and (4) maxillary artery, which supplied the tensor veli palatini. All muscles except the musculus uvulae had at least a dual blood supply. Analysis of this vascular anatomy suggests that (1) the overall generous blood supply of the velum allows it to tolerate the dissection performed during intravelar veloplasty and the Furlow double opposing Z-plasty; (2) dissection around the hamulus, along the medial pterygoid plate, and in the space of Ernst should be performed carefully to avoid damage to the ascending palatine artery, ascending pharyngeal, and recurrent pharyngeal arteries; (3) vertical pharyngeal flaps are random pattern in nature; and (4) the posterior tonsilar pillar flaps of the sphincter pharyngoplasty are adequately supplied by the hamular branch of the ascending palatine artery.     

Single-stage surgery for implant placement: a retrospective study

Single-stage implant placement surgery offers patients a number of advantages. These include reduced cost and time commitments and greater comfort, function, and convenience. This article reports on the results of using a single-stage technique with 58 patients fitted with 240 implants. No implant failures were detected in any patients prior to the final attachment of a Dolder bar. Among the 27 patients and the 125 implants followed for a longer period of time, 99.2% exhibited no signs of implant mobility or pain. Indicators of gingival health and oral hygiene ranged in quality from acceptable to ideal.     

Cataract surgery from a gender perspective--a population based study in Sweden

PURPOSE: To determine the presence of any gender-related differences of preoperative subjective visual functional problems that may explain the higher frequency of cataract surgery found in women. METHODS: All patients (n=453) who, during a one-year period, underwent cataract surgery at Norrlands University Hospital, Ume?, Sweden, were included in the study. Incidence, age-distribution, visual acuity, self-estimated ability to perform vision dependent tasks as well as subjective symptoms from the cataractous eyes preoperatively and visual acuity after surgery were analyzed separately in males and females. RESULTS: Before surgery there were no statistically significant differences between men and women in visual acuity of the eyes to be operated on and the fellow eyes. Preoperatively women had significantly more subjective problems with distance-estimation for near and far (57% and 60%, respectively) compared to males (45% and 43%, respectively). Women had significantly larger problems orientating in unfamiliar surroundings. CONCLUSION: There are gender-related differences in self-assessed visual function before surgery that might contribute to the higher incidence of cataract surgery in women. Preoperatively women experience a higher degree of visual functional problems than men. Women were not found to demand cataract surgery earlier than men when preoperative visual acuities were compared.