Evaluation of the training of the anesthesiologist

The effect of aminoglycosides on renal function was evaluated in 30 full-term infants who were treated within 24 h of birth with either amikacin (10 infants, group A), gentamicin (9 infants, group B), or netilmicin (10 infants, group C). Renal function was assessed before, during, and 48 h after discontinuation of therapy by measuring the plasma creatinine concentration (PCr), the fractional excretion of sodium (FENa), potassium, magnesium, phosphate (FEP), uric acid, and the urinary excretion of calcium (UCA/UCr ratio) immediately before (trough) and after (peak) the infusion of the aminoglycosides. The results were compared with 10 control newborns who did not receive antibiotics. Significant alterations in renal function were observed only during therapy with gentamicin (group B). These consisted of a sustained elevation of FENa and UCa/UCr ratio throughout therapy, a latent increase in FEP on the 7th day (P < 0.05), and lack of the normal postnatal decline of PCr in 3 of 9 infants (P < 0.01). These abnormalities persisted up to 2 days after discontinuation of therapy. Therapeutic doses of gentamicin may result in significant electrolyte disturbances in sick full-term infants.     

Volunteering for extra-hazardous duty.

What type of man volunteers for the hazardous work of participating in studies pertaining to protection against exposure to radiation? 489 cadets volunteering under experimental conditions to be exposed to cold or radiation were compared to 665 who did not. Some were asked to volunteer publicly and some privately. Psychological test scores and other data were used to compare the various conditions. "You can influence the amount of volunteering by manipulating the experimental conditions for volunteering." Volunteers were generally superior to nonvolunteers. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A driving-simulator test of Wilde's risk homeostasis theory.

Previous experimental tests of risk homeostasis theory (RHT) have failed to manipulate both motivational and nonmotivational variables in an ecologically valid within-subject design. In this study, 24 Ss operated an interactive driving simulator under varying levels of a within-subject motivational factor (monetary accident cost), a within-subject nonmotivational factor (speed limit), and a between-subjects nonmotivational factor (speeding fine). Consistent with RHT, increased speed limit and reduced speeding fine significantly increased driving speed but had no effect on accident frequency. Moreover, increased accident cost caused large and significant reductions in accident frequency but no change in speed choice. Results suggest that in contrast to motivationally based accident countermeasures, regulation of specific risky behaviors such as speed choice may have little influence on accident rates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pulmonary tuberculosis in 1996. Recent data and practical consequences for the anesthesiologist

Tuberculosis is one of the most widespread diseases, occurring in more than eight million persons, and about three million die annually of tuberculosis. In industrialized countries, the incidence has increased significantly over the last 10 years. HIV infection is a main factor leading to this increase. Outbreaks of nosocomial tuberculosis among patients and healthcare workers have been reported. Tuberculosis is often caused by multidrug-resistant bacilli in patients with HIV infection. Physicians must be aware of this danger and careful adherence to guidelines is required to prevent further nosocomial spread of the disease. Airborne transmission by inhalation of infectious aerosol justifies appropriate measures for respiratory isolation to protect medical staff and other patients from the transmission of tuberculosis. In combination with some anaesthetic agents, antituberculous drugs may be responsible for hepatic toxicity. Influence of tuberculosis on regional anaesthesia and mechanical ventilation is also considered.     

Application of the duty to protect to HIV-positive patients.

The spread of acquired immune deficiency syndrome (AIDS) has led to new questions regarding the limits of confidentiality in the psychotherapeutic relationship. We describe the duty-to-protect doctrine that has arisen out of Tarasoff and subsequent court decisions and apply it to situations in which human immunodeficiency virus (HIV)-positive patients may pose a health threat to others. No courts have as yet applied the duty to protect to cases of HIV infection. We conclude that although parallels exist between Tarasoff and HIV-infected patients, following good clinical practices can significantly reduce instances in which a duty to warn might arise. We recommend statutory solutions that would permit but not require warning potential victims of the HIV infection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of the ethical duty of physicians to disclose errors

A quantitative immunocytochemical procedure was used for evaluation of the blood-brain barrier (BBB) to endogenous albumin in plaque-forming (PF) and non-plaque-forming (NPF) groups of scrapie-infected mice at the clinical stage of disease. Ultrathin sections of brain samples (cerebral cortex, hippocampus and cerebellum) embedded in resin (Lowicryl K4M) were exposed to anti-mouse albumin antiserum followed by protein A-gold. Using morphometry, the density of immunosignals (gold particles per microns2) was recorded over four compartments: vascular lumen, endothelium, subendothelial space, and brain parenchyma (neuropil). Morphometric and statistical analyses did not reveal significant differences in the barrier function of the microvasculature of the cerebral cortex and hippocampus in either group of mice, although a slight increase in the number of leaking vessels in the PF group was noted. In contrast, in the cerebellum, the permeability of the microvessels to albumin was significantly higher in the PF than in the NPF mouse group, and this was paralleled by the infiltration of the walls of numerous vascular profiles with amyloid deposits (amyloid angiopathy). These data also indicate the existence of distinct regional differences in BBB function in the brain of scrapie-infected mice. The vascular amyloid deposits and the amyloid plaques present in the cerebral cortex of PF mice were labeled with numerous immunosignals suggesting the affinity of extravasated albumin to these deposits. In conclusion, no convincing evidence was obtained indicating that impairment of the BBB, manifested by increased permeability of vascular segments, is directly related to the deposition of amyloid in the vascular wall and in plaques. Segmental impairment of the barrier function seems to be rather the result of disturbed structural integrity of the components of the vascular wall.     

Psychotherapy and the law: The duty to warn.

Suggests that the approach by L. Everstine et al (see record 1980-31031-001) to the process of obtaining the client's informed consent is helpful and will protect both clients and therapists. The standard citation for the Tarasoff v. Regents of the University of California, 17 C.3d 425, 131 Cal Rptr. 14, 551 P.2d 334 (1976) is given. Also mentioned is a more recent case, Thompson v. County of Alameda, 27 Cal 3d 741, 167 Cal Rptr. 70, (July, 1980). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV, confidentiality, and duty to protect: A decision-making model.

Mental health professionals are confronted with complex issues surrounding confidentiality and duty to protect when treating clients with HIV. These professionals need to consider various factors when applying Tarasoff principles to protect potential victims, including the foreseeability of harm, the identifiability of the victim, and appropriate protective action. Professional ethical guidelines and legal mandates also need to be considered. The purpose of this article is to discuss the ethical and legal dilemmas faced by clinicians and to introduce a decision-making model that takes into account individual state laws. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Perioperative nursing orientation. A primer for designing your own program

The orientation program for OR nurses at Mount Sinai Medical Center has been in place for more than two years. Orientees have given consistently favorable evaluations of the program, and many of them have commented that this was the first real OR orientation that they had received in their careers. Staff acceptance of new employees has improved, and our retention rate of new employees is promising. New nurses who have been through the orientation program now can provide staffing in the OR so that more experienced nurses can participate in the RN first assistant training program that we have introduced. A structured orientation program ensures consistency in the information given to new employees. We continue to revise and improve the program based on changes in the workplace and orientees' evaluations. We believe that the time spent designing our program has paid off well in employee satisfaction and retention--in management terms, the return on investment has been good.     

Criterion shift rule and perceptual homeostasis.

Proposes a criterion shift rule that considers that the bases employed for evaluative judgments are displaced in the direction of a preceding or simultaneously encountered value. Consequences of this displacement have been discovered and rediscovered numerous times, and the many guises under which it has appeared in the literature are identified, including the diabatic effect, adaptation with negative aftereffect, attunement, and the law of contrast. The rule has been found to apply to a variety of perceptual judgments, such as those involving curvature of lines, visual area, linear and rotary movement, phonetic boundaries, and auditory localization. It also governs the systematic aftereffects produced by wearing distorted spectacles and the various examples of the context-contingent McCollough effect. The continual rediscovery of the aspects of the criterion shift rule are explained in terms of Le Chatelier's principle. It is contended that this rule may be involved in the central tendency effect observed when large numbers of judgments are made in laboratory studies, and it may contribute to experimental biases encountered when individuals make more than a single judgment in laboratory studies. It is suggested that the criterion shift rule reflects a continuing calibration of evaluative systems normally ensuring that behavior based on perception remains appropriate to current conditions. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sodium homeostasis in chronic decerebrate rats.

Two experiments examined physiological and behavioral concomitants of sodium need in supracollicularly transected and pair-fed intact male Sprague-Dawley rats. Chronic decerebrate Ss, like intact Ss, reduced their urine sodium output when placed on a sodium-deficient diet. Similarly, 24 hrs after sodium loading, decerebrate and intact Ss excreted comparable levels of the excess sodium. In the 2 hrs immediately following loading, decerebrate Ss excreted less sodium. In contrast, behavioral aspects of sodium homeostasis were completely absent in chronic decerebrate Ss. In separate experiments, intraoral intake and taste-reactivity responses elicited by intraoral infusions of NaCl were measured during sodium-replete and sodium-deficient conditions. In response to oral infusions of NaCl, intact Ss consumed significantly more and produced greater numbers of ingestive taste-reactivity responses when they were sodium deficient than when they were sodium replete. The same sodium-depletion treatments in chronic decerebrate Ss, however, altered neither the intraoral intake of NaCl nor the frequency of NaCl-elicited ingestive taste-reactivity responses. Results suggest that the behavioral compensatory responses that follow changes in the internal sodium state depend on forebrain mechanisms. (53 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public policy and public service: Our professional duty.

Psychology is a steadily maturing profession, and we psychologists are finally beginning to accept our societal responsibility to be involved in the public policy and political process. Although psychologists have shown increased involvement in the recent past, there are still many areas in which psychologists could become markedly more involved—especially in the area of programs that affect the quality of life of our nation's elderly, disabled, and poor citizens. As our profession seeks to become more active in the overall health care arena, we will, of necessity, begin to define the parameters of "quality of care" for other professions. In doing so, we must closely explore the "outer limits" of our own practice. We must ensure that all state and federal legislative (and administrative) policies do not impose arbitrary limitations on the scope of practice. To accomplish this objective, we must seek to influence our subset of our nation's health policy priorities and policies that we have traditionally shunned—the subset that affects "the public good." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled evaluation of thermal biofeedback and thermal biofeedback combined with cognitive therapy in the treatment of vascular headache.

One-hundred-sixteen patients suffering from vascular headache (migraine or combined migraine and tension) were, after 4 weeks of pretreatment baseline headache monitoring, randomly assigned to one of four conditions: (a) thermal biofeedback with adjunctive relaxation training (TBF); (b) TBF plus cognitive therapy; (c) pseudomeditation as an ostensible attention-placebo control; or (d) headache monitoring. The first three groups received 16 individual sessions over 8 weeks, while the fourth group continued to monitor headaches. All groups then monitored headaches for a 4-week posttreatment baseline. Analysis revealed that all treated groups improved significantly more than the headache monitoring group with no significant differences among the three treated groups. On a measure of clinically significant improvement, the two TBF groups had slightly higher (51%) degree of improvement than the meditation group (37.5%). It is argued that the attention-placebo control became an active relaxation condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

用职位说明书管理员工

没有职位说明书,员工当然不知道自己该对什么负责,当然也就不敢或者不愿意负责;没有职位说明书,企业人力资源管理部门也就不知道该对谁授权,不知道该授什么样的权力.所以问题根本的解决之道还是要从职位说明书做起,为员工订立职位说明书,用职位说明书管理员工.     

Satisfaction of active duty U.S. service members with military dental care

This study explores what factors influence whether active duty U.S. military personnel enroll their families in Department of Defense (DoD) or non-DoD dental insurance plans. The data come from a 26-site, cross-sectional survey of U.S. service members conducted from April 1994 to January 1995. A prestratified, randomly selected target sample of 15,915 service members yielded 12,950 respondents (81% response rate); 7,243 of these had insurance-eligible families. Age, gender, ethnicity, education, rank, marital status, branch of service, number of children, number of years of military service, and insurance status of respondents were collected on self-administered questionnaires. We performed stepwise, backward, logistic regression analysis to determine which factors influence a military family's dental insurance status. Results show that enrollment in DoD insurance is influenced by every demographic factor collected; enrollment in non-DoD insurance is influenced by fewer factors. The decision by U.S. service members to enroll their families in dental insurance plans is subject to many and complex influences.     

A model for the thermal properties

Thermal properties are important to several applications for powder metallurgy products. For example, liquid-phase sintered tungsten-copper composites are used in microelectronic packaging to obtain a high thermal conductivity in a low thermal expansion material. This article addresses modeling the thermal properties for composites fabricated by liquid-phase sintering. A computational cell is constructed with interlinked phases, consisting of a core of low thermal expansion material (tungsten) and a edge network of high thermal conductivity phase (copper). This structure is used to calculate the composition effects on the coefficients of thermal expansion and thermal conductivity. The results are applied to prior reports on W-Cu and used as a basis to identify several candidate high thermal conductivity systems for future development.