Patients' attitudes toward advance directives and end-of-life treatment decisions

Much of the patient education about advance directives described in the literature involves explaining the purpose of advance directives to patients and guiding them through the process of issuing a directive. However, well over half of the subjects in this study claimed to know enough about the directives to issue one, and almost all subjects expressed a preference for issuing directives when healthy. Although health care agencies that wish to adhere to the PSDA must continue to ask all patients if they have issued an advance directive, aggressive patient education programs that press hospitalized patients to consider issuing an advance directive may be perceived by patients as coercive and uncaring. Patient education may be more likely to achieve the goals of the PSDA if it is provided before hospitalization and if patients are encouraged to discuss their care preferences with family members who would be in a position to speak for them at the end of life. Further study of the few patients who choose to issue an advance directive would be informative. When and why they chose to issue the directive should be explored. Patients who report issuing an advance directive but do not provide their physician or hospital with a copy of the directive upon admission should also be studied to determine if this represents a desire not to activate the directive during the current admission or simply confusion about the disposition of this document. Finally, most studies of advance directives have been cross-sectional. Longitudinal study of patients who issue advance directives are needed to determine the effectiveness of these documents in influencing the end-of-life treatment that patients receive.     

Obstetricians'' knowledge and attitudes toward epidural analgesia in labour

A 30 kDa immunodominant surface antigen (p30) of Babesia equi has been used as a diagnostic antigen. The B cell epitopes on this molecule recognized by horse sera and monoclonal antibody (MAb) against p30, 36/133.97, were determined. A synthetic peptide of p30 with amino acid sequence of 123FYQEVLFKGFEAV135 exhibited strong positive reaction with the infected horse sera. In contrast, MAb 36/133.97 recognized different region of p30, as peptide synthesized with amino acid sequence of 27ASGAVVDFQLESI39 reacted strongly. In competitive inhibition ELISA, the binding of MAb 36/133.97 to recombinant p30 was inhibited by horse antibodies, although they did not recognize same or an overlapping epitope. The data on B cell epitopes in this study may be important in improving serodiagnostic methods of B. equi infection.     

A spontaneous induction of fetal membrane prostaglandin production precedes clinical labour

Fetal membranes from term human pregnancies produce prostaglandins, and may respond to bacterial endotoxin or interleukin-1 beta (IL-1 beta) with increased prostaglandin E2 (PGE2) production. The effects of endotoxin persisted for up to 24 h, whereas those of IL-1 beta were maximal 4-8 h after addition. The maximum levels of PGE2 (200-350 pg/ml) were similar in all experiments, and were independent of the stimulus used. Not all tissues responded to these stimuli; those which did not had basal levels of PGE2 production of 200-350 pg/ml, which was not further increased by endotoxin or IL-1 beta. The basal production from these tissues was therefore similar to the maximal production from those tissues which responded to endotoxin or IL-1 beta. The high basal production of PGE2 was attributed to prior in vivo activation of the membranes such that PGE2 synthesis could not be further stimulated in vitro. Overnight pretreatment with aspirin decreased basal PGE2 production from these activated membranes to < 100 pg/ml/4 h during subsequent culture in aspirin-free medium. Both endotoxin and IL-1 beta increased PGE2 production from the activated aspirin-pretreated membranes during this culture time, but this was transient as after 12 h of culture basal PGE2 production rose to over 200 pg/ml despite aspirin pretreatment.     

Prostaglandins compared with oxytocin for induction of labour at term (author's transl)

12 cases of induction of labour with prostaglandin F2 alpha and 8 with prostaglandin E2 were compared with 14 cases in which induction was undertaken with oxytocin. All inductions were successful, the induction--delivery intervals being slightly shorter in the prostaglandin groups than in the oxytocin group. Both with prostaglandin F2 alpha and with prostaglandin E2 the cardiotocogram showed uterine hyperactivity in most of the cases with an unexpected, episodically-occurring increase in basal uterine tone and remarkable tachysystoly. Uterine hyper-activity led to fetal heart rate alterations of the "dip 2" type in about 50% of the cases. According to these results prostaglandins cannot be considered superior to oxytocin for the induction of labour at term.     

Patients' rights.

Comments on T. S. Szasz's (see record 1983-05532-001) mention of slavery in proposing the idea of a "psychiatric will." The present author draws parallels between the rationale for the enslavement of Blacks and the rationale for involuntary commitment (vs patients' rights) of the mentally ill in the US. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' self-perceived treatment needs and their relationship to background variables.

Developed and administered a 93-item scale, assessing the psychicatric patient's self-perceived treatment needs, to 118 female and 114 male psychiatric patients of caucasian, puerto rican, and negro ethnic backgrounds. 7 factors were extracted by the principal component method. These factor clusters represented the need for help with anxiety-depression, superego complaints, gross psychotic symptoms, physical symptoms felt to be responsible for emotional difficulties, feelings of inadequacy, economic-vocational complaints, and marital difficulties. Results of further analysis indicate that these 7 factors show only a minimal relationship to the background variables chosen, I.e., sex, age, and ethnic background. The factor representing economic-vocational complaints was associated with the younger age groups, females, and the recently arrived immigrant group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reciprocal relation between attitudes and behavior recall: Committing people to newly formed attitudes.

Reports 3 studies that used a total of 195 male and female undergraduates. Exp I showed that shifts in attitude were accompanied by shifts in the recall of the more qualitative rather than quantitative aspects of past behaviors. Exps II and III assessed the effects of recall on Ss' commitment to newly formed attitudes. On the premise that behavior recall is biased so as to be consistent with salient attitudes, it was hypothesized that recall would serve to increase Ss' commitment to their attitudes. In Exp II it was assumed that degree of commitment to an attitude would be reflected in the persistence of the attitude, behavioral intention, and actual behavior. As anticipated, Ss' intentions were more consistent with their attitudes when they had been prompted to recall attitudinally relevant behaviors. However, recall did not affect attitude persistence or actual behavior. In Exp III, commitment was measured by resistance to an attack on an attitude. Ss were more likely to maintain an attitude in the face of an attack if they had been induced to recall attitudinally relevant behaviors. The data support the hypothesis that attitudes can affect recall, which in turn affects commitment to the attitudes. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

General practitioners'' attitudes to psychiatric and medical illness

BACKGROUND: General practitioners are increasingly involved in the care of patients with long-term psychiatric disorders. We have previously reported that general practitioners are less willing to treat patients with schizophrenia than those without such a diagnosis, but this may have been attributable to a reluctance to treat patients with any psychiatric or chronic illness. We, therefore, examined general practitioners' attitudes to patients with chronic psychiatric or medical illnesses. METHODS: A random sample of 260 local general practitioners were each sent one of our case vignettes which were identical apart from mention of a previous diagnosis of schizophrenia, depression, diabetes or no illness. The general practitioners were asked to indicate their level of agreement with 13 attitudinal statements based on the vignette. RESULTS: One hundred and sixty-six (66%) of the general practitioners responded to the case vignettes. Those responding to the vignette about the patient with schizophrenia were less happy to have that patient on their practice list and were more concerned about the risk of violence and the child's welfare. Those responding to the depression vignette were more likely to offer the patient antidepressants or counselling; and those who replied to the diabetes case were most likely to refer the patient to a hospital specialist. These differences were not attributable to the personal or practice characteristics of the general practitioners. CONCLUSIONS: Patients with schizophrenia arouse concerns in general practitioners that are not simply due to those patients suffering from a psychiatric or chronic illness. Our results suggest that some patients with schizophrenia may find it difficult to register with a general practitioner and receive the integrated community-based health care service they require. Psychiatrists should provide education and support to general practitioners who look after patients with schizophrenia.     

Casualty nurses' attitudes to attempted suicide

This study explores the attitudes of casualty nurses to attempted suicide. The nurses' age and length of experience in casualty were the independent variables. A total of 142 nurses from 11 hospitals in Northern Ireland had questionnaires circulated to them, with a 66.9% response rate. There were significant differences on four of the variables in relation to nurses' ages, and on two of the variables in relation to the nurses' length of experience in casualty. The older and the more experienced nurses seem to have more positive attitudes than the younger or the less experienced nurses. However, further nursing research, in Northern Ireland, is needed to corroborate these findings. Other recommendations are made.     

Asian women's attitudes to breast self-examination

This pilot study investigates the attitudes of Asian women towards breast self-examination and breast awareness. It attempts to identify why Asian women may not be aware of breast cancer or practise breast self-examination and discusses issues such as religious beliefs, psychological attributes, perception of the causes of breast cancer and the availability of resources and translated material.     

Doctors'' attitudes to acupuncture--a Norwegian study

Betahistine is widely used in the symptomatic treatment of peripheral and central vestibular disorders. However, its remains unknown whether the drug can act directly on inner ear sensory organs. To this end, the effects of betahistine (10(-7)-10(-2) M) were examined on isolated preparations of frog semicircular canal mounted in a double-celled bath which allowed drug administration both in the endolymphatic and in the perilymphatic fluid. The effects of betahistine were evaluated by recording ampullar receptor potentials and nerve firing rate both at rest and during mechanical stimulation of the isolated preparation. The results demonstrated that endolymphatic administration of betahistine had no effect, whereas its perilymphatic administration could reduce greatly ampullar receptor resting discharge but had little effect on mechanically evoked responses. This observation may explain the anti-vertigo effects of betahistine. Vertigo is normally due to uncontrolled changes in vestibular receptor resting discharge. It is therefore probable that any factor able to reduce the resting firing rate of vestibular receptors and, in consequence, its variations, may have an anti-vertigo action.