Introduction to the special issue: Testing: Concepts, policy, practice, and research.

Suggests that the social questioning and scientific probing of psychological testing has lasting benefits. Public debate has inspired new and creative thinking about the goals and uses of testing, the technology of test design, the interpretation of test scores, the adequacy and limitations of the theoretical foundations of psychological measurement, and the consequences of current practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homeless lesbians: psychology of the hidden, the disenfranchised, and the forgotten

1. Lesbians in general, and homeless lesbians in particular, are neglected and ignored not only in our culture but in the nursing profession as well. 2. Nurses who work with homeless women must be aware of and sensitive to lesbian issues when interacting with any clients. 3. The problems of individual lesbians cna be as diverse as they are for any client.     

Treatment guidelines: The good, the bad, and the ugly.

Treatment guidelines for psychotherapy describe a set of best practices based in part on scientific evidence. There have been several sets of such guidelines published recently by governmental, professional, and health services organizations. The adequacy of such guidelines, which perforce reduce the variability of professional services, depends on the adequacy of the scientific evidence with respect to both efficacy and clinical utility. The American Psychological Association formed a Task Force to develop a Template for Developing Guidelines in order to evaluate the scientific evidence for these guidelines. This article describes the Template and then applies it to a set of recently promulgated guidelines. The Template was able to demonstrate the strengths and weaknesses of the various documents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contrast-enhanced MRI of the breast: accuracy, value, controversies, solutions

OBJECTIVE: Contrast-enhanced MRI of the breast has been one of the most controversial areas of MRI. Even though most investigators have, in selected indications, been able to improve accuracy by the additional use of contrast-enhanced MRI, its abuse has been feared not only because of increased costs for imaging, but also because of increased biopsy rates caused by false positive calls and because of errors caused by insufficient standardisation. In this article an overview is given of the present knowledge about contrast-enhanced MRI of the breast. Factors that influence the accuracy and reproducibility of contrast-enhanced MRI are analysed. METHOD: Factors that influence accuracy include: (1) technical factors that influence accuracy, e.g. slice thickness (partial volume effect), motion reduction, reduction of (cardiac) artifacts, dosage of contrast agent, choice of pulse sequence and echotime, and choice of the method for elimination of fat signal. (2) Hormonal factors (timing of the examination with reference to the menstrual cycle, hormonal replacement therapy). They influence accuracy and must be taken into account. (3) Interpretation guidelines-their choice influences sensitivity and specificity mostly inversely and the use of information from conventional imaging appears necessary. (4) Patient selection influences accuracy for statistical and for biological reasons. RESULTS: Based on the present literature and on the experiences gathered in six German universities (> 12000 examinations) an excellent sensitivity (> 98%) can be achieved for the combination of mammography and MRI. However, specificity strongly varies with the indications. Recommended indications include examination of breasts with impaired evaluation due to severe scarring, after silicon implants and in the dense breast, exclusion of multicentricity and search for primary tumor. Indications under investigation include high risk patients and strictly selected problem cases. CONCLUSION: If appropriately applied and used for selected indications, contrast-enhanced MRI may allow a significant diagnostic gain. In order to take advantage of the full potentials of contrast-enhanced MRI the development of commercially available biopsy coils is essential.     

Nausea, vomiting, and retching: the management of the symptom experience

OBJECTIVES: To examine the physiology of nausea, vomiting, and retching (NVR); the impact of NVR on the patient: current measures to control NVR; and selfcare interventions. DATA SOURCES: Research studies, abstracts, and review articles relating to NVR associated with cancer treatment as well as pharmacological and nonpharmacological interventions. CONCLUSIONS: Management of the individual symptoms of NVR require expert, ongoing assessment of the patient's symptom experience that extends beyond the clinic or hospital visit. Although a number of pharmacological antiemetic agents are currently available and additional antiemetic drugs are in phase II or II trials, nonpharmacological interventions are essential to achieve effective management. IMPLICATIONS FOR NURSING PRACTICE: Continual assessment of the individual's symptom experience is imperative. Effective management of the symptom experience depends on the oncology nurses's ability to implement current knowledge of antiemetic, and other drugs; non-pharmacological interventions; and cost-effective and clinically useful patient outcomes.     

Dreaming souls: Sleep, dreams, and the evolution of the conscious mind: Book review.

Review of book, Owen Flanagan (Au.), Dreaming Souls: Sleep, Dreams, and the Evolution of the Conscious Mind. New York: Oxford University Press, 2000, 210 pp., $25.00. Reviewed by David Pincus. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal Desire: On Love, Children, and the Inner Life: Comment.

Comments on the review by Arietta Slade (see record 2005-12958-012) of the author's Maternal Desire: On Love, Children, and the Inner Life (2004). For many contemporary women, becoming a mother represents a crisis of desire. A woman finds herself suddenly, unbelievably compelled by her baby and motherhood. As Slade observed in her review, feeling the full weight of their maternal desire is conflictual for many achievement-oriented women. This is understandable, because the time devoted to caring for children is directly at odds with time devoted to other goals. However, as Slade also astutely notes, some women manage this conflict by devaluing, dismissing, or ignoring maternal desire, treating it as less valuable, less real, or less feminist than their other desires. This comment examines this tendency. The dismissal takes three main forms. The first is the view that, in talking about mothers' desire to care for their children, mothers risk naturalizing women's caregiving roles in a way that is detrimental to women's progress. Maternal desire is also neglected by the insistence that the problems and conflicts contemporary mothers face are caused by purely external forces. Finally, maternal desire is dismissed by construing it as a by-product of privilege, something only the lucky few have the luxury to indulge. Maternal Desire is an exploration of motherhood but also a plea for honoring our inner life and acknowledging the full complexity of our feelings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Helicobacter pylori: the mouth, stomach, and gut axis

The aim of this study was to identify the natural reservoir and route of transmission of Helicobacter pylori infection. Two hundred eight (208) dyspeptic patients (114 males, 94 females; peak age of cohort, 50-59.9) were recruited. Specimens were collected from saliva, supra- and subgingival dental plaque, tongue scrapings, and oropharyngeal swabs. At subsequent endoscopy, gastric antral biopsy was performed for the rapid urease test (RUT), microbiological culture, and, in some patients, histology. Gastric juice samples were aspirated, and in 50 patients duodenal aspirate was collected. Polymerase chain reaction (PCR) with primers targeted to the 16S rRNA sequence of H. pylori was also employed for each of the specimens. In those patients where H. pylori was detected from multiple sites (dental plaque, gastric juice, gastric biopsy, and duodenal aspirate), restriction endonuclease digestion with Hae III was performed to determine if they were epidemiologically linked. The results indicated that 15/208 patients (7%) tested positively for H. pylori by PCR in dental plaque; only 2 samples were positive by culture. In none of the other oral sites sampled was H. pylori detected by any test used in the study. Gastric juice and gastric biopsy specimens from 36/ 208 patients (17%) and 114/208 patients (55%), respectively, were positive by PCR. Duodenal aspirate from 6/50 patients (12%) also tested positively by PCR. All specimens tested by restriction endonuclease digestion with Hae III (15/15 patients) were positive in both antral biopsy and gastric juice specimens, as well as 5 specimens from the duodenal aspirate. Four of the dental plaque strains had restriction patterns similar to those of the stomach and duodenal sites, providing evidence that these sites were infected with the same strain of H. pylori. In conclusion, the results suggest that H. pylori selects the gastric mucosa as its preferred site. The detection in dental plaque could indicate that the oral cavity may act as a reservoir or sanctuary for the organism. Whether H. pylori is a resident or transient oral microorganism is still unclear, although it is more likely to be transient in nature.     

Engendering the dread disease: women, men, and cancer

This paper, based on an analysis of cancer articles published in popular periodical literature since the early part of the century, argues that gender has played a key role in medical and popular understandings of cancer. Cancer education, the author finds, has taught women and men different things. Public health materials created with the intention of improving health through education actually send a multiplicity of messages, not all of them helpful. This essay suggests that public health messages targeted by sex are problematic, although perhaps necessary. The paper also contributes to scholarship concerned with the question of how people develop their ideas about risk of disease.     

Renal lesions in Von Hippel-Lindau disease: the benign, the malignant, the unknown

This study analysed the frequency of distress at induction (DAI) in 2122 paediatric patients. The data were analysed to assess predictors of DAI and to examine associations between predictors of DAI and recovery characteristics. Patient age, preoperative behaviour, premedication (oral midazolam, n = 480) and venue for anaesthesia induction were associated with changes in the incidence of DAI. Distressed preoperative behaviour was a good predictor of DAI in all age groups. Premedication reduced the incidence of DAI in children aged 0.5-2 years old, and in older children who were distressed preoperatively. Induction in the Day Surgery Unit was associated with a reduction of the incidence of DAI in younger children. Children with DAI were more likely to suffer from distress at arousal (P = 0.001). Average early recovery time was prolonged 4.4 minutes and average discharge time in day patients was delayed 36 minutes by the use of oral midazolam premedication. Premedication was not significantly associated with arousal distress. We conclude that a policy of optimizing nonpharmacological approaches for minimizing induction distress, combined with selective premedication with oral midazolam, can produce a low incidence of induction distress and adverse effects.     

Lead and the kidney: nephropathy, hypertension, and gout

Lead intoxication in human beings has been documented since the second century B.C. Renal disease, hypertension, and gout have all been linked to lead by strong circumstantial evidence. Both acute and chronic nephropathy can occur as a result of lead poisoning. Acute renal failure develops following acute lead intoxication and is often associated with gastrointestinal, neurologic, and hematologic disorders. Both blood and urinary laboratory abnormalities are associated with acute intoxication and are often diagnostic. Chronic lead nephropathy, a chronic tubulointerstitial nephritis on biopsy, occurs in the setting of long-term lead exposure and is often associated with hypertension and gout. Diagnosis of chronic lead nephropathy is more difficult since the laboratory abnormalities seen with acute lead intoxication are not present with chronic lead exposure. The typical clinical picture and the exclusion of other causes of renal disease allow the diagnosis of chronic lead nephropathy to be made. Evaluation of lead stores by either the calcium disodium edetate (EDTA) mobilization test or K-x-ray fluorescence are helpful in clinching the diagnosis. Treatment with EDTA lead mobilization is effective for acute lead poisoning while avoidance of further lead exposure prevents recurrence of lead intoxication. Treatment of chronic lead nephropathy with EDTA lead mobilization is useful if renal failure is modest; however, EDTA mobilization is of no benefit in patients with more severe renal insufficiency.