Electrolysis: observations from 13 years and 140,000 hours of experience

Electrolysis has been performed since 1875. Electrolysis satisfactorily removes hair from women with static hair growth, but women with hirsutism often require concomitant management of their hormonal problems. We have found the blend method to be the most effective modality for permanent hair removal. Attention must be given to proper electrolysis technique, including accurate needle insertion and appropriate intensities and duration. Scarring does not occur with properly performed electrolysis. Hair is not an electrical conductor and electronic tweezers do not result in permanent hair removal. Shaving 1 to 5 days before electrolysis greatly increases efficacy because it ensures that only growing anagen hairs are epilated. The recent availability of EMLA (eutectic mixture of local anesthetics) has been beneficial in reducing the sensations of electrolysis. The availability of prepackaged, presterilized, individual electrolysis needles has greatly reduced the need for more complicated sterilization procedures.     

Military health care providers' views on prescribing privileges for psychologists.

Selected military psychologists have been trained and privileged to independently prescribe psychotropic medications. To explore the attitudes of health care professionals toward prescribing authority, a survey of 395 military psychiatrists, psychologists, primary care physicians, and social workers was conducted. Psychologists, physicians, and social workers supported prescribing privileges and continuation of the training programs. Results suggested that support by physicians and social workers is based on improving access to comprehensive mental health care for their patients. Psychologists advocating prescribing privileges at the state level need to pursue the training and licensing authority to prescribe independently. The opposition of organized psychiatry seems assured. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of topical anaesthesia and electronic nerve stimulation for reducing the pain of intra-oral injections

This paper describes a model for investigating the efficacy of different methods of alleviating the pain of intra-oral injections. The efficacies of the topical anaesthetic EMLA cream and electronic nerve stimulation as means of reducing the discomfort of palatal injections prior to the extraction of maxillary teeth were investigated using the model in one hundred patients. EMLA reduced the pain of injection compared with placebo (P < 0.05) whereas the pain reported after electronic nerve stimulation did not differ significantly from placebo. It is concluded that EMLA is useful in reducing the pain of palatal injections.     

Osteogenesis of the fetal bovine skull

BACKGROUND: We wanted to validate reports that deaf persons have difficulty obtaining medical care by comparing physicians' attitudes towards these patients with physicians' attitudes toward their patients in general. METHODS: Two questionnaires were randomly distributed to physicians attending continuing medical education conferences at the University of Michigan during a 3-month period. The questionnaires were identical except that one asked about deaf patients and the other about patients in general. The questions assessed the respondent's perceptions of communication with patients, attitudes toward their patients, knowledge of current information about deaf people, and demographics. RESULTS: One hundred sixty-five physicians responded, 94 to the general questionnaire and 71 to the deaf questionnaire. The two physician groups were similar demographically, but 165 differed significantly in communication and attitude variables. Physicians receiving the questionnaire focusing on deaf patients reported greater difficulties in understanding (P < 0.001) and maintaining free-flowing conversations (P < 0.001), and that these patients had more difficulty understanding them (P < 0.001), trusted them less (P < 0.001), asked them to repeat statements more often (P < 0.001) and were less likely to understand the diagnosis and recommended treatments (P < 0.001). Physicians also reported feeling less comfortable with deaf patients (P < 0.001) and that they asked fewer questions (P < 0.001). Physicians were more likely to say that deaf patients rely on interpreters (P = 0.040), get frustrated easily (P < 0.001), and are harder to communicate with (P < 0.001). There were no significant differences between the two groups in knowledge about deaf people. All physicians, however, displayed ignorance about their legal obligations under the Americans with Disabilities Act to provide interpreters for their deaf patients. CONCLUSIONS: Physicians surveyed about deaf patients reported significantly greater difficulties communicating with and different attitudes toward these patients than physicians surveyed about their patients in general. All physicians were unaware of their obligations under the Americans with Disabilities Act to provide interpreters for deaf patients. Research is needed to determine whether physician attitudes and beliefs affect the actual quality of care they deliver to deaf patients.     

Studies of drug delivery systems for a therapeutic agent used in osteoporosis. II. Enhanced absorption of elcatonin from nasal mucosa in rabbits

EMLA cream 5% (a eutectic mixture of lidocaine and prilocaine) is a topical anaesthetic that has become widely used to minimize pain from venipuncture in children. It has not, however, been recommended in neonates owing to the potential risk of methaemoglobinaemia induced by prilocaine. The aim of this study was to establish the safety of 1 g EMLA cream 5% used on intact skin in term neonates. Forty-seven neonates, aged 0-3 months, with a postconceptual age of > or = 37 weeks and a body weight between 2.8 and 5.7 kg, were included in a double-blind, randomized, placebo-controlled study. After baseline observations a total dose of 1.0 g EMLA/placebo was applied to two sites (0.5 g site(-1)) for 60-70 min. Venous methaemoglobin (metHb) levels were determined in each patient at baseline and at three randomly assigned times, 0.5-18 h after application. Following application of the cream, the mean metHb levels were 1.17% (range 0.50-2.53) in the EMLA group and 0.96% (range 0.50-1.53) in the placebo group. The metHb concentrations were significantly higher in the EMLA group in the intervals from 3.5 to 13 h after application than in the placebo group, but were well below potentially harmful levels. Based on these results, a 1-h application of 1 g EMLA cream is safe when used on the intact skin of term neonates below 3 months of age.     

Children's attitudes toward peers with disabilities: the Israeli perspective

Attitudes toward peers with disabilities were compared in two groups of elementary school children, Israeli (2845 children) and Canadian (1831 children), using the Chedoke-McMaster Attitudes Toward Children with Handicaps (CATCH) scale. Israeli children expressed significantly more positive general attitudes (P=0.0001). The more favourable attitudes were seen in both areas evaluated by the CATCH, the cognitive and the affective-behavioural. In both groups, children who had had previous experience with a disabled person expressed more positive attitudes (P=0.001). An effect of gender was seen in the Canadian but not in the Israeli children. Cultural factors appear to play a role in modelling children's attitudes toward their disabled peers and therefore should be considered before educational programmes are implemented.     

Tyrosine phosphorylation of focal adhesion kinase (p125FAK): regulation by cAMP and thrombin in mesangial cells

This study aimed at evaluating the influence of submaximal isometric contraction on pressure pain thresholds (PPTs) in 14 fibromyalgia (FM) patients and 14 healthy volunteers, before and after skin hypoesthesia. PPTs were determined with pressure algometry over m. quadriceps femoris before, during and following an isometric contraction. Maximum voluntary contraction (MVC) was assessed using a computerized dynamometer. A contraction of 22% MVC on average was held until exhaustion (max. 5 min) and PPTs were assessed every 30 sec. A local anesthetic cream and a control cream were applied following a double-blind design and PPTs were reassessed. In healthy volunteers PPTs increased during contraction (P < 0.001), then decreased after the end of contraction (P < 0.001) but remained above precontraction values during the 5 min of post-contraction assessments (P < 0.001). In FM patients PPTs decreased in the middle of the contraction period (P < 0.05) and remained below precontraction levels during the rest of the contraction period (P < 0.05) and during the 5 min of post-contraction assessment (immediately post-contraction NS; 2.5 min post-contraction P < 0.01; 5 min post-contraction P < 0.05). The normalized PPTs were significantly lower in patients than in controls during contraction (start P < 0.01; middle P < 0.001; end P < 0.001) and at all times during post-contraction assessments (P < 0.001). Anesthetic cream raised PPTs at rest in controls (P < 0.01) but not in FM patients, and did not influence contraction or post-contraction PPTs in either group. Therefore, the increased pressure pain sensibility in FM patients is more pronounced deep to the skin. The observed decrease of PPTs during isometric contraction in FM patients could be due to sensitization of mechanonociceptors caused by muscle ischemia and/or dysfunction in pain modulation during muscle contraction.     

Treatment failures in private practice: How do psychologists proceed?

Very little is known about how psychotherapists proceed when patients fail to progress. Psychologists in independent practice (N = 591) were surveyed regarding their approach to treatment failures in an updated partial replication of P. C. Kendall, D. Kipnis, and L. Otto-Salaj (1992). Overall, practitioners reported seeing patients a median of 12 sessions before concluding no progress was being made and relying on colleague consultation and clinical experience to formulate their next steps. Practitioners of different orientations varied on treatment duration and ensuing strategies. Specifically, psychodynamic practitioners treated patients significantly longer than cognitive-behavioral and eclectic practitioners before concluding treatment failure. Cognitive-behavioral and eclectic practitioners were more likely than psychodynamic practitioners to utilize treatment materials informed by psychotherapy outcome research and to refer patients to other clinicians. The ethical and practical implications of handling treatment failures in private practice are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with improved outcome of Pseudomonas aeruginosa bacteremia in a Finnish university hospital

All 134 episodes of bacteremia caused solely by Pseudomonas aeruginosa in a university hospital in the periods 1976-1982 and 1992-1996 were reviewed retrospectively to determine the clinical manifestations, outcome and prognostic factors. The mortality for the 30-day interval after drawing the first positive blood culture was 41%, but dropped from 53% in the first period to 29% in the second period (P=0.006). Mortality was highest in patients treated with an aminoglycoside only, as against those treated with other appropriate antibiotics (55% versus 25%, P=0.001). Over the two decades studied, use of an aminoglycoside only decreased, use of paracetamol (=acetaminophen) increased, and removal of both urinary and blood vessel catheters became more common. The mortality was 18% in patients with catheter removal (46% in the other patients, P=0.017) and 27% in patients who received paracetamol around the time of drawing the first positive blood culture (50% for the other patients, P=0.010). Logistic regression analysis showed that shock, central nervous system involvement, preceding thromboembolism and rapidly fatal underlying disease were associated with a fatal outcome, whereas catheter removal, appropriate antibiotic therapy and paracetamol therapy were associated with survival. The improved prognosis of Pseudomonas aeruginosa bacteremia over the two decades is thus due mainly to three changes in management of the infection: the more frequent use of new anti-pseudomonal beta-lactams and ciprofloxacin instead of aminoglycosides as monotherapy; the more frequent practice of removing catheters; and the increased use of paracetamol around the time of drawing the first positive blood sample.     

Rewards of entering podiatric medicine and attitudes toward older adults

This study examined the relationships between social and demographic characteristics (ie, gender, race, year in school, desired residency choice, and socioeconomic background), motivations for entering the profession of podiatric medicine (extrinsic and intrinsic rewards), and negative attitudes toward treating elderly patients. The study used ordinary least squares multiple regression models to analyze data from a random, national sample of 448 podiatric medical students. In particular, the ordinary least squares models were developed to determine the independent effect of intrinsic and extrinsic rewards on negative attitudes toward treating elderly patients. Consistent with the study hypotheses, after adjusting for social and demographic characteristics, the study found extrinsic rewards to have strong positive relationships with negative attitudes toward treating elderly patients, and intrinsic rewards to have strong negative relationships with negative attitudes toward treating elderly patients. The authors discussed the implications of the findings for podiatric physicians and educators training podiatric medical students.     

Age-related decreases in chromium levels in 51,665 hair, sweat, and serum samples from 40,872 patients--implications for the prevention of cardiovascular disease and type II diabetes mellitus

This report shows, for the first time using modern analytical techniques, highly significant age-related decreases in chromium levels in 51,665 hair, sweat, and serum samples obtained from 40,872 patients referred by their physicians to an independent medical research clinic and laboratory (r = -.598 to -.762, P < .0001 for all correlations). Males were found to have significantly lower mean chromium levels than females (P < .05 to .0001). There was good correlation between chromium levels in hair, sweat, and serum (r = .536 to .729, P < .0001 for all correlations), indicating that hair and sweat chromium levels are valid additions to the serum levels in assessing chromium status. Chromium measurements in sweat, hair, and serum were performed using graphite furnace atomic absorption spectrophotometry. The influences that age-related decreases in chromium levels might have on increasing the risk to develop age-related impaired glucose metabolism, disordered lipid metabolism, coronary heart disease, arteriosclerosis, and type II diabetes mellitus are outlined, and the role that refined carbohydrates play in the development of compromised chromium status is presented.     

Physician training for patient-centered nutrition counseling in a lipid intervention trial

BACKGROUND: We examined the effect of a 3-hr training program on physicians' lipid intervention knowledge, attitudes, and skills. The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered counseling to enable patients with elevated lipids to change their dietary patterns. METHOD: The training is part of a randomized trial of lipid-lowering interventions, the Worcester Area Trial for Counseling in Hyperlipidemia. Primary care internists practicing in a health maintenance organization (HMO) were assessed, before and after training using questionnaires and audiotapes to document changes in knowledge about diet, attitudes about intervention, reported nutrition intervention practices, and counseling and assessment skills. Physicians also rated the value that they thought the training program had to them. RESULTS: After completion of the program the physicians' use of dietary counseling steps, as assessed by blinded evaluation of audiotaped physician-patient interactions, significantly increased (mean pre = 5.4, mean post = 9.2; t = 9.9; P < or = 0.001). In this regard, there were instances in the use of 7 of the 14 specific counseling steps. Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale (mean pre = 3.2, mean post = 4.0; t = 4.25; P < 0.001), confidence in having an effect (mean pre = 3.3, mean post = 3.9; t = 3.16; P < 0.01), perception that materials were available to aid intervention (mean pre = 2.7, mean post = 4.0; t = 5.29; P < 0.001), and perception that they have access to a nutritionist (mean pre = 3.5, mean post = 4.0; t = 2.63; P < 0.01). They rated the value of the program between very good and excellent. CONCLUSION: Results of this 3-hr educational program indicate that physicians in an HMO are responsive to the teaching of specialized skills deemed important for promoting health behavior change in their patients.     

Willingness to perform euthanasia. A survey of physician attitudes

BACKGROUND: In the United States, few studies have examined important variables in physician attitudes toward the practice of euthanasia, such as the patient's underlying disease, mental capacity, and age, and the physician's specialty and religion. We administered a case-based survey to analyze the impact of such specific variables on physician attitudes toward the practice. METHODS: A four-section survey solicited (1) physician responses to three hypothetical cases in which patients requested euthanasia; (2) physicians' general opinions about euthanasia and how its legalization might affect them personally and professionally; and (3) demographic information. Analysis focused on physicians' characteristics as they related to their responses to the various aspects of euthanasia elicited in the survey. Univariate and multivariate analyses, using logistic regression, were performed. RESULTS: Completed and analyzable surveys were returned by 740 physicians. We found that physicians felt more comfortable with euthanasia requests from nondecisional, nonterminal patients who had left advance directives than they did with requests from decisional patients suffering from grave illnesses or injuries, or from decisional patients who had early signs of a progressive but nonlethal neurologic disease. We also found that physicians' specialties and religions correlated with their responses to the hypothetical cases and with their generalized attitudes toward euthanasia. CONCLUSIONS: Given the disparity in responding physicians' attitudes toward euthanasia, along with the fact that values based on religious affiliation or profession may underlie many physicians' opposition to the practice, we conclude that if euthanasia is to be legalized, safeguards protective of patients and physicians must be incorporated.     

Attitude change in college students and chronic patients: A dual perspective.

Assessed both initial attitudes and attitude change among 30 college students and 320 chronic patients participating in a hospital companionship program. Student attitudes toward a number of mental health concepts were initially similar to 2 student control groups (N = 30 each). Patient expectations of college students likewise were similar to patient controls. At the conclusion of the program, students manifested significantly more favorable attitudes toward patients and less favorable attitudes toward the mental hospital; patients saw the students as more nurturant than they had initially expected. A social hierarchy hypothesis is advanced to partially account for the reported success of similar companionship programs. (22 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-enzymatic peroxidation of lipids isolated from rat liver microsomes, mitochondria and nuclei

AIM: To compare lansoprazole 30 mg daily with ranitidine 150 mg b.d. in the treatment of acid-related dyspepsia in general practice. METHODS: In a double-blind, parallel group, randomized, mutlicentre study conducted in 32 general practices in the UK, 213 patients were randomized to receive lansoprazole 30 mg daily, and 219 to receive ranitidine 150 mg b.d., for 4 weeks. All patients had experienced symptoms of reflux-like or ulcer-like dyspepsia on at least 4 of the 7 days prior to the study; 75% had experienced dyspepsia in the past, and 74 of the lansoprazole patients and 77 of the ranitidine patients had documented histories of acid-related disorders, investigating by either radiology or endoscopy. RESULTS: After 2 weeks 55% of the lansoprazole patients and 33% of the ranitidine group were symptom-free (P = 0.001, chi 2 = 7.12) with corresponding 4-week figures of 69% and 44%, respectively (P = 0.001, chi 2 = 18.03). Similar figures were found at both 2 and 4 weeks for daytime and night-time heartburn and epigastric pain scores; in the lansoprazole group, at 4 weeks, 80% of patients were free of daytime heartburn and 81% of night-time epigastric pain, compared with 55% (P = 0.001, chi 2 = 15.44) and 65% (P = 0.01, chi 2 = 6.10) in the ranitidine group. CONCLUSION: Superior symptom relief for patients presenting with ulcer-like and reflux-like symptoms in general practice is provided by lansoprazole 30 mg daily compared with ranitidine 150 mg twice daily.     

Hospital practice: Psychology's call to action.

The general public has recently made demands for continuity of care in psychological services from outpatient settings to inpatient facilities and back. These demands plus 3 economic and structural modifications within the nation's health-care arena, including the incursion of for-profit health-care corporations into the health delivery industry, the 1985 Joint Commission of Accreditation of Hospitals decision to include nonphysician providers on hospital medical staffs, and the 1990 California Supreme Court Decision (CAPP v. Rank) ensuring full medical staff participation by California psychologists, have opened the doors to the independent practice of psychology in hospitals, rehabilitation centers, nursing homes, and day treatment facilities. This article presents current professional realities for psychologists in hospitals and health-care settings and reviews the work of the American Psychological Association in support of hospital independent practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)