Emergency contraception: is it time to change method?

The Yuzpe method of using combined oral contraceptives for emergency contraception has been available for 25 years; prevents 75% of pregnancies that would have occurred if no treatment were used; has an excellent safety record; and is contraindicated only in patients with a history of thromboembolism, migraine at presentation, or a history of migraine with aura. However, this method has side effects of nausea and vomiting, and the World Health Organization recently reported that use of levonorgestrel alone is effective and associated with fewer side effects. No additional research has been conducted on the timing or dosage of the estrogen-progestogen method, but some dose-effectiveness studies have been performed on mifepristone. Mifepristone, however, is not widely available. The levonorgestrel studies found a negative correlation between the interval from unprotected intercourse to treatment and effectiveness but concluded that levonorgestrel was more effective than the combined method (this study found a lower effectiveness for the combined method than previously reported). Given that each method is effective, consideration of whether the new one should be adopted must take into account the fact that the levonorgestrel is currently not licensed for this use, is not prepared in convenient dosages, and is more expensive and less available. Introduction of new methods of emergency contraception should augment choices rather than replace other methods.     

Interferon-induced thrombocytopenia: is it time for thrombopoietin

Four identification tests, proposed in addition to conventional methods, were evaluated with 320 fermentative nonlipophilic Corynebacterium strains: growth at 20 degrees C, glucose fermentation at 42 degrees C, alkalinization of sodium formate, and acid production from ethylene glycol. These tests were highly discriminant. Corynebacterium amycolatum displayed a unique profile, allowing it to be distinguished from similar species, such as C. xerosis, C. striatum, and C. minutissimum.     

Clinical adolescent psychology: What it is, and what it needs to be.

This commentary on the special section on clinical adolescent psychology (G. Holmbeck & P. Kendall, 2002) reviews and critiques the conceptual and empirical articles that this compilation comprises. As articulated in the conceptual contributions to this collection, two fundamental principles should guide research on the etiology, prevention, and treatment of psychological disorder and dysfunction during adolescence: First, drawing on the field of developmental psychopathology, the study of clinical adolescent psychology should focus on the trajectories of disorder that precede, characterize, and follow adolescence. Second, drawing on the literature on normative adolescent development, the study of clinical adolescent psychology must proceed with an explicit recognition of the unique biological, cognitive, psychosocial, and contextual features that define adolescence as a developmental period. Although the study of clinical adolescent psychology, as evidenced by this collection of articles, is appropriately grounded in the broader enterprise of developmental psychopathology, less progress has been made with respect to die integration of the study of clinical phenomena in adolescence with the study of normative adolescent development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

If it is supposed to be specialization, make it true specialization

As indicated by an Fe(II)-induced liposome peroxidation bioassay, the EtOAc extract of tart cherries (Prunus cerasus) was found to have strong antioxidant activity. Purification of this extract afforded chlorogenic acid methyl ester (1) and three novel compounds, 2-hydroxy-3-(o-hydroxyphenyl) propanoic acid (2); 1-(3', 4'-dihydroxycinnamoyl)-cyclopenta-2,5-diol (3), and 1-(3', 4'-dihydroxycinnamoyl)-cyclopenta-2,3-diol (4), as determined by their spectral data. At a 20-microM concentration, the antioxidant activities of compounds 3 and 4 were comparable to the antioxidant activities of caffeic acid, whereas compound 1 showed activity similar to chlorogenic acid. Also, these compounds showed antioxidant activities similar to the commercial antioxidants tert-butylhydroquinone and butylated hydroxytoluene. However, compound 2 was not active when tested at a 100-microM concentration.     

Complex semantic processing in old age: Does it stay or does it go?

Old adults' (N?=?24) and young adults' (N?=?24) speed of producing exemplars of semantic categories (i.e., semantic fluency) varying in difficulty was assessed both in a standard condition and in a "set-switching" condition where exemplars had to be produced from 2 categories in an alternating manner. "Retrieval-position function" parameters were used to assess speed of semantic access independent of nonsemantic factors. Results suggested age effects in nonsemantic components but not in semantic retrieval per se. Also, age deficits in set switching were relatively subtle. Findings are discussed with relation to issues of domain specificity of age effects as well as of the role of executive control during semantic retrieval and age differences therein. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contributions to patient adherence: Is it time to share the blame?

Poor adherence to treatment is well recognized and contributes significantly to treatment failures in medical care. Studies examining contributing factors have focused predominantly on the patient. Studies examining provider influences have primarily examined communication styles or educational practices. M. R. DiMatteo et al (see record 1993-26883-001) show that other characteristics of the provider may influence patient behavior. Particularly interesting is the finding that baseline adherence predicts adherence 2 yrs later. Although this study opens the door to an examination of provider characteristics and their influence on patient behavior, care needs to be taken to avoid too rapid an acceptance of the discrete findings. The study used self-report by interview, a measure that can be significantly biased. However, this study provides future avenues to explore using more objective measures of patient adherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

35 mm film vs. digital photography for patient documentation: is it time to change?

35 mm photography is currently the standard method of documenting a patient's appearance and recording the post-operative changes. With rapidly advancing technology, the digital system is now capable of providing vivid pictures that have multiple advantages over conventional 35 mm photography. Namely, digital pictures are comparatively inexpensive to take, can be stored as digital information, easily retrieved, and immediate viewing and imaging are possible. For many applications in plastic surgery patient documentation, digital photography is now more affordable and flexible than the 35 mm film system. The following is a cost and quality comparison between the two systems.     

The experiential relationship: Is it all-purpose or is it tailored to the individual client?

Examines whether the experiential relationship is all-purpose or tailored to the individual client. Experiential psychotherapy represents both extremes. The therapist relates in the same way in going through the same 4 steps in every session with every client. On the other end, crucial parts of the relationship are uniquely tailored by and for each client in each session. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individualized cardiovascular prevention: when and how far should it go?]

The antimicrobial activity of T cell-derived cytokines, especially interferon (IFN)-gamma, against intracellular pathogens, such as Chlamydia trachomatis, involves the induction of 3 major biochemical processes: tryptophan catabolism, nitric oxide (NO) induction and intracellular iron (Fe) deprivation. Since the epithelial cell is the natural target of chlamydial infection, the presence of these antimicrobial systems in the cell would suggest that they may be involved in T cell control of intracellular multiplication of Chlamydia. However, the controversy over whether these 3 antimicrobial processes are present in both mice and humans has precluded the assessment of the relative contribution of each of the 3 mechanisms to chlamydial inhibition in the same epithelial cell from either mice or humans. In the present study, we identified a Chlamydia-susceptible human epithelial cell line, RT4, that possesses the 3 antimicrobial systems, and we examined the role of nitric oxide (NO) induction, and deprivation of tryptophan or Fe in cytokine-induced inhibition of chlamydiae. It was found that the 3 antimicrobial systems contributed to cytokine-mediated inhibition of the intracellular growth of Chlamydia. NO induction accounted for approximately 20% of the growth inhibition; tryptophan catabolism contributed approximately 30%; iron deprivation was least effective; but the combination of the 3 systems accounted for greater than 60% of the inhibition observed. These results indicate that immune control of chlamydial growth in human epithelial cells may involve multiple mechanisms that include NO induction, tryptophan catabolism and Fe deprivation.     

Lessons learned about service quality: What it is, how to manage it, and how to become a service quality organization.

Discusses lessons that the authors' experiences in the area of service quality have taught them about how to help a business develop into the kind of company that can deliver quality service to its customers. A theme running through the article is that becoming such a company is a multistage process that involves coordinating changes in many facets of organizational functioning. Furthermore, it is repeatedly emphasized that the design of these facets must be aligned with the market sector the organization wants to target. Lessons 1, 2, and 3 address the implications of service marketing, operations management, and human resources management for delivering quality service. The integration of what has been learned in these 1st 3 lessons is the topic of Lesson 4: creating a climate and a culture for service. Finally, some practical suggestions and guidelines are offered for beginning the process of becoming a service organization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When is it helpful to convene the family?

There are three factors supporting current efforts to bring the family into the mainstream of American medicine: (1) research capabilities of the discipline of epidemiology, (2) the intervention skills developed by family therapy, and (3) pressures to provide cost-effective care as economic resources diminish. The fundamental question addressed in this paper is, when can it be helpful for the family physician to convene the family in the consultation room? Physicians in the field and residents in training are often reluctant to take this step because of time constraints, awkwardness in talking to two or more members of the family, and unfamiliarity with what to do with the information that is gathered. From currently available research data, a list of 14 medical conditions is presented in which it can be predicted that family functioning or nonfunctioning is contributing to the cause of disease, or that the family will experience a major reaction to the illness. These medical conditions offer an ideal opportunity to begin working with families. A specific case history illustrating this approach is presented to demonstrate that convening the family can be an important dimension of family medicine.