Training for managed care settings: How to make it happen.

Discusses the importance of and resistances to the training of experienced therapists in brief approaches to psychotherapy. Ways are examined of providing such training to psychotherapists who are working in systems where brief treatment is essential. Three principles of adult learning are described (e.g., adults want to apply their new learning immediately) to highlight the important relation between those principles and the training strategies implemented in the program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smiles make it easier and so do frowns: Masked affective stimuli influence mental effort.

Two experiments tested the hypothesis that exposure to masked emotional expressions during the performance of cognitive tasks influences effort mobilization. In support of the predictions, participants who processed masked sad faces during task performance under “do your best” instructions showed stronger sympathetic nervous system discharge to the heart (shorter pre-ejection period, higher systolic blood pressure) than participants who were exposed to masked smiling faces or angry faces. Assessed task appraisals suggest that these effects on effort-related cardiovascular reactivity occurred because the masked emotional stimuli influenced the level of experienced task difficulty. The findings are compatible with the effects of consciously experienced affect on effort-related cardiovascular response. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Medicare managed care. How physicians can make it better

The federal government is attempting to control anticipated, increased Medicare health care costs by providing the senior population with incentives to encourage their movement into managed care programs. For-profit corporate HMOs that currently dominate the managed care arena are coming under increased competitive pressure at a time when their perception of profiteering is undergoing increased public scrutiny. If physicians are to take advantage of this window of opportunity and successfully enter the Medicare managed care marketplace, they must identify the major deficiencies existing in the current model, and fashion a new product that divests itself of the profit orientation of current corporate HMOs. A nonprofit version of a highly integrated, multispecialty provider service organization (PSO) provides an appropriate model to effectively compete with the corporate HMO. The ideal physician-controlled managed care model must: develop a responsive policy board structure; create practice guidelines that decrease variation in physician practice; achieve an appropriate balance between primary and specialty medical care; and adopt a quality-assurance program that effectively addresses both process and outcome data.     

How many homeobox genes does it take to make a pituitary gland?

The secrets of anterior pituitary development and cell lineage determination have been revealed mostly by genetic analyses. The requirement for three homeobox genes, Lbx3, Lbx4 and Titf1, during early organogenesis was proven by gene targeting. Spontaneous mouse mutations revealed two additional homeobox genes, Pit1 and Prop1, that are critical for specialization and proliferation of subsets of the five differentiated cell types. Analysis of patients with pituitary insufficiency has demonstrated the importance of these two genes in human pituitary function. Recently, several other homeobox genes have been identified and implicated in pituitary organogenesis. Genetic manipulations of these genes will undoubtedly add to the emerging genetic hierarchy regulating the ontogeny of this major hormone-producing gland.     

Male menopause. How to define it, how to treat it

There has been a recent explosion of articles in the medical literature and newsbites on television and in the lay press regarding male menopause. Yet, many men are not familiar with the changes in sexuality that accompany aging. Primary care physicians therefore need to be well informed about the concept of male menopause and the dos, don'ts, and unknowns of treating it with testosterone.     

Laparoscopic splenectomy as an alternative to open surgery in the treatment of autoimmune thrombocytopenia

BACKGROUND: Several studies have shown the potential advantages laparoscopic splenectomy (LS) over open surgery. The aim of this study has been to evaluate the advantages of LS over open surgery in the treatment of autoimmune thrombocytopenia. PATIENTS AND METHODS: 54 consecutive patients splenectomized for the treatment of idiopathic thrombocytopenic purpura (ITP) or HIV-related thrombocytopenia were analyzed. Operative features (operative time, conversion to open surgery, accessory spleens), immediate (stay, analgesia and blood transfusion requirements) and late postoperative features (platelet count), as well as splenectomy-related complications in both surgical procedures were compared. RESULTS: Between February 1990 and February 1997, 54 splenctomies were performed for the treatment of autoimmune thrombocytopenia (ITP, n = 47, and HIV-related thrombocytopenia, n = 7). Eighteen were performed through an open approach, and 36 by laparoscopy. Both groups were comparable with regard to age, sex, platelet count, disease duration and body mass index. LS was completed in 34 cases (conversion to open surgery: 5.5%). The incidence of accessory spleens was 11% in the LS group and 5.5% in the open surgery group. Postoperative morbidity (16% vs 28%) and blood requirements (25% vs 33%) were lower after LS, but the differences did not reach statistical significance. Analgesia requirements (7 [SD 3] vs 11 [6]; p < 0.01) and postoperative stay (3.8 [2.6] vs 7.4 [3] days; p < 0.01) were significantly shorter after LS. Following splenectomy, the platelet counts became normal in 72% of patients submitted to LS and 78% of patients in the open surgery group. After 20 and 63 months mean follow-up, one patient in each group developed late complications. CONCLUSION: As compared to open surgery, LS offers a better immediate clinical outcome, with similar long-term results.     

Significant reduction in post-lumbar puncture headache using an atraumatic needle. A double-blind, controlled clinical trial

A characteristic headache occurs in about 36-55% of patients after lumbar puncture, and many of these patients need bed rest for one or more days to get relief. In a double-blind randomized trial we compared a new 22-gauge atraumatic puncture needle with the most widely used 20-gauge "conventional" needle. In 49 patients randomized to the atraumatic needle, post-lumbar puncture headache occurred in 6%, whereas in the 50 patients randomized to the conventional needle this occurred in 32% (p = 0.001). On the basis of these results we recommend use of the atraumatic needle in order to diminish the frequency of post-lumbar puncture headache.     

How people make support judgments: Individual differences in the traits used to infer supportiveness in others.

Social support and other social judgments are composed of several distinct components, of which relationship effects are an important part. With regard to support judgments, relationship effects refer to the fact that when judging the same targets, people differ systematicatly in whom they see as supportive. One explanation for this effect is that people differ in how they combine information about targets to judge supportiveness. Participants rated the supportiveness of hypothetical targets and targets from their own social networks. Multilevel modeling identified the traits participants used to make support judgments. There were significant differences in the extent to which participants used different target personality traits to judge supportiveness. In addition, participant neuroticism predicted the extent to which participants used target neuroticism and agreeableness to judge supportiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How would it feel if...? Mood as input to a role fulfillment evaluation process.

Most theoretical models of the relation between mood and evaluation suggest that people in positive moods tend to render more favorable evaluations than people in negative moods. If moods operate as input to a role fulfillment evaluation process, however, then mood-congruent evaluations are not inevitable, even when people incorporate their moods into their evaluations. Instead, the more people experience the feelings (negative or positive) they could expect to feel if the target had fulfilled its role (e.g., a particularly heart-wrenching sad story or an especially funny comedy), the more favorably people should evaluate the target. Three experiments supported this hypothesis. Only the mood-as-input model seems capable of accounting for the results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How far is it to the nearest hospital? Calculating distances using the Statistics Canada Postal Code Conversion File

This report demonstrates how to calculate distances between points described in terms of latitude and longitude, using the Postal Code Conversion File (PCCF) and other files available from the Geography Division of Statistics Canada. Examples based on hospital data show how the results can be summarized in the form of tables, figures, or maps. Aerial distance to the nearest hospital is a crude but objective indicator of geographic accessibility to hospital services. Distances were calculated between enumeration area centroids for the population and blockface or enumeration area centroids for the hospitals. The median aerial distance to the nearest hospital facility in Canada was less than 3 km, while the mean distance was about 6 km. For teaching hospitals, the median aerial distance was a little less than 30 km, while the mean distance was a little more than 90 km. As most health files for administrative and research purposes contain postal codes, these techniques have potentially wide application.     

Unskilled and unaware of it: How difficulties in recognizing one's own incompetence lead to inflated self-assessments.

People tend to hold overly favorable views of their abilities in many social and intellectual domains. The authors suggest that this overestimation occurs, in part, because people who are unskilled in these domains suffer a dual burden: Not only do these people reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the metacognitive ability to realize it. Across 4 studies, the authors found that participants scoring in the bottom quartile on tests of humor, grammar, and logic grossly overestimated their test performance and ability. Although their test scores put them in the 12th percentile, they estimated themselves to be in the 62nd. Several analyses linked this miscalibration to deficits in metacognitive skill, or the capacity to distinguish accuracy from error. Paradoxically, improving the skills of the participants, and thus increasing their metacognitive competence, helped them recognize the limitations of their abilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Critical thinking as an outcome of nursing education. What is it? Why is it important to nursing practice?

Critical thinking is currently a highly valued educational outcome throughout the educational spectrum, but particularly so in relation to higher and professional education. International concerns have focused upon citizen's thinking abilities and thus the nations' abilities to function and compete in complex societies and economies. Educationalists are questioning the wisdom of teaching content as opposed to teaching how to think as a means of dealing with relentless information development and change. Nursing education is also embracing the construct critical thinking as a desirable educational outcome. Some commentators refer to the importance of critical thinking in nursing practice as a central component or in some cases a given. This paper intends to examine the background to the construct and address in detail some of the important questions surrounding critical thinking, and its association with competent nursing practice.