Ethical guidelines for the inpatient psychiatric care of children.

Recommends concrete procedures for implementing APA's Ethical Principles during each phase of psychiatric hospitalization: admission, assessment, treatment planning, intervention, and discharge. The multiple needs of parents, child, and treaters within the hospital setting are examined. The benefits that derive from meeting clients' ethical rights are reviewed, and procedures for resolving conflicts between treaters and clients are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines

OBJECTIVE: Given concerns about use of psychotropic medication during pregnancy, the authors reviewed the literature regarding the effects of prenatal exposure to psychotropic medications on fetal outcome. METHOD: A MEDLINE search of all articles written in English from 1966 to 1995 was performed to review information on the effects of psychotropic drug use during pregnancy on fetal outcome. Where sufficient data were available and when methodologically appropriate, meta-analyses were performed to assess risk of fetal exposure by psychotropic medication class. RESULTS: Three primary effects are associated with medication use during pregnancy: 1) teratogenicity, 2) perinatal syndromes (neonatal toxicity), and 3) postnatal behavioral sequelae. For many drug classes there are substantial data regarding risk for teratogenicity. Tricyclic antidepressants do not seem to confer increased risk for organ dysgenesis. The available data indicate that first-trimester exposure to low-potency phenothiazines, lithium, certain anticonvulsants, and benzodiazepines may increase the relative risk for congenital anomalies. However, the absolute risk of congenital malformations following prenatal exposure to most psychotropics is low. CONCLUSION: Exposure to certain psychotropic drugs in utero may increase the risk for some specific congenital anomalies, but the rate of occurrence of these anomalies even with the increased risk remains low. Use of psychotropic medications during pregnancy is appropriate in many clinical situations and should include thoughtful weighing of risk of prenatal exposure versus risk of relapse following drug discontinuation. The authors present disorder-based guidelines for psychotropic drug use during pregnancy and for psychiatrically ill women who wish to conceive.     

National guidelines for clinical decisions, a methodological view

Medical guidelines used to be based mostly on expertise and experience. Since the eighties they are increasingly scientifically founded. In recent years results of possible treatments have been estimated quantitatively and compared. In drawing up the consensus text 'Antithrombotic prophylaxis of vascular events in patients with manifest atherosclerotic vasculopathy' the preparatory committee, after systematic arrangement of the relevant literature, made maximal use of the results of randomized prospective clinical trials of good quality and sufficient magnitude, published in peer-reviewed journals. For most indications, the pathophysiological reasoning and the study results were in agreement. A demonstrated effect of a treatment was evaluated on the basis of its magnitude and related to the associated costs and efforts. For the consensus 'Treatment and prevention of coronary heart disease by lowering the serum cholesterol level' use was made of estimates of effects of treatment with statins versus placebo. For prevention of total mortality and non-fatal myocardial infarctions and strokes, the relative risk reduction was 30-35%. The decrease of the absolute risk depended on the initial risk. The committee was of the opinion that treatment would be useful given an absolute risk of 25% of a (subsequent) manifestation of cardiovascular disease within 10 years. This would cost Dfl. 40,000.-per year of life gained, which the committee considered acceptable. In the argumentation of guidelines there is a trend to systematic evaluation and quantitative application of the research data. Subjective assessments remain necessary, particularly the evaluation of clinical relevance of observed or assumed effects of treatments.     

Purpose and guidelines for toxicokinetic studies within the National Toxicology Program

Urogenital mycoplasmal infections could affect use of primates as models for reproductive system studies and could affect reproduction in captive primates, but could be useful as animal models of similar human infections. We conducted a pilot study to assess detection of urogenital mycoplasmal infections in primates by use of polymerase chain reaction (PCR). Healthy animals were anesthetized, and vaginal, cervical, or endometrial and urethral swab specimens were collected from females and males, respectively. Specimens were tested by PCR supplemented with dot blotting and nonradiolabeled oligonucleotide probing for 16S rRNA sequences conserved among mollicutes. Specimens with positive results were tested by species-specific PCRs with primers for 16S rRNA sequences of Ureaplasma urealyticum and Mycoplasma hominis and for adhesin gene sequences of Mycoplasma genitalium. Spiked duplicate reactions were included as internal controls for each reaction. Results for 232 specimens from 166 animals indicate that naturally acquired urogenital infections are readily detected and suggest that urogenital mycoplasmal infections are common in laboratory primates (48/166 [29%] overall). M. hominis and U. urealyticum appeared to be common among the studied primates overall and especially in chimpanzees. Mycoplasmas other than M. genitalium, M. hominis, and U. urealyticum appeared to be at least as common as these three, with specimens from 18 of 48 animals (38%) having positive "generic" PCR results, but no positive results in species-specific PCRs.     

Diagnosis and management of asthma: a summary of the National Asthma Education and Prevention Program guidelines. National Institutes of Health

Asthma is a common disease that affects persons of all ages. It is responsible for more than 5,000 deaths annually in the United States and countless days absent from school and work. For these reasons, the National Institutes of Health established the National Asthma Education Program whose expert panels have published two reports: Guidelines for the Diagnosis and Management of Asthma in 1991 and a revised report in 1997. A summary of the Expert Panel Report 2 published in 1997 is presented with emphasis on the outpatient diagnosis, prevention, and treatment of asthma. Education of the clinician and the patient is essential for effective management of asthma, and effective communication between clinician and patient is essential for implementing asthma education. The goal of this summary is to communicate and disperse the asthma education provided by the Guidelines for the Diagnosis and Management of Asthma: Expert Panel Report 2 in hopes of improving asthma care and decreasing morbidity and mortality-attributed asthma.     

Substance misuse and psychiatric comorbidity: an overview of the OPCS National Psychiatric Morbidity Survey

There have been a number of national surveys of psychiatric morbidity which have included questions on drugs, alcohol and tobacco. These surveys have helped delineate the overlap between substance use and dependence and other psychological morbidity. There is a strong association reported between high substance consumption and other measures of psychological problems. This article provides an overview of a national household survey, a survey of institutional residents with psychiatric disorders and a national survey of a homeless population. All three surveys used comprehensive and complex sampling strategies and lay interviewers to conduct structured diagnostic interviews. The household survey included over 10,000 households, the institutional survey interviewed 755 individuals and the homeless survey of hostels, night-shelters, day centres and private-sector leased accommodation interviewed 1,061 individuals. This overview looks at patterns of nicotine, alcohol and other drug use in the different samples and examines interactions with other psychiatric morbidity. The survey reports that substance-related disorders are some of the commonest disorders in the community, with 5% of the household sample alcohol dependent, 7% alcohol dependent in the institutional sample and over 21% in the homeless sample recorded as alcohol dependent. Tobacco, alcohol and other drug use and dependence were dramatically higher in the homeless sample than in either of the other two samples. Substance use was significantly associated with higher rates of psychological morbidity as measured by the Clinical Interview Schedule Revised. Future service planning needs to take account of the striking disparity of prevalence of psychiatric disorders in different subsections of the population.     

Thrombolytic therapy in Missouri hospital emergency departments: compliance with the National Heart Attack Alert Program guidelines

Adhesive interactions between leukocytes and endothelium are required for subsequent leukocyte extravasation toward inflammatory sites. Understanding the possible kinetic expression of vascular cell adhesion molecule-1 (VCAM-1) in the middle ear cavity during an inflammatory cascade in vivo may be important for clarifying local immunological responses in otitis media. Two inflammatory models were produced in the rat and involved acute middle ear mucosal and cutaneous inflammation induced after inoculation or intradermal injection of lipopolysaccharide (LPS). After intravenous injection of both 125I-labeled anti-VCAM-1 and 131I-labeled control monoclonal antibody (mAb), the kinetic expression of VCAM-1 in the middle ear and skin was assessed by local radionuclide uptake. The biodistribution of an 125I-labeled anti-VCAM-1 mAb as a potential detector of focal inflammation was examined in normal rats. Both inflammatory lesions were characterized by early and sustained (up to 24 h) expression of VCAM-1, with maximal expression at 4 h after LPS stimulation. The kinetics of VCAM-1 expression was similar among the middle ear mucosa or skin specimens studied and different stimulation methods. A similar biodistribution and clearance of radioactivity between 125I-labeled anti-VCAM-1 mAb and 131I- or 99mTc-labeled control mAb were observed. The present result suggest that functional VCAM-1 induced by LPS is expressed in both middle ear tissue and skin lesions and may play a role in the initial stage of inflammatory response produced. Although VCAM-1 upregulation is a very early event in the inflammatory cascade, 125I-labeled anti-VCAM-1 mAb may be useful for the early detection of focal inflammation in the middle ear.     

The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting. The Academy of Psychosomatic Medicine

This practice guideline seeks to provide guidance to psychiatrists who regularly evaluate and manage patients with medical illnesses. The guideline is intended to delineate the knowledge base, professional expertise, and integrated clinical approach necessary to effectively manage this complex and diverse patient population. This guideline was drafted by a work group consisting of psychiatrists with clinical and research expertise in the field, who undertook a comprehensive review of the literature. The guideline was reviewed by the executive council of the Academy of Psychosomatic Medicine and revised prior to final approval. Some of the topics discussed include qualifications of C-L consultants, patient assessment, psychiatric interventions (e.g., psychotherapy, pharmacotherapy), medicolegal issues, and child and adolescent consultations.     

One emergency department''s system for tracking mental status changes in psychiatric patients, with guidelines for the care of violent patients

Bacteriophage T4 lysozyme has been purified using the Ni-chelate affinity chromatography technique from overexpressing Escherichia coli cells by fusion to an N-terminal 6x His tail. Regulation of the lysozyme gene expression has been found to be critical during growth phase of the bacteria by comparing different plasmid constructions. Whereas a tac-promoter fusion construct alone did not lead to efficient production of T4 lysozyme because of early cell lysis, an improved repressor sequence and co-overproduction of the tac repressor resulted in high-level synthesis of the foreign protein after IPTG induction. Purification of the fusion protein from autolyzed crude cell extracts is possible in a simple one-step procedure.     

National assessment of early elementary teachers perceived self-efficacy for teaching tobacco prevention based on the CDC guidelines

A national random sample of 505 early elementary school teachers completed a 47-item survey to determine their perceived self-efficacy for teaching tobacco prevention education based on the Centers for Disease Control and Prevention guidelines for grades K-3, their training status on tobacco prevention, and their level of teaching about tobacco prevention. Results indicated most of the teachers were female, White, held a bachelor's or master's degree, never smoked, and had not received formal tobacco prevention training. The teachers' scores were high for efficacy expectations, and for outcome expectations. Conversely, for outcome value, teachers ranked tobacco prevention fifth out of six health topics, as the most important health topic to teach elementary students. Also, teachers trained in four tobacco areas or more had statistically significantly higher scores for efficacy expectations than those trained in three or fewer areas. Statistically significant positive associations were also found between years of teaching tobacco prevention and efficacy and outcome expectation scores, and between the amount of time that tobacco prevention was taught during the past school year and outcome value.     

New guidelines for prevention, detection, evaluation, and treatment of hypertension: Joint National Committee VI

We developed an immunochromatographic whole-blood test (WBT) which detects antibodies to human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2) from fingerstick blood. The sensitivity and specificity of the WBT were 99.41% (1,018 confirmed positive patients) and 99.89% (941 uninfected patients), respectively (enzyme immunoassay [EIA] on serum or plasma as a reference). WBT performance was comparable to those of licensed EIAs and Western blotting, using 18 HIV-2 sera, 23 HIV-1 seroconversion panels, and a low-titer performance panel (in lieu of whole blood).     

Misguided guidelines.

The proposed guidelines (see record 2001-17060-009) would require detailed, probing inquiry into motivation for choosing assisted suicide. This is an appropriate requirement in principle. In practice, it will be virtually impossible to carry out this inquiry within likely statutory time limits. Evaluators most likely will either reject the guidelines as impractical or give them merely perfunctory observance. There is, moreover, an inherent tension in the evaluator's relationship with the patient between empathy and impersonal distancing that the guidelines do not adequately acknowledge; this tension necessarily compromises the evaluator's ability to apply the guidelines in the probing, detailed manner they envision. The guidelines provide false comfort that physician-assisted suicide can be carried out with adequately sensitive monitoring of voluntariness and mental competence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)