Patient attitudes toward physician treatment of obesity

Transverse myelitis is a rare complication of Epstein-Barr virus (EBV) infection. This article describes a case of a previously healthy patient with a subacute transverse myelopathy. The cerebrospinal fluid showed lymphocytic pleocytosis and protein elevation. A magnetic resonance imaging scan demonstrated abnormal spinal cord signal intensity over several cervical and thoracic segments, suggesting the diagnosis of transverse myelitis. The patient was treated with high-dose corticosteroids and had a rapid improvement. Serologic studies for other viruses were negative; antibody tests indicated acute EBV infection. It is thought this represents a case of transverse myelitis associated with acute EBV infection. Although a few similar patients have been reported previously, this case is the first where EBV serology suggested the etiology at the time of diagnosis, when EBV antibody titers and polymerase-chain reaction for EBV DNA in the cerebrospinal fluid were performed, and when a magnetic resonance imaging scan was used for diagnosis and follow-up.     

Awareness and attitudes concerning BRCA gene testing

We studied the changes in pulmonary hemodynamics induced by arm-stretching exercise in 12 patients with chronic pulmonary emphysema (CPE) and 9 control subjects (Controls). Both patients and control subjects underwent right heart catheterization with inspired gas analysis at rest and during exercise for the 6 minute-exercise test. Mean pulmonary arterial pressure (mPAP) in patients with CPE significantly increased from 18.5 +/- 3.9 mmHg at rest to 25.7 +/- 5.1 mmHg during exercise without decreased oxygen tension of the arterial blood. Both mPAP and total pulmonary resistance increased in proportion to the increases in cardiac output. Mixed venous plasma atrial natriuretic peptide (ANP) was significantly evaluated during exercise in patients with CPE, but did not in Controls. There were a significantly positive relationships between ANP and mPAP, and a significantly negative relationships between ANP and PvO2 during exercise. These results suggest that pulmonary hypertension during light exercise in cases of CPE may be caused by deterioration of the pulmonary capillary bed, and that ANP may be a useful indicator for evaluating pulmonary hypertension in patients with CPE.     

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.     

The impact of physician attitudes on patient satisfaction with care for low back pain

Oral administration of mancozeb (100 or 200 mg/kg body weight) for 7 consecutive days caused an increase in glutathione S-transferase (GST) activity in the liver of newborn, weanling and adult rats. This observed increase in GST activity was higher in weanling than in newborn and adult rats. Evaluation of acute effects at 4 and 20 h following oral administration of 200 mg mancozeb/kg showed a marginal increase in the levels of GST in adult rat liver. However, there was competitive inhibition of GST by the fungicide in vitro.     

Deliberation between physician and patient concerning active euthanasia at the patient's home

Three patients, one man aged 68 and two aged 67, with terminal incurable cancer, requested euthanasia. It was performed in two, the third patient eventually died without having repeated his request. There are three phases in euthanasia: orientation (the patient asks the physician whether he would be willing to assist should the need arise), organisation (the physician ensures that the necessary prerequisites are fulfilled, i.e. the patient's request must be voluntary, mature and longlasting, his suffering must be longlasting, unbearable and incurable, and another physician must have been consulted and must have prepared a written report), and the phase entered after the definitive decision to perform euthanasia has been taken. The physician should not be reluctant to bring up the subject at an early stage, as it may set the patient's mind at rest to have expressed a wish concerning suffering and the end of life.     

Beliefs and attitudes of interns at Ibadan General Hospitals concerning ten medical specialties

The authors report on a 62-year-old woman who suffered from partial nuclear oculomotor nerve palsy and the medial longitudinal fasciculus (MLF) syndrome caused by midbrain infarction. The lesion was confirmed to be in the mesencephalic tegmentum by axial sections acquired by magnetic resonance imaging (MRI). The lesion was located in the caudal region of the mesencephalic tegmentum by the sagittal MRI sections, and showed low signal intensity in T1-weighted images and high signal intensity in T2-weighted images. The patient exhibited bilateral ptosis due to the disturbance of caudal central nucleus and the supra-oculomotor area on both sides innervating the levator muscles of the upper eyelid. She also showed bilateral limitation of ocular adduction and supraduction; mild infraduction of the left eyeball; left monocular nystagmus; and disturbance of convergence, indicating partial involvement of the lateral somatic cell column innervating the muscles of the eyeball, the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) and the MLF. Furthermore, transient visual hallucinations similar to hallucinose pédonculaire were confirmed. We are not aware of any reports describing simultaneous occurrence of bilateral ptosis, MLF syndrome, and transient visual hallucinations similar to hallucinose pédonculaire in the same patient.     

Follow-up study of Finnish volunteer oocyte donors concerning their attitudes to oocyte donation

A questionnaire was sent to the first 30 Finnish volunteer oocyte donors at 12-18 months after donation to determine their experiences concerning treatment and attitudes to donation. All donations were carried out anonymously and without payment. The donors were recruited by advertising in newspapers. Most donors were very satisfied with the experience. The side-effects of the treatment had been slight and tolerable. In all, 85% of the respondents reported no gynaecological problems afterwards. The problems reported by the other 15% were minor and unrelated to the donation. A total of 67% of the respondents would have liked to have known if pregnancy had been achieved in the recipient, and 89% reported that they had thought about the possibility of a child from their donation. Some 42% of the respondents preferred to receive no information concerning either the child or the recipient couple. Of the respondents, 59% thought the offspring should be told about its origin and 33% thought the child should be given identifying information about the donor. About half of the others would agree to the release of non-identifying information. In all, 96% of the respondents reported that their own feelings were sufficiently taken into consideration during the treatment and 78% would donate again. No-one regretted their donation.     

Infants interpret ambiguous requests for absent objects.

The current studies investigated 2 skills involved in 14- to 20- month-olds' ability to interpret ambiguous requests for absent objects: tracking others' experiences (Study 1) and representing links between speakers and object features across present and absent reference episodes (Study 2). In the basic task, 2 experimenters played separately with a different ball. The balls were placed in opaque containers. One experimenter asked infants to retrieve her ball using an ambiguous request ("Where's the ball?"). In Study 1, infants used the experimenter's prior verbal and physical contact with the ball to interpret the request. A control condition demonstrated that infants were interpreting the request and not responding to the mere presence of the experimenter. Study 2 revealed that only infants who were given stable cues to the ball's spatial location appropriately interpreted the request: When spatial information was put in conflict with a color cue, infants did not select the correct ball. Links to infants' spatial memory skills and emerging pragmatic understanding are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the irrelevance of the classical negative evidence concerning the effect of attitudes on behavior.

Discusses 3 classic studies by R. T. La Piere (1934), B. Kutner et al (1952), and R. D. Minard (1952) which are often cited by researchers and textbook authors as evidence that attitudes do not affect behavior. The methodology of these studies is criticized, and it is argued that they provide inappropriate evidence for the behavior-attitude controversy. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responsivity of professional clinicians to requests for research participation.

Mailed 8 different types of requests for research participation to psychologists and psychiatrists (N = 412) employed in Canadian mental health facilities. There was a better response to requests for participation as research Ss than to more informal appeals. Responsivity was inversely related to expected visibility, including lack of anonymity of response. Results suggest that fear of evaluation largely determined response rates in studies soliciting clinicians to participate in research. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Etiological agents of infectious diarrhea: implications for requests for microbial culture

Gastrointestinal infections remain a frequent disease worldwide. In order to increase our knowledge of the epidemiology for our patient population, we retrospectively analyzed the results obtained for stool samples received at the clinical microbiology laboratory of the University Hospital of Geneva during a 4-year period. A total of 13,965 specimens from 7,124 patients (1.96 specimens per patient) were cultured, yielding 369 (2.6%) Salmonella spp., 408 (2.9%) Campylobacter spp., and 79 (0.6%) Shigella spp. The cumulative positivity rate of 6.1% decreased to 2.7% when patients received antimicrobial agents (P < 0.001). The positivity rate for 5,912 specimens obtained from patients hospitalized for < or = 3 days was 12.6%, whereas it dropped to 1.4% for patients hospitalized for > 3 days (P < 0.001). Of 3,837 stool samples originating from pediatric patients, 8.8% were positive, and 5.1% of 10,128 samples from adults were positive (P < 0.001). The cytotoxin of Clostridium difficile was detected in 379 of 3,723 samples analyzed (10.2%), and rotaviruses were detected in 190 of 1,601 samples (11.9%). We recommend that the use of cultures for enteric bacterial pathogens be restricted to patients hospitalized for < or = 3 days, with the exceptions of follow-up samples, specimens from immunocompromised patients, and patients whose first sample was culture negative or in the rare event of nosocomial food-borne outbreaks. For patients under antimicrobial therapy, testing for cytotoxin of C. difficile should primarily be requested; this analysis should also be accepted for samples from patients not receiving antimicrobial agents at the time of specimen collection. By applying these restrictions, we could have saved at least $5,000 annually.     

Attitude of psychiatric residents toward patient requests

The authors assessed residents' comfort in dealing with 14 previously identified types of patient requests in inpatient, outpatient, and acute service settings. First-year residents expressed significantly more discomfort than more experienced residents on 11 categories. They were also significantly less comfortable in the acute service than the inpatient setting. All residents expressed more comfort dealing with dynamic, psychological, and "nonsevere" requests. These findings suggest a need to teach residents specific therapeutic responses to various categories of requests and to evaluate the desirability of starting the residency experience on an acute service.     

Everyday rules for behavior: Mothers' requests to young children.

Examined how mothers socialize young children toward behavioral self-regulation. In a longitudinal paradigm focused on developmental issues, mothers of toddlers and preschoolers reported rules for everyday behaviors and noted the child's level of compliance. Results showed (1) commonalities among mothers in the network of rules being socialized, (2) age-related increases in numbers and kinds of rules, (3) a shift in the structure of rule networks from an early emphasis on safety toward encouraging autonomy and integrating children into the family, and (4) an inherent developmental organization within rule networks. For children, findings revealed (1) compliance was highest in situations that involved rules for safety and other's possessions, and (2) gradual age-related movement from external control to internally mediated compliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)