Ethics in split treatment.
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Combined Modality Therapy↗
Biomedical subjects
J A Lazarus
Publications and source records attributed to J A Lazarus.
Ethics in managed care.
The current era of managed costs and care create ethical dilemmas based on economic constraints and incorporation of principles of distributive justice. Traditional ethical concerns related to confidentiality, conflicts of interest, double agentry, and honesty are complicated by interference in the doctor-patient relationship caused by intrusive utilization management. National health reform must take these issues seriously to ensure that the "cure" promised by such reform efforts is not worse than the disease. The challenge for psychiatrists is to adapt to these constraints without losing site of traditional medical ethical positions. Once the ethics become diseased, no cure may exist at all.
Adult↗
Accuracy of dynamic isometric force production: the influence of age and bimanual activation patters.
The purpose of this study was to investigate how children and adults control bimanual activities with the influence of kinematic variables minimized. Force and timing measures were analyzed in self-paced, isometric bimanual pinch tasks performed by 6-, 8-, 10-, 12-year-old, and adult subjects. Subjects (n = 84) performed four tasks (inphase symmetrical, antiphase reciprocal, inphase asymmetrical force-right high, inphase asymmetrical force-left high) cycling between low levels (10--30%) of maximal volitional force during three 15-s trials. Bimanual tasks requiring similar activation between the hands were performed more accurately, more quickly, and with less force and timing variability than tasks requiring different actions and/or levels of force to be produced simultaneously. Evidence of force entrainment between the hands was exhibited when force direction (increasing vs. decreasing) was similar between hands but greater relative force was required of the left hand. Lower accuracy and greater variability resulted when controlled decrement of force was required to reach the lower force targets as opposed to the upper force targets which required subjects to increase force. Subjects in the two youngest age groups exhibited lower force accuracy and greater force and timing variability relative to older children and adults. Twelve-year-old subjects approximated adults' performance in all variables.
Adolescent↗
Reframing the professional ethic: the Council of Medical Specialty Societies consensus statement on the ethic of medicine.
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Decision Making↗
Motor overflow and children's tracking performance: is there a link?
The aim of this study was to investigate the interaction of skill performance, motor overflow, and hand linkage in the form of mirror movements in a visual-manual tracking paradigm across practice trials. We hypothesized that both the amount of motor overflow and the degree of hand linkage would be linked in an inverse way to the quality of task performance. Furthermore, we expected a short-term decrease in both of these factors as children practiced and improved their task performance. Sixteen right-handed, 6-year-old children tracked a visual target with their right hand by pinching two parallel steel bars instrumented with strain gauges. The left hand was also positioned by similar instrumented steel bars to measure overflow/mirroring. At both the beginning and end of practice trials, a cluster analysis was used to determine relationships among performance, overflow, and hand linkage variables. In general, the results support the main hypothesis that the amount of motor overflow and the degree of hand linkage are linked to the quality of task performance, but the relationships between these variables across short-term learning are nonlinear.
Attention↗
Ocular hypertension following cataract surgery in dogs: 139 cases (1992-1993).
OBJECTIVE: To document the incidence of postoperative ocular hypertension (POH) after cataract surgery in dogs. DESIGN: Retrospective analysis of medical records. SAMPLE POPULATION: 88 dogs that had had cataract surgery. PROCEDURE: The effect of several categorical variables on the development of POH was evaluated statistically. Postoperative ocular hypertension was defined as intraocular pressure > 25 and > 30 mm of Hg. RESULTS: The incidence of POH > 25 mm of Hg was 48.9%; > 30 mm of Hg, 33.8%; > 40 mm of Hg, 20.1%; and > 50 mm of Hg, 5.8%. Mean onset of POH > 25 mm of Hg was 4.9 hours. The incidence of POH was not affected by the type of surgery. Eyes that had phacoemulsification developed POH significantly more rapidly (mean, 3.9 hours), compared with those that had extracapsular lens extraction (8.4 hours). Mean phacoemulsification duration was greater in eyes that developed POH, and older dogs were more likely to develop POH. Development of POH was not correlated with sex, stage of cataract, type of surgical procedure performed, intraocular lens placement, preoperative lens-induced uveitis, or posterior lens capsule tears and vitrectomy. However, eyes that received intraocular lens implants developed POH more rapidly, compared with eyes without implants. CLINICAL IMPLICATIONS: The high incidence and early onset of POH after cataract surgery suggests that routine use of antiglaucoma medications in the first 12 hours after surgery is warranted.
Animals↗
Ethical issues in doctor-patient sexual relationships.
The clinical and ethical issues involved in sexual relationships between psychiatrists and patients, former patients, patients' relatives, and supervisees are reviewed. Case vignettes are presented to amplify the discussion. Risk prevention and response of the American Psychiatric Association are discussed.
Adult↗
Potentials associated with the Go/No-Go paradigm in traumatic brain injury.
Surface event-related potentials associated with visually triggered movements (Go) and the inhibition of planned movements (No-Go) were examined in seven healthy subjects and five postacute traumatic brain injured (TBI) subjects. Analysis showed that the cortical potential P1-N1 was similarly affected by condition in both the control and TB1 groups. Although TB1 subjects showed smaller P1-N1 amplitudes (Go = 2.91 uV; No-Go = 3.95 uV; p < .03) relative to control subjects (Go = 4.82 uV; No-Go = 6.03 uV; p < .03), both groups showed larger amplitudes in the No-Go condition. A bipolar lead (C3'-C3") over the sensorimotor cortex showed a reversal of polarity between Go and No-Go conditions which was synchronized with the EMG activity in all control subjects. This signal reversal and timing of potentials was absent in four of the five TB1 subjects' waveforms, suggesting difficulty in sensorimotor processes associated with movement control. In addition, TB1 subjects displayed a number of atypical stimulus-locked waveforms, which are discussed relative to the specific functional impairments of individual subjects. The results highlight the potential usefulness of such paradigms as the Go/No-Go procedure in the analyses of electroencephalographic waveforms and of the effects of TBI.
Adolescent↗
Sex with former patients almost always unethical.
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Codes of Ethics↗
Potentials associated with the initiation and inhibition of visually triggered finger movement in humans: the "no-go potential" in the go/no-go paradigm.
Surface event-related potentials associated with visually triggered movements (Go) and the inhibition of planned movements (No-Go) of the right index finger were examined in seven normal healthy subjects. Subjects' response priming was manipulated by presenting two sessions which either emphasized the Go condition (50 go trials vs. 30 no-go trials) or the No-Go condition (30 go trials vs. 50 no-go trials). Stimulus-locked waveforms showed enhanced components (P1-N1, N2, N1-P300) for the No-Go trials particularly in the response priming which emphasized the Go condition. It is suggested that the inhibition of planned movements is associated with surface negativity which trails the sensory P1-N1 potential yet may partially overlap it and therefore influence its amplitude. This "no-go" potential is dependent on the response priming of the subject and is most apparent when fast responses are planned and then arrested.
Adult↗
The role of attention in the regulation of associated movement in children.
The effect of attentional processes in regulating associated movement was studied in 10 male children in each of five age-groups from six to 16 years. They were asked to squeeze their index finger and thumb to 75 per cent of their own maximal volitional force under three conditions: a spontaneous baseline condition, a sensory feedback condition and a post-training condition without sensory feedback. Children of all ages were able to reduce the magnitude of associated movements during the sensory feedback condition. In the post-training condition some of the ability to inhibit was lost, particularly for the six-year-olds. This supports the view that the integration of higher order processes, such as attention, with lower-level neuromotor inhibitory mechanism, plays a role in the reduction of associated movement with increasing age. Implications for therapy with clinical populations are discussed.
Adolescent↗
Age differences in the magnitude of associated movement.
Using a quantitative measure of unintended mirror-movements in the contralateral limb during a unimanual task, the magnitude of associated movement across the ages from six to 16 years was determined. Male children in five age-groups (means 6.5, 8.5, 10.4, 12.4 and 16.5 years) were asked to squeeze their index finger and thumb together to various percentages of their own maximal volitional force. Results indicate that the 6.5-year-old group differ from all other age-groups, exhibiting significantly greater associated movements at all levels of force. The results are discussed in terms of the development of inhibitory control over innate neuromotor synergies.
Adolescent↗
Exertion level and the intensity of associated movements.
Associated movements in the contralateral limbs were measured quantitatively for 42 seven- to eight-year-old children who wrote with the right hand. Associated movements of the contralateral homologous muscles systematically increased as a function of the intensity of contraction of the active hand. The associated movements were more intense when the left hand was active. The order of hand use markedly affected the lateral asymmetry, indicating that the right and left hands were affected differentially by previous activity. Associated movements of the contralateral antagonist muscles were also observed, and their frequency varied as a function of active hand and exertion level.
Child↗
Ectopic peptides released by a human melanoma cell line that modulate the transformed phenotype.
Cells derived from a human melanoma strain by low-serum selection in monolayer were found to be capable of growth in semisolid medium, forming colonies ranging from tight to loose or dispersed. These phenotypes were found to be stable after cloning and retesting. Examination of the biological activities of ectopic peptides produced by a clone that gives rise to loose dispersed colonies revealed the presence of a transforming growth factor beta (TGF-beta; apparent Mr 14,700) and a single TGF-alpha species produced at an unusually high concentration (2.2 ng/ml). Coeluted with the TGF-alpha at approximately 22,500 was a mitogenic activity and a previously undescribed activity capable of modulating the phenotype of induced normal rat kidney fibroblast (NRK-49F) colonies in semisolid medium. This activity can modulate the usual tight colony to express a loose or dispersed phenotype characteristic of the producer cells. Both the possible role these ectopic peptides play in the expression of the transformed phenotype by the tumor cells producing them and the possible correlation between the Mr 22,500 epidermal growth factor-like peptide released by this particular tumor line and high molecular weight epidermal growth factor-like peptides found in the urine of cancer patients are discussed.
Animals↗
Time-limited sensitivity groups for medical students.
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Anxiety↗
Isometric pinch force control and learning in older adults.
The learning of a dynamic isometric pinch force task was investigated in young adults (aged 19 to 29 years) and older adults (aged 64 to 75 years) through use of a visuo-motor tracking paradigm. Both groups significantly improved performance over trials, retained what was learned 1 week later, successfully transferred to a new target, and demonstrated interlimb transfer of training effects, reflecting a strong central component to this task that is apparently intact in older adults. However, performance differences between the two groups remained throughout the trials. Although it appeared that older adults were able to utilize a model-based strategy to predict the target path, as evidenced by minimal response lag, their absolute performance was inferior to that of young adults relative to an overall root mean square error score, a correlation coefficient, and their increased use of high-frequency components in the tracking signal. The age-related performance differences may be attributable to a peripheral decrement in tactile sensibility and/or muscle reorganization as well as a slowness in processing afferent information.
Adult↗