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PubMedDate not supplied

[An approach to the structuring of printed materials in education technology for the independent study of the pharmacotherapy of emergency states].

In view of the fact that the sources of information (text-books, manuals, monographs) used in higher medical institutions lack a clear-cut system of directing the learning activities of those being thought, we have devised a variant of a manual that stipulates that a goal be defined, the content of pharmacotherapy of urgent states chosen, teaching material organized, a system of individual tasks set, results of learning controlled, auto-education and self-control exercised. The above type manuals are supposed to be a means of directing the activity aimed at learning to apprehend and must be a mainstay in the realization of the programme-deliberate management of quality of training a specialist.

Drug Therapy↗

PubMed1997

[Diabetic foot--an attempt at defining the risk factors for amputation].

The study included 65 patients--42 males and 23 females aged 67 +/- 17 with the diabetic foot syndrome. They were divided into 2 groups: those who underwent amputation (25 patients) and 40 who were treated conservatively. Amputations were preceded most frequently by ulceration (17 cases), phlegmona (5 cases) or dry necrosis (3 cases). The high percentage of amputations in the studied patients could be explained, at least in part, by poor general condition and advanced local changes. In the group of patients, who underwent amputation--in relation to those treated conservatively a decrease in filtration function was found (46.0 +/- 24.3 vs 89.5 +/- 26.2) and a higher percentage in the prevalence of microalbuminuria or proteinuria (80% vs 45%) as well as a higher percentage of cigarettes smokers in this group (72% vs 40%). The majority of the studied patients was characterized by poor education, lack of self-control of glycaemia, no efficient metabolic control of diabetes, measured by glycated haemoglobin and the presence of neuropathy and retinopathy. In addition, in 4 patients among the whole studied group (including 1 patient who underwent amputation), diabetes was newly diagnosed. These results indicate the necessity of improving education, early diagnosis of insulin independent diabetes, more frequent foot examinations and the elimination of amputation risk factors. Prophylaxis of diabetes foot associated with the proper treatment of diabetes is a necessary condition for decreasing of the amputation rate according to St. Vincent Declaration.

Aged↗

PubMed1997

Evaluation of a measure of learned resourcefulness for elders.

Learned resourcefulness is important in promoting independence and healthy, productive lifestyles among older adults, and therefore it is essential to have a measure of learned resourcefulness that is reliable and valid for this population. However, for elders published psychometric tests of Roseblaum's Self-Control Schedule (SCS), which is the measure of learned resourcefulness, are limited to internal consistency estimates. This study examined the ease of administration and psychometric properties of the SCS in three samples of healthy elders (age 65+). The findings yield promising evidence that the instrument is fairly easy for elders to understand when administered during face-to-face interviews. Evidence of reliability and validity is considerable, and the SCS shows acceptable internal consistency and construct validity. These findings support the potential usefulness of the measure of learned resourcefulness for adults.

Adaptation, Psychological↗

PubMed1998

[Evaluation of transcatheter hepatic segmental or subsegmental infusion of SMANCS for treatment of hepatocellular carcinoma].

A total of seventeen patients with hepatocellular carcinoma (HCC), nineteen HCCs, who underwent as an initial treatment transcatheter hepatic segmental or subsegmental arterial administration of SMANCS alone for hepatocellular carcinoma (HCC), were studied to evaluate the efficacy and complication of that treatment. The initial treatments provided CR in eight patients (47%), and repeat administrations of SMANCS achieved CR in an additional four patients (24%). The initial treatment provided a dense deposit of Lipiodol in the twelve tumors (63%), in five of which Lipiodol was thereafter washed out in some portions of the tumor. Complete necrosis was obtained in nine (75%) of fourteen hypervascular tumors, and in two (40%) of five intermediately vascular or hypovascular tumors. Segmental or subsegmental administration of SMANCS was well tolerated with self-controlled abdominal pain or fever well responding to medication. Ascites was seen in three cases, and atrophy of the segment infused occurred in five patients. Cholinesterase significantly reduced at one week and one month, then recovered to baseline two to three months after initial treatment. The cumulative survival rates were 77% at 1 year, 66% at 2 years, and 53% at 5 years in the whole patients. The survival rate was 100% at 5 years in the Child A group. In the patients who obtained CR using SMANCS alone, the survival rates were 89% at 1 year, 74% at 2 years and 56% at 5 years. Although this method may transiently deteriorate hepatic function, segmental or subsegmental administration of SMANCS may be an excellent therapeutic method for treatment of HCC and promising for use in properly selected patients.

Adult↗

PubMed1976

Which neuroses need specialist care?

In order to differentiate the neurotic patient who both needs and responds to psychiatric care from the majority of neurotic patients, who do not need this, carefully matched pairs of neurotic patients being treated at psychiatric and nonpsychiatric clinics in Montreal were followed up for 1 year. Improvement was substantial regardless of treatment, and the psychiatrically treated, on the whole, improved only slightly more than the others. However, one type of patient improved greatly under psychiatric care while improving almost not at all without it--introverts who considered themselves unhealthy but found life manageable, had avoided taking time off work or using anxiolytic drugs and appeared to handle their frustrations without repressing their irritation or losing self-control. It is suggested that it is mainly this type of neurotic that should receive specialist referral.

Adolescent↗

PubMed1998

[Psychological concepts in pain therapy practice. 2: Behavior therapy, self-management and overview of cognitive interventions].

In this part, the contribution of cognitive behavior therapy and the self management approach in psychological pain therapy is presented. A five-step-model of cognitive behavior is explained. The different steps are diagnostics, development of a new cognitive model of the disorder, acquisition of coping strategies, applications, transfer and relapse prevention. Focus of this paper are the coping strategies, thus, the interventions in confrontation with a pain stimulus. The self management approach has the goal to enable the patient to use coping strategies as quickly as possible by himself and to support the self-regulation of the patient. At the end, a survey about cognitive self-control strategies is given.

Adaptation, Psychological↗

PubMedDate not supplied

[Interneuronal frontal-amygdala interactions in cats trained for the quality of the reinforcement].

In eight cats the appetitive instrumental conditioned reflexes to light were elaborated by the method of "active choice" of reinforcement quality: the short-latency bar-pressing responses were reinforced with bread-meat mixture and the delayed responses were reinforced with meat. The animals differed in behavior strategy: six cats preferred the delayed pressings (the so-called "self-control" group), and two cats preferred the pressings with short delay (the so-called "impulsive" group). The multiunit activity in the basolateral amygdala and frontal cortex was recorded by chronically implanted nichrome semimicroelectrodes. The interactions of the neighboring neurons in the basolateral amygdala and the frontal cortex (within the local neuronal networks) and between the amygdalar and cortical neurons (distributed neuronal networks of amygdalar-frontal and fronto-amygdalar directions) were estimated by means of statistical crosscorrelation analysis of spike trains. The interneuronal cross-correlations were studied with delays in the range of 0-100 ms. The number of cross-correlations between the neuronal discharges both in the local and distributed networks was significantly higher in "impulsive" cats, mainly, with delays in the range of 0-30 ms. In both groups of animals the number of correlations was the highest during omissions of conditioned pressings, i.e., in cases of difficult choice of reinforcement. We suggest that the basolateral amygdala, frontal cortex, and amygdalar-frontal distributed neuronal networks are involved in the system of brain structures, which determine the individual features of animal behavior.

Amygdala↗

PubMed1997

Fractures of experimentally traumatized embalmed versus unembalmed cadaver legs.

Intact legs from six geriatric cadavers were fractured in a self-controlled study aimed at documenting the effects of embalming on both the soft and hard tissues of cadaver specimens subjected to biomechanical impact research. Upon bequeathal, one leg was removed and frozen while the other remained with the cadaver for embalming. The embalmed legs were amputated later and pre-test radiographs were made. For testing, a rod was inserted in the upright leg such that simulated upper body mass could be applied. A 50 kg cart propelled by a pneumatic accelerator to 7.5 m/s struck the anterior leg midway between the knee and ankle. The cart was headed by an instrumented steel pipe (4.75 cm dia.) coupled to a transducer which relayed impact force data to a Hewlett Packard 3562 A signal analyzer. Testing was captured on standard VHS video (30 frames/s) and 16 mm Color High Speed Film (1,000 frames/s). Post-test analyses included radiographs and thorough dissection. Peak forces were comparable for matched pairs. The unembalmed legs showed greater soft tissue damage (muscle and skin) but generally less bone fragmentation than their embalmed counterparts. Neurovascular components were virtually unharmed in most legs.

Aged↗

PubMed1998

[Clinical diagnosis of frontotemporal dementia].

Frontotemporal dementia (FTD) is poorly recognized clinically. Of the 1,517 patients examined at the Lille Outpatients Memory Clinic data bank (1991-1995), 74 fulfilled the criteria of the Lund and Manchester groups for FTD. They accounted for 5 p, 100 of all patients, 1 for 10 probable or possible Alzheimer's disease. Mean patient age was 63 years, duration of the disease was 5 years, mean Mini Mental State score was 23; 45 p. 100 belonged to the active population. Behavioral disorders occurred before the cognitive decline and remained the major feature. All patients had at least 3 of the following symptoms: self-control impairment, affective disorder, loss of interest and self-neglect. Memory impairment consisted of correct encoding and impaired retrieval processes, without major storage impairment. No patients had spatial disorientation. Language was usually reduced, EEG was normal. Two diagnoses were confirmed by autopsy: both consisted of aspecific frontal and temporal degeneration, 41 p. 100 of the patients were referred by a general practitioner, 30 p. 100 by a psychiatrist, 16 p. 100 by a neurologist, 2 p. 100 by other specialists, and 11 p. 100 following the advice of their relatives. FTD had never been suspected. Alzheimer's disease or non specified degenerative dementia was suspected in 2/3 of patients and a psychiatric disorder in 1/3. With the advent of novel pharmacological agents for the treatment of dementing disorders and for research purposes, the identification and accurate differentiation of FTD from Alzheimer's disease and psychiatric disorder is essential. Therefore, the role of multidisciplinary memory clinic is crucial to differentiate FTD from other degenerative dementias.

Age of Onset↗

PubMedDate not supplied

[Expectations of hospitalized patients as to their relationship with the nursing team].

This research has been made in infectious-parasitary disease sector of a public university hospital in Rio de Janeiro on the first semester of 1995. The logbook research has been introduced to 5 adult clients, from both sexes, who had been interned in the construction of two categories, which are: a) Category I: Feelings and expectations of the client and; b) Category II: Communication and relationship between client and nurse. The results found in the first category were: 1) Lack of affection; 2) Affection, fear and anxiety; 3) Loneliness and depression; 4) Reflection; 5) Insecurity; 6) Worry about the equipment, to be cut, to be impersonally treated, lose self-control and physical dependence. The results found in the second category were: 1) Doubts and interests in information about their disease, its evolution and how long they will stay in hospital: 2) Opportunity to express feelings and ideas; 3) Comprehension of the message given by the nurse. We emphasize the increase of interchange of information, ideas, beliefs, feelings and acts in nurse-client interaction to develop the therapeutic relationship aiming at helping the client to fulfill his basic needs.

Adult↗

PubMed1998

A contextually relevant assessment of the impact of child maltreatment on the social competencies of low-income urban children.

OBJECTIVE: A developmental-ecological model was used to explore the psychological adjustment and peer social competencies of maltreated preschool children. METHOD: Enhanced research methods were used that included verification of maltreatment status, multiple-variable matching of comparison children, and contextually relevant assessment. One hundred eight Head Start children, of whom 54 were maltreated, participated. Assessment of social functioning included measurement of peer play interactions, global social skills, peer sociometrics, and teacher and parent ratings of behavior problems. RESULTS: Findings indicated that maltreated children were significantly less interactive in peer play and overall exhibited less self-control and interpersonal skill in social interactions than nonmaltreated children. In addition, maltreated children were more likely than their nonmaltreated peers to receive low sociometric ratings and were found by both teachers and parents to display more internalizing behavior problems than comparison children. CONCLUSIONS: These findings indicate the importance of using developmentally sensitive research methods to inform contextually relevant interventions.

Case-Control Studies↗

PubMedDate not supplied

[Training in preventing assaultive behaviors for psychiatric professionals].

Dangerous behaviors in psychiatric institutions constitute major clinical and administrative problems. Staff competency in dealing with assaultive patients is an important factor in reducing institutional violence. One of the training programs for mental health staff working with dangerous patients is called Professional Assault Response Training (PART). PART is a product of several years of experience accumulated by the group of California authors in their efforts at designing a safe and effective approach in responding to various dangerous behaviors. PART principles guide staff in 1) de-escalating dangerous incidents through verbal crisis interventions; 2) avoiding or minimizing the risk of minor physical injury through evasion; 3) preventing serious bodily harm through the use of manual restraint. The importance of maintaining self-control by staff is reinforced throughout the entire course as a crucial professional skill. Other PART principles include identifying realistic treatment expectations for assaultive patients, proper physical mobility and emotional balance of staff, recognizing warning signals of impeding danger, using reasonable force to match response to the level of dangerousness. The PART training explores various theoretical explanations of violence (legal model, stress model, environmental model, communication model, developmental model, basic needs model and common-sense model). Verbal interventions which are a cornerstone of the PART approach are matching specific motives of threatening behavior--fear, frustration, manipulation and intimidation. Physical interventions taught in the course (evasion and manual restraint) include only techniques which can be used safely and which are not pain inducing. Finally, the PART training also assists staff in properly documenting assaultive incidents.

Aggression↗

PubMed1998

Sexual aggression among Asian Americans: risk and protective factors.

Rates of sexual aggression among Asian Americans are relatively low. It is possible that these low rates are because Asian Americans are less likely than other groups to develop developmental, motivational, and situational risk factors associated with sexual aggression. Moreover, an emphasis in Asian cultures on self-control of sexual and aggressive behavior may serve as a protective factor. Nevertheless, patriarchal aspects of Asian cultures may place some Asian Americans at risk for sexual victimization or perpetration of sexually aggressive behavior. Although Asian Americans may be at less risk for sexual aggression than other groups, interventions that counteract the patriarchal aspects of Asian cultures may further reduce risk.

Aggression↗

PubMed1998

The application of traditional martial arts practice and theory to the treatment of violent adolescents.

Components of an effective treatment program for violent adolescents, and the complex problems posed by youth gangs, are discussed. It is proposed that traditionally taught martial arts can provide a useful alternative for such dysfunctional adolescents. The literature on the use of martial arts in the treatment of violence is reviewed, and the program philosophy is described. The program utilizes a commitment to respect and self-control, with an emphasis on leadership and community service using the traditional model of a gentle warrior. Oversight is provided by trained instructors, whose psychological and philosophical approach stresses nonviolence. The program also assists youths in coping with the complexities of an often dysfunctional family environment. Clinical examples detail the application of such a program in specialized martial arts schools, residential treatment, and public school classes.

Adolescent↗

PubMed1998

[Depression with obsession of contrast content].

Twenty depressed patients (according to ICD-10) with obsessions of contrast content (homicidophobia--4 patients, suicidophobia--12, other contrast obsessions--4 cases) were examined. The affective disorders belonged to polar areas of a depressive spectrum: anxious depressions (with a prevalence of manifestations of positive affectivity in the form of somatopsychic hyperstesia) and existential depressions (with domination of manifestations of negative affectivity in the form of alienation of the vital functions). In anxious depressions there were compulsive obsessions of contrast content (12 patients), while in existential ones impulsive obsessions (8 cases). Compulsive obsessions of contrast contents (fear of a lack of self-control pronounced in the form of the attacks of lissophobia) were formed at the height of an anxious-depressive affect. Impulsive obsessions of contrast contents (fear of self-damage with elements of an obsessive drive to its realization) were formed during depressive devitalization and were exceeded by suicidal ideas. Comorbidity of depressive and obsessive manifestations was realized by a peculiar type of interrelations with formation of "convergent" symptoms which reflected an increase of severity of depressive disorders.

Adult↗

PubMed1997

[Experimental study of the mechanism on blood supply to delayed separated skin flap by ultrasonic Doppler].

In order to investigate the mechanism of blood supply to the delayed separated skin flap and the time and criteria for its transfer, 5 small-sized Banna pigs were selected to produce 14 skin flaps. In the experimental group the skin flap on one side was made from the middle of the back having an extra-thin steel sheet intervened between the flap and the soft tissue of the back whereas the flap on the opposite side without a steel sheet intervened was served as the self-control. The skin flaps were examined 3,7,10 and 20 days after the operation and 3,7 and 10 days after transfer, respectively, by (1) gross observation; (2) ultrasonic Doppler; (3) superficial skin temperature measurement and; (4) histomorphological examination. In the experimental group the survival rate of the flap was 100 percent whereas in the control group all of the flaps had necrosis from 30 to 50 percent after the flap being transfered. In the experimental group, the echo sound from the arterial blood flow from ultrasonic Doppler was heard at the pedicle 7 days after the operation, and as time elapsed, the echo sound spread distally, whereas in the controls no echo sound could be heard over the skin flap. There was significant difference statistically between the experimental and control groups in the temperature of the flaps while the flaps were being transferred (P < 0.01). The external diameters of the blood vessels in the central area of the skin flap were larger in the experimental group, 0.8 to 1.2 mm in comparison to 0.4 mm.

Animals↗

PubMed1997

[A histopathological study on Hunan aqueous drainage implantation in rabbit's eye].

Thirty eyes with 15 healthy white New Zealand rabbits subgrouped into two groups: right eye as an experimental group which was implanted Hunan aqueous drainage (HAD) and left eye served as self-control group in which a silicone band 7 mm in width and 7 to 10 mm in length was placed equatorially around the globe. Within 1 to 12 weeks postoperatively, we examined the anterior segment of the globe by the slit lamp microscopy (SLM) and made histopathological observation under light microscope after sacrifice and enucleation of eyeballs in five batches. SLM examination showed that 8 out of 15 eyes in experimental group showed mild or moderate ocular reaction which subsided within 2 to 14 days postoperatively. Histopathological observation revealed no obvious pathological lesions in the uveal tract tissues in the most globes. No foreign body macrophages were found. It indicates that HAD implant is nontoxic and nonallergenic, so it is adaptable for rabbit ocular tissue. The HAD implant can be used in human eyes, too.

Animals↗

PubMedDate not supplied

Exploring the psychological effects of intensive care on paediatric patients: issues from the literature.

The psychological needs of children in intensive care may often be neglected in favour of a more physiological approach to nursing care. Both the short- and long-term psychological effects of paediatric intensive care require examination. There is a lack of research-based evidence on the psychological effects of intensive care on children. The intensive therapy unit (ITU) itself, developmental age, role of the family, loss of self-control/routine, under/over-use of sedation and analgesia, play, and the ITU nursing staff all have a significant psychological impact on the critically ill child. Strategies that reduce the negative psychological effects of ITU must address the above issues.

Child↗