Feasible criteria for enrolling end-stage dementia patients in home hospice care

Hospice care is considered appropriate for end-stage dementia patients (Luchins & Hanrahan, 1993), yet less than 1 percent of hospice patients have a primary diagnosis of dementia (Hanrahan & Luchins, 1995). This pilot study tested the feasibility of providing palliative care for dementia patients. A common eligibility requirement for admission to hospice is that the patient is likely to die within six to seven months. The uncertain survival time of dementia patients thus prevents access to hospice programs. Therefore, enrollment criteria were developed based on the characteristics of advanced dementia and a history of medical complications. With these criteria established, it was then possible to enroll 11 patients over two years. The enrollment criteria proved successful in that the median survival time was five months, with an average of seven months. Eight of the 11 patients died during the study. Hospice care was well accepted by family caregivers and appeared to meet the patient's needs.     

Review of Making contact: Uses of language in psychotherapy.

Reviews the book, Making contact: Uses of language in psychotherapy by Leston Havens (see record 1986-97288-000). Drawing on ideas from psychoanalytic, existential, and interpersonal theories, the author has provided a thought-provoking and practical book about how to reach, affect, and influence the distant or absent patient through language. This book is not only thought-provoking and practical but also a pleasure to read; Havens possesses a graceful literary style that is vivid, witty, and filled with fresh metaphors. Havens avoids traditional terminology for describing the more disturbed patient in favor of a personal and less objectifying way of speaking. Havens has provided a framework for conceptualizing how language can be used in a disciplined and powerful way to locate the lost selves of our patients. By calling attention to how we speak, he reminds us that language, used empathically and authentically, is the most powerful tool we have to bridge the often wide chasm between us and our patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Standards of care for treating headache in primary care practice. National Headache Foundation

The following is a summary of guidelines created under the auspices of the National Headache Foundation, in an effort to improve the care of headache patients in primary care practice. The guidelines represent the consensus of an advisory panel of practitioners chosen by the NHF for their expertise in four specialty areas. A complete set of guidelines can be obtained by calling the National Headache Foundation at 1-800-843-2256 or by writing to them at 428 W. St. James Pl., 2nd Floor, Chicago, IL 60614-2750; the cost is $10.     

CO2 laser surgery in osteomyelitis

Spirituality is a critical component of the holistic mind-body-spirit model embraced by Hospice. Hospice chaplains, as part of the caregiving team, must understand their abilities and limitations in providing spiritual guidance to others who may differ in religious and spiritual beliefs.     

"Geographical center" of psychology.

Among the items of information which give us a better grasp of the nature of the field of psychology is the geographical distribution of psychologists. Leafing through the geographical section of the APA Directory, one is impressed by the pages and pages of names for some states, and one wonders whether the more populous parts of the country have a disproportionate part of our psychologists. This article presents a study which offers some crude information on these topics. The location of the "psychological center" might be a basis for choosing convention sites, making Chicago, Detroit, St. Louis, and Cincinnati likely spots. A speculative reader might care to draw some social implications about the discrepancies between population and psychological rankings of the states. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tumor cell recognition by lymphocytes: is the MHC always essential?

More than a year has passed since the Center to Improve Care of the Dying and the Corcoran Gallery of Art sponsored the symposium entitled: A Good Dying: Shaping Health Care for the Last Months of Life. Using the National Hospice Foundation sponsored exhibition, Hospice: A Photographic Inquiry, as a backdrop, the symposium included presentations on the current state of hospice care as well as the obstacles that limit access to hospice care. This article represents an update on many of the activities of the National Hospice Organization and the greater hospice community as we continue to improve access to quality hospice care.     

New perspectives on development and their implications for psychoanalytic treatment.

Reviews the book, Psychoanalysis and infant research by Joseph D. Lichtenberg (1983). The burgeoning field of infant research has burst through the seams of our traditional view of infants. We now know that neonates are far more aware of their environment, more capable of eliciting responses from people, and more differentiated in their responses to caretakers and to a variety of external stimuli than we had ever believed. In part, this new knowledge has been gained through clever, creative experimentation by academic researchers. Experiments have been devised which are simple enough for neonatal responsiveness, yet offer relevant information about the infant's learning, cognitive, and emotional capacities. Joseph Lichtenberg's book, Psychoanalysis and infant research, presents this rich body of research. Were he content to offer us this new and absorbing view of the neonate, that alone would make the book interesting and worthwhile. Lichtenberg, however, is more ambitious. He sees important implications of infant research for various aspects of psychoanalytic theory and believes that a careful reading of the infancy data will "lead to reexamination of our theory" (p. 27). While the reviewer thinks there is much that infant research can offer to inform psychoanalytic theory, more empirical data are clearly needed from this area as well as from clinical research in the psychoanalytic setting. Lichtenberg deserves our gratitude both for calling our attention to some of the most important research findings that have emerged to date and for directing us to consider the implications of these findings for psychoanalytic theory and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction.

As the celebration of the American Psychological Association's centennial closes with the end of 1992, so does the series of personal reflections and recollections on the development of professional psychology. Francis (Frank) A. Young, Ernst Beier, Rogers Wright, and Robert (Bob) Weitz—who have all been active in shaping professional psychology's future through their careers and through tireless efforts in state and national advocacy are our final writers. Frank Young, a prominent researcher in vision at Washington State University, presents how he became involved in state psychological association activities, ultimately becoming the executive officer of the Washington State Psychological Association and of APA's Division of State Psychological Association Affairs. Ernst Beier, an immigrant to the United States who fled his homeland during the Holocaust tells how he became interested in subtle cues in communication and shares some vignettes, one a life threatening one, about this. Rogers Wright has devoted his career to advocacy for psychology. A founder of psychology's first advocacy organization, Council for the Advancement of the Psychological Professions and Sciences, he recounts how advocacy has developed during the last three decades. The final essay is by Bob Weitz, the first psychologist to open a private practice in the state of New Jersey. His career, which has spanned half a century, gives us a glimpse of how clinical psychology grew to what it is today. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fill Placement on Slopes Underlain by Franciscan Mélange

Distress in two housing developments was caused by a deep bedrock landslide triggered by placement of a large upslope fill. The large fill was placed to create a visual barrier between the upslope development and downslope housing developments and to balance the cut and fill quantities for the upslope site. This case history presents some of the ramifications of fill placement on natural slopes surrounded by urban areas, such as overstressing underlying weak material that may exist below the depth of borings typically conducted for single family residences and office complexes; the importance of surface and subsurface information in a formation known locally as Franciscan complex/mélange (which is a block-in-matrix rock formation common to the area); the shear behavior of serpentinite, which is part of the Franciscan complex; and the importance of natural and man-made changes to a slope, such as rainfall, surficial grading, home construction, and fill placement. It also illustrates the importance of locating the critical slope cross section before construction and the proper use of back-analyses in a landslide investigation.     

Influence of Mechanical Draft Tube Fish Barrier on the Hydraulic Thrust of Small Francis Turbines

Environmental regulations have required from hydroelectric power plants more effective means of restricting the access of fish into the draft tube of hydraulic turbines. The decline of fish populations on rivers used for electricity generation has motivated the installation of mechanical gates as fish barriers on the tailrace pipe of hydroelectric power plants as a technical solution to preserve aquatic wild life. However, variations in the flow conditions through the turbine runner may modify the performance characteristics of turbines, thus affecting their capacity for electricity production. This note presents an experimental study of the influence of draft tube gates on the hydraulic forces acting on Francis turbines. A Francis turbine test bench was specially designed to allow this investigation. Measurements of the hydraulic thrust in relation to the level of flow restriction at the draft tube exit indicate that the mechanical gates excessively increase the axial load on the runner shaft, which may shorten the hydrogenerator unit life.     

Infectious disease physicians rate microbiology services and practices

Recent years have seen increasing emphasis on cost containment and quality improvement in clinical laboratory activities. Modifying those activities to enhance clinical relevance is one strategy that should be satisfying to both laboratory scientists and administrators. This guest commentary describes one approach to quality improvement--the use of user surveys to identify areas for improvement. As an initial attempt to define such areas in clinical diagnostic microbiology, infectious disease specialists, targeted for their particular interest and expertise in microbiology laboratory results, were polled and their responses were analyzed. Some of these data have been presented previously (E. J. Baron, D. P. Francis, and K. M. Peddecord, abstr. C-170, p. 520, in Abstracts of the 94th General Meeting of the American Society for Microbiology, 1994; K. M. Peddecord, E. J. Baron, D. P. Francis, and A. S. Benenson, abstr. C-172, p. 520, in Abstracts of the 94th General Meeting of the American Society for Microbiology, 1994; K. M. Peddecord, E. J. Baron, D. P. Francis, and J. A. Drew, Am. J. Clin. Pathol. 105:58-64, 1996). The discussion includes our recommendations for the use of these survey responses, and their limitations, as stimuli to initiate reexamination of certain microbiology laboratory practices in the interest of developing more cost-effective and clinically relevant protocols.     

The interdisciplinary bereavement team: defining and directing appropriate bereavement care

Hospice bereavement care often occurs in relative isolation from other program components; staff and volunteers are without the guidance, consultation and support provided through the interdisciplinary team that is enjoyed by personnel working in patient care areas. This article promotes a similar interdisciplinary team concept that has been successfully employed in one of the country's largest bereavement programs. Comprised of bereavement program staff, consultants from the patient care program, professional and lay volunteers, this interdisciplinary team defines and directs interventions provided by the bereavement care program.     

St. Louis encephalitis: clinical and epidemiologic aspects, Mississippi, 1974

During July, August, and September 1974, 23 confirmed or presumptive cases of St. Louis encephalitis occurred in Mississippi. Attack rates were highest in the northwest corner of the state and among persons over 70 years of age. Rural and urban residents had similar attack rates. Nine persons have not resumed their pre-illness level of activity because of residual neurologic impairment six months after their illness. Additional cases of St. Louis encephalitis are expected in the next few years.     

Reconsidering the sauce: A comment on Floyd.

Comments on the article Fundamentalism: Sauce for the goose by K. Floyd (see record 2007-09680-001). Floyd reminds us that the application of a little logic to the propositions we claim are true can sometimes show us that our beliefs are untenable, and that such a finding "could turn out to be very freeing indeed". In particular, he uses one of the arguments some of us struggled with the first time we met logic as a discipline: If P is true then Q is true. Q isn't true. Therefore, P isn't true. Floyd applies this principle to religious belief: If I believe that P is true and Q is true when in fact P implies that 0 is false then I am truly inconsistent! He also shows how easily we are willing to use such logic on the beliefs of others but not on our own beliefs. The current authors' attempt to demonstrate that Floyd makes several questionable steps in his reasoning, thereby calling into question the conclusions he draws. Floyd has sought to point out the lack of thought behind numerous religious beliefs. The current authors accept this general observation, but they believe it unfair to attribute this difficulty only to religious beliefs. The difficulty with religious beliefs is not that they are not concerned with truth vs. non-truth, but rather that for a number of reasons, the difference between these two poles is often not obvious. The question of the validity of religious beliefs is a philosophically spiny one that has been addressed, sometimes adequately and sometimes in very illogical, emotional and violent fashions, for thousands of years. It seems obvious to the authors that "three minutes thought" is not sufficient to untangle such an issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trends in cigarette smoking: the Minnesota Heart Survey, 1980 through 1992

OBJECTIVES: The purpose of this study was to describe trends in the prevalence of cigarette smoking between 1980 through 1982 and 1990 through 1992 in Minneapolis and St. Paul, Minn. METHODS: Three population-based surveys were conducted among adults 25 to 74 years of age in 1980 through 1982, 1985 through 1987, and 1990 through 1992. RESULTS: Overall age-adjusted prevalences of cigarette smoking declined significantly between 1980-1982 and 1985-1987 and between 1985-1987 and 1990-1992. Serum thiocyanate, a biochemical marker for tobacco use, also declined significantly over the 3 periods. CONCLUSIONS: Favorable trends in smoking prevalence and cigarette consumption among smokers were observed, but disturbing trends in some smoking behaviors were also noted.     

Pediatric coin ingestion: a home-based survey

To improve understanding of the natural history of pediatric coin ingestions, an anonymous, home-based mail survey of parents followed by a five-physician private pediatric practice in suburban Maryland was conducted. Of 2,263 families surveyed, 798 (35.3%) responded, representing 1,510 children. Sixty-one (4.0%, 95% confidence interval: 3.1% to 5.1%) children had swallowed a coin, at a mean age of 2.8 years. Fifty-two (85%) coin ingestions were managed at home, usually without calling a physician or poison control center. Only 9 (15%) children were examined by a physician. No child (95% confidence interval: 0% to 4.9%) underwent a removal procedure or had an adverse outcome. Most coin ingestions were found to have been managed at home, often without calling a physician or poison control center. Hospital- or poison control center-based studies underestimate coin ingestion incidence and overestimate the frequency of complications.     

Advances in hospice care

Hospice care developed in part as a reaction to the impersonal and technology-dependent end-of-life care offered by modern medicine. Unique approaches to care that emphasize interdisciplinary team management of troublesome symptoms and the promotion of quality of life as defined by the patient, are finding their way into all aspects of health care. Symptom control measures have expanded to include chemotherapy, radiation therapy, and multimodal therapies. Both the development of a unique knowledge base and advances in research have fostered the integration of hospice and palliative care into mainstream medicine.     

Real-Time Hydraulic and Hydrodynamic Model of the St. Clair River, Lake St. Clair, Detroit River System

The Huron-Erie Corridor serves as a major waterway in the Great Lakes and is the connecting channel between Lake Huron and Lake Erie. The system consists of the St. Clair River, Lake St. Clair, and the Detroit River, and serves as a recreational waterway, source of drinking water for Detroit and surrounding cities, as well as the only shipping channel to Lakes Huron, Michigan, and Superior. This paper describes a three-dimensional unsteady model of the combined system and its application to real-time predictions of physical conditions over the corridor. The hydrodynamic model produces nowcasts eight times per day and 48 h forecasts twice a day. Comparisons between model simulations and observed values show average differences of 3 cm for water levels and 12 cm/s for along-channel currents in the St. Clair River (compared to mean current values of 1.7 m/s) for the period of September 2007 to August 2008. Simulations reveal a spatially and temporally variable circulation in Lake St. Clair as well as significant changes in flow rate and distribution through the St. Clair Delta not accounted for in previous models.