Multiple sclerosis (MS) is a chronic, frequently progressive neurological disease of unknown etiology and uncertain trajectory. Physicians and nurses have historically been uncomfortable broaching the topic of a possible MS diagnosis with patients and have tended instead to talk about it in euphemistic terms. However, with the development of therapeutic agents that may be more effective early in the disease course, the early communication of diagnostic and treatment information has become increasingly important. In our MS clinic, individual with MS symptoms are rapidly referred and assessed by a team of experienced physicians and nurses. Our experience with this referral process has led to our adoption of Peplau's Interpersonal Relations Model as a guide to nursing practice. The central element of Peplau's model is the development of a therapeutic relationship between patient and nurse. This relationship develops through four overlapping stages: orientation, identification, exploitation, and resolution. The collaborative relationship that develops between nurse and patient enhances problem solving and creates a strong bond that is essential across the long trajectory of the illness.

Adaptation, Psychological↗

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Patients with medically unexplained symptoms: sources of patients' authority and implications for demands on medical care.

Lay and medical beliefs are not separate systems. The beliefs of somatizing patients, in particular, incorporate medical understanding and it has been argued that this increases the power that such patients exert in seeking treatment from doctors. To understand the nature and use of this power requires investigation of (i) how patients use medical ideas and language to explain their symptoms and (ii) how this process influences patients' expectations and evaluations of their doctors. We interviewed 68 patients, in whom no physical cause had been found for persistent physical symptoms. Their accounts of symptoms and of their experience of doctors were subjected to qualitative thematic analysis. As expected, patients used medical terms to explain their symptoms. However, these depicted explanatory themes which have long been familiar in traditional lay models: disease as a malign entity and imbalance between bodily forces. Patients' sense of authority over doctors derived, not from facility with medical language and ideas but from contrasting their own sensory, and therefore infallible, experience of symptoms with doctors' indirect and fallible knowledge. By providing explanations that questioned the reality of symptoms, doctors were perceived as incompetent and inexpert. Patients used their authority, not to seek treatment, but to secure naming of, and collaboration against, the disorder. Although these patients saw the doctors' role as limited and inexpert by comparison with their own, our analysis suggests ways in which doctors might more effectively engage with persistent somatizing patients.

Adult↗

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The role of sex steroids in the acquisition and production of birdsong.

Male birdsong is generally regarded as a secondary sexual characteristic under the control of gonadal steroids. Song typically waxes and wanes with the seasonal cycle of testicular growth and regression and decreases after adult castration. Testosterone therapy reinstates song, induces it in females, augments it in intact males, and spring testosterone profiles correlate with seasonal song production. Thus, testosterone has been viewed as a major factor in song acquisition and production acting either directly, or after aromatization within the brain. We show here, however, that song learning and early phases of the development of singing both take place in castrated male birds with no significant levels of testosterone in their blood plasma. Testosterone seems to be required for song crystallization, however. Oestradiol was unexpectedly still present after castration, evidently from a non-testicular source, throughout the period of male song acquisition.

Animals↗