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PubMed1993

Affect and outcome in short-term group therapy for loss.

Affect and work variables were monitored for 12 of 16 groups involved in a controlled outcome study of psychoanalytically oriented short-term group therapy. Groups were conducted by experienced therapists for outpatients who experienced difficulties adapting to personal losses through death, separation, or both. Postsessional ratings of positive and negative affect were provided by individual patients, therapists, and other patients. Psychodynamic work was rated independently using a content analysis system. Patients who had experienced separation were more inhibited in their affective expression. Rating sources agreed that positive affect increased over time. Direct relationships were found between positive affect and favorable outcome. Concerning negative affect, the strongest predictors of favorable outcome involved the interaction of affect and work. Implications of these findings are discussed in terms of the cathartic hypothesis.

Adult↗
PubMed1987

The effect of humor on aggression catharsis in the classroom.

Two studies were designed to measure the cathartic effects of humor on aggressive responses. In the first study, two versions (easy and difficult) of Raven's intelligence test were administered to two groups of high school students. Only the easy version could be solved in the alloted time. Rosenzweig's (1951) Picture Frustration test was then administered and the students' aggressive responses were scored. Results showed that those who did not solve the problems had significantly higher scores on aggressivity than did the others. The second study, using four different groups, was planned according to a modified Solomon design. Two of the four groups of students completed the difficult part of the Raven test, and then two video-tapes were presented: a humorous one to two groups and a neutral one to the others. Finally, the Rosenzweig Picture Frustration test was administered to all four groups. An analysis of variance computed on the aggressivity scores showed one significant difference: frustrated students who viewed the humorous videotape had lower scores than those viewing the neutral one.

Abreaction↗
PubMed1982

Acute poisoning: management protocol.

Management of the acutely poisoned patient should start with decontamination of the skin and irrigation of the eyes, if necessary, and assessment of cardiorespiratory status, neurologic status, and pupils and eye movement. If a definable toxic syndrome is present, the specific "antidote" should be given. If no such syndrome is apparent and the patient is comatose, 50 ml of 50% glucose and 0.4 mg of naloxone (Narcan) intravenously should be tried. General measures, applicable in either situation, include induction of emesis or lavage and administration of charcoal and cathartics.

Acute Disease↗
PubMed2004

The inspiration of hope in bereavement counseling.

While most healthcare workers would agree that hope is necessary for healthy living, the current understanding of hope and hoping is incomplete. This article reports on a study that attempted to answer the question: Do bereavement counselors inspire hope in their clients, and if so, how? The study used a modified grounded theory method and collected data, by means of interviews, from a total sample of 12 participants, comprising bereavement counselors and ex-clients who had received bereavement counseling. The data were coded and analysed using the constant comparative method, which produced an emerging, integrated, substantive grounded theory of hope inspiration for this client group. This theory includes a core variable: the implicit projection of hope and hopefulness; and three subcore variables: forging the connection and the relationship; facilitating a cathartic release; and experiencing a good (healthy) ending. The theory indicates that this hope inspiration appears to be a subtle, unobtrusive process that was bound up with the necessary and sufficient human qualities in the counselor and the projection of these into the environment (and client).

Bereavement↗
PubMed2003

'A lifestyle coat-hanger': a phenomenological study of the meanings of artwork for women coping with chronic illness and disability.

PURPOSE: The purpose of this phenomenological enquiry was to explore the meanings and functions of art for a group of women living with disabling chronic illness. Participants were recruited on the basis that they considered artwork as central to their current well-being. METHOD: Thirty women were interviewed and five submitted written narratives. Interpretative phenomenological analysis was carried out. RESULTS: About half of the participants had taken up their preferred artistic occupation since the onset of illness. Participants described their artwork as contributing to their health and well-being in many diverse ways. Art filled occupational voids, distracted thoughts away from illness, promoted the experience of flow and spontaneity, enabled the expression of grief, maintained a positive identity, and extended social networks. Its value was conceptualised by one participant as a 'lifestyle coat-hanger' organising numerous further roles and activities that gave purpose to life. Art was more than cathartic. It offered a versatile means of overcoming the restrictions imposed by illness on self and lifestyle, in many cases creating a more enriched lifestyle than before. CONCLUSION: The findings may encourage professionals working in health and rehabilitation settings to assist clients in identifying meaningful, creative occupations that are feasible within the limits imposed by illness or injury.

Adaptation, Psychological↗
PubMed2005

Psychosocial benefits of solitary reminiscence writing: an exploratory study.

Claims have been made that reminiscence has benefits for older people's psychological well-being, and that writing memories may be a therapeutic process. This paper describes an exploratory study in which five nursing home residents engaged in a process of writing their memories by themselves, in a series of booklets containing memory prompts and photographs, over a period of four weeks. Each completed booklet was typed up by researchers and returned to participants the following week, with a bound copy provided to participants at the end of the study period. Analysis focuses on two sets of data: an in-depth case study of one participant, and a thematic analysis of field notes, researcher reflections, and the written material produced by the other study participants. The case study revealed three main themes: views on the past; sharing the past; and confidence in writing about the past. The field note analysis indicated the presence of four themes: proof and maintenance of skills; psychological or internal processes; social contact; and pleasure in reminiscence. The writing was seen as cathartic and provided a meaningful purpose, an opportunity to exercise writing skills and memory, and a focus for participants to share key stories with others. This exploratory study suggests that there is potential in using solitary writing within a reminiscence framework to improve psychological well-being in older people. However, caution should be exercised when encouraging older people to write their stories. Issues of confidentiality, audience, support, and appropriateness of the activity for the individual need consideration.

Aged↗
PubMed2006

Aripiprazole exposures reported to Texas poison control centers during 2002-2004.

Aripiprazole is an oral atypical antipsychotic drug used in the treatment of schizophrenia and potentially other behavior disorders. The purpose of this study was to describe the epidemiology of aripiprazole exposures reported to Texas poison control centers. Human aripiprazole exposures reported to six Texas poison control centers were identified and comparisons were made between isolated and nonisolated cases with respect to various demographic and clinical factors. Of 280 human exposures involving aripiprazole, 35% were isolated and 65% were nonisolated. The patients were female in 52% of isolated and 60% of nonisolated cases. Isolated cases were significantly more likely to involve children < 6 yr of age. Fifty-eight percent of isolated cases were unintentional while 68% of nonisolated cases were intentional. Nonisolated cases were much more likely to already be at or en route to a health care facility when the poison control center was contacted. Of those cases with a known medical outcome, no adverse clinical effect was reported in 52% of isolated cases and 35% of nonisolated cases. The adverse clinical effects associated with isolated aripiprazole exposures were mainly neurological, cardiovascular, and gastrointestinal, with the most frequently reported adverse clinical effect being drowsiness or lethargy. The most commonly reported treatments for isolated aripiprazole exposures were single dose of activated charcoal, cathartic, intravenous fluids, dilution, lavage, and antihistamines. In conclusion, isolated and nonisolated aripiprazole exposures varied with respect to patient age, exposure reason, management site, and clinical outcome.

Adolescent↗
PubMedDate not supplied

Effect of ethanol on the retention of americium-241 in the baboon liver.

The oral administration of ethyl alcohol enhanced the excretion of 241Am from the liver of a baboon by 2.5 times that of a control animal. After ethanol administration, increases in the total content of 241Am excreted in feces were accompanied by corresponding increases in fecal volumes, although administration of nonalcoholic cathartics would not be expected to produce a similar effect. The effectiveness of ethanol as a decorporating agent may result from its ability to mobilize intracellularly bound 241Am from the liver, thereby making the nuclide more available for metabolic secretory mechanisms occurring via liver-bile-fecal route.

Americium↗
PubMed2000

Ecbalium elaterium (squirting cucumber)--remedy or poison?

BACKGROUND: Ecbalium elaterium is a plant endemic to the Mediterranean basin. Its roots and cucumber-shaped fruit have been used in folk medicine since antiquity. The alleged uses of the fruit juice are as a potent cathartic, analgesic, and antiinflammatory agent. Cucurbitacin B, a triterpene derivative is the active antiinflammatory principal. PATIENTS: We present a series of 13 patients who were exposed to the juice of Ecbalium elaterium in its natural form. In 3 patients, exposure was intranasal for the treatment of sinusitis or liver cirrhosis. In 3 other cases, children ingested the fruit unwittingly. In 6 patients, exposure was ocular and, in one, dermal. Within minutes of exposure, the patients exhibited irritation of mucous membranes at various degrees of severity manifested as edema of pharynx, dyspnea, drooling, dysphagia, vomiting, conjunctivitis, corneal edema, and erosion, depending on the route of the exposure. Recovery began within several to 24 hours after administration of oxygen, steroids, antihistamines, and beta-2-agonists. Ocular exposures responded to topical steroid and antibiotic eyedrops within a few days. The toddler with the dermal exposure remained asymptomatic. CONCLUSION: Exposure to the juice of Ecbalium elaterium, mainly in its undiluted form, may cause irritation of mucous membranes, supposedly of inflammatory nature. Patients exposed orally or intranasally should be closely followed for upper airway obstruction. Patients exposed ocularly should have their eyes promptly irrigated to prevent corneal and conjunctival injury.

Adolescent↗
PubMed1999

Prothiofos metabolites in human poisoning.

CASE REPORT: A 63-year-old woman was admitted to a local hospital after the ingestion of 40% prothiofos preparation (Tokuthion) 370 mL. Gastric lavage was performed and cathartics, active charcoal, diuretics, atropine sulfate, and pralidoxime were administered. Serum cholinesterase activity was 1.3 IU/L (normal 200-460 IU/L). The patient's consciousness was gradually restored after 4 hours of charcoal hemoperfusion and she was discharged 5 days after admission with no sequelae. METHOD: Plasma and urine prothiofos and metabolites were detected by gas chromatography-flame photometry and gas chromatography-mass spectrometry. Two despropyl metabolites were synthesized for identification and estimation. RESULTS: The main metabolites were identified with authentic prothiofos and methyl esters of synthesized des-S-propyl prothiofos oxon (O-2,4-dichlorophenyl O-ethyl phosphate), despropyl prothiofos oxon (O-2,4-dichlorophenyl O-ethyl phospholothiolate), and des-S-propyl prothiofos (O-2,4-dichlorophenyl O-ethyl phosphorothioate). Despropyl prothiofos (O-2,4-dichlorophenyl O-ethyl phosphorodithioate) was also identified in plasma. Large amounts of the hydrolyzed product, 2,4-dichlorophenol and its conjugate were also found. The metabolic pattern of prothiofos in humans appears to be different from that in rats.

Charcoal↗
PubMed2001

Abuse of telazol: an animal tranquilizer.

BACKGROUND: Telazol (tiletamine hydrochloride 50 mg/mL, zolazepam hydrochloride 50 mg/mL) is utilized in veterinary medicine as a small-animal anesthetic. Telazol is comparable to ketamine in efficacy, and in conjunction with ketamine, has been responsible for one reported human fatality. We report a case of a woman who abused telazol. CASE REPORT: A 30-year-old female employee at a local zoo was found unresponsive by fellow workers in a clean animal treatment room. Initial reports were that she had injected veterinary-grade diazepam and telazol. On-scene paramedics reported her as obtunded and arousable to deep painful stimuli, with gag reflex intact. Systolic blood pressure was 90 mm Hg by palpation. A fresh needle puncture mark was present on her right arm; nearby were a syringe, tourniquet, and bottles of each drug. Emergency Department assessment included airway, breathing, circulation, and intravenous access. She was lavaged and given activated charcoal with a cathartic. Shortly after arrival, she became alert and oriented. Family members insisted this was not an overdose. The patient had been previously evaluated for reported episodes of syncope, "only in the evening, while at work," and was prescribed diazepam for anxiety. Product information on telazol was limited to the Veterinary Drug Physician's Desk Reference. A urine drugs-of-abuse screen was positive for benzodiazepines and cannabinoids. The patient subsequently revealed a history of recreational use of telazol. She was discharged to an in-patient detoxification facility, 12 hours postadmission. CONCLUSION: Telazol used in veterinary medicine as an anesthetic agent, is structurally related to ketamine. Telazol causes almost immediate anesthetic effects, and sudden alertness is not uncommon as the effects of the drug subside. Urine drugs-of-abuse screens are unlikely to identify telazol. We report a veterinary worker who abused telazol.

Adult↗
PubMed2005

Iron ingestion: an evidence-based consensus guideline for out-of-hospital management.

From 1983 to 1991, iron caused over 30% of the deaths from accidental ingestion of drug products by children. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the primary author. The entire panel discussed and refined the guideline before its distribution to secondary reviewers for comment. The panel then made changes in response to comments received. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with suspected ingestions of iron by 1) describing the manner in which an ingestion of iron might be managed, 2) identifying the key decision elements in managing cases of iron ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of iron alone and is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. The panel's recommendations follow; the grade of recommendation is in parentheses. 1) Patients with stated or suspected self-harm or who are victims of malicious administration of an iron product should be referred to an acute care medical facility immediately. This activity should be guided by local poison center procedures. In general, this should occur regardless of the amount ingested (Grade D). 2) Pediatric or adult patients with a known ingestion of 40 mg/kg or greater of elemental iron in the form of adult ferrous salt formulations or who have severe or persistent symptoms related to iron ingestion should be referred to a healthcare facility for medical evaluation. Patients who have ingested less than 40 mg/kg of elemental iron and who are having mild symptoms can be observed at home. Mild symptoms such as vomiting and diarrhea occur frequently. These mild symptoms should not necessarily prompt referral to a healthcare facility. Patients with more serious symptoms, such as persistent vomiting and diarrhea, alterations in level of consciousness, hematemesis, and bloody diarrhea require referral. The same dose threshold should be used for pregnant women, however, when calculating the mg/kg dose ingested, the pre-pregnancy weight of the woman should be used (Grade C). 3) Patients with ingestions of children's chewable vitamins plus iron should be observed at home with appropriate follow-up. The presence of diarrhea should not be the sole indicator for referral as these products are often sweetened with sorbitol. Children may need referral for the management of dehydration if vomiting or diarrhea is severe or prolonged (Grade C). 4) Patients with unintentional ingestions of carbonyl iron or polysaccharide-iron complex formulations should be observed at home with appropriate follow-up (Grade C). 5) Ipecac syrup, activated charcoal, cathartics, or oral complexing agents, such as bicarbonate or phosphate solutions, should not be used in the out-of-hospital management of iron ingestions (Grade C). 6) Asymptomatic patients are unlikely to develop symptoms if the interval between ingestion and the call to the poison center is greater than 6 hours. These patients should not need referral or prolonged observation. Depending on the specific circumstances, follow-up calls might be indicated (Grade C).

Evidence-Based Medicine↗
PubMed1964

ERYTHROCYTE SENSITIZATION BY BLOOD GROUP-SPECIFIC BACTERIAL ANTIGENS.

Human and chicken erythrocytes are readily coated in vitro by blood group active protein-lipopolysaccharides and lipopolysaccharides from E. coli O(86) and E. coli O(128). Serum albumin, alpha(2)- and beta-lipoproteins inhibit this sensitization. Blood group B specific agglutination of erythrocytes with B or B-like antigens was obtained with antibodies purified by adsorption on and elution from B erythrocytes. Anti-blood group B and E. coli O(86)-specific antibodies could be eluted from E. coli O(86)-coated O erythrocytes. Eel anti-H(O) serum agglutinated O erythrocytes and only those A(1)B red cells which were coated with blood group H(O) active E. coli products. Blood group active substances specifically inhibited agglutination of lipopolysaccharide-coated erythrocytes by anti-B and anti-H(O) agglutinins. Demonstrable amounts of lipopolysaccharide could only be removed from coated erythrocytes by washing them at elevated temperatures (58 degrees C) in physiological solutions. Red cell sensitization with B active E. coli O(86) substances was achieved in vivo in a minority of severely diseased infants and in germ-free and ordinary chicks which were in tourniquet shock after treatment with cathartics. Therefore, a possible mode by which erythrocytes of patients with severe intestinal disorders acquire antigens is the fixation of bacterial substances to their surfaces, if there are not enough of the normally interfering plasma factors present.

Anemia↗
PubMed1991

Changing patterns of therapeutic agents in the elderly: a ten-year overview.

Drug use patterns in a large ambulatory elderly population were studied cross-sectionally over a 10-year period. There were 24192 drug histories obtained on 4509 individuals during the period from 1 August 1978 to 31 July 1988. The average number of drugs used per person increased from 3.22 in 1978-9 to 3.94 in 1987-8. Prescribed drug use increased by 0.52 per person compared with an increase of 0.21 for nonprescribed medication. Analysis of two mutually exclusive groups of participants from 1978-9 and 1987-8 revealed a significant (p less than 0.0001) increase in the use of nonprescribed medication but no significant increase in the use of prescribed medication after adjusting for age and sex effects. The four most frequently used therapeutic classes of drugs in 1978-9 as a percentage of all drugs used were antihypertensives (10.8%), analgesic-antipyretics (6.4%), antirheumatic (6.4%), and cathartics (5.4%) compared with the antihypertensives (9.5%), analgesic-antipyretics (5.9%), anticoagulants (5.5%), and antirheumatic (4.6%) for the 1987-8 period.

Age Factors↗
PubMed1993

Post-operative electrolyte imbalance: its incidence and prognostic implications for elderly orthopaedic patients.

In order to assess incidence and prognostic implications of post-operative electrolyte disorders for elderly patients, 180 patients aged 79.5 +/- 6.8 years, range 70-96 years, admitted to a geriatric-orthopaedic liaison service were prospectively followed from admission to discharge or death. The association of age, basic medical conditions, type of anaesthesia and perioperative complications with post-operative sodium/potassium imbalance and fatality was assessed by logistic regression analysis. The incidence of post-operative electrolyte imbalance and fatality was 15% and 8.8%, respectively. Electrolyte imbalance was independently predicted by spinal anaesthesia [odds ratio (OR) = 2, confidence limits (CL) = 1.24-3.19], multiple pathology (OR = 2, CL = 1.1-3.58), use of cathartics (OR = 1.76, CL = 1.05-2.91) and intra-operative complications (OR = 1.7, CL = 1.03-2.88). Death was predicted by electrolyte imbalance (OR = 2.32, CL = 1.21-4.43), post-operative noninfective complications (OR = 2.3, CL = 1.09-4.84) and age greater than 79 years (OR = 1.17, CL = 1.06-1.3). Post-operative electrolyte imbalance is a marker of very frail medical status and a risk factor for death among elderly orthopaedic patients.

Aged↗
PubMed1997

Current practices of preoperative bowel preparation among North American colorectal surgeons.

In North America, the rate of infections following colorectal surgery decreased after the introduction of oral antibiotic bowel preparation against colonic microflora. Eight hundred eight board-certified colorectal surgeons were surveyed for their current bowel preparation practices before elective procedures. The 471 responders (58%) all use mechanical preparation: oral polyethylene glycol solution (70.9% of the respondents), oral sodium phosphate solution with or without bisacodyl (28.4%), and "traditional" methods of dietary restriction, cathartics, and enemas (28.4%). Most surgeons (86.5%) add oral and parenteral antibiotics to the regimen; 11.5% add only parenteral antibiotics, 1.1% add only oral antibiotics, and 0.9% add no antibiotics. Generally (77.8% of cases), oral neomycin and erythromycin or metronidazole are combined with a perioperative parenteral antibiotic. Most individuals start the preparation as outpatients the day before surgery, and the parenteral drugs are added to the regimen 1-2 hours before the procedure. The use of outpatient bowel preparation is increasing; however, patient selection is critical, and education is needed to reduce the rate of complications.

Anti-Bacterial Agents↗
PubMed1999

Activation analyses of authenticated hairs of Napoleon Bonaparte confirm arsenic poisoning.

In 1960, activation analyses at the Harwell Nuclear Research Laboratory of the University of Glascow, London of authenticated hairs of Napoleon Bonaparte taken immediately after his death confirmed Napoleon's chronic arsenic poisoning on the island of St. Helena. Timeline correlation of his clinical symptomatology of the preceding 4 months, as reported in the written diaries of his exiled companions, further supports the effect of fluctuating, elevated toxic levels of arsenic on his health. Independent analyses of authenticated hairs of Napoleon by the Toxicology Crime Laboratory of the United States Federal Bureau of Investigation in 1995 reveals toxic levels of arsenic. The successful assassination of Napoleon included both a cosmetic and lethal phase. The cosmetic phase consisted of arsenic poisoning over time to weaken Napoleon, making the associated debility appear to be a natural illness and thus allay any suspicions prior to instituting the lethal phase. On May 3, 1821, at 5:30 P.M., the lethal phase was carried out. Napoleon was given Calomel (HgCl), a cathartic, and a popular orange-flavored drink called orgeat, which was flavored with the oil of bitter almonds. Together they formed mercury cyanide, which is lethal. Napoleon lost consciousness and died two days later.

Activation Analysis↗
PubMed2002

Repeated bleeding scintigraphy may reveal that stationary foci of activity represent sites of active hemorrhage.

The goal of bleeding scintigraphy is to localize the site of origin of a hemorrhage to within general regions of the large or small bowel. Activity is typically seen to extravasate from the blood pool into the lumen, and the collection of activity then moves on sequential images, as a result of the cathartic action of blood. Sometimes, bleeding studies show a stationary focus of activity without subsequent movement. It is generally assumed that these foci represent fixed structures, such as the urinary tract or prominent vasculature, rather than acute extravasation of labeled blood into the bowel. The authors report three cases in which repeated studies showed that fixed foci of activity were, in fact, related to gastrointestinal bleeding. In two instances, the fixed foci represented extravasated blood that, for unexplained reasons, did not move during the study. In an additional case, the fixed activity visualized was ultimately shown to be prominent varices, which were implicated in the bleeding. Recognition of these possibilities, and consideration of possible strategies to localize the bleeding site further, should facilitate optimal patient treatment.

Aged↗