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PubMedDate not supplied

The "most-significant-other" in the care of the breast cancer patient.

Most-significant-others can play a major role in helping breast cancer patients live stable, productive, and esteemed lives. Physicians are urged to respect and exercise their clinical judgment on the emotional makeup of the patient, the most-significant-other, and their relationship, and to instruct them according to their needs and capacities. Supportive roles include mobilizing social support; monitoring the patient's return to daily living; being with her during treatments, both physically and emotionally; and understanding her instinctive requests for assistance through double-bind and other difficult communication. Most-significant-others can be an extension of the physician's common sense and clinical care to the degree that they are able and willing to perform this important role.

Breast Neoplasms↗
PubMed1984

Development and behavior of cultured Schistosoma mansoni fed on human erythrocyte ghosts.

Schistosomula and adults of Schistosoma mansoni were grown from cercariae in cultures differing only in the treatment of the red blood cells fed to the organisms. "Pink ghosts," containing about 5% of the original hemoglobin, were produced by hemolysis in water; "white ghosts" with no detectable hemoglobin were made in 5 mM phosphate buffer, pH 8. Early growth and development were more rapid and vigorous, and pairs formed more readily when pink ghosts, rather than intact erythrocytes were fed. Schistosomula remained stunted and undeveloped when fed with white ghosts. Attempts at reconstitution of the latter by addition of hemoglobin, concentrated erythrocyte lysate, or pressure-liquefied pink ghosts did not restore growth-promoting activity. Pink ghost-fed worms, particularly paired males, attached to the dish bottom by their acetabulum and oral sucker and travelled by an active looping motion. Substrates of collagen or fibrin or a mammalian cell monolayer did not affect this behavior. Such attachment and locomotion are interpreted as instinctive migratory behavior of schistosomes.

Erythrocyte Membrane↗
PubMedDate not supplied

Can you read the emotional radar?

Emotional intelligence means that your instinct picks up what is happening to those around you. And it is a skill that can be learned, provided you have the time and inclination.

Emotions↗
PubMedDate not supplied

Teaching the humanities to medical students.

The decoding of the human genome offers great promise for the understanding and treatment of chronic human diseases at the last frontier. There is a widely recognised hazard that an exaggerated emphasis on molecular reductionism may lead to the loss of the essential humanitarian instincts of young doctors. To counteract this danger it is now accepted by many leading figures of the medical establishment that the undergraduate curriculum must evolve to incorporate a variety of subjects conventionally taught in the faculty of humanities at our great universities. In this article, the case is argued that the study of 'medical humanities' will enhance the empathy, communication skills, ethical standing and, paradoxically, the scientific literacy of the next generation of young doctors. As a clinical scientist, I cannot prove these assertions with an evidence base, but offer up arguments as qualitative or hypothesis generation.

Education, Medical, Undergraduate↗
PubMed1984

The structure of health care service--so-called the worried well patients and psychosomatic medicine.

The desire of people to receive the best health care services without difficulty is an instinctive one. However, defects in public health education and the irresponsible or sometimes sensational medical information released by the mass media are causing an excessive increase in the population's demand for health care services. As a result, so-called "worried well" patients are increasing and health care institutions are crowded with such patients, who play a major role in increasing national medical spending. On the other hand, it is difficult to say that health care institutions are providing satisfactorily continuous, consecutive and comprehensive health care services. Needless to say, in dealing with worried well patients, the health care institutions should make efforts towards early detection of disease, if any, but at the same time, a psychosomatic approach should be made, considering patients as holistic people with both a mind and body. To this end, interdepartmental and interhospital liaison becomes very important. From the viewpoint of comprehensive health care services, the author presents in this paper such cases where the health care services provided are regarded as defective in terms of continuity and points out the importance of systematized health care information and systematized health care services at all health care levels from primary to tertiary.

Adult↗
PubMed1993

Channeling home care expertise in disaster relief.

After a disaster hits, home care personnel have the instinct to run out immediately and help as many people as possible. Yet they can be most effective if they are part of an organized relief effort within the community. This article gives an idea of who the other players are and how they can best work together.

Disaster Planning↗
PubMed1976

[Clinical dynamics of several constitutional psychopathies during the period of their development].

The authors outline the main regularities in the dynamics of the formation of constitutional psychopathy in childhood and adolescence on the models of epileptoid and schizoid psychopathy. Some age traits of psychopathical and psychogenic reactions and their role in the formation of constitutional psychopathy are discussed. The period of their formation is considered as psychopathic development, due to a complex interaction of constitutional anomalies of temperament, instincts and drives with the micro-socio-psychological environment.

Adolescent↗
PubMed1976

["Analysis of fate" in psychiatry and psychotherapy. II. Correlations withe the level of general psychopathology].

We demonstrated in a group of 166 psychiatric patients, with disorders of schizophrenic and cyclothymic circle and with neuroses too, significant relations between the results of the projection test of Szondi and between the greatness of total psychopathology, evaluated by means of the Minnesota Multiphasic Inquiry (M.M.P.I.). We could ascertain, that the patients with the higher level of total psychopathology (evaluated by means of M.M.P.I.) have also a greater number of abnormal results according to the projection test of Szondi. At these patients we saw significantly more "valve groups", which witness to the irresolution in the instinctive motivations of behaviour. At these patients we could ascertain further the greater number of those personalities, which according to the projection test of Szondi suffered from a lack of breaking and self-critical elements in their behaviour. Subjects with heightened values of M.M.P.I. have significantly more results with abnormal relations of masculinity and of feminity according to the sexual index of Szondi test. The choices and the selection from the set of 48 fixed photographies, which the patient realises at the Szondi test in teen repeated sessions, form so a significant relation not only to the psychiatric diagnoses, as was ascertained in the first part of this work, but also to the height of total psychopathology, evaluated by means of the M.M.P.I. The familial subconsciousness influences so significantly the consciousness of personality and can participate substantially in the development of psychopathologic symptoms.

Humans↗
PubMed1992

High-wire act.

Food and Drug Administration chief David A. Kessler balances the instincts of a tough regulatory enforcer against the political realities of serving a President who preaches free-market values.

Administrative Personnel↗
PubMedDate not supplied

Strategy under uncertainty.

At the heart of the traditional approach to strategy lies the assumption that by applying a set of powerful analytic tools, executives can predict the future of any business accurately enough to allow them to choose a clear strategic direction. But what happens when the environment is so uncertain that no amount of analysis will allow us to predict the future? What makes for a good strategy in highly uncertain business environments? The authors, consultants at McKinsey & Company, argue that uncertainty requires a new way of thinking about strategy. All too often, they say, executives take a binary view: either they underestimate uncertainty to come up with the forecasts required by their companies' planning or capital-budging processes, or they overestimate it, abandon all analysis, and go with their gut instinct. The authors outline a new approach that begins by making a crucial distinction among four discrete levels of uncertainty that any company might face. They then explain how a set of generic strategies--shaping the market, adapting to it, or reserving the right to play at a later time--can be used in each of the four levels. And they illustrate how these strategies can be implemented through a combination of three basic types of actions: big bets, options, and no-regrets moves. The framework can help managers determine which analytic tools can inform decision making under uncertainty--and which cannot. At a broader level, it offers executives a discipline for thinking rigorously and systematically about uncertainty and its implications for strategy.

Capital Expenditures↗
PubMedDate not supplied

Even swaps: a rational method for making trade-offs.

Making wise trade-offs is one of the most important and difficult challenges in decision making. Needless to say, the more alternative you're considering and the more objectives you're pursuing, the more trade-offs you'll need to make. The sheer volume of trade-offs, however, is not what makes decision making so hard. It's the fact that each objective has its own basis of comparison, from precise numbers (34% versus 38%) to relationships (high versus low) to descriptive terms (red versus blue). You're not just trading off apples and oranges; you're trading off apples and oranges and elephants. How do you make trade-offs when comparing widely disparate things? In the past, decision makers have relied mostly on instinct, common sense, and guesswork. They've lacked a clear, rational, and easy-to-use trade-off methodology. To help fill that gap, the authors have developed a system-which they call even swaps-that provides a practical way of making trade-offs among a range of objectives across a range of alternatives. The even-swap method will not make complex decisions easy; you'll still have to make hard choices about the values you set and the trades you make. What it does provide is a reliable mechanisms for making trades and a coherent framework in which to make them. By simplifying and codifying the mechanical elements of trade-offs, the even-swap method lets you focus all your mental energy on the most important work of decision making: deciding the real value to your company of different courses of action.

Decision Making, Organizational↗
PubMedDate not supplied

How hardwired is human behavior?

Time and time again managers have tried to eliminate hierarchies, politics, and interorganizational rivalry--but to no avail. Why? Evolutionary psychologists would say that they are working against nature--emotional and behavioral "hardwiring" that is the legacy of our Stone Age ancestors. In this evolutionary psychology primer for executives, Nigel Nicholson explores many of the Science's central tenets. Of course, evolutionary psychology is still an emerging discipline, and its strong connection with the theory of natural selection has sparked significant controversy. But, as Nicholson suggests, evolutionary psychology is now well established enough that its insights into human instinct will prove illuminating to anyone seeking to understand why people act the way they do in organizational settings. Take gossip. According to evolutionary psychology, our Stone Age ancestors needed this skill to survive the socially unpredictable conditions of the Savannah Plain. Thus, over time, the propensity to gossip became part of our mental programming. Executives trying to eradicate gossip at work might as well try to change their employees' musical tastes. Better to put one's energy into making sure the "rumor mill" avoids dishonesty or unkindness as much as possible. Evolutionary psychology also explores the dynamics of the human group. Clans on the Savannah Plain, for example, appear to have had no more than 150 members. The message for managers? People will likely be most effective in small organizational units. As every executive knows, it pays to be an insightful student of human nature. Evolutionary psychology adds another important chapter to consider.

Biological Evolution↗
PubMedDate not supplied

Is it change? Or is it noise?

How can you tell the difference between mere noise, and a profound change headed your way? Your gut instincts may not always be a reliable gauge. It takes a long time for most people to become an executive leader. If you are typical, you were raised and trained in a different era, with different expectations. You see things with different lenses. So what can you trust? You can trust first principles. Ask yourself what you know about the reasons that changes are happening in this environment. Then ask yourself about what is being proposed--how does it fit with the roots of the changes in health care and your organization? The three change filters presented here can help you to figure out if it's change or just noise. Ask yourself: (1) what are the changes occurring in the health care industry; (2) is your organization ready for change; and (3) how likely is it that your organization will easily adopt this particular change? These three filters together will help you decide what is a truly important change, how ready your organization is for change, and whether it will adapt to this change with ease or difficulty.

Decision Making, Organizational↗
PubMed1989

Bronson's quality strategy. Interview by Donald E.L. Johnson.

Patric E. Ludwig, president of Bronson Healthcare Group, Kalamazoo, Mich., is leading his Bronson Methodist Hospital through the implementation of an ambitious quality improvement and cost containment program. A former management consultant and president of the Michigan Hospital Assn., Ludwig brings the analytical talents of a consultant and the political instincts of an association executive to the opportunity that many hospitals are considering and only a few are aggressively pursuing. In a recent interview with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management, Ludwig explained his organization's mandate from its board of directors and his strategy to win over his medical staff to the cost reduction and quality improvement programs.

Hospital Administration↗
PubMed1989

How to avert staff resignations. Part IV.

Responding to instinct and watching for clues are the first steps toward retaining your staff. This final article in a four-part series on recruitment and retention describes ways to prevent staffers from leaving.

Laboratories, Hospital↗
PubMed1976

[Aggression].

The aggressiveness is not a drive and has nothing in common with Freudian death instinct, but it is one of the ways to fulfill the possession desires and the narcissistic desires. As the way to achievement, it comes into a conflict with the fear of failure, with the co-operation advantages and with the altruistic human drives. As the latter ones are rather weak in an average person, the co-operation--as a basis of society--is in all its strata imbued with aggression. Each social structure, up to the present day, has contained aggression as an organic component. The hope of creating a society free from aggression is not based on the betterment of the human character, but on the growth of the productive forces. The existence of the interpersonal aggression has been concealed from a child, brought up in the spirit of the centuries-old fallacious educational principles. As a result, the child develops its first neurosis--the Superego neurosis. The Superego is not a structural component of the human psyche, but it is a neurotic formation. In the subsequent years, the confrontation of the child and the youth with the true aggression may affect his or her development in various ways. In some cases, the given individual disregards the Superego commands and pays for it with the neurosis of permanent guilt feelings. In other cases, the individual deals with the Superego as with the ethical values in themselves, and develops an inhibition neurosis (Gehemmtheitsneurose). Still in other cases he or she revolts against the mendacity of the society and develops a pseudopsychopathy. The proper education should strive to awake the nobe feelings in the child, but at the same time to reveal the whole truth about the existence of aggression in the human interrelations. In these conditions, through the conscious choice between the egoistic and the altruistic drives, could the growing person form the moral attitudes fitting his or her own nature. Because the ethics of the values in themselves is but a philosophical fiction, the only real ethics is that which is based on feelings.

Aggression↗
PubMedDate not supplied

Safe handling of large animals.

The major causes of accidents with cattle, horses, and other grazing animals are: panic due to fear, male dominance aggression, or the maternal aggression of a mother protecting her newborn. Danger is inherent when handling large animals. Understanding their behavior patterns improves safety, but working with animals will never be completely safe. Calm, quiet handling and non-slip flooring are beneficial. Rough handling and excessive use of electric prods increase chances of injury to both people and animals, because fearful animals may jump, kick, or rear. Training animals to voluntarily cooperate with veterinary procedures reduces stress and improves safety. Grazing animals have a herd instinct, and a lone, isolated animal can become agitated. Providing a companion animal helps keep an animal calm.

Accidents, Occupational↗