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PubMed2005

[Management of 103 limb reduction defects: a French-speaking fetal medicine club enquiry].

OBJECTIVES: Prenatal diagnosis of a limb reduction defect poses difficult medical and ethical problems. Prenatal diagnosis can be at the origin of two opposing medical attitudes, either a medical termination of pregnancy, or the specific management of the child at birth. The objective is to carry out an enquiry of practices and to determine whether there is a threshold in the gravity of the malformation from which the medical termination of pregnancy is accepted. MATERIAL AND METHOD: The study was carried out by a questionnaire addressed to the members of the French-speaking Club of Fetal Medicine. RESULTS: Outcome of 103 fetuses with limb reduction defect was described. Prenatal diagnosis and management of observed malformations were explained. CONCLUSION: Decisions concerning the outcome of the pregnancy are very variable from one couple to another and from one medical team to another. Parents making a request must be given complete information and accompanying psychological support. Collegial with a multidisciplinary team is necessary. For the parents, it is the physician's duty to avoid judgement errors related to anxiety and ignorance of the medical consequences. The physician should guide the parents towards the continuation of the pregnancy or its interruption. The proper decision proceeds from the reunion of the confidence of the couple and the conscience of the physician.

Abortion, Induced↗
PubMed1985

[Status epilepticus in the adult. Epidemiologic and clinical study in an intensive care unit].

The present study, conducted between January 1975 and June 1983, includes 282 adult patients admitted for status epilepticus (SE) in 2 intensive care units (3.5% of all admissions). In their great majority, i.e., 201, patients had no previous history of epilepsy, and initiated the SE during the course of recent affections such as brain or systemic diseases. In 81 patients with previous seizure, epilepsy was idiopathic in 20, and symptomatic in 61, the 3 main causes being cranial traumatism, cerebrovascular accident and chronic alcoholism. SE was of various causes. The most frequent were cerebro-vascular disease, post-anoxic encephalopathy, intoxication, bacterial or viral meningo-encephalitis. In some patients, SE was preceded by manifestations such as convulsions, behavorial disturbances or conscience impairment. One should be aware of these facts and undertake or increase an anticonvulsivant medication at their onset. Duration of SE, when clearly established, was highly variable but had no apparent correlation to sequelae or death occurrences. SE itself was directly related to death in only 2 cases; in all other instances death was the consequence of the primary disease. These results are consistent with previous reports: presently SE occurs more frequently in the course of other affections than in prior epileptic patients. The better vital prognosis of SE is due to the simultaneous conjunction of new anticonvulsivant medication and supportive care associated with the cure of the causative disease.

Adolescent↗
PubMed1999

Faithful representations with topographic maps.

Topographic map algorithms that are aimed at building "faithful representations" also yield maps that transfer the maximum amount of information available about the distribution from which they receive input. The weight density (magnification factor) of these maps is proportional to the input density, or the neurons of these maps have an equal probability to be active (equiprobabilistic map). As MSE minimization is not compatible with equiprobabilistic map formation in general, a number of heuristics have been devised in order to compensate for this discrepancy in competitive learning schemes, e.g. by adding a "conscience" to the neurons' firing behavior. However, rather than minimizing a modified MSE criterion, we introduce a new unsupervised competitive learning rule, called the kernel-based Maximum Entropy learning Rule (kMER), for topographic map formation, that optimizes an information-theoretic criterion directly. To each neuron a radially symmetric kernel is associated, with a given center and radius, and the two are updated in such a way that the (unconditional) information-theoretic entropy of the neurons' outputs is maximized. We review a number of competitive learning rules for building equiprobabilistic maps. As benchmark tests for the faithfulness of the representations, we consider two types of distributions and compare the performances of these rules and kMER, for batch and incremental learning. As a first example application, we consider non-parametric density estimation where the maps are used for generating "pilot" estimates in kernel-based density estimation. The second application we envisage for kMER is "on-line" adaptive filtering of speech signals, using Gabor functions as wavelet filters. The topographic feature maps that are developed in this way differ in several respects from those obtained with Kohonen's Adaptive-Subspace SOM algorithm.

Journal Article↗
PubMed2000

Medical economic considerations of supportive cancer care.

In an era of increasing cost containment in health care, it has become extremely important to allocate resources as efficiently as possible. This implies that formal health economic considerations are taken into account. One of increasing importance is the field of economic appraisal, which allows to quantify the value for money of medical interventions. This research is extremely useful in the field of supportive care of cancer patients. Economic considerations, social, political and ethical issues will also have to be addressed. The sum of these activities will enable us to make better choices in health care and ensure that sufficient resources are allocated to supportive cancer treatment. Cancer patients have physical, social, spiritual and emotional needs. They may suffer from severe physical symptoms, from social isolation, spiritual abandonment, and emotions such as sadness and anxiety, or feelings of deception, helplessness, anger and guilt. In some of them, the disease is rapidly progressing and ultimately they die. Their demanding care evokes intense feelings in health care providers, all the more since these incurable patients represent a challenge, which could be condensed under the heading "the challenge of medical omnipotence". The complexity of the matter, the interdisciplinary approach and the emergence of an increasingly cost conscience health care environment put supportive cancer care in a difficult realm.

Health Care Costs↗
PubMed1991

[EEG periodic lateralized activities associated with ischemic cerebro-vascular strokes: physiopathologic significance and localizing value].

Eleven cases of periodic lateralized epileptiform discharges (PLED) with stroke (9 cases) or transient ischemic attacks are reported. PLEDs are often associated with depression of conscience (81%) or partial pure motor epileptic seizures (90%). PLEDs and seizures seem independent on EEG. Ischemic strokes associated with PLEDs have some characteristic features: old age, vascular risk factors, parieto-occipital areas infarcts and frequent association with TIAs. PLEDs seem to be often associated with watershed infarcts. The relations between PLEDs and cerebral ischemia are discussed.

Aged↗
PubMed1998

Cardiac papillary fibroelastoma of the mitral valve chordae.

Papillary fibroelastomas are rare, benign, primary cardiac tumors, usually single and small. The neoplasm consists of a leafy, soft excrescence typically located on the cardiac valves. Although papillary fibroelastomas are usually an asymptomatic incidental finding at autopsy, or during cardiac operation, they are occasionally associated with embolic coronary or cerebral symptoms. A case of a patient is reported with papillary fibroelastoma of the mitral valve chordae, who presented several transitory ischemic attacks characterized by loss of conscience, visual bilateral deficit and right emiparesis. Because of their potential systemic embolization, we believe that these lesions should be always excised.

Aged↗
PubMed1998

The genetic effects of environmental lead.

This article reviews the effects of lead on genetic systems in the context of lead's various other toxic effects and its abundance and distribution in the environment. Lead is perhaps the longest used and best recognized toxic environmental chemical, yet it continued be used recklessly until only very recently. Lead is thus a lesson in the limitations and strengths of science, human conscience and common sense. Lead has been tested and found to be capable of eliciting a positive response in an extraordinarily wide range of biological and biochemical tests; among them tests for enzyme inhibition, fidelity of DNA synthesis, mutation, chromosome aberrations, cancer and birth defects. It reacts or complexes with many biomolecules and adversely affects the reproductive, nervous, gastrointestinal, immune, renal, cardiovascular, skeletal, muscular and hematopoietic systems as well as developmental processes. It is likely that lead is a selective agent that continues to act on and influence the genetic structure and future evolution of exposed plant and animal populations.

Animals↗
PubMed2002

[Stem cells and cell therapy. Contribution to the ethical debate].

Divergent and sometimes conflicting positions with respect to human stem cells and cell therapy do not merely reflect disagreement among scientists and conflicts of interest. They attest the ethical tension resulting from recent progress in understanding the earliest stages of development of the human being that can be observed in vitro. Can the extremely potent notion of the human person starting with conception apply to the very first stage of artificial in vitro fertilisation and disregard the fact that to be a real substitute for natural conception, implantation in the uterus that enables the oocyte to nest and a new human being to develop must also be included? Several arguments are presented that plead in favour of making a clear distinction between the status of in vitro cells obtained by artificial fertilisation and that of the embryo, which becomes a developing human being from the moment it implants in the endometrium of the uterus. This subject could have remained in the sphere of the individual conscience, but it has now become a theme for social debate! The revision of the French 1994 so-called Bioethics Laws, which was recently approved on first reading on 22 January 2002, authorizes research on spare embroys from in vitro fertilisation under certain conditions. However, for the sole reason that there is a risk of opening the door wide to reproductive cloning, which is unanimously rejected and condemned, all research on stem cells deriving from the nuclear transfer of a somatic cell is prohibited, irrespective of the distinction between cloning for therapeutic purposes and reproductive cloning. It is undeniable that if the efficacy of somatic stem cells could be demonstrated, they would offer a far more preferable solution, for several reasons, than those involving stem cells obtained from spare embryos from IVF or nuclear transfer. Nevertheless, how will a comparison of the two methods be possible if one of them is prohibited a priori? At present, many fear that French researchers will be prevented from doing essential research that, even if it has far to go, is indispensable if we wish to attempt to control the failures of natural procreation and open the way towards the new regenerative medicine that so many look forward to.

Bioethics↗
PubMed1999

Outpatient management of venous thromboembolism.

Low molecular weight heparins (LMWHs) have provided the necessary pharmacologic tool to facilitate the outpatient management of selected patients presenting with acute venous thromboembolism. A growing collection of clinical trial results supports the safety and efficacy of this cost-efficient management strategy. However, this approach requires careful patient selection and meticulous care planning. Several randomized multicenter trials have compared a primarily outpatient approach to treating uncomplicated proximal venous thrombosis with a LMWH administered subcutaneously once or twice daily to the inpatient use of unfractionated heparin (UFH). The results have been very encouraging and suggest that the use of subcutaneous LMWH in highly selected, uncomplicated venous thrombosis patients is as safe and effective as intravenous UFH, and that most patients can be treated as outpatient or be discharged early. Irrespective of parenteral anticoagulant approach, warfarin therapy was commenced on day 1 and continued for 3 months. A recent publication by Dedden and colleagues describes a 1-year experience with a pharmacy-managed program for the home treatment of patients presenting with proximal deep vein thrombosis. A plan for coordinated patient care was implemented which included a process for patient referrals, standardized protocol orders, a plan for holding area processing and home healthcare agency follow-up, and subsequent oral anticoagulation management. Results of the program demonstrate a significant healthcare savings (as compared with standard inpatient management) with no significant compromise in patient outcomes. Recently published trials by the Columbus Investigators and Simonneau and colleagues have looked beyond uncomplicated proximal venous thromboembolism to include patients presenting with recurrent venous thrombosis and pulmonary embolism. Results suggest the subcutaneous use of LMWH is as safe and effective as intravenous UFH. Such data begin to lay the scientific foundation for the expanded clinical base of patients who may be candidates for an outpatient management approach. In today's cost-conscience environment, managing the treatment of select venous thromboembolism patients with LMWH(s) and warfarin therapy in an outpatient environment represents an evolving approach that is economically logical, does not compromise patient outcomes, but requires considerable planning to address a myriad of logistical issues.

Fibrinolytic Agents↗
PubMed2000

The professional autonomy of the medical doctor in Italy.

This contribution deals with the issue of the professional autonomy of the medical doctor. Worldwide, the physician's autonomy is guaranteed and limited, first of all, by Codes of Medical Ethics. In Italy, the latest version of the national Code of Medical Ethics (Code 1998) was published in 1998 by the Federation of provincial Medical Associations (FnomCeO). The Code 1998 acknowledges the physician's autonomy regarding the scheduling, the choice and application of diagnostic and therapeutic means, within the principles of professional responsibility. This responsibility has to make reference to the following fundamental ethical principles: (1) the protection of human life; (2) the protection of the physical and psychological health of the human being; (3) the relief from pain: (4) the respect for the freedom and the dignity of the human person, without discrimination; (5) an up-to-date scientific qualification (Art. 5). The authors underline that autonomy is an anthropological--and consequently ethical-- characteristic of the human person. Different positions on autonomy in bioethics (individualistic, evolutionistic, utilitarian and personalistic models) are explained. The relation between the professional autonomy of the physician and the autonomy of the patient and of colleagues is discussed. In fact, the medical doctor is obliged: (1) to respect the fundamental rights of the person, first of all his/her life; (2) to ensure the continuity of the care, even if he can only relieve the patient's suffering; (3) to maintain, except under certain circumstances, professional secrecy and confidentiality regarding patients and their medical records. Moreover, the physician cannot deny the patient correct and appropriate information. He/she should not perform any diagnostic or therapeutic activity without the informed consent of the patient and the medical doctor must give up medical treatment in case of documented refusal of the individual. Furthermore, the medical doctor has the right to raise conscientious objections if he/she is requested to perform medical actions that are contrary to his/her conscience or medical opinion, unless this attitude would seriously and immediately harm the patient. Regarding the relationships with colleagues, the physician is obliged to solidarity, mutual respect, and care of sick colleagues. Finally, the authors discuss the Italian legislation affecting the physician's professional autonomy: (1) the SSN health care Acts; (2) the so-called Charter for Public Health Care Services; (3) the Acts on privacy; (4) Good Clinical Practice.

Benchmarking↗
PubMed2003

Punishment insensitivity and parenting: temperament and learning as interacting risks for antisocial behavior.

We review ideas about individual differences in sensitivity or responsiveness to common disciplinary behaviors parents use to correct aggressive and antisocial behavior in children. At extremes, children may be seen as "punishment-insensitive," an heuristic with some value relevant to models of the development of antisocial and aggressive behavior disorders. Literature from diverse fields, such as psychopathy, child temperament, socialization and the development of moral conscience, conditioning theory, and personality theory, have all utilized the idea that humans differ in their sensitivity to aversive stimuli and the cues that signal their occurrence, as well as their ability to inhibit reward-driven behavior, in the presence of punishment cues. Contemporary thinking places these dispositions squarely as basic biological aspects of temperament that moderate the effects of the environment (e.g., parenting) on outcomes (e.g., mental health). We review a largely forgotten literature that shows clearly that sensitivity to punishment is also reliably influenced by the environment itself. An attempt is then made to model the interactional processes by which parenting and punishment sensitivities in children magnify or diminish each other's progress toward healthy or antisocial development. Implications for parenting of children with low responsiveness to punishment strategies are discussed.

Antisocial Personality Disorder↗
PubMed2002

Does guilt proneness predict acute and long-term distress in relatives of patients with schizophrenia?

OBJECTIVE: The aim of the study was to improve our understanding of guilt proneness as predictor of acute and long-term stress responses in relatives of acutely admitted patients. METHOD: Forty-nine relatives in close contact with 36 patients suffering from schizophrenia DSM-III-R, completed Hostility Guilt (HG) and Guilt Conscience (GC) scales (Revised Mosher Guilt Inventory), and Levenson's Locus of Control Scale (LOC) at the patient's admission to hospital, and the General Health Questionnaire (GHQ) at the patient's admission and at 9 months after discharge. RESULTS: Acute distress (GHQ) was positively related to HG, but not when controlling for LOC. GC was positively associated with acute and long-term distress, GHQ-depression and coping-failure, and long-term GHQ-anxiety. When controlling for LOC, GC was still positively related to long-term distress. HG, GC and LOC explained 32% variance of GHQ at 9 months. CONCLUSION: GC seems to be an important predictor of long-term distress in relatives.

Adult↗
PubMed1994

Temperament and the development of personality.

We present a psychobiological approach to personality development, incorporating developmental principles outlined by R. B. Cairns (1979). We review individual differences in temperament and ask how a temperamental approach to personality might be congruent with these complex and flexible principles. We then illustrate the nature of temperamental processes by considering several developmental topics. We first consider the interaction of infant distress-proneness and maternal behavior in the development of attachment. We then describe the development of self-regulatory mechanisms, emphasizing development of conscience, aggression, and mastery motivation. Finally, we briefly review mechanisms of temperament and environment interaction, illustrating these processes through variable developmental pathways for risk of adolescent and adult psychopathology. Throughout, we stress the idea that temperamental models of personality development are dynamic, interactive, and fit well with Cairns's developmental principles.

Adolescent↗
PubMed2004

A six-factor structure of personality-descriptive adjectives: solutions from psycholexical studies in seven languages.

Standard psycholexical studies of personality structure have produced a similar 6-factor solution in 7 languages (Dutch, French, German, Hungarian, Italian, Korean, Polish). The authors report the content of these personality dimensions and interpret them as follows: (a) a variant of Extraversion, defined by sociability and liveliness (though not by bravery and toughness); (b) a variant of Agreeableness, defined by gentleness, patience, and agreeableness (but also including anger and ill temper at its negative pole); (c) Conscientiousness (emphasizing organization and discipline rather than moral conscience); (d) Emotionality (containing anxiety, vulnerability, sentimentality, lack of bravery, and lack of toughness, but not anger or ill temper); (e) Honesty-Humility; (f) Intellect/Imagination/Unconventionality. A potential reorganization of the Big Five factor structure is discussed.

Factor Analysis, Statistical↗
PubMed1996

Living a caring presence in nursing: a Heideggerian hermeneutical analysis.

While the claim has been made that caring is the most important, central focus of nursing, often the meaning of caring presence in nursing and human caring in general is so deeply embedded in our consciousness and our cultural practices that its presence is invisible or taken for granted. The purpose of this Heideggerian hermeneutical study was to illuminate nurses' shared practices and common meanings of living a caring presence in nursing. Five nurses wrote a story, one they would never forget, of living a caring presence. The stories were analysed and interpreted against a background of Heideggerian philosophy to reveal the constitutive pattern, "caring as the presencing of being'. Meaning and complexity of the pattern were revealed in themes that illuminate and articulate the essence of nursing and the phenomenon of caring. Themes were: the timelessness and spacelessness of caring, creating home, and the call to care as the call of conscience. The results can help to answer the Heideggerian question of what a marginalized cultural practice like the profession of nursing can teach a levelling technological society about the meaning of being.

Empathy↗
PubMed1998

A model of professional nurse caring: nursing students' experience.

Research into caring from the perspective of nursing students is poorly documented. This paper presents a study which described the construct of caring as experienced by students in pre-registration programmes at two universities in New South Wales, Australia. Qualitative data were collected using a questionnaire and semi-structured interviews. From the analysis of the data a model of professional nurse caring from the student's perspective was created. In this model, compassion, as the core of caring is actualized in the students' nursing of patients by communicating, providing comfort, being competent, being committed, having conscience, being confident and being courageous. Communication is not only an actualization of this caring but constitutes an important medium for the expression of caring actions.

Australia↗
PubMed2002

Food-related health perceptions and food habits among older women.

AIM: The aim of the present study was to explore food-related health perceptions and food habits among older women. BACKGROUND: Food-related health promotion has its main focus on disease prevention. With a holistic perspective on health, social and psychological aspects also need to be considered for total wellbeing. METHODS: Qualitative interviews, representing an ethnographic approach, were carried out with 18 women, aged 65-88, living alone or cohabiting, who independently managed shopping and cooking. Interviews were conducted at the women's homes, and analysed for coherent themes. The women also gave data on three days' eating and drinking in a food diary. FINDINGS; Two themes were found: 'A healthy slimming meal or the usual' and 'Meals -- a pleasure or an obligation'. The first theme summarized the women's health perceptions related to food, where the dominating view was fear of fat. Some also had a bad conscience about not eating according to recommendations. Use of low-fat products was not a predominant habit among these women. In the second theme, meals in fellowship were perceived as a pleasure, while women living alone tended to simplify cooking and eating. This was also reflected in their food habits, with fewer cooked meals, as well as events with coffee with cakes, compared with cohabiting women. CONCLUSIONS: Food-related health promotion must pay more attention to women living alone. Women who have lost their partners, may be at risk for poor nutritional intake as they often simplified the entire meal situation, while cohabiting women perceived food and cooking as a central task in their lives. One responsibility for nurses working in the community is to recognize and assess older women's deficient eating habits, assess them and plan eating together with the woman to prevent poor nutritional intake. Relatives and community staff could also be involved in this work.

Aged↗
PubMed2002

Foucault could have been an operating room nurse.

BACKGROUND: Operating room nursing is an under-researched area of nursing practice. The stereotypical image of operating room nursing is one of task- and technically-orientated aspects of practice, where nurses work in a medical model and are dominated by constraints from outside their sphere of influence. This paper explores the possibility of understanding operating room nursing in a different way. AIM: Using the work of Michel Foucault to analyse the work of operating room nursing, this paper argues the relevance of the framework for a more in-depth analysis of this specialty area of practice. CONTENT: The concepts of power, discipline and subjectivity are used to demonstrate how operating room nursing is constructed as a discipline and how operating room nurses act to govern and construct the specialty. Exemplars are drawn from extensive professional experience, from guidelines of professional operating room nursing associations, as well as published texts. The focus is predominantly on the regulation of space and time to maintain the integrity of the sterile surgical field and issues of management, as well as the use of the ethical concept of the 'surgical conscience'. CONCLUSIONS: This form of analysis provides a level and depth of inquiry that has rarely been undertaken in operating room nursing. As such, it has the potential to provide a much needed, different view of operation room nursing that can only help to strengthen its professional foundations and development.

Ethics↗