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PubMedDate not supplied

[Trends in the differential diagnosis of acute psychogenic states].

The approach of the concept of psychogenesis and its significances for the explanation of certain psychic disorders allows a clinical estimation of the positive and differential diagnosis of acute psychogenic states. The variety and polymorphism of the psychogenies, clinically expressed in variable degrees of conscience disorders as well as their frequency in the practice of general medicine underline the importance of the clinical examination, case history and usual paraclinical investigations. The estimation of symptomatology, motivation and the evolution of psychogenic states allows the avoidance of some severe diagnosis errors with tumours and cerebral vascular accidents, acute intoxications, comatose states or the debut of certain psychoses giving in this way the possibility of a correct directions in setting the diagnosis and therapy.

Acute Disease↗
PubMed1990

[Psychological stress before, during and after hospitalization for low back disease. Patients' experience illustrated by qualitative interviews].

Thirteen patients were interviewed 14 days after discharge for low back disease requiring hospitalization with the object of illustrating their experience of the period of waiting for admission, treatment in the primary and secondary health services, their relationships to children living at home during their illness and the effect of the low back disease on sexual life. The patients stated that the period of waiting was the worst, dominated by pain, uncertainty, loss of sleep and lowered self esteem. Treatment in the primary health sector was found to be unsatisfactory as regards relief of pain but satisfactory as regards contact with the general practitioner. In the secondary health sector, relief of pain was found to be satisfactory to varying extents while better contact with the doctor treating the case and the staff as a whole could be desired. Waiting and uncertainty while waiting for a diagnosis and result of treatment, inactivity and the poor contact with the staff were considered by the patients to be contributory causes to the increasing mental vulnerability. The relationship to children living at home was dominated by bad conscience prior to admission and by poor contact during hospitalization. Conditions improved after discharge. Practically no sexual activity occurred during the illness. This was not primarily experienced by the patients as a problem but they feared it might be so in the long run. Patients stated that they required mental support during hospitalization, better information and advice about practical problems after discharge.

Adult↗
PubMedDate not supplied

[The locked-in patient and the characteristics of the electrical activity of his brain].

"Locked-in" state differs from the known states characterized by the motor activity blockade, preservation of conscience of speech contact, despite the fact that connection with outer world during this state is limited only by vertical movements of eyes and eyelids in response to speech signals. Three "locked-in" men were studied at different stages of development of this state. Spectral-coherent analysis of the EEG was conducted. The most typical for the developed state of the "locked-in" man is a uniform change of the intercentral EEG relations. In the motor areas of the cortex alpha-activity and its links are not formed (coherence in alpha-range is zero) while high and low frequencies are coherent. In the visual areas, in contrast, the alpha-rhythm is coherent. Distinct interhemispheric asymmetry of coherent connections appears. In the right hemisphere a decrease of coherence level is sharp and even, in the left one--in occipito-temporal parts the level remains close to norm, while in the frontal parts of the cortex it decreases.

Alpha Rhythm↗
PubMed1990

Surgical asepsis revisited.

Basic principles, rituals, and surgical conscience are essential components of surgical asepsis. Surgical asepsis has become too complicated. Protective asepsis describes principles of good hygiene, sanitation, and impeccable aseptic technique; the term has received renewed interest in the advent and increased awareness of bloodborne diseases. Rituals may actually enhance learning and efficiency in the operating room even though they may or may not directly affect nosocomial infection rates.

Asepsis↗
PubMed1990

What's happened to aseptic discipline in the OR?

Aseptic discipline is the sum of the constraining factors governing the human behavioristic interface between the surgical environment and the surgical patient. Although certain details of the discipline may change with advances in immunology, pharmacology, surgical techniques, instrumentation, and other elements in the surgical environment, the basic principles of aseptic discipline must prevail and be enforced. Surgical professionals enter into an unwritten covenant to keep an unspoken promise to discharge their unseen duties in the aseptic chain of events, with only their own consciences to monitor their responsibility to the patient. The discussion of aseptic discipline is divided into its application to the five D's of infection control: discipline, defense mechanisms, drugs, devices, and design of the environment.

Asepsis↗
PubMed1990

Creating a caring environment: moral obligations in the role of dean.

Mayeroff (1971) states "from a loose stringing together of ideas a tight fabric emerges; ideas intertwine and tend to reinforce each other, making for a mutual deepening of meaning and gain in precision". The fabric throughout this discussion is nursing. Commitment, compassion, confidence, competence, and conscience represent the ideas that, when uniquely and beautifully woven together, create the aesthetic experience of caring in nursing. The dean of a caring-based nursing program is morally obligated to foster an environment that reflects a commitment to caring.

Empathy↗
PubMedDate not supplied

[Technological risks in the household].

It is very difficult to calculate precisely the phenomenon of domestic accidents in Italy because of the lack of sure statistics. Some rough evaluations estimate the domestic injuries as about 800,000-1 million, with about 9,000 dead in one year, whose causes depend on down-falls, scalds, poisonings, electrocutions, etc., due to technological installations (mainly electric and gas installations) and to the human behaviour. It is supposed that on 21 million installations existing in Italy, about 14 millions are not accorded to the rules of good technology. Until now, this matter has resulted only after a domestic injury, because no legislation had been issued. At least on March, the 5th, 1990, the Law no. 45 (published on the G.U. n. 59 of March, 12th, 1990) was issued. It obliges to build also the domestic technological installations according to the rules of good technology. Resides, it fixes the professional requirements of planners, installers and testers, making also the customers responsible. But being also human mistakes causes of accidents, some acts of sensibilization, information, and formation became more and more necessary addressed also towards those people who move within domestic walls, in order to create an "anti-injury conscience" that allows to became aware of dangerous situations at a rather instinctive level and to adopt safe measures as behaviour methodologies and postures.

Accidents, Home↗
PubMed1989

[The prevention of atherosclerosis].

Factors indicative of an increased risk for atherosclerotic disease comprise hereditary factors, male sex, abuse of tobacco, elevated total and LDL-cholesterol, hypertension, obesity and diabetes. Effective prevention is possible along two strategies: 1. population-oriented, using guidelines for life style, and 2. individual-oriented by identifying and treating those at significant risk. Changes in life style like to dispense with smoking, dieting and reducing cholesterol intake have to be tried before pharmacotherapy is attempted. Preventive measures should be encouraged as early as possible, ideally as health-conscience education of children. Efficient drugs are available but not very cost-efficient. They are useful as adjunct in selected cases.

Arteriosclerosis↗
PubMedDate not supplied

[Convulsive manifestations].

The convulsive crisis (involuntary muscular contractions, tonic then clonic, associated to a sudden loss of conscience) occur on comitial persons or represent the expression of a prolonger cerebral suffering following a deficiency of one or several nutrients, necessary to the function of the nervous system (glucose, oxygen...) or an drug intoxication (local anesthetics) of the nervous centers. Following the etiology, the following aspect will be studied: the different clinical forms, the differential diagnosis, the emergency treatment of the crisis according to their possible evolution and finally their prevention.

Dental Offices↗
PubMedDate not supplied

[Euthanasia].

After examining the question of euthanasia from various viewpoints, the paper concludes that the socioeconomic factor is one of the most significant. It also shows that the greatest responsibility falls on the physician who has no decalogue or rulebook to guide him apart from his own conscience.

Euthanasia↗
PubMed1989

[Ganglio-thalamic encephalomalacia. Ultrasonic diagnosis].

We have performed serial trans-fontanelle sonography on 69 newborns with perinatal asphyxia. Ten neonates presented high ultrasonic density in the thalamus and the basal ganglia. These images were preceded, in eight of them, by diffuse echoes for all of the CNS, corresponding to cerebral edema. The most significant clinical findings were convulsions and important depression of conscience level and muscular tone. Eight of ten newborns presented major abnormalities in the electroencephalogram (severe depression of background). Since its coexistence with other parenchymal lesions and poor neurologic development, we consider the ganglio-thalamic ultrasonic densities to be a sign of severe ischemic hypoxic cerebral damage.

Basal Ganglia Diseases↗
PubMed1989

[Acute rheumatic fever].

In view of the progress in modern medicine it might be of interest to revive how a century ago a physician diagnosed and treated without our current technology. The transition to science based medicine around 1840 invites to follow bedside medicine by reviewing old case histories in the light of current knowledge. The clinical lectures of Schoenlein one of the leading clinicians of this time appear particularly suited. This first part gives a short biography of Schoenlein and comments the history of a patient with the classic picture of rheumatic fever. This case demonstrates the priming of physicians by prevailing theory and philosophy which may be gracefully accepted by the patient. This brings to conscience that medicine and physicians have roles beyond modern technology.

Berlin↗
PubMedDate not supplied

[Language and ethics].

The author proposes the hypothesis that there exists an essential link between language and ethics, beyond the obvious fact that the postulates of ethics have to be expressed in a verbal way. He chooses two ways for demonstrating his hypothesis: a phenomenological description of the substantive element of language, which is the word, and then an analysis of both the philo- and the ontogenetic origin of ethical experience. Making evident the essential characteristics of language, among which it is appropriate to outline its capacity to give existence to things (as it is deduced from the analysis of some poetic texts), the author gets to unveil its deep ethic sense in the religious word: gods show themselves through the revealed word, and men address to them with their prayers. Gods give norms that imitate afterwards. The second way allows the author to demonstrate that the step from nature to culture is done through the norm, and this is basically verbal; but at the same time it is possible to demonstrate how the word is found in the base of the individual ethical experience, in that very particular phenomenon that is the voice of the conscience. In short, language is in its essence ethical, and the ethical experience is indissolubly bound to the verb.

Ethics↗
PubMed1989

[An implant-prosthetic solution to a Class III case].

When the surgeon operates a patient, he must be in a state of absolute serenity with regard to law and his own conscience. This aim can be achieved only when the patient is completely conscious of the type of operation which will be performed, as well as of all possible consequences which may occur afterwards. The balanced occlusion, in restaurations by total subperiosteal technique of serious cases of edentulism of maxillae, seems to be the only possible solution for the duration in time of the two sub-structures.

Adult↗
PubMed1989

Decision to withhold or withdraw support.

This decision-making process is inherently uncomfortable. The recognition and open discussions of the issues are relatively new. There is legal and practice precedent for withholding and withdrawing therapies and support. Institutions must now abide by Joint Commission guidelines while individual physicians are permitted to practice within their own conscience. Patients' best interests must be served, but it should be accepted that permitting the dying process to evolve while attending to comfort is not only an acceptable but desirable strategy. Finally, physicians must play an active and pivotal role as the facilitators of proper care. The details of proper medical care should be physician prescribed.

Decision Making↗
PubMed1989

Black student enrollment in US medical schools.

Blacks represent about 12% of the nation's population, but only 6% of the total medical school enrollment, 5% of medical school graduates, 5% of postgraduate trainees, 3% of physicians in practice, and 2% of medical school faculties. Addressing this underrepresentation of blacks in medicine not only is a matter of justice, equity, and national conscience but also has implications for the provision of quality physician care to this nation's minority and medically underserved populations. Black physicians are more likely to understand the cultural and social context of illness and disability among blacks and are also more likely to be able to communicate effectively with black patients. Black physicians are also more likely to practice in communities whose residents lack adequate access to medical care. An approach to addressing the problem of underrepresentation is proposed, consisting of activities at the precollege, college, and medical school levels.

Black or African American↗
PubMed1989

[Animal rights--new questions about animal ethics].

The assertion that animals have interests and rights comparable to those of humans raises some new questions: How should unavoidable conflicts between man and animal be solved? How should a decision be taken in a conflict between human demands of no vital necessity e.g. the consumption of meat or mobility, and the right of animals to live? The answers to these questions illustrate the scope and limitations of ethical discussions. In spite of this solutions have to be elaborated based on conscience, ideas of a fair partnership and theological considerations.

Animal Welfare↗
PubMed1986

For the handicapped, rights but no welcome.

The multiplication of rights--legally enforceable claims on the attention, actions, and resources of others--can carry us only so far. Improvements for the handicapped depend primarily on improving the attitudes of the nonhandicapped majority through appeals to conscience and good will.

Attitude↗