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PubMedDate not supplied

[A discussion of problems in interpretation of the Mental Health Act].

On the basis of their experience as psychiatrists, and observations of Mental Health Act influence on mutual relationships between psychiatrists, their patients and patients family members, the authors analyze situations in which strict, appliance of the law may be harmful, or, for other reasons, ethically doubtful. They suggest that the Mental Health Act is too meticulous in regulating the procedures regarding mentally disturbed persons. According to the law indications, motives for treatment without consent are more often social or behavioral rather than strictly medical. It limits the ability to help a lot of people who really require psychiatric care. Authors indirectly suggest that it is impossible to replace ethics and doctors' conscience by the law.

Ethics, Medical↗
PubMed1996

[Is there a social consensus which defines and understands the problems of conjugal violence?].

Why is that some relationships, initially harmonious, tip into violence and abuse? Many studies have examined the phenomenon to attempt to circumscribe the incidence and seize its dynamics. These studies seem to bring out a social phenomenon of quite serious amplitude. Thus, according to a study conducted by MacLeod and Cadieux in 1980, one in ten women is battered on a regular basis. According to Statistics Canada, in 1993, 25% of Canadian women have been victim of violence by their partner since the age of sixteen. Among this group, 15% are still living with the same partner. Moreover, despite programs destined to help victims of conjugal violence, the number of cases declared appears to have diminished. Such alarming results have brought many researchers to study the problem further. In the last ten years, some progress has thus been realized in the understanding of the phenomenon of violence against women. Programs of intervention, government involvement, judiciarization of certain forms of abuse, sensitization of the public regarding conjugal violence as well as denunciation of cases of violence have marked this progress. In spite of a rising conscience regarding conjugal violence, research sometimes runs up against obstacles. In spite of complex modelization of concepts and factors of prediction of the phenomenon, results sometimes appear disappointing. Thus, is there a social consensus on a definition of the problem and its dynamics? The authors will try to answer this question by reviewing different theoretical approaches used to define conjugal violence. They will then attempt to make a critical analysis of these theories by examining different empirical studies realized in this field.

Domestic Violence↗
PubMed1997

A personality disorder of excessive power strivings.

None of the existing formal diagnostic categories in psychiatry today addresses adequately the issues of excessive power-seeking, corruption and destructiveness. Excessive power strivings both poison the personality of the individual who is obsessed in his spirit and mind with power and do unacceptable harm to other peoples' lives. The present proposal of a diagnostic category of a Personality Disorder of Excessive Power Strivings is intended to fit into current diagnostic schema of DSM as well as into an earlier proposal (1) to examine in all psychopathology not only the burdens and damage people do and impose on their own selves and their own functioning, but also the harm they do to other peoples' lives and functioning. The diagnosis is to be used when the individual displays prolonged and severe manifestations of the following listed criteria: The basic feature which is always present in this personality disorder is: 1. Intense and extensive power strivings. In addition, at least three other of the following characteristics should be present; 2. Lack of empathy for people, and indifference to the suffering of others; 3. "Street smart" alertness and remarkable cunning committed to seizing and expanding power; 4. Ruthlessness in cultivation of power; 5. Scapegoating and projection of blame on to targeted individuals or a group, an insistent need to identify certain others as lowly, worthless and intended victims; 6. Corruption by power and addiction to power; 7. Demands of other people to be dependent on one's powerful personality, or that they become one's obedient followers; 8. Emphasis on symbolisms of pure vs. impure, holy vs. infidel, chosen vs. condemned; 9. A basic disrespect for the lives of others evidenced in callous or indifferent exposure of others to undue risks; 10. An absence of conscience in contexts of self-interest and opportunity; 11. A homicide/suicide orientation.

Antisocial Personality Disorder↗
PubMed1997

The Shouldice technique: a canon in hernia repair.

Controversy exists on the merits of the various approaches to inguinal repair. Evolution of the classic open repair has culminated in the Shouldice repair. Challenges from newcomers, namely, tension-free repair and laparoscopy, are being examined. These two techniques have a number of disadvantages: the presence of foreign bodies (prostheses) and their implication in cases of infection; the cost of prosthetic material, which is no longer negligible (particularly with expanded polytetrafluoroethylene); and problems of safety in that the laparoscopic approach is no longer a dependable asset except in the hands of a highly specialized and dextrous operator. Still, complications occur with laparoscopic repair that should not be associated with a surgical procedure that is considered benign, safe and cost-effective. Surgeons must recognize the pertinent facts and decide according to their conscience which method of repair to use.

Anesthesia, Local↗
PubMed1997

[A psychological burden on patients with clinical trials during anesthesia].

We investigated with questionnaires, psychological outline of 30 patients, who were requested to participate in clinical trials of anti-tachycardia drugs during anesthesia. Although 14 patients consented to the trial, the consent was not based on adequate understanding or volunteerism in 3 patients. Nine patients of the consented group were anxious about the possible use of the trial drug. Eight patients of the rejected group felt anxiety on surgery and anesthesia, which was the most common reason for rejection. Forty % of refused patients felt a guilty conscience or embarrassed. Although we tried to obtain patients' consent following governmental and institutional regulations and guidelines, not only the consented but also the refused patients suffer from psychological burden with the clinical trial. It is of concern that recruitment to the trial enhances anxiety of the patients as they already feel uneasiness, unrest, and insecurity facing anesthesia and surgery. To avoid entry of less informed or unwilling patients to the clinical trial, we must secure patients' veto, and recruitment should be performed by clinicians who are not involved in anesthesia practice.

Anesthesia↗
PubMed1996

Exile and professional identity: on going back to Cuba.

The author tells the story of her lifelong attempts to create a coherent, complex cultural identity from her family's multiple diaspora legacies, and the impact of these struggles on her personal and professional development. She emphasizes the intergenerational conflicts created by the sociopolitical circumstances of her generation's Cuban immigration experience, and progressive attempts to include her Cuban identity in her sense of self. An unexpected lesson in the politics and history of psychoanalysis, itself an immigrant movement that abandoned its social conscience to survive in exile, catalyzed a return to Cuba and a greater inclusion of its social values in her personal and professional lives.

Career Mobility↗
PubMedDate not supplied

[Sedation in endoscopic diagnosis: rationale of the use of specific benzodiazepine antagonists].

The aim of this study was to evaluate the best clinical use of Flumazenil, a specific antagonist of benzodiazepines, during endoscopic exams. Two-hundred patients were studied: 120 were treated with Flumazenil and 80 with placebo. The patients were prepared for the endoscopic exam with local anaesthesia and i.v. Diazepam administration. Controls performed at the end of the exam and at 5, 30, 120 e 240 minutes from the administration of Flumazenil and placebo, allowed to evaluate the state of awakeness, the level of conscience and the capacity of time-space orientation. Significantly statistical differences between the two groups were obtained at 5, 30 and 120 minutes after Flumazenil administration, while both groups had retrograde amnesia. The drug was well tolerated and there were no undesiderable side effects or reactions. The Authors therefore affirm that Flumazenil, in virtue of its competitive action toward benzodiazepine receptors, interrupts sedation with immediate awakening and improvement of the state of consciousness. Such drug, thus, permits the Day Hospital performance of endoscopic procedures which otherwise would require hospitalization, at the same time allowing the surgeon to use benzodiazepines at doses more adequate for surgical necessities.

Adult↗
PubMedDate not supplied

[Nursing evaluation of the effect of the type of sedation on the degree of anxiety in patients undergoing cardiac surgery].

The objective of this work is to identify the degree of preoperatory anxiety which patients who must undergo cardiac surgery present, and evaluate the influence of sedation with Propofol or Midazolam in the appearance of anxiety in the immediate and late postoperatory. The study population was formed by 22 patients, being appointed at random to receive Propofol or Midazolam in infusions. We used the scale of Max Hamilton in three consecutive stages (preoperatory, post-extubation, and pre-discharge) to measure the level of anxiety. Both groups were similar according to their distribution in sex, age, weight, conscience level and severity level at entrance. The patients who were sedated with propofol showed a level of postoperatory anxiety significatively lower than those patients who were treated with midazolam (p < 0.05). To conclude, we believe that the type of sedative used has a significant influence in the development of post-operatory anxiety.

Adult↗
PubMedDate not supplied

[Congenital heart block and pacemaker implantation (author's transl)].

A six years old boy was sent to our service due to a loss of conscience spell. He had no preceding history E.K.G. showed a complete A-V block. Laboratory findings were within normal limits. Cardiac catheterism was performed and it ruled out any antomic abnormality, making evident a good contraction ability. To decide pacemaker implantation we evaluted: 1. That cardiac frequency was not increased by exercise neither by action of pharmacologyc agents (atropine, insoproterenol).-2. The existence of wide and bizarre QRS ocmplex.-3. And dizziness spels. The patient has been controlled during the past two years. Parasistolia has appeared, not showing modification till today.

Child↗
PubMed1997

[Fracture of the glenoid fossa without condylar dislocation and with intact mandibular condyle. Report of a case].

The osteomuscular structure of the cranium presents peculiar anatomic characteristics that aim to preserve the noble organs that are housed inside or are adjacent to them. This is also true of the condylar region which protects the cranial cavity from forces transmitted to the glenoid cavity by the condyle in traumatism to the facial region and above all the genial symphysis. These factors act as "force breakers" to prevent the condyle penetrating the middle cranial fossa. Of these the most important is the presence of a line of minor resistance at the level of the condyle neck which is often the site of a protective fracture. However, the dislocation of the condyle in the middle cranial fossa is an occurrence that is reported in the literature, albeit very rarely; the fracture of the glenoid fossa with an intact mandibular condyle and without evident dislocation of the latter is even more rare. The paper reports the case of a 22-year-old male patient who was injured in the submental area leading to loss of conscience. CT revealed that the left mandibular condyle was intact whereas there was a comminuted fracture of the roof of the glenoid fossa and two fractures at the mandibular level. The patient also presented left otoliquorrhea. The glenoid fracture was not complete and therefore the mandibular condyle did not show evident dislocation nor was it necessary to resort to surgical or non-surgical treatment. After the reduction and restraint of the two mandibular fractures, occlusion was correct and the position of the left condyle was appropriate following X-ray control, even if the glenoid cavity was partially fractured. Otoliquorrhea resolved spontaneously after about three days and did not require any treatment. The case described here, which was recontrolled after some time, presented excellent functional results demonstrating that conservative treatment of the glenoid cavity fracture was the correct therapeutic choice.

Adult↗
PubMed1997

[Intermittent alcoholic behavior].

Intermittent alcohol disorders are defined by the paroxystic aspect of alcohol consumption followed by periods of time without alcohol ingestion. The most typical form of intermittent alcoholism is dispomania. During the acute episode of dipsomania, the patient presents an extreme craving for alcohol and a complete loss of control. The alcohol consumption usually leads to severe overdoses and coma. The cases of pure dipsomania are relatively rare in daily practice. Most often, intermittent forms of alcohol abuse or dependence are observed in patients who present, between the acute ingestions of alcohol, a chronic consumption. Intermittent ingestions of alcohol can also be present among subjects presenting a pathological personality (antisocial personality) and a past or present dependence syndrome to heroine. These patients use alcohol like a drug in order to get a modification of the conscience, a high, a sedation or a trip.

Alcohol Drinking↗
PubMedDate not supplied

[Perception of musical sounds: contributions of positron emission tomography].

The perception of music is not a single global process. It encompasses the integration into conscience of various elements, such as sound pitch, tone, rhythm and impression of familiarity. Thus, it may be subjected to cognitive studies based on specific and complementary abilities of both cerebral hemispheres in these tasks. A number of selected medical cases reported previously had already suggested anatomic-clinical correlations for the perception of the various components of musical sounds. The left hemisphere subserves rhythm and pitch perception, the sense of familiarity and identification of a musical piece. The right hemisphere plays a part in the perception of tone and melodic line. Position emission tomographic studies in normal subjects have corroborated these assumptions on hemispheric lateralization in musical perception. In addition, they have demonstrated previously unsuspected facts, such as the role of visual areas in pitch perception and the role of frontal cortex and especially of Broca's area in the perception of rhythm.

Auditory Perception↗
PubMed1998

[Depression as a psychophysical illness phenomenon].

The old Greeks understood depression as a somatic process as well as an oppressing experience. Disturbances of the transmitters, ligands and receptors and the decoupling of the feedback-systems of the hypothalamic-pituitary-adrenocortical systems with an impairment of the immune-system are experienced as depression with its narcissistic depletion and orientation towards conscience and order. Thereby the conscious experience is less differentiated than the complex somatic processes which are proving it. Under a holistic aspect it is, however, doubtful whether psychotherapy can be differentiated from somatotherapy. Each psychotherapy acts through the sensory organs on the body like somatotherapy. Until now, however, only a few results of research are known concerning somatic parameters, for example of the transmitter- and immune-processes of the body, during a simple, with preference cognitive-behavioral psychotherapy. For that the researchers would have to be trained to reach a reliable evaluation of its somatic parameters. As it was proved scientifically, the influence onto somatic functions is even possible with complex psychotherapeutic methods such as hypnosis. Such research is until now still relatively seldom done. This may be due, on one hand, to the fact that many psychiatrists and other physicians still maintain the fatal psychophysical dualism and on the other hand, that the pharmaceutical industry has until now not had an interest in comparative investigations concerning the effects of psychotherapy and pharmacotherapy.

Aggression↗
PubMed1998

Historical development of outcomes-based care delivery.

Outcomes-based care delivery is both a subtle and profound change in practice. It is proactive, patient-centered, data-generating, and establishes clear accountability. Most importantly, outcomes defined and managed at the patient-provider level will be the quality conscience as health care enters a new millennium.

Critical Pathways↗
PubMed1998

[Evolution of medical responsibility and code of ethics].

The evolution of the medical responsibility cannot escape from the determining influence of the scientific progress, but it is also significantly influenced by sociological and psychological factors that often are more difficult to analyse. If the ethical rules express the physicians' obligations in legal terms, it perfectly determines the spirit which must drive every physician thus revealing his sense of responsibility. This concept of the medical responsibility distinguishes and differentiates itself from the penalty responsibility and from the compensation responsibility which only takes place in the context of the compensation for a harm caused. The acquisition of the prime sense of the responsibility is a product of a background dominated by the experience, the example, the conscience. The expression of the medical responsibility is most of all personal, but more and more fits in with the public health issues and becomes a collective responsibility. Finally in order to meet the more and more accurate specialists' demands, the physician's responsibility which must remain within the boundaries of his competence must be fulfilled in the frame of a team. This dimension imposes on him new regulations that affect the quality of the relationship between the various contributors. An evolution of the responsibility thus grows according to the progress and within the adapted scope of ethics.

Ethics, Medical↗
PubMed1998

Perioperative nurses' encounter with value conflicts. A descriptive study.

The aim of the study was to gain a better insight into perioperative nurses' experience in a value conflict that has arisen in the perioperative caring environment and how they deal with it. In order to obtain as full and objective a picture as possible the critical incident technique was chosen. Perioperative nurses were asked to write down stories about value conflicts which they have experienced in the perioperative caring environment. When interpreting the textual content of the stories the aim has been to understand the meaning of nurses' experiences and how the nurses act in a value conflict situation. A value conflict is something that nurses have become part of against their own will. They are prevented from giving the good care they want to give, they are in conflict with themselves and have a bad conscience, and they feel guilt and shame for not having prevented the value conflict. The nurse who is involved in a value conflict aims, for the sake of the patient, to be a professional caring nurse. The nurse chooses to be the patient's neighbour, the one who suffers along with the patient and represents the patient's cry for help.

Attitude of Health Personnel↗