Users' subjective evaluation of electronic vision enhancement systems

The aims of this study were (1) to elicit the users' responses to four electronic head-mounted devices (Jordy, Flipperport, Maxport and NuVision) and (2) to correlate users' opinion with performance. Ten patients with early onset macular disease (EOMD) and 10 with age-related macular disease (AMD) used these electronic vision enhancement systems (EVESs) for a variety of visual tasks. A questionnaire designed in-house and a modified VF-14 were used to evaluate the responses. Following initial experience of the devices in the laboratory, every patient took home two of the four devices for 1 week each. Responses were re-evaluated after this period of home loan. No single EVES stood out as the strong preference for all aspects evaluated. In the laboratory-based appraisal, Flipperport typically received the best overall ratings and highest score for image quality and ability to magnify, but after home loan there was no significant difference between devices. Comfort of device, although important, was not predictive of rating once magnification had been taken into account. For actual performance, a threshold effect was seen whereby ratings increased as reading speed improved up to 60 words per minute. Newly diagnosed patients responded most positively to EVESs, but otherwise users' opinion could not be predicted by age, gender, diagnosis or previous CCTV experience. User feedback is essential in our quest to understand the benefits and shortcoming of EVESs. Such information should help guide both prescribing and future development of low vision devices.     

Violent and nonviolent methods of suicide: different patterns may be found in men and women with severe depression.

The objective of this study was to investigate violent and nonviolent suicidal acts in men and women with severe depression. The records of 98 suicide victims, who had been admitted to the Department of Psychiatry, Lund University Hospital, Sweden between 1956 and 1969, were evaluated and the subjects were monitored up to 1998. The female group displayed a significant linear trend for nonviolent completed suicide after one suicide attempt, and even more significantly, after repeated attempts. A switch from only nonviolent suicide attempts to completed violent suicide was significantly more common in men than in women. These different progressions may contribute to the expected finding that men used violent methods for completed suicide more often than women.     

Experiences of pain and distress in hip fracture patients

The aims were to investigate: (1) experiences of physical pain in elderly patients with hip fracture; (2) if background variables, confusion, experiences of pain and distress and interventions aimed at reducing pain and distress, functional ability, pain in the ambulance, and type of fracture varied between patients with more intense physical pain and patients with less intense physical pain. The sample included 49 patients, 70 years or older, with hip fracture. Structured instruments were used to interview and observe the patients on four occasions during the hospital stay. The patients’ experiences of physical pain decreased during the hospital stay. Physical pain at rest was lower than pain with movement. Patients who scored physical pain as more intense (group B) during the visit to the hospital had significantly more unfavourable experiences in the sensory, emotional, and existential dimensions the day before discharge from the hospital compared with the patients who scored pain as less intense (group A). The patients in group B perceived the interventions as less favourable than group A. Furthermore, group B had more intense physical pain in the ambulance than the patients in the other group. More patients in group B than in group A had additional health problems.     

Compliance with ambulatory saliva sampling in the Chicago Health, Aging, and Social Relations Study and associations with social support

Background: Noncompliance with instructed saliva sampling times in ambulatory settings can compromise resulting cortisol findings.Purpose and Methods: Here, the impact of noncompliance on the cortisol awakening response (CAR), an established marker for hypothalamic-pituitary-adrenal axis activity, was examined over 3 sampling days in middle- and older-age participants in the Chicago Health, Aging, and Social Relations Study.Results: Noncompliant participants had a significantly lower cortisol rise after awakening (assessed by an awakening sample and a 30-min after awakening sample) on 2 of the 3 sampling days (Day 1, ns; Days 2 & 3, ps<.02). Furthermore, social support measured by the Interpersonal Support Evaluation List correlated negatively with the number of “noncompliant” samples (r=−.19, p<.05), indicating that participants reporting more social support had more “compliant” samples.Conclusion: The results confirm that nonadherence to saliva sampling in ambulatory settings can exert a significant impact on the resulting CAR. Furthermore, the data raise the idea that the extent of nonadherence might be systematically associated with psychosocial factors like social support. For future studies on the relationship between CAR and psychological factors, we therefore recommend controlling for saliva sampling adherence because noncompliance might be systematically associated with the phenomenon being investigated. Funding was provided by the National Institute of Aging Grant No. PO1 AG18911 and the John Templeton Foundation. Brigitte M. Kudielka was supported by grants from the German Research Foundation (DFG grant KU 1401/3-1 and KU 140/4-1).     

Department of law and ethics

The January 7, 1988 issue of The New England Journal of Medicine has two interesting articles concerning what might generally be termed euthanasia. The article titled Initiating and Withdrawing Life Support represents a consensus among members of the Stanford University Medical Center Committee on Ethics. Its main authors have written a fine example of applied ethics (1).     

Evaluation of a learning resource center for cancer patients

To address cancer out-patients' needs for information, a self-servelearning resource center was established at a nearby hotel.This facility provides numberous written and audio-visual cancerinformation materials for out-patients being treated at theUniversity of Texas M.D.Anderson Cancer Center Houston, Texas.Over a three month period, we conductred a consumer profileand assessed consumer satisfaction and use of the learning resuorcecenter. Data were gathered primarily through a self-administeredpatient/family satisfaction questionnaire and through monthlyadministrative records. The primary variables associated withuse of the learning resource center were educational level andhow long one had been a patient at the M.D.Anderson Cancer Center.Respondents who had used the learning resource center also indicateda stronger preference for receiving information about cancerthrough written materials than those who had not used the center.Users’ degree of satisfaction with the learning resourcecenter was generally high. The case study presented here offersrecommendations for the practitioner regarding the establishmentand evaluation of a learning resource center for cancer out-patientsand addresses these issues in a unique program setting.     

Controlled natural cycle IVF: experience in a world of stimulation

A total of 134 controlled natural IVF (nIVF) cycles were reviewed retrospectively and compared with 370 stimulated IVF (sIVF) cycles. The clinical pregnancy rate per embryo transfer following nIVF was 27% and 47% in sIVF cycles for patients aged less than 35. However, natural cycle patients could attempt consecutive cycles with much less impact on their lives, both medically and financially. In patients under 35 years of age, the choice of controlled nIVF reduces the cost and risk to the patient, permitting her to have multiple, consecutive attempts, and cumulatively offers a clinical pregnancy rate which approaches that of sIVF. The multiple pregnancy rate in nIVF is significantly reduced compared with sIVF treatment cycles. In patients over 35 years of age the benefits of nIVF were much less evident (clinical pregnancy rate: 8% per embryo transfer) and the opportunity to transfer multiple embryos in these patients seems to be advantageous.     

Use of the Splenic and Hepatic Artery for Renal Revascularization in Patients with Atherosclerotic Renal Artery Disease

p = 0.17) and the average number of antihypertensive medications decreased to 1.9 (p= 0.001). During the median follow-up of 33 months, 10 patients died, mainly from cardiac causes. Our experience indicates that the splenic and hepatic arteries provide useful alternatives to renal revascularization in selected circumstances with an acceptable rate of perioperative mortality and morbidity. The expected long-term survival in this group of patients is low.