Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners.

In this study of the influences affecting general practitioners' decisions whether or not to prescribe, 69 principals and five trainees in general practice were asked about the factors that made these decisions difficult for them and the circumstances in which the decision caused them to feel uncomfortable. Discomfort was reported most frequently in prescribing for respiratory disease, psychiatric conditions and skin problems, though the range of problems mentioned was wide. The range of drugs for which the decision of whether or not to prescribe was difficult was also wide but psychotropic drugs, antibiotics, drugs acting on the cardiovascular system and non-steroidal anti-inflammatory drugs were most often mentioned. Patient factors said to be important included age, ethnicity, social class and education, the doctor's prior knowledge of the patient, the doctor's feeling towards the patient, communication problems, and the doctor's desire to try to preserve the doctor-patient relationship. Doctor specific factors included concerns about drugs, factors relating to doctors' role perception and expectations of themselves, uncertainty, peer influences, logistic factors, and the experience of medical or therapeutic misadventures. The results of this study support earlier work on the influence of social factors on prescribing decisions and show that this influence affects the entire range of clinical problems. The results also reveal the importance of logistic factors. The overriding concern of doctors to preserve the doctor-patient relationship and the range of attitudes, perceptions and experiences of doctors that have a bearing on the decision to prescribe begin to explain the apparent irrationality of some general practitioner prescribing.(ABSTRACT TRUNCATED AT 250 WORDS)     

T-wave amplitude utility revisited: some physiological and psychophysiological considerations.

The last decade has seen some quite polemicized discussions concerning the utility of T-wave amplitude as a psychophysiological measure, but more recent reports indicate that we are now moving into a more empirically oriented and analytic examination of this topic. Such a report is one by Contrada et al. (1989), who manipulated sympathetic (beta-adrenergic) influences both pharmacologically and behaviorally, and whose main conclusion was that their results "support the hypothesis that T-wave is significantly affected by beta-sympathetic influence on the heart". However, we question their other conclusion that "a nonspecific effect of heart rate change on T-wave amplitude would also account for these results", and also suggest that their discussion of the "implications for the utility of T-wave amplitude in psychophysiological research" bears further consideration. In particular, for psychophysiologists, of fundamental importance is the distinction between T-wave amplitude's utility as a physiological index and its utility as a psychophysiological index. Concerning the former issue, we consider: (a) the alpha/beta adrenergic distinction, (b) inappropriate T-wave amplitude augmentation effects to sympathomimetic stimulation, (c) the nonspecific-response-to-tachycardia argument, and (d) the view of pulse transit time as a criterial standard, rather than as a candidate index. Regarding the issue of psychophysiological index utility, we consider: (a) dependent-variable sensitivity, drawing a further distinction between reactive and specific sensitivity, and (b) independent-variable-manipulation effectiveness.     

An update on the antiestrogenic effect of smoking: a literature review with implications for researchers and practitioners

OBJECTIVE: To draw attention to the implications of smoking in the pathogenesis of osteoporosis and for the effectiveness and safety of hormone therapy. DESIGN Summary of own research and a MEDLINE search of English-language literature on the antiestrogenic effect of smoking in pre- and postmenopausal women published during the past two decades. RESULTS: Numerous observations suggest that part of the detrimental effect of smoking on bone metabolism is mediated by an adverse influence on sex-steroid metabolism, and in particular by an estrogen-lowering effect. Furthermore, in smokers, serum concentrations of estradiol and estrone during oral, but not parenteral, hormone therapy (HT) reach only half the concentrations of nonsmokers. Thus, cigarette smoking may reduce the favorable effects of HT significantly and may even negate the protective effects. In such cases, the failure of preventive therapy is a failure of dosing rather than of HT per se. CONCLUSIONS: We urge colleagues to take the antiestrogenic effect of smoking into account when drawing conclusions from population-based trials, as well as when prescribing HT to their patients for the prevention of menopause-related health problems.     

Electrogastrography for psychophysiological research: Practical considerations,analysis pipeline,and normative data in a large sample

Electrogastrography (EGG) is the noninvasive electrophysiological technique used to record gastric electrical activity by means of cutaneous electrodes placed on the abdomen. EGG has been so far mostly used in clinical studies in gastroenterology, but it represents an attractive method to study brain-viscera interactions in psychophysiology. Compared to the literature on electrocardiography for instance, where practical recommendations and normative data are abundant, the literature on EGG in humans remains scarce. The aim of this article is threefold. First, we review the existing literature on the physiological basis of the EGG, pathways of brain-stomach interactions, and experimental findings in the cognitive neuroscience and psychophysiology literature. We then describe practical issues faced when recording the EGG in young healthy participants, from data acquisition to data analysis, and propose a semi-automated analysis pipeline together with associated MATLAB code. The analysis pipeline aims at identifying a regular rhythm that can be safely attributed to the stomach, through multiple steps. Finally, we apply these recording and analysis procedures in a large sample (N = 117) of healthy young adult male and female participants in a moderate (<5 hr) to prolonged (>10 hr) fasting state to establish the normative distribution of several EGG parameters. Our results are overall congruent with the clinical gastroenterology literature, but suggest using an electrode coverage extending to lower abdominal locations than current clinical guidelines. Our results indicate a marginal difference in EGG peak frequency between male and female participants, and that the gastric rhythm becomes more irregular after prolonged fasting.     

Autosomal recessive or sex linked recessive: a counselling dilemma.

This paper discusses the difficult problem that arises when information is sought by female relatives of two or more brothers, each of whom has an identical but undiagnosed or 'new' syndrome, which is likely to be either autosomal recessive or sex linked recessive in inheritance. It is proposed that standard Bayesian methods may be applied in this situation thus incorporating the prior probability for each event with conditional probabilities based upon pedigree analysis.     

Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium chimaera

Prosthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected.     

Psychopathology in irritable bowel syndrome: support for a psychophysiological model

Previous research has established that patients with irritable bowel syndrome (IBS) frequently have comorbid psychiatric disorders. This study sought to establish if the timing of the onset of psychiatric disorders indicated that IBS was more likely to be caused by or more likely to cause psychological difficulties. Participants were 188 treatment-seeking IBS patients who were assessed for psychiatric diagnoses using a semistructured clinical interview. Timing of the onset of any lifetime psychiatric disorders was noted in an attempt to determine if psychiatric disorders were more likely to precede or follow the onset of IBS symptoms. Those participants that met criteria for an Axis I disorder sometime during their life were significantly more likely to develop an Axis I disorder before the onset of IBS symptoms. Anxiety disorders were the most likely disorder to develop before IBS. These results support the theory that psychiatric symptoms, especially anxiety, play a role in the development of IBS.     

Evoked potential augmenting-reducing: a reply to Connolly and Gruzelier

Connolly and Gruzelier (1982) published a study purporting to evaluate the methods and procedures employed in studies of the Buchsbaum evoked potential (EP) augmenting-reducing effect. Robinson et al. (1984) pointed out that the stimulus intensities employed by Connolly and Gruzelier were much lower than those normally employed by Buchsbaum and his associates. Consequently, the Connolly and Gruzelier data would not really be comparable to the data of Buchsbaum. Connolly and Gruzelier (1986) subsequently criticised the Robinson et al. report. These criticisms are considered in this letter and it is noted that the main points made by Connolly and Gruzelier are based on spurious as well as mathematically incorrect 'conversions' from units of illumination to units of luminance.     

Implicit memory bias and trait anxiety: a psychophysiological analysis

The effect of threatening words and anxiety upon implicit memory performance was investigated. It was predicted that anxious individuals would show a bias to threat-related material. In addition, psychophysiological measures were obtained to assess the attentional and encoding processes that might underlie this cognitive bias. Forty participants were equally allocated to high and low trait anxious groups, according to pre-determined cut-offs. All participants were exposed to threat and non-threat words and following a filler task, were asked to complete primed and unprimed wordstems. Implicit memory performance was assessed in terms of accuracy and reaction time for completion. Heart rate and electrodermal responses were measured. Results demonstrated initial increased cardiac deceleration to threat stimuli, subsequent cardiac acceleration to non-threat stimuli, and an implicit memory bias to non-threat material by all participants. These findings are discussed in relation to the 'vigilance-avoidance' model of attention to threat stimuli.