Impact of Kendall,Hollon, Beck,Hammen, and Ingram (1987) on treatment of the continuity issue in “depression” research

The article, Issues and Recommendations Regarding Use of the Beck Depression Inventory (Kendall, Hollon, Beck, Hammen, & Ingram, 1987), has had a major impact on depression research. A majority of studies using only the BDI in nonclinical samples now refer to the construct measured as dysphoria rather than depression. This word change, however, is not always accompanied by other changes in research design and interpretation that would seem warranted by the concerns that initially prompted the dysphoria recommendation, such as the nonspecificity of high BDI scores to major depression. Researchers typically continue to derive hypotheses from depression theory, use only the BDI to measure dysphoria rather than purer markers of negative affectivity, cite as a limitation of their findings the danger of assuming continuity between subclinical and clinical depression, and sometimes lapse into depression terminology. Alternative suggestions are made for considering how the particular goals of a study might lead to various ways of handling the continuity issue.We are grateful to Tony Ahrens, Diane Arnkoff, and anonymous reviewers for feedback on earlier drafts.     

Causal Thinking About Somatic Symptoms—How Is It Related to the Experience of Symptoms and Negative Affect?

The relation between causal thinking about somatic symptoms (psychological, somatic, and external symptom attribution) and the experience of somatic complaints and negative affect was studied in a community sample of 208 individuals. Although cluster analysis identified groups of individuals with psychological, somatic, and external attribution styles, the analysis also revealed groups of individuals with combinations of high or low scores on two or three attribution dimensions. Consistent with previous research, psychological attribution of symptoms was associated with a higher degree of somatic complaints and negative affect; this effect, however, was primarily due to a group of psychologizers/externalizers, and not to the pure psychologizers. Also in replication of earlier studies, all three attribution subscales were intercorrelated. The findings are discussed in terms of rumination processes. It is argued that the findings concerning psychological symptom attribution have received too little attention in the literature so far, probably because they go against dominant theoretical paradigms in psychosomatic medicine.     

Manualmedizinische Denkansätze für die Behandlung des tiefen Rückenschmerzes

Zusammenfassung Der tiefe Rückenschmerz ist ein Krankheitsbild, das schwierig zu diagnostizieren ist. Eine angemessene und kosteneffektive Behandlung erfordert eine genaue Diagnose. Die manualmedizinische Annäherung an den tiefen Rückenschmerz schließt die komplexen Wechselbeziehungen zwischen Struktur und Funktion ein. Behandlungsmethoden, die auf konservative Art die myofasziale, ligamentäre und artikuläre Integrität wiederherstellen, können die Inzidenz des failed back syndrome verringern. Durch das Erkennen der anatomischen und physiologischen Veränderungen, die diese Funktionsstörungen hervorrufen, verbessert die Anwendung osteopathischer manipulativer Therapie das Behandlungsergebnis und die Lebensqualität des Patienten wesentlich.Liebe Leserinnen und Leser,wir möchten Ihnen heute eine Veröffentlichung in englischer Sprache anbieten.Prof. Paul R. Rennie vom Department of Osteopathic Manipulative Medicine, Touro University Nevada, hat uns den Artikel Osteopathic reasoning for the treatment of low back pain (Manualmedizinische Denkansätze für die Behandlung des tiefen Rückenschmerzes) zur Publikation eingereicht. Es ist ein Versuch, in Einzelfällen einen aus den USA oder Großbritannien eingereichten Beitrag im Original zu veröffentlichen. Der Sinn einer Veröffentlichung im Original liegt z. B. auch darin, kennenzulernen, wie Fachtermini im Englischen gebraucht werden, die dann bei Eindeutschung oder deutscher Übersetzung oft nicht mehr dem ursprünglichen Sinn voll entsprechen. So ist im vorliegenden Falle der Herausgeber der Meinung, dass das amerikanische osteopathic reasoning dem deutschen manualmedizinische Denkansätze entspricht.Es ist nicht beabsichtigt, zukünftig die deutschsprachige Zeitschrift für Manuelle Medizin durch Veröffentlichung englischsprachiger Beiträge zu füllen. Wir werden weiterhin interessante Publikation aus dem Englischen übersetzen und in der Manuellen Medizin zweitpublizieren. Für eine Verbreitung der in der Manuellen Medizin publizierten Ergebnisse sind die jeweils beigefügten englischen Kurzfassungen erforderlich. Sollte die Leserschaft die Publikation einzelner englischsprachiger Artikel grundsätzlich ablehnen, so soll dies nicht wieder vorkommen. Ihre Meinung zu allen Facetten der Gestaltung unserer Zeitschrift ist den Herausgebern wichtig.L. Beyer, R. Kayser     

The Cognitive Content of Naturally Occurring Worry Episodes

Fifty-seven participants were selected to represent a wide range on the dimension of worry proneness. They monitored and listed their worrisome thoughts in a diary for 7 days, and rated the uncontrollability of each recorded worry episode. Content analysis revealed that 48% of worrisome thoughts could be categorized as reflecting a problem-solving process, 17% as anticipation of future negative outcomes, 11% as rumination, and 5% as reflecting palliative thoughts and self blame. The extent of negative outcome anticipation or problem solving did not covary with worry severity. Higher trait worry proneness and more frequent and uncontrollable worrying during the monitoring period were associated with more rumination and fewer reports of successful solutions to problems. The results suggest that worry consists largely of attempted problem solving, and that one possible mechanism in the emergence of pathological worry may be a failure to bring problem solving to a satisfactory conclusion.     

Early evaluation of coagulase negative staphylococcus in blood samples of intensive care unit patients

Of 2160 intensive care unit patients, 36 patients with positive blood cultures had coagulasenegative staphylococcus in one blood bottle, whereas the organism was present in two or more bottles in 38 cases. The groups were not significantly different in 27 clinical variables, obtained at the time of their first positive blood culture. There was also no significant difference in the antimicrobial sensitivities. No initial clinical data supported the classification of coagulase-negative staphylococcus as either pathogen or contaminant.When the 74 patients with blood culture positive coagulase-negative staphylococcus were compared with three control groups (absent septicemia, probable septicemia and proven septicemia) they were not different from those with probable septicemia. A discriminant analysis was performed comparing patients with absent septicemia and with proven septicemia in an attempt to classify patients with isolates of coagulase-negative staphylococcus in one of these groups at an early stage. Patients with two or more positive blood cultures were not statistically classified more frequently as septicemic than patients with one blood bottle positive for this organism. However, patients categorized as septicemic had a significantly higher mortality (59%) than those classified as non-septicemic (35%) (p<0.05).     

Patient assessment of a combined medical and nursing preparation to cytotoxic chemotherapy

At Auckland hospital there is a combined medical and nursing preparation for patients receiving cytotoxic chemotherapy. The aim of the current study was to assess whether patients felt that this combined approach had prepared them adequately for chemotherapy. Patients were asked to complete three questionnaires anonymously at different times in their treatment programme: Immediately prior to chemotherapy, after three cycles of chemotherapy and 2 months after completion of chemotherapy. A high level of satisfaction with the programme was demonstrated: 68% of patients thought the orientation programme had prepared them very well, 32% adequately and none poorly for their chemotherapy. Separate interviews with medical and nursing staff were thought a good idea by 86% of patients and only 1 of 100 medical and 100 nursing interviews was assessed as not worthwhile. This study suggests that a combined medical and nursing preparation is a worthwhile practice in preparing patients for cytotoxic chemotherapy.     

Comparison of anthelmintic effects of two doses of ivermectin on intestinal strongyloidiasis in patients negative or positive for anti-HTLV-1 antibody

Coinfection with HTLV-1 (T lymphotropic virus type I) has been observed in approximately 38% of cases of Strongyloides stercoralis infection in Japan. In the present study, we investigated whether the dose of ivermectin corresponding to approximately twice the conventional therapeutic dose could improve the anthelmintic rate without adverse effects in patients with intestinal strongyloidiasis, particularly in those positive for anti-HTLV-1 antibody. A single dose of 6mg ivermectin (mean, 110µg/kg) was administered and the same single dose was repeated 2 weeks later in 312 patients with intestinal strongyloidiasis during the period from 1990 to 1999. The long-term anthelmintic rate during the period of 12 months from 4 months after treatment was 77% (117/152) in all patients, and 92.7% (89/96) and 50% (28/56) in those negative and positive for anti-HTLV-1 antibody, respectively. Between 2000 and 2003, ivermectin was administered at 200µg/kg in 97 patients, and repeated 2 weeks later. The long-term anthelmintic rate was 96.8% (60/62) in all patients, and 100% (42/42) and 90% (18/20) in those negative and positive for anti-HTLV-1 antibody, respectively. These results showed that the long-term anthelmintic rates in all patients in the 200µg/kg dose group, and especially in those positive for anti-HTLV-1 antibody, were significantly higher than the respective rates of the 110µg/kg dose group. Based on these results and the observed safety of the double dose of ivermectin, the recommended dose of ivermectin for treatment of intestinal strongyloidiasis should be 200µg/kg in patients positive for anti-HTLV-1 antibody.     

The effects of PEEP on arterial oxygenation

The effect of positive end expiratory pressure (PEEP) on arterial oxygenation depends on many factors. Two of the most important are the quality and the quantity of the physiological shunt. The quality depends on the mixed venous oxygen tension, and the quantity on the shunt fraction. Each of these factors may rise or fall with PEEP, depending on the pulmonary and circulatory state of the patient. Their ultimate balance influences the change in arterial oxygen tension.     

“Skip areas” in hepatic steatosis: A sonographic-angiographic study

Skip areas in focal steatosis describes a newly proposed subsegmental type of focal steatosis, which differs in both extent and topography from the more classic lobar or segmental type of focal steatosis.In the subsegmental type of steatosis, fatty infiltration can be considered homogeneous through-out the liver, with the exception of small flattened portions of less affected parenchyma, called skip areas. These regions are mainly located in the subcapsular areas or along the interlobar fissures or the gallbladder bed.Observations using ultrasound in vivo, as well as on postmortem in vitro angiograms, suggest that both the extent and topography of these skip areas can be explained by local differences in vascular anatomy.     

Die „Gelenkschule“

Zusammenfassung Im Rahmen der Gelenkschule haben wir bei unseren stationären Patienten mit Gonarthrose das Fahrradergometertraining neben einer komplexen Physiotherapie und klassischen Naturheilverfahren, verbunden mit Gewichtsreduktion, eingesetzt. Es handelte sich um 26 Patienten (19 Frauen und 7 Männer) mit einem Durchschnittsalter von 55,1 Jahren und einem Body-mass-Index von durchschnittlich 36,8 kg/m².Alle Patienten hatten eine mäßige bis mittelgradige Gonarthrose im Röntgenbild (nach Kellgren und Lawrence [26]) mit Belastungsschmerzen.Mit Hilfe der visuellen Analogskala (VAS) konnten wir eine Linderung der Kniegelenkschmerzen durch das Fahrradergometertraining von 48,5% VAS und eine Verbesserung der schmerzfreien Fahrradergometerbelastungszeit von durchschnittlich 7,7 min bei der Aufnahme auf 23,3 min bei Entlassung feststellen.Eine Patientengruppe, die kein Fahrradergometertraining absolvierte, hatte nur eine Schmerzlinderung von 23,1% VAS gegenüber einer Fahrradergometertrainingsgruppe vergleichbarer stationärer Behandlungsdauer von 50% VAS.Das Fahrradergometertraining kann bei der Behandlung bestimmter Gonarthrosepatienten zur Schmerzlinderung empfohlen werden.Nach einem Vortrag auf dem Symposium Rheumatologie Manuelle Medizin und Rheumatologie, Deutsche Gesellschaft für Physikalische und Rehabilitative Medizin vom 29.–31. August 2003 in Weimar.Der 1. Teil der Gelenkschule ist 2003 erschienen in: Man Med 41:189–198.     

Protective effect of β-glucan on lung injury after cecal ligation and puncture in rats

Objective Understanding the biological mediators involved in the complex inflammatory response of sepsis and acute lung injury offers the possibility of future investigations targeting treatment based on these mediators. This study investigated whether macrophage activator -glucan has a protective effect on acute lung injury in an experimental model of sepsis.Design and setting Experimental study in an experimental research center.Materials 30 rats randomized into three groups (sham, sepsis, and -glucan).Interventions Cecal ligation and puncture were performed in the -glucan and sepsis groups. The -glucan group was given a single intraperitoneal dose of -glucan (4 mg/kg) following cecal ligation.Measurements and results Rats treated with -glucan had fewer circulating neutrophils, more blood monocytes, and higher serum interleukin 6 levels than septic animals. The percentages of neutrophils and lymphocytes from the bronchoalveolar lavage fluid and the myeloperoxidase activity measured in the lung tissue were lower in the -glucan group than in the sepsis group. Less alveolar hemorrhage and neutrophil infiltration were observed in lungs from animals in the -glucan group in the septic groups.Conclusions In this rat model of intra-abdominal sepsis -glucan treatment partially protected against secondary lung injury, decreased lung hemorrhages, and lung neutrophilia. These results suggest that -glucan protects against sepsis-associated lung damage.     

Oxygenation remains unaffected by increased inspiration-to-expiration ratio but impairs hemodynamics in surfactant-depleted piglets

Objectives Prolongation of inspiratory time is used to reduce lung injury in mechanical ventilation. The aim of this study was to isolate the effects of inspiratory time on airway pressure, gas exchange, and hemodynamics, while ventilatory frequency, tidal volume, and mean airway pressure were kept constant.Design Randomized experimental trial.Setting Experimental laboratory of a University Department of Anesthesiology and Intensive Care.Animals Twelve anesthetised piglets.Interventions After lavage the reference setting was pressure-controlled ventilation with a decelerating flow; IE was 11, and PEEP was set to 75% of the inflection point pressure level. The IE ratios of 1.51, 2.31, and 41 were applied randomly. Under open lung conditions, mean airway pressure was kept constant by reduction of external PEEP.Measurement and results Gas exchange, airway pressures, hemodynamics, functional residual capacity (SF₆ tracer), and intrathoracic fluid volumes (double indicator dilution) were measured. Compared to the IE of 11, PaCO₂ was 8% lower, with IE 2.31 and 41 (p0.01) while PaO₂ remained unchanged. The decrease in inspiratory airway pressure with increased inspiratory time was due to the response of the pressure-regulated volume-controlled mode to an increased IE ratio. Stroke index and right ventricular ejection fraction were depressed at higher IE ratios (SI by 18% at 2.31, 20% at 41; RVEF by 10% at 2.31, 13% at 41;p0.05).Conclusion Under open lung conditions with an increased IE ratio, oxygenation remained unaffected while hemodynamics were impaired.This study was supported by the Swedish Medical Research Council (project 4252), the Swedish Heart-Lung Foundation, Stockholm, Sweden, and the Laerdal Foundation for Acute Medicine, Stavanger, Norway     

Severe community-acquired pneumonia in ICUs: Prospective validation of a prognostic score

Objective To determine predictors of intensive care unit (ICU) mortality in patients with community-acquired pneumonia (CAP), to develop a pneumonia-specific prognostic index, and to evaluate this index prospectively.Design Combined retrospective and prospective clinical study over two periods: January 1987–December 1992 and January 1993–December 1994.Setting Four medical ICUs in the north of France.Patients Derivation cohort: 335 patients admitted to one ICU were retrospectively studied to determine prognosis factors and to develop a pneumonia-specific prognostic index. Validation cohort: 125 consecutive patients, admitted to four ICUs, were prospectively enrolled to evaluate this index.Results In the derivation cohort, 16 predictors of mortality were identified and assigned a value directly proportional to their magnitude in the mortality model: aspiration pneumonia (–0.37), grading of sepsis 11 (–0.2), antimicrobial combination (–0.01), Glasgow score >12+mechanical ventilation (MV) (+0.09), serum creatinine 15 mg/l (+0.22), chest involvement shown by X-ray 3 lobes (+0.28), shock (+0.29), bacteremia (+0.29), initial MV (+0.29), underlying ultimately or rapidly fatal illness (+0.31), Simplified Acute Physiology Score 12 (+0.49), neutrophil count 3500/mm³ (+0.52), acute organ system failure score 2 (+0.64), delayed MV (+0.67), immunosuppression (+1.38), and ineffective initial antimicrobial therapy (+1.5). An index was obtained by adding each patient's points. According to a receiver operating characteristic curve, the cut-off value of this index was 2.5. In the validation cohort, an index of 2.5 could predict death with a positive predictive value of 0.92, sensitivity 0.61, and specificity 0.98.Conclusion This index, which performs well in classifying patients at high-risk of death, may help physicians in initial patient care (appropriateness of the initial antimicrobial therapy) and guide future clinical research (analysis and design of therapeutic trials).     

The Use of “As Many As Can” Versus “Feel Like Continuing” Stop Rules During Worrying

Two studies are reported that investigated the processes involved in stopping worry. Study 1 found that the use of as many as can stop rules was significantly related to measures of trait worry and beliefs about the positive and negative consequences of worrying, and Study 2 demonstrated that the reported use of as many as can stop rules significantly predicted perseveration on behavioral measures of catastrophic worrying. Reported use of feel like continuing stop rules was unrelated to any measures of worry in both studies. These results indicate that the use of as many as can stop rules is a highly significant predictor of worry frequency and perseveration, and that beliefs about the positive and negative consequences of worry also independently predict the use of as many as can stop rules. These findings are consistent with (1) the view that the stop rules used by worriers are closely associated with, or directly derived from, the more stable, global beliefs that worriers hold about the utility of the worry process, and (2) predictions from the mood-as-input model of catastrophic worrying (H. M. Startup & G. C. L. Davey, 2001).     

New aspects of pulmonary mechanics: ‘slowly” distensible compartments of the respiratory system,identified by a PEEP step maneuver

Objective The aims of the present study were 1) to evaluate a method for identification of slowly distensible compartments of the respiratory system (rs), which are characterized by long mechanical time constants (RC) and 2) to identify slowly distensible rs-compartments in mechanically ventilated patients.Design Prospective studyon a physical lung model.Setting Intensive Care Unit, University Hospital, Tübingen.Patients and participants 19 patients with severe lung injury (acute respiratory distress syndrome, ARDS) and on 10 patients with mild lung injury.Measurements and results Positive end-expiratory pressure (PEEP)-increasing and-decreasing steps of about 5 cmH₂O were applied and the breath-by-breath differences of inspiratory and expiratory volumes (V) were measured. The sequence of Vs were analyzed in terms of volume change in the fast compartment (V_fast), the slow compartment (V_slow), total change in lung volume (VL) and mechanical time constant of the slow compartment (RC_slow). Thirty-eight measurements in a lung model revealed a good correlation between the preset V_slow/VL and V_slow/VL measured: r²=0.91 The V_slow/VL measured amounted to 0.94±0.15 of V_slow/VL in the lung model. RC_slow measured was 0.92±0.43 of the RC_slow reference. Starting from a PEEP level of 11 cmH₂O PEEP-increasing and PEEP-decreasing steps were applied to the mechanically ventilated patients. Three out of ten patients with mild lung injury (30%) and 7/19 patients with ARDS (36.8%) revealed slowly distensible rscompartments in a PEEP-increasing step, whereas 15/19 ARDS patients and 1/10 patients with mild lung injury showed slowly distensible rs-compartments in a PEEP-decreasing step (78.9% vs 10%,P<0.002, chi-square test).Conclusions The gas distribution properties of the respiratory system can be easily studied by a PEEP-step maneuver. The relative contribution of the slow units to the total increase of lung volume following a PEEP step could be adequately assessed. Slowly distensible rs-compartments could be detected in patients with severe and mild lung injury, however significantly more ARDS patients revealed slow rs-compartments in PEEP-decreasing steps. The influence of slowly distensible rs-compartments on pulmonary gas exchange is unknown and has yet to be studied.The work was performed at the Klinik für Anaesthesiologie und Transfusionsmedizin der Universität Tübingen     

Effect of rational and irrational beliefs on intensity and “inappropriateness” of feelings: A test of rational—emotive theory

This study tested the central rational-emotive hypothesis that greater inappropriate emotional distress is caused by irrational rather than rational beliefs about undesirable situations. Ellis and Harper (1975) have suggested that inappropriate emotions (such as anger) differ qualitatively from appropriate emotions (such as annoyance). Previous research, however, indicates that irrational beliefs are associated with greater appropriate as well as inappropriate negative emotions. In this study, a 3 ×2 pretest—posttest factorial design was used, in which 10 undergraduates of either sex were randomly assigned to one of three treatments, which involved imagining being in a situation. The control condition comprised an emotionally neutral scene, while the two experimental treatments contained rational and irrational statements about being left alone by one's partner at a party. The experimental manipulation was successful, and both inappropriate and appropriate negative emotions were found to be greater in the irrational condition as compared to the neutral or rational condition. Thus irrational beliefs were shown to have an effect on emotions, but the emotions associated with irrational beliefs differed from those associated with rational beliefs in quantity rather than in quality.     

Ultrasonic-enhanced gentamicin transport through colony biofilms of <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> and <Emphasis Type="Italic">Escherichia coli</Emphasis>

The hypothesis that ultrasound increases antibiotic transport through biofilms of Escherichia coli and Pseudomonas aeruginosa was investigated using colony biofilms. Biofilms grown on membrane filters were transferred to nutrient agar containing 50µg/ml gentamicin. A smaller filter was placed on top of the biofilm and a blank concentration disk was situated atop the filter. Diffusion of antibiotic through the biofilms was allowed for 15, 30, or 45min at 37°C. Some of these biofilms were exposed to 70-kHz ultrasound and others were not. Each concentration disk was then placed on a nutrient agar plate spread with a lawn of E. coli. The resulting zone of inhibition was used to calculate the amount of gentamicin that was transported through the biofilm into the disk. The E. coli and P. aeruginosa biofilms grown for 13 and 24h were exposed to two different ultrasonic power densities. Ultrasonication significantly increased the transport of gentamicin through the biofilm. Insonation of biofilms of E. coli for 45min more than doubled the amount of gentamicin compared to their noninsonated counterparts. For P. aeruginosa biofilms, no detectable gentamicin penetrated the biofilm within 45min without ultrasound; however, when insonated (1.5W/cm²) for 45min, the disks collected more than 0.45µg antibiotic. Ultrasonication significantly increased transport of gentamicin across biofilms that normally blocked or slowed gentamicin transport when not exposed to ultrasound. This enhanced transport may be partially responsible for the increased killing of biofilm bacteria exposed to combinations of antibiotic and ultrasound.     

Positive thinking: An unfair burden for cancer patients?

This presentation challenges the purveyors of the importance of positive thinking in the cure of cancer. Psychological support should allow the patient to come to terms with his or her situation in a way that works for that individual within a caring and realistic environment. In no way should psychological support add an extra burden to an already devastated patient. By forcing positive mental attitude, health-care professionals are not allowing patients to face reality. Promoters of the cure that comes with positive thinking are quoted, as well as authors who question the promoters' intent and outcome. It is felt that positive thinking may be appropriate as one of many successful coping strategies. To attribute more to it or, worse, to insist that patients believe in its power to cure may be courting emotional disaster.Presented as an invited lecture at the 6th International Symposium: Supportive Care in Cancer, New Orleans, La., USA, 2–5 March 1994     

Invisible diseases and the doctor-patient relationship

Abstract Headaches can be considered as a paradigm for the so-called invisible diseases; difficulties that headache patients encounter and complain from often relate more to the lack of understanding and communication than to lack of a cure by their doctors. Even when treatment is available, although symptoms are relieved, this might not cure the suffering and the burden caused by headache. This paper will present the difference between disease and illness, will highlight difficulties encountered by patients with invisible diseases and will underline how these difficulties might be reduced by a better doctor–patient relationship. The physician who acknowledges and considers the subjective aspects of the illness, has important elements both for a personalised diagnosis and for a therapy that the patient will be able and willing to follow. The physician has to improve and to train his/her human capabilities in order to have a good relationship with the ill person, and not only to use his/her technical skills for individualising and curing the disease in the patients body.*Section Editor     

Hypochloruria associated with hypovolemia

Hypochloruria is proposed as an indicator of hypovolemia in ICU non cardiac patients. Twelve of 13 patients presenting with Cl_u20 mmol·l^-1 and Na_u20 mmol·l^-1 or twice the Cl_u value had a CVP 0 mmHg. This pattern occurred in those with a metabolic alkalosis or acidosis, renal insufficiency or normal renal function, in the presence or absence of dopamine and/or diuretic administration and with or without controlled ventilation. Hypochloruria may be a better indicator of hypovolemia than a low urinary Na in ICU patients.