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.     

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.     

The concept of “baby lung”

Background The baby lung concept originated as an offspring of computed tomography examinations which showed in most patients with acute lung injury/acute respiratory distress syndrome that the normally aerated tissue has the dimensions of the lung of a 5- to 6-year-old child (300–500 g aerated tissue).Discussion The respiratory system compliance is linearly related to the baby lung dimensions, suggesting that the acute respiratory distress syndrome lung is not stiff but instead small, with nearly normal intrinsic elasticity. Initially we taught that the baby lung is a distinct anatomical structure, in the nondependent lung regions. However, the density redistribution in prone position shows that the baby lung is a functional and not an anatomical concept. This provides a rational for gentle lung treatment and a background to explain concepts such as baro- and volutrauma.Conclusions From a physiological perspective the baby lung helps to understand ventilator-induced lung injury. In this context, what appears dangerous is not the V_T/kg ratio but instead the V_T/baby lung ratio. The practical message is straightforward: the smaller the baby lung, the greater is the potential for unsafe mechanical ventilation.     

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).     

Does psychological characteristic influence physicians’ communication styles? Impact of physicians’ locus of control on interviews with a cancer patient and a relative

Context Physicians psychological characteristics may influence their communication styles and may thus interfere with patient-centred communication.Objective Our aim was to test the hypothesis that, in interviews with a cancer patient and a relative, physicians with an external locus of control (LOC; who believe that life outcomes are controlled by external forces such as luck, fate or others) have a communication style different from that of physicians with an internal LOC (who believe that life outcomes are controlled by their own characteristics or actions).Design, setting, participants and intervention Eighty-one voluntary physicians practising in the field of oncology were recorded while performing an actual and a simulated interview with a cancer patient and a relative.Main outcome measures Physicians communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians LOC was assessed using the Rotter I–E scale. The communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Students t test.Results In actual interviews, physicians with an external LOC talked more to the relative (P=0.017) and used more utterances with an assessment function (P=0.010) than physicians with an internal LOC. In simulated interviews, physicians with an external LOC used less utterances that give premature information (P=0.031) and used more utterances with a supportive function, such as empathy and reassurance (P=0.029), than physicians with an internal LOC.Conclusion These results provide evidence that physicians LOC can influence their communication styles. Physicians awareness of this influence constitutes a step towards a tailoring of their communication skills to every patients and relatives concerns and needs and thus towards a patient-centred communication.This research program was supported by the Fonds National de la Recherche Scientifique—Section Télévie of Belgium, the Fonds dEncouragement à la Recherche de lUniversité Libre de Bruxelles (Brussels, Belgium) and the CAM Training and Research Group (Brussels, Belgium).     

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.     

A new method for the diagnosis of acute hemorrhagic-necrotizing pancreatitis using contrast-enhanced CT

Twenty-eight consecutive patients with a first attack of alcohol-induced pancreatitis were studied using contrast-enhanced CT. The findings on CT were then related to the course of the disease. The patients with acute hemorrhagic-necrotizing pancreatitis showed significantly lower enhancement values of the pancreatic parenchyma than those with milder forms of the disease.The next 20 patients with severe pancreatitis were scanned using a slightly modified procedure. The enhancement values were calculated and plotted on the graphs for the 2 former groups.Two categories of pancreatic enhancement were found: low enhancement and high enhancement. In all 10 patients with low-enhancement values surgery revealed hemorrhagic-necrotizing pancreatitis. In the 10 patients with highenhancement values conservative treatment was continued, and the clinical course was nonfulminant in all of them.     

Stories from doctors of patients with pain. A qualitative research on the physicians’ perspective

Goal of work .The aim of this study was to explore the physicians internal representation of the doctor–patient relationship in the dramatic field of the patient with pain.Methods Using an open narrative format, 151 physicians were asked to Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain. The narrations were examined in accordance with a clinical-interpretive method.Main results Three perspectives of observation were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the depersonalization of pain. In the professional perspective, the narrative concerns the patient as a person and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives.Conclusions The professional perspective seemed to be the only place in which physicians could stop, a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.     

Angiographic manifestations of regional enteritis

Regional enteritis may be a protean disease, easily diagnosed when the common clinical presentation is noted. Occasionally, however, atypical features lead to the clinical suspicion of neoplastic disease. Four patients underwent angiographic evaluation in this clinical setting, all demonstrating similar changes in the mesenteric arteries. A serrated, corkscrew pattern was present and corresponded well to the perivascular fibrosis noted histologically. Recognition of this angiographic pattern may be important in differentiating neoplastic from inflammatory disease processes.     

Self-esteem and causal attributions for success and failure in children

In a comparison of causal attributions following success and failure in hypothetical social, athletic, and academic situations, high self-esteem grade school children were more likely than low self-esteem children to attribute their success to ability and their failure to either lack of effort or bad luck. Low self-esteem children, on the other hand, attributed their success more often than high self-esteem children to good luck (and in social situations to effort and task ease as well) and their failure to lack of ability. Whereas prior studies that focused only on the internal-external dimension found that low and high self-esteem children differed in their attributional style to success but not to failure, the present study found that when distinctions between behavioral and characterological attributions (stability and globality dimensions) were included, the two groups differed significantly in response to both success and failure. Although perhaps not generalizable beyond the present attribution measure, the most pronounced attribution differences between low and high self-esteem children were observed in the social domain, the least in the academic domain, with athletics falling in between. Finally, it was found that sex and age (within the limited fourth- to sixth-grade range examined in the present study) did not alter the overriding difference in attributional style between low and high self-esteem children.This study is based on a doctoral dissertation submitted by the first author under the supervision of the last author in partial fulfillment of the requirements for the Ph.D. degree at the University of Vermont.     

The “lung pulse”: an early ultrasound sign of complete atelectasis

Objective Complete atelectasis can be immediately generated by selective intubation. A dynamic lung ultrasound sign can be described as the association of absent lung sliding with the perception of heart activity at the pleural line, a sign which was called lung pulse. We examined whether this sign be used promptly to confirm complete atelectasis due to selective intubation.Design and setting Prospective study in the medical intensive care unit of a university-affiliated teaching hospital.Patients Consecutive patients with no history of respiratory disorders and needing intubation were enrolled. Fifteen patients with selective intubation of the right lung were compared with 30 patients with nonselective intubation and 15 healthy volunteers.Interventions The lung pulse was sought at the left anterolateral chest wall in intubated patients. Healthy subjects were studied during breathing and apnea.Results A left lung pulse was immediately present in 14 of 15 patients with right selective intubation, and absent, with normal lung sliding, in all 30 correctly intubated patients and in all 15 healthy subjects during breathing. All healthy subjects exhibited a lung pulse in apnea. The lung pulse had a sensitivity of 93% and a specificity of 100% for the diagnosis of complete atelectasis following selective intubation in patients without previous respiratory disorders.Conclusions The lung pulse is a sign of complete atelectasis which is observable immediately before radiological changes. Its absence which is correlated with the absence of selective intubation and of conserved lung inflation can eliminate the need for confirmation radiography.Electronic Supplementary Supplementary material is available in the online version of this article at .     

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).     

Studies on the ultrastructure of blood cells and the microaggregate fraction in stored human blood

Electron microscopy of citrate-phosphatedextrose (CPD) buffered bank blood performed over 21 days shows that the normal architecture of erythrocytes, platelets and leucocytes disappears and that deformed organelles, leucocyte ghosts, cell fragments and microaggregates accumulate. Leucocytes and platelets emerge as the most sensitive indicators of blood deterioration showing profound morphological changes from the first day. Microaggregates which passed through a 20-m high capacity transfusion filter were identified as platelet conglomerates, leucocyte ghost and platelet-leucocyte ghost coaggregates with diameters of 6–20, 20–30 and 30–40 m respectively. of these aggregates present in the filtrate, 62% fell into the size range of 20–40 m. The composition of microaggregates varies with storage time, the platelet conglomerates appear first during or after Day 1, leucocyte ghosts after Day 5 followed by platelet-leucocyte ghost coaggregate formation. At this stage the number of intact leucocytes and platelets is reduced and the filtrate shows an abundance of leucocyte debris. Microfiltration would thus appear to reduce but not eliminate the danger of microembolism and damage to capillary endothelium.     

Similarities between cognitive and humanistic approaches to psychotherapy

It is suggested that humanistic and cognitive therapies share some similar goals. Both see the employment of rigid absolutistic shoulds as generative of dysfunctional behavior. Both value self-acceptance, in the form of discouraging the client from forming negative overgeneralized trait-like self-judgements. Both value viewing one's failures and mistakes as part of a process of exploration and coping. Hypothesis-testing and holding constructs tentatively is also valued. At the level of practice some of Beck's cognitive strategies appear to help the client learn to stick to his/her moment to moment experiencing, and to be more phenomenological. Similarly Rogers' client-centered interventions appear to lay bare the client's negative self-statement process, and to counter and correct overgeneralized negative cognitions.     

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     

“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.     

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.     

Shock and the kidney: Pathophysiology and pharmacological support

This article reviews current knowledge as to the physiological mechanisms that control renal vascular resistence. The contribution of both extrinsic and intrinsic neuro-humoral regulation of both blood flow and glomerular filtration rate are described. The changes that occur both to the renal blood flow and glomerular filtration rate in the pathophysiological situation of pre-renal uraemia as well as acute tubular necrosis are described. Within this setting pharmacological manoeuvres that may improve both renal blood flow and glomerular filtration rate are discussed. In addition, the indications for and general principles of haemo- and peritoneal dialysis are described.     

Cognitive Mechanisms in the Avoidance of Painful and Dangerous Thoughts: Elaborating the Assimilation Model

The emotional processing of problematicexperiences is a central feature of psychotherapy.Stiles et al. (1990) propose an Assimilation model as ageneric account of such processes. This paper focuses on two aspects of this model: the concepts ofwarding off and unwantedthoughts showing how a cognitive scienceperspective can enrich our understanding of them. Wefocus on the ways in which cognitive processes (particularly different sorts ofmemory) mediate between experience and psychopathology.Two classes of problematic experiences that can beavoided or barred from full awareness to varying degrees are distinguished. We refer to this distinctionas the pain paradigm, in which experiencesare inaccessible to memory retrieval using verbalmnemonics,versus the panic paradigm, inwhich experiences fail to be retrieved or reported because theperson anticipates catastrophic consequences. We discusshow understanding the cognitive origins of thesephenomena promises to allow researchers and therapists to generate new approaches to overcome blocksin therapy.     

A study of the generation-of-alternatives process in social problem solving

This study evaluated three principles that have been recommended for generating alternatives in social problem solving: (1)quantity (i.e., the more alternatives generated the better), (2)deferment of judgment (i.e., it is better to generate alternatives without critically evaluating them at the same time),and (3)strategy-tactics (i.e., it is better to first generate a list of general approaches to the problem and then go back and generate specific means for implementing them).The results showed strong support only for the quantity principle. Data also suggested, however, that research should be done using more difficult test problems and subjects with greater deficits in social problem-solving ability before abandoning deferment of judgment and strategy-tactics procedures in social problem-solving training.