Death in the ICU: does the patient predict his own demise?

Critically ill patients who fear impending death may die suddenly. We studied prospectively the incidence of death in critically ill surgical patients who articulated the fear that they were about to die. Physiologic, environmental, and behavioral correlates which might influence perceptions of impending death were examined for both the study group and age- and diagnosis-matched control patients. Thirteen (2%) of 643 patients expressed the conviction that they were about to die. Five (38%) of 13 subjects and four (29%) of 13 controls died, an insignificant difference. The overall death rate in the ICU during the study period was 10%. We conclude that patients expressing fear of imminent death were no more likely to die than matched controls, but that they were among the most severely ill conscious patients in the ICU.     

Sustained and sustaining continuing education for therapists

Thirty-eight therapists who completed a 2-year continuing education program evaluated the effect of that program on how they conducted therapy and on themselves as individuals. The program differed from most continuing education offerings both in its ongoing nature and its emphasis on an interactive and dynamic use of material rather than on a purely didactic presentation. Participants described changes that they felt improved the quality of the therapeutic alliance, increased their ability to work effectively with difficult patients, and increased their self-awareness. This evaluation of the experience of a mature (over 10 years in operation) program is significant at a point when American Psychological Association (APA) is considering a broader conceptualization of continuing education models. These results also illustrate the importance of thoroughly evaluating the effect of continuing education. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Induction of colon tumorigenesis by glutathione depletion in p53-knock-out mice

In order to examine the role of glutathione (GSH), a key cellular antioxidant, on spontaneous tumor development, we tested the effects of buthionine sulfoximine (BSO), a specific inhibitor of GSH synthesis, and 1,2-oxothiazolidine-4-carboxylic acid (OTCA), a cysteine and GSH precursor, on tumor incidence and spectrum in p53 nullizygous (p53-/-) transgenic mice. Mice were randomly assigned to three groups: control (no treatment), BSO (20 mM in drinking water) or OTCA (6 g/kg in the diet) (n=30 per group). After 10 weeks, GSH levels were decreased 29-88% in all tissues except liver and brain in BSO-treated mice, while no changes were observed in most tissues from OTCA-treated animals. Mice in all groups showed similar survival patterns as well as incidence of the most commonly observed tumors: i.e., lymphomas (80%) and other tumors (38%). However, a 5-fold increase in incidence of colonic tumors (from 4-20%) was observed in the BSO-treated group, suggesting that GSH deficiency and loss of p53 function play contributory roles in colon carcinogenesis.