The Soul’s Legacy: A Program Designed to Help Prepare Senior Adults Cope With End-of-Life Existential Distress

Current innovative psychological therapies have made great progress in addressing existential suffering in dying patients but are often begun to late in the end-of-life process and often ignore religion, which for many is a major component in the meaning-making process. Therefore, this article explores how chaplains (who are familiar with various religious traditions without promoting them) can help prepare senior adults effectively cope with inevitable end-of-life existential issues. The project described in this article provides tools for chaplains to address the real issues that terrify us all, but particularly the elderly: death, isolation, and meaninglessness. It is proposed that the addition of a spiritual will or legacy of the soul added to end-of-life planning can help ameliorate existential suffering at life’s end.     

Validation of the Pain Sensitivity Questionnaire in chronic pain patients

Recently, a self-rating measure for pain perception based on imagined painful daily life situations, the Pain Sensitivity Questionnaire (PSQ), has been developed and shown to correlate with experimentally obtained pain intensity ratings in healthy subjects. Here, we assessed the validity of the PSQ for investigation of general pain perception (ie, pain perception outside the site of clinical pain) in chronic pain patients. PSQ scores were obtained in 134 chronic pain patients and compared to those of 185 healthy control subjects. In a subgroup of 46 chronic pain patients, we performed experimental pain testing outside the clinical pain site, including different modalities (heat, cold, pressure, and pinprick) and different measures (pain thresholds, pain intensity ratings). Results show that PSQ scores were significantly correlated with both experimental pain intensity ratings (Pearson's r=0.71, P<.001) and experimental pain thresholds (r=-0.52, P<.001). In addition, chronic pain patients exhibited significantly elevated PSQ scores as compared to healthy controls, consistent with the generalized increase of experimentally determined pain perception that has repeatedly been reported in chronic pain patients. These results demonstrate that the PSQ constitutes a valid self-rating measure of pain perception outside the clinical pain site in chronic pain patients and might serve as an alternative to experimental assessment of pain perception outside the clinical pain site in situations where experimental pain testing is not feasible.     

Implications of functionally different synaptic inputs for neuronal gain and computational properties of fly visual interneurons

Neurons embedded in networks are thought to receive synaptic inputs that do not drive them on their own, but modulate the responsiveness to driving input. Although studies on brain slices have led to detailed knowledge of how nondriving input affects dendritic integration, its origin and functional implications remain unclear. We tackle this issue using an ensemble of fly wide-field visual interneurons. These neurons offer the opportunity not only to combine in vivo recording techniques and natural sensory stimulation but also to interpret electrophysiological results in a behavioral context. By targeted manipulation of the animal's visual input we find a pronounced modulating impact of nondriving input, whereas functionally important cellular properties like direction tuning and the coding of pattern velocity are left almost unaffected. We propose that the integration of functionally different synaptic inputs is a mechanism that immanently equalizes the ensemble's sensitivity irrespective of the specific stimulus conditions.     

Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites: a multi-centre, randomized, dose-response study

BACKGROUND: The effect of specific immunotherapy (SIT) on eczema in atopic dermatitis is not known. Therefore, a multi-centre, randomized dose-response trial, double-blind with respect to the efficacy of a biologically standardized depot house dust mite preparation was performed. METHODS: Eighty-nine adults with a chronic course of atopic dermatitis, SCORAD >or=40 and allergic sensitization to house dust mites [CAP-FEIA >or=3] were included, of whom 51 completed the study. Subcutaneous SIT with a house dust mite preparation (Dermatophagoides pteronyssinus/D. farinae) applying maintenance doses of 20, 2,000 and 20,000 SQ-U in weekly intervals for 1 year. The main outcome measures addressed the change of the SCORAD as average of the values after 9 and 12 months of SIT in comparison with the value at baseline. RESULTS: The SCORAD declined in the three dose groups in a dose-dependent manner (P = 0.0368, Jonckheere-Terpstra test) and was significantly lower in the two high-dose groups (2,000, 20,000 SQ-U) compared with the low-dose group of 20 SQ-U (P = 0.0379, U-test) after 1 year of SIT. The use of topical corticosteroids was significantly reduced with higher doses (P = 0.0007, Mantel-Haenszel chi-square test). CONCLUSIONS: Allergen-SIT for 1 year with a house dust mite preparation is able to improve the eczema in patients with atopic dermatitis who are sensitized to house dust mite allergens and reduces the need for topical corticosteroids. SIT may be valuable in the treatment of this chronic skin disease.