Personality, drug of choice, and comorbid psychopathology among substance abusers

The current study investigated the association between substance abuse/dependence, drug of choice, and the personality traits of negative emotionality, positive emotionality, and constraint (disinhibition) as measured by the Multidimensional Personality Questionnaire. The sample comprises 325 subjects from the Yale Family Study, a family study investigating the relation between substance-use disorders and anxiety disorders and their transmission in families. A total of 205 (63%) met criteria for lifetime substance abuse/dependence, with the remainder comprising the comparison group. The substance abusers were placed into one of four predominant drug of abuse/dependence categories (opioid, cocaine or stimulants, marijuana or sedatives, or alcohol) based upon best-estimate diagnoses and one of five self-reported drug of preference groups (polysubstance, opioid, cocaine or stimulants, marijuana or sedatives, and alcohol). First, findings demonstrate that individuals with substance abuse/dependence, compared to those without, scored lower on constraint even after adjusting for socio-demographic factors, comorbid psychiatric disorder, and current/remitted substance-use disorder. Individuals with substance abuse/dependence scored marginally higher on negative emotionality, but this difference was statistically significant only when comorbid psychopathology was not controlled. Second, findings show that individuals who differ with respect to drug of choice-whether defined in terms of the predominant drug of abuse/dependence or self-reported drug of preference-vary in terms of constraint. After controlling for socio-demographic indicators and comorbid psychopathology, scores on constraint generally decreased with the social deviance of the drug of choice, thereby underscoring a potentially important link between disinhibition and drug selection.     

Patient‐centered,evidence‐based,and cost‐conscious cancer care across the continuum: Translating the Institute of Medicine report into clinical practice

In 2013, the Institute of Medicine (IOM) concluded that cancer care in the United States is in crisis. Patients and their families are not receiving the information that they need to make informed decisions about their cancer care. Many patients do not have access to palliative care and too few are referred to hospice at the appropriate point in their disease trajectory. Simultaneously, there is a growing demand for cancer care with increases in new cancer diagnoses and the number of patients surviving cancer. Furthermore, there is a workforce shortage to care for this growing and elderly population. The IOM's report, Delivering High‐Quality Cancer Care: Charting a New Course for a System in Crisis, outlined recommendations to improve the quality of cancer care. This article provides an overview of the IOM report and highlights the recommendations that are most relevant to practicing clinicians who care for patients with cancer across the continuum. The implementation of the recommendations in clinical practice will require better patient‐clinician communication, improved care coordination, targeted clinician training, effective dissemination of evidence‐based guidelines and strategies for eliminating waste, and continuous quality assessment and improvement efforts. CA Cancer J Clin 2014;64:408–421. © 2014 American Cancer Society.     

Detecting improvements in acute psychotic symptoms using experience sampling methodology

This study aimed to explore the feasibility and validity of using experience sampling methodology (ESM, or ecological momentary assessment or mobile device signaling) to measure temporal changes and fluctuations in psychotic symptoms in patients with acute psychosis at the start of antipsychotic treatment.     

A Model for Emergency Department End‐of‐life Communications After Acute Devastating Events—Part II: Moving From Resuscitative to End‐of‐life or Palliative Treatment

The model for emergency department (ED) end‐of‐life communications after acute devastating events addresses decision‐making capacity, surrogates, and advance directives, including legal definitions and application of these steps. Part II concerns communications moving from resuscitative to palliative and end‐of‐life treatments. After completing the steps involved in determining decision‐making, emergency physicians (EPs) should consider starting palliative measures versus continuing resuscitative treatment. As communications related to these end‐of‐life decisions increasingly fall within the scope of emergency medicine (EM) practice, we need to become educated about and comfortable with them.     

Cutaneous squamous cell carcinoma of the scalp extending to the skull: A case report and review of the literature

Squamous cell carcinoma (SCC) of the scalp has increased prevalence in older patients and often presents later in life. Mohs micrographic surgery remains the most effective treatment in most cases. Delayed presentation may result in localized bony invasion or distant metastases. We present a case of an elderly woman presenting with extension of SCC into the parietal bone of the skull.