The use of cueing and positive practice in the treatment of tongue thrust swallowing

Tongue thrust or reverse swallowing refers to the condition in which portions of the tongue rest or press against the teeth. In very severe cases the result can be dental malocclusion and/or speech difficulties. The present investigation evaluates the efficacy of cueing and positive practice in increasing the frequency of correct tongue position using a modified single subject withdrawal design with a 21 year old college student. The data indicate that the frequency of correct tongue positioning increased with the introduction of treatment. Follow-up data obtained 30 months post-treatment indicate that positive effects were being maintained.     

Migration and proliferation of endothelial cells in preformed and newly formed blood vessels during tumor angiogenesis

Tumor-induced capillary proliferation was studied in the rabbit cornea after implantation of V2 carcinoma 1 mm from the limbal vascular plexus. Limbal vessels were examined 1 to 10 days later with: [³H]thymidine autoradiography, electron microscopy, intravenous injection of colloidal carbon, and slit-lamp stereomicroscopy. Endothelial cells displayed surface projections and resembled regenerating endothelium 1 day after tumor implant. At 2 days, cells emigrated from preformed vessels toward the tumor implant. Simultaneously, cell junctions loosened and new lumina appeared in the walls of existing venules. Capillary sprouts were detected histologically at Day 4 and entered the corneal stroma by Day 6. New vessels were never seen in control eyes implanted with heat-killed tumor. The thymidine labeling index of endothelium was elevated on Day 2 and reached a peak of 8% on Day 3. After Day 4, labeled cells were located only near the distal tips of the growing capillaries. The labeling index ranged from 0.6 to 4%. In controls, labeling was less than 0.7% after 3 days.These studies suggest that active migration of preformed endothelial cells toward the tumor stimulus may precede cell proliferation during tumor angiogenesis. Whether this sequence occurs in other forms of neovascularization is unknown. However, once new capillaries have appeared, tumor-induced vessels elongate by mechanisms similar to wound-induced capillaries.     

Refusal of treatment: Suicide or competent choice

Increasingly, patients are exercising the right to refuse treatment. Patients who have been chronically ill or those who consider themselves terminally ill are most apt to do so. Accordingly, liaison psychiatrists are asked to determine whether refusal of treatment is an act of suicide or a competent choice. This is difficult to assess in the absence of delirium or over psychosis. It is suggested that the dynamics and affective tones of the patients' reaction to the health care system as well as to family and friends are of major significance in this determination The actual process of exploring these areas with patients making this choice is often therapeutic in restoring the patients' sense of control or authenticity. Often this process enables them to continue treatment and avoid the impulsive interpersonal anger that characterizes the suicidal act.     

Suicide vs right to refuse treatment in the chronically ill

Suicidal impulses in chronically ill patients can be clinically differentiated from the rationally exercised right to refuse further treatment. Examination of the immediate and historical dynamics of the patient's interaction with himself, his family, and the health care system, with particular regard to the affective tones associated with these interactions, forms the basis for making this differentiation.     

Characteristics of patients completing referrals from an emergency department to a psychiatric outpatient clinic

Many patients referred from emergency departments for psychiatric outpatient treatment fail to make contact with the facilities to which they have been referred.^1–4 Completion rates in the range of 7.1%–63% have been typically reported.^2,3,5 While diverse explanations such as the method of referral³ and characteristics of facilities¹ have been suggested as determinants of the low completion rate, research has focused largely on demographic characteristics of the patients referred.^3,5,6 For example, patient's sex,^2,5 socioeconomic status,¹ race,⁵ and age^2,3 have been found to relate to the completion of referrals made in the emergency department.While the clinical characteristics of psychiatric emergency department patients have received some attention, studies have focused more on describing these patients^6–9 than on investigating the relationship between their characteristics and successful completion of referrals. Furthermore, studies which have attempted to relate clinical characteristics to completion rates,^2,4,10 along with those focusing on demographic characteristics, have tended to overlook the question of whether patients who failed to complete their referrals to a particular facility actually made contact with some other psychiatric facility.The purposes of the present study are (1) to investigate both the demographic and clinical characteristics of patients who successfully complete referrals from a psychiatric emergency department to a psychiatric outpatient clinic and (2) to determine by means of a thorough follow-up the characteristics of patients who failed to complete the referral but sought treatment elsewhere in the community.