The value of flumazenil in the reversal of midazolam-induced sedation for upper gastrointestinal endoscopy

Fifty patients who underwent diagnostic upper gastrointestinal endoscopy after midazolam sedation were randomized to receive (after completion of the examination) either the benzodiazepine receptor antagonist flumazenil or an identical-looking placebo. The speed of recovery from sedation was assessed by reaction time testing, measurement of critical flicker fusion frequency, and the semi-quantitative SOCA scoring system. Measurements were made up to 6 h post examination in all subjects, and at 12 and 24 h in all in-patients (n = 20). Flumazenil-treated patients were significantly more alert than those who received placebo at 10 min, 30 min, 1 h and 2 h (P less than 0.001 in all instances). Thereafter the two groups were similar. There was no evidence of recurrence of sedation in flumazenil-treated patients, nor did this drug adversely affect the period of anterograde amnesia between the administration of midazolam and flumazenil.     

Ethical dilemmas in providing tobacco to developing countries: the case of China

We should recognize that we have a responsibility to people who live outside our own borders, and view ourselves as part of the global community. Looking at China we are faced with ethical dilemmas which require consideration. First, there is the ethical dilemma of business versus health. The opening and development of the tobacco business in China, which includes vigorous marketing, is considered against the health consequences of tobacco use which is estimated to cost 600 000 lives annually in China, rising to 2 million by 2025 without effective tobacco control programmes. A second ethical dilemma is employment versus impoverishment, in which the opportunities for work in the tobacco industry are considered against a background of malnutrition caused in part by a proportion of household budgets used to buy tobacco, and the erosion of the land, as trees are used to produce tobacco. Gains have already been made in tobacco control in China, with the way open for much development in the future.     

The death drive exemplified in a case of alcohol dependence

• ? When Freud first advanced the death drive it was considered a highly controversial theoretical idea. However, with the passage of time it has been slowly gaining support in certain psychoanalytical quarters.
• ? This paper aims to demonstrate the clinical usefulness of this theory in accordance with the Freudian and Kleinian model.
• ? Although the case history to be discussed is a severe case of alcohol dependence which had, previously, been unresponsive to treatment, many other maladies, both mental and physical, can be better understood in the context of the death drive being the principal motivating factor.

     

Exploring Paternal Influences on the Dieting Behaviors of Adolescent Girls

In this article we investigate fathers influence on the dieting behavior of their adolescent daughters. Fifty father-daughter dyads (N = 100) participated. The girls completed a questionnaire concerning their beliefs and behaviors with respect to dieting, their body satisfaction, and their perception of the advantages of being thinner. Fathers were surveyed in order to ascertain their perceptions of the advantages of slimness for adolescent girls and their beliefs regarding the importance of physical appearance and weight control in females of all ages. Associations were found between fathers attitudes to physical attractiveness in females, their perceptions of the impact of being slimmer for adolescent girls, and their daughters dieting behavior. Fathers who believed strongly in the importance of attractiveness and careful control of food intake by females were significantly more likely to have daughters who induced vomiting to lose weight. Fathers play an influential role in determining the dieting behavior of their adolescent daughters.     

Chemical synthesis of a neurotoxic polypeptide from the sea anemone Stichodactyla helianthus+

The sea anemone Stichodactyla helianthus neurotoxin I, a 48-residue polypeptide, was synthesized by automated solid phase methodology. The fully reduced polypeptide was subsequently refolded in the presence of a glutathione oxidoreduction buffer to the biologically active species containing three disulfide bonds. The overall yield after rigorous purification was 12.5%. The circular dichroism (CD), and proton nuclear magnetic resonance (¹ H NMR) spectra of the HPLC-purified synthetic toxin were indistinguishable from those obtained concurrently with the natural toxin. A subtilisin digest of the synthetic neurotoxin generated peptide fragments identical to that of a sample of the natural toxin subjected to the same treatment. The toxicity of the synthetic polypeptide was identical to that of the natural toxin (crab LD₅₀, 3.1μg/kg). The equilibrium dissociation constant (28 nM) for interaction of the synthetic toxin with crab axolemma vesicles was nearly identical to that of the natural toxin (25 nM).     

Pain and the administration of analgesia: what nurses say

? Pain of moderate to severe intensity continues to be an important problem for many hospitalized patients. ? Nurses spend more time with patients than any other health professional group and have a key role to play in the management of patients' pain. ? This paper reports the findings from a series of focus group interviews which were undertaken to explore nurses' perceptions regarding pain and the administration of narcotic analgesia. ? Themes identified from participants' comments related to (1) the pivotal role of nurses in pain management; (2) nursing assessment and pain management decisions (3) individual factors influencing nurses' pain management decisions and (4) the influence of others on nurses' pain management decisions. ? These findings have implications for further research and the development of innovative educational strategies.