Quality of life and breast cancer: relationship to psychosocial variables

The aim of this article is to shed more light on the relationship between quality of life and aspects of the psychosocial experience for women with breast cancer. The literature is briefly reviewed, including highlights of the psychosocial consequences of cancer, an exploration of the relationship of psychosocial variables to cancer, and a brief review of psychosocial interventions for cancer. Further, preliminary findings of an on-going NCI study are introduced. Finally, clinical implications are discussed. The purpose of this article is to provide a context and foundation on which future researchers and clinicians can build. Ultimately, we suggest that the biomedical model of disease, though crucial, does not take into account all of the complex factors involved in cancer. The current literature lends support to the argument that a broader, more integrative framework, which includes psychosocial factors, is needed.

Intentional systemic mindfulness: an integrative model for self-regulation and health

Self-regulation is the process whereby systems maintain stability of functioning and adaptability to change. Self-regulation is based on feedback loops which can be enhanced through attention. All self-regulation techniques, therefore, involve the cultivation of attention. However, the intention with which attention is directed may be crucial. In this paper, we explore intentional systemic mindfulness a model that explicitly introduces intention into self-regulation theory and practice. Intention as defined by this model is composed of the context of attention-systemic perspectives - and the quality of attention - mindfulness qualities. Intentional systemic mindfulness addresses both "why" (systemic perspectives) and "how" (mindfulness qualities) one directs attention, which may promote healing on multiple levels. Directions for research and implications for multiple levels of integrative health are considered.

Stress management in medical education: a review of the literature

PURPOSE

To review systematically clinical studies providing empirical data on stress-management programs in medical training.

METHOD

The authors searched Medline and PSYCHINFO from 1966 to 1999. Studies were included if they evaluated stress-management programs for medical trainees (medical students, interns, or residents); reported empirical data; and had been conducted at allopathic medical schools.

RESULTS

Although the search yielded over 600 articles discussing the importance of addressing the stress of medical education, only 24 studies reported intervention programs, and only six of those used rigorous scientific method. Results revealed that medical trainees participating in stress-management programs demonstrated (1) improved immunologic functioning, (2) decreases in depression and anxiety, (3) increased spirituality and empathy, (4) enhanced knowledge of alternative therapies for future referrals, (5) improved knowledge of the effects of stress, (6) greater use of positive coping skills, and (7) the ability to resolve role conflicts. Despite these promising results, the studies had many limitations.

CONCLUSION

The following considerations should be incorporated into future research: (1) rigorous study design, including randomization and control (comparison) groups, (2) measurement of moderator variables to determine which intervention works best for whom, (3) specificity of outcome measures, and (4) follow-up assessment, including effectiveness of future patient care.

r-Mode Oscillations in Rotating Magnetic Neutron Stars

We show that r-mode oscillations distort the magnetic fields of neutron stars and that their occurrence is likely to be limited by this interaction. If the field is greater, similar1016(Omega/OmegaB) G, where Omega and OmegaB are the angular velocities of the star and at which mass shedding occurs, r-mode oscillations cannot occur. Much weaker fields will prevent gravitational radiation from exciting r-mode oscillations or will damp them on a relatively short timescale by extracting energy from the modes faster than gravitational-wave emission can pump energy into them. For example, a 1010 G poloidal magnetic field that threads the star's superconducting core is likely to prevent the l=2 mode from being excited unless Omega exceeds 0.35OmegaB. If Omega is larger than 0.35OmegaB initially, the l=2 mode may be excited but is likely to decay rapidly once Omega falls below 0.35OmegaB, which happens in less, similar15 days if the saturation amplitude is greater, similar0.1. The r-mode oscillations may play an important role in determining the structure of neutron star magnetic fields.

On the Maximum Mass of Differentially Rotating Neutron Stars

We construct relativistic equilibrium models of differentially rotating neutron stars and show that they can support significantly more mass than their nonrotating or uniformly rotating counterparts. We dynamically evolve such "hypermassive" models in full general relativity and show that there do exist configurations that are dynamically stable against radial collapse and bar formation. Our results suggest that the remnant of binary neutron star coalescence may be temporarily stabilized by differential rotation, leading to delayed collapse and a delayed gravitational wave burst.

The construct of control in mind-body medicine: implications for healthcare

Research suggests that one of the principal reasons patients are attracted to alternative medicine is that they find many of these therapies more congruent with their philosophical orientation toward health. Many mind-body approaches, which are some of the most frequently used classifications of complementary and alternative therapies, grow out of research demonstrating the important role of psychological factors in treating and preventing illness. This article reviews research on one such factor--control--and its importance in health. Studies demonstrating the following are highlighted: (1) illness frequently results in feelings of loss of control; (2) gaining a sense of control can help patients to cope with illness; (3) whereas control may influence physiological function and health outcomes, the amount of active control we can exercise over physical functioning and health is limited; and (4) it is important to match control strategies to patient control styles and preferences. The implications of mind-body studies are also discussed.

Effects of mindfulness-based stress reduction on medical and premedical students

The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design. Findings indicate that participation in the intervention can effectively (1) reduce self-reported state and trait anxiety, (2) reduce reports of overall psychological distress including depression, (3) increase scores on overall empathy levels, and (4) increase scores on a measure of spiritual experiences assessed at termination of intervention. These results (5) replicated in the wait-list control group, (6) held across different experiments, and (7) were observed during the exam period. Future research should address potential long-term effects of mindfulness training for medical and premedical students.

Ultrasonographic diagnosis of recurrence after excision of an interdigital neuroma

We retrospectively reviewed the records of 20 patients (21 feet) with previous interdigital neuroma resections and symptoms suggestive for, but not diagnostic of, recurrent neuroma. Sonography was performed when clinical findings supplemented by local anesthetic block did not conclusively confirm the presence of recurrent neuroma. Studies performed in 13 patients (14 feet) were positive for recurrent neuromas. Three studies were indeterminate. The remaining four studies were negative for recurrent neuroma. The ultrasound studies were performed at an average of 19.2 months (range, 2-82 months) after the resection. Nine patients with 11 previous interdigital neuromas underwent ultrasonographic examination of the forefoot and subsequent revision neuroma resection. At surgery, gross and histologic findings were consistent with recurrent neuroma in 10 of 11 cases; one patient was found to have metatarsal-phalangeal synovitis. Ultrasonography appears to be a useful means for confirming neuroma recurrence in patients with symptoms after interdigital neurectomy when the diagnosis is not clear on physical examination.

Frequency of low level bacteremia in infants from birth to two months of age

BACKGROUND

The frequency of low level bacteremia (< or = 10 colony-forming units/ml) in infants from birth to 2 months of age and the optimal volume of blood and number of blood cultures to be collected have not been well-documented. During 1991 guidelines at this hospital for collection of blood for culture from these infants were revised.

METHODS

Blood from each infant with suspected bacteremia was usually inoculated into an Isolator 1.5 Microbial Tube (1.5 ml of blood) and a bottle of anaerobic broth (0.5 to 3.0 ml of blood). The use of a second Isolator tube and the total blood volume recommended for culture (2 to 6 ml) depended on the weight and total blood volume of each infant.

RESULTS

Forty-four bacterial pathogens were recovered from the blood of 40 (2.5%) of 1589 infants. Of 34 infants from whose blood the concentration of pathogens could be determined, 23 (68%) had low level bacteremia. Of 50 isolates of pathogens recovered from Isolator cultures, 32 (64%) were detected in counts of < or = 10 colony-forming units/ml. When 2 or 3 blood culture devices were inoculated with a total of 2 to 6 ml of blood from each infant, significantly more cases of bacteremia were detected (34 (3.0%) of 1126 infants had positive blood cultures) than when only one culture device containing < or = 1.5 ml of blood was used (2 (0.5%) of 398 infants had positive blood cultures; P = 0.008). However, when 4 or more culture devices were inoculated with a total of > 6 ml of blood from each infant (5 (7.7%) of 65 infants had positive blood cultures), the difference in recovery of pathogens compared with the culturing of from 2 to 6 ml of blood per infant was not significant (P = 0.089).

CONCLUSIONS

Low level bacteremia was common in our infants' patient population. The culturing of up to 6 ml of blood which represented up to 4.5% of an infant's total blood volume was required for detection of the pathogens.

Foreign bodies in small arteries after use of an infusion microcatheter

Over a 31-month period, we performed four neurointerventional procedures after which unexpected foreign bodies were noted in multiple arteries. All four procedures had in common the use of Fastracker-18 infusion microcatheters. Histologically, the intravascular debris looked strikingly similar to the hydrophilic coating on the catheter. An in vitro test mimicking clinical use of the microcatheter revealed that the hydrophilic coating can separate from the catheter. Until the coating is refined to make it more resistant to stripping, it may be advisable to reduce the amount of back-and-forth movement of these microcatheters if they have been positioned through guide catheters with small inner diameters and angled tips.

Sonographic evaluation of interdigital neuromas

Fifty surgical patients with symptoms suggestive of Morton's neuroma underwent preoperative ultrasound examination of the forefoot using a 7.5 MHz transducer. Fifty-five neuromas were excised. Of these, one neuroma had a ganglion associated with it and five neuromas were recurrent. Four feet had adjacent neuromas. Ultrasound accurately predicted the presence, location and size of the neuromas in 98% of the cases. There were no false positives. In all cases in which a neuroma was predicted by ultrasound, it was confirmed grossly at the time of surgery and later by histological exams. We conclude that ultrasound is an accurate technique in the diagnosis of interdigital neuromas.