Zopiclone as a preoperative night hypnotic: a double-blind comparison with temazepam and placebo

We have examined the hypnotic effects of zopiclone 7.5 mg and temazepam 20 mg compared with placebo in a double-blind, randomized, clinical study of 60 patients on the night before operation. Evaluation was both subjective (visual analogue scales and a sleep questionnaire), to measure the quality of sleep, and objective (critical flicker fusion, object recall and paired associates tasks), to measure residual impairment. We found that zopiclone was an effective single-dose hypnotic with similar residual effects to the benzodiazepine and it may therefore provide a suitable alternative to benzodiazepines.

Differential diagnosis of personality disorders by the seven-factor model of temperament and character

We used multiaxial structured interviews and questionnaires to evaluate the ability of self-reports on seven personality dimensions to predict independent interview diagnoses of DSM-III-R personality disorders. We studied 136 consecutive adult psychiatric inpatients, excluding those with psychosis, organic mental disorders, and severe agitation. Sixty-six patients had interview diagnoses of DSM-III-R personality disorders. Most also had mood disorders. We confirmed the hypotheses that self-reports of low self-directedness and cooperativeness strongly predicted the number of personality symptoms in all interview categories, whereas the other factors distinguished among subtypes as predicted. Self-directedness and cooperativeness also predicted the presence of any personality disorder by differentiating patients varying in risk from 11% to 94%. Patients in clusters A, B, and C were differentiated by low reward dependence, high novelty seeking, and high harm avoidance, respectively. We conclude that low self-directedness and cooperativeness are core features of all personality disorders and are validly measured by the seven-factor Temperament and Character Inventory, but not the five-factor Neuroticism-Extraversion-Openness inventory. Each DSM-III-R personality disorder category is associated with a unique profile of scores in the seven-factor model, providing an efficient guide to differential diagnosis and treatment.

Interaction of H2-receptor antagonists and benzodiazepine sedation. A double-blind placebo-controlled investigation of the effects of cimetidine and ranitidine on recovery after intravenous midazolam

H2-receptor antagonists differentially inhibit cytochrome P450 and this may affect the rate at which benzodiazepines are metabolised. However, it is not known whether this delayed clearance results in prolonged psychomotor impairment. In a randomised double-blind trial 28 healthy volunteers received two single doses of midazolam (0.07 mg.kg-1) at an interval of one week during which they took cimetidine 400 mg, ranitidine 150 mg or placebo, each twice daily. Recovery from the benzodiazepine was monitored on each occasion over a 12 h period using a battery of psychometric tests. There was wide individual variation in performance; however, an overall measure of impairment indicated a significant difference at 2.5 h (p < 0.05), the cimetidine group having a high impairment score. This decrement appeared to be in cognitive and psychomotor functions and was not reflected in the subjective assessment.

The meaning of quality of life for bone marrow transplant survivors. Part 2. Improving quality of life for bone marrow transplant survivors

Surviving bone marrow transplant (BMT) represents a major victory against malignant disease but also creates challenges of survivorship for patients and the professionals who care for them. Part 2 of this report presents the findings of a qualitative study (N = 119) related to improving quality of life (QOL) for BMT survivors. Results are shared based on BMT survivors' perceptions of (a) what makes QOL better, (b) what makes QOL worse, and (c) what doctors or nurses could do to enhance QOL. The findings of the study have been useful in constructing a quantitative instrument to measure QOL in BMT and in understanding the conceptual basis of QOL for the BMT population. Nursing interventions can improve the QOL for the BMT patient across all phases of the transplant process and long-term issues related to survival.

The meaning of quality of life for bone marrow transplant survivors. Part 1. The impact of bone marrow transplant on quality of life

Quality of life (QOL) is an important concept in cancer nursing and has particular significance for bone marrow transplant (BMT). BMT survivors are faced with the demands of acute transplant symptoms as well as chronic illness demands posttransplant. The purpose of this study was to explore the concept of QOL for BMT survivors and to gain understanding of nursing interventions that may improve QOL in this population. The conceptual framework for this study was derived from the model of QOL developed by Ferrell, Grant, and Padilla (1989) that depicts the QOL domains of physical well-being, psychological well-being, social concerns, and spiritual well-being. This qualitative study consisted of a one-time interview of 119 BMT survivors using six open-ended questions. The items were based on previous research of the authors and content validity was established by a panel of BMT experts. Content analysis was performed on verbatim written responses to six questions regarding BMT and QOL. Part one of this two-part report provides analysis based on the questions regarding the meaning of QOL to BMT survivors and the impact of BMT on QOL.

Cell proliferation and enzyme activities associated with the development of avian tibial dyschondroplasia: an in situ biochemical study

Avian tibial dyschondroplasia is a disorder of endochondral ossification which results in the accumulation of noncalcified, avascular cartilage. We have investigated the changes in cell proliferation and enzyme activities within specific cell types in the growth plate of chickens with differing severity of the disease using in situ biochemical techniques that allow the quantification of enzyme activity in unfixed undecalcified sections of tissue. Lactate dehydrogenase activity in the prehypertrophic zone and tartrate-resistant acid phosphatase activity in osteoclasts/chondroclasts were not affected by the severity of the disease. Glucose 6-phosphate dehydrogenase activity in both the proliferating and prehypertrophic zones of the growth plate was reduced in chicks with both moderate and severe lesions. Cell proliferation within the proliferating chondrocytes was slightly reduced in the severely affected birds. Alkaline phosphatase activity in the prehypertrophic chondrocytes was markedly elevated in chicks with moderate and severe lesions. These results rule out an increased rate of chondrocyte proliferation as a possible mechanism for the development of tibial dyschondroplasia. The aetiology of the disease therefore appears to be related to the control of chondrocyte differentiation, mineralization, and vascularization by local and/or systemic growth factors.

Will I forget?

Returning to nursing can be a worrying time. Is it worse for someone returning to the 'stress' environment of the operating theatre? Caroline Whitehead writes of her experience of returning to theatre nursing after a break of three years in which she completed a BA(Hons) degree.

Effect of corticosterone on circulating concentrations of corticosterone, prolactin, thyroid hormones and somatomedin C and on fattening in broilers selected for high or low fat content

Daily changes in the concentrations of plasma corticosterone, prolactin, thyroid hormones and somatomedin C were measured in 28-day-old fat and lean lines of broilers produced by selection for high and low concentrations of very low density lipoproteins (VLDL). The effects of daily injections of corticosterone on the concentrations of these hormones and on fattening were compared in the two lines. The selection procedure had no effect on the concentrations of any of the hormones. However, daily rhythms in concentrations of plasma corticosterone, tri-iodothyronine (T3) and prolactin were less often observed in the fat line than in the lean line. No differences were seen between lines in the daily rhythms in plasma thyroxine (T4) and somatomedin C. Daily injections of 2500 micrograms corticosterone/kg body weight, in both lines, depressed mean concentrations of plasma prolactin, T3 and somatomedin C and body weight. This dose of corticosterone also increased abdominal fat pad and liver weights expressed as a percentage of body weight. The liver and fat pad responses to 2500 micrograms corticosterone in both lines were greater when the steroid was injected at the end rather than towards the beginning of the 14-h daily photoperiod. There was no difference between the lines in the fattening response to corticosterone. Lower doses of 100 and 500 micrograms corticosterone per day did not induce fattening or affect concentrations of plasma prolactin. They did, however, depress concentrations of plasma T3. Concentrations of plasma T4 were increased in both lines treated with 2500, but not with 100 or 500 micrograms corticosterone, towards the beginning of the daily photoperiod.(ABSTRACT TRUNCATED AT 250 WORDS)

Physical measurements with a high-energy proton beam using liquid and solid tissue substitutes

The measurement of the physical parameters of a high-energy proton beam, using a range of liquid and solid tissue substitutes, is described. The system, the detectors used and the experimental verification of the tissue equivalence of the new tissue substitutes is presented. The measurements with the scattered but uncollimated proton beam in muscle- and brain-equivalent liquids and in water are compared to similar data obtained from the scattered but collimated beam. The effect of lung, fat and bone on the dose distributions in composite phantoms is also investigated and the necessary corrections established. A simulated patient treatment indicated that the Bragg peak can be positioned with an error not exceeding +/- 0.5 mm.

The aging psychiatric hospital: an approach to humanistic redesign

Since funds for the construction of new treatment facilities are scarce, outmoded wards must be redesigned to meet the current needs of users. The authors feel the redesign must integrate modern therapeutic concepts, humanistic patient requirements, and pragmatic budgetary limitations. They review current theory about the effects of the physical environment on behavior, and they discuss such questions as to what extent the need for security should govern ward design and how pleasant the environment should be. They also describe a specific redesign for a 32-bed psychiatric ward of a large federal hospital constructed in the early 1950s.