Psychological-mindedness: a conceptual model

Previous definitions of psychological-mindedness are reviewed and critiqued, and a new model presented. Though the construct has broad applications for psychotherapy issues, definitions appearing in the literature have lacked precision, inconsistently specifying the inclusion of and the interrelationships between the components of interest, ability, affect, and intellect. The simple yet comprehensive model presented here separates and defines the components and specifies their interrelationships. Accurate psychological-mindedness is defined as reflectivity about psychological processes, relationships, and meanings, and is displayed by an individual to the extent that he or she displays both interest in and ability for such reflectivity, and across both affective and intellectual dimensions. Ability is contributed to and limited by interest, and intellectual psychological-mindedness is contributed to and limited by affective psychological-mindedness. Implications for measurement and research are discussed.

In vivo demonstration of cardiac beta 2-adrenoreceptor sensitization by beta 1-antagonist treatment

Treatment with beta 1-selective antagonists causes selective sensitization of isolated strips of human atrial myocardium to the inotropic action of epinephrine and beta 2-agonists but not of norepinephrine. To determine whether beta 1-selective antagonist treatment alters the responsiveness of cardiac beta 2-adrenoreceptors in vivo, we measured the positive chronotropic responses to salbutamol injected into the right coronary artery. Ten patients treated with atenolol (50-100 mg daily) were compared with 10 patients not treated with beta-blockers. The mean dose required to cause an increase in heart rate of 30 beats/min was 2.29 micrograms (log dose 0.36 +/- 0.12 micrograms [mean +/- SEM]) in the atenolol-treated patients. In the non-beta-blocker-treated patients, the dose required to cause an increase in heart rate of 30 beats/min was significantly greater, 8.91 micrograms (log dose 0.95 +/- 0.11 micrograms) (p less than 0.005). We conclude that treatment with beta 1-selective beta-blockers leads to increased cardiac responsiveness to beta 2-adrenoreceptor stimulation. This may be the underlying mechanism of the beta-blocker withdrawal syndrome and may make the heart more susceptible to the adverse effects of epinephrine in situations of stress (e.g., myocardial infarction).

Health education theory: an application to the process of patient-provider communication

Although the medical visit is widely acknowledged as an important event presenting unique opportunities for the modification of health beliefs and behaviors, health education theory has provided few explanatory mechanisms for understanding its communication process. The purpose of this paper is to explore a theoretical model loosely derived from social exchange and reciprocity theory for viewing the dynamics and consequences of patient-provider interaction during the medical encounter. We have elaborated this notion of reciprocity to suggest that provider behaviors within both the technical and socioemotional realm inspire parallel patient behaviors. For instance, a physician who is very informative may expect a patient to remember his instructions and comply with his recommendations. Further, a physician who is warm and friendly will inspire parallel patient attitudes in the socioemotional domain, such as friendliness and satisfaction. However, we believe that the reciprocity principle is only partially operative between domains. While an informative physician may be perceived as concerned and caring, merely being nice or caring, in the absence of indications of task performance (such as information giving), does not supply the evidence on competence that patients need to decide to attend to information or adhere to a therapeutic regimen. Our theory of reciprocal exchange in the medical visit is consistent with a consumerist perspective of patient-provider relations and with the activated patient philosophy of health education.

Brachial plexus anesthesia in pediatric patients

Between 1980 and 1988 at our institution, brachial plexus anesthesia (BPA) was used in 109 pediatric patients who underwent 142 surgical procedures on an upper extremity, including 134 axillary blocks. Most patients older than 6 years of age had their blocks and surgical procedures with moderate sedation. The success rate was high--92.4% of axillary blocks and 100% of other blocks were adequate for surgical intervention in patients who required only intravenous sedation. The postoperative course in the BPA group was compared with that in 109 age-matched control subjects who underwent 188 procedures on an upper extremity during general anesthesia (GA). Admission to the recovery room after anesthesia occurred less frequently in the BPA group than in the GA group (27.5% versus 91.0%; P less than 0.01). Furthermore, nausea and vomiting were less frequent in the BPA group than in the GA group (P less than 0.01). Outpatients in the BPA group were less likely to require narcotic analgesics before dismissal than were those in the GA group (12% versus 31%; P less than 0.05). Admission of outpatients was infrequent in both groups (2% for BPA and 9% for GA). No significant difference was noted in 24-hour postoperative narcotic requirements between the BPA and GA groups.

Paradoxical effects of blood alcohol concentration charts

BACKGROUND

This study was designed to determine the association between alcohol drinking and the possession of blood alcohol concentration charts.

METHOD

A total of 30 college-age subjects participated in the study. Subjects were randomly assigned to either an experimental or a control group. All subjects answered a short entrance questionnaire to determine their height and weight. Those assigned to the experimental group were supplied a copy of a blood alcohol concentration chart and instructed in its use. The volume of alcoholic beverages consumed was surreptitiously counted for all subjects. Prior to leaving the premises the subjects completed an exit questionnaire which asked them to estimate the amount of alcohol they had consumed, whether they had driven to the pub, and whether they intended to drive away. The time spent in the pub was noted for each subject.

RESULTS

Among those in the control group there was a tendency to overestimate the volume consumed, and for those in the experimental group, a tendency to more accurately estimate their consumption. Those given blood alcohol concentration charts consumed alcohol at a significantly higher rate than did those in the control group.

CONCLUSION

A likely explanation for this outcome is that the chart served as a stimulus to prompt a drinker to more quickly achieve a blood alcohol level consistent with his/her drinking expectancies.

Administration of pig relaxin to beef heifers 4 or 7 days pre partum

Crossbred beef heifers (N = 36) were assigned to one of three treatment groups: untreated controls (C; N = 15); Group R4, treated with pig relaxin (1.0 mg i.m.) 4 days pre partum (N = 11); or Group R7, treated with pig relaxin (1.0 mg i.m.) 7 days pre partum (N = 10). Bioactivity of the pig relaxin (UMC-R-P8) was determined by the mouse interpubic ligament assay to be greater than or equal to 3000 U/mg, both before and after the experiment was conducted. Peripheral serum immunoreactive relaxin values were 7.5, 3.4, 2.5, and 1.5 ng/ml at 2, 4, 6 and 8 h after injection of relaxin, respectively. Gestation lengths were 282.9 +/- 1.1, 285.5 +/- 1.3 and 285.6 +/- 1.5 days for Groups C, R4 and R7 (C vs R4 + R7; P congruent to 0.08). Calving difficulty score (1 to 4) tended to be greater (P congruent to 0.08) for Group R4 and R7 heifers (C vs R4 + R7; 1.3 +/- 0.24 vs 1.75 +/- 0.28 + 2.04 +/- 0.32), but the incidences of dystocia and retained placentae were not influenced by treatment (P greater than or equal to 0.10). The mean concentration and concentration profile of daily serum progesterone, oestradiol-17 beta, dihydroprostaglandin F-2 alpha and relaxin were not affected by treatment from 6 days pre partum through 2 days post partum. Cervical diameter, cervical softness score, pelvic measurements, and vulva opening length during the periparturient period were not affected (P greater than or equal to 0.10) by treatment, but all of these characteristics changed over time (P less than or equal to 0.01), relative to calving. We conclude that i.m. administration of pig relaxin (greater than or equal to 3000 U) does not effectively alter periparturient characteristics of beef heifers. Discrepancies between these results and those reported for intracervical administration cannot be readily explained.

Selective beta 1-adrenoceptor blockade enhances positive inotropic responses to endogenous catecholamines mediated through beta 2-adrenoceptors in human atrial myocardium

We determined the relative contribution of beta 1- and beta 2-adrenoceptor stimulation to the positive inotropic responses of human atrial myocardium to catecholamines. (-)Norepinephrine produced stimulation predominantly through beta 1-receptors and (-)epinephrine through both beta 1- and beta 2-receptors. However, there were marked differences in the responses of tissues from patients treated with the beta 1-selective antagonist atenolol compared with non-beta-blocker-treated patients; surprisingly, beta 2-mediated responses were enhanced, and beta 1-mediated responses were unaltered. There was an enhanced responsiveness to (-)epinephrine (atenolol treated: -log M EC50, 7.57 +/- 0.07; non-beta-blocker treated: -log M EC50, 6.77 +/- 0.17; p less than 0.001), and the relative importance of beta 2-adrenoceptor stimulation was increased for both (-)norepinephrine and (-)epinephrine. In tissues from atenolol-treated patients, salbutamol, a beta 2-selective partial agonist, had an enhanced potency and a greater intrinsic activity (atenolol treated: -log M EC50, 7.13 +/- 0.09; intrinsic activity, 0.86 +/- 0.04; non-beta-blocker treated: -log M EC50, 5.76 +/- 0.44; intrinsic activity, 0.39 +/- 0.13). We investigated possible mechanisms underlying the enhanced responsiveness to beta 2 stimulation. Determination of beta 2-adrenoceptor affinity for salbutamol showed no change of affinity in atenolol-treated patients. Responses of the tissues to the cyclic AMP analogue dibutyryl cyclic AMP were not different between atenolol-treated and non-beta-blocker-treated patients. The results suggest that chronic blockade of beta 1-adrenoceptors causes enhanced coupling of beta 2-adrenoceptors to adenylate cyclase or to other mechanisms leading to increased contractile force.

Performance quality, gender, and professional role. A study of physicians and nonphysicians in 16 ambulatory care practices

The quality of medical care has rarely been evaluated in relation to practitioner or patient gender. Moreover, comparisons between physicians and nonphysicians typically are confounded by practitioner gender. In this study gender and professional role effects were analyzed separately for 162 male and female staff physicians, 191 male and female residents, and 73 female nonphysicians delivering adult and pediatric primary care in 16 ambulatory care practices. Analyses addressed influences of patient and practitioner gender as well as differences between physicians and nonphysicians. Results showed that female staff physicians performed better than male staff physicians for cancer screening in women by breast examination and Pap smears, but that female residents performed worse than male residents for urinary tract infections in children. Patient gender effects occurred for two tasks; for these, superior care was rendered to the gender with higher prevalence for the condition (girls for urinary tract infections, boys for otitis media). The results are considered in the context of the gender-relevance of particular medical tasks or conditions. Comparisons between physicians and nonphysicians were limited to female practitioners. Comparable or superior performance for nonphysicians was found for all tasks but one (cancer screening in women).

Surgical management of breast disease in an obstetrics and gynecology group

The surgical management of breast disease from 1978 through 1988 by the Women's Health Center of Logansport is reviewed. Three hundred twelve biopsy procedures resulted in the diagnosis of 59 cancers. Biopsy and mastectomy procedures were performed by the authors (obstetrician-gynecologists). There were no significant complications and all patients had an adequate surgical result. Preoperative needle localization techniques proved to be a safe and effective method to identify and remove nonpalpable mammographic abnormalities. Because women depend on their gynecologist for advice regarding reproductive organs including the breasts, it is logical for the gynecologic surgeon to become involved in the surgical management of breast disease.

Uterotropic actions of relaxin in prepubertal gilts

Uterotropic actions of relaxin (RLX) have been demonstrated in rats and mice but not in other species. Experiments were conducted to assess (1) if RLX has uterotropic effects in prepubertal gilts and (2) if RLX-induced imbibition of water by uterine tissues is mediated by histamine. Prepubertal gilts received (i.m.) either 0.5 mg pRLX (greater than or equal to 3000 U/mg; n = 10) in 0.1 M phosphate-buffered saline (PBS) or PBS vehicle (n = 8) every 6 h for 54 h. Additionally, one-half of each group received either (1) the histamine receptor antagonists (300 mg i.m. of each), pyrilamine maleate (H1) and cimetidine (H2), in PBS and corn oil, respectively, or (2) control vehicles every 6 h for 66 h beginning 12 h prior to initiation of RLX treatment. Treatment with RLX stimulated a twofold increase (p less than or equal to 0.05) in uterine weight in prepubertal gilts. Increases in total uterine weight were manifested by greater (p less than or equal to 0.05) uterine water content and dry weight in RLX-treated gilts. Cotreatment with histamine receptor antagonists did not alter RLX-induced changes in uterine water content or dry weight. Uterine contents of soluble protein and DNA were greater (p less than or equal to 0.05) in RLX-treated gilts compared to controls. Treatment with RLX tended (p approximately 0.08) to reduce protein; DNA ratio of uterine tissues and increased (p less than or equal to 0.05) uterine DNA as a percentage of uterine dry weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of the hamster DDT-1 cell aFGF/HGBF-I gene and cDNA and its modulation by steroids

Syrian hamster DDT-1 cells are derived from smooth muscle of the ductus deferens. DDT-1 cell growth is increased by the addition of testosterone (T). Acidic fibroblast growth factor (aFGF) or basic fibroblast growth factor (bFGF) also known as heparin binding growth factor I and II (HBGF-I and HBGF-II) can replace T in the stimulation of growth in these cells. This phenomenon is correlated with testosterone's ability to elevate aFGF/HBGF-I mRNA. The increase steady-state levels of aFGF/HBGF-I mRNA were documented by northern blots and by in situ hybridization. Using a 520 bp human aFGF/HBGF-I cDNA probe, a genomic clone with a 38 kb DNA insert was isolated from a cosmid library. By restriction enzyme analysis and southern hybridization, it was determined that there are three coding exons. DNA sequence analysis showed all of the coding region and 3' noncoding sequences were on this clone. A 5' noncoding exon not in the 38 kb insert is indicated, based on the cDNA sequences and genomic sequences of aFGF/HBGF-I's from hamster DDT-1 cells and several other species. The cDNA for hamster aFGF/HBGF-I was isolated from a DDT-1 lambda gt11 library and sequenced. Comparison of the coding region of aFGF/HBGF-I from four species shows a greater than 90% conservation of amino acid sequence.

Balloon dilatation of tricuspid stenosis caused by carcinoid heart disease

Double balloon dilatation of tricuspid stenosis caused by carcinoid heart disease was successful in a woman of 77.

Older patients' health status and satisfaction with medical care in an HMO population

Few studies have examined the relationship between older patients' satisfaction with medical care and their health status, and none of these investigations has been based at an HMO. To examine this question, data on 532 patients older than 70 years in an HMO were analyzed. Patients' reports of satisfaction with medical care were examined in relation to several dimensions of health status (based on self-reports, chart data, and physicians' ratings), their own sociodemographic characteristics, and characteristics of their primary physicians. Greater satisfaction was significantly associated with better self-rated health and physical function, less emotional distress, and more social activity but was not related to physicians' health ratings, number of diagnoses, or cognitive function. Mean levels of satisfaction were also significantly different for patients of different physicians but not appreciably related to patients' sociodemographic characteristics. When patient sociodemographic characteristics were controlled for, the relations of health status variables to satisfaction were essentially unchanged. It was concluded that the key issues to be resolved are whether better health leads to greater satisfaction or vice versa, and, in either case, whether the relations are mediated by factors relating to the patient's experience of medical care.

Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization

Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation by a geriatric assessment team, (2) consultation by a "second opinion" internist, and (3) only traditional health maintenance organization services (control patients). The geriatric assessment team identified previously unrecognized problems in 35% of patients and advised changes in medication regimens for more than 40%. Nevertheless, patients who received assessment achieved only a small benefit in cognitive function after 3 months, which was not sustained for 1 year. There was no difference among groups in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.

Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis

A meta-analysis was performed to examine the relation of patients' sociodemographic characteristics to their satisfaction with medical care. The sociodemographic characteristics were age, ethnicity, sex, socioeconomic status (three indices), marital status, and family size. Greater satisfaction was significantly associated with greater age and less education, and marginally significantly associated with being married and having higher social status (scored as a composite variable emphasizing occupational status). The average magnitudes of relations were very small, with age being the strongest correlate of satisfaction (mean r = 0.13). No overall relationship was found for ethnicity, sex, income, or family size. For all sociodemographic variables, the distribution of correlations was significantly heterogeneous, and statistical contrasts revealed the operation of several moderating variables. The meaning of the overall results and their relation to earlier reviews is discussed.

Enoximone potentiates the positive inotropic effects of beta-1- and beta-2-adrenoceptor stimulation in human atrial myocardium

The aim of these studies was to determine whether phosphodiesterase inhibition by enoximone is able to regulate differentially beta 1- and beta 2-adrenoceptor (AR)-mediated inotropic effects. Strips of human right atrial myocardium were stimulated with noradrenaline plus ICI 118,551 (selective beta 1-AR stimulation) or adrenaline plus CGP 20,712A (selective beta 2-AR stimulation). Concentration-effect curves were determined in the absence or presence of enoximone. Enoximone alone was shown to produce dose-related positive inotropic effects. In tissues from beta 1-blocker-treated patients, enoximone potentiated the responses to both beta 1-AR and beta 2-AR stimulation. There was a fall in -log EC50 (mol/l) of 0.7 +/- 0.2 (mean +/- SEM; n = 6) for beta 1-AR stimulation and of 0.6 +/- 0.1 (n = 10) for beta 2-AR stimulation. The potentiation of beta 2-AR responses in non-beta-blocker-treated patients was similar with a fall in -log EC50 (mol/l) of 0.5 +/- 0.1 (n = 6). The extent of potentiation was not significantly different between beta 1-AR and beta 2-AR stimulation, nor between beta 1-blocker-treated patients and non-beta-blocker-treated patients. Further experiments showed that the potentiation by enoximone of the effects of catecholamines was unaltered by diazoxide (n = 6). Enoximone thus causes positive inotropic effects and potentiates the effects of catecholamines acting through both beta 1- and beta 2-AR. These actions are consistent with inhibition of cyclic AMP hydrolysis. The potentiation of the effects of catecholamines by phosphodiesterase inhibition appears unaltered by prior patient therapy with beta 1 blockers.

Stable xenon versus radiolabeled microsphere cerebral blood flow measurements in baboons

Regional cerebral blood flow was simultaneously determined using the stable xenon computed tomographic and the radioactive microsphere techniques over a wide range of blood flow rates (less than 10-greater than 300 ml/100 g/min) in 12 baboons under conditions of normocapnia, hypocapnia, and hypercapnia. A total of 31 pairs of determinations were made. After anesthetic and surgical preparation of the baboons, cerebral blood flow was repeatedly determined using the stable xenon technique during saturation with 50% xenon in oxygen. Concurrently, cerebral blood flow was determined before and during xenon administration using 15-microns microspheres. In Group 1 (n = 7), xenon and microsphere determinations were made repeatedly during normocapnia. In Group 2 (n = 5), cerebral blood flow was determined using both techniques in each baboon during hypocapnia (PaCO2 = 20 mm Hg), normocapnia (PaCO2 = 40 mm Hg), and hypercapnia (PaCO2 = 60 mm Hg). Xenon and microsphere values in Group 1 were significantly correlated (r = 0.69, p less than 0.01). In Group 2, values from both techniques also correlated closely across all levels of PaCO2 (r = 0.92, p less than 0.001). No significant differences existed between the slopes or y intercepts of the regression lines for either group and the line of identity. Our data indicate that the stable xenon technique yields cerebral blood flow values that correlate well with values determined using radioactive microspheres across a wide range of cerebral blood flow rates.

Intracoronary injections of salbutamol demonstrate the presence of functional beta 2-adrenoceptors in the human heart

To demonstrate the presence of functional cardiac beta 2-adrenoceptors in man, we studied the responses to intracoronary injections of salbutamol in three groups of six patients. We injected salbutamol, a selective beta 2-adrenoceptor agonist, into the right coronary artery to avoid peripheral vasodilator action and to stimulate the sinoatrial node directly. Salbutamol injections caused a sinus tachycardia. The same doses of salbutamol injected into the aortic root caused no change in heart rate, ruling out a systemic effect. The mean dose required to cause an increase in heart rate of 30 beats/min (IHR30) was 2.6 micrograms in the first group of six patients. In 12 other patients salbutamol was given after beta-blockade to confirm the beta 2-selectivity of the responses. Doses of practolol (beta 1-selective blockade) and of propranolol (beta 1- and beta 2-blockade) that had equal beta 1-blocking activity were used. In six patients who were given practolol, the mean IHR30 dose was 2.1 micrograms. In six patients who were given propranolol, the mean IHR30 dose was significantly greater at 64 micrograms (p less than 0.001, practolol vs. propranolol). This study demonstrates that direct cardiac beta 2-adrenoceptor stimulation in man has a positive chronotropic effect.

Relationship of plasma gastrin immunoreactivity and gastroesophageal sphincter pressure in clinically normal dogs and in dogs with previous gastric dilatation-volvulus

Fasting and postprandial gastroesophageal sphincter pressure (GESP) and plasma gastrin immunoreactivity were measured in 6 dogs from 9 through 60 months after treatment for and recovery from gastric dilatation-volvulus (GDV). The GESP was not significantly increased in these dogs, compared with that in clinically normal dogs in either the fasting or postprandial state. Corresponding plasma gastrin immunoreactivity was not significantly increased in dogs of the GDV-recovered group, compared with that in clinically normal dogs (fasting or postprandial). An exaggerated increase in GESP in response to food-induced gastrin release was not observed in dogs of the GDV-recovered group. Exogenously administered pentagastrin (3-micrograms/kg bolus, IV) increased fasting GESP in clinically normal dogs over a 4-minute test period (P = 0.01). Gastric distention in response to oral administration of isosmolar saline solution (500 ml) did not significantly increase GESP or plasma gastrin immunoreactivity in clinically normal dogs. In anesthetized clinically normal dogs, gastric distention in response to use of balloons filled to exert intragastric pressure of 30 mm of Hg also did not cause significant increase in plasma gastrin immunoreactivity. Increased GESP, secondary to hypergastrinemia or gastric distention, is an unlikely cause of eructation failure in dogs with GDV.

A comparison of the effects of adrenaline and noradrenaline on human heart: the role of beta 1- and beta 2-adrenoceptors in the stimulation of adenylate cyclase and contractile force

The stimulant effects of adrenaline and noradrenaline on contractile force and adenylate cyclase, mediated through beta 1 and beta 2-adrenoceptors, are analysed in isolated atrial and ventricular myocardium of man. The tissues were obtained from patients without advanced heart failure undergoing heart surgery. Usually, both adrenaline and noradrenaline stimulated adenylate cyclase predominantly through ventricular and atrial beta 2-adrenoceptors. Because the relative density of beta 2-adrenoceptors is usually smaller than that of beta 1-adrenoceptors, stimulation of one beta 2-adrenoceptor leads to the production of up to 10 times more cyclic AMP molecules than does stimulation of one beta 1-adrenoceptor. Adrenaline and noradrenaline maximally enhance contractile force through both atrial and ventricular beta 1-adrenoceptors. Adrenaline can also maximally enhance contractile force through atrial beta 2-adrenoceptors. In the ventricle, adrenaline increases force via beta 2-adrenoceptors by up to 60% of its maximal beta 1 response. Noradrenaline can increase atrial and ventricular contractile force through beta 2-adrenoceptors but only at high concentrations. Unexpectedly, in atria from patients treated with the beta 1-selective antagonist atenolol, contractile responses to adrenaline are markedly and selectively augmented through activation of beta 2-adrenoceptors. In atria from atenolol-treated patients equi-inotropic concentrations of adrenaline and noradrenaline acting through beta 2 and beta 1-adrenoceptors, respectively, cause similar increases of cyclic AMP and of cyclic AMP-dependent protein kinase activity.