A day in the life: Couples' everyday communication and subsequent relationship outcomes

Understanding how communication processes contribute to well-functioning versus distressed couple relationships has relied largely on brief, laboratory-based conversations. Harnessing technological advancements, the present study extends the literature by capturing couples' naturalistic communication over one full day at Time 1 (T1). This study tested associations between data-driven categories of couple communication behaviors and relationship outcomes (i.e., relationship aggression, satisfaction, and dissolution) at Time 2 (T2), approximately 1 year later. Emerging adults in different-gender dating couples (n = 106 couples; 212 individuals; Mage = 22.57 ± 2.44; M relationship length = 30.49 months ± 24.05; 72.2% non-White) were each provided a smartphone programmed to audio record approximately 50% of a typical day. Interactions between partners were transcribed and coded for location, activity, affect, and a range of positive and negative communication behaviors for each partner. Even after controlling for T1 assessments of the relevant outcome, one's own hostility and one's partner's hostility at T1 were each positively associated with T2 relationship aggression and negatively associated with T2 relationship satisfaction. One's own withdrawal at T1 was positively associated with T2 relationship aggression perpetration, whereas one's partner's withdrawal was negatively linked to relationship satisfaction at T2. One's own playfulness, unexpectedly, was linked to lower subsequent relationship satisfaction. Withdrawal increased the likelihood of relationship dissolution, whereas warmth and playfulness decreased the likelihood of dissolution. The relevance of couples' ordinary, everyday communication for meaningful relationship outcomes is discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ischaemic stroke caused by Group B Streptococcus associated meningoencephalitis in young, immunocompetent adults - a case series and systematic review of literature

A 51-year-old man presented with mild headache followed by sudden onset of right sided weakness and dysarthria on the background of one week history of right sided sciatica and malaise. He was apparently immunocompetent with only past medical history being hypertension. There was no consumption of tobacco or excess alcohol and he previously had normal liver and renal function.

A man who became breathless after tiling a bathroom

Inhalational lung injury should be considered in patients presenting with acute respiratory symptoms and a history of occupational or recreational exposure to toxic substances. We present the case of a 29-year-old patient who developed pneumonitis following usage of waterproofing sealant spray in an enclosed space, despite the use of a dust mask. The patient was managed with oxygen therapy, corticosteroids and bronchodilators. He made a complete clinical recovery with resolution of almost all changes seen on computerised tomography (CT) imaging within 7 days.

The novel vasopressin receptor (V1aR) antagonist SRX246 reduces anxiety in an experimental model in humans: a randomized proof-of-concept study

RATIONALE

Arginine vasopressin (AVP) is a neuropeptide that modulates both physiological and emotional responses to threat. Until recently, drugs that target vasopressin receptors (V1a) in the human central nervous system were unavailable. The development of a novel V1a receptor antagonist, SRX246, permits the experimental validation of vasopressin's role in the regulation of anxiety and fear in humans.

OBJECTIVES

Here, we examined the effects of SRX246 in a proof-of-concept translational paradigm of fear (phasic response to imminent threat) and anxiety (prolonged response to potential threat).

METHODS

Healthy volunteers received both SRX246 and placebo in a randomized, double-blind, counter-balanced order separated by a 5-7-day wash-out period. Threat consisted of unpleasant electric shocks. The "NPU" threat test probed startle reactivity during predictable threat (i.e., fear-potentiated startle) and unpredictable threat (i.e., anxiety-potentiated startle).

RESULTS

As predicted, SRX246 decreased anxiety-potentiated startle independent of fear-potentiated startle.

CONCLUSIONS

As anxiety-potentiated startle is elevated in anxiety and trauma-associated disorders and decreased by traditional anxiolytics such as SSRIs and benzodiazepines, the V1a receptor is a promising novel treatment target.

A national UK audit for diagnostic accuracy of preoperative CT chest in emergency and elective surgery during COVID-19 pandemic

AIM

To report on a snap audit of all departments in the UK as to the value of preoperative thoracic imaging, preferably computed tomography (CT), of patients undergoing any surgery to assess for changes consistent with COVID-19 preoperatively.

MATERIALS AND METHODS

All Imaging departments in the UK were contacted and asked to record the number of preoperative CT examinations performed in patients being considered for both emergency and elective surgical intervention over a 5-day period in May 2020.

RESULTS

Forty-seven percent of departments replied with data provided on >820 patients. Nineteen percent of additional preoperative CT was in patients undergoing elective intervention and 81% in patients presenting with surgical abdominal pain. There was a high rate of false positives in patients who tested negative for COVID-19, producing a sensitivity for thoracic CT of 68.4%.

CONCLUSION

This UK-wide audit demonstrates that a large number of additional thoracic imaging examinations over a 5-day period were performed with a low sensitivity for the identification of COVID-19 in this preoperative group of patients. Given these findings, it is difficult to justify this additional examination in this group of patients.

Better cognitive efficiency is associated with increased experimental anxiety

There is increased interest in the development of cognitive training targeting working memory (WM) to alleviate anxiety symptoms, but the effectiveness of such an approach is unclear. Improved understanding of the effect of cognitive training on anxiety may facilitate the development of more effective cognitive training treatment for anxiety disorders. This study uses an experimental approach to examine the interplay of WM and anxiety following WM training. Previous studies show that increased demand on WM reduces concurrent anxiety evoked by threat of shock (induced anxiety). However, improving WM pharmacologically or via exercise prevents this anxiolytic effect. Conceivably, improving WM frees up cognitive resources to process threat information, thereby increasing anxiety. The present study tested the hypothesis that practicing a high load WM (i.e., increased demand) task would improve WM, and thus, free cognitive resources to process threat of shock, resulting in more anxiety (i.e., greater startle) during a subsequent WM task. Participants were randomly assigned to two training groups. The active-training group (N = 20) was trained on a 1- (low load) & 3-back (high load) WM task, whereas the control-training group (N = 20) performed a 0-back WM task. The experimental phase, similar in both groups, consisted of a 1- & 3-back WM task performed during both threat of shock and safety. As predicted, active training improved WM accuracy and increased anxiety during the experimental 3-back WM task. Therefore, improving WM efficiency can increase anxiety, possibly by freeing WM resources to process threat information.

Clinical benefits of a specialised clinic for hypertrophic cardiomyopathy

BACKGROUND

Hypertrophic cardiomyopathy (HCM) is the most common monogenic cardiac condition, with a range of investigation and management options available. Recent research has recommended management within multidisciplinary-dedicated HCM centres.

AIM

To assess the clinical impact of attendance at a specialised clinic on the management of HCM.

METHODS

A retrospective study of patients attending the HCM Clinic @ The Alfred during the first 2 years of operation was performed. Outcome measures comprised improvements in management of HCM as a result of attending the clinic including risk stratification and further investigations, medication changes, referral for implantable cardioverter-defibrillators (ICD) and septal reduction therapy, and screening of first-degree relatives (FDR).

RESULTS

Following specialised clinic attendance, there was an increase in patients investigated with 24-h Holter monitoring by 39%, stress echocardiography by 21% and cardiac magnetic resonance imaging by 70%. Medications were optimised in 47% of patients. Six per cent of patients underwent ICD implantation and 13% underwent septal myectomy. Seventy new FDR were screened identifying 10 new cases of HCM.

CONCLUSIONS

Attendance at our specialised HCM clinic leads to facilitation of cardiac investigations, optimisation of medical therapy, streamlining of referrals for ICD implantation and septal reduction therapy, and improved family screening. Referral to a specialised clinic offering comprehensive management should be considered for all patients with HCM.

Family screening in hypertrophic cardiomyopathy is underperformed, but can be improved by a specialised clinic

BACKGROUND

Hypertrophic cardiomyopathy (HCM) causes significant morbidity and sudden death. First-degree relatives (FDR) of affected patients are at risk due to autosomal dominant inheritance. Guidelines recommend clinical screening, including echocardiography, for all FDR.

AIM

We sought to determine adherence to these guidelines, and whether a specialised HCM clinic improves screening rates.

METHOD

This 12-month prospective follow-up study obtained family pedigrees from all patients referred to the HCM Clinic @ The Alfred. The number of living FDR was determined, and whether they had previously been assessed by echocardiography. One year after a coordinated clinic-based family screening approach was instituted, the number of additionally screened FDR was recorded.

RESULTS

Three hundred and eight living FDR of 61 HCM patients were identified. Of these, echocardiography had previously been performed in only 80 (26%), yielding 13 (16%) additional cases of HCM. Twelve months after attendance at our clinic, 51 additional FDR were screened (64% improvement) and 8 new cases of HCM were identified.

CONCLUSIONS

Recommended family screening for HCM is underperformed, resulting in missed opportunities to detect subclinical HCM. A coordinated approach through a specialised HCM clinic improves screening rates, thus referral to such a service should be considered for all patients with HCM and their families.

Enough to bring a lump to the throat: two emergency presentations to the acute medical take

An eighty nine year old woman was admitted with a two day history of abdominal pain and vomiting. Two months previously she had undergone a Hartmann's procedure following a sigmoid perforation secondary to diverticular disease. A hiatus hernia had been noted on a CT undertaken prior to her recent surgery.

Bone bruising of the knee

Bone bruising demonstrated by MRI is discussed with histological findings and proposed classifications. The effects of the mechanism of injury on bone bruising at the knee and the natural history of the process are reviewed. The relationship of bone bruising to osteochondral sequelae and to osteoarthritis are considered.

Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature

PURPOSE

To evaluate the effectiveness and safety of radiologic, percutaneous endoscopic (PEG), and surgical gastrostomy.

MATERIALS AND METHODS

This project involved 5,752 patients (837 patients underwent radiologic gastrotomy; 4,194, PEG; and 721, surgical gastrostomy). Seventy-two (47 male, 25 female; age range, 12-94 years) underwent gastrostomy within 1 year in this series (radiologic gastrostomy, n = 33; PEG, n = 35; surgical gastrostomy, n = 4). A meta-analysis of 5,680 additional cases from literature published from 1980 to the present was also performed.

RESULTS

Rates of successful tube placement were higher for radiologic gastrostomy than for PEG in our series and in the meta-analysis (99.2% vs 95.7%, P < .001). Major complications occurred less frequently after radiologic gastrostomy in our series and in the meta-analysis (5.9% vs 9.4% for PEG and 19.9% for surgery, P < .001). Thirty-day procedure-related mortality rates were highest for surgery (2.5% vs 0.3% for radiologic gastrostomy and 0.53% for PEG, P < .001).

CONCLUSION

Radiologic gastrostomy is associated with a higher success rate than is PEG and less morbidity than either PEG or surgery.

Clinical outcomes of patients with suspected pulmonary embolism using 99Tcm-Technegas as a ventilatory agent for lung scanning

Clinical outcome analysis was carried out in 175 of 206 consecutive patients referred for a lung scan with clinical suspicion of pulmonary embolism (PE). The follow-up time period ranged from 4 to 18 months. High-quality ventilation images corresponding to the six standard perfusion images were obtained using Technegas as a ventilatory agent. Lung scan reports showed that 22% of the patients had a high, 14% indeterminate, 18% low and 9% very low probability for PE and 37% were normal lung scans. These reports usually supported the referring clinicians' provisional diagnosis and were confirmed by the clinical outcome analysis of these patients giving an apparent sensitivity for the lung scan of 96% and specificity 93%. A strategy for lung scanning in PE is proposed.

The cost of acute asthma--how much is preventable?

Asthma is known to be widely under-treated, and unnecessary morbidity from the disease is common. This paper reports a prospective survey of hospital admissions for acute asthma and assesses the efficacy of pre-admission therapy in terms of preventing hospital admission. District and national costs were estimated for hospital admission of patients with acute asthma and, although the direct cost to the patients was not measured, a calculation was made of the number of working days lost annually. The results of this survey show the need for improved education of both doctors and patients, and in particular for improved clinical management. The findings also suggest that the cost to the patient, including those costs incurred by hospital admission, are potentially preventable.