Breaking the bad news: dilemmas in shared decision-making in medical practice

In a review of the literature, very little empirically based research was uncovered to guide the practice of health professionals who need to tell their patients bad news and help them to decide on their preferred treatment option. Various practising styles and guidelines are presented, and ethical and crosscultural challenges discussed. An enormous amount of research still needs to be done to discover the least stressful ways of dealing with these issues in health care settings.     

Favourite objects of autistic children

Favourite objects (FOs) of autistic children were compared with the FOs of healthy preschool and school children as well as mentally handicapped children. Three clusters of objects were obtained for normal children (comprising primary transitional objects and their forerunners, secondary transitional objects, and non-cuddly toys). When autistic children and mentally handicapped children were included, a fourth cluster of deviant objects was found. Frequency distributions of the two handicapped groups in the clusters were similar. Similarities between the two handicapped groups were also found within each cluster. The occurrence of secondary transitional objects was rare in the handicapped groups. The characteristics of "autistic" FOs reported in earlier case studies (e.g. being hard, often having an exciting effect, not being used in their adequate functions) were typical only of objects in the fourth cluster.     

Representation of spatial structure in reaching to a visual target.

Reaches made without feedback to positions on an object's surface reflect the spatial form of the surface. In Experiment 1, the reaching pattern varied with the stimulus surface's spatial attributes, consistent with a point-by-point perceptual representation of the surface. In Experiment 2, systematic reaching errors were determined solely by target position regardless of surface structure, implying a highly consistent representation of location. In Experiment 3, illusory slant was imparted to a surface by an aniseikonic lens. Individual variations in directly judged slant were reflected in the reaching pattern, implying organization of local perceptual representation of location and global perception of spatial attributes of the stimulus into a coherent structure.     

Choice between food and heroin: effects of morphine, naloxone, and secobarbital.

Baboons responded on a choice task on which discrete trials involved choosing between an intravenous injection of heroin (.32 or 1.0 mg/kg) or the availability of food pellets. An intertrial interval of three hours followed the completion of each trial. Under baseline conditions baboons consistently completed the eight available trials each day. Typically, animals chose heroin on three or four trials a day and food on the remaining trials. Animals tended to space the selection of heroin rather than choosing heroin on consecutive trials. A series of single-day experimental manipulations was undertaken to characterize performance further. Manipulation of the heroin dose produced shifts in the relative frequency of choosing the drug option which were inversely related to dose. Manipulation of number of pellets per food trial produced little change in distribution of choices. Noncontingent administration of morphine produced dose-related decreases in relative frequency of heroin choices, and a higher dose decreased the number of trials completed. Noncontingent naloxone produced dose-related increases in the relative frequency of heroin choices. Noncontingent secobarbital had no effect on distribution of choices, and high doses reduced the number of trials completed per day. The results suggest that morphine and naloxone produce shifts in this choice behavior by selectively interacting with the reinforcing properties of the option involving heroin.     

Some aspects on behavioral teratology research

A compelling question in teratology research is whether the experimental model used allows for extrapolation from laboratory animals to man. Our thesis is that behaviors that are biologically relevant for the animal are more likely to reveal the relationship between the behavior and its substrate than are non-specific behaviors. Applying this reasoning to the study of the ontogenesis of the behavior, we plead for including the use of species-typical behaviors in testing for teratogenic effects. Our further discussion is focussed upon the different levels at which an analysis of teratogenic effects may be carried out. At one level, the analysis is directed towards the behavioral effects of a given treatment; at another level to specify the function that is impaired by the treatment.     

Acute effects of triazolam on false recognition

Neuropsychological, neuroimaging, and electrophysiological techniques have been applied to the study of false recognition; however, psychopharmacological techniques have not been applied. Benzodiazepine sedative/anxiolytic drugs produce memory deficits similar to those observed in organic amnesia and may be useful tools for studying normal and abnormal memory mechanisms. The present double-blind, placebo-controlled repeated measures study examined the acute effects of orally administered triazolam (Halcion; 0.125 and 0.25 mg/70 kg), a benzodiazepine hypnotic, on performance in the Deese (1959)/Roediger-McDermott (1995) false recognition paradigm in 24 healthy volunteers. Paralleling previous demonstrations in amnesic patients, triazolam produced significant dose-related reductions in false recognition rates to nonstudied words associatively related to studied words, suggesting that false recognition relies on normal memory mechanisms impaired in benzodiazepine-induced amnesia. The results also suggested that relative to placebo, triazolam reduced participants' reliance on memory for item-specific versus list-common semantic information and reduced participants' use of remember versus know responses.     

Teaching with Spiritual Impact: An Analysis of Student Comments Regarding High‐ and Low‐Rated Spiritually Inspiring Religion Classes

We analyzed 2,621 written student comments to better understand themes which most contribute to religion classes being rated high or low in terms of the spiritual benefit students received from the class. From 2,448 religion classes taught from September of 2010 through April of 2014, comments from the top 61 (2.5 percent) and bottom 51 (2.1 percent) rated classes in terms of being “spiritually inspiring” were compared for emerging themes. The most frequent themes in higher‐ranked spiritually inspiring courses were (1) intellectually enlightening and (2) applied religion to life. In lower‐ranked spiritually inspiring courses the themes (1) class time was ineffective and (2) poor assessments were prevalent. We explore the practical implications from these and other findings.     

Prevalence of pathological Internet use among university students and correlations with self-esteem, the General Health Questionnaire (GHQ), and disinhibition.

Over the last few years, there has been increased interest in the addictive potential of the Internet. The current study was an attempt to replicate common findings in the literature and provide more evidence for the existence of Internet addiction among students--a population considered to be especially vulnerable. A total of 371 British students responded to the questionnaire, which included the Pathological Internet Use (PIU) scale, the General Health Questionnaire (GHQ-12), a self-esteem scale, and two measures of disinhibition. Results showed that 18.3% of the sample were considered to be pathological Internet users, whose excessive use of the Internet was causing academic, social, and interpersonal problems. Other results showed that pathological Internet users had lower self-esteem and were more socially disinhibited. However, there was no significant difference in GHQ scores. These results are discussed in relation to the methodological shortcomings of research in the area as a whole.     

Factor Structure of the Beck Depression Inventory—II in a Medical Outpatient Sample

This study examined the factor structure of the Beck Depression Inventory—II (BDI-II) in a sample of 127 individuals referred by their primary care physicians. Using exploratory factor analysis with oblique rotation, a 2-factor model appeared to be the most parsimonious representation of the data. The rotated factors accounted for approximately 53% of the variance. Consistent with previous research, the first factor was interpreted as a somatic–affective dimension and the second factor reflected a cognitive dimension. The correlation between these 2 factors was .79. It appears possible to divide the BDI-II into subscales to facilitate interpretation in medical patients.     

Dangerous sports and recreational drug‐use: rationalizing and contextualizing risk

This article reports upon the Interpretative Phenomenological Analysis (IPA) of a small number of semi‐structured interviews, conducted with persons engaging in either recreational drug‐use (primarily identified here as Ecstasy‐users) or dangerous sports (primarily identified here as bungee‐jumpers). Our analysis focuses upon the manner in which these participants make sense of their initiation and maintenance experiences, and the means by which they understand and make sense of risk. In particular, we draw attention to the distinctions between our participants' rational and contextual reconstructions of risky decisions. These distinctions indicate that our participants are able to draw upon a complex cultural and relational understanding of risk and pleasure, and are thus able to deal quite effectively with the contradictory experience of taking ‘non‐volitional’ action. This exploration of persons' strategies for displacing agency in relation to potentially negative outcomes may have implications for research and practice in related areas. Copyright © 2004 John Wiley & Sons, Ltd.