Development of the University of Pittsburgh Medical Center policy for the care of terminally ill patients who may become organ donors after death following the removal of life support

In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation.     

Argument versus dialogue: a response to Luepnitz, Madigan and other argumentative authors

In the context of family therapy's task of serving families, the purpose of theorizing is ultimately practical. It is a prevailing cultural practice among intellectuals to use up a vast amount of 'space' in our brains and in the pages of our journals theorizing at a great distance from the practical. One of the reasons for this distance from the practical may be the sophistic habit of argumentativeness. An alternative is proposed in which priority is given to the practical and dialogue is focused on the co-creation of meanings.     

Do substance abuse and mental health clients prefer automated assessments?

In both psychiatric and substance-abuse services, clinicians have been concerned with the introduction of automated assessments and with their clients’ reactions toward those assessments. The positive reactions of psychiatric clients have been well documented, but little has been known about substance-abusing clients’ impressions of automated assessments. The impact of automated assessment on clients seeking substance-abuse services was evaluated and compared with a previously analyzed sample of clients seeking mental health services. On the whole, both groups responded similarly and positively to automated assessments. Factor analyses revealed three underlying dimensions in client attitudes toward automated assessment,Completeness and satisfaction,Ease of use and enjoyment, andNegative attitudes. In addition, statistically, though not clinically, significant differences in attitudes were found between various demographic groups. Overall, the results support the use of automated assessments with individuals seeking either substance-abuse or mental-health services.     

Cerebral Anesthetization for Localization of Speech: The Contribution of W. James Gardner

In 1949, the neurologist Juhn Wada reported the first use of a new procedure for determining the localization of speech and language in neurological patients: examination of the effects on speech and language after injecting a barbiturate, sodium amytal, into the internal carotid artery of each hemisphere in succession. By the 1960s, Wada'sIntracarotid Amobarbital Procedure,orIAP,had become the method of choice for identifying the speech-dominant side in one kind of neurological patient, persons with epilepsy who are candidates for surgical resection, and it remains so today. In 1941, however, an American neurosurgeon, W. James Gardner, reported his use of a different anesthetization procedure for speech localization in neurological patients. Instead of injecting sodium amytal through the blood supply, as in the IAP, Gardner injected procaine hydrochloride directly into cortical tissue. In this paper, we provide a brief biography of Gardner. We then discuss his method of cortical anesthetization, the theoretical and empirical background guiding his use of this method and his choice of patients, and, finally, the fate of Gardner's method within the scientific community.     

A behavioral assessment scale for attention deficit disorder in brazilian children based on DSM-IIIR criteria

A teacher scale based on DSM-III-R diagnostic criteria for attention deficit hyperactivity disorder (ADHD) was developed for the behavioral assessment of children in Brazil. A total of 2, 082 children (782 males and 1,300 females) with a mean age of 11.2 years who were attending a public school in the greater Rio de Janeiro area were the subjects of this study. Two factors (Hyperactivity-Impulsivity and Inattention) were extracted from a principal-factor analysis conducted on the data, and the factor structure of the scale was found to be stable. Ratings of boys were higher than ratings of girls, and younger children had higher ratings than older children for both factors. Test-retest reliability for each item of the scale ranged from .56 to .70. The data are discussed in view of current controversies in the factor structure of teacher ratings of DSM-III-R ADHD symptoms.This research was supported by FINEP (42.88.0138.00) and FUNPENE. GNOB is the recipient of a CNPq Research Career Development Award (30.0197/82). RCAP was supported by a CNPq fellowship (82.2151/87). The authors are grateful to Rosely V. Magalhaes and Angela S. Guedes for assistance in data analysis with the SAS and SPSS packages. The authors wish to thank the school staff and teachers who participated in the study. This work was presented at the Fifteenth European Conference of the International Neuropsychological Society, Portugal, 1993.     

Gender differences in coping: A further test of socialization and role constraint theories

To further test role constraint and socialization theories of gender differences in coping, two studies were conducted to examine coping strategies in individuals occupying similar roles. The relations between coping strategy frequency and effectiveness and between coping strategy use and psychological functioning also were examined. Predominantly Caucasian female and male college students participated in the studies. Results indicated support for both socialization and role constraint theories. Effectiveness and frequency of coping strategy use were moderately correlated. Gender differences in cognitive appraisal varied with dispositional vs. situational assessment. The need for a more integrated model to explain gender differences in coping and implications for existing theories are discussed.     

Non-heart-beating organ donation: a reply to Campbell and Weber.

In the preceding commentary, Campbell and Weber raise two valid and important issues concerning non-heart-beating organ donation (NHBOD). First, because the procedure links withdrawal of life support and the potential for subsequent organ donation, the desire for organs may create a situation in which care of the dying individual has relatively less importance and the dying may receive suboptimal care. Second, even if concerns about care of the dying were dealt with adequately, there will not be enough non-heart-beating donors to significantly decrease the organ shortage that exists, making the procedure not worth the risk. We agree that attention to the important details of caring for the dying are, and must be, the primary concern of all health care workers caring for those individuals. Ensuring the patients' comfort, dignity, and autonomy, and providing for family and social support are the mainstays of this care. All policies for NHBOD should clearly support and mandate these concepts. Regarding the second concern, we agree that NHBOD is currently rare; however, evidence is increasing that this type of donation has great potential. Continued growth of the practice in this country will depend largely on public acceptance, which we believe will be directly influenced by whether the public perceives that care of the dying is not compromised by this procedure.     

Applications of a computer algebra system in introductory statistics

Maple, a computer algebra system, is employed in introductory statistics courses to promote conceptual learning by students of statistical principles without direct use of mathematics. Maple’s symbolic computation, graphic display, and animation capabilities support an integrated set of procedures for active study of sampling distributions and concepts related to samples, populations, and statistical decision making, error, and power. Students select parameter values for one-line commands and examine the effects of alternatives on computer-generated graphical representations of distributions. The 20 procedures written to support active student exploration of basic statistical concepts are described, and examples of exercises to support their use are provided.     

Behavior of neonates exposed in utero to methadone as assessed on the Brazelton scale

Twenty-nine infants exposed in utero to methadone and 37 comparison infants were examined on the Neonatal Behavioral Assessment Scale at early and late neonatal ages. All infants were full-term at birth, over 2500 g, and not yet circumcised at the early assessment. None of the methadone-exposed infants were breast-fed or were being treated pharmacologically for withdrawal. During the first week of life, methadone-exposed neonates differed from comparison ones in motoric behavior. Relative to comparison-group infants, they were jerkier and more tremulous, tense, active, and better able to put hand in mouth. By the end of the first month these differences diminished, although there was still a tendency for the methadone-exposed infants to have elevated body tonus. Neither perinatal complications, birth weight, nor sex of infant could explain the early neonatal differences between the methadone and comparison groups. Past the early stage of acute withdrawal, neonates exposed prenatally to methadone behave not unlike their nonexposed peers.