Clinical ethics consultations: reasons for optimism, but problems exist

[The author identifies] five problems familiar to clinical ethicists. (1) Physicians often do not recognize important ethical issues. (2) Debate exists over whether such consultations should give specific management recommendations. (3) Principles of medical ethics cannot, by themselves, resolve real ethical issues. (4) The patient's interests sometimes conflict with the interests of the family, the health professionals, and the hospital. (5) Clinical ethics consultations take a toll on the consultant....[He] discuss[es] the implications of each problem for clinical ethics consultations and offer[s] a solution to it.     

Heart rate--QT relationships during baroreceptor stimulation with diminished autonomic influence on the ventricles. Ventricular autonomic tone and QT interval.

The shortening of the QT interval of the electrocardiogram coincident with acceleration of heart rate and vice versa has been accepted for many years as evidence that the action potential duration and hence QT are necessarily dependent on heart rate. Exceptions to this rule have been attributed to the intervention of counteracting autonomic effects. In order to test this assumption, 26 conscious dogs divided into three groups were tested during baroreceptor stimulation by a bolus injection of phenylephrine. Seventeen dogs had been used in earlier studies in which they had undergone an experimental anterior myocardial infarction with apparent full recovery. A group of those dogs underwent beta-adrenergic blockade by intravenous atenolol 30 min prior to the baroreceptor activation. To test the intactness of the baroreceptor responses in the previously infarcted dogs, a third group of nine dogs that had had no prior myocardial infarction was included. All dogs were adapted to the laboratory environment and were not sedated during experiments. Simultaneous recordings of RR, QT interval, and phasic arterial pressure were made in all dogs before and during baroreceptor stimulation. In the normal group, and the previously infarcted group that received no atenolol, baroreceptor stimulation elicited a small (8/msec), but significant prolongation of the QT associated with a nearly 50% reduction in heart rate. The QT interval of the atenolol-treated dogs, although significantly more prolonged before stimulation, remained unchanged during the reflex. The data indicate that withdrawal of ventricular sympathetic tone may prolong the QT interval, thereby confirming the role of sympathetic innervation in the control of QT.(ABSTRACT TRUNCATED AT 250 WORDS)     

The influence of affect on self-focused attention: Conceptual and methodological issues

A number of investigators have suggested that affective states influence the focus of attention. One recent proposal is that negative moods increase self-focus. This review considers the evidence that bears on this hypothesis. Conceptual issues pertaining to the construct of self-focus are discussed first. Next, the various parameters that influence attentional focus are presented in order to provide a way of organizing the mood/selffocus literature. Studies that have used state measures of mood and self-focus are considered in this context. Methodological limitations of existing studies are discussed and directions for future work provided.     

Predictors of myocardial infarction over a span of 30 years in Roseto, Pennsylvania.

Predictors of myocardial infarction with or without survival were sought in a 30-year study of Roseto, Pennsylvania, a nearly exclusively Italian community of approximately 1,600, compared to the immediately adjacent town of Bangor with a population of approximately 5,000. At the start of the study the death rate from myocardial infarction among men in Roseto was less than half that in Bangor despite an equal prevalence of the usual risk factors, mainly smoking and diet. The communities were followed prospectively for 30 years during a striking social change in Roseto toward less family and community cohesion and more commitment to individual goals and adherence to materialistic values. During this period the prevalence of and mortality from myocardial infarction increased sharply to equal the situation in Bangor. The predictive values of measurements made of Rosetans during individual examinations in 1962-63 were tested against the outcome in 1990. Those who experienced fatal myocardial infarction and those who had a well documented infarction and survived were matched with and compared to controls. Although subjects with cholesterol concentration above 200 were twice as likely to experience myocardial infarction as those with concentrations below 200, less than 20% of those whose cholesterol concentration was above 200 experienced any evidence of myocardial infarction over the nearly 30-year period. Moreover, there were no significant differences between the coronary patients, with or without survival, and their sex, age, and cholesterol matched controls; nor were smoking, evidence of hypertension, diabetes, or obesity predictive of significant differences between the two groups. These data lead to the inference that while those with the conventional risk factors are more likely to develop myocardial infarction than are those without the risk factors, an even larger proportion of the population may have the risk factors and not succumb to myocardial infarction over a period of nearly three decades.     

Work,leisure, and psychological well-being in a sample of young adults

This study of 20 ‘white-collar’ workers aged 20–30 measured motivation, enjoyment and access to various categories of experience in both work and leisure, and examined their relationship with psychological well-being on a number of dimensions. The method used a short questionnaire, psychological scales and the innovatory ‘experience sampling methodology’ (ESM) where respondents answer questions in a diary on the receipt of a signal from a pre-programmed watch or radio pager eight times a day for 1 week. The results show, in line with other studies, that intrinsic motivation in daily life is correlated with happiness but that, not previously reported, when motivation at work is examined both extrinsic motivation and instances where a person had to do the activity but did not wish to be doing something else, i.e. ‘positive motivational change’, are correlated with positive aspects of psychological well-being, while instances where a person wanted to do the activity but wished to be doing something else, i.e. ‘negative motivational change’, correlated with negative aspects. The results also show that enjoyment in both work and leisure correlates with aspects of psychological wellbeing; and that macro ‘flow’ experiences, where high skills and high challenges are perceived as equal, are enjoyable and interesting and come primarily from work. The study also shows that categories of experience considered important for psychological well-being and deemed to come primarily from work can be obtained in leisure. The results are discussed in the context of person—situation interactions and processes, and it is advocated that these should be studied in a variety of samples.