When religion may be an ethical issue.

Though Americans are a religious people, there are times when religion or religious views may confound the ethical process. This article claims that religious values may be expressed as either principles or narratives, then seeks to establish a case for dealing with religious claims as "principled narratives." Methods of evaluation are explored and then seven guidelines are offered for dealing with religion in ethics consultations.

Affective verbal memory in patients with temporal lobe epilepsy.

Eighteen epileptic patients with unilateral temporal lobe epilepsy (9 left, 9 right) were evaluated with a verbal memory task involving recall of 2 stories, 1 with affective content and 1 that was neutral. A trend for better performance by the group with intact left hemispheres was found for a quantitative score of number of story units recalled. For a qualitative score of number of symbolic distortions, a main effect of affective load was found, such that more distortions were made for the story with affective than neutral content. This effect remained significant when the left temporal lobe epilepsy patients were analyzed separately and was not found for the right temporal lobe epilepsy patients alone. Additional analyses for the subset of 5 patients with left and 6 patients with right temporal lobectomies involving removal of the hippocampus and amygdala were in the same direction as the analyses for all 18 participants. These findings are consistent with other reports of material-specific memory deficits, such that verbal memory deficits are associated with left temporal lobe epilepsy. The differences between performance on the affective and neutral stories for the left and right temporal lobe epilepsy patients are discussed and related to the role of the amygdala in affective processing.

Emotional status after right vs. left temporal lobectomy.

Nineteen temporal lobectomy patients with epilepsy were evaluated (11 right and 8 left) with a brief questionnaire that addressed: (1) General Happiness; (2) Depression; (3) Anxiety; (4) Impulse Control; and (5) Socialization. The patients with left temporal lobectomy reported increases in depression and decreases in socialization compared with the right temporal lobectomy patients after surgery. Furthermore although the right temporal lobectomy patients reported increases in general happiness, no changes in general happiness were reported by the left temporal lobectomy patients. The present study supported the idea that an increased negative affect is associated with left rather than right temporal lobectomy. This is consistent with a model of negative emotional valence when the right hemisphere dominates awareness.

The patient who could not be discharged. How far should patient autonomy extend?

A male patient was admitted to the acquired immune deficiency syndrome (AIDS) unit for hemodialysis. His history revealed that he was homeless and that he had tested positive for human immunodeficiency virus (HIV+). He also had a history of alcohol and intravenous drug abuse and tuberculosis. Based on the results of a chest X-ray, he was placed in respiratory isolation. During the next few days of his hospitalization, he exhibited nonadherent behavior toward the treatment regime. Because of previous verbal and physical abuse to staff and patients, all local hemodialysis centers refused to accept him as a patient. Thus, he became a patient who seemingly could never be discharged. A discussion related to the theoretical and practical scope of patient autonomy, institutional altruism vs. institutional self-interest, and the need for social policy to facilitate a just and humane resolution to this ethical situation is presented here.

The spiritual dimension of palliative care.

OBJECTIVES: To review the relevant literature about spirituality and palliation in oncology and to suggest a model for framing and understanding the spiritual themes oncology patients may present. DATA SOURCES: Research studies, review articles, and books related to spirituality, palliation, patient and staff preferences, family therapy, and culture. CONCLUSIONS: Spirituality/religion is a significant element in the lives of most Americans and plays a role in coping with crisis events such as cancer. Responding to the spiritual dimension is an important part of palliative care. IMPLICATIONS FOR NURSING PRACTICE: Caregivers must learn and use appropriate assessment protocols and include appropriate spiritual/religious interventions in careplans.

Incidence of the Fuld WAIS-R profile in traumatic brain injury and Parkinson's disease.

The frequency of occurrence of the Fuld Profile for cholinergic deficiency was investigated in two clinical populations: inpatients who had suffered traumatic brain injury and outpatients who carried a diagnosis of Parkinson's disease. The observed incidence of positive Fuld profiles was not significantly different in the two groups, 14% in the traumatic brain injury group and 24% in the Parkinson's disease group. These findings are consistent with recent reviews of the sensitivity and specificity of the Fuld profile in various clinical and nonclinical populations. The generally low sensitivity of the Fuld profile does not support its usefulness in the differential diagnosis of dementia. However, it may serve as an indicator of cholinergic deficiency, which could be used to select patients who would be likely to respond to cholinomimetic therapies.

The continuum of deep/surface dyslexia.

A right-handed male sustained traumatic brain injury which resulted in anomia, dyslexia and agraphia. The most severe CT (computed tomography)-identified brain damage was located in the right parieto-temporal lobe. In the first months following the injury, the pattern of reading errors was similar to that associated with deep dyslexia. However, nonlexical derivation of phonology from print was not abolished. As the patient's ability to associate letter patterns with sounds improved, oral reading also improved. Although he no longer produced semantic errors in oral reading, he continued to produce oral reading errors that were visually and phonologically related to the targets. Four months after the injury, the error pattern observed in the patient's oral reading was consistent with very mild surface dyslexia. The significance of these observations to dual-deficit models of acquired dyslexia is discussed, as are their implications for rehabilitation.

The religious needs and resources of psychiatric inpatients.

A recent survey of psychiatric research indicates religion has been given little attention, and when it has been considered, the measures have been simplistic. The present study was designed to describe the religious needs and resources of psychiatric inpatients. With the use of a multidimensional conception of religion and two established instruments, 51 adult psychiatric inpatients were surveyed about their religious needs and resources. For comparison, 50 general medical/surgical patients, matched for age and gender, were also surveyed. Eighty-eight percent of the psychiatric patients reported three or more current religious needs. Although there were no differences in religious needs between the two patient groups, there were significant differences in religious resources. Psychiatric patients had lower spiritual well-being scores and were less likely to have talked with their clergy. Religion is important for the psychiatric patients, but they may need assistance to find resources to address their religious needs.

Effect of topiramate on attention.

Impaired attention is a frequently reported side effect of anti-epileptic medication, as well as a frequent general complaint of epilepsy. It is thus important to evaluate the effect of new medications on attention processes. Attention was assessed weekly in ten subjects receiving topiramate over a 3 month period. Attention was evaluated with digit span, a widely used index of attention. Different number sequences were constructed and randomized to allow for repeated use. Four of nine subjects showed significant correlations between topiramate dosage and forward digit span measured weekly, such that higher dosage was associated with poorer attention. The average topiramate dosage and seizure reduction did not differ between these subjects and those who did not show a significant relationship.

Effects of freezing, thawing, and storing human liver microsomes on cytochrome P450 activity.

The stability of cytochrome P450 enzymes, cytochrome b5, and NADPH-cytochrome c reductase was examined in (A) human liver samples frozen in liquid nitrogen and stored at -80 degrees C, (B) human liver microsomes suspended in 250 mM sucrose and stored at -80 degrees C, and (C) human liver microsomes subjected to as many as 10 cycles of thawing and freezing. In study A, microsomes from five human livers were prepared from fresh (unfrozen) tissue and from tissue that was stored frozen at -80 degrees C for 1, 2, 4, or 6 months. The apparent concentration of cytochromes P450 and b5 and the activity of NADPH-cytochrome c reductase decreased 20-40% as a result of freezing the liver, regardless of whether the liver was stored for 1 or 6 months. Similar decreases were observed in the activities of cytochrome P450 enzymes belonging to several gene families, namely CYP1A2 (7-ethoxyresorufin O-dealkylation and caffeine N3-demethylation), CYP2A6 (coumarin 7-hydroxylation), CYP2C9 (tolbutamide methylhydroxylation), CYP2C19 (S-mephenytoin 4'- hydroxylation), CYP2D6 (dextromethorphan O-de-methylation), CYP2E1 (chlorzoxazone 6-hydroxylation), CYP3A4solidus5 (testosterone 6beta-hydroxylation), and CYP4A9solidus11 (lauric acid 12-hydroxylation). Freezing human liver did not convert cytochrome P450 to its inactive form, cytochrome P420, but it increased the contamination of liver microsomes with hemoglobin or other heme-containing proteins, which resulted in a uniform decrease in the specific activity of cytochromes P450 and b5 and in the specific activity of all P450 enzymes. In study B, the concentration of cytochromes P450 and b5, the activity of NADPH-cytochrome c reductase, and the activity of individual cytochrome P450 enzymes were determined in 10 samples of human liver microsomes stored at -80 degrees C for approximately 0, 1, or 2 years. The sample-to-sample variation in the concentration and activity of cytochrome P450, cytochrome b5, and NADPH-cytochrome c reductase was nominally affected by long-term storage of human liver microsomes at -80 degrees C, indicating there was no differential loss of cytochrome P450 activity, cytochrome b5 concentration, or NADPH-cytochrome c reductase activity. In study C, microsomes from a pool of human livers were subjected to 1, 2, 3, 5, 7, or 10 cycles of freezing at -80 degrees C followed by thawing at room temperature. Freezing/thawing liver microsomes for up to 10 cycles did not convert cytochrome P450 to P420, nor did it cause significant loss of CYP1A2, CYP2A6, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4/5, or CYP4A9/11 activity. Overall, these results suggest that our current methods for storing and processing human liver are well suited to preserving microsomal P450 enzyme activity.

Hospitalized psychiatric and medical patients and the clergy.

Earlier research suggested that persons in a community with significant psychiatric disorders seek relief from their clergy as often as from trained mental-health professionals. In this research, contacts with clergy about current hospitalization by matched samples of inpatient psychiatric (N=51) and medical/surgical (N=50) patients were compared, as were responses to structured interviews about the importance of religion, religious affiliation, and participation, spiritual needs, and spiritual well-being. The findings suggest that the two groups were similar in demographics, the degree to which religion was a source of strength and comfort in their lives, and percentages reporting as having a clergy person; the group of hospitalized psychiatric patients was significantly less likely, however, than the sample of medical/surgical patients to have discussed their current hospitalization with their clergy persons. Possible causes for this difference as well as areas of further research are discussed.

Depression and the soul.

Clergy are often confronted by challenges in dealing with the depressed congregant. This paper addresses the interface between psychology, psychiatry, and religion in a discussion of two cases. Models are suggested for dealing with the issues raised by the depressed congregant. The paper developed from a symposium on "The Depressed Congregant: Three Pastoral Responses to a Case Vignette" presented at a conference for cleargy onDepression and The Soul, at Temple Sholom in Chicago.

Immunoelectron microscopy identification of early proliferating cells in rat liver tissue during hyperplasia induced by lead nitrate.

Recent studies have suggested that hepatic stem cells may be involved in at least some forms of liver epithelial growth. To obtain further information on this controversial hypothesis, we treated rats with lead nitrate to induce liver growth and identified the cells undergoing early DNA synthesis by bromodeoxyuridine immunohistochemistry, using both light and electron microscopic detection methods. Eight hours after an intravenous injection of lead nitrate 100 mumol/kg, DNA synthesis was detected in a few scattered hepatocytes and in nonparenchymal cells in portal connective tissue. At the light microscopic level, identification of nonparenchymal cells was limited to bile duct epithelial cells. Other cell types were also labeled, but their identity could not be established. At the ultrastructural level, however, four types of nonparenchymal cells were identified as containing bromodeoxyuridine immunogold particles. These four types included bile duct epithelial cells, fibroblasts, macrophages and nondescript periductular cells. These periductular cells displayed certain ultrastructural features of bile duct cells but did not line a lumen or display microvilli on their apical membrane, nor did they reside within the bile duct basement membrane. Because proliferation of nonparenchymal cells in portal areas preceded that of hepatocytes, it is suggested that the former reaction reflects a direct mitogenic effect of lead nitrate and not an adaptive growth response secondary to parenchymal enlargement. However, whether DNA synthesis in periductular cells or bile duct cells reflects activation of hepatic stem cells cannot be established from the present morphological observations. If so, such a progenitor compartment must be dormant because it does not seem to play a functional role in this and other forms of adult liver epithelial growth.

A preliminary investigation of opinions and behaviors regarding advance directives for medical care.

BACKGROUND: Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. METHODS: A questionnaire was administered by personal interview to a nonrandomized convenience sample of 46 inpatients and 50 outpatients at a large, tertiary care, urban academic medical center in the summer of 1991. RESULTS: Most respondents (77%) had heard of either the living will or durable power of attorney for healthcare, but only 52% correctly understood the purpose of these documents. Twenty-nine percent of the sample had executed an advance directive. Those who had advance directives were older and considered themselves less healthy than did those without advance directives. Unfamiliarity with advance directives and procrastination were cited most often as reasons for not having an advance directive. Most subjects (65%) had spoken with someone, usually a family member or close friend, about preferences for treatment during a critical illness. Although they had rarely discussed advance directives, 83% anticipated that they would be comfortable doing so with a physician or a nurse. CONCLUSIONS: Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.

Visual field differences for clockwise and counterclockwise mental rotation.

Geometric line drawings were presented to normal subjects in the left visual field (LVF) or right visual field (RVF) at various degrees of rotation from a centrally presented vertical standard. The task of the subject was to indicate with a reaction time (RT) response whether the laterally presented stimulus could be rotated into the vertical standard or if it was a rotated mirror image of the standard. In Study 1, an overall right hemisphere superiority was found for RT and accuracy on match trials. Most interestingly, interactions between Visual Field and Rotation Angle for the match accuracy data and between Visual Field and Direction of Rotation (clockwise or counterclockwise) for the match RT slopes were found. These interactions suggested that clockwise rotations were more readily performed in the LVF and counterclockwise rotations in the RVF, consistent with other literature for mental rotation. The purpose of Study 2 was to replicate this finding of visual field differences for rotation direction using a design in which direction and degree of rotation were varied orthogonally. No main effect of Visual Field was found. However, significant interactions between Visual Field and Rotation Angle were found for both RT and accuracy, confirming the presence of visual field differences for rotation direction in a new sample of subjects. These differences were discussed in terms of the possibly greater relevance of medially directed stimuli and a possible hemispheric bias for rotation direction, and in terms of interhemispheric transmission factors.