Conversation Starters For Virtually Any Situation
Lynch came to the lab from Salt Lake City to spend a year doing research under funding by the Howard Hughes Medical Institute. His project was to see whether O2 could cross the erythrocyte stroma. His knowledge of experimental hematology was invaluable. He prepared vesicles of washed erythrocyte stroma and soon showed that O2 generated on one side would reduce cytochrome c on the other side. Moreover stilbene sulfonates, known to block anion channels, prevented this cross stromal action of O2 (35). When R.E. perceived the reluctance of other members of my lab group to donate blood, he simply drew blood from his own arm. One day I overheard snatches of a conversation between R.E. and someone out in the lab. From the words I heard I assumed they were talking about beautiful women. They were actually discussing wines. R.E. was a connoisseur of wines.
The assessment of pain requires time and patience. Thorough history and physical examination are a crucial part of the assessment. First interview should focus on vital signs, state of hydration, and conversation style of the patient. If these patients are confused or show memory deficit or incoherent speech, then bedside psychological tests should be done to diagnose cognitive deficit. Elderly patients who have difficulty communicating with clinicians are at particular risk of under treatment (Bernabei et al. 1998, Pargeon and Hailey 1999, Fineberg 2006). Detailed chronological history may be collected from the patient, previous medical records or if patient shows memory difficulties or uncooperative behavior, direct interview of family members or caregivers residing with the patient. Systematic physical examination of body should be part of the pain assessment protocol. As most elderly patients suffering from pain are on multiple medications, adverse drug interactions should be kept...
In the UK, crises over bovine spongiform encephalopathy (BSE), otherwise known as mad cow disease, and genetically modified (GM) crops have forced the government to proclaim the value of early public participation in decision making 47,48 . A statement by the UK House of Lords Select Committee in 2000 concluded that today's public expects not merely to know what is going on, but to be consulted science is beginning to see the wisdom of this and to move out of the laboratory and into the community to engage in dialogue aimed at mutual understanding 49 . In Canada, the provincial government of British Columbia pioneered a Citizens' Assembly in 2003, charging 160 citizens with the task of evaluating the existing electoral system. A new BC Conversations on Health project aims to improve the health system by engaging in genuine conversation with British Columbians during 2007.
TS is a psychotic obsessive-compulsive disorder of lifelong duration. Its salient characteristics are recurring motor or vocal tics. The latter may be sounds such as barking and obscene language in between normal conversation (hence the name cursing disease ). The vocal tics are repetitive and explosive. They involve facial movements and abnormal head and limb activities. This compulsive behavior is repetitive and ritualistic. Because about 80 of TS patients respond to haloperidol, and sometimes other antidopaminergic drugs, the dopamine hypothesis has been invoked here. However, there have been reports where long-term neuroleptic therapy may have actually induced TS in schizophrenic patients.
The use of psychopharmacological interventions for adjustment disorders has not been agreed upon, and guidelines usually recommend that talking therapies be applied initially - psychotherapy or counseling. The Cochrane Database reveals only two randomized controlled trials of psychotherapeutic treatment for this condition. Gonzales-Jaimes and Turnbull-Plaza demonstrated that mirror psychotherapy for adjustment disorders with depressed mood secondary to a myocardial infarction was both an efficient and effective treatment. Mirror therapy is described as a type of therapy with psychocor-poral, cognitive, and neurolinguistic components, with a holistic focus. Mirror therapy was compared to Gestalt psychotherapy or medical conversation in addition to a control group. An activating intervention (emphasizing the acquisition of coping skills and the regaining of control) was employed specifically for patients with adjustment disorder associated with occupational dysfunction. In comparison...
It might even count as a modest success story 26 . Success is defined variously, of course, and what counts as success for a particular patient may emerge only through the give-and-take of narrative conversations. My particular success story entails my resistance to accepting the category of patient, a refusal that some other people in pain share. Medicine knows very little about such people, people who resist a self-definition or medical definition as patients, who manage to live successfully (on their own terms) with chronic pain. These are not people who cope or manage, which are medical terms applied to patients, but people who live with pain as nonpatients, who exist outside the structure of medicalization (which is also a temporal structure, as the term waiting room deftly indicates). Arguably, one measure of success for medicine would be fewer people with low back pain who present as patients, especially patients who accept or seek medical certification as disabled. I recognize...
We would like to thank John Brauman, Mo Cleland, Pehr Harbury, Judith Klinman, Geeta Narlikar, Greg Petsko, Shu-ou Shan, Vern Schramm, Peter Tonge, Dick Wolfenden, and members of the Herschlag lab for stimulating discussions and or comments on the manuscript and Alessio Peracchi for artwork. DH would like to thank the many enzymologists, in addition to those listed above, who have shared their perspectives and ideas over the years, in conversation and in print, and Peter and Patricia Walter for acting as surrogate hosts while portions of this review were written. In most cases references represent examples rather than inclusive lists we apologize for the numerous omissions of important citations required because of space constraints. This work was supported by grants from the National Institutes of Health and the Packard Foundation. DAK is an HHMI predoctoral fellow.
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