Correctional institution based sex offender treatment: a lapse behavior study.

The correctional community has engaged in a surge of sex offender treatment programs, both within the confines of the correctional institutions as well as at the community level. While there has been an increase in efforts to assess the effectiveness of these programs the research has been hampered by inconsistency in appropriate outcome measures. The present study addresses these shortfalls, while focusing on the early behavioral lapse indicators. The study focuses on the premise that not all sex offenders lapse in similar manners, and that those with adult and statutory victims would show more impulsive-criminal trends in lapse behavior when compared to those with child victims. The results support the premise on several variables, but not on sexual deviancy.

MEDLINEing. Why and how to conduct a literature search.

Have you ever proposed a new prehospital intervention at your local medical advisory committee only to be stopped dead in your tracks when another participant calmly asserts that your idea is not field appropriate, has too many risks or is simply ineffective, then cites medical literature that says so? If you haven't done your homework, you must fold up your notes and quietly return to your seat. To be sure you're prepared with the best, current research for such a proposal, you need the same research tool your physician colleagues use, and that's the ability to search the MEDLINE database. Read on to learn a free and easy way to access this very powerful research tool via the Internet.

Delayed weakness following a gunshot wound.

Injury to the vascular system in the cervical mediastinal area can cause delayed neurologic symptoms. In this article, the authors describe a patient in whom pseudoaneurysm formation after a gunshot wound eventually led to weakness in the shoulder and arm.

Evaluation of a pulse oximeter in the prehospital setting.

Paramedics field-tested a portable, battery-powered pulse oximeter to determine its applicability and usefulness as an adjunct to prehospital care. The pulse oximeter was attached to 62 consecutive patients who met local criteria for mandatory advanced life support base hospital contact. Arterial hemoglobin saturation (SaO2) levels and changes over time were documented by the pulse oximeter's integral printer and prehospital care reports prepared by paramedics. The pulse oximeter performed reliably in 60 patients (96.7%) by providing continuous SaO2 levels. Fifteen patients (24.2%) had saturations below 91%, and the pulse oximeter detected two (3.2%) otherwise undetected saturations below 80%. In each case, field intervention improved saturation. Pulse oximetry quantifies SaO2 changes correlated with many prehospital interventions: medications, suctioning, precarious gurney transport, oxygen therapy, and ventilatory assistance. The pulse oximeter performs reliably in the field and can be invaluable as an adjunct to patient care. Further prehospital studies are needed to evaluate specific field treatments and techniques, to assess the pulse oximeter's effect on morbidity and mortality, and to analyze the determination of severe hypoxemia in the field.

Dystonia musculorum deformans: three cases treated on a rehabilitation unit.

Dystonia musculorum deformans is a rare involuntary movement disorder of unknown etiology. We treated three brothers in one family on our rehabilitation unit, resulting in definite improvement in their ability to walk and control the dystonic movements, and in their speech and swallowing. All three benefited from orthoses to prevent equinovarus and maintain ankle stability. Intense concentration, such as needlepoint, seemed to reduce the amount of extra motion. Performing another activity during dystonic movements, such as pointing to a communication board, also seemed to give some relief. A special seating system using a collapsible wheelchair, a low center of gravity, and antitip wheels reduced one brother's frequency of falling. Swallowing finely cut foods was not a problem with any of our patients, although one had to be instructed in a special technique. An electronic communication board was very helpful. Our success in these cases should encourage others working in rehabilitation to consider such patients and to apply the principles of rehabilitation, particularly the total team approach, in their care.

Hip pain in children: an anatomic approach.

The practicing physician can be assured of both an accurate and systematic method for making a diagnosis when using an anatomic approach to the common clinical problem of hip pain. The numerous causes of hip and leg pain in the small child and adolescent and their management are reviewed.

A time-limited dynamic approach to adolescent inpatient group psychotherapy.

In response to sharply curtailed lengths of stay of adolescents in an inpatient psychiatric program, new therapeutic modalities need to be implemented. A time-limited dynamic approach to adolescent inpatient group psychotherapy is presented. The model integrates psychoanalytic and crisis theory into a group format. The primary focus in this model is upon resolution of problematic interpersonal interactions as they are related to the current crisis state. The group process, as related to the adolescent, involves three phases. These include an initial intake phase, which incorporates an ego-functioning assessment; a second or middle phase which focuses on making actions ego-alien; and the termination phase, which incorporates the learning experience and how it relates to the resolution of precipitators of the admission.

Selective antagonism of nicotine actions in the rat cerebellum with alpha-bungarotoxin.

Nicotine, locally applied to identified neurons in the rat cerebellar cortex, excites inhibitory interneurons, but depresses the discharge of Purkinje cells. Alpha-bungarotoxin blocked the excitatory actions of nicotine on the inhibitory interneurons. The antagonism of nicotine excitatory actions is largely irreversible and also insurmountable with higher doses of nicotine. The antagonism by alpha-bungarotoxin is, in addition, selective since there is no blockade of the inhibitory actions of nicotine on Purkinje neurons. The present data suggest that the excitatory actions of nicotine on inhibitory interneurons are mediated by neuromuscular-type nicotinic receptors in the cerebellum. Moreover, the present data also supports the hypothesis of multiple nicotinic sites of action in mammalian brain.

The electrophysiological effects of nicotine in the rat cerebellum: evidence for direct postsynaptic actions.

The agonistic actions of nicotine in the cerebellum were dependent on the type of cerebellar neuron studied. Purkinje cells were inhibited and cerebellar interneurons were excited by pressure-ejected nicotine. The simultaneous iontophoresis of Mg2+ failed to block nicotine agonistic actions on either cell type. Since Mg2+ reduces presynaptic release of neurotransmitters, our findings suggest that the pharmacological actions of nicotine on cerebellar neurons are due to direct postsynaptic mechanisms.

Transient locked-in syndrome and phenobarbital.

Locked-in syndrome is a rare syndrome characterized by quadriplegia, intact consciousness, mutism, and communication using vertical eye movements. We report the case history of a patient with transient locked-in syndrome following repeated shunt procedures for idiopathic aqueductal stenosis. Communication was with lateral eye movements. Although she eventually recovered and regained functional independence, high doses of phenobarbital, given to prevent seizures, sedated her and obscured her mental status during her rehabilitation. We urge the careful monitoring of all centrally acting agents in patients with locked-in syndrome.

Diagnosis of hip pain, an anatomic approach.

The authors state that there are many varied causes of hip and thigh pain, the signs and symptoms of which are often misleading and confusing, thus making diagnosis difficult. They present a logical categorized anatomic and neurologic approach toward clinical examination, designed to assure the physician of a correct diagnosis.

Autonomic dysreflexia in the spinal cord-injured. What the physician should know about this medical emergency.

Autonomic dysreflexia is a potentially fatal condition occurring in quadriplegics and paraplegics whose spinal cord lesion lies above the greater splanchnic outflow. Prompt recognition of common and less common clinical findings and a search for the causative stimulus are essential. Bladder distention and fecal impaction are the two most likely causes. Should it persist after removal of the stimulus, hypertension requires aggressive drug therapy to control massive sympathetic outflow.