You ≠ me: individual differences in the structure of social cognition.

This study investigated the structure of social cognition, and how it is influenced by personality; specifically, how various socio-cognitive capabilities, and the pattern of inter-relationships and co-dependencies among them differ between divergent personality styles. To measure social cognition, a large non-clinical sample (n = 290) undertook an extensive battery of self-report and performance-based measures of visual perspective taking, imitative tendencies, affective empathy, interoceptive accuracy, emotion regulation, and state affectivity. These same individuals then completed the Personality Styles and Disorders Inventory. Latent Profile Analysis revealed two dissociable personality profiles that exhibited contrasting cognitive and affective dispositions, and multivariate analyses indicated further that these profiles differed on measures of social cognition; individuals characterised by a flexible and adaptive personality profile expressed higher action orientation (emotion regulation) compared to those showing more inflexible tendencies, along with better visual perspective taking, superior interoceptive accuracy, less imitative tendencies, and lower personal distress and negativity. These characteristics point towards more efficient self-other distinction, and to higher cognitive control more generally. Moreover, low-level cognitive mechanisms served to mediate other higher level socio-emotional capabilities. Together, these findings elucidate the cognitive and affective underpinnings of individual differences in social behaviour, providing a data-driven model that should guide future research in this area.

Assessment of distal tip position of long-term central venous feeding catheters using transesophageal echocardiology.

BACKGROUND: Central vein catheter position is a vital element in promoting longevity and minimizing adverse events associated with long-term parenteral nutrition. Traditionally, position has been verified using a chest radiograph. However, this mode of assessment has limitations as the catheter is placed in a dynamic system subject to forces from changes in posture and diaphragmatic movement. METHODS: We compared the reported position using a chest x-ray compared with assessment using transesophageal echocardiology (TOE) in 9 patients receiving home parenteral nutrition. The x-ray was reported by a radiologist unaware of the study. RESULTS: There were discordant results in 7 of the 9 cases with catheter tip placed in the right atrium or impinging in the tricuspid valve which was not evident from the chest x-ray. TOE offered greater information of catheter tip position and relationship to adjacent anatomy. CONCLUSIONS: Further work is required but this observational study suggests guidelines suggesting the use of a chest radiograph to confirm catheter position may need to be re-assessed.

A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients.

BACKGROUND: Patients who undergo surgery are at risk of malnutrition due to periods of starvation, the stress of surgery, and subsequent increase in metabolic rate. There are limited data on nutritional outcome of surgical patients. AIMS: To investigate changes in nutritional status and the influence of oral supplements on nutritional status, morbidity, and quality of life in postoperative surgical patients. METHODS: Entry was determined by the presence of malnutrition, as defined by a body mass index (BMI) < or =20 kg/m(2), anthropometric measurements < or =15th percentile on admission, or initiation of oral diet postoperatively and/or a weight loss of 5% or more during the operative period. We studied 101 patients: 52 were randomised to the treatment group (TG) and prescribed a 1.5 kcal/ml nutritional supplement; 49 patients were randomised to the control group (CG) and continued with routine nutritional management. Nutritional status was assessed by weight, anthropometry, and grip strength, with measurements taken at two weekly intervals for 10 weeks. Complications, namely wound infection, chest infection, and antibiotic use were documented. Quality of life (QOL) was assessed using the UK SF-36 questionnaire. RESULTS: Patients in the control group lost a maximum mean (SD) of 5.96 (4.21) kg in weight over a period of eight weeks while patients in group TG lost less weight overall (maximum mean (SD) 3.40 (0.89) kg (p<0.001) occurring at four weeks and progressively regained weight from week 4). Anthropometry, grip strength, and QOL were similarly significantly different between groups (p<0.001). Fewer patients in the treatment group (7/52) required antibiotic prescriptions compared with the control group (15/49). CONCLUSIONS: Nutritional status declined for two months after discharge. Postoperative nutritional supplementation improved nutritional status, QOL, and morbidity in these patients.

Screening sigmoidoscopy: a randomised trial of invitation style.

OBJECTIVES: To examine uptake rates for screening sigmoidoscopy and whether offering prior consultation about sigmoidoscopic screening improves the uptake rate. DESIGN: Patients between 50.5-60.5 years of age registered with one practice were identified and offered screening sigmoidoscopy. Patients were randomly allocated to one of two groups. The first group was sent an invitation to have screening sigmoidoscopy along with an explanatory leaflet. The second group was sent the same invitation and leaflet but with an added option to discuss the test in the first instance with their general practitioner. Response rates (regarding reply to initial invitation and subsequent attendance for screening) in the two groups were measured. SETTING: Urban General Practice, Dundee, Scotland, UK. RESULTS: The overall uptake rate was low at 24%. Significantly fewer people in the second group (i.e. those with the option to discuss first) replied to the initial invitation. Assessing those who did reply, there was no difference between the two groups in numbers who thereafter went on to attend for screening. Only two percent of people took up the offer to find out more about the test from their general practitioner. CONCLUSIONS: The offer of flexible sigmoidoscopy as a screening test for colorectal cancer generates little interest in this population at present and compliance rates are low. The offer of prior consultation about the procedure with a patient's own general practitioner is not sufficient to generate interest. These results highlight potential difficulties with the introduction of a mass screening program.

The role of the gastroenterologist in the provision of artificial nutrition support.

BACKGROUND: Nutrition support is required for the prevention or treatment of malnutrition in patients with intestinal failure and those who are unable to eat. AIMS: To determine the demands upon gastroenterologists for nutrition support, the available resources, and compliance with the British Society of Gastroenterology (BSG) guidelines. METHOD: A questionnaire was circulated to all 483 consultant physician members of the BSG. RESULTS: There were 336 (70%) replies. Fifty-three per cent of respondents reported malnutrition in 20% or more of their patients. Seventy-nine per cent of consultants supervised patients on enteral feeding, and 64% supervised parenteral feeding. Feeding jejunostomy was used by 61% of Teaching Hospital (TH) consultants but only 38% of District General Hospital (DGH) consultants (P < 0.001). Twenty-seven per cent of respondents headed, or were members of, a nutrition support team (NST). Forty-five and 38% of respondents did not follow written protocols for peripheral and central parenteral nutrition, respectively. Fifty-five per cent monitored catheter complications, of whom 44% reported catheter infections in 5% or more of their patients. Weights of inpatients were obtained by 76% of DGH consultants and 91% of TH consultants (P < 0.001). Fifty-eight per cent of respondents did not arrange for nutritional screening. Ninety-six per cent of consultants could access a dietitian, 55% had access to an NST and 36% had a nutrition nurse specialist (NNS). An NNS was available to 57% of TH consultants but only 23% of DGH consultants (P < 0.001). CONCLUSIONS: Gastroenterologists have a major role in nutrition support. Facilities are suboptimal. Observing guidelines may improve nutritional care. These findings have implications for resources and training.

Disease-associated malnutrition in the year 2000.

Malnutrition is associated with increased morbidity and mortality and is common in patients admitted to hospital. Nutritional status is not routinely assessed on admission, and nutritional depletion escapes recognition in the majority of affected patients. Nutritional status declines during hospital stay, and this trend is most marked in patients who are already malnourished on admission. Techniques for nutritional support are available, their appropriate use leads to improved nutritional status and clinical outcome in most patients. There is evidence that the current use of artificial nutrition is suboptimal and associated with a high complication rate. The introduction of clinical guidelines and the formation of nutrition support teams will improve nutritional management in the future. The development of new substrates and 'pharmaconutrition' is likely to further improve the outcome for many patients. There will remain a need for more studies to define the cost efficacy of artificial nutrition across a broad spectrum of clinical practice.

Manganese requirement and toxicity in patients on home parenteral nutrition.

Two patients who were receiving home parenteral nutrition complained of vague neurological symptoms of such severity that they underwent full clinical appraisal. The only positive finding was that plasma manganese concentrations were greater than twice the upper 95% confidence interval of normal (7-27|nmol/l). In the light of this result all nine patients receiving home parenteral nutrition underwent evaluation for possible manganese toxicity. One other patient had serum manganese concentrations exceeding twice the upper limit (127|nmol/l). The three patients with elevated serum Mn had evidence of manganese deposition in the brain on magnetic resonance imaging scanning. In contrast two patients with normal plasma results had negative scans. Patient susceptibility appears very variable. We suggest that current amounts of trace elements provided in nutrition solutions may be a potential source of nutrient activity. The fine tuning of supply and demand may be difficult on account of a limited range of commercially available trace element solutions.

Skin content of 7-dehydrocholesterol in patients with malabsorption.

The mechanism for the development of vitamin D deficiency in patients with malabsorption remains unclear. We wished to examine the hypothesis that one factor was a reduced skin content of 7-dehydrocholesterol, the precursor for the formation of vitamin D in the presence of ultraviolet radiation. We measured 7-dehydrocholesterol in skin samples from 9 patients who had previously had vitamin D deficiency due to malabsorption (6 with Crohn's disease, 2 with primary biliary cirrhosis, and 1 with idiopathic pseudo-obstruction). We found no evidence of reduced levels of 7-dehydrocholesterol in the skin in these patients. Lack of 7-dehydrocholesterol does not contribute to vitamin D deficiency in malabsorption.

Audit of acute upper gastrointestinal haemorrhage: the effects of education and the introduction of a protocol.

The aim of this audit was to monitor the effects of the introduction of a protocol for the management of acute upper GI haemorrhage and a teaching programme for House Officers in Ninewells Hospital Dundee. All patients admitted to hospital with a history of acute haematemesis or melaena were included in the study and purpose designed audit forms were completed on all patients. Following an initial six month audit period the protocol and teaching were introduced. A further six months audit was then performed. A total of 310 patients were audited over the two six month periods. The results suggest that the introduction of a management protocol and training, in conjunction with a policy of active endoscopic intervention may reduce the number of out of hours emergency endoscopies and the need for emergency surgery.

Potential hazards of excluded bowel and use of parenteral nutrition: a case report.

This case demonstrates that excluded gut may be a reservoir for bacterial translocation and recurrent sepsis. Translocation may contribute to cholestatic hepatitis, and restoration of bowel continuity is fundamental to reversing these pathologic changes. It also emphasizes that parenteral nutrition even when used as interim supportive treatment is not without serious hazard.

A comparison between oral and nasogastric nutritional supplements in malnourished patients.

There is a common perception that malnutrition is an inevitable manifestation of illness, that oral nutritional supplements are not taken or reduce the consumption of oral diet, and that nasogastric feeding is poorly tolerated. This study assessed the efficacy of supplemental enteral feeding on the nutritional status of malnourished patients, to compare oral supplements (OS) with overnight supplemental nasogastric feeding (NG) on nutritional status and to determine the effect of nutritional supplements on oral diet. Malnourished hospital patients were randomized to one of three groups: control (C), OS, or NG. All patients had access to hospital diet. Supplements were prescribed to meet estimated nutritional needs. Nutritional status was recorded at the start and the end of the feeding period. The total nutritional intake was recorded. Weight gain occurred in 64% of the supplemented patients, whereas 73% of the controls lost weight with mean weight changes of +2.9% OS. +3.3% NG, and -2.5% C. There was no difference in the mean energy intake from food in the three groups. There were no documented complications of OS and three minor complications of NG. Both methods of supplementation allow weight gain without significantly affecting spontaneous oral intake.