13 research outputs found
Opiate Written Behavioral Agreements: A Case for Abandonment
Written behavioral agreements (WBAs) are gaining popularity as part of the effort to manage the alarming increase in prescription drug abuse. The rationale for increased use of WBAs in managing patients with chronic pain is that they are believed to increase adherence to agreed-upon behaviors, reduce addiction to or diversion of prescription drugs, and satisfy informed consent requirements. However, there are no high-quality data to support their widespread use in any of these areas. The evidence used to support the use of WBAs is insufficient to justify their unfairness and the high risk of harm they pose to the doctor-patient relationship. Instead, we contend that WBAs are being used to provide leverage for severing relationships with some of our most challenging patients. We propose that physicians treating patients for chronic pain abandon the use of WBAs. Alternatives include open communication, detailed informed consent processes, carefully documented discussions, and most important, commitment to ongoing relationships even with difficult patients
Medical Decision-making During the Guardianship Process for Incapacitated, Hospitalized Adults: A Descriptive Cohort Study
Neutral solvent/crown ether interactions 3. Reorientation of the hydrogen bonds in the low temperature (?150ïżœC) structure of 18-crown-6ïżœ2(CH3NO2)
A reinvestigation of the crystal and molecular structure of (18-crown-6) ïżœ 2 CH3NO2:D 3d stabilization via methyl hydrogen-crown oxygen ?hydrogen bonds?
Histories and Material Manifestations of Slavery in the Upper Gambia River Region: Preliminary Results of the Bandafassi Regional Archaeological Project
Recommended from our members
Apolipoprotein E (APOE) genotype has dissociable effects on memory and attentional-executive network function in Alzheimer's disease
The Δ4 allele of the apolipoprotein E (APOE) gene is the major genetic risk factor for Alzheimerâs disease (AD), but limited work has suggested that APOE genotype may modulate disease phenotype. Carriers of the Δ4 allele have been reported to have greater medial temporal lobe (MTL) pathology and poorer memory than noncarriers. Less attention has focused on whether there are domains of cognition and neuroanatomical regions more affected in noncarriers. Further, a major potential confound of prior in vivo studies is the possibility of different rates of clinical misdiagnosis for carriers vs. noncarriers. We compared phenotypic differences in cognition and topography of regional cortical atrophy of Δ4 carriers (n = 67) vs. noncarriers (n = 24) with mild AD from the Alzheimerâs Disease Neuroimaging Initiative, restricted to those with a cerebrospinal fluid (CSF) molecular profile consistent with AD. Between-group comparisons were made for psychometric tests and morphometric measures of cortical thickness and hippocampal volume. Carriers displayed significantly greater impairment on measures of memory retention, whereas noncarriers were more impaired on tests of working memory, executive control, and lexical access. Consistent with this cognitive dissociation, carriers exhibited greater MTL atrophy, whereas noncarriers had greater frontoparietal atrophy. Performance deficits in particular cognitive domains were associated with disproportionate regional brain atrophy within nodes of cortical networks thought to subserve these cognitive processes. These convergent cognitive and neuroanatomic findings in individuals with a CSF molecular profile consistent with AD support the hypothesis that APOE genotype modulates the clinical phenotype of AD through influence on specific large-scale brain networks