Specific coping styles are associated with varied risk of burnout in ED staff across several different types of hospitals in a regional network. Coping style intervention may reduce burnout, while leading to improvement in staff well-being and patient outcomes. Further studies should focus on building and sustaining task-oriented coping, along with alternatives to emotion-oriented coping.
Patients with borderline personality disorder frequently drop out prematurely from psychotherapy. This study examined factors related to treatment attrition in 180 patients enrolled in a randomized controlled trial comparing 1 year of Dialectical Behavior Therapy (DBT) to General Psychiatric Management (GPM). Completers and dropouts were compared on a range of variables, including demographics, Axis I and Axis II disorders, anger and impulsivity, therapeutic alliance, and treatment condition. The participants were on average 30.36 years old and 86% were female. Regression analyses revealed that individuals who dropped out had higher levels of anger (p = .01), greater Axis I comorbidity (p = .03), poorer therapeutic alliance (p = .003), and a higher number of lifetime suicide attempts (p = .05). An interaction was also found between Axis I comorbidity and treatment condition, with significantly lower rates of dropout seen in individuals with high Axis I comorbidity who were assigned to GPM compared to those assigned to DBT (p < .001).
It is now established that surviving axons in incompletely denervated striated muscle extend their existing fields of innervation by a process of collateral sprouting, thereby accounting for the functional recovery which occurs (for review see Edds, 1953). A similar process also occurs in skin partly deprived of its sensory nerve supply (Weddell, Guttmann & Gutmann, 1941). Although the phenomenon has not been directly observed in the sympathetic nervous system, there is evidence of remarkable recovery of function after incomplete denervation (Simeone, Cannon & Rosenblueth, 1938;Geohegan & Aidar, 1942).In the present work, partial denervation of the superior cervical ganglion in the cat was performed by severing rami communicantes from their respective thoracic nerves. Subsequently, sprouts arise within the ganglion from the remaining intact preganglionic fibres and form synapses with ganglion cells denervated by the preliminary operation. This spatial increment in the field of innervation of the remaining preganglionic fibres results in an almost complete functional recovery of the ganglion even when as many as 90 % of the fibres have been divided. Experiments have been performed so as to correlate the histological and functional changes within the ganglion, including the time course of the sprouting process and its effect on the acetylcholine release, electrical and pharmacological responses. It seems most likely that under similar conditions post-ganglionic fibres also respond by collateral sprouting.The factors responsible for the efficiency of the sprouting process in the sympathetic nervous system are discussed. A preliminary account of this work has already been published (Murray & Thompson, 1956).
BackgroundMicrocalcifications (MCs) are tiny deposits of calcium in breast soft tissue. Approximately 30% of early invasive breast cancers have fine, granular MCs detectable on mammography; however, their significance in breast tumorigenesis is controversial. This study had two objectives: (1) to find associations between mammographic MCs and tumor pathology, and (2) to compare the diagnostic value of mammograms and breast biopsies in identifying malignant MCs.MethodsA retrospective chart review was performed for 937 women treated for breast cancer during 2000–2012 at St. Michael’s Hospital. Demographic information (age and menopausal status), tumor pathology (size, histology, grade, nodal status and lymphovascular invasion), hormonal status (ER and PR), HER-2 over-expression and presence of MCs were collected. Chi-square tests were performed for categorical variables and t-tests were performed for continuous variables. All p-values less than 0.05 were considered statistically significant.ResultsA total of 937 patient charts were included. About 38.3% of the patients presented with mammographic MCs on routine mammographic screening. Patients were more likely to have MCs if they were HER-2 positive (52.9%; p < 0.001). There was a significant association between MCs and peri-menopausal status with a mean age of 50 (64%; p = 0.012). Patients with invasive ductal carcinomas (40.9%; p = 0.001) were more likely to present with MCs than were patients with other tumor histologies. Patients with a heterogeneous breast density (p = 0.031) and multifocal breast disease (p = 0.044) were more likely to have MCs on mammograms. There was a positive correlation between MCs and tumor grade (p = 0.057), with grade III tumors presenting with the most MCs (41.3%). A total of 52.2% of MCs were missed on mammograms which were visible on pathology (p < 0.001).ConclusionThis is the largest study suggesting the appearance of MCs on mammograms is strongly associated with HER-2 over-expression, invasive ductal carcinomas, peri-menopausal status, heterogeneous breast density and multifocal disease.
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