Factors influencing surgeons' decisions in elective cosmetic surgery consultations.

Background: Current guidelines for surgeons' decisions about whether to offer cosmetic surgery are ineffective. Therefore, surgeons have to make difficult decisions on a case-by-case basis. The authors sought to identify the patient variables that influence surgeons' decisions in practice.

Attributional lability in depression and paranoia.

Background: Attributions play an important role in depression and paranoia. However, contrary to most attributional models of psychopathology, there is evidence that attributional style is not a stable trait but is affected by recent experiences.

Method: Paranoid, depressed, and healthy participants were exposed to a mild stressor in the form of the requirement to complete an anagram task, which included insoluble items.

Use of simulated clients in training veterinary undergraduates in communication skills.

A course in communication skills has been developed specifically for veterinary students, based on those delivered at many medical schools, and making extensive use of professional actors as simulated clients. Its aim is to raise awareness of the importance of communication among veterinary undergraduates at all stages of the curriculum, and it allows them to role-play in acted-out scenarios. Facilitated small groups provide an environment in which students can receive feedback on their own performance and also give feedback to their colleagues.

A randomized controlled trial of group aerobic exercise in primary care patients with persistent, unexplained physical symptoms.

Background: The management of persistent, unexplained physical symptoms is challenging and often unsatisfactory for patients and doctors. Aerobic exercise training has benefited patients referred to secondary care with symptoms of chronic fatigue and fibromyalgia. It is not known if this approach is either possible or beneficial for patients with the broader range of persistent, unexplained symptoms found in primary care.

Health-related quality of life in patients with primary Sjögren's syndrome and xerostomia: a comparative study.

Objective: To compare the health status of groups of Primary Sjögren's and Xerostomia patients, using the Medical Outcomes Short Form 36 (SF-36). The SF-36 is a generic measure, divided into eight domains, used in the assessment of health-related quality of life.

Patients And Methods: The SF-36 was given to 2 groups: Group 1 comprised 43 patients diagnosed with Primary Sjögren's Syndrome (1 degrees SS) and an unstimulated whole salivary flow rate (UFR) of <0.

The impact of current media events on hallucinatory content: the experience of the intensive care unit (ICU) patient.

Objectives: To investigate the influence of current media events on hallucinatory content in ICU patients.

Design And Methods: Patients were interviewed over a one-year period, and their descriptions of hallucinatory experiences, together with weekly media stories, were assessed for themes of war.

Results: Media coverage for war-related stories rose significantly during the period of war in Kosovo (24/3/99-20/6/99).

The Liverpool brief assessment system for communication skills in the making of doctors.

Unlabelled: The teaching of clinical communication skills is gaining importance in medical schools. There is a need to design feasible assessments that are credible to faculty, students and the profession.

Aim: To design, and assess the reliability and validity of a new communication skills assessment system (the Liverpool Communication Skills Assessment Scale-LCSAS, and the Global Simulated Patient Rating Scale-GSPRS) for employment in OSCEs.

Examiner fatigue in communication skills objective structured clinical examinations.

Context: The assessment of undergraduates' communication skills by means of objective structured clinical examinations (OSCEs) is a demanding task for examiners. Tiredness over the course of an examining session may introduce systematic error. In addition, unsystematic error may also be present which changes over the duration of the OSCE session.

Assessing the development of communication skills in undergraduate medical students.

Context: The teaching of clinical communication skills' teaching has become an important part of medical school curricula. Many undergraduate medical courses include communication skills training at various points in their curriculum. Very few reports have been published on the development of communication skills over the duration of a medical undergraduate training.

The Objective Structured Video Exam for assessment of communication skills.

Objectives: (i) To design a new, quick and efficient method of assessing specific cognitive aspects of trainee clinical communication skills, to be known as the Objective Structured Video Exam (OSVE) (Study 1); (ii) to prepare a scoring scheme for markers (Study 2); and (iii) to determine reliability and evidence for validity of the OSVE (Study 3).

Methods: Study 1 describes how the exam was designed. The OSVE assesses the student's recognition and understanding of the consequences of various communication skills.

Sources of stress for orthodontic practitioners.

This paper aims to examine and highlight the difference between sources of stress and burn-out. The first part of the paper examines stress and the second part looks at the concept of burn-out with reference to how orthodontists compare with other dental professionals.

Persecutory delusions and autobiographical memory.

Objectives: It was hypothesized that people with persecutory delusions, such as depressed people, would experience difficulty when attempting to generate specific autobiographical memories.

Design: 20 deluded participants, 20 depressed patients and 20 normal controls were compared on an autobiographical memory test.

Methods: Participants attempted to recall memories to positive and negative cue words.

Two predictions about paranoid ideation: deluded, depressed and normal participants' subjective frequency and consensus judgments for positive, neutral and negative events.

Two groups of patients suffering from persecutory delusions, one consisting of patients also suffering from depression and a non-depressed group, together with clinically depressed and normal controls matched with the deluded patients for age and intelligence, were asked to rate the frequency with which selected positive, negative and neutral events had happened to themselves and to an average other person in the past, and the frequency with which these events were likely to happen to themselves and to an average other person in the future. Results were similar for both past and expected future events. Non-depressed-deluded, depressed-deluded and depressed patients rated negative events as occurring relatively more frequently in comparison to the normal controls.

Burnout and stress-related factors among junior staff of three dental hospital specialties.

Objective: To determine whether occupational stress, health status, job satisfaction and burnout differed between the three major hospital dental specialties, and to compare this data with previous studies.

Design: A cross-sectional survey.

Setting: The regional dental teaching hospital and outlying hospital units in Merseyside in 1993.

Abnormalities of self-representation and persecutory delusions: a test of a cognitive model of paranoia.

Patients suffering from persecutory delusions exhibit information processing and social reasoning biases that have been hypothesized to have a self-protective function. In a test of this hypothesis, patients suffering from persecutory delusions who were also depressed and non-depressed deluded subjects were compared with depressed and normal controls on two indirect assessments of self-schemata: the Dysfunctional Attitudes Scale (DAS) and incidental recall of negative and positive trait words that had previously been judged to be self-descriptive or not self-descriptive. Both the depressed subjects and the deluded subjects, whether or not they were depressed, scored highly on the DAS.

Stress in junior hospital medical and dental staff: a descriptive account of their concerns and needs.

Examines the issues of work-related stress in the healthcare professions, focusing on junior medical and dental staff. Identifies the stressors, and reports on an interview survey conducted as part of a larger study funded by the National Health Service Management Executive to identify the levels of stress. Concludes that outsourcing to an independent counselling service could prove to be an effective stress-management strategy.

The defensive function of persecutory delusions. Evidence from attribution tasks.

Abnormalities of 'social' reasoning were investigated in patients suffering from persecutory delusions and in matched depressed and normal controls using transparent (obvious) and opaque (unobvious) tests of attributional style. Whereas depressed and normal subjects yielded similar causal inferences for both attributional measures, the deluded subjects showed a marked shift in internality, attributing negative outcomes to external causes on the transparent Attributional Style Questionnaire but, on the more opaque Pragmatic Inference Task, attributing negative outcomes to internal causes and thus showing a cognitive style resembling that of the depressed group. This finding, interpreted in terms of explicit versus implicit judgements, supports the hypothesis that delusions function as a defence against underlying feelings of low self-esteem.

The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions.

In this paper we review a series of recent investigations into cognitive abnormalities associated with persecutory delusions. Studies indicate that persecutory delusions are associated with abnormal attention to threat-related stimuli, an explanatory bias towards attributing negative outcomes to external causes and biases in information processing relating to the self-concept. We propose an integrative model to account for these findings in which it is hypothesized that, in deluded patients, activation of self/ideal discrepancies by threat-related information triggers defensive explanatory biases, which have the function of reducing the self/ideal discrepancies but result in persecutory ideation.

Paranoia and the defensive attributional style: deluded and depressed patients' attributions about their own attributions.

A data set of Attributional Style Questionnaire responses collected by Kaney & Bentall (1989) from persecutory deluded, normal and depressed subjects was added to a similar data set collected by the first author. The attributions made for hypothetical positive and negative events by the combined pool of subjects were then blind rated for internality by five independent judges. Whereas the internality ratings made by the subjects for their own attributions showed evidence of an exaggerated self-serving bias in the case of the deluded subjects, and an absence of such a bias in the case of the depressed subjects, the independent ratings showed no such group differences.

Persecutory delusions and the self-serving bias. Evidence from a contingency judgment task.

The self-serving attributional bias was studied in matched groups of patients with persecutory delusions, patients with major affective disorder, and normal controls, (N = 14 in each group). On a preprogrammed computer task, subjects mainly won points in one condition and mainly lost points in the other. Subjects were asked to estimate the degree of control they thought they had over winning or losing in the two conditions.

Persecutory delusions and recall of threatening propositions.

Subjects suffering from persecutory delusions, psychiatric controls and normal subjects were required to recall immediately six passages of prose, half of which contained mildly threatening propositions. Deluded subjects recalled fewer propositions overall but more propositions of specifically threatening content. These findings suggest that the role of recall bias in persecutory delusions merits further study.

Paranoia and social reasoning: an attribution theory analysis.

The social reasoning of patients suffering from persecutory delusions and matched groups of depressed and normal controls was investigated using the framework of Kelley's (1967) theory of social attribution. Subjects were required to choose between person, circumstances and stimulus attributions for a series of social vignettes describing interactions between two persons. The vignettes varied in terms of the distinctiveness, consistency and consensus information supplied, as well as in respect of whether the actions described were positively or negatively valued.

Content specific information processing and persecutory delusions: an investigation using the emotional Stroop test.

Attentional bias was investigated in patients suffering from persecutory delusions and matched psychiatric and normal controls, using the emotional Stroop task. Subjects were required to colour name words which were either meaningless strings of Os, neutral words, words indicating negative affect, or words judged to be of paranoid content. In comparison with the control subjects the deluded patients demonstrated a selective increase of response time for the paranoid words.