Colmery-O'Neil VA Medical Center

See related article by Mor et al. in this issue.

Skin infections are commonly secondary to infection of Streptococcus pyogenes (Group A β-hemolytic streptococci), Stapylococcus aureus, or a combination of the 2 g positive organisms.

Aim: Insulin therapy is commonly associated with weight gain. The timing of prandial insulin administration may enhance its efficacy/safety and maintain effective weight control. This study examined the effect of postprandial vs. preprandial insulin glulisine on weight gain and glycaemic control in type 2 diabetes patients taking basal insulin.Methods: This was a multicenter, randomized, open-label trial conducted in 45 centres in the USA. A total of 716 patients with type 2 diabetes and glycated haemoglobin A1c (HbA1c) ≥7.5% and ≤10.0% were screened; 345 were randomized and 322 comprised the intent-to-treat group (premeal, 163; postmeal, 159). Insulin glargine once daily, ±metformin and subcutaneous injections of premeal or postmeal insulin glulisine were given for 52 weeks. Main outcome measures included changes in HbA1c, fasting plasma glucose and weight from study baseline to endpoint (week 52).Results: At study end, insulin glulisine achieved similar glycaemic control whether it was administered before or after meals (HbA1c: 7.04% premeal vs. 7.16% postmeal, p = NS). Overall hypoglycaemia incidence and severe hypoglycaemia rates were not significantly different between premeal and postmeal groups; however, symptomatic and nocturnal hypoglycaemia rates were higher in the postprandial group. Mean body weight was lower in the postmeal group, with the difference between postmeal and premeal weight change from baseline to week 52 of −0.87 kg (p = 0.243).Conclusion: Postprandial glulisine administration provided similar glycaemic control and was non-inferior to preprandial administration on weight gain, without additional risk of severe hypoglycaemia, showing dosing flexibility and the feasibility of such approach when clinically indicated.

1. The cognitive behavioral treatment context is essentially an educational function that focuses on eliciting changes in attitude and judgment, values, methods of cognitive processing, correction of distorted thinking, re-examination of internalized core assumptions, and subsequently, behavior. 2. The behavioral framework presumes that behavior is learned and can be unlearned or relearned, and that psychiatric disorders are severely complicated by maladaptive and dysfunctional attempts to compensate. 3. The cognitive models involve validation, remotivation, resocialization, reality testing through increasing coping and problem solving abilities, and increasing self esteem and a sense of personal control.

Combining psychoeducation and supportive psychotherapy resulted in a successful group experience for schizophrenics in a long-term care setting within a Veterans Administration Medical Center. This article describes the two approaches and discusses the ways in which they were combined and enhanced in a structured manner. A case study is presented and practice implications are explored. Important accomplishments and behavioral changes were observed in group members participating in this group. Schizophrenics with problematic behavioral histories and recurrent active psychoses were able to participate productively, work toward greater independence and achieve community living.

1. Nearly half of all orders for psychotropic medications are written "as needed" (PRN); therefore, the nurse must assume a vital function in the assessment, use, and evaluation of medication. 2. Placebo agents are known to have an effectiveness rate between 30% and 50%. Nurses and other health professionals severely underestimate the magnitude of this effect. 3. The patient's perception of the medication experience, beliefs, degree of trust, expectation, and the psychosocial context in which medications are used, contribute to agent effectiveness. 4. The nurse's personal beliefs, nonverbal cues, anticipation, and interpersonal style can influence effectiveness of agents in relieving symptoms; likewise, by understanding and increasing various interpersonal skills, professionals can enhance effectiveness of psychotropic agents.

Abstract Sixty male Vietnam combat veterans, 30 hospitalized for post-traumatic stress disorder (PTSD) and 30 with no PTSD or other psychiatric disorder, sorted and labeled their life events into numeric matrices (repertory grids). Through hierarchical-classes analysis of a subject's matrix, we could compare the hierarchical level (elaboration) of the subject's constructs of a negative combat event with the hierarchical levels of other subjects' constructs of negative combat events and with the subject's precombat life event construction. As predicted, the level of construct elaboration was virtually identical for the two groups for precombat non-trauma-related events but was reduced in the PTSD group for the negative combat event. In addition, the Pythagorean distance scores of the PTSD group indicated less conceptual distance between the negative combat event and negative life events after Vietnam compared with the non-PTSD group's scores. Patients with PTSD rated negative life events more extremely (fe...

This study investigated the systems of Minnesota Multiphasic Personality Inventory (MMPI) configural interpretation of Skinner and Jackson (1978) and Kunce (1979) with Vietnam veterans with posttraumatic stress disorder (PTSD). MMPI profiles of four groups differing in combat exposure were compared on four MMPI configural variables from Kunce (1979) and Skinner and Jackson (1978). The four groups were (a) PTSD sufferers, (b) Vietnam combat veterans without PTSD, (c) Vietnam noncombat veterans, and (d) Vietnam era veterans. All groups were further divided into hospitalized versus nonhospitalized subgroups. Dependent variables were Skinner and Jackson's (a) sociopathic modal profile, (b) neurotic profile, (c) psychotic profile, and (d) Kunce's emotional expression (enthusiastic-reserved) dimension. Results indicated that hospitalized PTSD subjects had significantly higher scores on Skinner and Jackson's neurotic profile; both hospitalized and nonhospitalized PTSD subjects had higher scores on the psychotic profile and were more "reserved" on Kunce's emotional expression dimension. Results were interpreted in terms of configural MMPI interpretation systems and the adjustment of Vietnam veterans with PTSD. PTSD was viewed as exhibiting cognitive, somatic, and affective features.