Search

Metal enolates play an important role in stereoselective organic synthesis. Their chemistry is affected profoundly by the metal counterion associated with the enolate fragment. In order to expand the potential of replacing main group with transition metal moieties in such species, methods have been developed for the synthesis of a number of stable, characterizable "late" transition metal ql-(C)-enolate complexes having the general structure LM-CH2COR (M = Mo, W, Re). The chemistry of these materials (e.g., functional transformations of the organic carbonyl group, transfer of the enolate moietry to organic substrates such as aldehydes and alkynes) has been investigated. The scope and mechanisms of the enolate reactions will be discussed in detail.

According to previous reports, the quality of the physician-patient relationship plays an important role in medical outcome. A patient's responsiveness to suggestions, perceptions of treatment, and physical distress may be affected both by the type of interpersonal relationship and by the patient's anxiety. To test these hypotheses, 57 women who received elective abortions were treated by the physician in either a "paternalistic" or "egalitarian" interpersonal style. Each patient was tested for responsiveness to suggestions regarding changes in somatic perception such as heat or pain; a measure of psychological dependency on the physician was also obtained in addition to ratings of discomfort and signs of physiological distress during the medical procedure. Patient anxiety was not related to any of these variables, but patients treated in a paternalistic manner had higher responsiveness to suggestibility (P less than .001), felt they could depend more on the physician and perceived him as warmer and more supportive (P less than .01), had less discomfort during the procedure (P less than .05), and had a lower incidence of physiological distress compared with patients treated in an egalitarian manner. It was concluded that, for patients in crisis, paternalistic treatment by a physician may promote positive psychological and medical outcome.

Metal enolates play an important role in stereoselective organic synthesis. Their chemistry is affected profoundly by the metal counterion associated with the enolate fragment. In order to expand the potential of replacing main group with transition metal moieties in such species, methods have been developed for the synthesis of a number of stable, characterizable "late" transition metal ql-(C)-enolate complexes having the general structure LM-CH2COR (M = Mo, W, Re). The chemistry of these materials (e.g., functional transformations of the organic carbonyl group, transfer of the enolate moietry to organic substrates such as aldehydes and alkynes) has been investigated. The scope and mechanisms of the enolate reactions will be discussed in detail.

Clinically, the first line of treatment for patients experiencing potentially lethal arrhythmias includes antiarrhythmic medications and/or treatment of underlying causes such as ischemia or congestive heart failure. However, if the treatment is not successful in controlling the arrhythmia, the automatic implantable defibrillator is a viable alternative for the prevention of sudden death in these patients. The case report presents one example of how the automatic implantable defibrillator can supplement conventional medical therapy when success in suppressing recurrent arrhythmias cannot be obtained. This concept has been demonstrated in this 59-year-old woman who underwent several medication trials in an attempt to control her life-threatening arrhythmias.

Compliance management was taught to the mother of a 6-year-old girl with attention deficit-hyperactivity disorder who had not responded to methylphenidate. Compliance improved from 13% during baseline to better than 80% during training. When methylphenidate was terminated during compliance training the child's behavior simultaneously improved in one setting and temporarily decreased in another setting. Child behavior remained positive during two years of follow-up. Possible reasons for these findings and implications for practice are discussed.

Stillbirth is a professional blind spot for physicians and nurses, who may experience denial in dealing with the bereaved mother and her family. Providing choices and information about the conduct of labor and perinatal decisions, as well as pictures of the infant, a hospital birth certificate and other memory items, may be helpful to the parents in their grief. Hospital perinatal loss teams can provide support both to families and to medical staff.

To make a differential diagnosis between depression, normal grieving, and pathological grief reactions is a common problem for family physicians. Patients often present to the family physician with physical symptoms, such as pain, headache, dizziness, fatigue, and disturbances of digestion and sleep, rather than psychological symptoms. Treatment modalities and effectiveness differ depending on specific diagnosis. The family physician is in a unique position to influence prevention, early detection, and morbidity of these disorders.