Desire

An instrument for measuring patients' preferences for two identified dimensions of autonomy, their desire to make medical decisions and their desire to be informed, was developed and tested for reliability and validity. The authors found that patients prefer that decisions be made principally by their physicians, not themselves, although they very much want to be informed. There was no correlation between patients' decision making and information-seeking preferences (r = 0.09; p = 0.15). For the majority of patients, their desire to make decisions declined as they faced more severe illness. Older patients had less desire than younger patients to make decisions and to be informed (p less than 0.0001 for each comparison). However, only 19% of the variance among patients for decision making and 12% for information seeking could be accounted for by stepwise regression models using sociodemographic and health status variables as predictors. The conceptual and clinical implications of these findings are discussed.

desire

Objectives: To assess the prevalence of desire for hastened death among terminally ill cancer patients and to identify factors corresponding to desire for hastened death. Design Prospective survey conducted in a 200-bed palliative care hospital in New York, NY.

Main outcome measure: Scores on the Schedule of Attitudes Toward Hastened Death (SAHD), a self-report measure assessing desire for hastened death among individuals with life-threatening medical illness.

Results: Sixteen patients (17%) were classified as having a high desire for hastened death based on the SAHD and 15 (16%) of 89 patients met criteria for a current major depressive episode. Desire for hastened death was significantly associated with a clinical diagnosis of depression (P=.001) as well as with measures of depressive symptom severity (P

Conclusions: Desire for hastened death among terminally ill cancer patients is not uncommon. Depression and hopelessness are the strongest predictors of desire for hastened death in this population and provide independent and unique contributions. Interventions addressing depression, hopelessness, and social support appear to be important aspects of adequate palliative care, particularly as it relates to desire for hastened death.

"Guided by an unwavering belief that love, desire, and freedom of the imagination were the salvation of humanity, the Surrealist vision was expressed in some of the most provocative works of art of the 20th century," commented Philippe de Montebello, Director. "This is a groundbreaking exhibition that may both challenge and delight the visitor by the breadth, richness, and frankness of its images."

The mingling of love and a demanding, sometimes aggressive sexuality is perhaps nowhere better or more disturbingly shown than in the work of Hans Bellmer (1902-1975), whose Surrealist photographs explore sensual pleasure and psychic anxiety through pictures of large, specially-constructed dolls. Darker aspects of desire are also evoked in works by Surrealist masters Joan Miró and Roland Penrose (1900-1984), among many others who remain remarkable not so much for their openness in sexual matters as for their refusal to allow love to be divorced from eroticism. In their portrayals of encounter, desire, and carnality, the Surrealists continue to facilitate ways of seeing the world anew.

While we know that an individual must decide to support a change, achieving this seemingly simple milestone is not as easy as it sounds. In fact, some of the greatest challenges for change management professionals lie within this element of the ADKAR model. Learn why desire requires a carefully architected change management strategy in order for your changes to succeed below.

More and more and more awareness does not result in desire. Continuing to focus on the reasons for change and not translating those reasons into the personal and organizational motivating factors is a trap some change management practitioners face, and it can be very discouraging and annoying for employees. Your change management plans will require artful use of key business leaders as sponsors of change, and of managers and supervisors as coaches to employees during the change process.

Many practitioners say that desire is the most difficult of the five building blocks to achieve. Desire is difficult because it is ultimately a personal decision that is not under our direct control. While there are certainly ways to try and influence a person's decision to embrace a change, in the end individuals must make this decision themselves. As with awareness, desire is only achieved when the individual says to us, "I will be part of this change."

Awareness and desire, the first two elements of ADKAR, can ebb and flow. Sometimes, change management professionals will conclude that once they have created awareness and desire, they no longer need to reinforce these elements. They quickly move on to training to help build knowledge and ability. However, in reality, awareness and desire can go away as quickly as they were created. It requires reinforcement and continued communication to maintain the levels of awareness and desire necessary to make changes successful.

HSDD is characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship or the effects of a medication or other drug substance. Acquired HSDD develops in a patient who previously experienced no problems with sexual desire. Generalized HSDD refers to HSDD that occurs regardless of the type of sexual activity, situation or partner.

Vyleesi activates melanocortin receptors, but the mechanism by which it improves sexual desire and related distress is unknown. Patients inject Vyleesi under the skin of the abdomen or thigh at least 45 minutes before anticipated sexual activity and may decide the optimal time to use Vyleesi based on how they experience the duration of benefit and any side effects, such as nausea. Patients should not use more than one dose within 24 hours or more than eight doses per month. Patients should discontinue treatment after eight weeks if they do not report an improvement in sexual desire and associated distress.

The effectiveness and safety of Vyleesi were studied in two 24-week, randomized, double-blind, placebo-controlled trials in 1,247 premenopausal women with acquired, generalized HSDD. Most patients used Vyleesi two or three times per month and no more than once a week. In these trials, about 25% of patients treated with Vyleesi had an increase of 1.2 or more in their sexual desire score (scored on a range of 1.2 to 6.0, with higher scores indicating greater sexual desire) compared to about 17% of those who took placebo. Additionally, about 35% of the patients treated with Vyleesi had a decrease of one or more in their distress score (scored on a range of zero to four, with higher scores indicating greater distress from low sexual desire) compared to about 31% of those who took placebo. There was no difference between treatment groups in the change from the start of the study to end of the study in the number of satisfying sexual events. Vyleesi does not enhance sexual performance.

ISD can also relate to the partner (the person with ISD is interested in other people, but not his or her partner), or it can be general ( the person with ISD isn't sexually interested in anyone). In the extreme form of sexual aversion, the person not only lacks sexual desire, but may find sex repulsive.

However, testosterone is the hormone that creates sexual desire in both men and women. Testosterone levels may be checked, especially in men who have ISD. Blood for such tests should be drawn before 10:00 a.m., when male hormone levels are at their highest.

Communication training helps couples learn how to talk to one another, show empathy, resolve differences with sensitivity and respect for each other's feelings, learn how to express anger in a positive way, reserve time for activities together, and show affection, in order to encourage sexual desire.

In other cases where there is an excellent and loving relationship, low sexual desire may cause a partner to feel hurt and rejected. This can lead to feelings of resentment and make the partners feel emotionally distant.

Reading books or taking courses in couple's communication, or reading books about massage can also encourage feelings of closeness. For some people, reading novels or watching movies with romantic or sexual content also can encourage sexual desire.

Women's sexual desires naturally fluctuate over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause or illness. Some medications used for mood disorders also can cause low sex drive in women.

If you're concerned by your low desire for sex, talk to your doctor. The solution could be as simple as changing a medication you are taking, and improving any chronic medical conditions such as high blood pressure or diabetes.

Desire for sex is based on a complex interaction of many things affecting intimacy, including physical and emotional well-being, experiences, beliefs, lifestyle, and your current relationship. If you're experiencing a problem in any of these areas, it can affect your desire for sex.

"Queer Ecologies must guide the development of our sexual politics, the visions of our environmental activisms, the re-viewing of our biosocial histories, the expansion of our environmental justice initiatives, and the engendering of, as contributor Dianne Chisholm writes, 'an ecological future for queer desire'.Vol. 37, No. 4, Summer 2012"

Explores the subject of desire in modern media and culture. Freud's ideas have had a profound influence on everything from the earliest manuals on public relations to the struggles of modern feminism. We will read a range of psychoanalytic theorists while studying how their insights have been put to work by both the culture industry and its critics. 041b061a72