Biomedical subjects

D D Cooke

Publications and source records attributed to D D Cooke.

5 recordsLinked to original sources

PubMed2001

Psychosocial interventions for caregivers of people with dementia: a systematic review.

The content of interventions for caregivers of dementia patients is highly varied. None of the reviews conducted to date have focused on evaluating the effects of the content of interventions exclusively for dementia caregivers, and this issue is not well understood. The purpose of this review was to first identify the type of components (e.g. education, counselling) that have been utilized in psychosocial/psycho-educational interventions for dementia caregivers, and to evaluate the success of the different components or combination of components in producing positive outcomes for dementia caregivers. Forty studies were included in the review. Approximately two-thirds of the interventions did not show improvements in any outcome measures. Among those studies, which did demonstrate improvements, the inclusion of social components (e.g. social support) or a combination of social and cognitive (e.g. problem solving) components seemed to be relatively effective. It is important to note, however, that these analyses were based on small numbers and the review was limited by a number of methodological issues (e.g. poor description of interventions). To advance our understanding of the efficacy of psychosocial interventions for caregivers of people with dementia, a more systematic approach is required. Intervention components need to be carefully contrasted in appropriately designed studies of sufficient size.

Adaptation, Psychological↗

PubMed1997

Acoustic neuroma surgery: outcome analysis of patient-perceived disability.

OBJECTIVE: Numerous studies have investigated the outcome of acoustic neuroma (AN) treatment using classical medical measures. In an effort to describe the long-term lifestyle consequences of AN removal from the patient's perspective, patients filled out detailed questionnaires concerning their functional status. STUDY DESIGN: This was a retrospective survey. SETTING: This study was performed at a tertiary referral center. PATIENTS: A total of 130 late postoperative acoustic neuroma patients were surveyed a minimum of 6 months following surgery (average, 39 months). Survey response rate was 65% (130/200). MAIN OUTCOME MEASURES: The main outcome measures were the patient's perception of their hearing, balance, facial expression, and eye function in relation to its impact upon the activities of daily life. A comparison of pretreatment with long-term posttreatment functional levels. RESULTS: When asked to designate their "most significant" symptom, hearing loss was by far most prevalent (61.3%), followed by balance troubles (14.3%) and facial weakness (10.1%). The relatively low incidence of facial weakness as the patient's dominant complaint was somewhat surprising. When considering the incidence of each symptom, women were more likely to complain of facial weakness, dry eye, and headache, whereas men had a marginally higher incidence of hearing loss and imbalance. Patient age had no apparent influence upon either the distribution or severity of symptomatic complaints. Both hearing in the tumor ear and overall auditory function (e.g., the ability to understand in a restaurant) tended to worsen following surgery. One finding, which was both unanticipated and intriguing, was the improvement in sound localization ability reported by 57% of patients following surgery. Although the proportion of patients complaining of frequent tinnitus increased postoperatively, the number of patients who found the tinnitus troublesome decreased markedly. In terms of balance function, only 31% preoperatively and 15% postoperatively described themselves as free of balance difficulties. An aid to ambulation (e.g., cane, walker) was needed in five patients (4%) preoperatively, two of whom regained the ability to walk independently following tumor removal. CONCLUSIONS: These functional outcome data provide much useful information to both patient and clinician to consider when contemplating the optimal course of AN management. Although virtually all acoustic neuroma patients have some degree of persistent symptoms over the long-term, the data indicates that most of these are attributable to the tumor itself as opposed to the after effects of its surgical removal. The relatively slight differences between preoperative and late postoperative symptom profiles was a rather unanticipated finding. As the degree of disability tends to increase with larger tumor sizes, these data tend to support a policy of early intervention.

Adolescent↗

PubMed1997

Socioeconomic impact of acoustic neuroma surgery.

OBJECTIVE: This study aimed to assess the impact of acoustic neuroma (AN) surgery on socioeconomic function. STUDY DESIGN: This study was a retrospective postal survey. SETTING: The study was performed at a tertiary referral center. PATIENTS: One hundred thirty late postoperative AN patients were surveyed a minimum of 6 months after surgery (average 39 months). The survey response rate was 65% (130 of 200). MAIN OUTCOME MEASURES: These included effect of AN surgery on employability, income, activities of daily living, social involvement, and psychological well-being. RESULTS: When comparing preoperative occupational status with latest follow-up, 2 of 125 (1.6%) became unemployed from their usual occupations. An additional 15 of 125 (12%) retired, attributing their retirement to the effects of the tumor itself (3), an aftermath of surgery (2), and causes unrelated to their AN (10). After AN removal, two formerly unemployed patients became employed. Among those remaining employed, there was no significant impact of surgery on either income or work responsibility. Return to normal activity was gradual: < or = 6 weeks, 31%; < or = 3 month, 64%; and < or = 6 months, 84%. Among activities of daily living, the tasks most often impaired (both before and after tumor removal) were ladder climbing and night driving, whereas dressing and bathing were seldom problematic. Overall, patients reported a minor decline in ability to perform routine daily activities after tumor removal. Social function (contact with friends, community involvement, and participation in sports) changed little after surgery. The incidence of both stress and depression decreased slightly after tumor removal. CONCLUSIONS: The economic, social, and psychological impact of AN and its surgical management appears to be relatively minor, with few individuals having life altering consequences.

Activities of Daily Living↗

PubMed1995

Implants for cranioplasty.

As long as there have been skull defects, there has been a recognized need to cover them in some way. Cranioplasty is the surgical correction of skull defects. The two major purposes of performing a cranioplasty are to protect the brain and to provide reasonable cosmesis. The two physical requirements of the implant are strength and malleability. Originally, foreign materials such as precious metals were used. Autogenous bone grafts have also achieved successful results. Over the past quarter-century, the popularization of acrylics and radiolucent metals has favored them over bone because of their ease of use, the absence of need to harvest donor bone, and, particularly, bone's tendency to resorb or scar. Yet foreign materials can cause excessive inflammation, producing a synovial membrane at the interface between the host bone and cranioplasty construct, increasing the risk of infection. Currently, hydroxyapatite-based ceramics, which may induce bone growth into the implant, are increasingly being used. Future applications will include antibiotic-impregnated implants and computer-generated models to improve the precision of cranioplasty fit and cosmesis.

Biocompatible Materials↗

PubMed1979

Light scattering and fluorescence by small particles having internal structure.

We consider two related, yet distinct queries: 1. How does the internal morphology of a small particle affect the elastic light scattering signals? We have devised an algorithm, presently accurate for particles comparable only to small biological spheres (diameter less than 1 micron), which suggests that light scattering is sensitive to internal morphology only in the backward directions. Accordingly, observations should be obtained in these directions when probing for internal morphology. 2. How are fluorescent signals affected when the active molecules are variously distributed within small particles? One cannot assume that the fluorescent signals are simply proportional to the number of active molecules contained in the particle because there may also be a dependence upon the geometrical and optical properties of the particle and upon the particular spatial distribution of these molecules within the particle. Indeed, even the measured emission spectrum may be affected by such morphological features. Here, too, these calculations are mainly restricted to small particles (diameter less than 1 micron) in which the fluorescent molecules are isotropic and immobile. Under these conditions the effects are quite dramatic. These effects should be considered in quantitative procedures which utilize fluorescence for determining the concentration of specific molecules in small particles such as biological cells. They may provide a clue for discriminating among cells which differ morphologically or in which the spatial distribution of the fluorescent moiety differs. These effects may be minimized by utilizing a light source which is polarized perpendicularly to the scattering plane.

Cells↗