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D Lindberg

Publications and source records attributed to D Lindberg.

17 recordsLinked to original sources
PubMed2001

2000 200-city survey. Operational & clinical EMS trends in large, urban areas.

The year's survey illustrated ongoing stability with respect to providers and operational approaches, and explored relationships that could provide opportunities for improvement. The continued use of hot response to every request for service is a high-risk response strategy. Today's EMD protocol systems can enable systems to safely prioritize requests for service. Response time performance reported by measure interval and averaged response time, while appearing to follow a rational model for transportation providers, fell short with respect to first responder response times which appeared to have no correlation with response clock start times. A possible explanation for this difference is the lower percentage of first responder agencies that are subject to external response-time performance review. The medical direction results suggest an investment in a full-time medical director could reduce online medical control requirements. The use of handheld computing technology could serve as a vehicle for building accurate clinical databases, as well as a means to deliver DS technology to the patient's bedside. Use of this technology could also improve reimburesment through more accurate reporting. The future of EMS has enormous challenges that must be overcome, especially in light of reduced health-care insurance reimbursements. However, these challenges also present an opportunity for EMS to reinvent itself. The capture and analysis of operational and clinical data by EMS systems will prove essential to understanding what changes can be made to enable them to meet future demands.

Data Collection↗
PubMed1999

Electrocorticographic coherence patterns.

The availability of implantable subdural electrode arrays has made systematic studies of electrocorticographic (ECoG) coherence possible. Studies of coherence patterns recorded directly from human cortex are reviewed along with the presentation of original human clinical data, which reveal reliable and characteristic patterns of coherence. A data-driven technique for discriminating between reliable and unreliable coherence and phase values is described and used to reveal the relationship between coherence and cortical anatomy, such as in the region of the central sulcus, where low phase coherence declines and high phase-shifted coherence increases. Analysis of coherence magnitude and phase makes it possible to determine which signals likely arise from the cortical surface, and which arise from the depths of a sulcus. Alterations in coherence patterns caused by tumors or epilepsy are described and may be used to identify normal and pathological functional relationships between distant cortical areas. Some electrophysiologic/pathologic correlations indicate at least two types of epileptic abnormality, implying a sequence in breakdown of epileptic tissue. The relationship between coherence patterns and behavior and cognition is introduced and compared to similar studies of single-unit binding in animals.

Aphasia↗
PubMed1999

Genetic alterations on 3p, 11q13, and 18q in nonfamilial and MEN 1-associated pancreatic endocrine tumors.

Pancreatic endocrine tumors occur sporadically and as part of the multiple endocrine neoplasia type 1 (MEN 1) and von Hippel-Lindau (VHL) syndromes. The MEN1 locus on 11q13 and a candidate tumor suppressor locus on 3p are known to be hemi- or homozygously mutated in a subset of these tumors. Chromosome arm 18q harbors the SMAD4/DPC4 tumor suppressor gene that is frequently deleted and inactivated in tumors of the exocrine pancreas. We have analyzed 22 nonfamilial and 16 MEN 1-associated pancreatic endocrine tumors for loss of heterozygosity (LOH) at 3p, 11q13, and 18q. LOH at 3p was revealed in 45% and 36% of tumors from 31 patients with nonfamilial and MEN 1-associated disease, respectively. The corresponding proportions for 11q13 were 55% and 91%, and for 18q 27% and 25%, respectively. A striking relation between LOH at 11q13 and 3p and a malignant phenotype was found for the nonfamilial tumors. None of the six benign tumors (all of them insulinomas) had allelic loss at 3p or 11q13, whereas 92% (P < 0.01) of the malignant tumors (including malignant insulinomas) had such deletions. Besides the 11q13 abnormality, more than half of the MEN 1-associated tumors had additional genetic lesions affecting 3p or 18q. LOH analysis of several tumors from two MEN 1 patients suggested different clonal origin of the lesions. Sequencing of the SMAD4/DPC4 gene did not identify mutations in coding regions or at exon/intron boundaries in tumors with LOH at 18q. The data indicate involvement of tumor suppressor genes on 3p and 18q, in addition to the MEN1 gene at 11q13, in the tumorigenesis of both nonfamilial and MEN 1-associated pancreatic endocrine tumors.

Biomarkers, Tumor↗
PubMed1998

Mutation of the multiple endocrine neoplasia type 1 gene in nonfamilial, malignant tumors of the endocrine pancreas.

Endocrine pancreatic tumors are rare neoplasms that occur sporadically or as part of a multiple endocrine neoplasia type 1 (MEN1) syndrome. Germ-line mutations of the MEN1 gene, located at 11q13, have been demonstrated in MEN1 kindreds, and loss of heterozygosity (LOH) on 11q13 together with somatic MEN1 mutations have been detected in 20% of nonfamilial parathyroid tumors. Here, we examine 11 non-MEN1 malignant tumors of the endocrine pancreas, 9 nonfunctioning tumors, and 2 glucagonomas. LOH of at least one informative locus on 11q13 was found in 70% of the tumors. Three tumors displayed somatic mutations of the MEN1 gene together with LOH on 11q13, whereas the corresponding germ-line DNA was normal. These findings support the hypothesis that MEN1 gene mutations contribute to the tumorigenesis of nonfamilial, malignant endocrine pancreatic tumors.

Adult↗
PubMed1998

Parathyroid MEN1 gene mutations in relation to clinical characteristics of nonfamilial primary hyperparathyroidism.

Biochemical signs and severity of symptoms of primary hyperparathyroidism (pHPT) differ among patients, and little is known of any coupling of clinical characteristics of nonfamilial pHPT to genetic abnormalities in the parathyroid tumors. Mutations in the recently identified MEN1 gene at chromosome 11q13 have been found in parathyroid tumors of nonfamilial pHPT. Using microsatellite analysis for loss of heterozygosity (LOH) at 11q13 and DNA sequencing of coding exons, the MEN1 gene was studied in 49 parathyroid lesions of patients with divergent symptoms, operative findings, histopathological diagnosis, and biochemical signs of nonfamilial pHPT. Allelic loss at 11q13 was detected in 13 tumors, and 6 of them demonstrated previously unrecognized somatic missense and frameshift deletion mutations of the MEN1 gene. Many of the detected mutations would most likely result in a nonfunctional menin protein, consistent with a tumor suppressor mechanism. Clinical and biochemical characteristics of HPT were apparently unrelated to the presence or absence of LOH and the MEN1 gene mutations. However, the demonstration of LOH at 11q13 and MEN1 gene mutations in small parathyroid adenomas of patients with slight hypercalcemia and normal serum PTH levels suggest that altered MEN1 gene function may also be important for the development of mild sporadic pHPT.

Adenoma↗
PubMed1989

Effectiveness of a writing system using a computerized long-range optical pointer and 10-branch abbreviation expansion.

Many individuals with limited abilities require specialized technological writing systems. These individuals and the clinicians and engineers who work with them need information regarding the effectiveness of various systems. This study developed a methodology for assessing the effectiveness of a technological writing support system and evaluated its success. The Long-Range Optical Pointer and 10-Branch Abbreviation Expansion System developed at the Trace R&D Center at the University of Wisconsin was used. The study applied a single subject research design: a series of AB replications with naturally-occurring baselines comparing data within subjects across behavior, and across subjects. Behaviors assessed included typing rate, efficiency, and accuracy. The results demonstrate the effectiveness of this system with four individuals with severe physical disabilities and one able-bodied person. Among the data collected, typing rates were found to range from 3 to 15 words per minute, with suspected dependency on familiarity with the system. Discussion highlights the potential benefits of this system and the critical requirement to individually assess a person's needs in order to appropriately select and prescribe these types of technology. The need for further application-oriented single-subject research as well as classical human factors research is emphasized.

Adult↗
PubMed1981

Personality changes in chronic schizophrenic patients during five years' treatment with intensive psychotherapy in combination with depot neuroleptics I. Analysis of changes as measured by the Holtzman Inkblot Technique.

Twelve schizophrenic inpatients (experimental group) from one department of psychiatry were treated in an integrated programme lasting for at least 5 years (1967--1972). Two more patients participated during the last 4 years of the study. The treatment included depot neuroleptics in combination with individual and group psychotherapy. During the first 3 years of the investigation, the patients of the experimental group were urged to participate in individual and group psychotherapy twice a week. During the last 2 years patients were only offered group psychotherapy once a week. A matched sample of 13 schizophrenics (control group) was selected from other departments at the hospital. The main aim of this study was to describe and measure personality changes after this treatment programme as measured by the Holtzman Inkblot Technique. During the first 3 years of the investigation, a stable and continuously improved intellectual capacity and less disordered through processes were found, as measured by the Holtzman test. After a further 2 years a slight decrease in variables measuring intellectual capacity and more disordered thinking was found. Compared to the control group not receiving psychotherapy, the experimental group spent more days outside hospital during the observation period 1968--1975. The difference was not statistically significant, however. After 2 years of treatment the experimental group's of patients Activities of Daily Living (ADL performance) was increased -- at 5% level of statistical significance -- and it remained at about the same level throughout this investigation. The level of work performance, however, was not changed in this study. The patients in the experimental group were compared with two American reference groups; average adults and schizophrenics. After 3 years' treatment the experimental group had become more similar to the average adults than to the schizophrenics. Two years later a slight deterioration was found. Although psychotherapy seemed to have had additive positive effects in chronic schizophrenia, measures to prevent relapse must be considered.

Activities of Daily Living↗
PubMed1981

A controlled study of 5 years' treatment with psychotherapy in combination with depot neuroleptics in schizophrenia. II. Personality changes measured by ten selected Rorschach variables.

Fourteen chronic schizophrenics (experimental group) were matched with 13 schizophrenics (control group), with respect to sex, age, and time of first admission for the disease. The patients in the experimental group were treated with depot neuroleptics in combination with psychotherapy in a 5 year treatment programme. The control group were mainly treated with broad-spectrum neuroleptics and no structured psychotherapy. The main aim of this study was to investigate personality changes in these groups after 5 years' treatment, as measured by ten selected Rorschach (Ro) variables. Five control patients refused to be tested before the study. At the evaluation 5 years later, 3 had committed suicide and one had moved to another town and could not be tested. In the experimental group 1 patient committed suicide. Compared to the results before treatment, the experimental group's mean total scores on the 10 Ro variables after 5 years' treatment were significantly changed in a direction indicative of improvement (p less than 0.001). The control patients changed significantly in a direction indicative of deterioration (p less than 0.02). The differences in mean total scores between the 2 groups were statistically significant (p less than 0.001), in favour of the experimental group. This study has shown improved intellectual capacity, ego-strength and better ability for reality testing when psychotherapy was combined with depot neuroleptics, compared to schizophrenics treated with neuroleptics but no structured psychotherapy.

Antipsychotic Agents↗
PubMed1981

Integrated rehabilitation in schizophrenia. Development of treatment methods and presentation of some results.

The embryo to our integrated treatment programme was "combination treatment in schizophrenia". This combination treatment included behavioural therapy, psychotropic drugs and dynamic psychotherapy. It was also integrated with work therapy and sociotherapy. A number of prospective and retrospective studies for the development work are exemplified. The method of development and method descriptions for above all the psychotherapeutic work are presented. During the years most of the patients have been treated either by D. Lindberg (psychologist) or U. Malm (physician) under the medical responsibility of the head of the department (S.J. Dencker, M.D.). The resulting "integrated treatment programme" is described. The treatment comprises depot neuroleptics in combination with psychosocial measures during a time of two years. During this period the contributions of a head therapist, usually a specially trained psychologist or physician, are coordinated. After a diagnostic phase, including international rating scales and special record keeping, comprising 1--2 weeks, a medical adjustment time and a contact establishing period follows for about 1 month. When the patient is able to stay in an open ward a three months integrated treatment programme in hospital is started. In hospital the patients are either offered group psychotherapy 4 times a week (the "country model") or once a week (the "big city model") in combination with depot neuroleptics and other planned psychosocial methods. Our experiences from a treatment with integrated treatment programme point at the fact that patients with some form of schizophrenic state can live in the society "with a good quality of life". Methods and evaluations of the continued rehabilitation measures are proceeded and like Hogarty et al. (1976) we are looking for new roads.

Activities of Daily Living↗
PubMed1981

Some practical points concerning psychotherapy in the integrated treatment programme during the first 3 months in hospital. Comments on the three detailed descriptions of psychotherapy with schizophrenics.

Some previous studies of individual and group psychotherapy in schizophrenia are presented. A team consisting of a main therapist (usually a specially trained psychologist or social-worker), who works closely with a group leader (usually a specially trained mental nurse) was developed. Together they carried out and monitored the integrated treatment programme in hospital. This programme included intensive psychotherapy, social training, ADL training and a system for evaluation of the treatment process when combined with neuroleptics. Some practical points concerning individual and group psychotherapy with schizophrenics during the first 3 months in hospital are presented. This treatment has been carried out on a routine basis for the last 7 years.

Humans↗
PubMed1979

Symptom reduction in depression after treatment with L-tryptophan or imipramine. Item analysis of Hamilton rating scale for depression.

Thirty-eight in-patients with endogenous- and 20 in-patients with non-endogenous depression, took part in a multi-centre 3-week double-blind trial where patients were randomly allocated to treatment with either 6 g L-tryptophan or 150 mg imipramine daily. Item analysis of Hamilton ratings, before the investigation and weekly during the trial period demonstrated few statistically different mean scores on individual items between the two treatment groups. After 3 weeks' treatment a statistically significant item mean reduction on the 0.1% level was found in the item Agitation in favour of imipramine-treated, and in the item Work and Activities in favour of L-tryptophan-treated endogenously depressed patients. After 3 weeks' treatment a statistically significant item mean reduction on the 5% level was found in the item Suicide in favour of imipramine-treated non-endogenously depressed patients. The present study has shown that, after 3 weeks' treatment, imipramine and L-tryptophan has decreased the mean score on individual items of HRS in about the same degree.

Adolescent↗
PubMed1978

Three years' maintenance neuroleptic treatment in schizophrenia--before and beyond.

A group of patients with schizophrenia, initially 67 patients, was studied over a period of 3 years. After three years 36 out of 67 patients were still on the same depot neuroleptic. The main aim was to describe and compare maintenance neuroleptic therapy using two depot neuroleptics, fluphenazine decanoate and pipotiazine palmitate, given monthly. Before the outpatient care the patients had participated in the department's comprehensive hospital treatment including depot neuroleptic medication. After a 1-year clinical trial with frequent assessments of the patients, significant symptom reductions were found on all rating scales. During the last 2 years of the study only drug therapy was given. Improvement concerning social function in the community and work level as well as the low-rated psychopathology noted at the start of study also persisted at the 3-year follow-up. The side effects were low in frequency and quality. These results show the clinical value of long-term maintenance treatment with depot neuroleptics. The results also confirm that the favourable effects of the hospital treatment demonstrated before the start of the clinical trial could be maintained. The possibilities of further improving aftercare and outpatient treatment beyond medication alone are discussed.

Adolescent↗
PubMed1978

How schizophrenic patients change during 3 years' treatment with depot neuroleptics.

A group of patients, initially 67 individuals, with chronic schizophrenia were studied on repeated occasions during 1 year and followed up after 3 years. The patients were given depot neuroleptics, either fluphenazine decanoate or pipotiazine palmitate, at intervals of 1 month. The symptom scores from three rating scales were subjected to factor analysis. Four factors were found to explain the variance satisfactorily: one comprising psychopathological symptoms specific for schizophrenia, one relating to contact disturbances, one psychomotor activity and one representing neurotic symptoms. Analysis of these factors revealed certain differences between the treatment groups over time and demonstrated the effect of combination of psychotherapy and neuroleptic drugs in a subgroup of patients. This type of analysis of treatment results might contribute to improving our knowledge of rehabilitation of schizophrenic patients and help us to draw up giudelines for selection of suitable measures.

Antipsychotic Agents↗