PubMed Health⌕ Search

Biomedical subjects

J F Malec

Publications and source records attributed to J F Malec.

29 records · Page 2Linked to original sources
PubMed1991

Age-associated memory impairment diagnoses: problems of reliability and concerns for terminology.

Objective memory criteria for diagnosing age-associated memory impairment (AAMI), age-consistent memory impairment, and late-life forgetfulness (LLF) were applied to 523 cognitively normal older persons divided into 2 groups on the basis of the clinical memory assessment battery they received. Seventy-seven percent of Group 2 and 98% of Group 1 met the Crook et al. (1986) cognitive criteria for AAMI on at least 1 test. Rates based on individual tests varied from 7% to 96%. Objective-cognitive criteria for LLF were met by no members of Group 1 but by 31% of Group 2. Results suggest that, as proposed, the criteria for age-related diagnoses lack reliability. Concerns regarding the diagnosis of normal memory in older populations are considered.

Aged↗
PubMed1991

Goal attainment scaling and outcome measurement in postacute brain injury rehabilitation.

Relationships among two-month and final goal attainment scaling (GAS) scores, preadmission and final Portland Adaptability Inventory (PAI) scores, and work outcome for 16 graduates of a comprehensive, postacute brain injury rehabilitation program were examined. Final GAS scores were higher for program graduates who obtained the most desirable work outcomes, and preadmission and final PAI scores were lower for the successful program graduates. Final GAS scores were significantly correlated with other outcome measures. Preadmission PAI scores predicted work outcome, and two-month GAS scores predicted final GAS scores. Initial PAI scores distinguished between program successes and failures, but not between program successes and dropouts. A brief look at one case illustrates the modified application of GAS in postacute brain injury rehabilitation. Results of this study and case analyses support GAS as a quantifiable, individualized measure that is useful for (1) monitoring patient progress, (2) structuring team conferences, (3) ongoing rehabilitation planning and decision-making, (4) concise, relevant communication to family, referral sources, and funding sources, and (5) overall program evaluation when used in the context of other objective outcome measures. Although our results support the clinical utility of GAS, further study is recommended to assess the psychometric characteristics of GAS in this application.

Adult↗
PubMed1990

Psychological and mood disturbance associated with the diagnosis and treatment of testis cancer and other malignancies.

Eighty-seven men with testis cancer (TC) and 35 men with other cancers (OC) completed measures of mood (Profile of Mood States) and of personality and psychopathology (Millon Clinical Multiaxial Inventory). Effects of primary disease, phase of diagnosis and treatment, locoregional vs. cytotoxic treatment, age, and marital status on these measures were examined. TC patients appeared more distressed during treatment, particularly during cytotoxic as compared to locoregional treatment, than before or after treatment, and more distressed than OC patients. Being married appeared to buffer the stress of cancer and its treatment. Although treatment, particularly cytotoxic therapy, appeared to result in transient distress, results did not offer strong evidence that cancer and its treatment typically precipitate severe psychopathology.

Adaptation, Psychological↗
PubMed1990

Types of affective response to stroke.

Most studies of depression after stroke have included heterogeneous samples of patients. These studies have generally not qualified patients as to age, absence of neurologic, psychiatric, and substance abuse histories, and other complicating factors. Of 155 inpatient rehabilitation admissions after acute unilateral cerebrovascular accident, only 26 met the following strict criteria for inclusion: age older than 55 years, no history of or concomitant brain disease or injury, and no history of major affective, thought, or substance abuse disorder. Two examiners independently administered the Hamilton Depression Rating Scale, a mood adjective checklist, and a modified Mini-Mental State Examination to 20 subjects who agreed to participate. They also rated subjects on research diagnostic criteria for depression and obtained a dexamethasone suppression test for each subject. Eighteen subjects completed neuropsychologic evaluation. All evaluations were completed within six weeks of the patient's stroke. Subjects fell into four distinct clinical groups based on averaged data: (1) no affective symptoms, (2) verbal distress only, (3) vegetative symptoms only, and (4) a combined disorder with both distress and vegetative symptoms. The presence of verbal reports of distress, vegetative signs, or both were associated with longer hospital stays and greater neuropsychologic impairment.

Affective Symptoms↗
PubMed1989

Psychosexual adaptation to breast cancer surgery.

Disturbances associated with a breast cancer diagnosis were defined when psychological assessments from 63 patients with a known breast cancer diagnosis were compared to those from 56 patients with an as yet undiagnosed malignancy. Subsequent assessments from the 56 patients with an undiagnosed breast cancer showed disturbances after they saw a physician compared with the assessments from 72 similar patients ultimately diagnosed as benign. Apprehension apparently arose from clues given before a biopsy was done even though the cancer was not yet diagnosed. Compared with the benign breast disease group, the disturbances in patients suspected or diagnosed with breast cancer were found chiefly in assessments of mood and adjustment, and less in assessments of more durable characteristics of personality, psychopathology, and sexual behavior. Psychological problems associated with breast cancer decreased over time, but residuals persisted for at least 16 months postoperatively. Few differences were found between 41 patients who elected breast-conserving surgery and 78 who were treated with mastectomy. Problems were not eliminated by operations which saved the breast.

Adaptation, Psychological↗
PubMed1987

Factors influencing options in primary breast cancer treatment.

Primary breast cancer treatment is determined by tumor factors and by patient preference. Breast cancer treatments that preserve the cosmetic appearance of the breast are appealing and effective for appropriately selected patients; long-term survival following tumor excision and breast irradiation appears to be comparable to that for mastectomy. Since April 1981, when a protocol was developed and treatment options were offered, factors influencing treatment selection have been analyzed in 206 consecutive primary breast cancer patients. Mastectomy was dictated by tumor-related factors in 96 patients (47%); 110 patients (53%) had the option of mastectomy or conservation--tumor excision plus radiotherapy to the breast. Among these 110 eligible patients, 54 chose conservation (49%) and 56 chose mastectomy (51%). Intraoperative findings for ten patients electing conservation necessitated mastectomy, so conservation was accomplished for 44 (21%) of those treated for breast cancer. Beginning in July 1982, breast cancer patients took a battery of psychosexual assessments before any operation (Profile of Mood States [POMS], Health Locus of Control Scale [HLCS] Locke-Wallace Marital Adjustment Test [MAT], Psychosocial Adjustment to Illness Scale [PAIS], Derogatis Sexual Function Inventory [DSFI], Millon Clinical Multiaxial Inventory [MCMI], and a Breast Cancer Information Test [BCIT]). Comparisons of psychologic and demographic variables were made between patients who chose mastectomy and those who chose conservation. No demographic variable was statistically significantly related to choice, although older women tended to select mastectomy more than younger women. Compared with those who elected conservation, women who elected mastectomy were more tense and anxious (P less than .01), more introverted (P less than .01), felt more depressed and dejected (P less than .05), and reported more sexual problems (P less than .05). Those who elected conservation valued their physical appearance more highly (P less than .01) and were generally more self-interested (P less than .05). Mastectomy was dictated by medical considerations for approximately half of patients with breast cancer. Among candidates for breast conservation, the importance of retaining the breast appeared to be determined to a significant degree by measurable psychological factors.

Body Image↗
PubMed1986

Psychological distress among women with breast problems.

Visiting a physician for evaluation of a breast problem which could be cancer is often assumed to be a highly stressful experience. This study evaluates the degree of emotional distress in women about to undergo examination for signs or symptoms of breast disease. Three hundred twenty-two women who attended the Breast Problem Clinic of the Wisconsin Clinical Cancer Center were studied. Each patient completed standard self-administered psychologic tests to evaluate mood disturbance (Profile of Mood States [POMS]) and responsibility taken for overall health care (Health Locus of Control [HLCS]). Results of these tests were compared to control populations of normal college women and female psychiatric outpatients. The women seen in the Breast Problem Clinic were significantly less distressed on POMS subscales which measure depression, anger, fatigue, and confusion than both psychiatric outpatients and normal college women (P less than 0.001). A second group of 17 women who were seen in the hospital 24 to 48 hours before definitive breast cancer surgery were also studied. Women evaluated as inpatients before breast cancer surgery were more distressed than the women attending the outpatient clinic on most POMS subscales, but were not clearly different from normal college women. No differences between the groups were seen for the HLCS. These data indicate that emotional distress among women attending a breast problem clinic is not extraordinary, but that emotional distress heightens when the diagnosis of breast cancer is known.

Breast Neoplasms↗
PubMedDate not supplied

Physical and psychological outcome after burns.

The relationship between compliance of moderately or severely burned patients with suggested plans of treatment and outcome was examined retrospectively by reviewing medical records. This review was limited to patients admitted to our facilities between 1977 and 1982 with burns in the moderate or major burn category and admitted within seven days of their injuries. The outcome measures included the following: limitation in range of motion (ROM), hypertrophic scar formation, total days of care required, quality of life, and impact of event. Noncompliance was related to the outcome as measured by limitation in ROM (P less than 0.01) and total days of care required (P less than 0.0001). A trend for diminished quality of life was related to noncompliance (P less than 0.08). Extent of injury (measured by total body surface area involved) was not related to ROM, quality of life, or impact of event but was related to total days of care required (P less than 0.01); there was also a trend toward scarring (P less than 0.06).

Activities of Daily Living↗
PubMedDate not supplied

Outcome evaluation and prediction in a comprehensive-integrated post-acute outpatient brain injury rehabilitation programme.

Outcomes for 29 individuals with brain injuries (BI) were examined following a comprehensive-integrated rehabilitation programme. From programme admission to completion, proportion living with no supervision increased from 59% to 93%; proportion in transitional or competitive work placements increased from 7% to 59%; unemployment decreased from 76% to 31%. Significant changes in behaviour and functional abilities and achievement of individual goals were also documented with the Portland Adaptability Inventory (PAI) and Goal Attainment Scaling. One year follow-up of 21 graduates indicated general maintenance of gains in independent living and work. At follow-up 86% were living without supervision; 48% were in competitive work; one in transitional work; and 29% unemployed. Although individuals entering treatment less than 1 year after injury showed greater gains than those injured more than 1 year prior to admission, both early and late intervention groups showed significant changes on outcome measures. More extensive disabilities as measured by the PAI had a negative impact on programme outcome. Except for reading ability, neuropsychological measures obtained prior to admission did not significantly predict outcome. Programme costs are reported. Results indicate that the group-oriented comprehensive-integrated approach to post-acute brain injury rehabilitation is effective and cost-effective, and recommend early intervention for optimal outcomes.

Activities of Daily Living↗
PubMedDate not supplied

Ethics in brain injury rehabilitation: existential choices among western cultural beliefs.

The following issues in the practice of brain injury rehabilitation are explored: (1) validity of support for efficacy based on experience in clinical practice, (2) validity of support for efficacy based on research, (3) consumer protection, (4) qualifications and regulation of individual providers, (5) regulation of programme development and marketing. Ethical responses to these issues from each of three cultural belief systems (humanism, science and self-interest) are examined from a metaphilosophical perspective based on contemporary cognitive psychology and on philosophies of social constructionism and existentialism.

Biomedical Research↗