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Biomedical subjects

K Hodges

Publications and source records attributed to K Hodges.

At least 19 recordsLinked to original sources
PubMed1998

Use of the Child and Adolescent Functional Assessment Scale (CAFAS) as an outcome measure in clinical settings.

This article discusses how the Child and Adolescent Functional Assessment Scale (CAFAS) can be used as an outcome measure in clinical settings. Outcome data from two clinical samples are provided: a small community mental health center located in Michigan and a large referred sample from the Fort Bragg Evaluation Project. Outcome indicators for assessing change over time included overall level of dysfunction, percentage of respondents with severe impairment, mean total score, mean scores for individual CAFAS subscales, and change in total score at the client level. Implications of the findings were discussed from several perspectives: improving services to individual clients, developing databases at the local level that can be used for the agency's continuing self-scrutiny, and pooling databases across sites that can be used to study broader issues within a managed care environment.

Activities of Daily Living↗
PubMed1997

Use of the Child and Adolescent Functional Assessment Scale to predict service utilization and cost.

The Child and Adolescent Functional Assessment Scale (CAFAS) is a multidimensional measure of impairment that assesses the extent of interference in day-to-day functioning secondary to emotional, behavioral, or substance use problems. Respondents were 984 youths, aged 5 to 17, who were referred for mental health services. They were assessed at intake and at 6 and 12 months postintake with a battery of measures administered by evaluation staff who were independent of treatment. Utilization indicators included restrictiveness of care, total cost, number of bed days, and total number of days of service received. The CAFAS total score at intake was a significant predictor of service utilization and cost determined at 6 and 12 months postintake. The CAFAS score was also the best predictor when compared with other measures of psychopathology. Only the CAFAS and presence of conduct disorder contributed to the prediction of service utilization and cost at 12 months.

Adolescent↗
PubMed1994

Platelet alpha 2-adrenergic receptor binding and the effects of d-amphetamine in boys with attention deficit hyperactivity disorder.

Presynaptic inhibitory alpha-adrenergic receptors are involved in regulating the release of norepinephrine (NE) through a negative feedback mechanism mediated by NE. Increased alpha2-adrenergic receptor activity suggests decrease NE release and activity, while decreased alpha2-adrenergic activity suggests increase NE release and activity. A large body of evidence suggests the involvement of a disturbance in NE activity in the pathophysiology of attention deficit hyperactivity disorder (ADHD) in childhood. Platelet alpha2-adrenergic receptor binding was compared in 23 boys aged 7-12 with the diagnosis of ADHD and 11 normal controls. The ADHD boys tended to have lower levels of alpha2-binding than controls. The administration of d-amphetamine in a double-blind placebo-controlled crossover design did not have any effect on alpha2-receptor binding in ADHD boys. Nonresponders to d-amphetamine had the lowest alpha2-receptor binding compared to responders and controls. These findings suggest a normal alpha2-adrenergic activity in ADHD boys responders to d-amphetamine and a possible increase in NE release in ADHD boys nonresponders to d-amphetamine due to decreased alpha2-adrenergic receptors.

Attention Deficit Disorder with Hyperactivity↗
PubMed1993

Structured interviews for assessing children.

Structured interviews provide a valuable means of obtaining and quantifying information about the mental status of children. This review indicates that children can reliably self-report and that the information they provide can concur with the opinion of adults knowledgeable about them. However, considerably more research is warranted before it may be assumed that these interviews are adequately reliable and valid. In general, it appears that the task of documenting the psychometric soundness of these interviews has not been taken seriously, as if content validity were sufficient. For example, except for the CAS and the DISC, there has been little effort to study contrast group validity (i.e. whether the interview even differentiates "known groups"). More specifically, review of the reliability and validity data relevant to DSM-III-R diagnoses provides support for the CAS, DICA, ISC and K-SADS, with the validity data for the DICA being weaker than for the others. One limitation of these data for the DICA, ISC and K-SADS is that the diagnoses were clinician-generated, rather than algorithm-generated. Unfortunately the processes for generating clinical diagnoses were not specified, except for criterion reference to DSM-III-R. The findings for the DISC and the DISC-R are notably weak. There is no evidence for DISC reliability, except for adolescents, and the validity studies have demonstrated only weak relationships. There has been limited study of the psychometric properties of symptom scales. In fact, for two interviews (i.e. DICA and ISC), there are no data available. Reliability for the DISC scales is adequate only for adolescents. Psychometric data have been generated for the CAS and the K-SADS, with considerably more studies conducted with the CAS. The relative paucity of interest in scale scores is striking given that they provide a continuous variable which can indicate extent of symptoms. Other measures of mental status, besides presence/absence of diagnosis, will become increasingly important as research in child psychopathology progresses toward more sophisticated studies (i.e. treatment effects, risk factors). These interviews are labor intensive and costly to the researcher as well as time-consuming and tedious for the children and parents. Given this commitment, researchers should invest in developing other ways of exploiting the richness of the data generated. An example is the CAS "content" scales, which generate scores reflecting on the child's functioning in various areas (e.g. school, friends, family). As the evolution of these interviews continues, it will be important to remain attentive to the developmental limitations of children.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

Computer-assisted work station timing analysis of instrument labor efficiency.

Labor use ratings assigned to instruments by the Workload Recording Method (WRM) do not change with batch size or walk-away time use. The authors evaluated the effect of both on the labor use of the analyzers Paramax B6100 (Baxter Paramax, Irvine, CA) and Ektachem 700 (Eastman Kodak, Rochester, NY) by timing all worked and walk-away intervals on both instruments. Extrapolation of the data to a workload of slightly more than 1.1 million tests showed that reapportionment of tests to various batch sizes caused Paramax-Ektachem labor cost differences to fluctuate between $37,254 and $34,995. When the minimum usable walk-away interval length was varied from 1 to 20 minutes, Ektachem savings over Paramax increased from $8,700 to $61,400. The WRM predicted a constant $29,050 labor cost advantage for Ektachem over Paramax. If other instruments show similar labor use characteristics with respect to batch size and walk-away utility, laboratory managers who do not consider these factors may fail to select the most cost-effective instruments for their laboratories.

Computer Systems↗
PubMed1991

Surgical management of intractable seizure disorders.

The surgical treatment of intractable seizures is still regarded by some as an experimental procedure with questionable rationale. However, in centers where care is taken in the selection process and facilities are available for adequate diagnosis, the procedure has been successful in complete alleviation of seizures in some cases. The decision about surgical interventions for epilepsy is never an easy one. Potential surgical candidates are evaluated by a team of specialists and undergo numerous diagnostic tests and examinations before a decision for surgery is made. It is essential for the neuroscience nurse to have knowledge of the underlying etiology of seizures, diagnostic testing and surgical procedures in order to effectively care for the seizure patient pre- and postoperatively. With this knowledge, nursing management becomes a vital part in the total treatment of the seizure patient.

Epilepsy↗
PubMed1990

Intellectual ability and achievement in psychiatrically hospitalized children with conduct, anxiety, and affective disorders.

The IQ and academic achievement of psychiatrically hospitalized children were studied. The sample consisted of 76 children, with a mean age of 10 years, who received diagnoses of conduct, oppositional, anxiety, and affective disorders on the basis of a structured diagnostic interview. A relative deficit in verbal abilities was observed for conduct-disordered children, extending to pre-adolescents the findings previously obtained for adolescent delinquents. Depressed children were characterized by underachievement, which is consistent with the learned helplessness literature. Contrary to expectations, children with an anxiety disorder had a lower IQ than children without the disorder. No cognitive deficits were observed for children diagnosed as oppositional.

Achievement↗
PubMed1990

A matched comparison of adjustment in children with cystic fibrosis and psychiatrically referred and nonreferred children.

Utilized the Child Assessment Schedule, a standardized clinical interview, to assess psychosocial adjustment in terms of DSM-III diagnoses. The criteria for a major DSM-III diagnosis were met by 58% of the children with cystic fibrosis compared to 23% for the nonreferred children and 77% for the psychiatrically referred children. Children with cystic fibrosis generally did not demonstrate more symptoms of psychological disturbance than nonreferred children. It was in terms of worries, poor self-image, and anxiety, that the children with cystic fibrosis demonstrated symptom levels comparable to that of psychiatrically referred children. Findings are discussed in terms of the specific risk of internalizing behavior problems for children with chronic illness.

Adaptation, Psychological↗
PubMed1990

Internal consistency of DSM-III diagnoses using the symptom scales of the Child Assessment Schedule.

Internal consistency of the major diagnostic categories for children was assessed, using the symptom scale scores of the Child Assessment Schedule. Alpha coefficients were calculated for three samples: 116 nonpsychotic psychiatrically disturbed children, 63 children with cystic fibrosis, and 177 children from a community based sample. For the psychiatric sample, a high level of internal consistency was demonstrated for all the symptom scales (i.e., attention deficit, conduct, anxiety, and depression). For the nonpsychiatric samples, the attention deficit and depression scales were reliable, with lower levels of endorsement and more variability observed for the other scales. These results are supportive of the clustering of diagnostic criteria present in DSM-III.

Adolescent↗
PubMed1990

Parent-child agreement on symptoms assessed via a clinical research interview for children: the Child Assessment Schedule (CAS).

This study examined the relationship between symptom type and parent-child agreement, as reflected in symptom scores on a structured diagnostic interview, the Child Assessment Schedule (CAS). Forty-eight psychiatric inpatients (mean age 10 years) were administered the CAS. Their mothers were interviewed independently with the parent form. The average time between interviews was 12 days. High parent-child agreement was found for conduct/behavioral problems and moderate agreement for affective symptoms. Parents reported more conduct-related problems; children reported more anxiety and somatic symptoms and more family problems. The pattern of parent-child differences was the same as observed for other interviews.

Adolescent↗
PubMed1990

Transcranial Doppler pulsatility in vasodilation and stenosis.

Although blood velocity in the major intracranial vessels is readily measured with transcranial Doppler ultrasound (TCD), the interpretation of velocity changes is by no means straightforward. For example, a velocity increase can arise from either a local stenosis or a decrease in downstream resistance, and these mechanisms have contradictory implications for blood flow. To determine whether TCD pulsatility might distinguish these two mechanisms, Doppler ultrasonic readings were taken from an artificial vascular model under conditions of either stenosis or distal dilation. In addition, TCD studies of nine patients with unihemispheric arteriovenous malformations (AVM's) and 16 TCD studies of seven patients with unihemispheric aneurysmal vasospasm were reviewed, and pulsatilities of the AVM's (representing decreased resistance) were compared with those of the vasospastic vessels (representing stenosis). The average percentage drop in pulsatility in the vasodilated configuration of the model/percentage increase in velocity was 0.38 +/- 0.08 (+/- standard error of the mean), while that for stenosis was 0.20 +/- 0.01. Similar comparisons of the patient population yielded 0.67 +/- 0.16 for the AVM group and 0.26 +/- 0.04 for the vasospasm group. These differences were significant (p less than 0.05). The fall in pulsatility associated with a given increase in velocity is significantly greater when the velocity increase arises from diminished downstream resistance than from stenosis.

Cerebrovascular Circulation↗
PubMed1990

Intracarotid hydroxyethyl methacrylate solution causing stroke in dogs.

Hydroxyethyl methacrylate (HEMA) has been advocated as a polymerizing solution with which to prevent deflation of detachable balloons in interventional neuroradiology. It is pertinent to know if unpolymerized HEMA would have untoward effects if accidentally released into the carotid artery by balloon rupture or deflation. Seven mongrel dogs underwent transfemoral catheterization of the common carotid artery and subsequent injection of HEMA solution in volumes of 1 cc in five dogs, 2 cc in one, and 4 cc in one. Angiography performed at the time of injection revealed evidence of intravascular thrombosis as well as possible spasm. Three surviving animals were sacrificed at 48 hours; the brains were fixed and examined histopathologically. One brain was normal and one was autolyzed and could not be examined. Five of the seven animals had histopathologically documented cerebral infarctions of varying size. No foreign substance was seen within the blood vessels to suggest intravascular polymerization. The animals injected with 2 or 4 cc HEMA solution did not survive 48 hours. Literature review reveals little documentation of the toxicology of intravascular HEMA. With its increasing popularity as a compound for polymerization in detachable balloons introduced into the brain, further investigations are warranted to understand the physical properties of the compound and potential risks of its use.

Animals↗
PubMed1989

Internal consistency of a diagnostic interview for children: the Child Assessment Schedule.

The purpose of this study was to evaluate the internal consistency of the content scales of the Child Assessment Schedule (CAS). A total of 116 psychiatric patients with a mean age of 10 years were administered the interview, and 92 parents were administered the parent version. Coefficient alpha was calculated for each of the 11 content scales. High internal consistency was demonstrated for school, friends, worries, mood, physical complaints, and expression of anger. More moderate but acceptable alphas were observed for the family, fears, and self-image scales. The same general pattern of results was observed for both the child and parent interviews. Additional analyses revealed that the number of items in the CAS could be reduced up to 30% without sacrificing internal consistency. These results indicate that 9 of the scales yield reliable scores.

Child↗
PubMed1989

Meningioma, astrocytoma and germinoma: case presentations of three intracranial tumors.

In this article three intracranial tumors are described including signs, symptoms and radiologic findings. Two of the more common tumor types are discussed--meningioma and astrocytoma, along with one less common type, the germinoma. The germinoma with its less common features provides an interesting comparison. Each tumor is exemplified using case presentations. The neuroscience nurse, in understanding the mechanisms by which these tumors manifest themselves, will be better able to predict treatment, outcome and correlate nursing care as necessary.

Adult↗
PubMed1989

Reversible middle cerebral artery embolization in dogs without intracranial surgery.

Using dogs, we developed an intravascular model for reversible middle cerebral artery occlusion that does not involve intracranial surgery or enucleation. Using silicone plastic plugs with a suture embedded within them, we embolized the middle cerebral artery in 19 dogs via the cervical carotid artery. The free end of the suture remained accessible in the neck, and after variable dwell times traction was placed on the suture and the plug was withdrawn. Placement of the plug in the middle cerebral artery produced ischemia in the basal ganglia. The degree and distribution of cortical ischemia were variable as evidence by the pathologically documented scattered nature of infarcts that resulted when the plug was left permanently in the middle cerebral artery and when it was removed after 1 or 2 hours. Angiography demonstrated occlusion of the middle cerebral artery with the plug in place as well as reperfusion when the plug was withdrawn. This modification of a previously described model of middle cerebral artery occlusion provides an opportunity to study structural, physiologic, and biochemical events occurring in acutely hypoperfused cerebral tissue as well as critical changes leading to irreversible injury without the disadvantages of surgical manipulation required by all previous models of reversible cerebral ischemia.

Animals↗