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Biomedical subjects

Robert Savage

Publications and source records attributed to Robert Savage.

17 recordsLinked to original sources
PubMed2006

Echocardiographic predictors of successful versus unsuccessful mitral valve repair in ischemic mitral regurgitation.

Mitral valve (MV) annuloplasty is the standard surgical technique for the management of ischemic mitral regurgitation (MR). However, < or = 1/3 of patients develop recurrent MR after annuloplasty. Therefore, we sought to identify the preoperative echocardiographic parameters that predict annuloplasty failure in patients with ischemic MR. Intraoperative transesophageal echocardiograms from 365 patients who underwent MV repair for ischemic MR were reviewed. Of the 365 patients, 297 (81%) had satisfactory outcomes with < 2+ MR, and 68 (19%) had recurrent MR (> or = 2+) during a mean follow-up of 269 days. The mitral annular parameters, including mitral annular diameter, tethering height, and tethering area of the mitral leaflets, were determined in 3 different echocardiographic views. On multiple logistic stepwise regression analysis, a higher mitral annular diameter, higher tethering area, and higher MR severity were identified as independent predictors for failure of MV repair (p < 0.0001). In conclusion, these results demonstrated that preoperative echocardiographic findings can be used to identify patients with ischemic MR at increased risk of repair failure. These echocardiographic measurements should be used to guide the cardiologist and cardiac surgeon in the choice of MV repair versus replacement in patients with ischemic MR.

Adult↗
PubMed2006

Efficacy of risperidone versus olanzapine in patients with schizophrenia previously on chronic conventional antipsychotic therapy: a switch study.

The objective of the study was to examine whether patients with schizophrenia who were judged to be stable on long-term treatment with conventional antipsychotic medications would further benefit from a switch to an atypical antipsychotic drug. Thirty-six subjects with schizophrenia spectrum disorder, on conventional antipsychotic medication therapy for at least 2 years, were randomized in double-blind fashion to risperidone versus olanzapine. Patients were titrated up to 6 mg risperidone or 15 mg olanzapine as tolerated, followed by tapering and discontinuation of conventional antipsychotic medication. Atypical antipsychotic agents were then administered alone (monotherapy) for 12 weeks. Efficacy and tolerability were assessed using the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale, and Simpson Angus Scale. Body weight was measured at each visit. Both treatment groups exhibited marked and similar improvement in the total PANSS score from baseline to study endpoint (22 weeks) [risperidone: baseline=59.3 (SE 3.1), 22 weeks=44.3 (SE 2.3) (p<0.001); olanzapine: baseline=55.9 (SE 3.3), 22 weeks=46.9 (SE 3.2) (p<0.001). Both groups also exhibited significant reductions in PANSS factor scores for positive and negative symptoms and disorganized thoughts. Only risperidone-treated patients exhibited significant decreases in uncontrolled hostility/excitement and anxiety and depression. Of note, while positive factor scores exhibited the majority of change within the first 10 weeks, negative factor scores continued to decline significantly in both treatment groups throughout the study. Tolerability assessments did not differ between groups. The results indicate that both atypical antipsychotic medications provided significant additional improvement in symptom severity in patients with schizophrenia previously on conventional antipsychotic agents.

Adult↗
PubMed2006

Rimes are not necessarily favored by prereaders: evidence from meta- and epilinguistic phonological tasks.

This article explores young children's facility in phonological awareness tasks requiring either the detection or the articulation of head, coda, onset, and rime subsyllabic units shared in word pairs. Data are reported from 70 nonreading children and 21 precocious readers attending preschools. Prereading children were able to articulate shared heads, codas, and onsets, although rimes rarely were articulated. Precocious readers were able to articulate shared rimes, but articulation performance was still most accurate for onsets and codas. Rimes and heads were equally accessible in the detection task and were identified more often than onsets and codas (nonreaders) and codas (readers). It is concluded that the articulation advantage for nonrime units cannot simply reflect early reading instruction. This disjoint pattern of phonological awareness in detection and production tasks does not support Goswami's phonological status hypothesis. Results may instead reflect quite distinct influences on epilinguistic and metalinguistic phonological development.

Analysis of Variance↗
PubMed2006

Cognitive processes in children's reading and attention: the role of working memory, divided attention, and response inhibition.

Children experiencing attention difficulties have documented cognitive deficits in working memory (WM), response inhibition and dual tasks. Recent evidence suggests however that these same cognitive processes are also closely associated with reading acquisition. This paper therefore explores whether these variables predicted attention difficulties or reading among 123 children with and without significant attention problems sampled from the school population. Children were screened using current WM and attention task measures. Three factors explained variance in WM and attention tasks. Response inhibition tasks loaded mainly with central executive measures, but a dual processing task loaded with the visual-spatial WM measures. Phonological loop measures loaded independently of attention measures. After controls for age, IQ and attention-group membership, phonological loop and 'central processing' measures both predicted reading ability. A 'visual memory/dual-task' factor predicted attention group membership after controls for age, IQ and reading ability. Results thus suggest that some of the processes previously assumed to be predictive of attention problems may reflect processes involved in reading acquisition. Visual memory and dual-task functioning are, however, purer indices of cognitive difficulty in children experiencing attention problems.

Attention↗
PubMed2006

African-American community attitudes and perceptions toward schizophrenia and medical research: an exploratory study.

INTRODUCTION: Ensuring adequate representation of all demographic groups in medical research is necessary in order to ensure that the benefits associated with participation are equitably shared. Mental health research is unique in that the stigma associated with mental illness, such as schizophrenia, further hinders participation. Using focus groups, we set out to explore the attitudes and views of African Americans with regard to schizophrenia and medical research. METHODS: Four focus group discussions were conducted, with 23 participants divided into two groups of working and retired adults, and two groups of full- and part-time students selected from inner-city residents of Birmingham, AL, and surrounding counties. Data obtained were analyzed using the content analysis method. RESULTS: Diverse views were expressed about the cause of mental illness, and much of this was influenced by cultural beliefs. There was considerable misunderstanding of schizophrenia, and the majority of participants described the disease in terms of positive symptoms only. Whereas for older participants the Tuskegee syphilis study experience was an important factor in their reluctance to participate in medical research, younger participants expressed no knowledge of the study. Among younger participants an assumed level of social distrust was evident, with prominent fear of participating in research that employs physically intrusive methods. CONCLUSION: The provision of accurate information through trusted community sources and open dialogue will help to dispel myths, correct faulty assumptions and increase African-American participation in schizophrenia research.

Black or African American↗
PubMed2005

Financial capacity in persons with schizophrenia and serious mental illness: clinical and research ethics aspects.

In contrast with issues of consent capacity, financial capacity has received surprisingly little clinical or ethical attention in the psychiatric literature. Issues of financial capacity emerge frequently regarding clients with serious mental illness (SMI), and their resolution has practical and ethical significance for clients, their families, and mental health professionals. These issues include whether a client has sufficient financial skills and judgment to live independently, whether a client requires a representative payee, and what goals for community reintegration should be established with a client. Similar to informed consent, issues of financial capacity raise ethical challenges for clinicians, caseworkers, and agencies. The present article addresses clinical and research ethics questions related to financial capacity in clients with schizophrenia and SMI. Clinical questions concern evaluation of financial capacity in clients with SMI, whether to seek assignment of a mandatory representative payee, whether to leverage treatment compliance through a representative payee arrangement, and whether a mental health professional should also serve as a client's representative payee. The research ethics question addresses implications of providing financial compensation for research participation to individuals with SMI and limited financial capacity and means. The ultimate goal of this article is to focus clinical and ethical attention on a neglected decisional capacity in SMI that is of fundamental importance for clients, families, clinicians, and researchers.

Biomedical Research↗
PubMed2005

Evidence of a highly specific relationship between rapid automatic naming of digits and text-reading speed.

This paper explores the specificity of the relationship between rapid automatic naming and reading fluency. Reading accuracy, rate, and fluency was measured among a sample of 67 children, the majority of whom were very poor readers. Regression analyses revealed that phonological processing tasks predicted reading accuracy and comprehension whereas rapid digit (but not picture) naming predicted reading accuracy and rate. After further controlling reading accuracy, digit naming was still a significant predictor of reading rate. This suggests that rapid alphanumeric naming is a highly specific predictor of reading rate and that rapid digit naming and phonological processing are distinct contributors to different aspects of reading in poor readers.

Automatism↗
PubMed2005

Phoneme manipulation not onset-rime manipulation ability is a unique predictor of early reading.

BACKGROUND: Phonological awareness is known to be an excellent predictor of later reading acquisition. It remains unclear, however, whether phoneme manipulation alone best explains this association or whether an additional direct contribution of onset-rime awareness is predictive. This issue is explored here. METHOD: A longitudinal study is reported predicting national test and teacher-assessed performance of 351 children aged 7 from phonological awareness measures, pupil baseline attainment and background measures at age 5. RESULTS: Explicit phoneme manipulation skills at age 5 correlated most strongly with literacy skills at age 5. Phoneme manipulation at age 5 predicted all four reading measures taken at age 7 after pupil background, baseline data and onset-rime awareness were controlled in regression analyses. Onset-rime manipulation did not predict reading at 7 in parallel analyses. After controlling for initial reading at age 5, phoneme manipulation still predicted reading comprehension, and teacher-assessed reading and writing at age 7. CONCLUSIONS: Results support the existence of a route from phoneme manipulation, but not an additional direct route from explicit onset-rime manipulation at 5, to reading at 7. Practically, findings show that professionals can augment baseline and pupil background data with phoneme manipulation screening in the early identification of learning needs.

Aptitude↗
PubMed2005

Evaluating current deficit theories of poor reading: role of phonological processing, naming speed, balance automaticity, rapid verbal perception and working memory.

To clarify the nature of cognitive deficits experienced by poor readers, 9-10-yr.-old poor readers were matched against 9 chronological age and 9 younger reading age-matched controls screened and selected from regular classrooms. Poor readers performed significantly more poorly than chronological age-matched peers on digit naming speed, spoonerisms, and nonsense word reading. Poor readers were also significantly poorer than reading age-matched controls on nonword reading but were significantly better than reading age-matched controls on postural stability. Analyses of effect sizes were consistent with these findings, showing strong effects for digit naming speed, spoonerisms, and nonword reading. However, effect size analysis also suggested that poor readers experienced moderate difficulties with balance automatisation but did not show verbal speech perception deficits relative to either control

Child↗
PubMed2004

Predicting curriculum and test performance at age 7 years from pupil background, baseline skills and phonological awareness at age 5.

BACKGROUND: Phonological awareness tests are known to be amongst the best predictors of literacy; however their predictive validity alongside current school screening practice (baseline assessment, pupil background data) and to National Curricular outcome measures is unknown. AIM: We explored the validity of phonological awareness and orthographic measures, the Infant Index baseline assessment (Desforges & Lindsay, 1995), gender, free school dinners, and SEN status taken at age 5 in the prediction of English, Maths, and Science performance in Key Stage 1 of the National Curriculum in England. SAMPLE: 435 children from nine schools in one Local Educational Authority (LEA) were screened at entry aged 4 or 5, and at 5:8, and age 7. METHOD: We trained schools Learning Support Assistants (LSAs) to administer orthographic and phonological awareness measures. Teachers collected data on all baseline and Key Stage 1 performance measures. RESULTS: A series of 13 logistic regression analyses revealed that phonological awareness and orthographic knowledge best predicted 12 of 13 measures of performance at Key Stage 1. Additional variance was nearly always explained by SEN status. In 11 analyses the Infant Index baseline score predicted performance at age 7 and was the best predictor of maths test performance. Gender was an occasional additional predictor. CONCLUSION: School LSAs can be readily trained to administer phonological awareness measures to cohorts of 5-year-old children. Such measures used in conjunction with baseline measures significantly enhance prediction of Key Stage 1 performance. Deploying LSAs in this fashion significantly enhances a school's capacity to identify young children for whom additional support may be necessary.

Awareness↗
PubMed2002

Development and analysis of a new certifying examination in perioperative transesophageal echocardiography.

UNLABELLED: A key element in developing a process to determine knowledge and ability in applying perioperative echocardiography has included an examination. We report on the development of a certifying examination in perioperative echocardiography. In addition, we tested the hypothesis that examination performance is related to clinical experience in echocardiography. Since 1995, more than 1200 participants have taken the examination, and more than 70% have passed. Overall examination performance was related positively to longer than 3 mo of training (or equivalent) in echocardiography and performance and interpretation of at least six examinations a week. We concluded that the certifying examination in perioperative echocardiography is a valid tool to help determine individual knowledge in perioperative echocardiography application. IMPLICATIONS: This report describes the process involved in developing the certifying transesophageal echocardiography examination and identifies correlates with examination performance.

Anesthesiology↗
PubMed2002

The role of temporal lobe and orbitofrontal cortices in olfactory memory function.

Differences in verbal and nonverbal olfactory identification and recognition were examined among three groups with brain impairment. A left cerebrovascular accident (LCVA) group, a right CVA (RCVA) group, and a traumatic brain injury (TBI) group were compared with two nonimpaired age-matched comparison groups on olfaction identification and recognition abilities. Odors were presented to the left and right nostrils, which maximized hemispheric differences in olfactory processing. Results showed that persons with LCVA demonstrated the greatest impairment on the verbal identification of odors, while persons with RCVA showed the most impairment on the nonverbal identification of odors. Persons with TBI showed an inconsistent impairment across both verbal and nonverbal odor identification tasks. Odor recognition was impaired in both CVA groups as well. In contrast, persons with TBI performed better on the delayed odor recognition tasks. Results are discussed in relation to hemispheric differences in processing olfactory information.

Journal Article↗
PubMedDate not supplied

Pathways to long-term recovery: a preliminary investigation.

Recovery from addiction is a lifelong process. While there is a large body of empirical data on the short-term effectiveness (one to two years) of various treatment modalities, very little is known about the processes of recovery over time. This is particularly unfortunate as treatment gains are often short-lived and even multiple treatment episodes do not always succeed in breaking the addiction cycle. Further, treatment represents only one of the paths to recovery. This article reports on a study of individuals in long-term recovery from substance abuse (median = 12 years) and examines the factors they cite as important in establishing and maintaining their recovery status. Key factors reported were social and community support, affiliation with 12-Step organizations and negative consequences of substance use. Implications for clinical practice and future research directions are discussed.

Adult↗