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Biomedical subjects

S W Harkins

Publications and source records attributed to S W Harkins.

At least 19 recordsLinked to original sources
PubMed1996

Response to tacrine in patients with dementia of the Alzheimer's type: cerebral perfusion change is related to change in mental status.

We evaluated change in cerebral hypoperfusion by single photon emission computed tomography (SPECT) in 12 patients with a clinical diagnosis of dementia Alzheimer's type (DAT) before and after treatment with Tacrine. Based on clinical evaluation of the SPECT scans before and after treatment, two groups of patients were identified. One (N = 5) experienced a relative decrease in cerebral perfusion and a decrease in mini-mental status examination (MMSE) scores across the treatment interval and was labeled "non-responders". A second group consisting of 7 patients was judged as showing an increase in cerebral perfusion at follow-up compared to baseline and an increase in MMSE scores. These were termed "responders". The group difference in MMSE score change was significant (Fisher's exact test: p < 0.008). Sensitivity (0.85) and specificity (1.0) and Receiver Operating Characteristic values (discriminability or d' = 3.12 and bias or beta = 4.6) indicated that direction of change in cerebral perfusion was a reasonable indicator of direction of change in MMSE scores. These results suggest that SPECT determined changes in cerebral perfusion may be useful in identification of DAT patients who are more likely to respond to centrally active agents such as tacrine.

Aged↗
PubMed1995

Pain-related limitation in activities of daily living in patients with chronic orofacial pain: psychometric properties of a disability index.

Pain-related limitations in activities of daily living are presented for 272 patients reporting orofacial pain of the temporomandibular region using the seven-item Pain Disability Index. Results showed that the factor structure for orofacial pain patients differed little from the factor structure for outpatients visiting chronic pain clinic settings. Analysis of pain diagnostic subgroups showed that patients suffering myogenous complaints had higher scores for four of seven daily-living activities that involved pain-related limitations than patients suffering discal disorders. The factor analytical findings indicated that these patients share common pain-related limitations in activities of daily living. These findings are also consistent with previous results indicating greater pain in orofacial pain patients diagnosed with pain complaints primarily myogenous in origin than in pain patients having discal disorders.

Activities of Daily Living↗
PubMed1992

Interexaminer comparison of bone scintigraphy and panoramic radiography of temporomandibular joints: correlation with signs and symptoms.

Panoramic radiographs of the temporomandibular joints of patients with orofacial pain were examined for evidence of pathology by three different groups of four dental specialists and by a group of four general dentists. Bone scans of the same joints were used as the "gold standard" for identification of disorder and indicated a low rate of correct readings by the four professional groups. When the symptomatic side of the complaint was used as the gold standard, there was no statistically significant association with the bone scan observations. Comparative analysis of other patient symptoms showed little agreement with panoramic radiographs and scintigraphs. Reliability estimates may be highly variable, even among clinical experts. These results show that neither radiologic technique would be definitive for diagnosis of TM disorders.

Adolescent↗
PubMed1991

Efficacy of bladder training in older women with urinary incontinence.

The efficacy of bladder training was evaluated in a randomized clinical trial involving 123 noninstitutionalized women 55 years and older with urinary incontinence. Subjects were urodynamically categorized as those with urethral sphincteric incompetence (N = 88) and those with detrusor instability with or without concomitant sphincteric incompetence (N = 35). Bladder training reduced the number of incontinent episodes by 57%; the effect was similar for both urodynamic diagnostic groups. The quantity of fluid loss was reduced by 54%. This was greater for patients with detrusor instability than for those without it. Diurnal and nocturnal voluntary micturitions were also reduced. The effect on nocturnal micturition, however, was not observed in subjects with unstable detrusor function. It is recommended that bladder training be considered as an initial step in treatment of women with urinary incontinence. Provided prior comprehensive clinical evaluation is done, it can be prescribed without the need for urodynamic characterization.

Aged↗
PubMed1991

Symptom report in orofacial pain patients: relation to chronic pain, experimental pain, illness behavior, and personality.

A study was conducted to determine symptom report patterns in a heterogenous population of orofacial pain patients and to evaluate how symptom patterns relate to various dimensions of the human pain experience. Results indicated that symptoms frequently associated with chronic orofacial pain disorders can be described by four indices related to the temporomandibular joint (TMJ) and its movement; discomfort of and parafunctional activities related to the masticatory muscles; interference of pain with activities of daily living; and presence of orofacial pain unrelated to myogeneous or arthrogenous TMJ disorders. Of these four symptom indices, only the pain interference (symptom) index was related to clinical pain and illness behavior. None was related to personality. Two of the indices were influenced by diagnosis. Biomechanical symptoms and parafunctional activities appear to be insignificantly related to perceived pain intensity, pain responsiveness, illness behavior, or personality, but are related to diagnosis. The results indicated that relatively simple symptom checklists have potential utility in screening orofacial pain patients and in evaluation of treatment outcome.

Adolescent↗
PubMed1990

An evaluation of sensory changes and pain relief in trigeminal neuralgia following intracranial microvascular decompression and/or trigeminal glycerol rhizotomy.

Nineteen patients with trigeminal neuralgia were treated with either trigeminal ganglion glycerolysis or glycerolysis and intracranial microvascular decompression. All had a good degree of pain relief. Of those receiving glycerol alone (group A), 50% subjectively reported a mild reduction of fine tactile sensation. A similar response was reported by those treated with both glycerol and decompression (group B). The degree of sensory loss was so mild that thermal testing was useless as a discriminatory tool. The degree of sensory loss was not greater when both surgical procedures were performed than when the less-invasive trigeminal ganglion glycerolysis alone was used.

Aged↗
PubMed1988

Rate of forgetting in mild Alzheimer's-type dementia.

Patients with mild dementia of the Alzheimer's type (DAT) and matched controls were examined for rate of forgetting line drawings of common objects. DAT patients demonstrated rapid forgetting in the first 10 min after learning to criterion. This finding is discussed with respect to memory consolidation and neuropathologic changes in dementia of the Alzheimer's type.

Aged↗
PubMed1988

The urinary diary in evaluation of incontinent women: a test-retest analysis.

This study investigated the use of a one-week urinary diary in the evaluation of incontinent women. The sample consisted of 50 community-dwelling women, ages 55 years and older, ambulatory, and mentally intact, who were volunteers in a clinical trial on behavioral management for urinary incontinence. All subjects kept a urinary diary for two consecutive weeks. An analysis of the immediate (one-week) test-retest variability and correlations on weekly diurnal micturition frequency, nocturnal micturition frequency, and urinary incontinent episodes were performed in subjects with sphincteric incompetence alone (N = 34) and in those with detrusor instability with or without concomitant sphincteric incompetence (N = 16). In addition, information obtained on history was compared with that obtained from the diary. Diurnal micturition frequency, nocturnal micturition frequency, and number of incontinent episodes were highly reproducible and did not differ by urodynamic diagnosis. Test-retest correlations were highest with diurnal micturition frequency and incontinent episodes. Lower correlations were observed with nocturnal micturition frequency, with a significant difference observed between diagnostic groups. Although modest, significant relationships between data collected by history and diary were observed in the overall sample, but there were significant differences between diagnostic groups. The results indicate that a one-week diary is a reliable method for assessing the frequency of voluntary micturitions and involuntary episodes of urine loss.

Aged↗
PubMed1987

Assessment of recovery from injury to inferior alveolar and mental nerves.

Thirty-four patients had surgery near but not transecting either the inferior alveolar nerve or mental nerve. Thermal tests revealed that between 62% and 81% of the nerves that were evaluated had sensory deficits. Sixty-seven percent of patients had abnormal intraoral and extraoral responses to fine tactile testing. The least discriminative test was two-point contact. A smaller percentage (14% to 23%) were hyperpathic to heat stimuli, and a few (5% to 15%) had completely normal thermal and tactile sensation. A high percentage (43% to 71%) of patients elected to have corrective nerve surgery.

Adolescent↗
PubMed1987

Sensory-affective relationships among different types of clinical and experimental pain.

Different types of pain patients used visual analogue scales (VAS) to rate their level of pain sensation intensity (VAS sensory) and degree of unpleasantness (VAS affective) associated with pain experienced at its maximum, usual, and minimum intensity. Women used the same VAS to rate their labor pain during early, active, and transition phases of stage I and in pushing (stage II). Consistent with the hypothesis that the affective dimension of clinical pain can be selectively augmented by perceived degree of threat to health or life, cancer pain patients and chronic pain patients gave higher VAS affective ratings as compared to VAS sensory ratings of their clinical pain, whereas labor patients and patients exposed to experimental pain gave lower VAS affective ratings compared to their VAS sensory ratings of pain. Affective VAS but not sensory VAS ratings of pain were considerably reduced when women in labor focused on the birth of the child as compared to when they focused on their pain. The results underscore the importance of utilizing separate measures of the sensory intensity versus the affective dimension of clinical pain and provide evidence that the affective dimension of different types of clinical pain is powerfully and differentially influenced by psychological contextual factors.

Adult↗
PubMed1987

Age and forgetting rate with pictorial stimuli.

The rate of forgetting standardized line drawings of common objects was assessed in groups of young (M age = 22 years) and older (M age = 70.5 years) subjects. The two groups forgot equal quantities of pictorial stimuli over successive intervals of 10 min, 2 hr, and 48 hr, after being matched for original learning. In contrast, the older subjects showed the expected age decrement in reproduction of geometric designs from memory. These findings indicate that aging does not affect retention of pictures when differences in learning and retrieval abilities are controlled.

Adolescent↗
PubMed1987

Effects of age, stimulus selection, and retrieval environment on odor identification.

Age differences in odor identification were investigated by using relatively familiar and unfamiliar chemical stimuli and enhancing the retrieval environment by restrictive reminding of memories evoked by stimulus during initial presentation. Age differences were seen in initial identification, in learning the labels of items in the stimulus set, in presentation. Age differences were seen in initial identification, in learning the labels of items in the stimulus set, in forgetting over a 24-hr period, but not in forgetting over a 7-day period. Old (n = 20) and young (n = 20) study participants benefitted equally from enrichment of retrieval environment with restrictive reminding of memories evoked at initial presentation. Item analysis indicated that selection of stimuli had a significant effect on age differences in odor identification.

Adolescent↗
PubMed1987

Cognitive, affective, and behavioral effects of reminiscence group therapy on demented elderly.

Twenty-seven demented elderly nursing home residents were given either reminiscence group therapy or supportive group therapy or were assigned to a no-treatment control group. The self-reported level of depression in participants given reminiscence therapy was positively affected compared to participants in the supportive therapy and control groups, but no significant effects were found for cognitive or behavioral functioning. Results are discussed in terms of the issue of the applicability of reminiscence therapy for cognitively impaired persons, the appropriateness of the measures used in this study to assess depression, cognitive ability and behavioral functioning, and in conjunction with clinical observations made during the process of therapy.

Aged↗
PubMed1987

Psychosocial impact of urinary incontinence in women.

This study explored the psychosocial impact of urinary incontinence and investigated its relationship to urodynamic diagnosis and degree of involuntary urine loss. The sample comprised 69 community-dwelling women, ages 55 years and older, who were ambulatory and mentally intact, and who had volunteered in a clinical trial on incontinence. Psychosocial impact was measured by an investigator-designed instrument, the Incontinence Impact Questionnaire. Urodynamic evaluation included detrusor and urethral sphincteric function tests. Subjects were grouped into two urodynamic diagnostic categories: sphincteric incompetence (N = 47) and detrusor instability with or without concomitant sphincteric incompetence (N = 22). Severity of incontinence was determined by a one-week urinary diary and a fluid loss quantitation test. Each of the items on the Incontinence Impact Questionnaire was affected by urinary incontinence, although to varying degrees. Activities involving unfamiliar places where the availability of restrooms was unknown were most affected. Subjects with detrusor instability with or without concomitant sphincteric incompetence reported significantly higher impact than subjects with sphincteric incompetence alone. There were modest correlations between psychosocial impact scores and both the number of weekly incontinent episodes and the quantitation of fluid loss. The results in this study population indicate that the relationships between the perceived impact of incontinence and objective measures of its severity are complex and not directly proportionate.

Aged↗
PubMed1987

Fluid loss quantitation test in women with urinary incontinence: a test-retest analysis.

A modified perineal pad-weighing method for objective quantitation of fluid loss is presented. The bladder was filled by retrograde flow, a sequence of provocative maneuvers was performed under direct supervision, and fluid loss was determined by pad weights. An analysis of immediate test-retest correlation and variability was done in patients with either sphincteric incompetence alone (N = 46) or detrusor instability with or without concomitant sphincteric incompetence (N = 21). Test-retest correlations were high in both groups, suggesting that the method could be applied as an index of severity of urinary incontinence in women. Test-retest within-patient variability was considerable, and limits its usefulness in the analysis of treatment outcome.

Adult↗