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Physicians' review of significant interventions by clinical pharmacists in inpatient care.

Clinical pharmacists in this study hospital reported 1027 interventions in patient drug therapy over two time periods of three and two weeks each. When peer-reviewed for clinical significance, 36 of these interventions were deemed significant in terms of saving patients' lives or preserving major organ functions; 983 were judged to improve drug therapy to an acceptable level based on standards of the professional literature (8 recommendations were informational i.e., not clinically significant). These 36 interventions were subjected to an independent, blind review by three practicing physicians who were given the same ranking system for clinical relevance as the one used by the peer reviewers. The physicians independently concurred with the peer reviewers on the two interventions initially ranked as 6 (lifesaving in nature). Of the interventions ranked 5 (preserving major organ functions) by the peer-review group, 53 percent were given a rank of 5 by the physicians. However, the remaining 47 percent were given a rank of 4 (upgrading patient drug therapy to the most appropriate level based on professionally accepted standards). In this era of program evaluation and justification, the process of encouraging other health professionals to review pharmacists' contribution to patient care should not be overlooked.

Drug Therapy

Contemporaneous and longitudinal prediction of children's social functioning from regulation and emotionality.

Relations of regulation and emotionality to social functioning were examined for 77 children followed from early to middle school age. Parents and teachers reported on children's social behavior, emotionality, and regulation, and children engaged in analogue peer conflict situations (i.e., with puppets). High-quality social functioning was predicted by high regulation and low levels of nonconstructive coping, negative emotionality, and general emotional intensity. Prediction often was obtained across reporters and time, although prediction was strongest within context (home versus school). Moreover, measures of regulation and emotionality frequently contributed unique variance to the prediction of social functioning. Contemporaneous correlations at age 8-10 were similar to those obtained at age 6-8, and prediction of later social functioning from emotionality and regulation at age 4-6 was similar at ages 6-8 and 8-10.

Adaptation, Psychological

Development of an instrument to measure caring peer group interactions.

The purpose of this study was to develop psychometric properties of the Peer Group Caring Interaction Scale (PGCIS) designed to measure caring during informal peer interactions as experienced by undergraduate nursing students. The PGCIS has two subscales that address caring peer behaviors and interactional events during which students assist their peers in the resolution of specific needs. PGCIS psychometric properties were developed using data from 873 junior students enrolled at 87 BSN schools of nursing. Internal consistency reliability was demonstrated for the 9-item Caring Behaviors and the 7-item Giving Assistance subscales with a coefficient alpha of .91 for each. Findings from an exploratory factor analysis supported the two subscale structure of the PGCIS. The PGCIS scores correlated positively with scores on the Intimacy subscale of the Organization Climate Description Questionnaire (OCDQ) and the Peer Group Interaction Scale and inversely with scores on the OCDQ Disengagement subscale. The findings from this study provide beginning support for the PCGIS as a valid and reliable approach to the measurement of caring in academic settings. Additional studies are recommended to continue the psychometric evaluation of this instrument.

Adult

Mastery versus ability appraisal: a developmental study of children's observations of peers' work.

This study was designed to test the hypothesis that there is an age-related shift from mastery enhancement to relative ability assessment in the goal of social comparison. Children at ages 5, 7, and 10 made pictures with stickers under conditions of high or low concern with relative performance (competition/no competition) and high or low procedural ambiguity (free design/copying a drawing). The effects of the manipulations on frequency of glancing at the experimenter and the drawing were similar at all ages; competition enhanced glancing at peers, however, only at ages 7 and 10. The hypothesized shift in the function of social comparison was further supported by age differences in children's explanations for glancing at peers and by the pattern of intercorrelations between glances at the 3 targets and between glances and picture quality. The results indicate how mastery-based comparisons can promote mastery and performance and illustrate some costs older children may pay for their tendency to observe others primarily to assess relative ability.

Achievement

Neuropsychology of early-treated phenylketonuria: specific executive function deficits.

This study explored the hypothesis that children with early-treated phenylketonuria (PKU) are selectively impaired on executive function measures, even when still on diet. The rationale for this hypothesis is that even mild elevations in phenylalanine (Phe) can lead to lower central levels of biogenic amines, including dopamine (DA). We hypothesize that this mild DA depletion causes subtle prefrontal dysfunction, which in turn affects executive functions such as set maintenance, planning, and organized search. 11 preschool early-treated PKU children (M age = 4.64) and a sample of age- and IQ-matched unaffected peers (n = 11) were evaluated on a battery of executive function (EF) measures. In addition, a "non-executive function" task, recognition memory, was administered to all subjects. Group comparisons demonstrated that PKU children were significantly impaired on an executive function composite score; there were no group differences, however, in recognition memory. These results supported the hypothesized specific deficit in executive function. Furthermore, within the PKU group the executive function composite score was significantly negatively correlated with concurrent phenylalanine levels, even after controlling for the correlation between IQ and executive function skills. This second finding provides support for the proposed biochemical mechanism underlying the specific cognitive deficits.

Child, Preschool

The impact of social support and self-esteem on adolescent substance abuse treatment outcome.

Although poor social resources and low self-esteem have been implicated in the development of teenage drug abuse, the role of these factors in the remission of adolescent addiction remains unclear. This study examines social support characteristics and self-esteem in relation to outcome following adolescent chemical dependency treatment. Adolescents and their parents completed self-report questionnaires and a research interview during treatment and at 6 and 12 months post-treatment. Two types of outcome were assessed at follow-up: (1) alcohol and drug use, and (2) functioning in major life domains (e.g., family, school/work, peers). Results indicate that the quality of social resources (i.e., drug-use patterns of supports) reported during treatment was related to alcohol- and drug-use status post-treatment, with abstainers reporting more nonusing supports than teens who returned to heavy drug use. Self-esteem and the degree of satisfaction with social support during treatment were negatively correlated with the number of major life problems during the 6 months following discharge. Altogether, inpatient measures of self-esteem, number of high-quality supports, and social support satisfaction accounted for 16% of the variance in 6-month substance use outcome and 25% of the variance in psychosocial functioning 6 months post-treatment. Six-month social support and self-esteem measures were similarly related to 1-year outcome. The implications of these findings for adolescent drug abuse treatment are discussed.

Adaptation, Psychological

The reactivity of the antistriational antibodies associated with thymoma and myasthenia gravis.

Using immunofluorescence forty-nine sera giving striational staining of skeletal and cardiac muscle have been tested on glycerinated myofibrils. By comparing immunofluorescence and phase contrast it has been found that these antibodies are rather heterogeneous but at least three different staining patterns can be identified. Some patterns may be associated with the presence of a thymoma or may be induced by penicillamine treatment of patients with rheumatoid arthritis. Routine screening for antistriational antibodies may lead to the recognition of undiagnosed myasthenia gravis and thymoma. Antistriational autoantibodies may be useful in the further study of the structure and function of the sarcomere.

Antibodies

Preschool peer perceptions of the behavior of hyperactive and aggressive children.

To assess if preschool children can successfully identify externalizing symptomatic behaviors in their male classmates, and if these perceptions are associated with peer-rated popularity and rejection, 154 preschool boys and girls were interviewed using a peer nomination procedure. Behavioral data on the same preschool boys (N = 86) were also provided by their respective teachers. Preschool children were capable of providing stable nominations of popularity, rejection, and aggression, boys and girls significantly agreed in their nominations, and these nominations were not a function of the age of the rated child, although they differed somewhat as a function of the age of the rater. Teachers and peers reflected significant convergence in ratings of hyperactivity and aggression and teacher ratings of peer problems significantly agreed with actual peer nominations of popularity and rejection. Boys nominated as aggressive were more rejected by their classmates, whereas boys nominated as hyperactive were either more popular and/or more rejected. Limited evidence for differential patterns of relationships among hyperactivity, aggression, and peer status was obtained for both the peer and teacher data.

Aggression

Teacher- versus peer-mediated instruction: an ecobehavioral analysis of achievement outcomes.

In three experiments, we compared the effects of instructional arrangements that varied in: teacher versus peer mediators, methods used, levels of student academic responding generated, and content taught and tested. Instructional arrangements (i.e., tasks, structure, teacher position, teacher behavior) and students' levels of academic responding were measured by an observation system which served as an index of the independent variables. Students' accuracy on weekly spelling, arithmetic, and vocabulary tests and pre- and post-standardized achievement tests (Experiments 2 and 3 only) were the dependent variables. Results indicated that the classwide peer tutoring, compared to the teacher's procedure, produced more student academic responding and higher weekly test scores, regardless of treatment order or subject matter content (Experiment 1). The four lowest performing students in each class, in particular, benefited from peer tutoring, often performing as well as the other students. These findings were replicated in Experiments 2 and 3 wherein content taught/tested was also manipulated. Standardized test score gains were higher in those areas in which peer tutoring was used longest. Issues related to the functional analysis of instruction and achievement gain are discussed.

Achievement

Bowel function, mental health, and psychosocial function in adolescents with Hirschsprung's disease.

Congenital intestinal malformations are uncommon and may pose lasting somatic difficulties. Patients with anorectal anomalies have a high frequency of persistent faecal dysfunction and psychosocial problems. This study examined whether adolescents with Hirschsprung's disease have more psychosocial problems than their healthy peers. Nineteen adolescents (mean age 15.7 years) with Hirschsprung's disease were assessed for bowel function, anorectal physiology, mental health, and psychosocial functioning by physical examinations, semistructured interview, and standardised questionnaires. The adolescents were compared with controls. The parents of 13 adolescents with Hirschsprung's disease were interviewed and completed questionnaires. Thirty two per cent of the adolescents with Hirschsprung's disease had significant impairment of continence, but no more psychopathology (16%) nor psychosocial dysfunction as a group than their healthy peers. Faecal incontinence was associated with poorer psychosocial functioning and parental criticism. The fact that a significant number of patients with Hirschsprung's disease have incontinence into adulthood indicates the need for parental counselling, encouraging realistic expectations about continence.

Adolescent

Individual risk and social risk as interacting determinants of victimization in the peer group.

This study evaluated the hypothesis that the behavior problems that place children at risk for victimization by peers are associated with victimization primarily when children are also at social risk for victimization. Social risk was defined as lacking supportive friends or as being rejected by the peer group. Participants were 229 boys and girls in the 3rd through 7th grades (M age = 11 years 2 months). As predicted, behavior problems (internalizing problems, externalizing problems, and physical weakness) were more strongly related to victimization when children had few friends, had friends who were incapable of fulfilling a protective function (e.g., were physically weak), or were rejected by peers than when children had more friends, had friends capable of defending them, or were better liked by peers. Results illustrate the principle that individual risk variables depend on social context for expression.

Child

Relationship between social perception and peer status in children with learning disabilities.

This study was undertaken to examine the social perceptual skill deficit theory in explaining the low peer acceptance of children with learning disabilities. The quality of tests measuring social perception was also examined. Thirty 9- to 12-year-old children with learning disabilities and a matched control group were given two measures of social perception: a laboratory task and a behavior rating scale. The behavior rating scale was completed by the children's teachers. In addition, the Peer Acceptance Scale (Bruininks, Rynders, & Gross, 1974) was administered to assess peer status. Results showed that the children with learning disabilities differed significantly from their nondisabled peers on each of the three measures-the children with learning disabilities obtained lower social perception and peer acceptance scores. However, the relationships between sociometric status and social perception varied as a function of task. A small but significant correlation wa found between the behavior rating scale and peer status. The laboratory task was not correlated with either the behavior rating scale or peer status. Results are discussed in terms of the psychometric properties of laboratory versus naturalistic measures of social perception and the importance of establishing the external validity of social skill measures by correlating them with outcome measures such as peer status.

Child

Peer relationship problems in children with Tourette's disorder or diabetes mellitus.

Peer relationships, social skills, self-esteem, parental psychopathology, and family functioning of children with Tourette's disorder and a chronic disease control group of children with diabetes mellitus were compared. Children with Tourette's disorder had poorer peer relationships than their classmates and were more likely to have extreme scores reflecting increased risk for peer relationship problems than children with diabetes mellitus, but did not report self-esteem problems or social skills deficits. Measures of peer relationships were not related to severity or duration of tics. Children with Tourette's disorder and Attention Deficit Hyperactivity Disorder were at increased risk for poor peer relationships. The psychosocial problems of children with Tourette's disorder do not appear to be the generic result of having a chronic disease.

Adolescent

Exaggerated responsiveness to thyrotrophin releasing hormone: a risk factor in women with coronary artery disease.

Thyroid function tests were performed and thyroid antibodies and serum cholesterol concentrations measured in 12 women aged 60 years or under with severe coronary artery disease proved by coronary angiography. This group was compared with 11 women with normal coronary angiography. Ten out of the 12 women with coronary artery disease had an exaggerated response of thyroid stimulating hormone to thyrotrophin releasing hormone compared with two out of 11 controls (p less than 0.008). The mean serum cholesterol concentration was significantly higher in those with coronary artery disease than in the controls. Thyroid antibodies were present in four of those with coronary artery disease and one of the controls. There was no difference in the risk factors for coronary artery disease between the two groups except for cigarette smoking. Eleven out of 12 in the coronary artery disease group smoked cigarettes compared with four out of 11 in the control group (p less than 0.01). Minimal impairment of thyroid function is an important risk factor for coronary artery disease in women.

Coronary Disease

Risk factors in schizophrenia: the Stony Brook High-Risk Project.

The goals of the Stony Brook High-Risk Project are to identify precursor patterns, environmental stressors, and protective factors that are differentially predictive of psychopathology. In phase I we assessed 219 families and 544 children aged 7-15, including 31 families and 80 children with a schizophrenic parent, 70 families and 154 children with a unipolar depressed parent, 58 families and 134 children with a bipolar parent, and 60 normal control families with 176 children. A 3-year followup was conducted on 84 percent of the sample, and an additional followup is underway. Our data include measures of: (1) psychological functioning of the parents; (2) the environment, including family functioning, marital adjustment, and parenting practices; (3) child adjustment, including peer, or teacher, parent, and self-ratings; (4) early signs or precursors to the development of schizophrenia or affective disorder, including cognitive slippage, attentional deficits, hedonic capacity, depressogenic attributional styles, and subsyndromal affective patterns. Considerable deviance in family functioning, expressed in conflict, marital discord, and parenting skills, was characteristic of the families with an ill parent, and this discord was related to child adjustment. Children with a schizophrenic parent showed multiple and extensive cognitive, attentional, and social impairments, and at the 18+ followup, 22.8 percent of them compared with 9.6 percent of the normal controls were assigned a DSM-III diagnosis.

Adolescent

Impact of peer review in reduction of permanent pacemaker implantations.

Because of a sharp increase in the number of permanent pacemakers inserted at The Brooklyn Hospital between 1972 and 1976, a peer-review committee was established to monitor subsequent pacemaker implantation. Total initial implants declined from 48 to 22 per year in the two years that followed. The number of implantations for sinoatrial bradycardias declined from 50 to 27 and the number of implantations for intraventricular conduction defects declined from 32 to five in the two years after peer review, compared with the two years before. There was no change in the number of pacemakers implanted for complete or advanced heart block. Almost 10% of patients who received a pacemaker between 1972 and 1976 had other conditions that might have accounted for the events that precipitated the decision to implant a pacemaker. The symptoms for which the pacemaker was implanted persisted in 19% of patients, despite a normally functioning pacemaker system. Patients receiving a permanent pacemaker before peer review had a 17% one-year and a 43% three-year mortality. When a more critical patient selection process was instituted, a smaller percentage remained symptomatic (9% vs 19%) and three-year survival rate was improved (86% vs 57%). From 1977 through 1978, when permanent pacemaker implantations declined, the number of hospital, medical service, and coronary care unit admissions increased. It is concluded that peer review can have substantial impact on permanent pacemaker implantations.

Arrhythmias, Cardiac

Gender differences in a clinic-referred sample of attention-deficit-disordered children.

This study of attention-deficit-disordered children revealed that females were more frequently retained in school and evidenced greater impairment on spatial memory tasks. Moreover, there was a trend for girls to be older at the time of referral. With age, the girls evidenced more severity across a wider array of measures, including cognitive functioning, poorer academic achievement, and more problems with peers.

Achievement

IPRO's Health Care Quality Improvement Program.

IPRO is a peer-review organization in New York State that functions under a contract with the Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services for assuring quality of care for Medicare patients. In 1993, IPRO initiated its Health Care Quality Improvement Program (HCQIP). The purpose of this program is to develop information on patterns of care and outcomes, to share this with health care providers, and in so doing effect measurable improvements in care and outcomes. In order to achieve improvements in the quality of care, IPRO has initiated a series of cooperative projects which combine pattern analysis and feedback. These cooperative projects cover a broad range of medical care issues and areas. They have demonstrated that IPRO, providers, and physicians can collaborate to establish and implement efforts to achieve the ultimate goal of improved quality of care for Medicare beneficiaries.

Aged