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PubMed1985

Comprehension of information for informed consent by spouses of surgical patients.

The adequacy of comprehension of the information needed for informed consent to participate in research on spouse responses to a husband's or wife's general surgery was assessed. Comprehension of information about the research study by 75 spouses was measured by the Informed Consent Questionnaire containing questions on study purpose, time involvement, nature of participation, risks, benefits, voluntariness, confidentiality, and anonymity. The result showed that 72 of the 75 spouses had adequate comprehension of the information for informed consent. Because adequate comprehension is atypical of most studies, possible reasons for this unexpected result are discussed and then explained within a self-determination theory of informed consent.

Comprehension↗

PubMed2006

Neural activity of inferences during story comprehension.

In this event-related functional magnetic resonance imaging (fMRI) study, participants listened to and comprehended short stories implying or explicitly stating inference events. The aim of this study was to examine the neural mechanisms that underlie inference generation, a process essential to successful comprehension. We observed distinct patterns of increased fMRI signal for implied over explicit events at two critical points during the stories: (1) within the right superior temporal gyrus when a verb in the text implied the inference; and (2) within the left superior temporal gyrus at the coherence break or when participants need to generate an inference to understand the story. To find the most compelling evidence of neural activity during inference generation, we examined fMRI signal at these two critical points separately for people with high working memory capacity (i.e., those individuals who are most likely to draw inferences during text comprehension). Interestingly, high working memory individuals showed greater fMRI signal for implied than explicit events in the left inferior frontal gyrus at the coherence break compared to low working memory individuals. This present study provides evidence that areas within the superior temporal gyrus and inferior frontal gyrus are heavily recruited when individuals generate inferences, even during ongoing comprehension that demands many cognitive processes. In addition, the data suggest that the right hemisphere superior temporal gyrus is particularly involved during early inferential processing, whereas the left hemisphere superior temporal gyrus is particularly involved during later inferential processing in story comprehension.

Adolescent↗

PubMed2005

Summation of semantic priming and complex sentence comprehension in Parkinson's disease.

Research has suggested that the integrity of semantic processing may be compromised in Parkinson's disease (PD), which may account for difficulties in complex sentence comprehension. In order to investigate the time course and integrity of semantic activation in PD, 20 patients with PD and 23 healthy controls performed a lexical decision task based on the multi-priming paradigm. Semantic priming effects were measured across stimulus onset asynchronies of 250 ms, 600 ms, and 1200 ms. Further, PD participants performed an auditory comprehension task. The results revealed significantly different patterns of semantic priming for the PD group at the 250-ms and 1200-ms SOAs. In addition, a delayed time course of semantic activation was evident for PD patients with poor comprehension of complex sentences. These results provide further support to suggest that both automatic and controlled aspects of semantic activation may be compromised in PD. Furthermore, the results also suggest that some sentence comprehension deficits in PD may be related to a reduction in information processing speed.

Acoustic Stimulation↗

PubMed2006

Evidence for bilateral involvement in idiom comprehension: An fMRI study.

The goal of the current study was to identify the neural substrate of idiom comprehension using fMRI. Idioms are familiar, fixed expressions whose meaning is not dependent on the literal interpretation of the component words. We presented literally plausible idioms in a sentence forcing a figurative or a literal interpretation and contrasted them with sentences containing idioms for which no literal interpretation was available and with unambiguously literal sentences. The major finding of the current study is that figurative comprehension in the case of both ambiguous and unambiguous idioms is supported by bilateral inferior frontal gyri and left middle temporal gyrus. The right middle temporal gyrus is also involved, but seems to exclusively process the ambiguous idioms. Therefore, our data suggest a bilateral neural network underlying figurative comprehension, as opposed to the exclusive participation of the right hemisphere. The data also provide evidence against proposed models of idiom comprehension in which literal processing is by-passed, since figurative processing demanded more resources than literal processing in the language network.

Adult↗

PubMed2005

Hemispheric asymmetries and joke comprehension.

Joke comprehension deficits in patients with right hemisphere (RH) damage raise the question of the role of the intact RH in understanding jokes. One suggestion is that semantic, or meaning, activations are different in the RH and LH, and RH meanings are particularly important for joke comprehension. To assess whether hypothesized differences in semantic activation in the two hemispheres were relevant to joke comprehension, we recorded event-related brain potentials (ERPs) as healthy adults read laterally presented "punch words" to one-line jokes and nonjoke controls. Jokes presented to the RVF/LH elicited larger amplitude N400 than the nonjoke endings; when presented to the LVF/RH, the joke and nonjoke endings elicited N400s of equal amplitude. This finding suggests that semantic activations in the two hemispheres do differ, with RH semantic activation facilitating joke comprehension.

Adult↗

PubMed2004

Action comprehension in aphasia: linguistic and non-linguistic deficits and their lesion correlates.

We tested aphasic patients' comprehension of actions to examine processing deficits in the linguistic and non-linguistic domains and their lesion correlates. Twenty-nine left-hemisphere injured patients and 18 age-matched control subjects matched pictured actions (with the objects missing) or their linguistic equivalents (printed sentences with the object missing) to one of two visually-presented pictures of objects. Aphasic patients performed poorly not only in the linguistic domain but also in the non-linguistic domain. A subset of the patients, largely consisting of severe and non-fluent aphasics, showed a greater deficit in the linguistic domain compared with the non-linguistic domain and across the patient group, deficits in the linguistic and non-linguistic domains were not tightly correlated. Poor performance in pantomime interpretation was associated with lesions in the inferior frontal, premotor and motor cortex, a portion of somatosensory cortex, and the caudate, while poor reading comprehension of actions was associated with lesions around the anterior superior temporal lobe, the anterior insula and the anterior portion of the inferior parietal lobe. Lesion size did not correlate with deficits. The lesion results for pantomime interpretation deficits demonstrate that lesions in the frontal component of the human analog of the "mirror neuron system" are associated with deficits in non-linguistic action understanding. For reading comprehension deficits, the lesion correlates are brain areas known to be involved in linguistic tasks including sentence processing and speech articulation; the parietal lesion site may also correspond to a subpart of the human mirror neuron system. These results indicate that brain areas important for the production of language and action are also recruited in their comprehension. Similar findings have been reported in electrophysiological and neuroimaging studies. Our findings now also lend neuropsychological support to an embodied view of brain organization for action processing.

Adult↗

PubMed2006

Improving comprehension of informed consent.

OBJECTIVE: To explore the way the doctor-patient communication process may be improved by adopting the patients' conversational style in the development of written materials for surgical patients. METHODS: Written information prepared by doctors, specialists in abdominal surgery, was tested for comprehension on patients undergoing cholecystectomy, using the standard Cloze test procedure. At the same time, the patients were asked to describe in their own words all they knew about their illness and the treatment. The collected 150 patient narratives were analyzed, and a typical narrative for each educational level was selected based on average SMOG score, word count and sentence length. The patient-worded information was then tested for comprehension on new patients, selected from primary health care, using the same Cloze procedure as with doctor-developed information. Patient profile of best lay communicators was defined using also sociodemographic characteristics, and reported information seeking and decision making preferences. RESULTS: Only 50% of patients completed Cloze test, of which over 40% showed poor comprehension. Analysis of transcribed narratives collected from 150 patients showed increasing complexity of style by educational level (average SMOG score 7, 8, and 9; sentence length 11, 13, and 15 words; for low, medium, and high educational level, respectively). Cloze tests based on typical narratives, and tested on primary care patients, indicated to the style best understood by all. Dominant characteristics of patients producing a narrative of similar style to the best-understood narrative were observed: medium educational level, women over 60, urban workers, interviewed after surgery, informed by specialist at ultrasound, knowledge about illness from 1 to 10 years, learned most about illness from lay people, those who wanted more information in both oral and written form, and preferred active role in decision making. CONCLUSION: Analysis of patient profiles with typical narratives that were best understood by other patients shows where to look for lay experts in doctor-patient communication. PRACTICE IMPLICATIONS: Obtained findings indicate to the importance of patient participation in developing informed consent information, and to the possible method for improving comprehension of educational patient materials in general.

Adolescent↗

PubMed2006

When Broca experiences the Janus syndrome: an ER-fMRI study comparing sentence comprehension and cognitive sequence processing.

The determining of brain regions that exhibit specific activity during sentence comprehension compared to other non-linguistic cognitive tasks constitutes one of the important challenges in the domain of functional neuroimaging of the faculty of language. In the current paper we report an event-related functional magnetic resonance imaging (ER-fMRI) experiment, in which we directly compared the cerebral basis of sentence comprehension on the one hand, and of abstract sequence processing on the other hand. Previous experimental work done in our group, as well as different observations from recent behavioural, neurophysiological and functional neuroimaging experiments led us to propose the hypothesis that both of these tasks would share certain computational properties. Thus, this experiment was designed to show which brain regions would be implicated in both tasks and compare them to brain regions that would be specifically engaged in sentence comprehension. Results from this experiment suggest that distinct sub-regions in the left prefrontal cortex, potentially including Broca's area show distinct activation patterns during both of these tasks. Results are discussed in the context of a construction-based model of sentence processing (see Dominey and Hoen, 2006, this issue) that is based on a dual-path processing mechanism separating function and content information processing. We propose and discuss the hypothesis that subparts of Broca's area BA 44 and BA 45 would respectively be implicated in two different aspects of sentence comprehension: i) a general structure mapping capability and ii) the online integration of semantic representations onto structural constraints.

Adult↗

PubMed2002

The comprehensiveness care of sickle cell disease.

Millions of people across the world have sickle cell disease (SCD). Although the true prevalence of SCD in Europe is not certain, London (UK) alone had an estimated 9000 people with the disorder in 1997. People affected by SCD are best managed by a multidisciplinary team of professionals who deliver comprehensive care: a model of healthcare based on interaction of medical and non-medical services with the affected persons. The components of comprehensive care include patient/parent information, genetic counselling, social services, prevention of infections, dietary advice and supplementation, psychotherapy, renal and other specialist medical care, maternal and child health, orthopaedic and general surgery, pain control, physiotherapy, dental and eye care, drug dependency services and specialist sickle cell nursing. The traditional role of haematologists remains to co-ordinate overall management and liase with other specialities as necessary. Co-operation from the affected persons is indispensable to the delivery of comprehensive care. Working in partnership with the hospital or community health service administration and voluntary agencies enhances the success of the multidisciplinary team. Holistic care improves the quality of life of people affected by SCD, and reduces the number as well as length of hospital admissions. Disease-related morbidity is reduced by early detection and treatment of chronic complications. Comprehensive care promotes awareness of SCD among affected persons who are encouraged to take greater control of their own lives, and achieves better patient management than the solo efforts of any single group of professionals. This cost-effective model of care is an option for taking haemoglobinopathy services forward in the new millennium.

Anemia, Sickle Cell↗

PubMed2004

The relationship between age, verbal working memory, and language comprehension.

A structural modeling approach was used to examine the relationships between age, verbal working memory (vWM), and 3 types of language measures: online syntactic processing, sentence comprehension, and text comprehension. The best-fit model for the online-processing measure revealed a direct effect of age on online sentence processing, but no effect mediated through vWM. The best-fit models for sentence and text comprehension included an effect of age mediated through vWM and no direct effect of age. These results indicate that the relationship among age, vWM, and comprehension differs depending on the measure of language processing and support the view that individual differences in vWM do not affect individuals' online syntactic processing.

Adolescent↗

PubMed2002

The role of comprehensive renal clinic in chronic kidney disease stabilization and management: The Northwestern experience.

In this article, we maintain that the management of patients with chronic kidney disease (CKD) is best provided in a clinic setting that integrates nephrologic expertise, patient education, and comprehensive supportive services. Our experience with a CKD clinic in an urban academic setting is described. As a way to assess and quantify the impact of our clinic on clinical outcomes, we have analyzed our results in terms of 2 variables: presence of permanent access at the time of dialysis initiation and impact on renal function as assessed by calculated glomerular filtration rate (GFR). The number of clinic visits was taken as an index of comprehensive renal care before dialysis initiation. Individuals who started dialysis with a functioning permanent access had been seen in our clinic more frequently than those seen less frequently (20 +/- 3.5 and 4.4 +/- 2.1 visits, respectively, P <.005). The impact on renal function was analyzed in a group of 80 unselected patients stratified into 3 stages based on the recently published National Kidney Foundation Disease Outcomes Quality Initiative (K/DOQI) guidelines: stage III (mean GFR 39 +/- 1.5 mL/min, n = 21), stage IV (mean GFR 21 +/- 0.6 mL/min, n = 46), and stage V (mean GFR 12 +/-.76 mL/min, n = 13). Provision of comprehensive renal care in conjunction with anemia management using weekly injections of erythropoietin subcutaneously resulted in stabilization of GFR in patients with stages IV and V over a period of 15 months of follow-up evaluation. In patients with stage III CKD, GFR decreased over the initial period of follow-up evaluation (first few months), and to a lesser extent by the end of follow-up evaluation (15 mo). Further studies are underway to discern the factor(s) underlying the overall clinic effect versus a beneficial effect of anemia correction on GFR. Our data suggests that stabilization of GFR is a goal that can be accomplished with comprehensive renal care provided in an organized clinic setting.

Ambulatory Care Facilities↗

PubMed2003

Visual-sequential and visuo-spatial skills in dyslexia: variations according to language comprehension and mathematics skills.

This study focused on visual-sequential and visuo-spatial functions in a group of 39 heavily dyslexic children, compared to a Control group. Mean age was 12.72 (SD 1.71). The dyslexia group was divided into three subgroups by language comprehension and mathematics skills. Only on a visual-sequential task was no difference seen between the groups. The main differences occurred between the two dyslexic subgroups with no language comprehension impairment, but with varying mathematics skills. Whereas the subgroup with good mathematics skills scored within the upper ranges, the mathematics-impaired subgroup showed significantly lower scores. The third dyslexic subgroup, with both language comprehension and mathematics impairments, performed within the norm. The study indicates a dissociation between language comprehension and visuo-spatial skills in dyslexia, which has implications for how variations in dyslexia should be understood. The results also show that the visuo-spatial impairments seen in one of the dyslexia subgroups lead to two ways of understanding mathematics impairment when it co-occurs with dyslexia: (1) as a visuo-spatial problem; (2) as a linguistic problem. These distinctions should imply different intervention strategies in dyslexia.

Adolescent↗

PubMed2003

Traffic sign symbol comprehension: a cross-cultural study.

The objective of this study was to evaluate the comprehension levels of highway traffic sign symbols used in different countries, to identify underlying rules that affect comprehension levels, and recommend approaches to deal with the problem. The need for such an evaluation was based on today's travel culture where people are often licensed in one country and then drive--without any further training--in another country. We compared the comprehension levels of different traffic sign symbols in four countries with moderate to high levels of motorization: Canada, Finland, Israel, and Poland. Five different driver populations were sampled in each country: novice drivers, college students, tourists, problem drivers, and older drivers. There were large differences in comprehension among specific sign messages, different countries, and different driver populations. Signs were comprehended best when they were consistent with general ergonomic guidelines for display design as they relate to spatial compatibility, conceptual compatibility, physical representation, familiarity, and standardization. Illustrations of compliance with these principles and violations of these principles are presented, and their implication for traffic safety are discussed. Specific recommendations for sign design that is compliant with ergonomic principles, and for greater international cooperation in sign symbol design are made.

Accidents, Traffic↗

PubMed2005

Assessment of story comprehension deficits after brain damage.

A story comprehension task was specifically developed for the clinical diagnosis of text comprehension deficits. The performance of 49 healthy control participants on qualitatively different Yes/No questions confirmed that both salience and explicitness of information had an impact on question difficulty. An unselected group of brain damaged patients (n = 96) made more errors, particularly on questions about implicit information. The subgroup of patients with left-hemispheric vascular aetiology (n = 18) had particular difficulties with stated details, patients with right-hemispheric vascular aetiology (n = 12) with implicit main ideas, and patients with traumatic brain injury (n = 34) were most impaired on implicit information. Correlations with neuropsychological test scores also confirmed that the questions successfully tapped different subprocesses of comprehension. Performance on implicit main ideas was correlated with tests of executive functions, whereas the performance on the other three question types was correlated with long-term memory and verbal learning. These results suggest that the story comprehension test is a useful diagnostic tool for neuropsychological assessment.

Adolescent↗

PubMed2004

Double dissociation between picture naming and comprehension: an electrostimulation study.

We performed a cortico-subcortical language electrical mapping, using a picture naming task and a semantic test of association, during resection of a left posterior temporal glioma in an awake patient. Two discrete naming sites were identified in the posterior part of the left superior temporal gyrus, plus a third distinct site between the two previous areas, inducing specific comprehension disorders without anomia when stimulated. After resection, white matter stimulation elicited anomia without comprehension disorder. We suggest the existence of distinct naming and comprehension systems, which can explain the possibility of a double dissociation aphasic syndrome: one with normal undertanding but naming error, reflecting post-semantic problems of access to the phonological form; the other with correct naming but without normal comprehension, testifying to a direct non-semantic pathway for naming.

Adult↗

PubMed1996

Optometric record keeping in a comprehensive health care environment.

Optometric records which have evolved in private practice must be reconsidered when included in a comprehensive care environment. These hospital, health maintenance organization (HMO), preferred provider organization, and similarly linked systems require a higher degree of communication among specialties than do self-standing practices. Furthermore, the administrative requirements of such a system require more standardization, cost sensitivity, medicolegal compliance, and other elements pecular to a comprehensive facility. The expended scope of care provided by optometrists within a hospital requires familiarity with a new range of procedures, languages, and reports. Information from laboratories, radiology, and other areas must be incorporated into the optometric record. Continuity of care is more complex. Opportunities for strong interprofessional synergies within the organization arise directly from proactivity in optometric record keeping. New legal hot spots arise from questions of records ownership, access, and privacy. Billing procedures are becoming extremely important, with significant effects on quality assurance audits, coding, doctor "profiling" against fraud, and abuse; these priorities can interfere with clinical priorities. Driven primarily by the concerns and resources of large third-party payers, technology is making rapid changes in the form of optometric record keeping in comprehensive systems. Electronic data management will change the face of medical records, although administrative data will be digitized much more quickly than clinical notes. Comprehensive care environments will be the "test beds" for these technologies. Optometry is in a good position to show its contribution to the health care team through leadership in the implementation of new record keeping models.

Comprehensive Health Care↗

PubMed2006

Assessing the reading comprehension of adults with learning disabilities.

BACKGROUND: This study's aim was to begin the process of measuring the reading comprehension of adults with mild and borderline learning disabilities, in order to generate information to help clinicians and other professionals to make written material for adults with learning disabilities more comprehensible. METHODS: The Test for the Reception of Grammar (TROG), with items presented visually rather than orally, and the Reading Comprehension sub-test of the Wechsler Objective Reading Dimensions (WORD) battery were given to 24 service-users of a metropolitan community learning disability team who had an estimated IQ in the range 50-79. RESULTS & CONCLUSIONS: These tests were demonstrated to have satisfactory split-half reliability and convergent validity with this population, supporting both their use in this study and in clinical work. Data are presented concerning the distribution across the sample of reading-ages and the comprehension of written grammatical constructions. These data should be useful to those who are preparing written material for adults with learning disabilities.

Adolescent↗

PubMed2003

Paraphrase procedures for assessing comprehension of health outcome measures: an illustration from schizophrenia research.

Valid measurement of health outcomes require instruments that are meaningful to those who use them. Clinicians, patients, and others involved in health care have different perspectives on health conditions that are likely to lead to different interpretations of outcome measures and reductions in the accuracy and validity of outcome measurements. This study used paraphrase procedures, a systematic approach for evaluating respondent comprehension, to evaluate descriptions designed for use in studies of schizophrenia treatment outcomes. In four stakeholder groups directly and indirectly involved in schizophrenia treatment (clinicians, patients, patients' families, and the general public), the paraphrase procedures identified comprehension problems that could compromise measurement quality and yielded specific information to guide improvement of the outcome descriptions. The paraphrase procedures detected comprehension problems that were not identified by respondents. This study suggests that systematic assessment of comprehension can improve the quality of health outcome measurement.

Adult↗