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PubMed2005

Does total knee replacement restore normal knee function?

Despite the advanced age of many patients having total knee arthroplasty, previous attempts to quantify patient function postoperatively have not allowed for normal deterioration of musculoskeletal function that occurs with aging. We determined the effects of aging on knee function, thereby providing a realistic level of normal, healthy knee function for patients and surgeons after total knee arthroplasties. A self-administered, validated knee function questionnaire consisting of 55 scaled multiple choice questions was used in this study. Responses were collected from 243 patients at least 1 year after they had total knee arthroplasties, and from 257 individuals (age- and gender-matched) who had no previous history of knee disorders. Many of these latter subjects reported that they could do most of the activities cited in the questionnaire without symptoms attributable to their knees. However, knee symptoms were experienced more frequently during activities that placed greater loads on the extremity. There was no difference in the knee function of men and women, and both groups had continuous deterioration in knee function with increasing age. There were large differences in the functional capacity to do activities involving the knee between the group of patients who had total knee arthroplasties and the age- and gender-matched patients with no previous knee disorders. Overall, 52% of the patients who had total knee arthroplasties reported some degree of limitation in doing functional activities, versus 22% of subjects with no previous knee disorders. Two groups of activities were identified: activities in which the patients and control subjects had essentially similar knee function (swimming, golfing, and stationary biking), and activities in which the function scores of the control group exceeded the scores of the patients who had total knee arthroplasties (kneeling, squatting, moving laterally, turning and cutting, carrying loads, stretching, leg strengthening, tennis, dancing, gardening, and sexual activity). Our data show that many of the limitations reported by patients after total knee arthroplasties are shared by individuals with no previous knee disorders. However, only approximately 40% of the functional deficit present after a total knee arthroplasty seems to be attributable to the normal physiologic effects of aging. Patients who had total knee replacements still experienced substantial functional impairment compared with their age- and gender-matched peers, especially when doing biomechanically demanding activities. This suggests that significant improvements in the procedure and prosthetic designs are needed to restore normal knee function after a total knee arthroplasty.

Adult↗

PubMed1998

Use of peer ratings to assess sociability among inpatients with severe psychiatric disorders.

OBJECTIVE: A critical component of inpatient treatment for persons with severe psychiatric disorders is an evaluation of their social impairments. Most existing methods for such evaluations involve staff input and can be both time-consuming and expensive. This paper reports on the use of peer ratings as a method for assessing sociability, an aspect of social functioning in this clinical population. METHODS: Thirty-two inpatients with severe psychiatric disorders who had spent an average of 18 months on an inpatient unit in a state facility rated the popularity of their inpatient peers by completing a 7-point scale measuring how much they enjoyed visiting with each patient. The reliability of peer ratings and their association with staff ratings of patients' behavior on the unit were assessed. RESULTS AND CONCLUSIONS: The peer ratings had excellent test-retest reliability and were highly associated with staff members' independent evaluations of patients' behavior. Peer ratings appear to have promise as a measure of social functioning among inpatients with severe psychiatric disorders.

Adult↗

PubMed2002

Multicenter clinical research in adult critical care.

OBJECTIVE: To describe the development, organization, and operation of several collaborative groups conducting investigator-initiated multicenter clinical research in adult critical care. DESIGN: To review the process by which investigator-initiated critical care clinical research groups were created using examples from Europe, Australia, the United States, and Canada. Various models of group structure and function are discussed, highlighting complementary approaches to protocol development, multicenter study management, and project funding. DATA SOURCES: Published peer review research and unpublished terms of reference documents on the structure and function of these groups. DATA SYNTHESIS: The overall goal of clinical critical care research groups engaged in multicenter studies is to improve patient outcomes through conducting large, rigorous investigations. Research programs we reviewed included the following: a) multicenter epidemiologic studies and surveys; b) technology evaluations of mechanical ventilation; c) investigations focused on three priority fields (acute lung injury, infection, and acute brain injury); d) a series of randomized trials of treatments for one syndrome (acute respiratory distress syndrome); and e) diverse methodologies addressing several clinical problems. The structure and function of these research groups differ according to their historical development, research culture, and enabling resources. Specific protocols emerge from clinical questions generated by investigators or from collectively prioritized research agendas. Project funding includes government support, peer-review grants, intensive care foundations, industry, local hospital funds, and hybrid models. Infrastructure for study management varies widely. CONCLUSIONS: Several national and international groups have engaged in investigator-initiated multicenter critical care research. The development, organization, and operational methods of these groups illustrate several collaborative models for clinical investigations in the intensive care unit. Common characteristics of these groups are a cohesive spirit, a sense of mission to achieve shared research goals, and acknowledgment that such an organization is much more than the sum of its parts.

Adult↗

PubMed2006

Patterns of normal human brain plasticity after practice and their implications for neurorehabilitation.

OBJECTIVES: To illustrate how our knowledge about normal patterns of experience-induced plasticity can provide insights into the mechanisms of neurorehabilitation; to provide an overview of the practice-effects literature in order to simplify and amalgamate a large number of heterogeneous findings and identify typical patterns of practice effects and their determining factors; and to concentrate on the impact of practice on higher cognitive functions, such as working memory, and present some preliminary but promising behavioral data that show how practice on a complex cognitive task can benefit cognitive functioning more generally. DATA SOURCES: We performed a systematic search for peer-reviewed journal articles using computerized databases (PubMed, ISI Web of Science, PsycINFO). DATA SELECTION: Neuroimaging studies using functional magnetic resonance imaging (fMRI) or positron-emission tomography (PET) to examine functional activation changes as a result of practice on sensory, motor, or cognitive tasks in normal (healthy) populations were included in the review. Further studies were identified that examined the effects of rehabilitative training on functional activations in clinical populations using fMRI or PET. DATA EXTRACTION: Important characteristics of the selected studies were summarized in a systematic manner so to enable the extraction of specific factors impacting on the pattern of practice effects observed. DATA SYNTHESIS: We identified a number of factors that impact on the patterns of practice effects observed and discuss how the insights gained from the study of healthy populations can by applied to rehabilitation of cognitive deficits in clinical populations. CONCLUSIONS: Progress in our understanding of neurorehabilitative plasticity will be enabled by neuroimaging examinations of cognitive rehabilitation training grounded in a knowledge of normal (healthy) patterns of brain activation and practice-induced plasticity.

Brain↗

PubMed1992

Functional status as an overall measure of health in adults with cystic fibrosis: further validation of a generic health measure.

We studied the validity of a generic health measure in a population with a chronic, life-shortening illness. Thirty-seven adults with cystic fibrosis (CF) and 46 of their healthy peers completed a questionnaire which included 12 questions on functional status from the RAND Health Insurance Study. For the CF group, the questionnaire and a medical chart review yielded data on 7 additional health variables, including pulmonary function. After data collection, members of the CF group were followed for 5 years, by which time 11 had died. The functional status of the CF group was significantly lower than that of the comparison group. Within the CF group, functional status correlated significantly with 6 of the 7 other health variables. Analysis using the Cox proportional hazards model showed that functional status alone was a significant (p less than 0.001) predictor of a CF subject's survival time; in a multivariate model a non-significant trend suggested that lowered functional status may be associated with an increased risk of early death even after adjustment for pulmonary function and percent ideal body weight. These results extend previous findings and suggest that functional status can be used as an overall measure of health in a wide variety of studies.

Activities of Daily Living↗

PubMed2006

The development of a new day treatment program for older children (8-11 years) with behavioural problems: the GoZone.

The main aim of this article is to describe the development of a new day treatment program for older children (8-11 years) with behavioural problems. The article outlines the content of the program and it also sets out the rationale behind the development of the new day service. The day program involves therapeutic and educational input and children attend the program two days a week for one academic term (10-13 weeks). Therapeutic input focuses on improving functioning in relation to a number of developmental processes that are known to be linked to the development of problem behaviour. These include improving emotional competence, dealing with peer relationship problems and interpersonal difficulties, and changing negative patterns of thinking about the self and others. The GoZone team also attempt to work collaboratively with the children's families and schools. A preliminary investigation of the effectiveness of the program is also reported. Parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ) pre- and posttreatment. Findings showed that over the course of treatment parents reported a significant decrease in overall levels of emotional and behavioural problems and also reported a significant decrease in levels of emotional symptoms and peer problems. However, no significant changes in emotional and behavioural functioning were reported by teachers at school over the course of treatment. Potential ways of boosting the magnitude of positive change achieved by the new day treatment program are discussed.

Affect↗

PubMed1989

Behavioral and autonomic responses to peer separation in pigtail macaque monkey infants.

Brief maternal separations of young nonhuman primates have been used extensively to study the behavior and physiology of attachment, loss, and bereavement. The physiological responses to the loss of alternative attachment figures, such as peers, is less well documented in nonhuman primates. This study examined both autonomic and behavioral responses of peer-reared pigtail macaque infants to separation. Eight infants were removed from their mothers at birth and reared in four peer pairs. At 6 months of age, each monkey was implanted with a multichannel biotelemetry device which transmitted heartrate, body temperature, EEG, EMG, and EOG. Blood was collected twice weekly for immunological assessment. Behavioral and physiological data, including sleep, were collected for 1 week of baseline, 2 weeks of separation, and 1 week of reunion. Behavioral and physiological results indicated agitation but not depression following separation from their peer attachment figures. We found reduced mitogenic responses to pokeweed consequent to peer separation, suggestive of altered B-cell function. REM variables were the only sleep measures affected by the separation, and were suggestive of agitation but not depression.

Animals↗

PubMed2002

Social problems associated with ADHD vs. ODD in children referred for friendship problems.

Four groups were composed of children referred for friendship problems (age range: 6 to 12 years old). One group was diagnosed with both Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional-Defiant Disorder (ODD), one group with ADHD only, one group with ODD only and one group with neither disorder. Parents and teachers were given questionnaires to rate the social behavior of each child. The groups differed significantly on one parent scale (Self-control) and one teacher scale (Aggression). Inspection of the items composing these scales suggested that some items measured social relationships with adults while other items measured peer relationships. Subsequent factor analysis separated peer and adult components. Analysis of subscales derived from factor analysis revealed the diagnosis of ADHD was associated with increases in classroom disruption and decreased resistance to provocation by peers, while the diagnosis of ODD was associated with increased in hostility towards peers, decreased resistance to provocation by peers and decreased respect for adults. Limitations of the study were: domains of social functioning assessed, sample size and diversity, and the absence of a comparison group with adequate peer relationships. Social skills programs should target social deficits associated with ODD and ADHD. The scales refined in the present study offer a convenient means of assessing peer dysfunction from the points of view of parents and teachers.

Analysis of Variance↗

PubMed1993

New morbidity-problems and peer relations in a sample of Swedish primary school children: a follow-up from the first to the third grade.

The stability in the new morbidity-problem domains motor skills, reading/writing ability, behavioral-psychological-social function and concentration ability in school, and the stability of peer status and peer preferences as well as relationships between peer status and problems among boys and girls was studied in a sample of 81 Swedish primary school children. The children were rated by teachers and made peer nominations six months after school start, and in the third grade. There was considerable stability in problems, while the stability in peer status was modest. There were marked gender differences. Boys in contrast to girls improved in motor skills from the first to the third grade, and boys had more concentration problems and multiple problems than girls in both grades 1 and 3. In the first grade low peer acceptance in boys was accompanied by low motor skills. In the third grade, low peer acceptance in boys was accompanied by deficient concentration ability and externalizing problems. For girls, few relationships between low peer acceptance and problems emerged Various explanations for these findings are discussed.

Child↗

PubMed1988

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↗

PubMed1997

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↗

PubMed1998

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↗

PubMed2006

The expanding role of leukotriene receptor antagonists in chronic asthma.

OBJECTIVE: To provide a comprehensive review of studies that evaluate the effects of leukotriene receptor antagonists in adult chronic asthma. DATA SOURCES: A literature search using MEDLINE, Clinical Evidence, and the Cochrane Library was performed using the following keywords: randomized controlled trial, asthma, cysteinyl leukotriene, leukotriene receptor antagonist, antileukotriene, montelukast, zafirlukast, pranlukast, inflammation, lung function, exacerbations, and symptoms. STUDY SELECTION: Relevant peer-reviewed articles (mostly randomized controlled trials, meta-analyses, and reviews) published up to July 2006 were selected and extracted. RESULTS: Leukotriene receptor antagonists are beneficial across a range of asthma severities and may have a particular role in exercise-induced asthma, aspirin-sensitive asthma, and individuals with concomitant allergic rhinitis. CONCLUSION: In the management of chronic asthma, leukotriene receptor antagonists have emerged as a useful oral nonsteroidal anti-inflammatory adjunct both as monotherapy and in combination with other classes of drugs. Monitoring their effects in terms of lung function alone may result in clinicians missing beneficial effects on inflammatory biomarkers, airway hyperresponsiveness, and exacerbations.

Adrenal Cortex Hormones↗

PubMed1989

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↗

PubMed2001

Comparison of three generic questionnaires measuring quality of life in adolescents and adults with cystic fibrosis: the 36-item short form health survey, the quality of life profile for chronic diseases, and the questions on life satisfaction.

OBJECTIVE: To compare different generic instruments in measuring quality of life and to demonstrate dimensions of quality of life (QL) in patients with cystic fibrosis (CF). METHODS: The short-form-36 health survey (SF-36), the quality of life profile for chronic diseases (PLC), and the questions on life satisfaction (FLZ(M)) were simultaneously employed in a cross-sectional study with 70 adolescents and adults with CF. The different concepts of the measures were compared. Internal consistency (Cronbach's alpha), convergent and construct validity (correlation patterns, common factor analysis), and external validity (correlations with symptom and pulmonary function scores, with intensity of therapy; comparisons with healthy peers) of the three instruments were investigated. RESULTS: Similar reliability, but different validity of the questionnaires are demonstrated. Seventy-three percent of the total variance across the three measures could be explained with a seven-factor-solution: (1) physical functioning (19.3% of total variance), (2) mental health (19.3%), (3) social integration (7.5%), (4) role function/pain (7.5%), (5) economic/material living conditions (7.5%), (6) partnership/family (6.7%) and (7) anxiety (5.2%). DISCUSSION: The different validity of the instruments has to be considered in chosing a questionnaire appropriate to the purpose of measuring. Shortcomings of each instrument can be overcome by multimethod designs and by developing disease-specific scales.

Adolescent↗

PubMed1999

Performance evaluation and patient outcomes monitored by nurse practitioners and certified nurse-midwives in Florida.

In this descriptive survey study, four elements of performance evaluation of advanced practice nurses (APNs) currently in clinical practice were examined: evaluation frequency, evaluation responsibility, evaluation parameters, and monitored patient outcomes. Questionnaires were mailed to 2,093 APNs living in Florida and licensed by the Florida State Board of Nursing. Eight hundred twenty-two usable surveys were returned, for a 39% response rate. Of these respondents, 654 were in clinical practice as APNs, and comprised the final sample. The majority (56.9%) received formal annual evaluations, and most (75.9%) were evaluated primarily by physicians; only 17.5% reported peer evaluation. The most frequent evaluation parameters were appropriateness of care, patient satisfaction, patient outcomes, and patient volume. Patient outcomes fell into four categories: clinical endpoints, complications, compliance, and functional status. A need to increase the regularity, formality, and peer review elements of APN performance evaluation was concluded.

Adult↗

PubMed1990

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↗

PubMed1991

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↗