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PubMed2005

[Simulation and airway management].

Despite the development of new devices and strategies to manage and secure the difficult airway, morbidity and mortality in anaesthesia due to airway problems such as difficult intubation or unrecognised failed intubation remain high. The problem seems to lie in the transfer of skills and strategies to daily clinical practice. Common methods for airway management training include theoretical instructions and hands-on sessions with manikins, animal models and cadavers. Simulation provides the opportunity to train skills and resolve specific situations embedded in a realistic scenario, facilitate the transfer of cognitive, psychomotor and affective abilities into daily clinical practice and help to improve behaviour in critical situations. This article outlines new training concepts in airway management with the help of simulation and simulators. We describe technical prerequisites and provide information on the implementation of difficult airway scenarios.

Anesthesiology↗
PubMed2003

The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies.

BACKGROUND: The contribution of hip fracture to the risk of subsequent fractures is unclear. METHODS: Data from the Baltimore Hip Studies and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used. Baltimore subjects enrolled at the time of hip fracture ( n=549) and EPESE subjects without previous fractures at baseline ( n=10,680) were followed for 2-10 years. Self-reported nonhip skeletal fracture was the outcome, and hip fracture was a time-varying covariate in a survival analysis stratified by study site. The model was adjusted for race, sex, age, BMI, stroke, cancer, difficulty walking across a room, dependence in grooming, dependence in transferring, and cognitive impairment. RESULTS: The rate of all subsequent self-reported fractures after hip fracture was 10.4 fractures/100 person-years. The unadjusted hazard of nonhip skeletal fracture was 2.52 (95% confidence interval 2.05 to 3.12) for subjects with hip fracture compared with subjects without; when adjusted for other known fracture risk factors the hazard ratio was 1.62 (1.30 to 2.02). Men and women had a similar relative risk increase. The increased risk of secondary fracture after hip fracture persisted over time. CONCLUSIONS: A hip fracture is associated with a 2.5-fold increased risk of subsequent fracture, which is not entirely explained by prefracture risk factors. Careful attention to secondary prevention is warranted in these patients.

Aged↗
PubMed1997

Neuropsychological aspects of multiple sclerosis: a quantitative review.

Neuropsychological studies of multiple sclerosis (MS) from a 20-year period were reviewed using meta-analytic and vote-count techniques. Mean effect sizes comparing MS and healthy control groups on variables categorized by neuropsychological domain were small to moderate in magnitude; all were statistically significant (M(r) = .22 (.13) to .46 (.15), rW = .23 to .43, all p < .05). Interhemispheric transfer, general cognitive ability, and learning/memory were more highly related to MS than were visuoperceptual, visuospatial, and visuoconstructional ability, language and conceptual ability (all p < .05); other domains were generally intermediate. Despite previous reports to the contrary, disease subtype was not shown to be consistently related to neuropsychological status independently of other potential explanatory variables. Findings were interpreted with regard to future research and clinical activities involving patients with MS, including selection of tests for brief neuropsychological screening examinations.

Adult↗
PubMed2004

Functional independence of residents in urban and rural long-term care facilities in Taiwan.

PURPOSE: To compare the score of functional independence measure (FIM) between urban and rural residents living in long-term care facilities (LTCF) in Taiwan. METHODS: A total of 437 subjects in 112 licensed LTCF in Taiwan were randomly selected by stratification strategy. Physical therapists interviewed the subjects in nursing homes (NH) and intermediate care facilities (ICF) to obtain the basic data, and the FIM score. RESULTS: (1) There was no significant difference in basic demographic data between urban and rural LTC subjects. (2) Most of the subjects in urban and rural LTCF were males, less than 80 years old, single/widowed, having multiple diseases, using more than one assistive devices, and having social welfare financial support. (3) Motor abilities (eating, grooming, and transfer) and cognition (comprehension, social interaction and problem solving) in rural LTCF subjects were significantly (p < 0.05) higher than those in urban areas as revealed by the FIM assessment. (4) The median of FIM total score of rural LTCF subjects was 90.5, which was significantly (p < 0.05) higher than that of urban LTCF subjects (median = 76). CONCLUSIONS: Some of the functional performance of subjects in rural long-term care institutions is better than those in urban areas. Our results may provide guidelines for the manpower and equipment supply estimation.

Activities of Daily Living↗
PubMed1978

Long-term durability and transfer of enhanced conceptual performance in the elderly.

To evaluate the durability and transfer of enhanced cognitive functioning in the elderly, subjects (ages 64 to 84) who had previously participated in a unidimensional concept identification study were tested on a bidimensional conjunctive concept identification problem. The conjunctive problem was administered approximately 12 mo after completion of the unidimensional study. In the earlier unidimensional study, substantial and equivalent improvement had been found with both a training group and a reinforced training group. In this study, efficient conjunctive problem solving was found with the (unidimensional) training group, showing that enhanced cognitive performance can be durable and transfer to a similar task. Durability and trasnfer were not observed with the (unidimensional) reinforced training group, however, a finding that appears to have resulted from the extrinsic reinforcement token system employed in the unidimensional training with that group.

Age Factors↗
PubMed2001

Satisfaction with medical rehabilitation in patients with cerebrovascular impairment.

OBJECTIVE: Overall satisfaction has important social and economic implications for patients who have received inpatient medical rehabilitation. We conducted this study to examine the overall satisfaction level at 3- to 6-mo follow-up for inpatients with cerebrovascular impairments discharged from medical rehabilitation. DESIGN: The study was retrospective using information from a national database representative of medical rehabilitation patients across the United States. Information submitted in 1997 and 1998 to the Uniform Data System for Medical Rehabilitation by 177 hospital and rehabilitation facilities from 40 states was examined. The final sample included 8,900 patient records. The main outcome measure was the level of satisfaction with medical rehabilitation at 80-180 days postdischarge follow-up. RESULTS: A logistic regression model including ten independent variables was used to predict satisfied vs. dissatisfied at follow-up. Three statistically significant variables were included in the final model and correctly classified 95.1% of the patients. Higher FIM instrument discharge scores were associated with increased satisfaction. Further analysis of the FIM instrument subscales indicated that higher ratings in transfers, social cognition, and locomotion were significantly associated with increased satisfaction. CONCLUSION: We identified several functional variables associated with increased satisfaction after medical rehabilitation in persons with stroke. The ability to objectively assess patient satisfaction is important as consumer-based outcome measures are integrated in accreditation and healthcare evaluation.

Activities of Daily Living↗
PubMed2006

Effect of galantamine on acetylcholinesterase and butyrylcholinesterase activities in the presence of L-carnitine in rat selected brain and peripheral tissues.

OBJECTIVES: The alkaloid galantamine (GAL), which exhibits a combined anticholinesterase and direct parasympathomimetic mechanism of action, is employed in conjunction with therapeutic interventions in the stimulation of central cholinergic transfer in cognitive diseases. We attempted to achieve pharmacologically-induced enhancement of the parasympathomimetic activity of GAL in the key areas of rat brain, using an interactive combination of the alkaloid with the transmembrane enhancer L-carnitine (CAR). METHODS: We investigated activities of acetylcholinesterase (AChE) in brain areas (frontal cortex, basal ganglia, septum and hippocampus) and the hypophysis, and that of butyrylcholinesterase (BuChE) in plasma and liver. RESULTS: Following administration of the highest of the GAL doses used (2.5; 5; 10 mg/kg i.m.), AChE activity decreased mainly in the frontal cortex, hippocampus and hypophysis. In the interaction of GAL and CAR, AChE inhibition was stronger but without any statistical significance. The peripheral inhibition of BuChE was found to be dose-dependent. Premedication by CAR led to a slight change in the values of the activities monitored. CONCLUSIONS: CAR in terms of positive modulation of GAL targeting to the central nervous system had no statistically significant effect.

Acetylcholinesterase↗
PubMed1988

Prevalence of urinary incontinence in patients receiving home care services.

We conducted a 1-day survey to determine the prevalence of urinary incontinence among patients in four home care programs in southern Ontario and the characteristics of incontinent patients. Of the 2801 patients for whom the continence status was known, 22% were assessed as incontinent. The mean age of the incontinent patients was 74 (extremes 18 and 101) years, and 65% were women. A total of 89% had at least one functional disability in cognition, mobility, transferring in and out of bed or chair, or undoing garments. The incontinence was moderate to severe in 41% of the patients, and 95% of the family caregivers living with these patients viewed the incontinence as a problem. Palliative rather than remedial treatment was used most frequently; only 5% of the patients had undergone a urodynamic assessment in the previous year. Future research should emphasize the assessment of remedial interventions.

Adolescent↗
PubMed1999

Pharmacokinetics of NS-105, a novel cognition enhancer. 2nd communication: distribution and transfer into fetus and milk after single administration, and effects of repeated administration on pharmacokinetics and hepatic drug-metabolizing enzyme activities in rats.

The tissue distribution and transfer into the fetus and milk of NS-105 ((+)-5-oxo-D-prolinepiperidinamide monohydrate, CAS 110958-19-5), a novel cognition enhancer, were investigated in rats after single oral administration of 14C-NS-105. The effects of repeated oral administration on the pharmacokinetics of NS-105 and hepatic drug-metabolizing enzyme activities also were investigated in rats. The radioactivity concentration in most tissues of male rats reached a maximum of 0.5 h after the single oral administration of 14C-NS-105, indicating rapid absorption and distribution, 0.5 h after the administration, the highest concentrations were present in the kidney and stomach, and the lowest in the white fat. The concentrations in the remaining tissues were moderately lower than the plasma value. The radioactivity concentrations in all the tissues tested decreased along with the plasma concentration, and were below or near the detection limit 24 h after the administration. Most of the radioactivity in the plasma, liver, kidney and cerebrum was due to unchanged NS-105. The tissue distribution patterns of radioactivity in female (non-pregnant) and pregnant rats after the oral administration of 14C-NS-105 did not differ from the pattern in male rats, revealing neither sex- nor pregnancy-related differences in NS-105 distribution. In pregnant rats, the maximum concentration in the fetus was 66% of that in the maternal plasma. In lactating rats, the radioactivity concentration in the milk was similar to that in the plasma. During and after the repeated oral administration of 14C-NS-105, the plasma concentrations and cumulative urinary and fecal excretions of radioactivity did not change with the number of administrations and were similar to the corresponding values after the single administration. The radioactivity concentrations in most tissues 8 h after the 7th, 14th and 21st administrations were about twice the corresponding values after the single administration, indicating that there is no marked accumulation of radioactivity in the tissues and that a steady state level was reached within 1 week. Repeated oral administration of NS-105 (10 mg/kg) to male rats did not affect hepatic drug-metabolizing enzyme activities.

Animals↗
PubMed1977

Schizophrenic cognitive dysfunction: a deficit in rule transfer.

This study examined conceptual rule learning (RL) deficit in male schizophrenic Ss categorized into three groups as defined by Whitaker Index of Schizophrenic Thinking (WIST). Ss were administered a conjunctive, disjunctive, conditional or biconditional rule learning task, WIST, and Shipley-Hartford Memory Scale. It was shown that: (a) the WIST reliably differentiates among three levels of thought disorder as reflected by a deficit in inter-problem transfer of rule learning; (b) certain WIST and Shipley parameters reliably predict RL performance; and (c) phenothiazine dosage levels show no influence on the WIST and no correlation with RL. The findings indicate that cognitive dysfunction in schizophrenics is evidenced by limited inductive reasoning, insufficient channel capacity for filtering out irrelevant information, and inability to gain from antecedent RL experience. Principal locus of schizophrenic thought disorder is examined within a stimulus encoding-information processing paradigm.

Adult↗
PubMed2026

The asymmetry of working memory training transfer: A systematic review and meta-analysis.

Working memory (WM) training is widely used to enhance cognitive performance; however, its transfer to untrained tasks remains controversial. Traditional theories emphasize task similarity as the primary determinant of training transfer, but they cannot fully explain emerging evidence of asymmetric transfer across tasks. Two directional transfer hypotheses are proposed here to explain this asymmetry: the resource-based transfer advantage hypothesis predicts stronger transfer from more to less cognitively demanding tasks, whereas the ability-based transfer advantage hypothesis predicts stronger transfer from tasks engaging broader task-general abilities to tasks engaging task-specific narrower abilities. The contrast between span and updating paradigms provides an informative framework for distinguishing these accounts, because updating tasks are generally more cognitively demanding, whereas span tasks involve broader abilities. Accordingly, we conducted a three-level meta-analysis of 55 studies (208 effect sizes; N = 3,492). The results showed that updating training transferred reliably to span tasks (g = 0.176, p < .001), whereas span training did not reliably transfer to updating tasks (g = 0.048, p = .453), supporting the resource-based account. This advantage of updating training also extended to non-WM outcomes and was more pronounced at lower training doses, in non-adult samples, and with verbal stimuli. Together, these findings extend WM transfer theory beyond task similarity by highlighting the importance of cognitive demand and offer guidance for WM training design.

Humans↗
PubMed2006

[Effects of therapy goal oriented cognitive behavioural aftercare measures on therapy transfer following inpatient psychosomatic rehabilitation].

OBJECTIVE: After discharge from inpatient psychosomatic rehabilitation patients often face problems to transfer and stabilize the modifications they have achieved in the clinic. Using targeted outpatient aftercare interventions up to eight weeks after discharge from the inpatient programme we tried to support this transfer, thus enhancing treatment effectiveness. METHOD: The evaluation was carried out as a field experiment. Patients were matched into pairs and then allocated randomly to either a control or an experimental condition. The experimental group, which had participated in specific aftercare measures after inpatient therapy, was compared to the control group at "discharge from clinic" and "twelve weeks post-discharge" relative to a number of variables relevant in therapy outcome. RESULTS: Twelve weeks post-discharge patients who had participated in aftercare measures show significantly better progress relative to their physical and psychological complaints than patients in the control group. Also, they are more capable of coping with psychosocial demands of their everyday life. They experience better control of their symptoms and they are more successful in attaining the goals they have set for themselves for the time after discharge. CONCLUSIONS: The findings show that supplementing psychosomatic inpatient rehabilitation with specific aftercare measures will lead to better transfer and to increased effectiveness of psychosomatic rehabilitation. Also on account of our results, outpatient rehab aftercare programmes have in the meantime become a regular component of inpatient psychosomatic rehabilitation in Germany.

Adult↗
PubMed1997

Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit.

OBJECTIVES: To compare outcomes (physical functions and discharge destinations) of cognitively impaired and intact older hip fracture patients, and to identify cognitive skills related to functional gains. DESIGN: Prospective longitudinal study of hip fracture patients treated on an acute inpatient rehabilitation service, with evaluation of functional performance and living status determined at admission and discharge. SETTING: A specialized inpatient geriatric rehabilitation program at Wesley Woods Geriatric Hospital, which is affiliated with Emory University School of Medicine. SUBJECTS: Fifty-eight hip fracture patients, 35 with and 23 without cognitive impairment. MEASUREMENTS: Cognitive functioning measured by the Mattis Dementia Rating Scale (MDRS); functional outcome assessed by the Functional Independence Measure (FIM); comparison of pre-fracture with discharge living environments. MAIN RESULTS: Both cognitively impaired and intact hip fracture patients exhibited similar overall FIM motor improvements as well as functional gains in specific FIM areas measuring self-care, sphincter control, and locomotion (e.g., walking). Cognitively intact patients, however, displayed significantly greater gains in mobility (e.g., transfers) at discharge. Cognitively impaired patients who lived in the community were as likely as intact patients to return to the community. Patients who entered the program at a modified dependence level (FIM 3-5) and achieved motor independence at discharge (FIM 6-7) had higher MDRS initiation/ perseveration and memory scores. CONCLUSIONS: Hip fracture patients with cognitive impairments can achieve positive outcomes as defined by functional improvement and discharge destination. Intensive post-fracture rehabilitation in the early phase of recovery may promote functional independence and a return to the community for older patients at risk for nursing home placement. Future research should examine the long-term maintenance of these improvements and explore how rehabilitation interventions can be altered to enhance outcome.

Aged↗
PubMed2002

Does cognitive status moderate the health effects of single-person room transfers on nursing home residents?

PURPOSE: This study investigated whether cognitively impaired nursing home residents are particularly vulnerable to harmful effects during single-person, intrabuilding room transfers. DESIGN AND METHODS: A variation of a pretest-posttest experimental-comparison group design was used. Data on cognitive status, mortality, and seven morbidity outcome measures were abstracted from the Minimum Data Set Plus and were analyzed by means of event history analyses, controlling for covariates as well as baseline status of outcome variables. RESULTS: None of the Relocation x Cognitive Status interaction effects were significant at the Bonferroni corrected p value. IMPLICATIONS: These findings suggest that cognitive status may not moderate the health effects of single-person room transfers.

Aged↗
PubMed2001

Effects of cognitive processes and task complexity on acquisition, retention, and transfer of motor skills.

This experiment was designed to investigate the effect of cognitive problem-solving operations (termed contextual interference) and complexity of tasks on the acquisition retention and transfer of motor skills. Ninety-six children, ages 7.5-9.5 practiced the task of throwing beanbags under either low contextual interference (blocked practice), high contextual interference (random practice) or medium contextual interference (combined practice). Half of the participants acquired a complex task and the other half a simple task. All participants performed 30 acquisition trials, 9 retention trials and 4 transfer trials. Results indicated that participants who practiced in the blocked practice group did not differ in their performance whether they acquired complex or simple tasks. On the other hand, participants from the random and combined practice groups who acquired simple tasks performed better than those who acquired complex tasks. These findings support the hypothesis that there is a limit to the interference during practice that will benefit retention and transfer, thus creating the contextual interference effect. It seems that the complex-task condition combined with random or combined practice schedule increased the difficulty of acquisition, possibly impeding the cognitive processing during acquisition, thus impairing the learning process.

Analysis of Variance↗
PubMed2004

Is interlimb transfer of force-field adaptation a cognitive response to the sudden introduction of load?

Recently, Criscimagna-Hemminger et al. (2003) reported a pattern of generalization of force-field adaptation between arms that differs from the pattern that occurs across different configurations of the same arm. Although the intralimb pattern of generalization points to an intrinsic encoding of dynamics, the interlimb transfer described by these authors indicates that information about force is represented in a frame of reference external to the body. In the present study, subjects adapted to a viscous curl-field in two experimental conditions. In one condition, the field was introduced suddenly and produced clear deviations in hand paths; in the second condition, the field was introduced gradually so that at no point during the adaptation process could subjects observe or did they have to correct for a substantial kinematic error. In the first case, a pattern of interlimb transfer consistent with Criscimagna-Hemminger et al. (2003) was observed, whereas no transfer of learning between limbs occurred in the second condition. The findings suggest that there is limited transfer of fine compensatory-force adjustment between limbs. Transfer, when it does occur, may be primarily the result of a cognitive strategy that arises as a result of the sudden introduction of load and associated kinematic error.

Adaptation, Physiological↗
PubMed1995

Steering through the murky waters of a scientific conflict: situated and symbolic models of clinical cognition.

The situated action perspective, which embraces a diversity of views, challenges several of the fundamental assumptions of the symbolic information-processing framework underlying cognitive science and artificial intelligence. In this paper, we consider the following issues; symbolic representations, plans and actions, distributed cognition, and the transfer of learning. We evaluate each of these issues in terms of research and theories in clinical cognition and examine the implications for education and training, and for the integration of intelligent systems in medical practice. We argue for a reconceptualization of the symbolic framework in terms of the way the role of internal representations and cognitive activities are perceived. However, symbolic representations are integral to medical cognition and should continue to be central in any theoretical framework. A re-examination of cognitive science in medicine in terms of the relationship among physicians, technology, and the workplace could prove to be constructive in bridging the gap between theory and practice.

Artificial Intelligence↗