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PubMed1989

Natural alteration of speaking rate: the effect on passage comprehension by listeners over 75 years of age.

The purpose of the study was to assess the comprehension performance of "old-old" listeners for naturally rate-altered passages. Fourteen men and 14 women between 75 and 84 years of age responded to comprehension questions after hearing matched passages at four different rates. The listeners' performances were significantly worse under 60% time compression than at normal rate and two rates of time expansion. Comprehension differences between the sexes were not significant. The results are compared with prior findings for old-old listeners responding to electronically altered speech stimuli (Schmitt, 1983a) and for "young-old" listeners (65-74 years of age) who also responded to naturally rate-altered passages.

Aged↗

PubMed1988

[Psychophysical data and speech comprehension after 2 years with the Clark/Nucleus prosthesis].

Psychophysical data such as threshold and comfort levels indicate an extensive preservation of auditory nerve fibers. Changes of these data can point to increasing damage of nerve fibres due to long-term electrical stimulation or to obliteration of the cochlea when an intracochlear system is used. Unfavourable levels indicate negative influence on speech comprehension. The psychophysical data and the speech comprehension of 10 patients fitted with a Clark/NUCLEUS cochlear implant in the last 2 years have been analysed. During this period of time the threshold and comfort levels remained almost stable, whereas speech comprehension is still increasing, though to a lesser extent, after 2 years with the implant. These results indicate that the patients suffer neither an increasing destruction of auditory nerve fibres nor severe intracochlear changes.

Auditory Threshold↗

PubMed1988

Quality and comprehensiveness of the National Drug Code Directory on magnetic tape.

The quality and comprehensiveness of the FDA's National Drug Code Directory (NDCD) in magnetic tape form was evaluated. The internal quality of the tape was measured by performing cross-checks of the four record types found on the tape and by checking for the presence of "illegal" characters. The comprehensiveness of the tape was evaluated by determining the extent to which a sample of items from nine community and hospital pharmacies could be matched with code numbers on the NDCD tape. A second test of comprehensiveness measured the match rate between the shelf stock sample and National Drug Code (NDC) numbers in a magnetic tape supplied by a regional wholesaler. External quality was measured by comparing the NDC numbers on the containers of items from the shelf sample with the corresponding information in the NDCD tape. More than 300 discrepancies among the four types of records were discovered, and more than 100 "illegal" characters were present in each of the four record types. Matches on the NDCD tape could be found for 80% of the items in the shelf stock sample and 69.5% of the items in the tape supplied by the wholesaler. A total of 156 errors were discovered when the codes on containers in the shelf sample were matched with the NDCD tape information, yielding an error rate of 6.5%. Because of the 6.5% error rate, the usefulness of the NDCD tape is questionable. Since only 80% of an off-the-shelf sample of drugs had matches on the NDCD tape, about 20% of drug products would have to be matched with some other information source. How these figures for the NDCD tape compare with figures for proprietary tapes is not known.

Drug Information Services↗

PubMed2025

[First results of comprehensive genomic studies on solid tumours in National Institute of Oncology].

AIMS: The Molecular Pathology Laboratory of the National Institute of Oncology has been performing comprehensive genomic studies (500-gene panel) since 2021. This paper summarizes our results obtained between 2022 and 2024, focusing on clinical requests, the histological type of cases studied and the potential therapeutic benefit of identified variants. METHODS: Comprehensive genomic profiling was performed using next generation sequencing on an Ion S5 Plus system (Thermo Fisher Scientific) with Oncomine Comprehensive Assay Plus kit. DNA and RNA were extracted from formalin- fixed, paraffin-embedded samples. RESULTS: 402 analyses were performed. We identified mutations with therapeutic significance in 37.3% (150/402) of cases, including 26.4% (106/402) of cases with on label therapies. The most frequently investigated cases were soft tissue sarcomas and gynaecological tumours. CONCLUSIONS: Genetic alterations with therapeutic relevance primarily include high TMB and high GIS. Previously unknown mutations suitable for targeted therapy were rarely identified, as almost all cases had previously undergone small targeted panel testing.

Humans↗

PubMed1985

Young children's comprehension of montage.

2 studies examined children's comprehension of brief stop-animation televised segments incorporating elements of cinematic montage such as pans, zooms, and cuts. Children reconstructed the action and dialogue in these segments using the same dolls and settings depicted. In Study 1, there was no effect of cinematic techniques on reconstruction performance of 3- and 5-year-olds as compared to control segments filmed without these techniques. The results challenged the assumption that the use of such techniques per se contributes to young children's poor comprehension of television shows. In Study 2, 12 new segments were produced in which comprehending the montage required inferences of character perspective, implied action sequences, spatial relationships, and simultaneity of different actions. Averaging across all segments, 62% of the 4-year-olds and 88% of the 7-year-olds demonstrated clear comprehension of the montage. Inferences concerning implied action sequences were easiest for both ages. Inferences of simultaneity were most difficult for 4-year-olds, whereas inferences of character perspective were most difficult for 7-year-olds. Preschool children are thus capable of understanding cinematic events conveyed through camera techniques and film editing, despite previous assertions to the contrary. This ability nevertheless substantially increases with age.

Child↗

PubMed1967

Comprehensive history taking for the non-psychiatrist.

To an increasing degree the psychiatrist is oriented to the community and general hospital either as consultant, therapist, or collaborator in overall patient management. In these new roles, he becomes a more comprehensive physician and also conveys psychiatric insights to his colleagues.Psychological factors and the patient's personality "style" influence the development and course of every disease, complicating diagnosis and effective treatment. It is a basic requirement that a good working alliance be established between patient and physician. This is assisted by comprehensive history taking, which clarifies the lifesetting in which the illness began, the patient's personality and his habitual reactions of emotional regression under stress. It will also point up errors introduced by the patient, omissions, and distortions in offering the subjective data which the physician must evaluate.SEVEN MAJOR PERSONALITY TYPES AND APPROPRIATE PHYSICIAN RESPONSES ARE OUTLINED: the dependent demanding oral patient, the orderly controlled obsessive, the dramatic seductive hysteric, the long-suffering masochist, the querulous paranoid, the overbearing narcissist and the aloof withdrawn schizoid.The non-psychiatrist can resolve complex and puzzling medical problems if he has an increased awareness of how emotional forces complicate illness and if he can exploit comprehensive history taking to the full.

Diagnosis↗

PubMed1978

Test of the generality of Bobrow and Bower's comprehension hypothesis.

In a test of the generality of the comprehension hypothesis, EMR children were assigned, following pretraining measures, to experimental(n = 24) and control (n = 12) conditions. The experimental group was given intensive training with both self-generated and supplied links, while the control group participated in the same training format but without mediational instruction. Posttraining measures strongly supported the applicability of the comprehension hypothesis to the associative learning of EMR children. Superior associative learning and greater comprehension occurred under generate as compared to supplied conditions.

Association Learning↗

PubMed1984

Effects of anxiety-reducing hypnotic training on learning and reading-comprehension tasks.

The effect of anxiety-reducing hypnotic training on learning and reading-comprehension tasks was examined. Fifteen college students who reported having test-taking anxiety were randomly assigned to an experimental or a control group. The experimental group received hypnotic training to reduce anxiety prior to taking a learning and reading-comprehension test. No significant difference was found between the experimental and the control group on the simple-recall task. However, on the reading-comprehension test the experimental group scored significantly higher than the control group. Further examination of the total score revealed that the experimental group difference was due to superior performance on the inference items. There was no difference between groups on items that required the recall of information from the passage. These findings support the notion that hypnotic training may be useful to reduce anxiety and improve test performance.

Anxiety↗

PubMed1983

Procedures for handling antineoplastic injections in comprehensive cancer centers.

The procedures for handling injectable antineoplastic drugs in comprehensive cancer centers in the U.S. are summarized. In May 1982, a survey was sent to directors of pharmacy at 27 institutions designated as comprehensive cancer centers. Some questions duplicated a 1979 survey, while others addressed points in recently published guidelines on handling antineoplastic medications. Representatives of 21 institutions responded. These institutions represented 13,638 beds, 1,848 of which were oncology beds. Seventeen institutions had written policies for the preparation of antineoplastics, but only nine had a training program. The pharmacist or pharmacy technician prepared these medications in 12 institutions. Ten institutions prepared antineoplastics in a vertical laminar-flow hood. Gloves and masks were worn by employees in 20 and 13 of the institutions, respectively. Six institutions in some way assessed the health of employees handling antineoplastics. Eleven institutions had written policies on disposal of antineoplastics; 13 institutions disposed of this waste separately. Ten institutions had a training program for administration of antineoplastics. Compared with 1979, the trend is toward increased protection of persons handling injectable antineoplastic agents, but the procedures used at comprehensive cancer centers are not uniform.

Antineoplastic Agents↗

PubMed1993

Bringing comprehensive health education to the New York City Public Schools: a private-public success story.

The New York Academy of Medicine has pioneered a far-sighted effort which successfully introduced two model health education curricula into the New York City Public Schools at both the elementary and middle school levels. The curriculums for kindergarten through sixth grades, Growing Healthy, are currently being used in 525 of New York's 625 elementary schools, and the curriculum for seventh and eighth grades, Being Healthy, is in place in 60 of 200 junior high schools. These curricula offer a comprehensive approach to health education that promotes emotional well-being as well as physical health by improving health behaviors, attitudes, and academic performance of students through hands-on and interactive activities which develop decision-making skills and the ability to make healthful choices. The program has met with ongoing success and expanding influence, as the result of several important factors. First, the New York Academy of Medicine took a leadership role in supporting a venture outside its own walls and became an active advocate for comprehensive health education in the public schools. The Academy's standing as a prestigious yet independent medical association brought influence to the organizing efforts and contributed the credibility needed to get the program off the ground. Second, the Division of Student Support Services of the New York City Public Schools gave strong acceptance and cooperation leading to ongoing financial support and institutionalization of the program. Added to that is the enthusiasm of teachers, administrators, and other in-school personnel who have made the lessons of Growing Healthy and Being Healthy meaningful by reaching hundreds of thousands of students across New York City. Another important factor is the oversight and longevity which has been provided by the unusual gathering of doctors, educators, public health specialists, funders, and city administrators who created an effective private-public coalition 15 years ago and have remained committed to working together. Last through its ongoing efforts, the Academy's Office of School Health Programs has stayed at the forefront of developments in health education. By continuing to evaluate their activities and by constantly integrating new materials into the existing curricular framework, they have demonstrated that a comprehensive health education program can be both meaningful to children and responsive to community needs by reflecting current public health issues and concerns.

Child↗

PubMed1993

Elements of a comprehensive absenteeism control program: role of the occupational health nurse.

Absence from work costs American companies more than $40 billion annually. Absenteeism control programs can be cost effective, but relatively few companies in the U.S. seem to have comprehensive programs. Key elements in a comprehensive program include return to work opportunities, careful job design, standards for expected times off, clear administrative responsibility for communicating with absent employees and health care providers, and an effective information system. Perhaps the most important factor in a successful program is employee centered management and a corporate philosophy that views employees as assets. The occupational health nurse is ideally suited by education, knowledge, and job function to lead the design and management of a comprehensive absenteeism control program.

Absenteeism↗

PubMed1993

Comprehensive program for handling hazardous drugs.

Development and implementation of a comprehensive program for safe handling of hazardous drugs is described. A comprehensive, multidisciplinary program for handling hazardous drugs was developed at a 1000-bed tertiary care, university teaching institution. Hazardous drugs were identified by a hazardous-drug working group consisting of occupational health professionals, pharmacists, and an industrial hygienist. The Occupational Safety and Health Administration (OSHA) 1986 handling guidelines were used as a template, with input solicited from pharmacy staff and from other institutions. A new system for receiving, storing, and transporting hazardous drugs--which also included new labeling for such drugs--was implemented. The new guidelines were discussed with the staff, with emphasis placed on absolute compliance and incorporation of the guidelines into standard operating procedures and daily pharmacy practices. All pharmacy employees underwent retraining to ensure complete understanding. A voluntary medical surveillance program for pharmacy employees was developed concomitantly to monitor exposure to genotoxic hazardous drugs. Implementation of a comprehensive program for safe handling of hazardous drugs increased employee understanding of the need for such a program and improved the hospital's compliance with recent OSHA regulations.

Baltimore↗

PubMedDate not supplied

The Deaconess Informed Consent Comprehension Test: an assessment tool for clinical research subjects.

We developed an instrument to assess comprehension of informed consent information among 275 adults entering one of four ambulatory trials. At the conclusion of trial enrollment, subjects rated their understanding of the information presented and completed the Deaconess Informed Consent Comprehension Test (DICCT). Subjects completed the vocabulary subtest of the revised Weschler Adult Intelligence Scale (WAIS-R) and the reading subtest of the revised Wide Range Achievement Test (WRAT-R). The DICCT for 50 subjects was scored by 2 blinded investigators. Interrater agreement was 0.84 (df = 49, p < 0.001). To investigate the DICCT's potential validity, its scores were correlated with WAIS-R vocabulary scores (r = 0.44, df = 199, p < 0.01) and WRAT-R reading scores (r = 0.39, df = 268, p < 0.01). Understanding of consent information was rated as thorough by 70% of subjects. The mean +/- SD DICCT score was 20.4 +/- 3.9. The DICCT is a reliable instrument to assess comprehension of informed consent information. There is preliminary evidence for the scale's validity. The subjects believed that they had greater understanding of study information than was shown by the DICCT.

Adolescent↗

PubMed1996

Pattern of prenatal care and infant immunization status in a comprehensive adolescent-oriented maternity program.

OBJECTIVE: To examine the relationship between patterns of prenatal care utilization and the subsequent pattern of preventive infant health care utilization among patients in a comprehensive, multidisciplinary, adolescent-oriented maternity program. METHODS: We hypothesized that the mothers of incompletely immunized 8-month-olds were less compliant with their own prenatal care appointments than were mothers of fully immunized 8-month-olds. We retrospectively reviewed the medical records of 150 consecutively delivered infants and their adolescent mothers. Data concerning the pattern of prenatal and postnatal use of preventive health care services and potentially confounding maternal characteristics were collected. RESULTS: Of the 150 infants aged 8 months, 22 (14.7%) were incompletely immunized. Mothers of completely and incompletely immunized infants did not differ in age, school enrollment status, or compliance with prenatal appointments. However, the latter group initiated prenatal care later, obtained fewer prenatal visits, returned later for postpartum care, and were more likely to be black and to report inadequate family support after delivery. Three of the 5 characteristics entered a logistic regression function that predicted the risk of incomplete immunizations at 8 months of age: third-trimester initiation of prenatal care (odds ratio, 4.05; 95% confidence interval, 1.19-13.7), inadequate family support (odds ratio, 3.42; 95% confidence interval, 1.17-10.0), and black race (odds ratio, 3.14; 95% confidence interval, 1.19-8.69). The total model chi 2 was 15.8 (P < .001). CONCLUSIONS: Among patients in a comprehensive adolescent-oriented maternity program, the timing of the first prenatal visit helps to identify infants who are at increased risk for incomplete primary immunization status. Our findings favor preferential allocation of scarce, costly outreach services to infants born to adolescent mothers who enter prenatal care during the third trimester.

Adolescent↗

PubMed2005

Assessment of capacity to consent to research among older persons with schizophrenia, Alzheimer disease, or diabetes mellitus: comparison of a 3-item questionnaire with a comprehensive standardized capacity instrument.

CONTEXT: Considerable discussion surrounds issues related to the capacities of neuropsychiatric patients to consent to research, yet few empirical investigations have directly compared decisional capacity among patients with a serious mental illness with that among patients with neurologic or medical conditions. Also, as requirements for formal assessment of decisional capacity are becoming more common, there is a clear need to identify efficient screening methods. OBJECTIVES: To compare decisional capacity among 3 diagnostic groups, and to examine the degree to which impaired understanding can be detected with a brief set of screening questions. SETTING: Outpatient veterans hospital clinic and university-based neuropsychiatric research centers. DESIGN/ PARTICIPANTS: Cross-sectional comparison of decisional capacity among older (>/=60 years) outpatients with schizophrenia (n = 35), mild to moderate Alzheimer disease (n = 30), and type 2 diabetes mellitus (n = 36), and determination of sensitivity and specificity of a screening measure. MAIN OUTCOME MEASURES: Three-item decisional capacity questionnaire and the MacArthur Competence Assessment Tool for Clinical Research. RESULTS: Patients with diabetes mellitus performed the best on the capacity instruments, patients with Alzheimer disease had the worst performance, and patients with schizophrenia were intermediate. However, there was considerable heterogeneity within each group. Even within diagnostic groups, the level of cognitive functioning (measured with the Mini-Mental State Examination) was generally the best predictor of decisional capacity (particularly in the understanding component). The 3-item questionnaire was sensitive to impaired understanding as measured with the MacArthur Competence Assessment Tool for Clinical Research understanding subscale. CONCLUSIONS: Decisional capacity differed among the 3 groups; there was considerable heterogeneity even within each diagnostic group, so individualized consideration of capacity may be warranted. The level of cognitive deficits is 1 potential marker of which participants should receive comprehensive capacity evaluations, but sensitive brief questionnaires targeting key aspects of disclosed information may also provide an effective means of screening for participants warranting comprehensive capacity evaluations.

Age Factors↗

PubMed1998

Delivery of comprehensive cancer care at Kaiser Permanente.

BACKGROUND: Kaiser Permanente (KP) is a large health maintenance organization (HMO) operating in 14 states and caring for 8,000,000 members in hundreds of facilities staffed by thousands of physicians and support personnel. Cancer care is provided to these KP members as part of the health care package. METHODS: KP insures members for all their health care needs and provides needed services in their own facilities except in rare circumstances. Professional services are provided by physicians of the Permanente Medical Groups, locally governed groups of physicians contractually bound to Kaiser Permanente by capitation agreements. These agreements cover the full range of services for cancer and all other diseases. KP uses evidence-based guidelines to rationalize the provision and delivery of medical care for its members. A large investment in technology has allowed these guidelines to be generally available on local intranets and has facilitated the development of a computerized medical record and linkages to multiple clinical and administrative databases for all providers. Several of the KP regions have strong commitments to research in the public domain and have integrated this effort into the clinical practice of oncology, particularly in clinical trials in cancer treatment and prevention. Research efforts also exist in the areas of cancer epidemiology and outcomes. RESULTS: Cancer care is integrated fully into the comprehensive medical care provided the KP member. Health benefits cover the full range of cancer prevention and treatment without distinction by diagnosis. CONCLUSIONS: Within the broad range of health care options in the U.S., KP represents a good example of the value of a large HMO to deliver comprehensive general medical and oncologic care.

Comprehensive Health Care↗

PubMed1996

A family retreat as a comprehensive intervention for children with arthritis and their families.

OBJECTIVE: Family resources and coping skills are important to adaptation to pediatric chronic illness. Psychological and educational interventions have been found to enhance the coping skills of children with juvenile rheumatic disease (JRD) and their families. We examined the efficacy of a 3-day family retreat as a multidisciplinary, comprehensive treatment. METHODS: Children with JRD and their caregivers completed questionnaires assessing the children's behavioral and emotional functioning, pain, strain on caregivers' work and leisure activities, and caregivers' psychological distress before and 6 months after the family retreat. Principal caregivers were both parents for 16 children, mothers only for 10 children, and an aunt for 1 child. RESULTS: Improvements were found in children's emotional functioning, strain on caregivers' work, and strain on caregivers' leisure activities. Reductions in reported pain were not consistently revealed. CONCLUSIONS: Family retreats are an efficacious, multidisciplinary approach to helping families of children with JRD cope with the disease and its manifestations. Importantly, retreats offer a comprehensive intervention package that might not be available to families on an individual basis.

Adaptation, Psychological↗

PubMed2004

Exploring comprehensibility and manageability in palliative home care: an interview study of dying cancer patients' informal carers.

The presence of an informal carer is often a prerequisite for successful palliative home care, and the staff's ability to support informal carers' coping in such situations is important. Recent research has revealed that it is possible to achieve positive psychological states in palliative care despite the burdening situation. As there is a lack of theory-based coping studies, the aim of this study was to describe, within the context of palliative home care, two concepts in Antonovsky's theory of Sense of Coherence: comprehensibility (a perception that the challenge is understood) and manageability (a perception that the resources to cope are available). Tape-recorded semi-structured interviews with 19 informal carers during ongoing palliative home care were transcribed and analysed with a qualitative hermeneutic approach. Elements that facilitated comprehensibility included open information, symbolic information, basic life assumptions and previous knowledge. These were important for creating a congruent inner reality (as opposed to chaos). Resources contributing to manageability dealt with power, support, competence and accessibility, which on a more abstract level resulted in a feeling of togetherness (as opposed to isolation). The findings are discussed in relation to the complexity of communication between staff and carers within palliative care.

Adaptation, Psychological↗