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At least 1,153 records · Page 64Linked to original sources

PubMed2004

Improvements in neurocognitive function and mood following adjunctive treatment with mifepristone (RU-486) in bipolar disorder.

High cortisol levels are found in severe mood disorders, particularly bipolar disorder. Hypercortisolaemia may cause or exacerbate both neurocognitive impairment and depressive symptoms. We hypothesized that antiglucocorticoid treatments, particularly corticosteroid receptor antagonists, would improve neurocognitive functioning and attenuate depressive symptoms in this disorder. To test this hypothesis, 20 bipolar patients were treated with 600 mg/day of the corticosteroid receptor antagonist mifepristone (RU-486) or placebo for 1 week in a double-blind crossover design. Over the total 6 weeks of the study, neurocognitive and neuroendocrine function were evaluated at baseline, days 21 and 42. Mood symptoms were evaluated weekly. Nineteen subjects completed the protocol; there were no drop-outs due to adverse events. Following treatment with mifepristone, selective improvement in neurocognitive functioning was observed. Spatial working memory performance was significantly improved compared to placebo (19.8% improvement over placebo). Measures of verbal fluency and spatial recognition memory were also improved after mifepristone. Beneficial effects on mood were found; Hamilton Depression Rating Scale scores were significantly reduced compared to baseline (mean reduction of 5.1 points) as were Montgomery-Asberg Depression Rating Scale scores (mean reduction of 6.05 points). No significant change occurred after placebo. These data require replication but provide preliminary evidence that glucocorticoid receptor antagonists may have useful cognitive-enhancing and possibly antidepressant properties in bipolar disorder.

Adult↗

PubMed1976

The expanding classroom trends and issues in postgraduate medicine. Why self-assessment?

Self-assessment can provide more than a direction for independent study and credit toward recertification. It can also provide an effective learning experience if the instruments are designed to serve an instructional purpose as well as the more traditional measurement function. Based on existing research, the characteristics of self-assessment instruments--questioning, controlling attention, elucidating objectives, evoking performance, and assessing outcomes--can enhance the learning and retention of new material.

Attention↗

PubMed1986

Pharmacists' beliefs and values about advertising patient oriented services.

Pharmacists' beliefs about the utility of advertising sources and values for advertising outcomes were studied to learn about the decision-making process for advertising patient oriented pharmacy services in the ambulatory setting. The data suggest that pharmacists in the sample believe advertising through word-of-mouth communication is more likely to result in positive outcomes than either yellow pages or local newspaper advertising.

Advertising↗

PubMedDate not supplied

An easier technique for minimally invasive video-assisted thyroidectomy.

Because of the efforts of many pioneer surgeons, the minimally invasive video-assisted thyroidectomy (MIVAT) has been recognized as a safe procedure, offering advantages such as better cosmetic outcome and less analgesic need. The MIVAT technique was described in 51 selected patients in 2001. The technique was not therefore widely used because of the excess operating time compared with traditional thyroidectomy, and most importantly, this method needed a steep learning period. This study reports a modified MIVAT procedure, which can make this operation easier and shorten the time of learning. We compared the outcomes of the originally described methods with our modified method. The selection criteria for performing MIVAT were as follows: thyroid nodules in one lobe and less than 50 mm on their largest diameter, benign lesion proved by fine-needle biopsy, patient without history of thyroiditis, and no previous neck surgery or irradiation. All patients received lobectomy. Sixty patients were eligible for MIVAT during a period of 27 months. The patients were divided into two groups. Group A consisted of the 17 patients who underwent MIVAT using the original technique that was described previously. Group B consisted of the 43 patients who underwent MIVAT using a self-designed Army retractor with a mosaic ring. The mean operation time of Group A was 120 minutes and that of Group B was 59.2 minutes. The size of the incisions was no difference in either group. There were no postoperative complications except in one patient with transient recurrent laryngeal nerve palsy in Group A. There was one conversion to open thyroidectomy in Group A and none in Group B. The cosmetic results were no different between the two groups. In conclusion, the use of a modified Army retractor with a mosaic ring made the MIVAT procedure easier and offered similar advantages.

Adolescent↗

PubMed2001

Acquisition of new "words" in normal subjects: a suggestion for the treatment of anomia.

The study explores the efficacy of three learning methods in normal controls. Thirty subjects, randomly assigned to the repetition, reading aloud, or orthographic cueing method, were asked to learn 30 new "words" (legal nonwords arbitrarily assigned to 30 different pictures); 30 further new "words" were used as controls. Number of trials to criterion was significantly lower, and number of words remembered at follow-up was significantly higher for the orthographic cueing method. Two aphasic patients with damage to the output lexicons were also rehabilitated with the same three methods. In both patients the orthographic cueing method was significantly more efficacious. The differences in learning efficacy of the three methods are discussed.

Adult↗

PubMed1991

Research in physical medicine and rehabilitation. XII. Measurement tools with application to brain injury.

There are basic principles and techniques of measurement that are relevant across biomedical disciplines. The purpose of this article is to explain some of the most important of these for medical rehabilitation, to illustrate how to use them to choose assessment instruments and to describe the nature of measurement in medical rehabilitation by examples in brain injury rehabilitation. Reliability is basic to any scientific measure. Validity, the ultimate criterion, is closely associated with the purpose of the measure. Content validity, criterion validity and construct validity are explained. Sensitivity to rehabilitative interventions and significance in patients' real lives (ecological validity) are emphasized. Measures of functional outcomes (disability) may show improvement after rehabilitation even when impairment measures do not. An extensive but selected list of measures of coma, global status, disabilities, communicative and cognitive impairments, and handicaps is presented, and their main uses are illustrated. Examples illustrate how to choose measures to study comprehensive program-level outcomes, to study learning-based interventions and to develop a general purpose database. Although there are many measures of activities of daily living and mobility, little published evidence of reliability and validity could be found even for some well-known scales. Ecologically valid and sensitive outcome measures are especially needed. Studies of the clinical utility of measures were also scarce. Many of these gaps can be spanned by clinical researchers with limited resources. Physical medicine and rehabilitation will benefit from formal studies of the reliabilities and validities of both its old and its new measurement instruments and by increased sophistication in choice of measures.

Brain Injuries↗

PubMed2005

Verb learning in children with SLI: frequency and spacing effects.

PURPOSE: This study explored the effect of frequency (number of presentations), and spacing (period between presentations) on verb learning in children with specific language impairment (SLI). Children learn words more efficiently when presentations are frequent and appropriately spaced, and this study investigated whether children with SLI likewise benefit. Given that these children demonstrate greater frequency dependence and rapid forgetting of recently acquired words, an investigation of frequency and spacing in this population is especially warranted. METHOD: Twenty-four children with SLI (mean age 5;6 [years;months]) and 24 language-matched control children (mean age 3;4) were taught novel verbs during play sessions. In a repeated measures design, 4 experimental conditions combined frequency (12 or 18 presentations) and spacing (all presentations in 1 session, or spread over 4 days). Comprehension and production probes were administered after the final session and 1 week later. RESULTS: Although the children with SLI benefited significantly from frequent and widely spaced presentations, there were no significant effect in the control group. The language-impaired children showed rapid forgetting. CONCLUSIONS: The frequency and spacing of presentations crucially affect the verb learning of children with SLI. A training regimen characterized by appropriately spaced intervals and moderate repetition will optimally benefit lexical learning.

Case-Control Studies↗

PubMed1991

Ureterorenoscopy: factors influencing success.

The first 100 patients with ureteric calculi to undergo planned ureteroscopy and lithotripsy were retrospectively studied to evaluate the factors which influenced the success of the procedure. All 75 males and 25 females who underwent this procedure had surgical indications to treat the stones. The factors influencing a successful outcome were studied over four different time frames. It was found that the procedure was more successful in females, and lower ureteric stones. The stone size did not affect the outcome as expected. The learning curve was very evident as increased experience produced higher success rates for ureteric access and lithotripsy, less morbidity, shorter operating time and lower open surgery rates. The introduction of the miniscope and laser lithotripsy was however the most significant factor in ensuring a successful outcome.

Adult↗

PubMed1999

Use of the balanced scorecard to improve the quality of behavioral health care.

As the debate over managed care continues, measuring quality has increasingly become a focus in health care. One approach to measuring quality is the use of a scorecard, which summarizes a critical set of indicators that measure the quality of care. The author describes the Balanced Scorecard (BSC), a tool developed for use in businesses to implement strategic plans for meeting an organization's objectives, and shows how the BSC can be adapted for use in behavioral health care. The scorecard addresses quality of care at five levels: financial, customer, outcomes, internal processes, and learning and growth. No more than four or five realistic objectives are chosen at each level, and an indicator for the achievement of each objective is designed. The BSC integrates indicators at the five levels to help organizations guide implementation of strategic planning, report on critical outcomes, and offer a report card for payers and consumers to make informed choices.

Behavioral Medicine↗

PubMedDate not supplied

Transforming administration to support science in the schoolhouse for students with disabilities.

I examine the role that administrators play in facilitating the development, adoption, use, and evaluation of scientifically based interventions within the school culture to support the educational outcomes of students with learning disabilities (LD). Two ways of transforming the administrative role to support science in the schoolhouse are presented; one considers the importance of including language in future legislation that acknowledges the role of administrators in school reform, and the other focuses on establishing a national research agenda addressing issues of leadership and special education. I argue that these 2 venues should serve to identify and to stimulate the use of evidence-based administrative practices that ultimately increase educational outcomes for students with LD, improve teacher instruction, and transform the leadership mission.

Education, Special↗

PubMed2005

Simulations of a modified SOP model applied to retrospective revaluation of human causal learning.

Dickinson and Burke (1996) proposed a modified version of Wagner's (1981) SOP associative theory to explain retrospective revaluation of human causal judgments. In this modified SOP (MSOP), excitatory learning occurs when cue and outcome representations are either both directly activated or both associatively activated. By contrast, inhibitory learning occurs when one representation is directly activated while the other is associatively activated. Finite node simulations of MSOP yielded simple acquisition, overshadowing, blocking, and inhibitory learning under forward contingencies. Importantly, retrospective revaluation was predicted in the form of unovershadowing and backward inhibitory learning. However, MSOP did not yield backward blocking. These predictions are evaluated against the relevant empirical evidence and contrasted with the predictions of other associative theories that have been applied to retrospective revaluation of human causal and predictive learning.

Forecasting↗

PubMedDate not supplied

The RN-BSN bridge course: transitioning the re-entry learner.

BACKGROUND: Although most RN-to-BSN programs offer bridge courses, little can be found in the literature about common course objectives, content, or outcomes. METHOD: This article details course objectives, course content, course implementation, and preliminary outcomes of a primarily distance learning RN-to-BSN bridge course at a northern California university. RESULTS: Preliminary outcome assessments suggested greater than expected increases in role and campus socialization, as well as computer literacy, as a result of RN-to-BSN bridge course implementation. CONCLUSION: The RN-to-BSN bridge course can successfully be used to transition the re-entry student and may be the link allowing RN-to-BSN students to effectively face the concurrent challenges of role socialization and computer literacy while mastering course content and course objectives.

Adaptation, Psychological↗

PubMed2005

Acquired distinctiveness and equivalence in human discrimination learning: evidence for an attentional process.

In a first stage of training, participants learned to associate four visual cues (two different colors and two different shapes) with verbal labels. For Group S, one label was applied to both colors and another to both shapes; for Group D, one label was applied to one color and one shape, and the other label to the other cues. When subsequently required to learn a task in which a given motor response was required to one of the colors and one of the shapes, and a different response to the other color and the other shape, Group D learned more readily than Group S. The task was designed so that the associations formed during the first stage of training could not generate differential transfer to the second stage. The results are consistent, however, with the proposal that training in which similar cues are followed by different outcomes will engage a learning process that boosts the attention paid to features that distinguish these cues.

Association Learning↗

PubMed1996

Teaching intonation to young deaf children with the intonation meter.

Incorrect production of intonation contours is a common phonatory problem in prelingually, profoundly deaf speakers. To help deaf speakers improve this, a visual display system for teaching intonation has been developed. In this system, called the Intonation Meter, visual feedback of intonation is given as a continuous representation of the pitch contour containing only the perceptually relevant aspects of the intonation pattern. This pitch-contour representation is supposed to facilitate the interpretation of the visual feedback of the pitch contour. A study was carried out, using a Single-Subject Design, in which subjects alternately received intonation training by means of regular methods and intonation training by means of regular methods in which also use was made of the Intonation Meter, to evaluate the effectiveness of the Intonation Meter for teaching intonation to young deaf children. Prelingually profoundly deaf children aged 6 to 7 years and 9 to 11 years participated in this study. The results showed that the 9 to 11 year old children showed most progress when the Intonation meter was used in intonation training whereas 6 to 7 year olds progressed well irrespective of whether or not the Intonation Meter was used, which is in accordance with the theory of a critical period for language learning. Alternatively, it is hypothesized that the cognitive requirements of the visual feedback might be to advanced for very young children to be helpful in learning to produce certain pitch contours.

Child↗

PubMed1998

Persistence of developmental dyscalculia: what counts? Results from a 3-year prospective follow-up study.

OBJECTIVE: To study the natural history of developmental dyscalculia (DC), a specific learning disability affecting approximately 5% of the normal school age population and to identify factors that contribute to persistence. STUDY DESIGN: Of a cohort of 3029 fourth-grade students, 185 children were classified as having DC; 140 participated in phase 1 in which they underwent IQ testing; arithmetic, reading, and writing evaluations; and an assessment for attention-deficit/hyperactivity disorder over a 3-year period. Three years later (phase 2), 88% of the children (123 of 140) were retested. RESULTS: The arithmetic scores of 95% of the 123 children with DC fell within the lowest quartile for their class. At phase 2, 47% (57 of 123) of the children were reclassified as having persistent DC, scoring in the lowest 5% for their age group (13 to 14 years old). Factors significantly associated with persistence of DC in a multivariate model were severity of the arithmetic disorder and arithmetic problems in siblings of the probands. Factors that were not associated with persistence included socioeconomic status, gender, the presence of another learning disability, and educational interventions. CONCLUSIONS: The outcome of DC is similar to that of other learning disabilities, with a persisting course in almost half of affected children; the remainder continue to perform poorly in arithmetic. The ultimate outcome of children with dyscalculia and the effect on education, employment, and psychologic well-being have yet to be determined.

Adolescent↗

PubMed1997

Safety of intrahippocampal depth electrodes for presurgical evaluation of patients with intractable epilepsy.

PURPOSE: Intracerebral depth electrodes are used in preoperative evaluation of selected patients with intractable epilepsies. In spite of their usefulness, safety of depth electrodes is disputed, and the number of insertions is decreasing. This study examined retrospectively possible deleterious effects such as perioperative complications, induction of epileptogenesis, and neuropsychologic deficits. METHODS: Clinical course and neuroradiologic findings of 115 patients with bilaterally inserted longitudinal intrahippocampal depth electrodes (IDEs) were analyzed. Hippocampal resection specimens were examined histopathologically. To detect newly developed epileptogenic areas, EEG recordings, seizure control, and semiology after standardized resection procedures were compared between patients who received IDEs and those who did not. To demonstrate functional deficits caused by IDE insertion into an unaffected hippocampus of the speech-dominant hemisphere, changes of verbal learning and memory performances before and after right amygdalohippocampectomy were compared between patients evaluated with and without IDEs. RESULTS: Five significant complications without any permanent neurologic deficit were noted, and only one was specifically linked to IDE insertion. The tissue damage associated with the insertion was minimal and sharply circumscribed. No differences of seizure outcome after standardized resections were identified between patients with and without IDEs. In postoperative EEG recordings, there was no evidence of new epileptogenic areas. No verbal memory deficit caused by IDE implantation into the hippocampus of the speech-dominant hemisphere was detectable. CONCLUSIONS: Results indicate that it is safe to implant these IDEs in selected patients.

Adult↗

PubMed2005

Written language skills in children with benign childhood epilepsy with centrotemporal spikes.

PURPOSE: The goal of this work was to study written language skills in children with benign childhood epilepsy with centrotemporal spikes (BCECTS) in the absence of atypical clinical or electroencephalographic (EEG) features (n = 32), as compared with controls (n = 36). METHODS: BCECTS patients (7-16 years), attending regular school, without cognitive or behavioral regression, or atypical EEG patterns, completed four tests assessing written language skills and one nonverbal cognitive test. School performance information was recorded. Seizure types, duration, and frequency; awake and sleep interictal EEG findings; and medication status were documented. Epilepsy and educational outcome was recorded for a period of 1-5 years after diagnosis. RESULTS: As a group, BCECTS patients performed significantly worse than controls in spelling, reading aloud, and reading comprehension; presented dyslexic-type errors; and frequently had below-average school performance. Among 11 with poor written language performance, 4 had developmental dysfunctions before school and seizure onset and, as a group, demonstrated low performance on a nonverbal cognitive test. Even though 65.6% were on anticonvulsants due to frequent seizures and/or seizures while awake, none belonged to the atypical BCECTS spectrum with respect to clinical or EEG findings. Increased epilepsy duration and seizure frequency were less represented in patients with no or mild written language problems than in those with poor performance. Otherwise, clinical course and EEG findings in this group were no different than those for the 11 children with severe written language problems. Clinical follow-up indicated that learning problems appear persistent and several children require remedial classes and/or tutoring after the epilepsy has resolved. CONCLUSIONS: Children with severe but not atypical BCECTS performed, as a group, significantly worse than controls in written language skills, specifically in spelling, reading, aloud and reading comprehension; they also presented many difficulties also found in children with dyslexia. However, poor written language performance was not considered specific to BCECTS because it occurred in children with generally low cognitive capacity and/or preexisting developmental dysfunctions. Moreover, a dissociation between epilepsy outcome and learning problem outcome, in the subgroup with poor performance, casts doubt on the existence of a possible causal link between BCECTS and educational performance.

Adolescent↗

PubMed2003

Empirical and theoretical implications of additivity between reinstatement and renewal after interference in causal learning.

An experiment explored the effects of context change (renewal) and presentation of the outcome (reinstatement) upon retroactive interference in causal learning. An interference task was used where a sequential relationship between the name of a food and two different outcomes was established (A+|A*). Renewal and reinstatement effects appeared as partial attenuation of retroactive interference. The combination of both treatments produced complete recovery of first-learned information (A+). This complete reversal on the estimations of participants suggests that renewal and reinstatement effects within this paradigm imply partial recovery of the first-learned information, rather than response at a chance level emitted by confused participants. On the other hand, additivity between reinstatement and renewal suggests that reinstatement may be due to the combined effect of different underlying processes.

Journal Article↗