Influence of learning curve on the success of transradial coronary angioplasty.
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Angioplasty, Balloon, Coronary↗
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Analyses of client variables in a series of psychotherapy sessions with two child clients.
Studied the process of child psychotherapy by means of analyses of client verbal behaviors. Audio-video recordings were made of nine intermittent psychotherapy sessions with 2 child clients, aged 8 and 12. A randomized mastertape of 4-minute segments was rated for self-exploration by means of the Carkhuff scale. Transcripts were categorized by means of an extended Snyder system and a preliminary set of grammatical variables. Transcripts then were minutized, and all client variables were intercorrelated and factor-analyzed. According to the research expectations, a high level of interrater reliability for the Carkhuff scale and high levels of interjudge agreement for the extended Snyder system were found. Analyses of the client variables demonstrated the nature of each client's verbal responding as well as their pattern of change across successive therapy sessions. The overall verbal response behavior of each client was summarized best through the factor analyses. Communalities and individual differences between the clients were discussed. Future directions for the study of client variables in child psychotherapy process research were suggested.
Affective Symptoms↗
Chronic epilepsy and cognition: a longitudinal study in temporal lobe epilepsy.
It remains unclear whether uncontrolled epilepsy causes mental decline. This longitudinal study contrasts change of memory and nonmemory functions in 147 surgically and 102 medically treated patients with temporal lobe epilepsy. All participants were evaluated at baseline (T1) and after 2 to 10 years (T3). Surgical patients underwent additional testing 1 year postoperatively (T2). Data were analyzed on an individual and group level. Sixty-three percent of the surgical and 12% of the medically treated patients were seizure-free at T3. Fifty percent of the medically treated and 60% of the surgical patients showed significant memory decline at T3 with little change in nonmemory functions (difference not significant). Surgery anticipated the decline seen in the medically treated group and exceeded it when surgery was performed on the left, or if seizures continued postoperatively. Seizure-free surgical patients showed recovery of nonmemory functions at T2 (p < 0.001) and of memory functions at T3 (T3, p = 0.03). Multiple regression indicated retest interval, seizure control, and mental reserve capacity as predictors of performance changes. In addition, psychosocial outcome was better when seizures were controlled. In conclusion, chronic temporal lobe epilepsy is associated with progressive memory impairment. Surgery, particularly if unsuccessful, accelerates this decline. However, memory decline may be stopped and even reversed if seizures are fully controlled.
Adult↗
Hidden curriculum in continuing medical education.
In developing curricula for undergraduate and graduate medical education, educators have become increasingly aware of an interweaving of the formal, informal, and hidden curricula and their influences on the outcomes of teaching and learning. But, to date, there is little in the literature about the hidden curriculum of medical practice, which takes place after graduation and certification. This article initiates that discussion with influences of the hidden curriculum on the actions physicians take or do not take in caring for patients. Hafferty's framework of institutional policies, evaluation activities, resource-allocation decisions, and institutional slang, along with our knowledge of health services research and the continuing medical education (CME) research literature, suggests that there is a hidden and powerful curriculum that affects physician performance. Determining whether the hidden curriculum conflicts with the messages that we are delivering through formal CME (courses, clinical practice guidelines, peer review journals) may contribute to improving our impact on physician performance.
Curriculum↗
A pictographic method for teaching spelling to Greek dyslexic children.
In the Greek orthography every letter consistently represents the same sound, but the same sound can be represented by different letters or pairs of letters. This makes spelling more difficult than reading. Two methods of teaching spelling to Greek dyslexic children are compared. The first involved pictograms (specially drawn pictures) for use when alternative spellings are possible. This is referred to as the 'PICTO' method. The second was in effect a combination of two traditional methods: the first involved the teaching of letter-sound correspondences in a multisensory way; the second involved the use of concepts derived from linguistics, the children being taught the derivations of words and shown how the same root morphemes, derivative morphemes, etc., were cosistently represented by the same spelling pattern. This combination of methods is referred to as 'TRAD', signifying 'traditional'. There were 72 subjects in the study, aged between 9 and 11 years. Four different teachers, each using both PICTO and TRAD, took part in the teaching sessions. The PICTO method proved considerably more effective; and possible reasons are suggested as to why this might be so.
Child↗
Multiagency outcome evaluation of children's services: a case study.
Outcome monitoring has become a focus of accountability for public and nonprofit human service agencies. Besides providing answers to funders' questions about the services' impact, outcome monitoring helps administrators improve program effectiveness. After a three-year development period and a one-year implementation experience, SumOne for Kids represents a technically advanced outcome-monitoring system for children's mental health and/or child welfare services. Initiated, designed, and tested by 31 children's service agencies throughout Pennsylvania, and with state bureaucrats' and policy makers' encouragement, SumOne for Kids represents an effort to create a bottom-up/top-down process for implementing a statewide outcome-monitoring system. This article describes the genesis of this outcome-monitoring system, primary design principles, use of social validation for outcome selection, resolution of methodological difficulties, and reasons for selecting functional over clinical outcomes. The article reviews lessons learned through the development experience instructive to children's service managers, program evaluators, and industry leaders interested in establishing outcome-monitoring systems.
Child↗
[Temporal lobe epilepsy: longitudinal clinical, neuropsychological and psychosocial follow-up of surgically and conservatively managed patients].
Little is known about the differential long-term outcome from surgical and nonsurgical therapy in patients with chronic epilepsy. In the present study, 161 surgically or nonsurgically treated patients with drug-resistant temporal lobe epilepsy (TLE) were re-evaluated according to a detailed clinical, neuropsychological, and psychosocial protocol with a mean follow-up interval of 58 months. Freedom from seizures was achieved in 64% of the surgical group; yet 23% of the nonsurgical patients became seizure-free as a result of modifications in drug therapy. Generally, socioeconomic development was poorer in nonsurgical than in surgical patients. Freedom from seizures, employment, and the absence of depression were significant determinants of better quality of life. As for neuropsychological outcome, verbal memory impairment was common after left-sided temporal resection; however, there was no evidence of a marked progression of cognitive impairment after the first postoperative year. In nonsurgical patients, too, cognitive capacities were surprisingly stable over time, although persisting seizures and good baseline performance predicted a poorer neuropsychological outcome.
Adult↗
[Modular memory training for elderly adults: concept and evaluation].
We present a modular concept of a cognitive training relevant to the demands of everyday life of community dwelling older adults. The concept has three major advantages. First, it takes into account the current performance levels and needs of the trainees. Second, the training is economical in aiming at selecting the most effective training elements. Third, the concept allows the evaluation of single elements of the training. The application of this concept points at the importance of training content being relevant to trainees' everyday lives. Results indicate that training effectiveness depends on the starting level of performance and the cognitive domain being trained. Overall, the results demonstrate the possibility to maximize training gains of older adults by designing adequate trainings for well-defined subgroups of normal older adults.
Activities of Daily Living↗
[Inception cohorts for spondyloarthropathies].
The spondyloarthropathies (SpA) are important inflammatory rheumatic diseases--not only because patients of young age are frequently involved. Ankylosing spondylitis, reactive arthritis, and undifferentiated spondyloarthropathy are prototypes of SpA which share several clinical features and the strong association with HLA B27. Despite its high prevalence there are many shortcomings in early diagnosis and therapy of SpA. The same is true for the knowledge on course, prognostic factors, and the socioeconomic consequences of these diseases. Furthermore, our knowledge about pathogenesis and therapy is still limited. Due to the known deficiencies in rheumatologic education, there are clear-cut deficiencies in the health care provided by general practitioners. The aim of the project presented here is to built up a cohort of early SpA patients to learn about course and outcome of SpA. In this regard, special attention is paid to the inclusion of patients with juvenile SpA since AS starts frequently in the 2nd decade of life and because the clinical picture with more frequent peripheral joint involvement differs from AS of adult onset. Moreover, these cohorts play an essential role for other projects of the MedNet subdivision of infect-associated arthritides/spondyloarthropathies in which studies on diagnosis, therapy, immunology, and genetics of the SpA performed.
Adult↗
Prediction of the early prognosis of the hepatectomized patient with hepatocellular carcinoma with a neural network.
The early prognosis of the hepatectomized patients with hepatocellular carcinoma was determined preoperatively with a perceptron-type neural network. The neural network was trained with the preoperative data of 54 example cases with the early prognosis, successful or died of hepatic dysfunction, as teaching signals. After learning these examples, the neural network came to give a precise prediction to the example data except for one case. With the learned neural network, the outcomes of the hepatectomy of 11 patients (10 successful; 1 died) were predicted prospectively with 100% precision. The usefulness of the neural network for the prediction was determined.
Adult↗
Measuring cardiopulmonary resuscitation performance: a comparison of the Heartsaver checklist to manikin strip.
Both checklists and recording manikin strips (strips) are used for evaluation of cardiopulmonary resuscitation (CPR) performance. To examine their relationship, we simultaneously evaluated single rescuer CPR of 255 subjects using both checklists and strips. For Group 1 (N = 192; general public tested in Heartsaver course) we compared the total number of initial ventilations and compressions judged to be correct by checklists with those judged to be correct by strips. For Group II (N = 63; physicians, nurses, general public tested in retention studies) we compared each subjects checklist with their own strip for evaluation of correct ventilations and compressions. In Group I, CPR was judged to be correct two to four times more frequently by checklists than by strips. In Group II, all correlations were poor. The most common disagreements were with performances evaluated as correct by checklist but not by strip. Therefore, the current checklist may be a poor instrument for measuring CPR. More accurate evaluation should improve learning and therefore improve outcome following cardiac arrest.
Educational Measurement↗
Repetitive transcranial magnetic stimulation as treatment of poststroke depression: a preliminary study.
BACKGROUND: Depression has a significant impact on poststroke recovery and mortality. There are a proportion of patients with poststroke depression (PSD) who do not respond to antidepressants. Repetitive Transcranial Magnetic Stimulation (rTMS) might be a safe and effective alternative in these refractory cases. METHODS: We conducted a randomized, parallel, double-blind study of active versus sham left prefrontal rTMS in patients with refractory PSD. After discontinuing antidepressants, patients were randomly assigned to receive 10 sessions of active (10 Hz, 110% of the motor threshold, 20 trains of 5 seconds duration) or sham left prefrontal rTMS. Efficacy measures included HAM-D scores, response and remission rates. Patients completed a neuropsychological battery at baseline and after completing the protocol. RESULTS: When compared with sham stimulation, 10 sessions of active rTMS of the left dorsolateral prefrontal cortex were associated with a significant reduction of depressive symptoms. This reduction was not influenced by patient's age, type or location of stroke, volume of left frontal leukoaraiosis or by the distance of the stimulating coil to the prefrontal cortex. However, there was a significant positive correlation between the percentage of reduction of Ham-D scores and frontal gray and white matter volumes. There were no significant changes in cognitive functioning between the active and the sham stimulation groups. In addition, there were few and mild adverse effects that were equally distributed among groups. CONCLUSIONS: Taken together, these preliminary findings suggest that rTMS may be an effective and safe treatment alternative for patients with refractory depression and stroke.
Aged↗
Hippocampal volume, memory, and cortisol status in major depressive disorder: effects of treatment.
BACKGROUND: Depression has been linked to stress, memory deficits, and hypercortisolemia. However, the relationships between depression, hippocampal structure and function, and cortisol levels are unclear and the effects of antidepressant treatment on the measures are not well studied. METHODS: Whole hippocampal volume, performance on verbal and visual declarative memory function and cortisol status was evaluated in 38 subjects with major depressive disorder (MDD) and 33 healthy subjects. All measures were repeated in a subgroup (n = 22) of depressed patients after successful selective serotonin reuptake inhibitor (SSRI) treatment. RESULTS: Hippocampal volume was not significantly different between patients with untreated MMD and healthy subjects, after controlling for whole brain volume, age and gender. However, depressed subjects had significantly greater deficits in delayed memory and percent retention on the verbal portion of the Wechsler Memory Scale-Revised (WMS-R) compared with healthy subjects, without significant differences in visual memory, attention, vigilance, or distractibility. Baseline plasma or urinary free cortisol (UFC) was not related to either hippocampal volume or memory deficits. Successful treatment with antidepressants did not change hippocampal volume but did result in a significant improvement in memory function and a reduction in UFC excretion. CONCLUSIONS: Medication-free nonelderly depressed outpatients without alcohol dependence or adverse experiences in childhood had normal hippocampal volume. Focal declarative memory deficits in depression supported localized hippocampal dysfunction in depressed patients. Treatment with antidepressants significantly improved memory and depression but did not alter hippocampal volume, suggesting that antidepressants may improve hippocampal function in the absence of detectable structural changes.
Adult↗
Courtship learning: scent of a woman.
Learning to predict an outcome based on previous experience is of considerable selective advantage. Getting it wrong can be costly. In a complex environment, however, using the appropriate predictor is not necessarily a trivial task.
Animals↗
Directed forgetting in PTSD: a comparative study versus normal controls.
The most characteristic feature of Post-Traumatic Stress Disorder (PTSD) is the reexperiencing syndrome. The patient's memory seems to be fixed on the traumatic event, which may be due to disturbance of the autobiographic memory. To retrieve memories, others have to be inhibited. These inhibition mechanisms have been studied using the Directed Forgetting Paradigm, which measures the capacity to forget recently processed information and to retain the relevant information. Our hypothesis is that during PTSD, the memory is saturated with traumatic memories, so that the patients are no longer able to use the inhibitory processes. Therefore, during a Directed Forgetting Task (DFT) in which words "to remember" and words "to forget" are given, PTSD patients cannot inhibit the words "to forget", and so recall more words than the controls. We studied 30 patients with PTSD and compared them with 30 healthy controls, using DFT. The results show that the patients remembered significantly fewer words overall, and fewer of the words "to remember" than the controls, both for immediate and final recall. Our results are in favor of a reduction in directed forgetting in patients suffering from PTSD, resulting in difficulty in inhibiting irrelevant information from the overall information. There seems to be a deficit in the inhibitory processes in the memory in PTSD.
Adult↗
Corticosteroids for the treatment of Landau-kleffner syndrome and continuous spike-wave discharge during sleep.
Landau-Kleffner syndrome and its variants such as continuous Spike-Wave Discharge during Sleep (CSWS) are progressive epileptic encephalopathies of childhood. The treatment of this unusual group of patients is controversial. We describe our experience in treating patients with Landau-Kleffner syndrome and CSWS with corticosteroids. The patients received Prednisone 1 mg/kg/day for 6 months, 1 year, then yearly. Follow-up was for 1-10 years (mean 4 years). Ten patients, 3 females, 7 males were studied. Age of onset ranged from 2 to 11 years (mean 7.5 years). Eight patients manifested Landau-Kleffner syndrome, and two had CSWS. Most patients had seizures (8/10); however, two patients did not have clinical seizures. MRI was normal in all patients. SPECT scan was abnormal in four patients, normal in three, and not available in three. All but one patient manifested significant improvement in language, cognition, and behaviour, which continued after the corticosteroid trial. Side effects were few (4/10) and transient and consisted of weight gain (2), behavioral change (1), and hypertension (1). Corticosteroids are a safe and effective treatment for patients with Landau-Kleffner syndrome and CSWS. Most patients had improvement in language, cognition, and behaviour after treatment. Side effects are few and reversible, and benefits appear long lasting. Corticosteroids should be considered as a treatment option in children with Landau-Kleffner syndrome and CSWS.
Child↗
A cost-benefit analysis of community and institutional placements for persons with mental retardation in Oklahoma.
Matched samples of 174 pairs of persons with mental retardation who live in either community settings or congregate care settings were compared on both cost and outcome dimensions. It was learned that costs were significantly lower in community programs. Greater levels of service and integration were evident in the community programs, but institutional programs offered vocational opportunities for more individuals. Although we were able to predict with accuracy who lived in community and institutional settings, we were unable to predict costs.
Adult↗
Cognitive problems related to epilepsy syndromes, especially malignant epilepsies.
Neurocognitive impairment is frequent in epilepsy patients. Causes are multiple, and may be influenced by several factors including the epilepsy syndrome. Most cognitive complaints in adult patients are mental slowness, memory difficulties and attention deficits. In children, cognitive problems are more diffuse, responsible for language troubles, learning difficulties, poor academic outcome, behavior problems and finally unfortunate socio-professional prognosis. The most devastating epilepsy syndromes such as epileptic encephalopathies are nearly exclusively described in infancy and childhood. This paper will review the major cognitive complaints in relation to the epilepsy syndrome, with a more detailed interest for the malignant epilepsies in infancy and childhood such as Ohtahara and West syndrome, Lennox-Gastaut syndrome and epileptic encephalopathis with continuous spike-and-wase during slow wave sleep. The impact of surgery on cognition will be briefly discussed in adults and youger patients.
Cognition Disorders↗