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At least 1,261 records · Page 70Linked to original sources
PubMed2002

Computer-enhanced telemanipulation enables a variety of totally endoscopic cardiac procedures.

BACKGROUND: Since its introduction in the field of cardiac surgery in 1997, computer-enhanced telemanipulation has been used in a number of different specialized areas. In cardiac surgery, various procedures have been successfully completed in totally endoscopic fashion ever since. Between June 1999 and January 2002, 75 closed-chest cardiac procedures have been performed at our institution using the da Vinci telemanipulation system. PATIENTS AND METHODS: In 42 patients, a single-vessel totally endoscopic coronary artery bypass was performed on the arrested heart (left internal thoracic artery (LITA) to left anterior descending artery (LAD), n = 36; right internal thoracic artery (RITA) to right coronary artery (RCA), n = 6). 12 patients had different types of multivessel revascularization using both internal thoracic arteries. 8 patients underwent LITA-to-LAD grafting on the beating heart. 10 patients underwent closure of an atrial septal defect (9 direct, 1 patch). 3 patients received an epicardial left ventricular pacemaker lead, 2 of which were reoperations. RESULTS: Overall conversion rate to any kind of incision was 25 %. The last 26 LITA to LAD patients on the arrested heart had a conversion rate of 4 %. There were no mortalities, 3 patients required reexploration via a median sternotomy, and one patient suffered a hypoxemic brain damage. The first 22 TECAB patients demonstrated excellent graft patency in angiographic control upon discharge. None of the atrial septal defect (ASD) closures showed any residual shunt on the intraoperative transesophageal echocardiogram (TEE). Patients with end-stage heart failure had successful biventricular stimulation. CONCLUSION: Our current experience confirms the feasibility of various totally endoscopic cardiac procedures with good clinical outcomes. After a steep learning curve, the conversion rate could be lowered to an acceptable figure. Some of these procedures at our institution became a reasonable treatment alternative in selected patients.

Coronary Artery Bypass↗
PubMed2004

[Antipsychotics and memory functions in schizophrenic patients].

OBJECTIVE: The aim of this study was to evaluate the effects of antipsychotics on memory functions in schizophrenic patients under clinical routine conditions. METHOD: Schizophrenic patients (n = 111) before discharge to outpatient treatment were evaluated on verbal memory function. Data were analyzed according to pharmacological treatment controlling for age. RESULTS: We observed that treatment with atypical antipsychotics (n = 80) compared with conventional neuroleptics (n = 31) was significantly associated with a more favorable effect on memory function. In short-term- and working-memory and retention a clear advantage of atypical antipsychotics could be seen. CONCLUSIONS: Results from this study suggest that even under clinical routine conditions atypical antipsychotics have an advantage on memory function when compared with conventional antipsychotics.

Adult↗
PubMed2000

Decision-making for a successful bowel continence program.

Bowel continence is one of the most difficult challenges for patients with spina bifida. Incontinence acts as a social stigma for children and a barrier for adults seeking employment. We present an algorithm for stepwise decision-making in construction of personalized continence programs for greater likelihood of success. The protocol contains 13 assessment points including; stool consistency, frequency and amount; mobility; level of paraplegia: diet; medication; anal/rectal canal tone; prior programs attempted; family routines; age; accessibility; and learning issues. Based on outcomes of these assessments, an individualized bowel program is constructed. The algorithm helps the practitioner and patient decide on components and indicators of a successful continence program. The recommended program might include timed toileting, suppository, continence enema, and ACE procedure, or a combination. Evaluation and patient education address adequate fluid/fiber, appropriate toileting equipment, and use of stool softeners/laxatives. Descriptions are available. Key elements in monitoring a continuing plan for continence include: the degree of constipation and its etiology; changing age; family availability for assistance until interdependence is optimal; wheelchair accessibility of the toilet; and ability to transfer to and from the toilet. Use of the algorithm allows for careful decision-making based on information from the patient and family. This has led to greater success in bowel continence in children with spina bifida.

Adolescent↗
PubMed2002

Remediating deficits of switching attention in patients with acquired brain injury.

OBJECTIVE: This study was designed to evaluate the remediating effects of two types of aid on a test of switching attention administered to patients with acquired brain injury (ABI). Based on the separation of cognitive functions suggested by a neural network model, it was hypothesized that external inhibition of obsolete rules, and increased salience of stimuli, would differentially improve the WCST performance of participants with ABI. DESIGN AND METHOD: The Wisconsin Card Sorting Test (WCST) performance of 24 patients with ABI assigned to three treatment groups (no treatment, external inhibition, increased stimulus salience) was compared to normal controls. MAIN OUTCOMES: External inhibition of learned rules reduced perseverative errors, while increased stimuli salience reduced random errors, committed by patients with ABI. CONCLUSIONS: The pattern of results supports the separation of functions in switching attention suggested by a neural network model, and establishes minimal aids necessary for remediating deficits associated with ABI.

Adult↗
PubMed2005

Rehabilitation of verbal working memory after left hemisphere stroke.

PRIMARY OBJECTIVE: To assess a rehabilitation programme of working memory. RESEARCH DESIGN: Single case multiple-baseline-across-behaviour design in a patient with chronic stroke suffering from a specific impairment of working memory. METHODS: Rehabilitation included training of storage and processing components of verbal working memory. Outcome was assessed with specific working memory tests, non-specific tasks requiring working memory, non-target tasks not requiring working memory and questionnaires addressing daily-life functioning. This assessment was performed twice before the experimental therapy and once after. RESULTS: Cognitive measures were stable before therapy. A statistically significant improvement was found for target measures and for daily-life skills. In contrast, no change was found on non-target tasks. CONCLUSION: Improvement was not apparently related to spontaneous recovery, since performance was stable before therapy. This study suggests that specific cognitive training may improve working memory in patients with brain injury.

Activities of Daily Living↗
PubMedDate not supplied

The Women's Circle comes full circle.

Women have been the backbone of service provision for health and healing in the Native American community in the San Francisco Bay Area. The contributions of Native women are exemplified in the Women's Circle of the Native American Health Centers in San Francisco and Oakland. Women receive a broad range of services through the Women's Circle--in a coed residential substance abuse treatment facility (Friendship House), in groups, in one-on-one counseling, and at the Friendship House American Indian Lodge, a residential women and children's facility in Oakland. This article will look at lessons learned, using both quantitative outcome measures and ethnographic means to examine the impact of the Women's Circle and how the circle was completed. Program staff were interviewed to gain insight into how the program impacted female clients. The article juxtaposes the program elements clients identified as important to their healing and staff's perceptions about the growth of the program. Distinct women's health issues--physical, emotional, mental and spiritual-sculpted program development. Significant findings and lifestyle changes that occurred around involvement in the Women's Circle are examined.

Alcoholism↗
PubMed2006

Treatment of irregular word spelling in acquired dysgraphia: selective benefit from visual mnemonics.

In contrast to the numerous treatment studies of spoken language deficits, there have been relatively few studies concerned with the treatment of spelling disorders. Among these, there have been only a small number that have targeted specific components of the spelling process. We describe a successful single case treatment study for FME, a woman with acquired dysgraphia, which was conducted within a cognitive neuropsychological framework. Pre-treatment assessment revealed a semantic deficit, impaired access to output orthography and probable additional degradation of the actual representations within the orthographic output lexicon. The treatment study was therefore directed towards relearning spellings by strengthening, and facilitating access to, specific orthographic representations for writing. In order to maximise the functional outcome for FME, treatment was focused on high frequency, irregular words. The treatment programme was carried out in two phases, one without and one with the use of mnemonics, and the results showed a selective training effect with the mnemonics alone. Treatment benefits were item specific but long lasting, and a significant improvement in FME's spelling performance was still evident at 2 months post-treatment. The current study confirms how cognitive neuropsychological theories and methods can be successfully applied to the assessment of acquired spelling impairments, and exemplifies how treatment with carefully designed mnemonics is of benefit if the inability to retrieve orthographic representations for writing is aggravated by a semantic deficit.

Agraphia↗
PubMed2006

Generalization decrement in human contingency learning.

An association between a cue and an outcome will generalize to a similar novel cue to some extent, but not completely. Learning theorists refer to the discrepancy between responding elicited by the original cue and the novel cue as a generalization decrement. Two experiments used a contingency learning task with human participants to compare the size of a generalization decrement between configurations of cues that were altered by adding or subtracting compositional elements. The results suggest that adding elements to a configuration can produce a generalization decrement, but removing elements produces a more robust generalization decrement. Furthermore, the generalization decrement caused by adding elements was not likely to be caused by competing orienting responses. The results are used to contrast Pearce's (1987, 1994) and Wagner's (2003) models of stimulus generalization.

Cues↗
PubMed1999

Language outcome following multiple subpial transection for Landau-Kleffner syndrome.

Landau-Kleffner syndrome is an acquired epileptic aphasia occurring in normal children who lose previously acquired speech and language abilities. Although some children recover some of these abilities, many children with Landau-Kleffner syndrome have significant language impairments that persist. Multiple subpial transection is a surgical technique that has been proposed as an appropriate treatment for Landau-Kleffner syndrome in that it is designed to eliminate the capacity of cortical tissue to generate seizures or subclinical epileptiform activity, while preserving the cortical functions subserved by that tissue. We report on the speech and language outcome of 14 children who underwent multiple subpial transection for treatment of Landau-Kleffner syndrome. Eleven children demonstrated significant postoperative improvement on measures of receptive or expressive vocabulary. Results indicate that early diagnosis and treatment optimize outcome, and that gains in language function are most likely to be seen years, rather than months, after surgery. Since an appropriate control group was not available, and that the best predictor of postoperative improvements in language function was that of length of time since surgery, these data might best be used as a benchmark against other Landau-Kleffner syndrome outcome studies. We conclude that multiple subpial transection may be useful in allowing for a restoration of speech and language abilities in children diagnosed with Landau-Kleffner syndrome.

Adolescent↗
PubMedDate not supplied

Executive memory dysfunctions following mild traumatic brain injury.

OBJECTIVES: To explore the contribution of executive dysfunctions to mnemonic problems in adults with mild traumatic brain injury (MTBI). DESIGN: Prospective quasiexperimental between-groups design. PARTICIPANTS: Ninety-nine persons with MTBI were compared to 90 control group participants matched for gender, age, and education. SETTING: Two Canadian brain injury rehabilitation programs. MAIN OUTCOME MEASURE: California Verbal Learning Test. RESULTS: Participants with MTBI showed a significant deficit in free recall on the California Verbal Learning Test but performed similarly to the comparison group on the recognition task. Furthermore, the participants with MTBI were less likely to use semantic clustering as a memorizing strategy and made more intrusion errors and false-positive errors on the recognition task. CONCLUSIONS: While the scores for the participants with MTBI are only slightly lower than the norm, they demonstrate that MTBI has a negative effect on mnemonic performance. The results are explained in terms of a deficit in registration/retrieval processes rather than a malfunction of the storage processes. This supports the initial hypothesis that executive dysfunctions are detrimental to the quality of mnemonic functions in patients with MTBI.

Adolescent↗
PubMed1992

The coming influence of a social sciences perspective on medical education.

Medical education will change from within in response to continued advances in biological sciences and technology, but changes that are occurring outside the natural sciences can have greater impact, especially (1) the reconceptualization of the meaning of health, (2) the increase in the number and range of different health improvement strategies, (3) the growing awareness of the paradox of the relatively low health status of the U.S. population and high per-capita and national health care expenditures, and (4) shifts in the causes of illness and death. These changes make it necessary for medical students to be given a foundation in both the natural and the social sciences, for most ill health has causal roots in both the social and physical environment, even though it is not understood how some of these outside influences are translated into disease or biologic derangements that lead to disease. Consideration should be given to changes in medical education that include (1) interpreting the sociology as well as the biology of health, (2) expanding the horizons of medicine to incorporate health improvement as well as disease cure, (3) training for population-based health care at the community level, and (4) learning to assess medical outcomes with more than biometric measures to include measurements of functioning and well-being. The author presents in detail a health input-output model to show the complex interrelationships of socio-ecologic (i.e., outside) factors and the individual's genetic-biologic makeup (inside factors) that determine the individual's state of health.

Cause of Death↗
PubMed1997

Management of rheumatoid arthritis.

There is increasing evidence that reduction of disease activity by disease-modifying drugs alters the disease course of rheumatoid arthritis and that patients benefit from early introduction of disease-modifying antirheumatic drugs. To ensure accurate diagnosis and timely referral, training of medical students and residents in rheumatology and access to a physician experienced in the management of rheumatic diseases is important. Because spontaneous remission is rare, the risk of overtreatment of a few patients is outweighed by the benefits of early treatment for the majority of patients. Also, side effects may be reduced with optimation of titration of disease activity based on standardized, reliable, valid, sensitive, and easily interpretable measures with clear-cut decision rules. A potential solution to the practical problems involving the scoring of patient questionnaires such as the Health Assessment Questionnaire and the Rheumatoid Arthritis Disease Activity index and clinical algorithms such as the Disease Activity Score is the provision of a feedback system similar to a laboratory. To feed back the results of titration of disease activity with the goal of permanently improving health outcomes in an ongoing learning process may be called clinical quality management. From a health care system or political perspective, clinical quality management that demonstrates the commitment of rheumatology toward continuous improvement of rheumatoid arthritis care may become an important activity of rheumatology societies in countries where specialty care is under scrutiny and where specialists are increasingly required to show the benefits of their care.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Equine-facilitated psychotherapy benefits students and children.

Baccalaureate nursing students who participated in equine-facilitated psychotherapy (EFP) clinical observation found that they could benefit as much from the program as the child clients. By identifying beneficial educational outcomes of this nontraditional learning assignment, the authors hope readers will explore similar possibilities for nurses at various stages of their professional development.

Adolescent↗
PubMedDate not supplied

Outcomes of videotape instruction in clinic waiting area.

PURPOSE: The purpose of our study was to examine the effectiveness of general health-promotion teaching for patients in the waiting room of a clinic, using focused videotape instruction. DESIGN: An experimental design was used. SAMPLE: Subjects were patients (N = 215) in the waiting rooms of clinics in a university medical center in the Midwest. METHOD: Patients were randomly assigned to two groups: focused videotape instruction in the clinic (n = 106) and control (no instruction in the clinic waiting area) (n = 109). The outcome measures included patient learning about a health education topic and patient satisfaction with overall care, explanations by the provider, and education received during the clinic visit. FINDINGS: There was a significant gain in knowledge for patients who viewed the videotape in the waiting room (t = 5.43, df = 213, p < .0001), and they were more satisfied with their education compared with the control group (t = 4.73, df = 213, p < .0001). IMPLICATIONS: This study supports focused video instruction as an effective and efficient teaching intervention for disseminating health information in the waiting area.

Educational Measurement↗
PubMedDate not supplied

Computers in patient education.

Nurses in practice have an increasing need to become aware of the computer-based resources available and the evidence regarding their use in the process of patient education. This synthesis of the literature examines research related to computer-based patient education. A particular focus is placed on the nurse clinician's perspective and the role of the nurse as a patient educator in the digital age. Two primary healthcare database resources, MEDLINE and CINAHL, were selected for review of the current literature. A listing of articles related to the use of computer technology in patient education was obtained from both of these databases. The search strategy included exploding the subject heading terms "computer" and "patient education," and included articles from 1971 to 2001. Computer-based patient education is an effective strategy for improving healthcare knowledge and clinical outcomes. Computer-based learning can be tailored to the individual's age and specific learning needs. Furthermore, although access to computer-based resources continues to be a barrier for some, socioeconomic disparities have no reported impact on patients' abilities to use computer-based technologies effectively.

Attitude to Computers↗
PubMed2003

Laparoscopic radical prostatectomy: decreasing the learning curve using a mentor initiated approach.

PURPOSE: Laparoscopic radical prostatectomy is being evaluated at several centers in the United States as a treatment option for localized prostate cancer. It is a technically difficult operation to perform with a steep learning curve. It has been stated that 50 procedures are necessary to satisfy the learning curve. To expedite performance and evaluation of laparoscopic radical prostatectomy a surgeon (mentor) who had performed 200 cases was invited to instruct a fellowship trained laparoscopist (trainee). MATERIALS AND METHODS: From March 2001 through September 2001 we performed 30 laparoscopic radical prostatectomies. The mentor performed the first 12 procedures with the trainee acting as assistant (group 1). The subsequent 18 procedures were performed by the trainee with the mentor acting as assistant (group 2). A final set of 20 procedures was performed by the trainee alone using 1 of 3 urological residents as the assistant (group 3). The transperitoneal approach was used and all suturing was intracorporeal. Preoperative data included prostate specific antigen, clinical stage, Gleason grade and median patient age. Intraoperative data included operative time, the blood loss/transfusion rate and intraoperative complications. Postoperative data included pathological stage, prostate specific antigen, the positive margin rate, catheter dwell time and hospital stay. When applicable, statistical significance was determined using the standard paired t test. RESULTS: There was no statistical difference in median operative time in groups 1 and 2 (248 and 258 minutes, respectively, p = 0.15). Similarly there was no difference in groups 2 (trainee and mentor assistant) and 3 (trainee alone) (p = 0.26). There was a difference in operative time in groups 1 and 3 (p = 0.04). Mean estimated blood loss was comparable in groups 1 to 3 and not statistically different (150, 250 and 250 cc, respectively, p = 0.15). Mean organ weight was also comparable (64, 59 and 55 gm., respectively). Hospital stay was 3 days in all groups. Catheter time decreased as confidence was gained with the procedure (range 6 to 33 days). Final pathological stage was compared among the 3 groups. There was an overall increase in positive margins in groups 1 to 3 (16%, 22% and 30%, respectively, p not significant). However, the positive margin rate for stage pT2 disease was similar at 15.5% for groups 1 and 2, and 14% for group 3. CONCLUSIONS: Laparoscopic radical prostatectomy is a technically challenging operation that is in the early stages of evolution and evaluation. We present an intensive, mentor initiated approach to decrease the learning curve and maintain outcomes.

Education, Medical, Continuing↗
PubMed2004

Memory outcome after selective amygdalohippocampectomy in patients with temporal lobe epilepsy: one-year follow-up.

PURPOSE: In a previous study we reported clinically significant memory declines 3 months after selective amygdalohippocampectomy (SAH) in 140 patients with mesial temporal lobe epilepsy, particularly if the resection was left-sided. We supposed that the observed postoperative impairments might have reflected acute effects of surgery. Therefore we evaluated in the present study whether a recovery can be found 1 year after surgery. METHODS: Verbal and nonverbal memory functions were assessed in 115 patients before and 3 and 12 months after unilateral SAH. RESULTS: No recovery of postoperative verbal memory declines was found in the left-SAH group. Clinically meaningful losses were still evident in 33 to 50% of patients. In right-SAH patients, a recovery of verbal memory was indicated, and effects of surgical complications were no longer evident. One year after surgery, the corresponding preoperative performance was the only significant predictor of a postoperative change in the left-SAH group. CONCLUSIONS: Verbal memory decline observed 3 months after left SAH is persistent 1 year after surgery. Declines in verbal memory, which were observed in some right-SAH patients at the short-term follow-up, seem to be temporary.

Adult↗