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PubMed2002

Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients.

BACKGROUND AND PURPOSE: Prediction of activities of daily living (ADL) functions at an early stage after a stroke is critical because it enables clinicians to set treatment programs and goals. The objective of this study was to assess the relationship between trunk control at an early stage and comprehensive ADL function (as assessed by combining basic ADL and instrumental ADL [IADL]) in patients at 6 months after stroke. METHODS: A total of 169 stroke patients participated in this prospective study. Trunk control was measured with the use of the trunk control items of the Postural Assessment Scale for Stroke Patients (PASS-TC). In addition to the PASS-TC score, age, sex, type of stroke, side of hemiparesis, urinary incontinence, limb paresis (measured by the Fugl-Meyer motor test), balance (measured by the Fugl-Meyer balance test), and basic ADL (measured by the Barthel Index) were also selected as predictor variables. These variables were assessed at 14 days after stroke or earlier. The Barthel Index and Frenchay Activities Index (measuring IADL) were administered at 6 months after stroke. The sum of the standardized Barthel Index and standardized Frenchay Activities Index scores was used to assess comprehensive ADL function. RESULTS: Multivariable stepwise linear regression analysis showed that PASS-TC score, age, Fugl-Meyer motor test score, and Barthel Index score (listed by the order of forward selection) were the strongest predictors of comprehensive ADL function. These results were internally validated with the use of the bootstrap resampling technique. The PASS-TC score alone accounted for 45% of the variance in predicting comprehensive ADL function. Results also indicated that the PASS-TC score had slightly more power in predicting comprehensive ADL function than either the Fugl-Meyer motor test score or Barthel Index score. CONCLUSIONS: The findings of this study provide strong evidence of the predictive value of trunk control on comprehensive ADL function in stroke patients. The results imply that early assessment and management of trunk control after stroke should be emphasized.

Abdomen↗

PubMedDate not supplied

Effect of attention therapy on reading comprehension.

This study quantified the influence of visual attention therapy on the reading comprehension of Grade 6 children with moderate reading disabilities (RD) in the absence of specific reading remediation. Thirty students with below-average reading scores were identified using standardized reading comprehension tests. Fifteen children were placed randomly in the experimental group and 15 in the control group. The Attention Battery of the Cognitive Assessment System was administered to all participants. The experimental group received 12 one-hour sessions of individually monitored, computer-based attention therapy programs; the control group received no therapy during their 12-week period. Each group was retested on attention and reading comprehension measures. In order to stimulate selective and sustained visual attention, the vision therapy stressed various aspects of arousal, activation, and vigilance. At the completion of attention therapy, the mean standard attention and reading comprehension scores of the experimental group had improved significantly. The control group, however, showed no significant improvement in reading comprehension scores after 12 weeks. Although uncertainties still exist, this investigation supports the notion that visual attention is malleable and that attention therapy has a significant effect on reading comprehension in this often neglected population.

Attention↗

PubMedDate not supplied

Effect of attitudes and perceptions of independent community pharmacy owners/managers on the comprehensiveness of strategic planning.

OBJECTIVE: To assess the attitudes and perceptions of independent community pharmacy owners/managers about the comprehensiveness of strategic planning conducted for their pharmacies. DESIGN: Cross-sectional study. SETTING: United States. PARTICIPANTS: Nationwide random sample of 1,250 owners/managers of independent community pharmacies. INTERVENTION: Mailed survey. MAIN OUTCOME MEASURES: Comprehensiveness of strategic planning conducted; components used in the strategic planning process. Attitudes and perceptions of owners/managers of independent community pharmacies toward strategic planning. RESULTS: A total of 527 (42.1%) usable questionnaires were returned. Of the 141 (26.8%) respondents who indicated that they conduct strategic planning, most components of the process were used. However, only 78 (55.3%) of those respondents conducted a review of pharmacy systems, and only 60 (42.6%) periodically evaluated implemented strategies. Approximately 88% of the variance in comprehensiveness was accounted for by 12 variables identified as significantly associated with the comprehensiveness of strategic planning conducted by owners/managers of independent community pharmacies. These included factors such as favorable cost-benefit relationship, impact of the Medicare Modernization Act of 2003, and remaining competitive in the pharmacy marketplace. CONCLUSION: While a minority of the survey population, respondents who reported conducting strategic planning used a reasonably comprehensive process. Further, several variables were identified as significant factors associated with comprehensiveness of strategic planning conducted.

Attitude↗

PubMed2004

What's it all about? Investigating reading comprehension strategies in young adults with down syndrome.

The purpose of reading is for the reader to construct meaning from the text. For many young adults with Down syndrome, knowing what the text is all about is difficult, and so for them the activity of reading becomes simply the practice of word calling. It is suggested in the literature that for those individuals with Down syndrome, learning can continue into adolescence and that this may be the optimal time for learning to occur. However, a review of the literature revealed limited empirical research specifically relating to the reading comprehension of young adults with Down syndrome. Recent findings from Latch-On (Literacy And Technology Hands On), a research-based literacy and technology program for young adults with Down syndrome at the University of Queensland, revealed that comprehension remained the significant area of difficulty and showed least improvement (Moni & Jobling, 2001). It was suggested by Moni and Jobling (2001) that explicit instruction in comprehension using a variety of strategies and meaningful, relevant texts was required to improve the ability of young adults with Down syndrome to construct meaning from written texts. This paper is based on an action research project that was developed within the Latch-On program. The project utilised a modification of Elliot's (1991) action research model and was conducted to investigate specific teaching and learning strategies that would enhance the reading comprehension of young adults with Down syndrome. The participants were 6 young adults with Down syndrome ranging in age from 18 to 25 years. As the data from this project are still being analysed, preliminary findings of one participant are presented as a case study. The preliminary findings appear to indicate that the program of specific teaching and learning reading comprehension strategies used in this project was beneficial in the participant's reading comprehension.

Adolescent↗

PubMed2000

Using the comprehensive geriatric assessment technique to assess elderly patients.

OBJECTIVE: To review the concept, components, and characteristics of the Comprehensive Geriatric Assessment technique. DATA SOURCES: Medline and non-Medline literature search. STUDY SELECTION: The following key words were used: Comprehensive Geriatric Assessment; all available years of study were reviewed. DATA EXTRACTION: Studies that assessed the Comprehensive Geriatric Assessment technique's benefits were examined. DATA SYNTHESIS: By using the Comprehensive Geriatric Assessment programme, accurate diagnoses can be made, treatable illness can be screened for, therapeutic plans can be formulated, and the optimal placements of patients can be achieved. Assessment should be performed at each level of geriatric care; various well-validated scales are used to measure the activity of daily living of patients. The Comprehensive Geriatric Assessment programme can improve functional status; reduce the use of medications, nursing homes, and medical services; and reduce mortality rates. Most studies confirm that a successful programme requires careful patient targeting, implementation of the programme by attending physicians, and patient adherence to the recommendations made. CONCLUSION: A well-targeted Comprehensive Geriatric Assessment programme and the control of patients' adherence to recommendations are effective in improving the well-being of elderly patients.

Activities of Daily Living↗

PubMed2002

A comprehensive model for assessing lake eutrophication.

The evaluation of eutrophication or trophic state of a lake is in fact a multivariate comprehensive decision-making process quantifying the qualitative problem. Therefore, we should use a comprehensive method to assess lake eutrophication. On the basis of summarizing some comprehensive methods for assessing lake eutrophication reported in China and abroad, it is pointed out that the trophic state index (TSI) should be a major method for evaluating lake eutrophication, since it could provide a continuous numerical class of lake trophic state and a rigorous foundation of quantitative studies of eutrophication mechanism. Using analytic hierarchy process (AHP) to determine the weight attributions in the selected comprehensive indices, the authors, constructed a comprehensive assessment model as: TSI = W(Chla) x TSI(Chla) + W(Sd) x TSI(Sd) + W(TP) x TSI (TP) or TSIM = W (Chla) x TSIM(Chla) + W(Sd) x TSIM(Sd) + W(TP) x SIM(TP) where W(X) were the weights for the above three parameters with value in percentage as 54.0, 29.7 and 16.3, respectively. Additionally, the relations between comprehensive evaluation and other statistical methods such as cluster analysis were briefly discussed.

Animals↗

PubMed2004

[A research on the public health index related to the comprehensive assessment on floods].

OBJECTIVE: To develop a public health index related to the comprehensive assessment on the impact caused by floods. METHODS: A Analytic hierarchy process (AHP) theory was used to establish the initial evaluation system on the impact of floods. Modified-Delphi process was used to screen and determine the indicators and their weights while synthetical scored method was used to establish the comprehensive assessment model. Percentile was used to differentiate the degree of floods. Finally, analysis of variance (ANOVA) and correlation analysis were used to test the differentiability of the model for different degree of floods and the independence of these indicators. RESULTS: The model of comprehensive assessment on the impact of floods was set up, including six first-ranking indicators and twenty-four sub-indicators. The values of comprehensive assessment were divided into five grades by the percentiles. Verified results indicated that there were significant difference among the five grades (F = 76.11, P < 0.01) and all indicators were independent. CONCLUSION: An index of comprehensive assessment on the impact of floods was established, which could be used to evaluate the impact of floods and to differentiate the degree of flood, which seemed to have the characteristic of reliability, comprehensiveness and practicability.

Analysis of Variance↗

PubMed1985

Comprehension and production of idioms in dysphasia.

The comprehension and production of idioms was investigated in 10 dysphasic adults. Two different tasks, one comprehension and the other production, were developed. The production task required the subject to verbally explain 15 idioms. The comprehension task necessitated the selection of the correct figurative representation of the idiom from four illustrations: a literal, a literal variation, a figurative, and an unrelated picture. Results indicated no significant correlation between overall comprehension and production performances. No significant difference was found between the comprehension or the production of idioms when type or severity of dysphasia was considered. A significant difference was found, however, in the type of incorrect response, in that subjects selected the literal depiction more often than other foil representations for the comprehension.

Adult↗

PubMed1980

Message comprehension as a function of intelligibility and advance knowledge of the topic.

The relationship was investigated between estimated intelligibility (EI) and message comprehension (ability to answer questions presented at various levels of intelligibility). In Exper. I, 10 young adults identified the S/N ratio they associated with 0, 25, 50, 75, and 100% intelligibility for easy story material in speech-shaped noise at a constant 75 db SPL; subsequently, at the S/N's thus determined, comprehension was measured with easy short-answer questions. There was a very strong relationship between EI and comprehension, suggesting that the two were more or less synonomous. In Exper. II, comprehension with easy short-answer questions was measured at EI's of 25, 50, and 75% when each question was preceded by relevant, irrelevant, or no cues to the general topic of the question. Relevant cues had a positive effect which was significant at the 25 and 75% EI levels. The suggestion from Exper. I on the identity of EI and comprehension was modified to show that EI levels are a psychoacoustic variable which can be used to identify a regular decrease in comprehension when the speech signal is progressively masked by speech-shaped noise, but that the actual level and rate of decrease in intelligibility is a function of other factors, including psycholinguistic features of the message itself.

Cues↗

PubMed1996

Parent comprehension of polio vaccine information pamphlets.

BACKGROUND: Medical information pamphlets often are written using language that requires a reading level higher than parents of many pediatric patients have achieved. Anecdotal reports suggest that many parents may not readily understand the federally mandated Public Health Service vaccine information pamphlets prepared by the Centers for Disease Control and Prevention (CDC) in 1991. The level at which the pamphlets need to be written for low-reading-level parents is undetermined, as is whether parents reading at higher levels will accept low-reading-level materials. METHODS: To determine whether a simple pamphlet prepared at a low reading level using qualitative and adult education techniques would be preferable to the available CDC polio vaccine information pamphlet, we conducted an integrated qualitative-quantitative study. We compared the parent reading time and comprehension of a simplified pamphlet (Louisiana State University, LSU) comprising 4 pages, 322 words, 7 instructional graphics, and a text requiring a 6th grade reading ability with the equivalent 1991 CDC vaccine information pamphlet comprising 16 pages, 18,177 words, no graphics, and a text requiring a 10th grade reading level. We measured the reading ability of 522 parents of pediatric patients from northwest Louisiana seen at public clinics (81%) and in a private office (19%). Of the entire group, 39% were white, 60% African-American, and 1% Hispanic; the mean age was 29 years; the mean highest grade completed was 12th grade 3 months; and the reading level was less than 9th grade in 47% of parents and less than 7th grade in 20%. After parents were given one of the pamphlets to read, their reading time, comprehension, and attitude toward the pamphlet were measured. RESULTS: Mean comprehension was 15% lower for CDC than for LSU (56% vs 72% correct; P < .001) and reading time was three times longer for CDC than for LSU (13 minutes 47 seconds vs 4 minutes 20 seconds; P < .0001). These trends were significant for parents reading at all but the lowest levels. Mean comprehension and reading time did not differ among parents reading at the third grade level or less. However, mean comprehension was greater and reading time lower for LSU among parents at all reading abilities greater than the third grade. Parents in the private practice setting took the longest time to read the CDC (20 minutes 59 seconds vs 5 minutes 46 seconds, LSU), yet their comprehension on the LSU was significantly higher than on the CDC (94% vs 71%; P < .0001). Two focus groups of high-income parents were unanimous in preferring the LSU. CONCLUSIONS: A short, simply written pamphlet with instructional graphics was preferred by high- and low-income parents seen in private and public clinics. The sixth grade reading level appears to be too high for many parents in public clinics; new materials aimed at third to fourth grade levels may be required. The new 1994 CDC immunization materials, written at the eighth grade level, may still be inappropriately high. The American medical community should adopt available techniques for the development of more effective patient-parent education materials.

Adolescent↗

PubMedDate not supplied

A comparison of the long-term results of posterior and comprehensive release in the treatment of clubfoot.

This study compared the long-term results of posterior and comprehensive release in the treatment of clubfoot. Patients were eligible for this study if the clubfoot was idiopathic and treatment was performed before 2 years of age. Medical records were reviewed to obtain the age, sex, bilaterality, and details of surgical treatment. Posterior release (performed before 1971) consisted of Achilles tendon lengthening and posterior ankle and subtalar releases. The comprehensive release, as described by Carroll, was performed after 1972. At the time of final review, patients completed Ponsetti's functional 100-point grading system, were examined, and had foot radiographs performed. Of 81 eligible patients, 59 (72%) were reviewed. Children in the two groups were not significantly different at the time of surgery for age, sex, and bilaterality. The patients were evaluated an average of 28 years (range, 25-30) after surgery in the posterior-release group and 16 years (range, 13-20) after surgery in the comprehensive-release group. Ponsetti scores were higher in the comprehensive-release group (mean, 86 vs. 81) but were not significantly different (p = 0.13). The comprehensive-release group required fewer procedures per patient compared with the posterior-release group (1.5 procedures vs. 2.0; p = 0.04). The ankle range of motion was similar in the two groups (p = 0.12), but the percentage of patients with subtalar stiffness was higher in the posterior-release group (50 vs. 18%; p = 0.01). Although the two groups were not statistically different based on the function-weighted Ponsetti scale, the comprehensive group had fewer operations, more complete correction of heel varus, and improved subtalar motion.

Achilles Tendon↗

PubMed1996

[Comprehensive staging laparotomy in stage I epithelial ovarian cancer].

OBJECTIVE: To evaluate the significance of comprehensive staging laparotomy in stage I epithelial ovarian cancer. METHODS: Forty-three patients with stage I epithelial ovarian cancer were divided into 3 groups and retrospectively analysed. Thirty two of these patients allotted to stage I ovarian cancer according to FIGO criteria were ascertained by comprehensive staging laparotomy (group A), 5 patients were upstaged following comprehensive staging laparotomy (group B) and 6 patients were staged without comprehensive laparotomy (group C). RESULTS: The mean operation time was 2 hours and 40 minutes, the mean volume of blood loss was 460 ml and no severe complications occurred during the comprehensive staging laparotomies. 13.5% (5/31) of patients were found to have retroperitoneal metastasis and then therefore were upstaged as stage III. Group A and B had better prognosis. During the 39.7 months followup period, tumor-free survival rates in group A and B were 97% (31/37) and 5/5 respectively. In group C, 2 patients recurrent and one died of the diseases, a tumor-free survival rates of 4/6. There was a significant difference in tumor-free survival rates between group A and C (P = 0.038). CONCLUSION: Comprehensive staging laparotomy should be considered as an important criterion in FIGO staging of epithelial ovarian cancer and a standard procedure in the treatment of stage I epithelial ovarian cancer.

Carcinoma, Endometrioid↗

PubMed1997

Transient and sustained processing: effects of varying luminance and wavelength on reading comprehension.

BACKGROUND: Reading disability (RD) is a serious epidemiologic problem and may affect up to 15% to 20% of elementary school children. This study addresses whether the reading comprehension skills of children with RD improve as wavelength and contrast of light are altered. METHODS: Fifty-six children, identified as either normal or reading disabled, were required to read a series of standardized 300-word passages under four conditions: no filter (baseline); light gray filter, dark gray filter, and blue filter. Each reading selection was timed, reading comprehension was measured, and data were processed. RESULTS: Initial standardized reading comprehension test scores significantly differentiated average from poor readers. Using reading selection levels consonant with each subject's ability, no significant differences were measured in baseline comprehension scores between good and poor readers. Comprehension scores of poor compared to good readers were significantly better using blue filters (p < 0.01). CONCLUSIONS: Our study suggests an association between wavelength of light, luminance, and reading performance. Blue filters were found to improve reading comprehension in poor readers. The results support the concept of a transient system deficit involving wavelength of light and reading performance.

Child↗

PubMed1996

Impact of advance directive videotape on patient comprehension and treatment preferences.

OBJECTIVE: To examine the effects of an advance directive videotape on patient comprehension of advance directive concepts and preferences for resuscitation. DESIGN: Pilot study, randomized cohort trial. SETTING: Extended Care and Rehabilitation Center, Veterans Affairs Medical Center, Durham, NC. PARTICIPANTS: Thirty-six residents of the center; mean age, 69 years. INTERVENTIONS: Sixteen subjects observed an advance directive videotape, and 20 subjects observed a health-relative videotape. All subjects received written material and counseling on advance directives. MEASUREMENT: Structured interviews were conducted at three time points relative to the educational program (pretest, posttest, delayed posttest), measuring comprehension of two advance directive concepts (living will and cardiopulmonary resuscitation) and resuscitation preferences based on hypothetical clinical vignettes. Mean comprehension and mean resuscitation preference scores were derived for each time point. RESULTS: The mean comprehension score improved an average of 1.6 points for all subjects from pretest to delayed posttest (P < .001); however, score changes were not significantly different between the two video groups (P = .39). Mean resuscitation preference scores were stable over time, and there were no significant score differences between the two video groups. CONCLUSION: The advance directive videotape did not significantly affect resuscitation preferences or comprehension of selected advance directive concepts.

Advance Directives↗

PubMed2006

Structured telephone-based outreach using nonmedical personnel can improve adherence to comprehensive care in families of children with sickle cell disease.

Comprehensive medical care of patients with sickle cell disease decreases morbidity, mortality, and health care resource utilization. Nonadherence to comprehensive care is a barrier to further improvement in the outcomes of these patients. We investigated the feasibility and acceptability of telephone-delivered structured follow-up, support, and education provided by nonmedical personnel and its impact on adherence to comprehensive measures. A semistructured script was designed that included a series of questions relating to the patient's well-being and health-related behaviors and was administered by a graduate student researcher in genetics. Families of all 202 children followed at Children's Hospital of Pittsburgh were attempted to be contacted at 3 monthly intervals from their last contact. A total of 76% [147] of those called were available and willing to talk. Eighteen months after initiation of the study, the number of patients who had not attended comprehensive care clinic for 2 years or more decreased from 46 (19.7%) to 23 patients (9.9%) (P = 0.0019). Similarly, the proportion of eligible patients who had undergone transcranial Doppler screening within the past 12 months increased from 34 to 49% (P = 0.0501). Structured telephone-based follow-up is feasible and well accepted and can lead to improved adherence with comprehensive care measures.

Anemia, Sickle Cell↗

PubMed2006

Development of written information for antiretroviral therapy: comprehension in a Tanzanian population.

OBJECTIVE: To design and develop a simple, easily readable patient information leaflet (PIL) for a commonly used antiretroviral (ARV) regimen and to evaluate its readability and acceptability in a Tanzanian population. METHOD: A PIL incorporating simple text and pictograms was designed for the antiretroviral regimen of stavudine, lamivudine and efavirenz. The PIL was designed according to established good design guidelines, modified during a multi-stage iterative testing process and piloted in a South African Xhosa population. The PIL was made available in both English and Kiswahili. Sixty Tanzanian participants who were not taking ARVs were interviewed. They were asked to read the PIL in the language of their choice and were then asked a series of two-part questions; the first part required participants to locate the information in the PIL, after which they were asked to explain the information in their own words. Acceptability was assessed through close-ended questions and open-ended feedback. The influence of selected patient characteristics on comprehension of the PIL was investigated using one-way ANOVA and t-tests for independent samples with a significance level set at 0.05. MAIN OUTCOME MEASURE: Comprehension of the written information in an overall percentage understanding. RESULTS: The overall average percentage comprehension of the PIL was 95%. The target set by the EC guideline that at least 80% of participants correctly locate and understand the information was achieved for 19 of the 20 questions. Five of the six instructions illustrated by pictograms were correctly understood by all participants. The only patient characteristics significantly associated with comprehension were educational level and self-reported ease of reading the PIL. Acceptability of the PIL was high and positive comments were associated with simplicity, good design, easy readability and user-friendliness, the latter enhanced by the inclusion of pictograms. CONCLUSION: The PIL designed for this study was shown to be effective in communicating information about ARVs. Patient characteristics must be taken into account when developing written information, and the final document must be tested for comprehension in the target population.

Adolescent↗

PubMed1986

The place of primary health care in a comprehensive health system.

UNLABELLED: In considering the place of Primary Health Care in a comprehensive health system, we must first consider what is meant by the term 'comprehensive'. Comprehensive systems take into account all phases of life from infancy to old age, and integrate all aspects of being, including physical, psychological, mental, social, environmental, political and so on. It is the task of those who deliver the primary health care system to evaluate and prioritize health needs in specific populations, and to implement programs which honor the community's unique priorities, taking into account all phases and aspects of life. Drawing upon data collected from a comprehensive field survey of community health activities in Hiketa, in Kagawa Prefecture in Shikoku, and other similar surveys carried out in Japan, as well as references such as the Report of the International Conference on Primary Health Care (Alma Ata), and the World Health Organization Global Strategy for Health for All by the Year 2000, this background paper will outline the critical aspects to be considered in implementation of primary health care in comprehensive health systems, as a context for further discussion. Aspects to be considered are as follows: Community representation and participation Evaluation of health needs Prioritization of health needs IMPLEMENTATION: consultation with specialists IMPLEMENTATION: utilization of local resources IMPLEMENTATION: health education IMPLEMENTATION: support of local government IMPLEMENTATION: co-ordination of laymen, specialists, officials and others Evaluation Follow through. Illustrative examples will be used to highlight problems and solutions as each aspects is considered.

Community Health Services↗

PubMed2005

Conspicuity, memorability, comprehension, and priming in road hazard warning signs.

This study assessed driver reactions to 16 road hazard warning signs of various formats by projecting life-sized video of road scenes to drivers in a driving simulator. A range of measures, including attentional and search conspicuity, implicit and explicit recognition, dynamic and static comprehension, and sign priming were collected. Of the signs tested, road works and school warning signs were most often detected, remembered, and understood. Slippery surface warnings were associated with some of the lowest detection and comprehension rates. The effectiveness of the different formats depended on the type of hazard sign. In the case of road works warnings, a flashing variable message format was only slightly more conspicuous than the large dimension format, equal in comprehensibility, and perhaps somewhat worse in terms of memorability. For the school warnings, however, the flashing variable message format appeared to convey a greater sense of potential hazard, produced superior search conspicuity and priming, and was equal in terms of memorability and comprehensibility. The range of measures worked well as a whole with the two measures of conspicuity and the measure of static comprehension showing the greatest consistency.

Accidents, Traffic↗