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PubMed2006

Treating complicated grief and substance use disorders: a pilot study.

Empirically supported treatments for co-occurring substance use disorders (SUDs) and grief problems are lacking, despite the salience of grief pathology in substance abusers. Identification of a syndrome of complicated grief, distinct from bereavement-related depression and anxiety, led to the development of a targeted treatment, but this treatment has not been tried with persons with SUDs. We recruited 16 adults with complicated grief and substance dependence or abuse into an open pilot study of a manualized 24-session treatment, incorporating motivational interviewing and emotion coping and communication skills into our efficacious complicated grief treatment. Completer and intent-to-treat analyses showed significant reductions in Inventory of Complicated Grief and Beck Depression Inventory scores, with large effect sizes. Timeline Followback percent days abstinent increased significantly in both analyses, with medium to large effect sizes, and cravings declined significantly. Study limitations notwithstanding, complicated grief and substance use treatment appears to be a promising intervention that merits further research.

Adult↗
PubMed1995

Preparing for and surviving a JCAHO inspection.

Foresight and planning can reduce stress associated with a JCAHO survey. Important resources for the epidemiologist include the Comprehensive Accreditation Manual for Hospitals, recommendations from previous JCAHO surveys, and educational meetings. Communication with colleagues who have been reviewed recently is an invaluable means of preparing for future surveys. Finally, although JCAHO accreditation is important, it is equally important to realize that the primary purpose of quality improvement programs is to improve the structure, process, and outcome of care.

Accreditation↗
PubMed1998

Effects of early augmentation of labour with amniotomy and oxytocin in nulliparous women: a meta-analysis.

OBJECTIVES: To estimate the effects among nulliparae of early augmentation with amniotomy and oxytocin on caesarean delivery, and on other indicators of maternal and neonatal morbidity including transfusion. Apgar score < 7 at 5 minutes, and admission to the special care nursery. DESIGN: Meta-analysis. METHODS: Published studies were identified through manual and computerised searches. Two unpublished studies were identified through direct communication with the investigators. Twelve trials were identified which compared a policy of early labour augmentation including amniotomy followed by oxytocin with a less active form of management. Two methodologically unacceptable studies were excluded. Studies were grouped according to whether they admitted only women with abnormal progress (therapy trials: n = 3) or accepted women with normal labour (prevention trials: n = 7). RESULTS: Unstratified analysis did not provide support for the hypothesis that early augmentation reduces the risk of caesarean section (typical odds ratio [OR] 0.9; 95% CI 0.7-1.1). The typical odds ratio for prevention trials was similar to that obtained in the unstratified analysis (typical OR 0.9, 95% CI 0.7-1.2). Although only a small number of women have been randomised in therapy trials, a trend toward a reduction in the rate of caesarean section with early intervention was seen in this group (typical OR 0.6, 95% CI 0.2-1.4). CONCLUSIONS: Early augmentation does not appear to provide benefit over a more conservative form of management in the context of care of nulliparous women with mild delays in the progress of labour. In the context of established delay in labour, an active policy of augmentation may reduce the risk of caesarean section. However, only three small trials have been performed in this context, and they do not have adequate power to allow firm conclusions to be drawn.

Amnion↗
PubMed1977

Motor development of autistic monozygotic twins: a case study.

A pair of autistic monozygotic twins were assessed on relevant portions of the Geddes Psychomotor Inventory. Over-all motor development of the 3-yr., 6-mo. old twins was similar and considered a partial consequence of the same genotype and comparable environmental experiences from birth. The twins exhibited poor or unsuccessful performance on tasks requiring abilities in language, communication, and appropriate relationships to objects; superior performance on specific fine manual motor skills, walking balance board, and climbing; at-age performance on tasks which were considered measures of patterned gross movement, balance, postural maintenance, and spatial orientation; and few typical autistic motor characteristics.

Autistic Disorder↗
PubMed2002

Middle temporal visual area microstimulation influences veridical judgments of motion direction.

Microstimulation of direction columns in the middle temporal visual area (MT, or V5) provides a powerful tool for probing the relationship between cortical physiology and visual motion perception. In the current study we obtained "veridical" reports of perceived motion from rhesus monkeys by permitting a continuous range of possible responses that mapped isomorphically onto a continuous range of possible motion directions. In contrast to previous studies, therefore, the animals were freed from experimenter-imposed "categories" that typify forced choice tasks. We report three new findings: (1) MT neurons with widely disparate preferred directions can cooperate to shape direction estimates, inconsistent with a pure "winner-take-all" read-out algorithm and consistent with a distributed coding scheme like vector averaging, whereas neurons with nearly opposite preferred directions seem to compete in a manner consistent with the winner-take-all hypothesis, (2) microstimulation can influence direction estimates even when paired with the most powerful motion stimuli available, and (3) microstimulation effects can be elicited when a manual response (instead of our standard oculomotor response) is used to communicate the perceptual report.

Algorithms↗
PubMed2002

[The enlightenment on pregnancy and birth in the 16th century].

The enlightenment of people on pregnancy and childbirth is not just a contemporary phenomena. Henrik Smiths laegebog (Manual of Medicine) from 1557 is part of a tradition of communication and education going from antiquity to the present day. This book not only tells us the gynecological and obstetrical knowledge of a period, but is also an exciting reflexion of the perception of the same historical periods' view on gender, body and sexuality.

Denmark↗
PubMed2001

Minimizing Digital Imaging and Communications in Medicine (DICOM) Modality Worklist patient/study selection errors.

Frequently when patient and study identification information (patient name, patient identification, date of birth, sex, and accession number) are manually entered at a modality, typographical errors occur that have to be corrected before the acquired images can be matched to the proper patient and study on a picture archiving and communication system (PACS). The Digital Imaging and Communication in Medicine (DICOM) Modality Worklist service alleviates these problems by automatically transferring this data from the radiology information system (RIS) to the image acquisition modality. The technologist then does not have to manually re-enter the data to place it into the image files. With modality worklist, precise patient and study data are obtained and placed into the image headers with no typographical errors. When the images are sent to the PACS, they match the corresponding patient and study records, and are immediately incorporated into the electronic patient record. While modality worklist does replace the manual keying of the data and virtually eliminates typographical problems, it introduces a new source of human error: the incorrect selection of the patient and/or study from the computerized worklist, and the resultant mislabeling of the images. When these mislabeled images are sent to the PACS, they are immediately associated with the wrong patient and/or study, where they potentially may cause serious harm. The goal of this report is to raise awareness to this problem, to identify the major causes of these errors, and to offer some practical suggestions on how to minimize them.

Forms and Records Control↗
PubMed2001

The conceptions of the nature of learning of first-year physiotherapy students and their relationship to students' learning outcomes.

Research shows that students' conceptions of what 'learning' is influences both their approaches to learning and their learning outcomes. Lower level conceptions of learning are associated with surface approaches to learning, encouraging poor quality learning outcomes. However, more advanced conceptions are associated with deep learning approaches and high-quality learning outcomes. The Structure of Observed Learning Outcomes (SOLO) taxonomy was used to analyse the conceptions of learning of a new intake of physiotherapy students. The presence of a relationship between these and assessment outcomes was also investigated. As in other studies, a majority of students had lower level conceptions of learning than desired in higher education. However, a larger proportion of students had higher levels of conception than has been found in other research. A direct relationship between conceptions of learning and learning outcomes was also identified. The implications of these findings for achievement of high-quality learning are discussed.

Journal Article↗
PubMedDate not supplied

The Roter Interaction Analysis System (RIAS) in oncological consultations: psychometric properties.

One of the most frequently used systems to analyse doctor-patient communication is the Roter Interaction Analysis System (RIAS). However, it has mostly been applied and evaluated in primary care settings. Two studies are presented in which the psychometric properties of the RIAS are investigated in an oncological setting. In the first study (N = 25) the feasibility, inter-rater reliability and content validity of the RIAS was investigated. In the second study, we evaluated the discriminant validity of the RIAS. Results of the first study showed that coding of tapes was more time consuming than indicated by the Roter manual. The inter-rater reliability proved to be high for both physician communication (0.68-1) and patient communication (0.60-1). The content validity proved to be acceptable: all utterances could be classified. However, coding dilemmas regarding affective communication occurred. The RIAS provided no option to classify communication of a third person present. Some communication categories were never or rarely used. Results of the second study indicate that the RIAS was able to discriminate between communicative behaviors in oncological consultations (N = 60) and three different GP-samples (random-GP sample N = 329, hypertension sample N = 103, gynaecology sample N = 65). To conclude, the psychometric properties of the RIAS are satisfactory in an oncological setting.

Adult↗
PubMed1998

From airports to care centers. Transferring information technology to support patient care reengineering.

PROBLEM: To improve communication among caregivers about the status of patients under their care. SOLUTION: Replacing manual white boards with electronic bed boards/inpatient databases, similar to airport display technology. RESULTS: Improved data quality from having patient data displayed in a standardized manner across care centers. KEYS TO SUCCESS: "We used a process redesign team, which focused on specific issues related to the processes used in providing patient care."

Computer Communication Networks↗
PubMed1989

Content listings for consistency of policies and procedures in an academic department.

Communicating expectations is central to effective management. In a large academic department spread over several sites, written guidelines are often necessary to limit misinterpretation of these expectations. Three "operation manuals" for residents, faculty, and support staff were developed to supply these guidelines. They have evolved into an effective means of communicating departmental policy and standards for performance. The table of contents are provided as a guide for those developing new academic departments.

Communication↗
PubMed2001

[Severely injured patients after the initial phase--vegetative state or remaining cognitive functions?].

BACKGROUND: We wanted to quantify improvements in the subacute rehabilitation phase in patients with severe brain injuries classified as vegetative or minimal brain consciousness. MATERIAL AND METHODS: Five patients were studied during a 12 months period using a method called Coma Recovery Scale (CRS) as described by Giacino et al. (1991). The parameters measured included visual and hearing functions, motor functioning, oromotor/verbal function, communication, and arousal. The observations of the patients and commandos given were standardised in a manual, and the responses achieved from the patients were recorded according to a scale for each parameter. RESULTS: This procedure for measuring closely the progress over time in these severely brain injured patients, was used for planning a realistic rehabilitation program. It was found to be very practical in communication with relatives of the patients and with the other therapists involved. INTERPRETATION: By decomposing the cognitive functions by this method using all the available possibilities for inputs, even minimal improvement in the cognitive functions mentioned could be uncovered and recorded.

Adolescent↗
PubMed2006

Interpersonal psychotherapy for somatizing patients.

The interpersonal model is important for understanding somatizing behavior. According to this model, somatizing behavior is a form of interpersonal communication driven by insecure attachment. Interpersonal psychotherapy (IPT) is a time-limited, manual-based treatment designed to relieve symptoms and improve interpersonal functioning. Based on our experience using IPT with somatizing patients, we recommend a series of strategies for its successful implementation. These strategies include an emphasis on the therapeutic alliance within a bilaterally negotiated treatment contract, and aiming for improvement in interpersonal functioning rather than for alleviation of physical symptoms. Specific techniques include the use of bridging metaphors, communication analysis, and genuine positive reinforcement. With a focus on communication in a time-limited frame, fostered by a strong collaborative relationship, IPT appears to be a promising method of reducing somatizing behavior. We urge further research on the efficacy of this form of therapy.

Adaptation, Psychological↗
PubMed1993

The direct service volunteer and voluntary board member: what are the roles and responsibilities?

The role of the direct service volunteer on the voluntary board is explored and its organizational structure is examined to determine if it facilitates the flow of information from volunteers. The study questions whether volunteers can effectively communicate their suggestions and concerns about volunteer and organizational needs given the structure imposed by Board Member Manual procedure. A two-way relationship via the Voluntary Advisory Committee is suggested where political participation through the committee can give volunteers a political structure to express opinions pertinent to volunteer causes and clear lines of communication between staff, volunteers, and the leadership can be established.

Communication↗
PubMed2001

Regulation of cognitive activity and early communication development in young autistic, mentally retarded, and young normal children.

Based on the Piagetian framework, this study examined regulation of cognitive activity and developmental communication profiles and their interrelationship in groups of autistic, mentally retarded, and normal children of comparable overall, verbal, and oculo-manual developmental ages (from 6 to 24 months). Regulation of activity was assessed with both an object permanence test and an original behavior grid, and development of communication skills with the Guidetti-Tourrette scales (French adaptation of the Seibert-Hogan scales). The results showed evidence of certain types of dysregulation of cognitive activity and a general delay in communication ability in autistic children compared to the other two groups. Moreover, although the intensity of some of these disorders decreased in relation to the developmental levels of social interaction and joint attention in normal children, they were related to both high and low levels of development of social interaction only in autistic children. These findings raise the hypothesis of a relationship between a disorder of disengaging from an activity and developmental levels of social interaction noted at two transitory periods of early development (12 and 24 months) only in children with autism. Developmental and neuropsychological interpretations of this particular pattern are proposed.

Autistic Disorder↗
PubMed1996

In search of clinical excellence.

This article was presented as a lecture at the 1995 Combined Sections Meeting by Joseph P. Farrell, MS, PT, who received the Orthopaedic Section's Paris Distinguished Service Award. He was recognized for service to the Orthopaedic Section in the area of manual therapy and for the formation of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Clinical excellence is a journey that every clinician should commence early in his/her career. The purpose of this paper is to discuss clinical excellence and its importance to the physical therapy profession. To address this topic, the following items will be discussed: 1) clinical competency and clinical expertise; 2) communication and patient management in the current era of health care reform; 3) politics relating to manual therapy; 4) the role of manual therapy in our profession; 5) clinical residency educational programs; and 6) the academic and clinician role in education. The author concludes that if physical therapy is a profession of excellent clinicians, then the physical therapy profession can survive evolving changes in the health care system.

Clinical Competence↗
PubMed2003

Accuracy of computer diagnosis of melanoma: a quantitative meta-analysis.

BACKGROUND: Recent developments in computer technology have raised expectations that fully automated diagnostic instruments will become available to diagnose cutaneous melanoma without the need of human expertise. OBJECTIVES: To critically review the contemporary literature on computer diagnosis of melanoma, evaluate the accuracy of such computer diagnosis, analyze the influence of study characteristics, and compare the accuracy of computer diagnosis of melanoma with human diagnosis. METHODS: Quantitative meta-analysis of published reports. DATA SOURCES: Eligible studies were identified by a MEDLINE search covering the period from January 1991 to March 2002, by manual searches of the reference lists of retrieved articles, and by direct communication with experts. RESULTS: Thirty studies with substantial differences in methodological quality were deemed eligible for meta-analysis. Five of these complied with the predetermined list of "good quality" requirements, but none met all methodological quality requirements. Ten of these studies compared the performance of computer diagnosis with human diagnosis. The diagnostic accuracy achieved with computer diagnosis was statistically not different from that of human diagnosis (log odds ratios, 3.36 vs 3.51; P =.80). The diagnostic performance of the computer diagnosis was better for studies that used dermoscopic images than for studies that used clinical images (log odds ratios, 4.2 vs 3.4; P =.08). Other study characteristics did not significantly influence the accuracy of the computer diagnosis. CONCLUSIONS: The computer diagnosis of melanoma is accurate under experimental conditions, but the practical value of automated diagnostic instruments under real-world conditions is currently unknown. We suggest minimum requirements for methodological quality in future experimental studies or, ideally, randomized controlled trials.

Clinical Trials as Topic↗
PubMed1990

The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education.

We report the prevalence rates for dementia and Alzheimer's disease (AD) obtained from a probability sample survey of 5,055 noninstitutionalized older persons in Shanghai, China. A two-stage procedure was used for case finding and case identification. A Chinese version of the Mini-Mental State Examination was used to determine cases of possible dementia. Three different cutoff points on this mental status test were used depending on the respondent's level of education. Clinical evaluations, based on functional assessments and psychiatric interview, medical and neurological examinations, three standardized mental status tests, and a selected group of psychometric tests, were made in the second stage of the study to ascertain the clinical diagnosis of dementia and AD utilizing the Diagnostic and Statistical Manual for Mental Disorders, edition 3 and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria, respectively. The prevalence rate of dementia in persons 65 years and older was 4.6%. Clinically diagnosed AD accounted for 65% of the subjects with dementia. These findings indicate that the prevalence of dementia in Shanghai is very much higher than figures published earlier for China and Japan, and at the lower part of the range of values reported for community residents in the United States and other Western countries, but less than half of that reported in the recently published survey of the elderly in East Boston. Increasing age, gender (female), and low education are each highly significant and independent risk factors for dementia. One hypothesis to explain the increased prevalence in elderly women who had received no formal education invokes the possibility of an effect of early deprivation, perhaps lowering brain "reserve," allowing the symptoms of dementia to appear at an earlier date during disease progression.

Age Factors↗