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PubMed2000

Students' perceptions of the relative advantages and disadvantages of community-based and hospital-based teaching: a qualitative study.

AIMS: To obtain the perceptions of first-year clinical medical students of the relative advantages and disadvantages of community-based and hospital-based clinical teaching. METHODS: A qualitative study. A purposive sample of first-year clinical medical students who had experienced both community-based and hospital-based teaching was invited to participate in individual semistructured interviews or focus groups. Interviews and focus groups were audiotaped and transcribed to facilitate content analysis of the data. A total of 24 students participated in individual interviews and a further 18 took part in focus groups. RESULTS: Respondents identified advantages and disadvantages specific to teaching in each setting. Chief advantages of hospital-based learning were perceived to include learning about specialties and the management of acute conditions, and gaining experience of procedures and investigations. Community-based learning was perceived as particularly appropriate for learning about psychosocial issues in medicine, for increasing students' awareness of patient autonomy and for improving communication skills. In addition, aspects of organization and of teaching methods employed by community tutors, although not site-specific, were viewed as conducive to a positive educational experience. Students perceived some areas, such as clinical skills acquisition, to be equally well learned in either setting. DISCUSSION: As community-based teaching forms a greater proportion of the undergraduate medical experience, medical educators must find ways of determining the specific advantages that community and hospital settings can contribute to undergraduate learning and of using these resources effectively to develop comprehensive and integrated curricula. Innovations in teaching methods may also be necessary to provide an effective educational experience and promote active learning.

Adult↗
PubMed2003

Self-perceived competence, learning conceptions and preferred learning situations in the domain of communication.

BACKGROUND: An important purpose of education in the field of social work is the development of social-communicative competence and students' individual learning theories (ILTs) concerning this domain. AIMS: Our first aim was to develop diagnostic instruments for ILT assessment and to understand the relationships between ILT variables. Our second purpose was to study the differences in ILT variables between students of three study years. SAMPLES: A total of 396 full-time social work students participated in this study: 176 first-year, 147 second-year and 73 fourth-year students (92% women and 8% men). METHOD: Based on a theoretical framework, three questionnaires have been constructed, covering three ILT variables: self-perceived competence, learning conceptions and preferred learning situations. For scale construction, principal component analyses and reliability analyses were conducted. ANOVAs and post hoc comparisons of means were used to investigate cross-sectional differences regarding ILT variables. Pearson correlations and regression analyses were performed to gain more insight into the relationships between ILT variables. RESULTS: Five aspects of self-perceived competence, four learning conceptions and five preferred learning situations were found. Learning conceptions and self-perceived competencies were found to be predictors of students' preferred learning situations. Many differences were found between the three groups of students, especially between the first-year students and the others. CONCLUSIONS: When studying the acquisition of social-communicative competence, it is important to take students' individual learning theories into account. Increased insight into the role ILTs play can be of help in improving social work education.

Choice Behavior↗
PubMedDate not supplied

Endoscopic biliary drainage in patients with amebic liver abscess and biliary communication.

BACKGROUND: Percutaneous drainage or surgery is required when amebic liver abscess (ALA) fails to respond to medical management. In some of these patients, non-response may be due to communication of ALA with the biliary tree. This report describes our experience with the use of endoscopic biliary draining in such patients. METHODS: Medical records of patients with ALA undergoing either needle aspiration or percutaneous pigtail drainage were retrieved; the indications for drainage were: abscess volume exceeding 250 mL, a thin rim of tissue (< 1 cm thick) around the abscess, systemic toxic features and failure to improve on medical treatment. Patients with abscess drain output >25 mL/day persisting for 2 weeks or presence of bile in the drain fluid underwent endoscopic biliary drainage. RESULTS: A total of 115 patients with ALA underwent percutaneous treatment. None of the 25 patients with needle aspiration needed any further treatment. Of the 90 who underwent catheter drainage, the catheter could be removed within one week in 77 patients; the remaining 13 patients (median age 42 years, range 24-65; all men) had an abscess-biliary communication. In them, the median catheter output was 88 mL/day (range 45-347) and 54 mL/day (28-177) at 2 days and 2 weeks after catheter placement. The drain fluid contained bile in all 13 patients and in addition contained pus in 10 patients. Eleven patients had a solitary abscess and two had multiple abscesses. Cholangiogram showed biliary communication in all 13 patients. All patients were treated with placement of 10F biliary endoprosthesis or 10F nasobiliary drain. Pigtail catheter was removed within 1 week in 11 of 13 patients. CONCLUSION: In patients with amebic liver abscess communicating with the biliary tree, biliary stenting may hasten clinical recovery and allow early removal of liver abscess catheter drain.

Adult↗
PubMed1995

Presenting a scientific paper, including the pitfalls.

The tone of the presentation is set with the writing of the abstract. Wanting a trip to Vienna is not a good enough reason for framing an abstract unless the data are really interesting. If you don't find them so, you can bet your life that nobody else will. Have you presented the work before? Increasingly, the forms inviting abstracts stipulate that they should contain novel data. This protects the audience from boredom and your reputation from the aspersion that you never have anything new to say. It has been my practice to communicate similar data at a second meeting provided it contains some new results and that it is targeted at a totally unrelated specialist group. Hopefully, no one will have heard the information before. However, it is not acceptable to simply rehash the same abstract but should reflect the special interests of the second group. If one genuinely wants the abstract accepted for oral presentation it must contain a clear hypothesis, a brief description of methods, an exposition of results, and a conclusion. That well worn phrase 'results will be presented' simply raises the suspicion that the author is hoping that the data will be ready by the time that the conference begins. Sometimes, in the rush to meet deadlines for abstract submission, the needs of coauthors are overlooked. This is a sensitive area and can easily temporarily wreck what appeared to be a harmonious collaboration. Do make sure that all coauthors have seen the abstract before submission and are happy with the content--it is good research practice and important to the smooth running of the research group.

Communication↗
PubMed2001

Prospective study of telephone consultation and communication in pediatric infectious diseases.

BACKGROUND: Subspecialists are often called on to provide informal or "curbside" telephone consultation. There is limited documentation of the time spent on, content, nature and source of such consultations by pediatric infectious disease (PID) specialists. Nursing staff frequently assist physicians by triaging telephone calls. No previous studies have examined this aspect of their role in subspecialty practice. METHODS: We prospectively recorded all telephone calls to a newly established PID program for 1 year. Results were entered into a database and analyzed using the ABSTAT software. RESULTS: A total of 621 calls were received by the PID specialist and 1,260 by the PID nurse from March 1, 1999, through February 29, 2000. The mean number of calls per month was 51.8 +/- 24.8 for the physician and 105 +/- 43.3 for the nurse. The mean time spent per call was 9.6 +/- 5.9 min for the physician and 3.3 +/- 1.4 min for the nurse. A total of 103.5 h were spent directly on telephonic consultation/communication by the physician and 68.7 h by the nurse, respectively. Of the calls to the physician 78.6% came from other physicians, 51.5% being pediatricians in practice and 57% involving case management. Calls to the nurse were primarily from the laboratory (26.3%), with 93% regarding patients seen on the inpatient or outpatient service. CONCLUSIONS: Telephone consultation/communication is an integral and important part of a PID practice.

Communicable Diseases↗
PubMed2005

Investigation of misfiled cases in the PACS environment and a solution to prevent filing errors for chest radiographs.

RATIONALE AND OBJECTIVE: The aim of the study was to survey misfiled cases in a picture archiving and communication system environment at two hospitals and to demonstrate the potential usefulness of an automated patient recognition method for posteroanterior chest radiographs based on a template-matching technique designed to prevent filing errors. MATERIALS AND METHODS: We surveyed misfiled cases obtained from different modalities in one hospital for 25 months, and misfiled cases of chest radiographs in another hospital for 17 months. For investigating the usefulness of an automated patient recognition and identification method for chest radiographs, a prospective study has been completed in clinical settings at the latter hospital. RESULTS: The total numbers of misfiled cases for different modalities in one hospital and for chest radiographs in another hospital were 327 and 22, respectively. The misfiled cases in the two hospitals were mainly the result of human errors (eg, incorrect manual entries of patient information, incorrect usage of identification cards in which an identification card for the previous patient was used for the next patient's image acquisition). The prospective study indicated the usefulness of the computerized method for discovering misfiled cases with a high performance (ie, an 86.4% correct warning rate for different patients and 1.5% incorrect warning rate for the same patients). CONCLUSION: We confirmed the occurrence of misfiled cases in the two hospitals. The automated patient recognition and identification method for chest radiographs would be useful in preventing wrong images from being stored in the picture archiving and communication system environment.

Database Management Systems↗
PubMed2003

Quality of life after parotid-sparing IMRT for head-and-neck cancer: a prospective longitudinal study.

PURPOSE: Parotid-sparing intensity-modulated radiotherapy (IMRT) for head-and-neck cancer reduces xerostomia compared with standard RT. To assess potential improvements in broader aspects of quality of life (QOL), we initiated a study of patient-reported QOL and its predictors after IMRT. MATERIALS AND METHODS: This was a prospective longitudinal study of head-and-neck cancer patients receiving multisegmental static IMRT. Patients were given a validated xerostomia questionnaire (XQ), and a validated head-and-neck cancer-related QOL questionnaire consisting of four multi-item domains: Eating, Communication, Pain, and Emotion. The Eating domain contains one question (total of six) asking directly about xerostomia. In both questionnaires, higher scores denote worse symptoms or QOL. The questionnaires and measurements of salivary output from the major glands were completed before RT started (pre-RT) and at 3, 6, and 12 months after RT. The association between the QOL scores and patient-, tumor-, and therapy-related factors was assessed using the random effects model. RESULTS: Thirty-six patients participating in the study completed the questionnaires through 12 months. The XQ scores worsened significantly at 3 months compared with the pre-RT scores, but later they improved gradually through 12 months (p = 0.003), in parallel with an increase in the salivary output from the spared salivary glands. The QOL summary scores were stable between the baseline (pre-RT) and 3 months after RT scores. Patients receiving postoperative RT (whose pre-RT questionnaires were taken a few weeks after surgery) tended to have improved scores after RT, reflecting the subsidence of acute postoperative sequelae, compared with a tendency toward worsened scores in patients receiving definitive RT. After 3 months, statistically significant improvement was noted in the summary QOL scores for all patients, through 12 months after RT (p = 0.01). The salivary flow rates, tumor doses, mean oral cavity dose, age, gender, sites or stages of tumor, surgery, and use of chemotherapy were not associated with the QOL scores at any point. The mean dose to the parotid glands correlated with the QOL scores at 3 months (p = 0.05) but not at other post-RT periods. The XQ and QOL summary scores did not correlate before RT but were significantly correlated at each post-RT point (p < 0.01), with a linear correlation coefficient (r) of 0.59, 0.72, and 0.67 at 3, 6, and 12 months, respectively. At these points, the XQ scores also correlated significantly with the scores of each of the individual QOL domains (p < or = 0.01), including the domains Pain and Emotion, which did not contain any xerostomia-related question. CONCLUSION: After parotid-sparing IMRT, a statistically significant correlation was noted between patient-reported xerostomia and each of the domains of QOL: Eating, Communication, Pain, and Emotion. Both xerostomia and QOL scores improved significantly over time during the first year after therapy. These results suggest that the efforts to improve xerostomia using IMRT may yield improvements in broad aspects of QOL.

Adult↗
PubMed2005

End of life in nursing homes: connections between structure, process, and outcomes.

PURPOSE: This study was a prospective, in-depth exploration of the experience of dying in two nursing homes from the perspective of residents, staff, and family members. DESIGN AND METHODS: A qualitative, case study design was used. Formal and informal interviews, participant observation, and document review were the primary data collection methods. A total of 56 declining residents were followed until death or for 6 months, whichever occurred first. RESULTS: The intimate linkages between structure, process, and outcome were evident in both nursing homes. The two homes had contrasting institutional philosophies, reflected in staffing and environment (structure) and processes of care. Processes included different patterns of planning, communication, and decision making. Most importantly, outcomes (residents' satisfaction with care and quality of life while approaching death) were substantively different. IMPLICATIONS: Institutional philosophy and leadership permeate all aspects of care. A compliance- centered, deficiency-free approach to assessing quality of care is not sufficient to address the needs of declining residents. A client-centered philosophy that embraces "caring for dying people," combined with integrated care planning, contributes to improved resident outcomes.

Adult↗
PubMedDate not supplied

Detection of central pulmonary embolism on computed tomography densitometry images before computed tomography pulmonary angiography.

OBJECTIVE: The purpose of this article is to describe the imaging findings of acute central pulmonary embolism on computed tomography (CT) densitometry images performed before contrast-enhanced CT pulmonary angiography. METHODS: A retrospective review was conducted of reports from all CT pulmonary angiograms performed at our institution, and cases of acute central pulmonary embolism, defined as those with clot in the main, left, or right pulmonary arteries, were identified. Images of positive studies were reviewed on a picture archiving and communications system (PACS) workstation. RESULTS: A total of 1282 CT pulmonary angiograms were obtained for evaluation of possible acute pulmonary embolism, and 1 combined CT aortogram and pulmonary angiogram was performed for aortic dissection and acute pulmonary embolism. Two hundred fourteen (16.7%) examinations positive for acute pulmonary embolism were identified, 26 (12.1%, 2.0% of total examinations) of which had central clots. Of the 26 patients with central acute pulmonary embolism, 12 (46.1%, 5.6% of all positive studies and 0.9% of all CT pulmonary angiograms) had clots that were visible on the densitometry images. CONCLUSION: Although an uncommon finding, acute central pulmonary embolism can be detected on CT densitometry performed to optimize opacification of the pulmonary arteries for CT pulmonary angiography and may prove useful in selected clinical situations.

Acute Disease↗
PubMed2005

A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre.

BACKGROUND: High-risk organizations such as aviation rely on simulations for the training and assessment of technical and team performance. The aim of this study was to develop a simulated environment for surgical trainees using similar principles. METHODS: A total of 27 surgical trainees carried out a simulated procedure in a Simulated Operating Theatre with a standardized OR team. Observation of OR events was carried out by an unobtrusive data collection system: clinical data recorder. Assessment of performance consisted of blinded rating of technical skills, a checklist of technical events, an assessment of communication, and a global rating of team skills by a human factors expert and trained surgical research fellows. The participants underwent a debriefing session, and the face validity of the simulated environment was evaluated. RESULTS: While technical skills rating discriminated between surgeons according to experience (P = 0.002), there were no differences in terms of the checklist and team skills (P = 0.70). While all trainees were observed to gown/glove and handle sharps correctly, low scores were observed for some key features of communication with other team members. Low scores were obtained by the entire cohort for vigilance. Interobserver reliability was 0.90 and 0.89 for technical and team skills ratings. CONCLUSIONS: The simulated operating theatre could serve as an environment for the development of surgical competence among surgical trainees. Objective, structured, and multimodal assessment of performance during simulated procedures could serve as a basis for focused feedback during training of technical and team skills.

Attention↗
PubMed1972

Rehabilitation after cardiac illness.

Though the total number of patients with cardiac illness referred to a work classification clinic was relatively small (57), the results obtained in terms of patients at work in the year after assessment is encouraging. It is suggested that a comparatively simple method can help in the rehabilitation of patients, often by removing minor anxieties, and by improving communication among the various agencies interested in the welfare and employment of the individual patient.

Depression↗
PubMed2005

Alternative input devices for efficient navigation of large CT angiography data sets.

PURPOSE: To compare devices for the task of navigating through large computed tomographic (CT) data sets at a picture archiving and communication system workstation. MATERIALS AND METHODS: The institutional review board approved this study, and all subjects provided informed consent. Five radiologists were asked to find 25 different vascular targets in three CT angiography data sets (average number of sections, 1025) by using several devices (trackball, tablet, jog-shuttle wheel, and mouse). For each trial, the total time to acquire the targets (T1) was recorded. A secondary study in which 13 nonradiologists performed seven trials with an artificial target inserted at a random location in the same image data was also performed. For each trial, the following items were recorded: time until first target sighting (t2), time to manipulate the device after seeing the target, sections traversed during t2 (d1), time from first sight to target acquisition (t4), sections traversed during t4 (d2), and total trial time. Statistical analysis involved repeated-measures analysis of variance (ANOVA) and pairwise comparisons. RESULTS: Repeated-measures ANOVA revealed that the device used had a significant (P < .05) effect on T1. Pairwise comparisons revealed that the trackball was significantly slower than the tablet (P < .05) and marginally slower than the jog-shuttle wheel (P < .10). Further repeated-measures ANOVA for each secondary outcome measure revealed significant differences between devices for all outcome measures (P < .005). Pairwise comparisons revealed the trackball to be significantly slower than the other devices in all measures (P < .05). The trackball was significantly (P < .05) more accurate than the other devices for d1 and d2. CONCLUSION: The trackball may not be the optimal device for navigation of large CT angiography data sets; the use of other existing devices may improve the efficiency of interpretation of these sets.

Angiography↗
PubMed2004

Ecology drives the worldwide distribution of human diseases.

Identifying the factors underlying the origin and maintenance of the latitudinal diversity gradient is a central problem in ecology, but no consensus has emerged on which processes might generate this broad pattern. Interestingly, the vast majority of studies exploring the gradient have focused on free-living organisms, ignoring parasitic and infectious disease (PID) species. Here, we address the influence of environmental factors on the biological diversity of human pathogens and their global spatial organization. Using generalized linear multivariate models and Monte Carlo simulations, we conducted a series of comparative analyses to test the hypothesis that human PIDs exhibit the same global patterns of distribution as other taxonomic groups. We found a significant negative relationship between latitude and PID species richness, and a nested spatial organization, i.e., the accumulation of PID species with latitude, over large spatial scales. Additionally, our results show that climatic factors are of primary importance in explaining the link between latitude and the spatial pattern of human pathogens. Based on our findings, we propose that the global latitudinal species diversity gradient might be generated in large part by biotic interactions, providing strong support for the idea that current estimates of species diversity are substantially underestimated. When parasites and pathogens are included, estimates of total species diversity may increase by more than an order of magnitude.

Biodiversity↗
PubMed2002

The effects of postmenopausal hormone replacement therapy on hemostatic variables: a meta-analysis of 46 studies.

The aim of the study was to summarize and reanalyze all available data from the literature to study the overall effect of postmenopausal hormone replacement therapy (HRT) and its various forms on hemostatic variables. Studies were identified from literature searches by Medline and Index Medicus, review articles and personal communications. Reference lists of all articles were checked to find additional studies. Principal investigators were contacted and asked to provide additional data if required. Data were collected separately for each factor of the hemostatic system. Studies written in any language were included. Each collection of studies was analyzed using standard methods for meta-analysis. A total of 76 arms of 48 studies were eligible for analysis. This included 6,119 women using HRT and 24,974 non-users. The age of investigated women was 40-68 years. HRT was associated with significantly decreased levels of fibrinogen, factor VIII, antithrombin III, and proteins C and S, but significantly increased plasminogen levels. HRT with estrogen alone or in combination with progestins, oral vs. transdermal regimens, different estrogen preparations and various progestins induced significantly different changes in many cases. In conclusion, HRT was associated with changes that could explain the increased rate of venous thrombotic events, and also with some changes that could account for beneficial vascular effects. Surprisingly, the addition of progestins induced favorable changes in many cases. Also, transdermal use was associated with more beneficial effects than oral regimens in some cases.

Adult↗
PubMed2006

Educating physicians to treat erectile dysfunction patients: development and evaluation of a course on communication and management strategies.

PURPOSE: To describe the development and assess the outcome of a workshop on erectile dysfunction (ED) management based on participating physicians evaluations. METHOD: The study involved physicians who attended a workshop offered throughout the country, during a 3-year period. The workshop included tutorials, video-based dramatizations, and role-play sessions. A pilot study investigated the workshop's impact on physicians' attitudes toward patient-centeredness and sexual behavior issues; Patient-Practitioner Orientation Scale (PPOS) and Cross Cultural Attitude Scale (CCAS) were administered before and after the course. New knowledge acquisition, quality of presentation, and workshop's usefulness in their clinical practice were the dimensions used for workshop's evaluation. Analysis used quantitative and qualitative methods. RESULTS: A total of 194 questionnaires were administered during the pilot study and the response rate was 53.6%. A shift in attitudes toward patient-centeredness and less judgmental attitude toward patients' sexual attitudes were revealed (total PPOS score and Sharing subscale: P < 0.05, CCAS: P < 0.001). Six hundred physicians were asked to evaluate the workshops and the response rate was 62.3%. The tutorial session for "medical treatment of ED" (P < 0.001) and the role-play on sexual history taking (P < 0.05) received higher evaluation scores. Qualitative analysis showed that the most frequently reported category referred to the appropriateness of role-play as a teaching and awareness-raising technique (31.25%); a need for changes in clinical practice and communication patterns was identified by 20% of the participants who stressed the necessity for multidisciplinary approach, as well as the adoption of a nonjudgmental attitude toward patients. CONCLUSION: Training courses on ED management, using a combination of tutorial and interactive sessions, constitute an effective way of providing knowledge, enhancing physicians' communication skills with ED patients, and influencing attitudes toward patient-centeredness in sexual issues. Such results strongly support the establishment of sexual medicine courses at continuing medical education curricula.

Adult↗
PubMed2004

Assessment of medical communication skills by computer: assessment method and student experiences.

BACKGROUND: A computer-assisted assessment (CAA) program for communication skills designated ACT was developed using the objective structured video examination (OSVE) format. This method features assessment of cognitive scripts underlying communication behaviour, a broad range of communication problems covered in 1 assessment, highly standardised assessment and rating procedures, and large group assessments without complex organisation. SETTING: The Academic Medical Centre (AMC) at the University of Amsterdam, the Netherlands. Aims To describe the development of the AMC Communication Test (ACT); to describe our experiences with the examination and rating procedures; to present test score descriptives, and to present the students' opinions of ACT. DESIGN: The ACT presents films on history taking, breaking bad news and shared decision making. Each film is accompanied by 3 types of short essay questions derived from our assessment model: "knows", "knows why/when" and "knows how". Evaluation questions about ACT were integrated into the assessment. Participants A total of 210 third year medical undergraduates were assessed. This study reports on the 110 (53%) students who completed all evaluation questions. RESULTS: Marking 210 examinations took about 17 days. The test score matched a normal distribution and showed a good level of discrimination of the students. About 75% passed the examination. Some support for the validity of our assessment model was found in the students' differential performance on the 3 types of questions. The ACT was well received. Student evaluations confirmed our efforts to develop realistic films that related well to the communication training programme. CONCLUSIONS: The ACT is a useful assessment method which complements interpersonal assessment methods for the evaluation of the medical communication skills of undergraduates.

Attitude of Health Personnel↗
PubMed2005

Repair of impaired myocardium by means of implantation of engineered autologous myoblast sheets.

OBJECTIVES: Autologous skeletal myoblast cell transplantation by means of the injection method is subject to the loss of intercellular communication, extracellular matrix, and cell numbers. We hypothesize that the implantation of skeletal myoblast cell sheets might be more advantageous in repairing the impaired heart by providing uniform and stable cell delivery with less cell loss and without disrupting the cell-cell microenvironment. METHODS: Left anterior descending coronary artery-ligated Lewis rat hearts (2 weeks, total n = 173) received 1 x 10(7) autologous skeletal myoblasts by means of cell transplantation either through myoblast injection or implantation of 2 monolayer-constructed myoblast sheets (5 x 10(6) cells per sheet) or through medium injection. Myoblast sheets were constructed with temperature-responsive, polymer-grafted cell-culture dishes, which release the confluent cells from the dish surface at less than 20 degrees C. RESULTS: Echocardiographic results indicated higher improvement of cardiac performance in the myoblast sheet group than among the other groups until 8 weeks after cell transplantation. Histologic comparison revealed greater cellularity and abundant widespread neocapillaries within the noticeable uniform thickened wall in myoblast sheet group hearts only. Fibrosis was substantially reduced with skeletal myoblast sheet implantation compared with skeletal myoblast cell injection. Obviously higher numbers of hematopoietic stem cells (c-kit, stem cell antigen 1, and CD34) were observed in the myoblast sheet group infarct heart region. Reverse transcription-polymerase chain reaction results showed expression of stromal-derived factor 1, hepatocyte growth factor, and vascular endothelial growth factor as follows: myoblast sheets > myoblast injection > control. CONCLUSIONS: Myoblast sheets repaired the impaired myocardium, reduced fibrosis, and prevented remodeling in association with recruitment of hematopoietic stem cells through the release of stromal-derived factor 1 and other growth factors. Our experiment indicates a therapy for patients with severe heart failure.

Animals↗
PubMed2003

Corpus callosum development in childhood-onset schizophrenia.

OBJECTIVE: Corpus callosum (CC) size and interhemispheric communication differences have been reported between patients with schizophrenia and normal controls. Childhood-onset schizophrenia (COS) is a severe form of the disorder that is continuous with later-onset disorder. Corpus callosal area was examined for COS at initial scan and prospectively through adolescence, and related to other developmental abnormalities for this group. METHOD: A total of 113 anatomic brain MRI scans were obtained from 55 COS (22 female) and 110 scans from 56 age- and gender-matched healthy volunteers (22 female), across ages 8-24. Baseline and prospective rescans were obtained at approximately 2-year intervals. The midsagittal areas for total corpus callosum and seven subregions were calculated using an automated system. Cross-sectional and longitudinal data were combined using mixed model regression analysis to compare developmental changes for the two groups. RESULTS: No diagnostic differences were seen at time of initial scan. Longitudinally, and in contrast to healthy volunteers, patients with schizophrenia showed a significant difference in developmental trajectory for the area of the splenium, both before (p=0.012) and after (p=0.05) adjustment for total cerebral volume. The area of the splenium becomes significantly smaller in COS, starting at about age 22. CONCLUSION: Patients with schizophrenia showed a significant difference in developmental trajectory for the splenial area, which seems to decline for COS. If replicated, this may reflect anticipated late occipital and extrastriate changes in brain regions.

Adolescent↗