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PubMed2005

Clinical diagnosis and management of Alzheimer's disease.

The diagnosis of dementia of the Alzheimer's type is defined by criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the National Institute of Neurologic, Communicative Disorders and Stroke-AD and Related Disorders Association. The latter divides diagnosis into definite, probable, and possible Alzheimer's disease (AD), with definitive diagnosis requiring pathologic confirmation. Both criteria require that other causes of dementia are excluded. A diagnosis of AD can be made with reasonably high accuracy using a combination of clinical criteria, neuropsychologic testing, and conventional CT and MR imaging. There is increasing emphasis on early recognition. Although current therapies produce a mild improvement in symptoms, there are several disease-modifying therapies on the horizon. This article reviews current standards in clinical diagnosis and management.

Aged↗
PubMedDate not supplied

Testing of a medical linear accelerator's computer-control system.

In August of 1987, the Radiation Oncology Center at the Mallinckrodt Institute of Radiology became the first academic-medical-center user of Varian's computer-controlled therapy accelerator, a prototype version of the 2100C. Installation was accomplished by the retrofit of a computer system to our two-year-old Clinac 1800. Being well aware of the malfunctions that occurred in other computer-controlled accelerators, we took extraordinary measures to assure proper operation of the new, computerized, system. Our acceptance procedure included tests of (i) mechanical systems (isocentricity, digital readouts, etc.); (ii) radiation parameters (flatness, symmetry, output, etc.); (iii) manual safety systems (emergency off switches, etc.); (iv) the computer console systems (communications integrity, state integrity, etc.); and (v) the interlock systems (some 50 electrical, mechanical, and/or computer-controlled interlocks). As items (i), (ii), and (iii) do not differ significantly from the tests for a non-computer-controlled machine, they will not be discussed here. Rather, this report will concentrate on the methods that were devised to test the computer-control and interlock systems.

Computer Systems↗
PubMed2005

Intervening to improve communication between parents, teachers, and primary care providers of children with ADHD or at high risk for ADHD.

This study examines interventions designed to improve communication between individuals who take care of children with ADHD. A teacher rating of 6,171 elementary school children identifies 1,573 children with ADHD or with high risk for ADHD. Parent interviews and information from teachers are collected on 243 children who are randomized into treatment and control conditions and followed for 39 months. The interventions consisted of group workshops and single one-on-one tutorials with parents, teachers, and providers about the evaluation and treatment of ADHD that stressed the need for communication between the three parties. There are few significant effects on communication that are short lived. Results suggest that the interventions are insufficient to cause significant increase in communication. Future attempts to improve parent-teacher-provider coordination should be continuing rather than single-session interventions.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Dementia and Alzheimer's disease in community-dwelling elders taking vitamin C and/or vitamin E.

BACKGROUND: Since increased oxidative stress may impair cognition and be a risk factor for dementia, there has been interest in determining whether use of antioxidants could protect against such events. OBJECTIVE: To determine whether supplement use of vitamins C and/or E in a community-based sample of older African American and white individuals delayed incident dementia or Alzheimer's disease (AD). METHODS: We selected a subgroup from the Duke Established Populations for Epidemiologic Studies of the Elderly, a longitudinal study of community-representative persons aged 65-105 years living in 5 adjacent counties in North Carolina, and followed them for dementia (1986-1987 through June 2000). Information gathered during in-home interviews included sociodemographic characteristics, health status, health service use, and vitamin use. Diagnosis of dementia and AD was based on evaluations using the clinical and neuropsychological batteries of the Consortium to Establish a Registry for Alzheimer's Disease, with final determination by consensus agreement of specialists using Diagnostic and Statistical Manual of Mental Disorders, third revision, and National Institute for Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders criteria. RESULTS: Of 616 persons initially dementia-free (mean age 73 y; 62% female; 62% African American), 141 developed dementia, of whom 93 developed AD. Increased age and mobility problems were risk factors for dementia (only age for AD), while an increased number of outpatient visits reduced the likelihood of developing dementia. Neither use of any vitamins C and/or E (used by 8% of subjects at baseline) nor high-dose use reduced the time to dementia or AD. CONCLUSIONS: In this community in the southeastern US where vitamin supplement use is low, use of vitamins C and/or E did not delay the incidence of dementia or AD.

Aged↗
PubMed2004

Concordance among readers of self-help books about important ideas.

Amount of agreement among readers about the relevant information in a self-help psychology book was measured to assess whether readers' choices are unique or overlapping. 15 men and 14 women attended two 1-hr. sessions in which they read and marked relevant information in the first 60 pages of a self-help psychology book. Comparison of the amount and pattern of marking across pages and lines on five specific pages showed that there was a statistically significant amount of agreement on which pages contained relevant ideas and which lines contained important concepts. There were no differences between men and women.

Adult↗
PubMedDate not supplied

[Multimedia learning program for medical consultation].

To improve communicative competence during physicians' consultations, we developed a computer-assisted multimedia learning programme. This programme can be used in medical education as well as in continuing education for physicians. Dependent on individual skills and needs, the system, based on hypertext links, can be tailored to expand and improve communicative competence in a series of steps. The programme is based on a manual of medical interviewing and breaking bad news. The user gains information about theory and techniques of verbal intervention. He is trained to be able to reflectively observe and interactively intervene in video-taped and transcribed physician-patient dialogues. In a contrast-typological approach to model learning, in which negative and positive cases can be compared in a problem-based concept, alternative types of interventions can be recognised and evaluated. Finally, the learning goals in verbal intervention techniques should be subject of self-evaluation which can be objectified by further evaluations.

Communication↗
PubMed1992

Digital patient records and the medical desktop: an integrated physician workstation for medical informatics training.

The Institute of Medicine and others have advocated a shift from a paper-based to an electronic medical record and many authorities have advanced the concept of a physician workstation that can provide access to a wide variety of both clinically and reference oriented medical information. We have developed a working model of an integrated physician workstation based on a graphically oriented "Medical Desktop," for personal computers. This system gives the user access to much of the information necessary for the practice of medicine, by integrating an electronic medical record (notes, orders, consults, lab values, and radiological studies, organized both independently and in a "Visual Chart") with tools such as drug references, clinical manuals, textbooks of medicine, literature searching, expert system decision support, and electronic communication. It contains an on-line help system that facilitates use and allows access to all the systems' capabilities. This system has been used to teach students and physicians the methods and potential of computer-based medical information management to prepare them for the impact of computers in their practices and educate them concerning the imperative for the involvement of all health care providers in implementing these changes.

Computer Graphics↗
PubMed2006

Medication errors and patient complications with continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) is commonly used for renal support in the intensive care unit. While the risk of medication errors in the intensive care unit has been described, errors related specifically to CRRT are unknown. The purpose of this study is to characterize medication errors related to CRRT and compare medication errors that occur with manually compounded solutions versus commercially available solutions. We surveyed three separate internet-based, pediatric list serves that are commonly used for communications for programs utilizing CRRT. Data regarding CRRT practices and medication errors were recorded. Medication errors were graded for degree of severity and compared between programs using manually compounded dialysis solutions versus commercially available dialysis solutions. In a survey with 31 program responses, 18 reported medication errors. Two of the 18 were related to heparin compounding, while 16/18 were due to solution compounding errors. Half of the medication errors were classified as causing harm, two of which were fatal. All medication errors were reported by programs that manually compounded their dialysis solutions. Medication errors related to CRRT are associated with a high degree of severity, including death. Industry-based, commercially available solutions can decrease the occurrence of medication errors due to CRRT.

Child↗
PubMed1990

Total communication use among elementary teachers of hearing-impaired children.

This study examined the degree to which teachers' signed Manually Coded English messages represented their spoken utterances. Results indicate that educators in early elementary programs can, and do, provide a complete manual representation of their spoken English messages. This is in contrast with earlier research with middle school educators and parents of hearing-impaired children. Findings indicate that MCE proficiency may be influenced both by teacher attitude regarding the importance of signing a complete message and the degree to which program supervisors monitor teacher implementation of clearly specified MCE policies. Findings from this study have implications for programs to train teachers in using MCE and also provide information on the effects of program policy on teacher use of sign language.

Child↗
PubMed1998

Patient Impairment Lexicon: a psychometric analysis.

Growth in managed care has magnified the needs for assessment of treatment efficacies and standardized communication regarding treatment needs. Addressing both needs requires a common terminology describing the scope of treatable mental health impairments. The Diagnostic and Statistical Manual of Mental Disorders-IV provides a common categorical language for describing clinical disorders, but its categories are not discrete and do little to facilitate communication regarding specific treatment needs. Goodman, Brown, and Deitz developed a Patient Impairment Lexicon intended to address these limitations. The current vignette study provided initial psychometric assessment of this nomenclature, specifically examining interrater reliability, temporal stability, and content validity. Findings are discussed with respect to both applications in managed care and psychometric research.

Activities of Daily Living↗
PubMed1994

A data management program for the Electra 800 automatic analyser.

The Electra 800 automatic coagulation analyser rapidly performs most chronometric coagulation tests with high precision. To facilitate data handling, software, adaptable to any PC running under MS-DOS, was written to manage the analyser. Data are automatically collected via the RS232 interface or can be manually input. The software can handle 64 different analyses, all entirely 'user defined'. An 'electronic worksheet' presents the results in pages of ten patients. This enables the operator to assess the data and to perform verifications or complementary tests if necessary. All results outside a predetermined range can be flagged and results can be deleted, modified or added. A patient's previous files can be recalled as the data are archived at the end of the day. A 120 Mb disk can store approximately 130,000 patient files. A daily archive function can print the day's work in alphabetical order. A communication protocol allows connection to a mainframe computer. This program and the user's manual are available on request, free of charge, from the authors.

Autoanalysis↗
PubMed1984

A microcomputer technique for the detailed behavioural, and automatic statistical, analysis of animal behaviour.

In view of the intense concentration and time investment required for the detailed assessment of animal behaviour, various strategies have been employed to facilitate the quantitative description of movements and postures of animals. In a recent communication, we outlined a microcomputer technique which enabled individual operators to record frequency and duration of a large number of behavioural elements. However, this method required the manual collation and transcription of summary data in order to effect statistical analysis, an operation which involved avoidable and time-consuming repeated data handling. The present communication details a microcomputer technique which aids the recording of frequency, real-time duration and real-time latency measures. Further, this program automatically collates, transcribes and executes statistical analysis (Kruskal-Wallis, Mann-Whitney) without involving manual data manipulation, other than at the initial behavioural analysis level and thus, represents an aid to reducing the total time investment required to effect complete behavioural analysis.

Animals↗
PubMed1995

Information in general medical practice: a qualitative approach.

The aims of the study reported here were to describe the information-related behavior of general medical practitioners, to study information communication in general practices, and to establish guidelines for good practice. General practitioners (GPs) were interviewed, and information and communication audits also involving other staff at the practices were undertaken. The main reasons why GPs needed information were for patient care, managing the practice, legal and ethical matters, and teaching trainee GPs. Most practices had problems with internal and external communication and the storage and retrieval of information. The main conclusion is that practices need to have an information strategy that considers human, manual, and computer aspects of information handling.

Appointments and Schedules↗
PubMed1997

Olfactory dysfunction for pyridine and dementia progression in Alzheimer disease.

OBJECTIVE: To investigate whether odor detection sensitivity for pyridine, suggested by previous research not to be affected, is impaired in Alzheimer disease (AD) and whether an association exists between odor threshold and both degree of dementia and rate of dementia progression in AD. METHOD: The method of constant stimuli was used to determine odor thresholds for pyridine in 18 patients with AD (Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria) and 16 healthy elderly control subjects. All participants were carefully examined with medical and neuropsychological tests. RESULTS: Six patients with AD but none of the controls were anosmic (total olfactory loss) to pyridine, and the 12 nonanosmic patients had significantly higher detection thresholds (50% probability for detection, 323 parts per billion [ppb]) than did the controls (50% probability for detection, 105 ppb). In addition, an association was found between odor threshold and both degree of dementia and rate of dementia progression in AD. CONCLUSIONS: In contrast to previous findings, our results provide evidence that odor sensitivity in AD is impaired for pyridine. Odor sensitivity, in addition to other suggested predictors of progression rate, may be of interest for defining subgroups of AD or for clinical prognostic judgments of single patients.

Aged↗
PubMed2003

Natural imitation induced by joint attention in Japanese monkeys.

To examine whether joint attention enables Japanese monkeys to imitate human actions, we presented an oral action and manual actions directed towards targets to three monkeys who had joint attention through communicative eye-gaze and pointing gestures and to one monkey who had incomplete joint attention and who had acquired imperative pointing but not the use of eye-gaze gestures. Two of the monkeys who were already capable of joint attention were also able to imitate naturally, while the monkey who did not previously show joint attention was not able to imitate until acquiring joint attention capacity. We suggest that joint attention induces natural imitation during interaction between different species--in this case, between monkeys and humans--while individuals not showing joint attention but only attention to a target or movement are only able to follow motion. The monkey may be endowed by nature with motion-following capacity. We speculate that motion-following capacity is developed and controlled through joint attention, and is connected with natural imitation.

Animals↗