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PubMed2026

Dual-tasking reveals severity-dependent reorganization of cortical beta energy landscapes in Parkinson's disease.

Dual-task impairment is a hallmark of Parkinson's disease (PD), yet the large-scale neural mechanisms underlying postural-motor interference remain poorly understood. In particular, it is unclear how cortical network dynamics reorganize across disease severity when postural control competes with concurrent task demands. This study investigated EEG-derived beta-band cortical energy landscapes in healthy older adults, early-stage PD, and mid-stage PD during single- and dual-task conditions. Dual-task behavioral cost increased with disease severity for concurrent manual performance (p < 0.001), whereas a quadratic pattern was observed for postural performance. Energy landscape analysis revealed severity-dependent reconfiguration of cortical beta dynamics. Dual-task-related landscape changes in effective network flexibility (ΔNeff), landscape geometry (ΔEvar and ΔGmag), and dominant low-energy attractor organization (ΔLow mass and ΔLow area) showed significant monotonic trends (p < 0.05), reflecting progressive constrained cortical network dynamics with advancing PD severity. In addition, dual-task-related landscape alterations were associated with clinical severity, as indexed by Hoehn and Yahr stage (|r| = 0.353-0.423, p = 0.016-0.048), and showed associations with motor impairment, as measured by MDS-UPDRS part III scores (|r| = 0.333-0.455, p = 0.009-0.063). These findings demonstrate that dual-task demands induce severity-dependent reconfiguration of cortical beta energy landscapes in PD. Energy landscape geometry may capture systems-level neural constraints associated with dual-task susceptibility in PD, providing a physiologically grounded framework to characterize disease-related functional vulnerability.

Humans↗

PubMedDate not supplied

Psychiatric severity and behavior change in alcoholism: the relation of the transtheoretical model variables to psychiatric distress in dually diagnosed patients.

Treatment programming for individuals diagnosed with a chronic mental illness and an alcohol use disorder could be enhanced by employing techniques that focus on those change process variables that are most strongly related to psychiatric distress. Prochaska and DiClemente's transtheoretical model (TTM) provides a useful framework within which to study these relations. The associations between psychiatric severity and the TTM constructs of stages and processes of change, decisional balance, temptation, and self-efficacy were measured among 132 alcohol-dependent patients in a public mental health clinic's outpatient dual diagnosis program. Participants' scores on the Temptation subscale of the Alcohol Abstinence Self-Efficacy Questionnaire are strongly related to psychiatric severity: The more psychiatric distress a person is experiencing, the more he or she is tempted to drink, particularly in situations that trigger negative affect. Decisional balance considerations are also related to psychiatric severity: The higher participants scored on the Global Severity Index of the Brief Symptom Inventory, the more importance they placed on the negative aspects, or cons, of drinking. Subjects with more psychiatric distress also scored higher on the maintenance stage of change subscale, possibly indicating an increased fear of relapse and struggle to maintain sobriety.

Adult↗

PubMedDate not supplied

Role strain of clinical nursing faculty.

A survey was conducted of 226 clinical faculty from associate (ADN) and baccalaureate (BSN) degree programs in the Midwest. The purpose of the research was to examine role strain among clinical nursing faculty. Although clinical faculty experienced overall a low degree of role strain, they reported role overload and conflict. BSN faculty had more interrole conflict (t = 2.57, df = 215, P = .01) and role ambiguity (t = 2.37, df = 215, P = .01) than ADN faculty. Faculty with doctorates teaching clinical courses had higher role strain scores than other faculty. Teachers at the sophomore level reported the most role strain compared with teaching other levels of students. As expected, full-time faculty had significantly more role strain and demands on them compared with part-time clinical faculty. Findings from the research provide a framework for faculty orientation and development programs and highlight the importance of learning how to balance the demands and responsibilities of clinical teaching.

Education, Nursing, Associate↗

PubMed2001

Stroke care: a method for measuring compliance with AHCPR guidelines.

The purpose of this article is to describe a method for converting practice guidelines to measurement criteria. To evaluate the processes of care received by patients with stroke at 11 Veteran's Administration hospital sites, we developed a measurement system based on Agency for Health Care Policy and Research (AHCPR) Post-Stroke Rehabilitation Clinical Practice Guidelines. Guideline recommendations were used as the framework for identifying important dimensions of care, and for developing chart abstraction instruments for both the acute and postacute settings. Using a modified Delphi technique to solicit opinions from an expert panel, a method was developed for aggregation of item-level chart abstraction components to overall guideline compliance scores. The measurement system was shown to have good-to-excellent intrarater and interrater reliability at the item, dimension, and overall compliance score levels. Abstraction of a sample of 100 medical records demonstrated the ability of the instruments to detect variability in processes of post-stroke care. This study provides the foundation for future research, which will evaluate associations between processes of post-stroke care, as measured by this medical chart abstraction system, and patient outcomes. (All abstraction instruments, criteria, and scoring algorithms described in this article are available for download at http://www2.kumc.edu/coa.)

Aged↗

PubMed1989

A framework for planning public health nursing services to families.

We designed a model to assist public health nurses and nursing supervisory staff in planning, delivering, and evaluating their services to families. Specifically, the intent was to assist nurses to estimate the numbers and types of services required. The model includes a gradient of family health characteristics, an original delineation of nine basic public health nursing services, a coping index and scoring guidelines, and a methodology for integrating assessment of health needs and coping abilities.

Adaptation, Psychological↗

PubMed1990

The relationship between culture, personality, and sexual jealousy in men in heterosexual and homosexual relationships.

This study proposes a new approach to sexual jealousy, that of attitude theory. Within that framework, it examines the roles of culture and personality in the development of sexual jealousy. Using 194 men representing 62 male homosexual couples and 81 heterosexual couples, three hypotheses were analyzed: (1) that jealousy measured by a standard attitude measure, the semantic differential technique, will significantly positively correlate with scores on a standard jealousy measure, Eugene Mathes' Interpersonal Jealousy Scale; (2) that men in heterosexual couples will have higher levels of sexual jealousy than men in homosexual couples; and (3) that sexual jealousy is inversely correlated with self-actualization personality. All three hypotheses were supported, suggesting that sexual jealousy, viewed as an attitude, is mediated by culture and personality.

Adult↗

PubMed1988

From inquiry to judgment: age and sex differences in patterns of adult moral thinking and information-seeking.

This research examined age and sex variations in moral judgment processes across the life-span, primarily using objective questionnaire techniques. Both stage level of judgment and patterns of requests for further information following dilemma presentation were studied in 242 respondents, ages fourteen to ninety-two, in order to measure individual differences in judgment orientations hypothesized by Gilligan and suggested by theorists of aging. There were few indications of sex differences in either stage or patterns of information-seeking, except for a generally greater preference for additional information in decision-making by women. With respect to age trends, participants over age seventy-five scored at significantly lower stage levels than younger adult groups. However, elderly adults' judgments did not appear simply "regressed" to earlier developmental levels. On both objective and open-ended measures, older participants seemed more likely than younger groups to assimilate moral dilemma information to their own general cognitive frameworks, consistent with an hypothesis of greater synthesis in judgment among the elderly.

Adolescent↗

PubMedDate not supplied

[Multicenter study of the risk of infection in diabetics. I. Correlation between altered glucose metabolism and cutaneous reactivity to the Multitest IMC].

Within the framework of a multicentre study on the risk of infection in diabetes, organised to document the frequency of subjects predisposed to infoffion among the diabetic population and to evaluate the effects of Thymostimulin on the latter, 176 subjects (38%) with a deficient response (less than or equal to alarm score), of which 82 (18%) were totally anergic, were selected from a population of 460 diabetic subjects, both type I and type II, using the Multitest IMC multiantigenic delayed hypersensitivity test. It was not possible to establish any relationship between altered skin response and age, whereas males appeared to be more predisposed than females. The degree of metabolic compensation also influenced the degree of skin response, although this was not decisive. Hypergic and anergic responses were more frequent in type I diabetic subjects than in type II subjects, probably due to the greater immunological involvement of this type of diabetes.

Adolescent↗

PubMed1991

[Psychosomatic dysfunctions in the female climacteric. Clinical effectiveness and tolerance of Kava Extract WS 1490].

Within the framework of a randomized, placebo-controlled double-blind study, two groups each containing 20 patients with climacteric-related symptomatology were treated for a period of 8 weeks with kava WS 1490 extract 3 X 100 mg/day or a placebo preparation. The target variable - the HAMA overall score of anxiety symptomatology - revealed a significant difference in the drug-receiving group vis-à-vis the placebo group already after only 1 week of treatment. The course of such further parameters as depressive mood (DSI), subjective well-being (patient diary), severity of the disease (CGI), and the climacteric symptomatology (Kuppermann Index and Schneider scale) over the overall period of treatment demonstrate a high level of efficacy of kava extract WS 1490 in neurovegetative and psychosomatic dysfunctions in the climacteric, associated with very good tolerance of the preparation.

Climacteric↗

PubMed1994

Quality evaluation in the management of child sponsorship programmes.

Programme evaluation tactics for child sponsorship programmes have historically concentrated on quantitative analysis of service units, amount of money invested, number of countries served, the number of projects, and number of children in each project. While these are valuable measures of programme variables, they do not assess the impact of programmes on the lives of the children sponsored. Outcome measures designed to assess programme impact add greatly to the information available to child welfare professionals. This study collected data about the impact of the programme on the lives of the children. The Child Welfare League's Child Well-Being Scales (CWBS) were used to assess programme impact. Twelve scales were chosen as directly related in type to the programmes administered by Children International, a traditional and well established child sponsorship organization located in Kansas City, Missouri. A thirteenth scale was suggested by field workers in India as particularly relevant to Third World populations. The scales were translated into languages appropriate to each population in the programme countries. Social workers in each country were trained to administer and score them. This analysis used the emerging data technology becoming available to programmes in Third World countries. The system enables administrators in the Third World to evaluate, enhance and summarize their programmes in a way understandable across borders. Epi Info (Dean et al., 1990) was customized to provide the framework for the analysis. The population for this study was selected by a 5% random sampling of children currently enrolled as sponsored children (180,000+ worldwide). These were compared with a waiting-list control group selected randomly from lists of children who have applied for sponsorship but have not yet been receiving services (n = 50 from each project).(ABSTRACT TRUNCATED AT 250 WORDS)

Charities↗

PubMed2004

Evaluation and treatment of spinal injuries in the patient with polytrauma.

Spinal injuries occur frequently in the patient with polytrauma making the knowledge of the evaluation and treatment of these injuries invaluable to the trauma team. In the immediate moments after these injuries, critical steps can be taken to prevent additional injury and insure maximum neurologic and functional recovery of the patient. A simple, standardized approach to treating the patient at the scene, examining the patient in the trauma admitting area, ordering appropriate radiographic studies, and instituting early treatment can markedly influence a patient's maximal recovery. Furthermore, background knowledge in the classification and ultimate treatment goals allows for an effective communication between the initial treating team and the spinal surgeons involved. The work on indicators of potential spinal instability by White and Panjabi and the three-column classification of spinal injuries of Denis lends insight to the potential consequences of spinal trauma. A thorough appreciation of these concepts puts evaluation and treatment of these injuries into a logical framework with which spinal injuries initially can be approached.

Cervical Vertebrae↗

PubMed2005

Analgesia and anesthesia for neonates: study design and ethical issues.

OBJECTIVE: The purpose of this article is to summarize the clinical, methodologic, and ethical considerations for researchers interested in designing future trials in neonatal analgesia and anesthesia, hopefully stimulating additional research in this field. METHODS: The MEDLINE, PubMed, EMBASE, and Cochrane register databases were searched using subject headings related to infant, newborn, neonate, analgesia, anesthesia, ethics, and study design. Cross-references and personal files were searched manually. Studies reporting original data or review articles related to these topics were assessed and critically evaluated by experts for each topical area. Data on population demographics, study characteristics, and cognitive and behavioral outcomes were abstracted and synthesized in a systematic manner and refined by group members. Data synthesis and results were reviewed by a panel of independent experts and presented to a wider audience including clinicians, scientists, regulatory personnel, and industry representatives at the Newborn Drug Development Initiative workshop. Recommendations were revised after extensive discussions at the workshop and between committee members. RESULTS: Designing clinical trials to investigate novel or currently available approaches for analgesia and anesthesia in neonates requires consideration of salient study designs and ethical issues. Conditions requiring treatment include pain/stress resulting from invasive procedures, surgical operations, inflammatory conditions, and routine neonatal intensive care. Study design considerations must define the inclusion and exclusion criteria, a rationale for stratification, the confounding effects of comorbid conditions, and other clinical factors. Significant ethical issues include the constraints of studying neonates, obtaining informed consent, making risk-benefit assessments, defining compensation or rewards for participation, safety considerations, the use of placebo controls, and the variability among institutional review boards in interpreting federal guidelines on human research. For optimal study design, investigators must formulate well-defined study questions, choose appropriate trial designs, estimate drug efficacy, calculate sample size, determine the duration of the studies, identify pharmacokinetic and pharmacodynamic parameters, and avoid drug-drug interactions. Specific outcome measures may include scoring on pain assessment scales, various biomarkers and their patterns of response, process outcomes (eg, length of stay, time to extubation), intermediate or long-term outcomes, and safety parameters. CONCLUSIONS: Much more research is needed in this field to formulate a scientifically sound, evidence-based, and clinically useful framework for management of anesthesia and analgesia in neonates. Newer study designs and additional ethical dilemmas may be defined with accumulating data in this field.

Analgesia↗

PubMed2006

Impact of a rheumatology expert nurse on the wellbeing of patients attending a drug monitoring clinic.

AIM: This paper reports a study to test the hypothesis that consultation with a clinical nurse specialist in a drug monitor clinic has a measurable impact on the well-being of patients with rheumatoid arthritis. METHOD: A single blinded randomized controlled trial was carried out with 71 patients with rheumatoid arthritis who were starting new disease-modifying anti-rheumatic therapy at a district general hospital. Patients were randomized into two groups over a 3-year recruitment period. Intervention group patients were monitored by a rheumatology clinical nurse specialist using Pendelton's framework to assess patient needs alongside safety monitoring. Control group patients were seen by an outpatient staff nurse for safety monitoring only over a 1-year period. The primary outcome measures were the Arthritis Impact Measurement Scales and the Rheumatology Attitude Index. Data were also collected on the Disease Activity Score, number of consultations with healthcare professionals and changes in drug therapy. Data were collected at baseline, 3, 7 and 12 months between 1999 and 2002. RESULTS: The Intervention group had greater change scores than the Control group for the Arthritis Impact Scale, with statistical significance shown at 7 months (P = 0.03). At 12 months the Rheumatology Attitude Index had improved by a mean of 1.8 in the Intervention group and deteriorated by 0.3 in the Control group. Changes in the Disease Activity Score were greater in the Intervention group at all time points, with statistical significance at 12 months (P = 0.048). There was little difference in the number of consultations or changes in drug therapy between the two groups. CONCLUSION: Consultation with an expert rheumatology nurse in a drug monitor clinic may add value in terms of improving patients' perceived ability to cope with the arthritis.

Activities of Daily Living↗

PubMed2006

Establishing a definition for a nurse-led clinic: structure, process, and outcome.

AIM: This paper reports a study to define a nurse-led clinic by exploring the domains of structure, process and outcome. BACKGROUND: Nurse clinics have been introduced as a measure to support intermediate care after the acute phase of disease. Previous studies have been mainly descriptive, or have only addressed a particular aspect of clinic service. METHODS: This exploratory study was conducted in two phases. In the first phase, nurses from 34 clinics were interviewed. In the second phase, 162 clinic sessions were observed, and 162 patients and 16 physicians were interviewed. The data were collected in 2001-2003. RESULTS: The nurses who ran the clinics were very experienced, and resources were available to support their work. Over 80% of their work was independent or interdependent, involving skills such as adjusting medications, and initiating therapies and diagnostic tests according to protocols. The principal interventions were assessments and evaluations, and health counselling. The nurses rated 'management of symptoms', 'prevention of complications', and 'client satisfaction' as the top three key indicators of their success. All patients studied showed improvement after the nurse clinic consultation, but the best rates were found in wound and continence clinics. Satisfaction scores for both nurses and clients were high. Physicians valued their partnership in care with the nurses, but were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. CONCLUSIONS: A nurse clinic is an effective alternative model of ambulatory healthcare delivery that uses a holistic framework.

Ambulatory Care↗

PubMed1975

Relations between performance on the advance matrices and the EPI in high-intelligence subjects.

This study continues the investigation of the relationship between performance on tests of intelligence, and the personality parameters of the Eysenckian theoretical framework. Candidates for admission to an honours degree course (n = 281) were given the Advanced Progressive Matrices as a screening device. Those admitted to the course were on later occasions given both forms of the Eysenck Personality Inventory (EPI). In view of problems of test-retest on the EPI, scores were analysed in a novel fashion to give three groups: 'introverts', 'extraverts' and 'ambiverts'. The 'introverts' scored significantly highest on the Matrices, but the scores of the 'ambiverts' were lowest. Neuroticism showed little interaction with other variables. These results are discussed in terms of the theory of reactive inhibition. New data on the Advanced Progressive Matrices are given which are significantly higher than the published university norms.

Humans↗

PubMed2004

Undergraduate knowledge of aging: a comparative study of biopsychosocial content.

This study assesses undergraduate knowledge of aging, distinguishing between types of deficits (ignorance vs. misinformation) and content areas as delineated by a biopsychosocial framework. Knowledge is examined as an outcome of taking an aging elective, while accounting for course rating and knowledge retention. A diverse body of UCLA undergraduate students who took an aging course (n = 349) and a stratified random comparison group (n = 430) took Palmore's Facts on Aging Quiz and scored 14 and 12 items correct, respectively. Undergraduates (n = 779) showed a good knowledge of aging in the psychological- cognitive domain, but consistent with previous findings, they exhibited deficits primarily in the social-demographic realm. Taking an aging course was significantly related to better overall knowledge of aging (correct) (p </= .0001), and fewer don't know responses (p </=.0001). Course rating and shorter timing until testing were also significantly related to better knowledge.

Adult↗

PubMed2003

Design and testing of a tool for evaluating the quality of diabetes consumer-information Web sites.

BACKGROUND: Most existing tools for measuring the quality of Internet health information focus almost exclusively on structural criteria or other proxies for quality information rather than evaluating actual accuracy and comprehensiveness. OBJECTIVE: This research sought to develop a new performance-measurement tool for evaluating the quality of Internet health information, test the validity and reliability of the tool, and assess the variability in diabetes Web site quality. METHODS: An objective, systematic tool was developed to evaluate Internet diabetes information based on a quality-of-care measurement framework. The principal investigator developed an abstraction tool and trained an external reviewer on its use. The tool included 7 structural measures and 34 performance measures created by using evidence-based practice guidelines and experts' judgments of accuracy and comprehensiveness. RESULTS: Substantial variation existed in all categories, with overall scores following a normal distribution and ranging from 15% to 95% (mean was 50% and median was 51%). Lin's concordance correlation coefficient to assess agreement between raters produced a rho of 0.761 (Pearson's r of 0.769), suggesting moderate to high agreement. The average agreement between raters for the performance measures was 0.80. CONCLUSIONS: Diabetes Web site quality varies widely. Alpha testing of this new tool suggests that it could become a reliable and valid method for evaluating the quality of Internet health sites. Such an instrument could help lay people distinguish between beneficial and misleading information.

Diabetes Mellitus↗

PubMedDate not supplied

A pilot study to measure the caring efficacy of baccalaureate nursing students.

Caring in professional nursing, often described as the essence of nursing, has gained increasing attention over the past several decades. Many programs claim to be based on a caring philosophy and practice. Despite the expectation that graduates of nursing programs will develop relationships with their patients and practice within a caring framework, evaluation of caring competencies is not well developed. The purpose of this pilot study was to measure the self-reported caring competency of baccalaureate nursing students using the Coates Caring Efficacy Scale (CES) (1). Students from prenursing courses to final semester seniors completed the CES (N = 193). Mean scores in this cross-section of students were higher than those reported by Coates for novice student nurses, but slightly lower than those Coates reported for comparable baccalaureate seniors. Final semester seniors identified their families as making the greatest contribution to their development of caring; only a few reported the influence of the nursing curriculum. This study, while limited to students in one program, provides beginning evaluative data of self-reported caring competencies of nursing students.

Adult↗