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PubMedDate not supplied

Supportive telephone intervention for patients receiving chemotherapy. A pilot study.

Psychosocial interventions have been shown to improve quality of life (QOL) for many cancer patients. A pilot study was conducted to assess the feasibility of a psychoeducational intervention for cancer patients receiving chemotherapy. Eight patients receiving chemotherapy for colorectal carcinoma participated. The intervention is based on a modification of Interpersonal Therapy. It consisted of four sessions, administered biweekly, using a manual format, by a psychiatric nurse clinician over the telephone. The participants also completed a set of QOL measures by telephone to assess tolerance of the planned assessment. The patients received assistance with treatment-related side effects, reported improved ability to communicate with their physician, and gained an understanding of the stresses they discussed. The patients felt satisfied with the emotional support and medical information provided. A randomized trial is planned to test the intervention for patients participating in a cooperative trial sponsored by the National Cancer Institute.

Aged↗
PubMed1997

The Food and Agriculture Organization food-composition initiative.

The 1992 International Conference on Nutrition, new legislation in developing countries, and international trade agreements have renewed interest in food-composition data. Because of the costs involved in gathering such information and the need for it to be uniform, collaborative efforts are required. The production of new food-composition data must be viewed with respect to value gained for money spent, the need for more precise information, and the opportunity to use new analytic methods while not depending too heavily on high-technology systems. The Food and Agriculture Organization and the United Nations University have agreed to collaborate in stimulating the development of new food-composition programs. Their efforts will be directed toward promoting national, regional, and international activities in the food-composition field and will include strengthening existing laboratory facilities and programs, publishing technical manuals and documents, assisting countries to disseminate data, training workers, and sponsoring regional workshops. The Food and Agriculture Organization is well positioned to fulfill this coordinating role because of its past work in food composition, international mandates regarding its activities, its established communication system with national governments, and its ability to provide open forums for discussion of food-composition issues.

Food Analysis↗
PubMed1992

A PC-based imaging system for automated platelet identification.

In this communication, a PC-based imaging system was developed for automatically identifying fluorescence-labeled individual platelets adherent to protein-coated surface under flow conditions. It is to eliminate the laborious and time-consuming task, and the subjective error of manual measurements. Based upon the features of adherent platelets, three passes of the image processing were developed for platelet identification. From the results, 90-95% accuracy could be routinely obtained. The platelet distribution and other related parameters could be easily extracted and investigated.

Algorithms↗
PubMedDate not supplied

Evaluation of vocabularies for electronic laboratory reporting to public health agencies.

Clinical laboratories and clinicians transmit certain laboratory test results to public health agencies as required by state or local law. Most of these surveillance data are currently received by conventional mail or facsimile transmission. The Centers for Disease Control and Prevention (CDC), Council of State and Territorial Epidemiologists, and Association of Public Health Laboratories are preparing to implement surveillance systems that will use existing laboratory information systems to transmit electronic laboratory results to appropriate public health agencies. The authors anticipate that this will improve the reporting efficiency for these laboratories, reduce manual data entry, and greatly increase the timeliness and utility of the data. The vocabulary and messaging standards used should encourage participation in these new electronic reporting systems by minimizing the cost and inconvenience to laboratories while providing for accurate and complete communication of needed data. This article describes public health data requirements and the influence of vocabulary and messaging standards on implementation.

Centers for Disease Control and Prevention, U.S.↗
PubMed1998

Pragmatic language behaviors of adults diagnosed with chronic schizophrenia.

35 adults diagnosed with schizophrenia provided samples of narrative and conversational discourse and completed a criterion-referenced test of pragmatic language ability. There was a significant relationship between performance on pragmatic language tasks and perceived over-all functioning of schizophrenic subjects as measured by psychological assessment. Subjects who were perceived as functioning at low levels on the Global Assessment of Functioning Scale from the Diagnostic and 1994 Statistical Manual of Mental Disorders had low self-disclosure in conversation, produced less information in narratives, and produced more nonscorable items on a criterion-referenced test of pragmatic language. Appropriateness of speech suprasegmentals was also related to patients' perceived effectiveness as communicators as well as to their perceived over-all functioning as measured by the Global Assessment of Functioning Scale.

Adult↗
PubMed1991

Thumbtack use for control of presacral bleeding, with description of an instrument for thumbtack application.

There is well-known difficulty in controlling hemorrhage from presacral vessels. There are reports on the use of thumbtacks to secure hemostasis in the face of presacral hemorrhage. This communication reports the successful use of thumbtacks to establish presacral hemostasis and describes a simple instrument designed to afford easier and more precise anterior sacral application of thumbtacks. The instrument is easy to make. It was devised because of difficulty encountered with manual placement of hemostatic thumbtacks and the absence of totally satisfactory delivery by any of the standard surgical instruments available.

Blood Vessels↗
PubMed1990

Factors in functional assessment.

UNLABELLED: The list of individualized needs of the wheelchair user as developed by the medical and personal profile assessment can be categorized under the general goals to be accomplished through the process of the wheelchair recommendation: MEDICAL PROFILE: MEDICAL HISTORY: (1) Compensate for loss or absence of function. (2) Promote good health through prevention of problems. Physical Assessment: (1) Maintain proper seating and posture of the individual in the wheelchair. (2) Correct or accommodate for deformity through positioning in the wheelchair. PERSONAL PROFILE: Social History/User Goals: (1) Minimize mobility limitations as they apply to educational, vocational, socialization, and recreational pursuits. (2) Minimize mobility limitations as they apply to communication. (3) Promote positive self-image. Functional Abilities: (1) Optimize physical performance of wheelchair user for: (a) wheelchair mobility, and (b) transfers. (2) Assist family or caretaker in performance of: (a) dependent mobility, and (b) handling. (3) Provide means of dependent, manual mobility. ENVIRONMENT: Minimize the impact of the environment on mobility in: (a) home, vocational/educational, community and recreational settings, and (b) transportation of the wheelchair.

Choice Behavior↗
PubMed1994

Automatic speech recognition to aid the hearing impaired: prospects for the automatic generation of cued speech.

Although great strides have been made in the development of automatic speech recognition (ASR) systems, the communication performance achievable with the output of current real-time speech recognition systems would be extremely poor relative to normal speech reception. An alternate application of ASR technology to aid the hearing impaired would derive cues from the acoustical speech signal that could be used to supplement speechreading. We report a study of highly trained receivers of Manual Cued Speech that indicates that nearly perfect reception of everyday connected speech materials can be achieved at near normal speaking rates. To understand the accuracy that might be achieved with automatically generated cues, we measured how well trained spectrogram readers and an automatic speech recognizer could assign cues for various cue systems. We then applied a recently developed model of audiovisual integration to these recognizer measurements and data on human recognition of consonant and vowel segments via speechreading to evaluate the benefit to speechreading provided by such cues. Our analysis suggests that with cues derived from current recognizers, consonant and vowel segments can be received with accuracies in excess of 80%. This level of performance is roughly equivalent to the segment reception accuracy required to account for observed levels of Manual Cued Speech reception. Current recognizers provide maximal benefit by generating only a relatively small number (three to five) of cue groups, and may not provide substantially greater aid to speechreading than simpler aids that do not incorporate discrete phonetic recognition. To provide guidance for the development of improved automatic cueing systems, we describe techniques for determining optimum cue groups for a given recognizer and speechreader, and estimate the cueing performance that might be achieved if the performance of current recognizers were improved.

Adolescent↗
PubMed2007

[Frankfurt group social communication and interaction skills training for children and adolescents with autism spectrum disorders].

OBJECTIVE: Despite the recognition of the need for group-based training programmes for children and adolescents with autistic disorders, there are only very few specific German-speaking training programmes available. Since 2003, a structured group training programme on social skills for children and adolescents with high-functioning autism or Asperger syndrome has been developed and conducted at our department. The training programme focuses on the main deficits of those disorders. Thus, the primary goal is to improve communication and interaction skills. METHOD: Participants are children and adolescents without significant cognitive and language delays. Principles of intervention include structured formats, combination of theoretical and practical elements, predictable rules, consideration of individual difficulties, and sequential and progressive learning. Techniques range from structured games, the training of affect recognition, group activities, role play, team discussions, and feedback to homework using a newly designed manual on our group-based social skill training programme and curriculum. Generally, three groups of 5-7 participants each and of different age range (children, adolescents) meet weekly/biweekly for 1-1.5 hours (excluding the holidays). Two trainers--who change during the programme--carry out each of the sessions. Trainers meet regularly with the parents to discuss experiences and to provide details of the programme. RESULTS: Acceptance by and satisfaction with the programme are high among participants, as is the mutual recognition of and tolerance of their respective problems. Both feedback from parents and trainers' clinical impressions indicate distinct improvement of verbalization and contact abilities. Participants seem to benefit particularly from role play. CONCLUSIONS: Qualtitative measures (impressions of the participants, their parents and their trainers with regard to change in behaviour skills) suggest mounting interaction, communication, and problem-solving skills during the group treatment. An ongoing pilot evaluation also includes measurements of effects in everyday settings. Depending on the results, the training subsequently could be conducted and evaluated in groups with both pervasive developmental, as well as other psychiatric disorders.

Adolescent↗
PubMed1999

Tracheal resection and reconstruction.

PURPOSE: To review the literature on tracheal and carinal resection and reconstruction, and to report the general approach to these patients, as well as the general guidelines for the safe administration of anesthesia. The airway management is extensively reviewed. SOURCE: Articles obtained from a Medline search (1960 to October 1997; keywords: tracheal surgery, carinal surgery, airway management). Textbook literature including the bibliographies were also consulted. PRINCIPAL FINDINGS: Benign or malignant tracheal and carinal pathology causing obstruction can be managed in several ways but resection and reconstruction are the treatment of choice for most patients with tracheal stenosis or tumour. Surgery of the trachea is a special endeavour where the airway is shared by the surgeon and the anesthesiologist. The principal anesthetic consideration is ventilation and oxygenation in the face of an open airway. Ventilation can be managed in different ways, including manual oxygen jet ventilation, high frequency jet ventilation, distal tracheal intubation, spontaneous ventilation, and cardiopulmonary bypass. CONCLUSION: The management of anesthesia for tracheal surgery presents many challenges to the anesthesiologist. Knowledge of the various techniques for airway management is crucial. Meticulous planning and communication between the anesthesia and surgical teams are mandatory for the safe and successful outcome of surgery for patients undergoing this procedure.

Anesthesia↗
PubMed2003

Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population.

OBJECTIVE: s To determine the psychometric properties of the Vanderbilt Attention Deficit/Hyperactivity Disorder Parent Rating Scale (VADPRS), which utilizes information based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (DSM-IV). The VADPRS was created to collect uniform patient data and minimize the time burden of lengthy interviews. METHODS: Participant data (N = 243) was used from the first 2 years of a longitudinal study on communication among physicians, teachers, and parents in diagnosing, treating, and managing children with attention deficit/hyperactivity disorder (ADHD). The reliability, factor structure, and concurrent validity of the VADPRS were evaluated and compared with ratings of children in clinical and nonclinical samples on the Vanderbilt ADHD Teacher Rating Scale and the Computerized Diagnostic Interview Schedule for Children-IV, Parent version. RESULTS: The internal consistency and factor structure of the VADPRS are acceptable and consistent with DSM-IV and other accepted measures of ADHD. CONCLUSION: The VADPRS is a reliable, cost-effective assessment for ADHD in clinical and research settings.

Attention Deficit Disorder with Hyperactivity↗
PubMed1975

Prevention of blindness from glaucoma using the King's College Hospital computerized problem orientated medical record.

(1) Chronic glaucoma accounts for a high proportion of blindness which is preventable and calls for energetic action because existing knowledge is not applied as it should be because of the indifference of the Department of Health and Social Security to the glaucoma problem. (2) The condition is frequently insidious and advanced before being identified, and requires life-long supervision. (3) When diagnosed, the management of glaucoma is frequently inadequate and intermittent for a variety of reasons. (4) AtKing's College Hospital, a Glaucoma Centre has been initiated to supervise accurately and regularly a large number of glaucoma patients, assisted by numerical recording and computer analysis. While we are fortunate in having a computer in the hospital, it is important to emphasize that the system can be operated without this facility, either by employing manual methods, or by batch processing. It would be both possible and desirable to organize recording a nd analysis on a regional basis in collaboration with hospitals wishing to participiate. (5) Attempts are being made to improve the early diagnosis ofglaucoma by better communication between the hospital ophthalmologists, and other members of the medical, optical, and ancillary professions by lectures, demonstrations, and publications. (6) Research is always hampered by the absence of factual knowledge. It is planned to use fully the opportunity for research into glaucoma made possible by this basic organization. At present however, we consider it more important to carry out investigations into the problems of organizing the investigation, treatment, and follow-up of glaucoma patients than t o embark on a few individual projects of research. We are serously hampered in our work by shortage of funds for staff and facilities, but we look forward confidently to the time when, with the essential support of the Department of Health, these methods will give us access to the facts of glaucoma, which besides enabling us to give a high standard of treatment to our patients, will give us an unprecedented opportunity of wide ranging research into all aspects of this important disorder.

Blindness↗
PubMed1984

Teaching brief psychotherapy for spouses of cancer patients: us of a codable supervision format.

While there has been increasing recognition of the psychosocial needs of cancer patients, the plight of the patient's spouse has been less well addressed. As part of an ongoing study in this area, we have developed a counseling manual which defines the parameters of a therapy intervention for cancer patients' spouses with problematic adjustment. In order to monitor the consistency of the therapy, we have also developed a codable supervision rating sheet, which is the topic of this report. All therapist communications are rated on a three-dimensional format which specifies general content area, level of intervention, and the presence of a focus specific to the therapy. This codable rating sheet is used in a group supervision process. It provides an innovative method to teach and supervise therapy, helps delineate specific elements of therapy judged to be important, and also has implications for psychotherapy research which extend beyond this specific project.

Adaptation, Psychological↗
PubMed1975

[Akinetic mutism and bicingular softening. 3 anatomo-clinical cases].

The authors describe three pathological cases of akinetic mutism with, as a common basic lesion, bilateral infarction of the cingulate gyrus secondary to aneurysm of the anterior communicating artery (case n degrees 1), to a huge olfactory meningioma (case n degrees 2), both operated on, and to atheromatous occlusion of the anterior cerebral arterial system (case n degrees 3). These three cases enable a variety of "anterior and waking" akinetic mutism to be described which is unusual enough to be compared with other mesencephalic and diencephalic aspects of this syndrome. It is in fact an akinetic mutism characterized by: a certain dissociation in its non-response to various stimuli, a particularly marked appearance of wakefulness when day-time alertness is considered, conservation of the waking-sleeping rhythm, perception and reaction unpredictable and paradoxical in both degree and quality, complete absence of any spontaneous verbal communication in contrast to relative break-down of solicited communication which is infrequent, uncertain and unresponsive to the usual methods of stimulation, without any possibility of a code. In addition, there is a remarkable mimic and segmental general akinesia, resistant to the usual nociceptive stimuli, but sensitive to slight excitation of the manual and oral zones. Besides this special akinetic mutism, there are variously systematised signs, mostly asymmetrical, indicating lesion of the cortico-sub-cortical frontal structures bordering on the gyrus cinguli. This unusual behaviour pattern corresponds in these three cases to extensive anterior bilateral ischemic lesions of the cingulate gyrus regularly associated with bilateral infarctions confined to the medial aspect of F1 in the superficial territory of the two anterior cerebral arteries, to possible neurosurgical changes (ablation of the right frontal pole) and to compressive or ischaemic lesions of the gyrus rectus. These exclusively cortico-sub-cortical associated lesions are in contrast with the remarkably intact caudate nuclei, the pallidal, thalamic, hypothalamic and septal formations and the anterior pillars of the fornix. These findings compared with the results of experimental research carried out by M. Kennard, help, if help is needed, to resolve the apparent contradictions between the effects of therapeutic cingulectomies or cingulotomies and the scanty pathological data already available in cerebral vascular pathology.

Adult↗
PubMedDate not supplied

My experience with the Cancer Survival Toolbox.

Nurses are instrumental in educating patients and their families about how to navigate the cancer experience. Patients often state that they would not know much about their disease and treatment if not for their nurse's teaching. The Cancer Survival Toolbox, a comprehensive set of audiotapes, is a free resource that helps people dealing with cancer develop and use key coping skills--communicating, finding information, making decisions, solving problems, negotiating, and standing up for their rights. Supplemental modules deal with issues facing the underinsured and uninsured, barriers to care for older cancer survivors, and concerns of caregivers. The Cancer Survival Toolbox Group Facilitator's Training Manual is a valuable resource for anyone working with cancer support groups. All healthcare professionals, cancer survivors, and lay caregivers can use the toolbox in a variety of ways. This article offers suggestions about how to ensure that cancer survivors and caregivers have the opportunity to use this unique resource.

Caregivers↗
PubMed2005

Autism -- experiences in a tertiary care hospital.

UNLABELLED: Pervasive developmental disorders (PDD) or Autistic Spectrum Disorders (ASD) include Autistic Disorder (commonest), Asperger's syndrome, Childhood Disintegrative Disorders, Rett's syndrome and PDD-NOS (not otherwise specified). OBJECTIVE: Autism is an important cause of social disability and reported more often from the developed world than from the developing countries. The present study was aimed to establish the diagnosis of autism amongst children with derangements of language, communication and behavior; ascertain and treat the co-morbidities; identify underlying cause and create a sensitivity and awareness among various health care professionals. METHODS: Sixty-two of the seventy-five referred patients fulfilled the DSM-IV (Diagnostic and Statistical Manual of Mental Disorder) criteria for autism. Evaluation included a detailed history, clinical examination, IQ assessment, Connor's scoring for hyperactivity and Fragile-X screening. Management of co-morbidities was done. A follow up of these patients was done. Parents' assessment of the child was also done. A registry for autistic children was established at the Department of Pediatrics with other major institutions of Delhi. RESULTS: The male:female ratio was 8:1 and missed diagnosis was common. Professional awareness is merited. Behavioral modification by early intervention and stimulation improved the core symptoms of autism. Important co-morbidities included mental retardation (95%), hyperactivity (53%) and seizures (10%) cases. Control of co-morbidities in these children facilitated child's periodic assessment and implementation of intervention programmes. In the registry initiated 62 patients were enrolled at AIIMS and 6 were identified from other hospitals. CONCLUSION: Autism does occur in Indian children too. Diagnosis is often missed. Capacity building among health professionals by a more structured teaching of developmental disabilities in the medical curriculum is required. The need to attend to co-morbidities and associated symptoms was clear. The initiation of the registry and beginning of networking was important.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Decision support for diagnosis of lyme disease.

This paper describes the development of a Bayesian model for diagnosis of patients suspected of Lyme disease, and the integration of such a model into a medical information system. A Bayesian network incorporating the clinical history and laboratory results has been constructed. Because many of the symptoms are not exclusive to Lyme disease and they develop over time, the clinical history is important for making the correct diagnosis. The model is based on time slices, where each time slice contains the observed pathological picture from one consultation with for example, the general practitioner. Since the time intervals between consultations typically are not equivalent, we have developed a novel method that can handle non-equivalent time intervals between the time slices in the network. The method is based on a description of the general development pattern of Lyme disease, which is implemented in a model that states the conditional probabilities of experiencing a certain pathological picture given time since infection. The model has been integrated into a web-based medical information system, called Borrelia Systems, which has enabled us to evaluate the model during a progressive diagnostic process. The integration has been accomplished through the development of a Bayesian Application Framework. This framework specifies a communication data structure in XML providing a graphical user interface and database components, which can be used when developing systems that are based on Bayesian networks. The framework generalizes the integration of Bayesian networks so that it is possible to switch network without manually having to update or change the system.

Bayes Theorem↗
PubMed2006

Autism: A review for family physicians.

Autism is a complex neurodevelopmental disorder characterized by qualitative impairments in social interaction and communication, with restricted, repetitive, stereotyped patterns of behavior, interests and activities. These behaviors manifest along a wide spectrum and commence before 36 months of age. Diagnosis of autism is made by ascertaining whether the child's specific behaviors meet the Diagnostic and Statistical Manual of Mental Disorders-IV-Revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Recent neuroimaging research studies indicate that autism may be caused by atypical functioning in the central nervous system, particularly in the limbic system: amygdala and hippocampus. In a third of autistic children, loss of language and/or social skills occurs during the second year of life, usually between 15 and 21 months of age. Comorbidity with mental retardation, epilepsy, disruptive behaviors and learning difficulty is not uncommon. Although there is currently no known cure for autism there is evidence to suggest that early intervention therapy can improve functioning of autistic children. Judicious use of psychotropic drugs is necessary to manage associated aggression, hyperactivity, self-mutilation, temper tantrums; but drugs are not a substitute for behavioral and educational interventions. The family physician can play an important role in detecting autism early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child's progress on a long term basis.

Attention Deficit and Disruptive Behavior Disorder↗