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PubMed1994

Comprehensive management of otitis media with effusion.

Comprehensive management of otitis media with effusion begins with a detailed assessment of disease burden and causative factors. Efforts directed toward primary control should precede medical or surgical interventions. The natural history and management of acute and subacute effusions differ greatly from that of effusions present two to three months or longer. Decisions for or against surgical intervention must be individualized based on open communication between the family, consultant otolaryngologist, child's primary care practitioner, and the communicative disorders specialist.

Acute Disease↗
PubMedDate not supplied

Adaptive computing for people with disabilities.

Adaptive computing is a relatively new area, and little has been written in the nursing literature on the topic. "Adaptive computing" refers to the professional services and the technology (both hardware and software) that make computing technology accessible for persons with disabilities. Nurses in many settings such as schools, industry, rehabilitation facilities, and the community, can use knowledge of adaptive computing as they counsel, advise, and advocate for people with disabilities. Nurses with an awareness and knowledge of adaptive computing will be better able to promote high-level wellness for individuals with disabilities, thus maximizing their potential for an active fulfilling life. People with different types of disabilities, including visual, mobility, hearing, learning, communication disorders and acquired brain injuries may benefit from computer adaptations. Disabled people encounter barriers to computing in six major areas: 1) the environment, 2) data entry, 3) information output, 4) technical documentation, 5) support, and 6) training. After a discussion of these barriers, the criteria for selecting appropriate adaptations and selected examples of adaptations are presented. Several cases studies illustrate the evaluation process and the development of adaptive computer solutions.

Computers↗
PubMed1994

Infant sleep position and risk for sudden infant death syndrome: report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD.

OBJECTIVE: To evaluate the current knowledge on the relationship between infant sleep position and sudden infant death syndrome (SIDS), and to determine how the information can be used to guide further activities in the United States. METHODS: Data from international vital statistics, epidemiologic studies of SIDS risk factors, and studies of outcomes of public health interventions that advocated nonprone sleeping to reduce the risk for SIDS were discussed at a meeting held by the National Institute of Child Health and Human Development (NICHD) with cosponsorship from the National Institute on Deafness and Other Communication Disorders (NIDCD), and the National Center for Health Statistics (NCHS) on January 13, and 14, 1994. RESULTS: Trends in postneonatal mortality and SIDS rates from 1980 through 1992 were evaluated for Australia, Britain, New Zealand, the Netherlands, Norway, Sweden, and the United States. All of the countries that experienced a rapid decline in prone sleeping also had reductions of approximately 50% in their SIDS rates. Postneonatal mortality rates dropped as well, with the reduction in SIDS being the primary contributor to the reported declines. The major behavioral change in all targeted populations was in sleep position. No significant changes were observed in the proportion of parents who smoked cigarettes, or in breast-feeding. Preliminary data from population-based studies showed there were no reported adverse outcomes associated with a change to side or back sleep position, such as an increase in deaths due to aspiration or in apparent life-threatening events. CONCLUSION: The overwhelming opinion of the assembled experts was that the evidence justified greater effort to reach parents with the American Academy of Pediatrics' recommendation that healthy infants, when being put down to sleep, be positioned on their side or back.

Humans↗
PubMed1993

Advances in Alzheimer's disease. A review for the family physician.

Alzheimer's disease accounts for approximately two thirds of all cases of dementia in the United States and $90 billion in health care costs annually. Clinical and laboratory diagnostic tools have been refined so that clinicians now can diagnose Alzheimer's disease with up to 90% accuracy. Criteria for clinical diagnosis have been outlined by a work group of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. Key diagnostic tools include a complete patient history, mental status testing, and a thorough diagnostic workup to exclude the possibility of a reversible disease mimicking the symptoms of Alzheimer's disease. Currently, management of Alzheimer's disease involves a two-pronged approach: behavioral-supportive care and pharmacologic control of disruptive behavioral symptoms. In the future, drug therapy may be available to maintain memory and cognitive function. Cholinesterase inhibitors, which block the decrease in choline acetyltransferase activity associated with Alzheimer's disease, appear promising. The realistic goal of health care providers at the present time, however, should be symptom control rather than disease reversal.

Aged↗
PubMed1993

[Presbycusis].

Hearing loss in the elderly is the most common type of hearing impairment. The term presbyacusis has been used to describe this category of hearing loss when there are no other etiological factors. However, the term is not precise, because any of several locations along the auditory pathway may be involved to produce the symptoms. The diagnosis is based more on the course of the hearing loss and the associated biological signs of aging than on specific criteria. The loss of speech-understanding ability is one of the most important indicators for a therapeutic intervention, which generally aims at amplification using a personal hearing aid. An improvement in speech-understanding ability with a hearing aid depends on several complex factors, and there is a large amount of intersubject variability in the benefit derived from amplification, even when the magnitude of the hearing loss is comparable. The aim of research on presbyacusis over the next several years--keeping in mind the demographic development in the industrialized countries--will be to further the differential analysis of the factors contributing to auditory communication disorders in the aging population.

Aged↗
PubMed1993

[A critical review of the problem of children at audiological and phoniatric risk in the first year of life].

The "M. L. Marenzi" Centre of Infantile Otophoniatrics, in collaboration with the Department of Neonatal Pathology of the Fatebenefratelli Hospital in Milan, performed longitudinal controls of an audiological and phoniatric type in 252 children. In the present study attention is focused in particular on audiological evaluations made in a group of 71 infants aged from 6-9 months old. During audiological tests the evaluation of auditory capacity and the type of response to acoustic stimulus were taken into account. The behavioural observation of selective attention to sound is a very important index of the maturity of sensorial patterns. The retarded development of response to an acoustic stimulus may indicate future communication disorders. The type of response to acoustic stimulus obtained in 71 infants were compared with those in a further two groups of children: the first comprised 3822 children with no audiological risk, and the second 3755 children at audiological risk according to Feinmeser and Telly's expanded list. This comparison highlighted a significant persistence of an archaic-type response in the group of infants from the Department of Neonatal Pathology. It is therefore essential that these children are examined further from a phoniatric point of view.

Audiometry, Pure-Tone↗
PubMedDate not supplied

The progressive making of a foremost chiropractic researcher: Fred Illi from Geneva.

Until after the workshop on the research status of Spinal Manipulative Therapy at the National Institute of Neurological and Communicating Disorders and Strokes (NINCDS) in Bethesda, Maryland, in 1975, research had been a very elusive yet critical part of chiropractic evolution. In the past, chiropractic education emphasized basic sciences for legitimacy. To increase their competitive edge, chiropractors all too frequently looked to medical research rather than conducting research of their own. A few exceptionally gifted individuals and agencies within the profession developed new paradigms, improved modalities, and clinical mastery. Very little descriptive information has been made available to assess either these individuals or their achievements. With more than half the profession having less than 10 yr of practice, it becomes necessary to kindle a reappraisal of what once was in the particular area of chiropractic research. The case of Fred Illi has been chosen to illustrate the inherent difficulties that faced anyone bold enough to try and coherent enough to be successful.

Chiropractic↗
PubMed1995

Clinicopathologic study of probable Alzheimer disease: assessment of criteria for excluding cerebrovascular disease.

The National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer Disease and Related Disorders Association criteria for probable Alzheimer disease (AD) require exclusion of non-AD dementia-producing conditions but do not specify how the non-AD conditions are to be identified. We addressed this issue for the case of cerebrovascular disease (CVD) by defining exclusion rules based on commonly described clinical features: (a) history of strokelike episodes; (b) history of stepwise cognitive decline; (c) focal deficits on neurological examination; and (d) evidence of significant CVD on neuroimaging. We applied these rules retrospectively to clinical records for 92 cognitively impaired patients who otherwise met criteria for probable AD and whose brains were subsequently available for postmortem examination. We used Fisher's exact test to assess the effectiveness of the exclusion rules in predicting the presence of CVD on autopsy. Prediction was better than chance when all four clinical features were used together (p = 0.0008) and when the stepwise decline or neuroimaging criteria were used alone (p = 0.03 and p = 0.05, respectively). Overall, the CVD exclusion rules were deficient because of low accuracy (50.0%) and low sensitivity (52.6%). These results support provisional use of the CVD criteria chosen for this study but suggest that modifications are needed for acceptable diagnostic accuracy and sensitivity to be achieved.

Alzheimer Disease↗
PubMed1995

Orthostasis in Alzheimer disease: a retrospective analysis.

Vitiello et al. (1993) recently reported statistically significant decreases in systolic blood pressure upon standing in patients with Alzheimer disease (AD) (n = 60) as compared with healthy elderly controls (n = 20), which would suggest a possible autonomic dysfunction associated with AD. To investigate this issue, we conducted a retrospective analysis of blood pressures and heart rates of 31 patients 55-85 years of age (mean 69.6) who met National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer Disease and Related Disorders Association criteria for probable AD. The patients were selected from a pool of placebo-treated patients with AD in five inpatient phase I clinical trials. All patients met rigorous entrance criteria and thus were in excellent physical health except for AD. Blood pressure and pulse were assessed after 3-5 min of lying down and after 1-3 min of standing. Systolic and diastolic blood pressures showed decreases upon standing of 12 mm Hg (8.6%) and 6 mm Hg (8.2%), respectively, on day 1 and decreases of 10 mm Hg (7.6%) and 4 mm Hg (5.7%), respectively, on day 7 of hospitalization (p < 0.05). Pulse rates increased upon standing by 17% and 13% on days 1 and 7, respectively (p < 0.05). Our data support the finding of Vitiello et al. of significant postural decreases in systolic blood pressure in patients with AD. Well-controlled, prospective studies of orthostasis in AD and healthy elderly subjects should be conducted to determine its prevalence in both populations and to determine whether the orthostatic changes seen in AD differ from those in normal aging.

Aged↗
PubMed1996

Prevalence of dementia in an urban area in taiwan.

This two-stage epidemiologic study was to investigate the prevalence and types of dementia among elderly people in the Saa-Min district of Kaohsiung City in Taiwan. In stage one, the Chinese Mini-Mental Status Examination (CMMSE) and Blessed Dementia Rating Scale were employed. In stage two, a comprehensive neurobehavioral examination and neuropsychologic tests were administered by neurologists and neuropsychologists. Dementia was defined by DSM-III-R criteria. The National Institute of Neurological and Communication Disorders and Stroke-Alzheimer's Disease and Related Disorders Association guidelines for Alzheimer's disease (AD) and the National Institute of Neurological Disorder and Stroke-Association international pour la Recherche et l'Enseignement en Neurosciences criteria for vascular dementia (VaD) were applied. A total of 1,016 randomly selected elderly people participated in phase one: 131 people with CMMSE below cutoff values participated in phase two, of whom 45 were confirmed to have a form of dementia. The prevalence of dementia in this sample was 4.4% (3.2% in men and 5.8% in women): 2.0% for those 65 to 74 years old, 8.3% for those 75 to 84 and 24.4% for those > or = 85 years old; 6.0% for those who were illiterate, 3.3% for those who attended grade-school; and 2.8% for those who finished junior-high-school. AD (22 cases, 48.9%) was the most common cause of dementia, followed by VaD (11 cases, 24.4%) and mixed dementia (MIX: 5 cases, 11.1%). Old age and being female were significant high risk factors for AD. Medical history indicated that stroke and hypertension were significant risk factors for VaD. A relatively high prevalence of dementia was observed in this study, probably because we assessed neurobehavior in great detail. Although AD was the leading cause of dementia in the present population sample. VaD and MIX also comprised an important proportion, reflecting the high prevalence of stroke in Taiwan. Older women had high risk for AD, not for VaD; and those with a history of stroke and hypertension had high risk for VaD, not for AD.

Aged↗
PubMed1997

Predicting time to nursing home care and death in individuals with Alzheimer disease.

OBJECTIVE: To develop and validate an approach that uses clinical features that can be determined in a standard patient visit to estimate the length of time before an individual patient with Alzheimer disease (AD) requires care equivalent to nursing home placement or dies. DESIGN: Prospective cohort study of 236 patients, followed up semiannually for up to 7 years. A second validation cohort of 105 patients was also followed. SETTING: Three AD research centers. PATIENTS: All patients met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable AD and had mild dementia at the initial visit. INTERVENTION: Predictive features, ascertained at the initial visit, were sex, duration of illness, age at onset, modified Mini-Mental State Examination (mMMS) score, and the presence or absence of extrapyramidal signs or psychotic features. MAIN OUTCOME MEASURES: (1) Requiring the equivalent of nursing home placement and (2) death. RESULTS: Prediction algorithms were constructed for the 2 outcomes based on Cox proportional hazard models. For each algorithm, a predictor index is calculated based on the status of each predictive feature at the initial visit. A table that specifies the number of months in which 25%, 50%, and 75% of patients with any specific predictor index value are likely to reach the end point is then consulted. Survival curves for time to need for care equivalent to nursing home placement and for time to death derived from the algorithms for selected predictor indexes fell within the 95% confidence bands of actual survival curves for patients. When the predictor variables from the initial visit for the validation cohort patients were entered into the algorithm, the predicted survival curves for time to death fell within the 95% confidence bands of actual survival curves for the patients. CONCLUSIONS: The prediction algorithms are a first but promising step toward providing specific prognoses to patients, families, and practitioners. This approach also has clear implications for the design and interpretation of clinical trials in patients with AD.

Age of Onset↗
PubMed1995

Transdisciplinary collaboration of academia and practice in the area of serious mental illness.

The Transdisciplinary Collaboration Project at San Jose State University in San Jose, California, focuses on providing high-quality services for persons with serious mental illness living in the community while preparing future mental health professionals to practise in an environment of cultural diversity and cost containment. Rehospitalization and emergency psychiatric services were decreased and community tenure increased at two board and care sites. The total cost savings for 1 year for 25 individuals was $373,830. Nursing, communication disorders, occupational therapy, social work, and therapeutic recreation students and faculty provided over 5000 hours of direct care during the 1993-95 academic years. Studies on client and student satisfaction revealed high levels of satisfaction. Unique components of the project include university organized transdisciplinary seminars for students, agency personnel and, when appropriate, residents, faculty practice, faculty led groups, employment for former clients/consumers and faculty consultation services.

California↗
PubMed1976

Objective instrumental memory and performance tests for evaluation of patients with brain damage: a search for a behavioral diagnostic tool.

Cognition and performance of patients with localized and diffuse brain damage was evaluated through the application of objective perceptual testing. A series of visual perceptual and verbal tests, memory tests, as well as reaction time tasks were administered to the patients by logic programming equipment. In order to avoid a bias due to communicative disorders, all responses were motor, and achievement was scored in terms of correct identification and latencies of response. Previously established norms based on a large sample of non-brain-damaged hospitalized patients served to standardize the performance of the brain-damaged patient since preliminary results showed that age and educational level constitute an important variable affecting performance of the control group. The achievement of brain-damaged patients, corrected for these factors, was impaired significantly in all tests with respect to both recognition and speed of performance. Lateralized effects of brain damage were not significantly demonstrated. However, when the performance was analyzed with respect to the locus of visual input, it was found that patients with right hemispheric lesions showed impairment mainly on perception of figurative material, and that this deficit was more apparent in the left visual field. Conversely, patients with left hemispheric lesions tended to show impairment on perception of visually presented verbal material when the input was delivered to the right visual field.

Adolescent↗
PubMed1997

Hear ye? Hear ye! Successful auditory aging.

Age-related hearing loss (presbycusis) is a multifactorial process that affects nearly all people in their senior years. Most cases are due to a loss of cochlear hair cell function and are well mediated by communication courtesy and modern amplification technology. Severe hearing loss is generally due to cochlear problems or age-related diseases and may require speech reading, assistive listening devices, and cochlear implants, depending on the degree of loss. Presbycusis may seriously impair communication and contribute to isolation, depression, and possibly dementia. Accurate diagnosis and prompt remediation are widely available but are frequently underused. Geriatric health care and well-being is enhanced by the detection and remediation of communication disorders.

Aged↗
PubMed1998

Hearing loss: terminology and classification. Joint Committee of the American Speech-Language-Hearing Association and the Council on Education of the Deaf.

The following position statement and technical report were developed by the Joint Committee of the American Speech-Language-Hearing Association (ASHA) and the Council on Education of the Deaf (CED) and approved as Association policy by the ASHA Legislative Council in November 1997 (LC 6-97). CED member organizations are reviewing the document for approval in 1998. Joint Committee members responsible for the development of this document include (from ASHA) Joan Marttila, chair 1996-97; Linda Seestedt-Stanford, chair 1994-95; Evelyn Cherow, ex official; Donald Goldberg; Dawna Lewis; Leslie Ann McMillian; Jane Seaton; Alicia Stewart; and Larry Higdon, vice president for professional practices in audiology and monitoring vice president; and (from CED) Kathee Christensen; Steve Nover; Marilyn Sass-Lehrer; and Patrick Stone. This document supersedes ASHA policy: Definitions of Communication Disorders and Variations: Hearing Disorders section.

Hearing Disorders↗
PubMedDate not supplied

A review of the randomized controlled trials of tacrine in the treatment of Alzheimer's disease: methodologic considerations.

This review examines the features of the 16 randomized controlled trials that have been published on the use of oral tacrine for treating probable Alzheimer's disease and explores the methodologic problems associated with these studies. Patient selection using the standard National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) criteria is now a feature of all studies; however, the specificity of the diagnosis, the severity of the dementia, the heterogeneity of the dementia with respect to disease and patient genotype, and the health status of the patients all are factors that may affect responsiveness to therapy. Most studies use crossover designs; however, because of the progressive nature of the disease and the variability in the rate of decline, parallel group studies over a length of time sufficient to produce worsening in disease severity in a placebo group appear to be most suited to detecting clinically relevant therapeutic effects. The close relation between dose, efficacy, and serious adverse events has been a problem in the tacrine trials, since many studies, titrating to maximum tolerated doses, have used clinically ineffective doses. This problem can be circumvented by the use of fixed-dose regimens. Three broad classes of outcome measures have been used to assess treatment efficacy: 1) performance-based tests of cognitive function, 2) global impressions of change on the part of the clinician or care giver, and 3) functional measures of daily living. Including a limited number of each type of measure provides strong evidence of clinically relevant therapeutic benefit; however, more widely accepted and better validated instruments need to be developed for all three areas.

Alzheimer Disease↗
PubMed1998

[Comprehensive approach to cerebral palsy: changes of concept in Japan].

Cerebral palsy is associated not merely with impairments of posture and locomotion, but also with various other problems. Medical illnesses should be treated by an adequate system. Emotional disturbances require a psychological support. Communication disorders may be overcome with proper modern equipments Perceptional deficits and sensory impairments should also be addressed. Care systems for physically handicapped children in Japan were established by the concept of ryoiku, a term in Japanese created about fifty years ago by K. Takagi, Professor of the Department of Orthopedics, University of Tokyo. This term can hardly be translated into English, bot in my view stands for a comprehensive approach comprising orthopedic treatments, educational programs and vocational trainings. Based on this concept, Dr. Takagi founded an institution for the physically handicapped in 1942; followed by establishment of similar institutions in all areas of Japan after World War II. Despite its historical role, ryoiku does not meet any more the current standard of care for cerebral palsy. We need now a new comprehensive term and management systems. A novel medical subdivision "medicine for developmental handicaps" may also be necessory. In this paper I made an overview of current problems of children and adults with cerebral palsy. I proposed a new concept of ryoiku and emphasized the need for the new medicine to treat developmental handicaps.

Adult↗