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PubMed1995

The core of negative symptoms in schizophrenia: affect or cognitive deficiency?

The association of negative symptoms on one hand and cognitive failures and language and thought disturbances on the other hand was examined in 25 schizophrenics and 22 neurotics over a 2-month period of intensive therapy. Psychopathological negative symptoms were more pronounced in schizophrenics than in neurotics at the first assessment before intensive therapy. However, cognitive and language performance showed no difference between the groups in both cross-sectional comparisons before and after treatment. Thus, our hypothesis that cognitive deficiencies are the core of negative symptoms could not be confirmed. It is discussed that young schizophrenics at an early stage of the illness may imply more affective components in the psychopathology of their negative syndrome than chronic schizophrenics with more pronounced cognitive deficits.

Adolescent↗
PubMed2006

Breast cancer risk reduction options: awareness, discussion, and use among women from four ethnic groups.

BACKGROUND: With recent advances in breast cancer risk reduction practices, it is increasingly important to assess both the breadth of and disparities in use across different racial/ethnic groups. METHODS: We conducted telephone interviews with 1,700 women ages 40 to 74, from four racial/ethnic groups, without prior history of breast cancer, who received mammograms at one of five mammography facilities in San Francisco. Main outcomes measured included recognition of tamoxifen, raloxifene, genetic testing, and prophylactic surgery. Global indicators (recognition of any therapy, discussion of breast cancer risk) were developed from original outcome measures and analyzed using logistic regression. RESULTS: Multivariate analyses indicate that race/ethnicity and interview language affected recognition of therapies and discussion of risk. White women were more likely than all other women to recognize any therapy and more likely than Asian-Americans to discuss risk. Women at high risk, who had a prior abnormal mammogram, who perceived themselves to be at high risk, or who were exposed to breast health information were more likely to discuss risk. CONCLUSIONS: Women are aware of preventive therapies, although discussion and use is limited. Interventions to increase use of therapies should focus on those at high risk.

Adult↗
PubMed1996

Teaching strategies for the development of clinical reasoning.

A primary aim of occupational therapy education is to teach students how to think like practitioners, that is, how to engage in clinical reasoning. Since the early 1980s, occupational therapy clinical reasoning research has elucidated a language that describes the various types of thinking therapists use in clinical practice, a language that has the potential to make previously tacit thought processes accessible to conscious examination and improvement. Occupational therapy educators can use that language to make their teaching of clinical reasoning more explicit to students. This article examines occupational therapy teaching methods using the language of clinical reasoning, categorizing them by the types of clinical reasoning they promote. Current clinical reasoning language is reviewed, and teaching strategies to facilitate the various types of clinical reasoning are described.

Decision Making↗
PubMed1990

[Language and speech disorders in preschool children and possibilities for rehabilitation--frequent ear-nose-throat findings that may be responsible for language and speech disorders].

Speech disorders in preschool children generally have to be treated by speech therapy with continuing support of the parents. Depending on the severity and cause of the disorder supplementary therapeutic interventions in specialised institutions or individual psychotherapy may be necessary in addition to speech therapy. Careful differential diagnosis before starting any specific therapy is mandatory.

Child↗
PubMed2005

Effects of antibiotic therapy on outcomes of patients with coronary artery disease: a meta-analysis of randomized controlled trials.

CONTEXT: Although Chlamydia pneumoniae infection has been associated with the initiation and progression of atherosclerosis, results of clinical trials investigating antichlamydial antibiotics as adjuncts to standard therapy in patients with coronary artery disease (CAD) have been inconsistent. OBJECTIVE: To conduct a meta-analysis of clinical trials of antichlamydial antibiotic therapy in patients with CAD. DATA SOURCES: The MEDLINE and Cochrane Central Register of Controlled Trials databases were searched from 1966 to April 2005 for English-language trials of antibiotic therapy in patients with CAD. Bibliographies of retrieved articles were searched for further studies. Presentations at major scientific meetings (2003-2004) were also reviewed. Search terms included antibacterial agents, myocardial infarction, unstable angina, and coronary arteriosclerosis. STUDY SELECTION: Eligible studies were prospective, randomized, placebo-controlled trials of antichlamydial antibiotic therapy in patients with CAD that reported all-cause mortality, myocardial infarction, or unstable angina. Of the 110 potentially relevant articles identified, 11 reports enrolling 19,217 patients were included. DATA EXTRACTION: Included studies were reviewed to determine the number of patients randomized, mean duration of follow-up, and end points. End points of interest included all-cause mortality, myocardial infarction (MI), and a combined end point of MI and unstable angina. DATA SYNTHESIS: Event rates were combined using a random-effects model. Antibiotic therapy had no impact on all-cause mortality among treated vs untreated patients (4.7% vs 4.6%; odds ratio [OR], 1.02; 95% confidence interval [CI], 0.89-1.16; P = .83), on the rates of MI (5.0% vs 5.4%; OR, 0.92; 95% CI, 0.81-1.04; P = .19), or on the combined end point of MI and unstable angina (9.2% vs 9.6%; OR, 0.91; 95% CI, 0.76-1.07; P = .25). CONCLUSION: Evidence available to date does not demonstrate an overall benefit of antibiotic therapy in reducing mortality or cardiovascular events in patients with CAD.

Angina, Unstable↗
PubMed2026

Effectiveness of Caregiver-Mediated Spoken Language Interventions for Children Under Five at Risk of Developmental Language Disorder: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Caregiver-mediated interventions are commonly used by Speech and Language Therapists to support early language development. Developmental Language Disorder (DLD) is associated with reduced quality of life throughout the lifespan. Understanding factors that predict intervention success is essential for developing appropriate, cost-effective therapy provision for the approximately 12% of preschool children who present with early markers for Developmental Language Disorder (DLD). This systematic review and meta-analysis examined the effectiveness of caregiver-mediated spoken language interventions for under-fives at risk of DLD, and factors influencing intervention effectiveness. METHODS: A systematic review following PRISMA guidelines was conducted. Five electronic databases were searched to identify experimental studies comparing caregiver-mediated spoken language interventions to control conditions in under-fives presenting with risk factors for DLD. Risk factors included prematurity, socioeconomic factors, caregiver language development concerns, and formal or informal language screening or assessment scores. Twenty-six experimental studies with 1407 child participants were included in qualitative synthesis. Meta-analysis was performed on nine Randomised Controlled Trials involving 947 children. RESULTS: Effectiveness was examined for outcomes including child language gains, child wellbeing, inclusion and attainment. Meta-analysis indicated a significant effect of caregiver-mediated spoken language interventions on language outcomes compared to treatment-as-usual, non-language intervention or waitlist control conditions. Non-language outcomes were evaluated via qualitative synthesis. Interventions significantly improved language development trajectories for under-fives presenting with risk factors or early markers for DLD. CONCLUSION AND IMPLICATIONS: This review contributes to the growing evidence base demonstrating that caregiver-mediated interventions can positively impact language development and wellbeing outcomes for children under five at risk of DLD. These findings support the implementation of caregiver-mediated environmental language interventions in clinical practice to maximise accessibility and cost-effectiveness while delivering optimal outcomes for vulnerable populations. WHAT THIS PAPER ADDS: What is already known on this subject Previous research on caregiver-mediated spoken language interventions has highlighted gaps in the evidence regarding the impact of risk factors, demographic characteristics, dosage and intervention components on child language outcomes. Developmental Language Disorder has relatively high population prevalence, estimated at 7%. Prevalence is associated with risk factors including low household socioeconomic status (SES), prematurity and late language emergence. In contrast to its prevalence, there is low public and professional awareness of DLD and a low diagnostic rate. Therefore, a strengthened evidence base and additional insights into the factors affecting success of family-based interventions is important in order to increase the effectiveness of service provision and care planning for this underserved population. Timely and effective intervention with young children presenting with early markers for DLD has the potential to offer lifelong improvement to their wellbeing, inclusion and attainment outcomes. Recent systematic reviews of the effectiveness of caregiver-mediated language interventions had differences in population age range and diagnostic inclusion criteria. What this paper adds to existing knowledge Our review examines the effectiveness of caregiver-mediated early spoken language interventions on child language, attainment and wellbeing, and on caregiver self-efficacy and adherence to language support strategies. Our population was children under five presenting with risk factors for Developmental Language Disorder, in the absence of other neurodevelopmental or genetic conditions such as intellectual disability or autism. This review adds depth and detail to the evidence base supporting the effectiveness of caregiver-mediated spoken language interventions in improving outcomes for this population of young children, and factors that influence their success. What are the potential or actual clinical implications of this work? The high prevalence of Developmental Language Disorder, estimated at around 7% of the population, and the strong association with risk factors including low SES, prematurity and late language emergence, coupled with the low awareness of DLD and low diagnostic rate, mean that a strengthened evidence base and additional insights into the factors affecting success of family-based interventions can increase the effectiveness of service provision and care planning for this population. Timely and effective intervention in this group of young children has the potential to improve wellbeing and attainment outcomes across the lifespan. This review contributes to our understanding of how to implement cost-effective, socially valid and maximally engaging partnership working with families of young children at risk for DLD.

Humans↗
PubMed1983

The effect of stimulus variation on lexical learning.

At some early stage in a child's development of the comprehension and production of language, he/she must recognize that single words correspond to referents in the environment. How to best present the critical aspects of the environment to which a verbal label is attached is not entirely known. For language-impaired children it is important to know how to highlight this relationship between linguistic and nonlinguistic cues so that therapy will be most effective. To examine how language-impaired children best learn single word lexical items, nouns and verbs were taught expressively through two modes of stimulus presentation thought to highlight the nonlinguistic environment: object manipulation and picture identification. The efficacy of these two treatment conditions was assessed with four children functioning at Piaget's sensorimotor period of development by using a single subject, alternating treatments design. The results indicated individual variation in learning strategies. Two of the children learned more single words (nouns and verbs) in the object manipulation condition. One child learned equally well in both conditions and the fourth child learned best in the picture identification condition. Variables accounting for the individual variation are discussed.

Child, Preschool↗
PubMed2006

A language programme to increase the verbal production of a child dually diagnosed with Down syndrome and autism.

BACKGROUND: The incidence of children dually diagnosed with Down syndrome and autism is estimated to be as high as 11%. There is a paucity of research investigating linguistic treatment interventions for such children. This single-subject experiment examined a programme designed to increase the language production and verbal behaviour of a 9-year-old dually diagnosed boy who had been receiving a 15-h/week home-based applied behaviour analysis (ABA) programme. METHODS: Training principles were derived from previously empirically validated research in discrete trail learning and natural environment teaching, as well as modified incidental teaching procedures. The crux of the language programme involved withholding reinforcement until a spoken request was made. RESULTS: Language production noticeably increased for each target area after the introduction of the language programme and was maintained at a 9-month follow-up session. CONCLUSIONS: A combined treatment approach incorporating direct instruction, natural environment teaching and incidental teaching can be effective in increasing and maintaining responsive and spontaneous speech in a child with Down syndrome diagnosed with autism. Replication studies are needed with such multiple dually diagnosed children to further evaluate the effectiveness and generalizability of this combined language programme.

Autistic Disorder↗
PubMed1994

Clinical research in allied health.

Allied health professionals in nutrition and medical dietetics, occupational therapy, physical therapy, and speech-language pathology and audiology play both unique and key cross-cutting roles in the furtherance of clinical research. Clinical research in nutrition and medical dietetics uniquely focuses on food nutrient intake and the metabolic utilization of nutrients. Clinical research in occupational therapy has a special focus on the relationship of impairment to disability, the adaptation to disability and the maximization of function. Physical therapy clinical research uniquely targets movement dysfunction and its evaluation and treatment within the context of quality and effective care. Clinical research in speech-language pathology and audiology is singular in its focus on deafness and hearing disorders, voice, speech, language and related disorders, and intersections among these and other neurological and physical conditions. Thus, all of these disciplines are making unique contributions to clinical research. Clinical research in these allied health professions is much more than the above specific foci. Inasmuch as these disciplines are rooted in practice, their contributions to research are inherently clinical. Many, if not most, of these contributions represent further validations of clinical practice or its underlying knowledge base. This means that, at a macro level, clinical research in allied health is very much "applied" research. Within allied health clinical research, this emphasis is redoubled at the "person," or individual level, where considerable attention is given to concepts of function and effectiveness. Clinical research in allied health has played a key cross-cutting role through its emphasis on collaboration. Possibly due to their professional maturation within multidisciplinary academic units, allied health professionals have demonstrated a level of comfort with multidisciplinary and interdisciplinary collaborations unique within many academic health science centers. While the above contributions are considerable, much more could be accomplished if identified barriers to career progression could be addressed. Principal barriers to the development of clinical research careers in allied health lie in the areas of training, mentoring, and funding. The lack of financial support for clinical research training is the major impediment. Progress in these areas, although valuable in itself, could also lead to more dedicated release time in clinical and academic settings, improved predoctoral and postdoctoral research training mechanisms, and better alignment of institutional and system reward structures with the clinical research mission. Within the existing constraints, allied health professionals have performed remarkably well in tapping into funding streams created for other disciplines and in establishing research traditions within relatively young health professions.(ABSTRACT TRUNCATED AT 400 WORDS)

Allied Health Occupations↗
PubMed2003

Which commercial thickening agent do patients prefer?

If an objective swallowing assessment reveals that a particular patient is at risk of aspirating liquids into the trachea while drinking, speech and language therapists may prescribe a commercial "thickening agent" to mix into their drinks. If used correctly, these can help to reduce the risk of aspiration. This study compared the palatability of the five main thickening agents currently available on prescription in the UK. Eight patients, three therapists, and ten therapy students blind-tested three different nonalcoholic drink flavors, thickened with each of the five thickening agents. Their perceptual rating of each of these drinks was recorded using 5-point visual analog scales. Significant differences between the visual analog scale scores for each of the thickening agents was found, independent of the drink flavor. There was no significant difference between the patient and the therapist results. By offering the more palatable thickening agents in drink flavors that patients enjoy, we would hope to improve compliance with speech and language therapy recommendations, thereby reducing the patient's risk of aspiration.

Aged↗
PubMed2006

Ventilator-associated pneumonia: what is new?

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection among patients receiving mechanical ventilation. Failure to initiate appropriate and adequate therapy (i.e., the etiologic organism is sensitive to the therapeutic agent, the dose is optimal, and the route of administration is correct) promptly in patients with VAP has been associated consistently with higher mortality rates. However, effective antimicrobial therapy for patients with true VAP can be achieved while avoiding excessive antibiotic use and the emergence of multidrug-resistant strains in the ICU. METHOD: Review of the pertinent English-language literature. RESULTS: Antimicrobial therapy for patients with VAP should follow a two-stage process. The first stage is identifying true pneumonia rapidly and starting therapy with an empirical regimen that is likely to be appropriate. In general, this requires using broad-spectrum antibiotics in all patients in whom there is a possibility that the etiologic pathogen could be difficult to treat (e.g., multi-drug-resistant pathogen). The second stage focuses on trying to achieve this objective without overusing and abusing antibiotics and combines a number of steps, such as stopping therapy in patients with a low probability of the disease, streamlining treatment once the etiologic agent is known, switching to monotherapy after three to five days, and shortening the duration of therapy to seven or eight days, as dictated by the patient's clinical response to therapy and information about the bacteriology of the infection. CONCLUSION: Although such a strategy seems a logical way to manage patients with VAP, data are still needed to determine how best to achieve this process.

Anti-Bacterial Agents↗
PubMed2003

What is the available evidence for hormone replacement therapy in women with stress urinary incontinence?

OBJECTIVE: To examine the evidence for the effectiveness of estrogen replacement therapy, with or without progesterone, for the treatment of stress urinary incontinence (SUI) in hypoestrogenic women. METHODS: MEDLINE, DARE, CINAHL, Cochrane Central Register of Controlled Trials, and EMBASE databases were searched for studies, in all languages, that used estrogen therapy, with or without progesterone, in hypoestrogenic women with SUI. The following key words were used in the search: estrogen, hormone replacement therapy, female urinary incontinence, stress urinary incontinence, and urodynamic stress incontinence. Studies that did not specify a subgroup with SUI among women with mixed incontinence were excluded. RESULTS: Of the papers included in this evaluation, 14 were non-randomized studies of estrogen treatment with or without progesterone; 6 were randomized trials of estrogen alone, combined with other treatments; 4 were placebo-controlled randomized trials, 2 of which were with progesterone; and 2 were meta-analyses. A symptomatic or clinical improvement was detected only in nonrandomized studies; randomized trials did not suggest a benefit of estrogen therapy, with or without progesterone, among postmenopausal women with SUI. CONCLUSIONS: Further research, ideally randomized placebo-controlled trials, is required to determine the risks and benefits of estrogen treatment alone in the management of SUI in postmenopausal women.

Estrogens↗
PubMedDate not supplied

Current perspectives on the management of seasonal affective disorder.

OBJECTIVE: To concisely review the etiology and current treatment modalities of seasonal affective disorder (SAD). DATA SOURCES: A MEDLINE search (1966-1999) was performed using the search term "seasonal affective disorder." The search was subsequently focused to "drug therapy" with limits of human studies and English-language papers. The search term "light therapy" was combined with "seasonal affective disorder." STUDY SELECTION AND DATA EXTRACTION: Articles discussing the epidemiology and treatment of SAD were independently examined by each author. Additional literature was reviewed from selected references identified by the original articles. DATA SYNTHESIS: SAD most likely results from a deficiency in serotonin. Light therapy remains the therapeutic intervention with the most experience and success. Selective serotonin reuptake inhibitors (SSRIs) have also shown benefit in treating the disorder. CONCLUSION: SAD is an important subtype of major depressive disorder. Clinicians should remain vigilant for signs and symptoms of the illness. Successful treatment may include light therapy or antidepressants, particularly SSRIs.

Antidepressive Agents↗