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PubMed1985

The DSM-III personality disorders. Perspectives from psychology.

Although psychiatry and psychology have shared an interest in the classification of personality throughout the history of both professions, the efforts of each have largely been independent, with little collaboration or communication. We attempt to bridge this gap by describing a number of research programs in psychology that have implications for the psychiatric diagnosis of personality disorders. We discuss in particular the prototypal model of categorization, the use of behavioral indicators, the identification of prototypic acts, the aggregation of behavior across time and situations, the dimensional model of classification, and the interpersonal circumplex.

Humans↗

PubMed1995

Corpus callosum and simple visuomotor integration.

Malcolm Jeeves was the first to demonstrate lengthened interhemispheric transmission times in subjects with agenesis of the corpus callosum by using a simple reaction time paradigm with lateralized unstructured light stimuli and crossed and uncrossed hand responses. Uncrossed responses can be integrated within one hemisphere, whereas crossed responses require a communication between the two hemispheres. In the normal brain this communication is effected rapidly by the corpus callosum, whereas in the acallosal brain it must occur much more slowly by way of less efficient alternative interhemispheric pathways. Using a similar experimental paradigm we have studied normal subjects, subjects with a complete callosal agenesis and epileptic patients with surgical callosal sections, either complete or partial. All subjects with complete callosal defects showed much lengthened interhemispheric times compared to normal controls. Virtually normal interhemispheric transmission times were found in subjects with partial callosal defects, whether anterior or posterior, suggesting a possible equipotentiality of different portions of the corpus callosum in the mediation of crossed manual responses. In both normals and acallosals there were no crossed-uncrossed differences in reaction time when responses were made unilaterally with lower limb effectors or para-axial upper limb effectors, as well as bilaterally with upper-limb proximal and para-axial effectors. Since these effectors can be controlled directly from either side of the brain via bilaterally distributed motor pathways, crossed responses using them, unlike crossed manual responses, do not require an interhemispheric integration.

Animals↗

PubMed2006

Accuracy of digital and analogue cephalometric measurements assessed with the sandwich technique.

INTRODUCTION: The purpose of the study was to evaluate the accuracy of cephalometric measurements obtained with digital tracing software compared with equivalent hand-traced measurements. In the sandwich technique, a storage phosphor plate and a conventional radiographic film are placed in the same cassette and exposed simultaneously. The method eliminates positioning errors and potential differences associated with multiple radiographic exposures that affected previous studies. It was used to ensure the equivalence of the digital images to the hard copy radiographs. Cephalometric measurements instead of landmarks were the focus of this investigation in order to acquire data with direct clinical applications. METHODS: The sample consisted of digital and analog radiographic images from 47 patients after orthodontic treatment. Nine cephalometric landmarks were identified and 13 measurements calculated by 1 operator, both manually and with digital tracing software. Measurement error was assessed for each method by duplicating measurements of 25 randomly selected radiographs and by using Pearson's correlation coefficient. A paired t test was used to detect differences between the manual and digital methods. RESULTS: An overall greater variability in the digital cephalometric measurements was found. Differences between the 2 methods for SNA, ANB, S-Go:N-Me, U1/L1, L1-GoGn, and N-ANS:ANS-Me were statistically significant (P < .05). However, only the U1/L1 and S-Go:N-Me measurements showed differences greater than 2 SE (P < .0001). CONCLUSIONS: The 2 tracing methods provide similar clinical results; therefore, efficient digital cephalometric software can be reliably chosen as a routine diagnostic tool. The user-friendly sandwich technique was effective as an option for interoffice communications.

Adolescent↗

PubMed2006

Disseminating evidence-based practices in substance abuse treatment: a review with suggestions.

Although substance abuse professionals are generally open to new and better therapeutic methods, most evidence-based treatments do not easily find their way into practice. Natural diffusion processes for innovations in substance abuse treatments are relatively informal and have yielded a widely acknowledged gap between science and community practice. This review focuses on methods for effectively disseminating new treatment methods into practice. Therapist manuals and one-time workshops are in themselves relatively ineffective in helping practitioners gain proficiency in new clinical approaches. Individual performance feedback and coaching improve the acquisition of clinical skills. Specific incentives for implementation may also be needed to encourage treatment providers, programs, and systems to adopt new approaches.

Behavior Therapy↗

PubMed2001

Planning of a community-based approach to injury control and safety promotion in a rural community.

This paper describes the planning of a community-based approach to injury control and safety promotion, the Kolan Injury Prevention Program. The process involved the establishment of a local steering committee, 11 months of injury surveillance, a critical review of the evidence base, community consultations and assessment of community resources. There were 412 recorded injury cases during the surveillance period, with higher rates among men, manual workers, those aged 15-34 years, sport/leisure activities and around the home and farm. Salient issues for residents included a lack of access to safety information and skills, particularly with regard to first aid and bush fire for isolated residents and rurally inexperienced new residents. While injury prevention was identified as an important issue for the community, the rapidly changing size and nature of the community and its infrastructure made this a particularly challenging issue. Challenges included limited availability of volunteers from key sectors, lack of formal data collection systems, difficulties in mobilising support for a broad issue like injury, limited communication networks and the negative impact of distance and role uncertainty on community ownership of the program. This case study illustrates the steps involved in an effective community-based needs assessment addressing injury prevention. Such an approach, if carried out systematically, will help ensure that the strategies and programs developed will be both appropriate and likely to obtain the support of the local community.

Adolescent↗

PubMed1999

Autism and autistic behavior in Joubert syndrome.

To determine whether individuals with Joubert syndrome exhibit features of autism as defined by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), we examined 11 children with Joubert syndrome using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule-Generic. Three children met DSM-IV criteria for autistic disorder and one for pervasive developmental disorder not otherwise specified. The other seven all demonstrated at least one DSM-IV symptom of autism, but did not meet criteria for a pervasive developmental disorder. Both total number of DSM-IV symptoms and number of social symptoms distinguished the autism and nonautism subgroups. In contrast, the two subgroups displayed similar levels of communication impairments and repetitive or stereotyped behavior. The key to diagnosing autism in Joubert syndrome is to focus on social behaviors, particularly milestones typically achieved very early in life (eg, attending to human voices, showing objects of interest, enjoyment of social interactions). Implications for the role of the cerebellum in nonmotor behavior and for clinical management of Joubert syndrome also are discussed.

Adolescent↗

PubMed1998

A systematic review of the literature on patient priorities for general practice care. Part 1: Description of the research domain.

To make health care more responsive to patient needs, insight into patient priorities is needed. A systematic literature review, using electronic and manual searches, was made of studies on patient priorities with regard to primary health care. Data-extraction was performed by two researchers, followed by systematic analyses of study features. 57 studies were included. The aspects of care and methods used showed a wide variation. Aspects most often included were "informativeness", "humaneness" and "competence/accuracy". Based on an analysis of 19 studies, the following aspects were seen by patients as most important in more than 50% of the studies that included them: "humaneness", "competence/accuracy", "patients' involvement in decisions", "time for care", "other aspects of availability/accessibility", "informativeness", "exploring patients' needs", "other aspects of relation and communication" and "availability of special services".

Adult↗

PubMed2003

An Australian Aboriginal birth cohort: a unique resource for a life course study of an Indigenous population. A study protocol.

BACKGROUND: The global rise of Type 2 diabetes and its complications has drawn attention to the burden of non-communicable diseases on populations undergoing epidemiological transition. The life course approach of a birth cohort has the potential to increase our understanding of the development of these chronic diseases. In 1987 we sought to establish an Australian Indigenous birth cohort to be used as a resource for descriptive and analytical studies with particular attention on non-communicable diseases. The focus of this report is the methodology of recruiting and following-up an Aboriginal birth cohort of mobile subjects belonging to diverse cultural and language groups living in a large sparsely populated area in the Top End of the Northern Territory of Australia. METHODS: A prospective longitudinal study of Aboriginal singletons born at the Royal Darwin Hospital 1987-1990, with second wave cross-sectional follow-up examination of subjects 1998-2001 in over 70 different locations. A multiphase protocol was used to locate and collect data on 686 subjects with different approaches for urban and rural children. Manual chart audits, faxes to remote communities, death registries and a full time subject locator with past experience of Aboriginal communities were all used. DISCUSSION: The successful recruitment of 686 Indigenous subjects followed up 14 years later with vital status determined for 95% of subjects and examination of 86% shows an Indigenous birth cohort can be established in an environment with geographic, cultural and climatic challenges. The high rates of recruitment and follow up indicate there were effective strategies of follow-up in a supportive population.

Journal Article↗

PubMed2005

Prevalence and correlates of anxiety among nursing home patients.

BACKGROUND: Very little is known about the prevalence and correlates of anxiety among nursing home patients. The current knowledge is predominantly based on information from population-based studies among elderly. METHODS: Prevalence of anxiety was measured with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) in a sample of 333 nursing home patients of somatic wards of 14 nursing homes in the Netherlands. Participants were over 55 years, had a MMSE-score >14 and were able to communicate sufficiently. Information about demographic, health-related, psychosocial and care-related characteristics was collected in interviews with participants and from attending physicians and nursing home staff. RESULTS: The prevalence of anxiety disorders was 5.7%, of subthreshold anxiety disorders 4.2% and of anxiety symptoms 29.7%. Only health-related characteristics (MMSE-score >23, depression, stroke) were significantly associated with anxiety disorders and subthreshold anxiety disorders. Demographic (>6 years education), health-related (depression, impaired vision, pain) and psychosocial characteristics (a recent negative life event) were significantly associated with anxiety symptoms. No care-related characteristics were associated with anxiety. LIMITATIONS: The study population is a selective one (>55 years, MMSE >15, able to communicate sufficiently). The data were collected cross-sectionally. CONCLUSIONS: Anxiety disorders and anxiety symptoms occur frequently among nursing home patients and are mainly associated with health-related characteristics. Physicians should focus special attention on patients with depression or stroke.

Aged↗

PubMed1987

[The crisis in psychiatric diagnosis].

The validity of psychiatric diagnosis has been in doubt recently, partly because of its unreliability and partly also as a result of sociopolitical and antipsychiatric trends. Psychiatrists rallied to meet this challenge by developing modern systems of classification. However, these were evolved with a purely descriptive intent and thus became part and parcel of "biological psychiatry". At first, the new classification systems offered the great advantage of making scientific communication easier, but they have been the target of renewed criticism because of problems such as different competing classifications, restriction of characteristic parameters to purely empirical observations, and neglect of clinically important criteria. Although diagnoses are now much more easily classified and rechecked, the development of diagnostic tools seems to have reached a limit requiring a revalidation and reconsideration of the psychopathological fundamentals of psychiatric diagnostics.

Humans↗

PubMed2007

Mental ill-health in adults with intellectual disabilities: prevalence and associated factors.

BACKGROUND: Reported prevalence of mental ill-health among adults with intellectual disabilities ranges from 7 to 97%, owing to methodological limitations. Little is known about associations. AIMS: To determine the prevalence of mental ill-health in adults with intellectual disabilities and to investigate factors independently associated with it. METHOD: Population-based study (n=1023) with comprehensive individual assessments modelled using regression analyses. RESULTS: Point prevalence of mental ill-health was 40.9% (clinical diagnoses), 35.2% (DC-LD), 16.6% (ICD-10-DCR) and 15.7% (DSM-IV-TR). The most prevalent type was problem behaviours. Mental ill-health was associated with more life events, female gender, type of support, lower ability, more consultations, smoking, incontinence, not having severe physical disabilities and not having immobility; it was not associated with deprived areas, no occupation, communication impairment, epilepsy, hearing impairment or previous institutional residence. CONCLUSIONS: This investigation informs further longitudinal study, and development of appropriate interventions, public health strategy and policy. ICD-10-DCR and DSM-IV-TR undercount mental ill-health in this population compared with DC-LD.

Adolescent↗

PubMedDate not supplied

Patient care automation: the future is now. Part 3. The five rules of automation.

Five key principles for creating effective operations optimization-based patient care automation have now been established: (a) The old system architectures did not provide operations optimization; (b) primary patient care optimization (nurses and doctors) must be the central focus of any effective system; (c) the system must provide a platform that allows for eliminating both the retrospective and prospective (subterranean) paper records; (d) point-of-care data capture, including at the bedside, must be provided; and (e) integration around the patient is critical to success. Systems that ignore these principles will ultimately be doomed to repeat the problems of the manual system. Adherence to these principles opens a myriad of possibilities and provides a road map for how such a system should function. The next installment in this series of articles will address the ramifications of integration in system design and system use. The positive effects that such system designs can have on the realization of demonstrable benefits from system technology will also be reviewed.

Computer Communication Networks↗

PubMed1989

The role of microcomputers in electronic health claims processing.

This article explores the state-of-the-art in electronic health claims processing. Beginning with an examination of the step-by-step manual process, it moves on to explore the current use of microcomputers to both speed up the processing, and to improve the accuracy and completeness of claim submission. The article also examines some of the benefits cited by microcomputer claims systems users, and it concludes with a look at what features could be incorporated in the future to create a fully electronic claims processing environment.

Computer Communication Networks↗

PubMed1994

A computerized dispatch system that really delivers.

In 1990, Victoria Hospital in London, Ontario undertook a review of its Central Portering Department. The department's name was changed to Distribution Services and its need for more efficient servicing of customers led to the search for a computer system to replace the manual dispatch operation. After failing to find an existing system, the hospital contracted to develop its own system, called Vic Tracker. The system categorizes and prioritizes requests and produces various activity reports. Response time has improved 50% on average, and improved efficiency and a pre-booking feature has resulted in a decrease of approximately 100 calls per day.

Computer Systems↗

PubMed2000

Structure and content of 400 CT reports in four teaching hospitals using a new, Windows-based software tool.

PURPOSE: To test a new software tool developed for analysis of radiology reports and to compare CT reports from four different teaching hospitals. MATERIAL AND METHODS: Four hundred CT reports were randomly collected from four Finnish university hospitals. A Windows 3.1-based software tool was developed to make a comparative analysis of the information content of CT reports. The structure of the reports was partly analyzed manually. RESULTS: The new software tool greatly facilitated semiquantitative analysis of the information content of residents' and radiologists' reports. There were some local differences in the length and structure of the reports, the choice of vocabulary and the number of differential diagnoses given, and large differences in the use of an "impression" section. Thorough description of focal lesions was included in less than 50% of the reports from each of the four institutions. CONCLUSION: The variation in well-structured CT reports indicates considerable geographic differences in radiology reporting, which may reflect the long-term influences of a few teachers. Rational application of the communication standards should improve the quality of written radiology reports. Such standards should be emphasized, particularly in teaching hospitals.

Hospitals, Teaching↗

PubMed1996

Half a century with scientific medical information in Czechoslovakia.

The author reviews his participation in the development of scientific medical information in the former Czechoslovakia, beginning with the classical methods using the Universal Decimal Classification, through the development of the method of manual peek-a-boo punched cards, till the experimental and routine use of the first commercially available National Elliott 8O3B and Minsk-22 computers (Index Radiohygienicus with a KWIC index). Simultaneously he founded and managed the Information Center for Radiation Protection, and later the Information Center of the Institute of Hygiene and Epidemiology. Then he was charged with the projection and methodological guidance of the system of libraries and information centers in the Czech health institutions. In his theoretical and experimental research the author was interested in the feasibility of algorithms for the selection of keywords from scientific texts, in the modelling of the communication of medical scientific information in Czechoslovak conditions, and in extensive statistical studies of the relation between information supply to authors and their citation behavior and citedness. Practical measures for overcoming information barriers were suggested. All results of these activities were published in more than 100 papers and research reports, half of which are cited in References.

Czechoslovakia↗

PubMed2005

Knox's cube imitation test: a historical review and an experimental analysis.

The cube imitation test was developed by as a nonverbal test of intelligence. Many variants show satisfactory reliability, but performance is correlated both with Verbal IQ and with Performance IQ. Performance is impaired by cerebral lesions but unrelated to the side of lesion. Examinees describe both verbal and visuospatial strategies. In a new experiment, performance was disrupted by concurrent random generation, manual tapping, and articulatory suppression. The cube imitation test is not simply a measure of the ability to retain visuospatial information but also depends on verbal representations as well as attentional capacity. Even so, the test was central to the modern appreciation that any adequate measure of intelligence must incorporate both verbal tests and performance tests.

History, 20th Century↗

PubMedDate not supplied

The ABCs of DME: a home care durable medical equipment/home oxygen program.

With the evolution of high-tech healthcare in the home setting, patients and families now need to learn the skills to perform the tasks that previously were done in hospital settings by health professionals. Numerous private and federally funded home health organizations are offering services to this patient population. The mission of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is to improve the quality of care provided to the public (JCAHO, 1991b). In 1988, the commission implemented standards for the accreditation of home care and began to survey home care providers (JCAHO, 1988). Standards governing the provision of durable medical equipment are included in the JCAHO Accreditation Manual for Home Care (1991a). The article describes an effective collaborative approach used to develop a comprehensive durable medical equipment/home oxygen (DME/home O2) program at the Department of Veterans Affairs Medical Center (DVAMC), now called the Veterans Health Administration Medical Center, in East Orange, NJ. Project management principles were used by the quality management (QM) staff to develop and implement the DME/home O2 program successfully.

Communication↗