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At least 1,297 records · Page 72Linked to original sources
PubMed1996

Linguistic interaction: the active role of parents in speech therapy for cleft palate patients.

As speech and language intervention becomes more naturalistic, it seems obvious that language and other developmental competencies are, in a strong way, a function of the quality and quantity of relationships in which the child evolves. This paper compares two different speech therapy groups of cleft palate children. Children included in the first group received therapy alone with the speech pathologist, whereas children from the second group received speech therapy accompanied by their mothers. The purpose was to evaluate and provide the mothers with interaction modes for facilitating communication. Both groups were evaluated before and after the therapy period in order to measure the advance of each group. The patients accompanied by their mothers showed a significantly higher linguistic advance as compared to patients receiving therapy without their mothers. The results in this study support the statement that linguistic development in the cleft palate child is strongly related to adult-child mode of interaction.

Child, Preschool↗
PubMed1990

[Pneumocystis carinii pneumonia in HIV infections. Committee of the 1st Consensus Conference of anti-infectious therapy organized in May 1990 in Paris by the Société de Pathologie Infectieuse de Langue Française].

At the end of the first consensus conference on anti-infectious therapy organized by the French Language Society of Infectious Pathology in May 1990 and devoted to pneumocystosis in patients with human immunodeficiency virus (HIV) infection, the consensus committee produced this paper which answers the following 4 questions: what are the indications, technical requirements, sensitivity and benefits of induced expectoration in the diagnosis of Pneumocystis carinii pneumonia? what are the initial and secondary severity factors; in which cases is transfer to an intensive care unit indicated; in which manner can treatment be modified? what is the position occupied by corticosteroid therapy in the management of pneumocystosis? when is prophylaxis of pneumocystosis indicated; what prophylactic methods are used and how to choose among them?

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Therapy of speech development delay in mentally retarded children].

Twenty-one mentally retarded children participated in 40 language training sessions each that were based on behavior therapy. The training program had four levels of difficulty. The appropriate level for a given child was determined by evaluation of the child's spontaneous speech. Of the 21 children, 8 started with a 6-week waiting period. During this time they had 40 sessions of occupational therapy. The effect of the waiting period and of therapy on the children's speech was assessed by analysis of spontaneous verbal utterances and by specially constructed imitation tests. The children were tested before the waiting period and before and after therapy. Whereas the waiting period by itself had no significant effect, the therapy led to a significant increase in the mean length of utterances (in morphemes) and to highly significant improvement on the imitation tests.

Child↗
PubMed2004

The use of botulinum toxin for the treatment of gastrointestinal motility disorders.

Botulinum toxin type A is used extensively for the management of gastrointestinal smooth muscle disorders. This review is a comprehensive summary of the current status of this therapy. It includes English-language research from 1966 to 2003 and relevant abstracts from subspecialty meetings from the past 3 years. Botulinum toxin appears to be beneficial for achalasia, gastroparesis, sphincter of Oddi dysfunction, anal fissure and anismus. Very few placebo-controlled trials have been performed despite widespread use of toxin for the past 10 years. Botulinum toxin appears to be safe and side effects are uncommon. Despite uncontrolled data, botulinum toxin is now used for a variety of spastic disorders of GI smooth muscle. In some instances this therapy may preclude the need for more invasive treatments. Controlled trials are needed.

Anti-Dyskinesia Agents↗
PubMed2000

Practice guidelines for the management of patients with sporotrichosis. For the Mycoses Study Group. Infectious Diseases Society of America.

UNLABELLED: The recommendations for the treatment of sporotrichosis were derived primarily from multicenter, nonrandomized treatment trials, small retrospective series, and case reports; no randomized, comparative treatment trials have been reported. Most cases of sporotrichosis are non life-threatening localized infections of the skin and subcutaneous tissues that can be treated with oral antifungal agents. The treatment of choice for fixed cutaneous or lymphocutaneous sporotrichosis is itraconazole for 36 months. The preferred treatment for osteoarticular sporotrichosis also is itraconazole, but therapy must be continued for at least 12 months. Pulmonary sporotrichosis responds poorly to treatment. Severe infection requires treatment with amphotericin B; mild to moderate infection can be treated with itraconazole. Meningeal and disseminated forms of sporotrichosis are rare and usually require treatment with amphotericin B. AIDS patients most often have disseminated infection and require life-long suppressive therapy with itraconazole after initial use of amphotericin B. OVERVIEW: Sporotrichosis is caused by the dimorphic fungus Sporothrix schenckii, which is found throughout the world in decaying vegetation, sphagnum moss, and soil. The usual mode of infection is by cutaneous inoculation of the organism. Pulmonary and disseminated forms of infection, although uncommon, can occur when S. schenckii conidia are inhaled. Infections are most often sporadic and usually associated with trauma during the course of outdoor work. Infection can also be related to zoonotic spread from infected cats or scratches from digging animals, such as armadillos. Outbreaks have been well-described and often are traced back to activities that involved contaminated sphagnum moss, hay, or wood. Most cases of sporotrichosis are localized to the skin and subcutaneous tissues. Dissemination to osteoarticular structures and viscera is uncommon and appears to occur more often in patients who have a history of alcohol abuse or immunosuppression, especially AIDS. Spontaneous resolution of sporotrichosis is rare, and treatment is required for most patients. Although sporotrichosis localized to skin and subcutaneous tissues is readily treated, management of osteoarticular, other localized visceral, and disseminated forms of sporotrichosis is difficult. OBJECTIVE: The objective of these guidelines is to provide recommendations for the treatment of various forms of sporotrichosis. OUTCOMES: The desired outcomes of treatment include eradication of S. schenckii from tissues, resolution of symptoms and signs of active infection, and return of function of involved organs. In persons with AIDS, eradication of the organism may not be possible, but clinical resolution should be attained and subsequently maintained with suppressive antifungal therapy. EVIDENCE: The English-language literature on the treatment of sporotrichosis was reviewed. Although randomized, blinded, controlled treatment trials were sought, none were found to have been performed for the treatment of sporotrichosis. Therefore, most weight was placed on those reports that were derived from multicenter trials of specific treatment modalities for sporotrichosis. Small series from a single institution and individual case reports were accorded less importance. VALUES: The highest value was placed on clinical efficacy and the ability of the antifungal regimen to eradicate the organism, but safety, tolerability, and cost of therapy were also valued. BENEFITS AND COSTS: The benefits of successfully treating sporotrichosis accrue primarily for the patient. Because this infection is not spread from person-to-person, public health aspects of treatment are of minor importance. Most forms of sporotrichosis are not life-threatening; thus, therapy is aimed at decreasing morbidity, improving quality of life, and allowing the patient to return to occupational and familial pursuits. (ABSTRACT TRUNCATED)

AIDS-Related Opportunistic Infections↗
PubMed1992

Metabolic and anatomic thyroid emergencies: a review.

PURPOSE: To review the diagnosis and management of thyroid diseases, both metabolic (thyroid storm and myxedema coma) and anatomic (substernal goiter, lymphoma, anaplastic carcinoma) that may require intensive care therapy. DATA SOURCES: English-language articles were identified through a search of the MEDLINE and Index Medicus databases. Bibliographies of retrieved articles were examined for relevant articles. STUDY SELECTION: Approximately 250 articles were reviewed. Those articles deemed most representative were utilized. Case reports were included to highlight rare, but potentially lethal complications. DATA EXTRACTION: All data were analyzed by one observer. Limitations of the data are discussed. DATA SYNTHESIS: Guidelines for determining the etiology of thyrotoxic crisis are outlined. Criteria for distinguishing critically ill hypothyroid patients from those patients with the euthyroid sick syndrome are given. Therapy for both disorders must be aggressive and multifaceted, and detailed management is indicated. Substernal goiter is almost always benign, but may cause various acute complications, including dyspnea, respiratory failure, superior vena caval syndrome, esophageal varices (downhill), and others. Surgery almost always corrects the problem. Lymphomas present with rapid thyroid enlargement. Recent studies suggest that surgery may assume more of a supportive role, used principally to obtain adequate tissue for histologic classification. CONCLUSIONS: Thyroid disorders can produce emergencies requiring the attention of multiple medical and surgical specialists. While management is often successful, future studies should address the following three areas: a) optimization of thyroid hormone dose for treatment of myxedema coma; b) clarification of the role of radiotherapy and/or chemotherapy for thyroid lymphoma; and c) more effective therapy for anaplastic carcinoma.

Airway Obstruction↗
PubMedDate not supplied

Efficacy of multidisciplinary treatment program on long-term outcomes of individuals with Parkinson's disease.

We examined the impact of multidisciplinary clinical management of the Parkinson's Disease Research, Education, and Clinical Center program on Parkinson's disease progression. Initial and follow-up scores on the Part III Motor Examination subscale of the Unified Parkinson's Disease Rating Scale (UPDRS) were examined. Overall, 37 (75.5%) of the 49 patients demonstrated stable or improved UPDRS motor scores at 1- to 3-year follow-up; in the 1-year group (n = 28), 22 patients (78.6%) improved, while 6 (21.4%) worsened. In the 2-year group (n = 15), 10 (66.7%) improved, while 5 (33.3%) worsened. In the 3-year group (n = 6), 5 (83.3%) improved, while 1 (16.7%) worsened. Multidisciplinary interventions included neurology (95.9% of patients), physiatry (93.9%), nursing (87.8%), psychology (42.9%), medication changes (59.2% increases, 18.4% decreases), rehabilitation therapies (physical, occupational, speech-language, 67.3%), functional diagnostic testing (18.4%), support group (16.3%), home exercise instruction (85.7%), and disease and wellness education (81.6%). Improved and worsened patients did not significantly differ on the individual program components. Clinical implications and study limitations are discussed.

Aged↗
PubMed1999

Drugs and the pleura.

PURPOSE: To identify the drugs associated with pleural disease and to review the clinical, radiographic, and pleural fluid findings that occur, the natural history of the pleural reaction, and the response to therapy. DATA SOURCES: English-language articles published from January 1966 through April 1998 were identified through searches of the MEDLINE database, selective bibliographies, and personal files. DATA EXTRACTION: Case reports, letters, and review articles were assessed for relevancy. Reports of drug-associated pleural effusion, pleuritis, and/or pleural thickening were analyzed. Drug effect was believed to be causal when exposure induced pleural disease, when the pleural response remitted on discontinuation of the drug, and when the pleural disease recurred with reexposure. Drug association was inferred when the pleural disease occurred following drug exposure and remitted after drug discontinuation. The incidence, clinical presentation, dose and duration of drug therapy, chest radiographic findings, pleural fluid analysis, and response to therapy were recorded. CONCLUSIONS: A relatively small number of drugs were found to induce pleural disease when compared to the number of drugs implicated in causing disease of the lung parenchyma. Treatment of drug-induced pleural disease consists of drug therapy withdrawal and corticosteroids for refractory cases. Knowledge of the potential of drug-induced pleural disease will provide a clinical advantage to the physician and should lead to decreased morbidity and economic burden for the patient by avoidance of further diagnostic testing.

Humans↗
PubMed1994

Practitioner review: early developmental language delay: what, if anything, should the clinician do about it?

Early developmental language delay is characterized by slow development of language in preschoolers. The condition is frequent among two- and three-year-olds, causes concern among parents, and generates differences of opinion as to significance among informed professionals. Poorer long-term outcomes are much more likely if language delay persists until the later preschool years, and if the delay is not specific to language and/or includes problems in understanding. Specific language delay in the preschool period is better characterized as a risk factor than a disorder; most children with specific language delay recover to the normal range by five years of age.

Child↗
PubMed1994

Timing of baseline quality of life assessment in an international adjuvant breast cancer trial: its effect on patient self-estimation. The International Breast Cancer Study Group.

BACKGROUND: Variability in timing of baseline quality of life (QL) assessments in two ongoing International Breast Cancer Study Group (IBCSG) randomized clinical trials occurred as a result of allowing some flexibility in the timing. This retrospective report describes the QL timing in relation to surgery and start of adjuvant therapy and its effect on QL self-estimation. PATIENTS AND METHODS: Self-administered measures of baseline QL were obtained on day 1 of adjuvant therapy or as close to that date as possible from 1389 pre- and post-menopausal women with operable breast cancer. RESULTS: Fifty-four percent of QL assessments were done on day 1 of adjuvant therapy, 18% before day 1 and 28% after. An ANOVA, controlling for surgery, institution and language, showed that: for patients receiving endocrine therapy alone, QL improved as time from surgery increased, but start of adjuvant treatment had no effect, while for chemotherapy patients, appetite, physical well-being and, in pre-menopausal patients, coping were worse 1 to 5 days after the start of treatment. Chemotherapy had little effect on mood and emotional well-being. CONCLUSIONS: Timing of QL assessment in relation to diagnosis affects global adjustment measures; timing in relation to chemotherapy affects measures sensitive to toxicity. Timing is an important consideration in study conduct and data analysis.

Adult↗
PubMed1996

Atrial fibrillation: restoration and maintenance of sinus rhythm and indications for anticoagulation therapy.

PURPOSE: To review the efficacy and safety of electrical and pharmacologic conversion of atrial fibrillation, strategies for maintenance of sinus rhythm, and the importance of antithrombotic therapy. DATA SOURCES: English-language trials were identified from the MEDLINE database through 1995, bibliographic references, Current Contents, textbooks, and recent abstracts. STUDY SELECTION: Randomized trials (including abstracts) were selected. Cohort studies were used if randomized trials were not available. DATA EXTRACTION: Study design and data were extracted from clinical trials. Statistical analysis of combined data was not appropriate, given the marked variations in study designs and study populations. DATA SYNTHESIS: Cardioversion restores sinus rhythm in more than 80% of patients. In atrial fibrillation of recent onset, pharmacologic regiments have a success rate of 40% to 90%. Sinus rhythm at 1 year is maintained in 30% of patients without antiarrhythmic therapy but in 50% of patients with such therapy. The efficacy and safety of antiarrhythmic drugs relative to one another are not established because trials done to date have been small and cases vary. Successful cardioversion and maintenance of sinus rhythm are most predictable when the duration of atrial fibrillation is brief. Warfarin reduces the incidence of ischemic strokes and emboli in patients with nonvalvular atrial fibrillation from 4.5% to 1.4% per year. Aspirin (325 mg/d) appears to be equally effective in patients younger than 75 years of age who do not have hypertension or a history of thromboembolism or recent heart failure. Although warfarin is more effective than aspirin in preventing embolic strokes in patients older than 75 years of age, it may increase the incidence of hemorrhagic stroke and result in a similar rate of disabling stroke. CONCLUSION: Cardioversion remains the preferred method with which to re-establish sinus rhythm. Long-term antiarrhythmic therapy is warranted only if recurrences or initial clinical instability are seen; pro-arrhythmic concerns and potential side effects should guide drug selection. Antithrombotic therapy is indicated for all patients older than 60 years of age and in all patients younger than 60 years of age who have clinical evidence of a primary cardiac disorder.

Algorithms↗
PubMed1987

Different clinical perspectives of good and poor therapy sessions.

This study investigated differences in causal attributions made by student clinicians taking actor and observer roles in good and poor therapy sessions. One hundred thirty-four graduate student clinicians in speech-language pathology were asked to imagine a hypothetical good or poor therapy session in which they took either the role of a clinician working with a client in a session or that of a clinician observing the session. To account for the session's hypothesized outcomes, clinicians taking the actor role cited client causes more frequently than other causes while clinicians taking the observer role cited clinician causes. These results are consistent with the actor-observer bias documented extensively in the psychological and educational literatures. Clinicians' causal attributions also differed for good and poor therapy sessions. Implications are discussed in terms of possible impact on the clinical training process in speech-language pathology.

Attitude of Health Personnel↗
PubMed2006

A Java-based enterprise system architecture for implementing a continuously supported and entirely Web-based exercise solution.

Since machine-based exercise still uses local facilities, it is affected by time and place. We designed a web-based system architecture based on the Java 2 Enterprise Edition that can accomplish continuously supported machine-based exercise. In this system, exercise programs and machines are loosely coupled and dynamically integrated on the site of exercise via the Internet. We then extended the conventional health promotion model, which contains three types of players (users, exercise trainers, and manufacturers), by adding a new player: exercise program creators. Moreover, we developed a self-describing strategy to accommodate a variety of exercise programs and provide ease of use to users on the web. We illustrate our novel design with examples taken from our feasibility study on a web-based cycle ergometer exercise system. A biosignal-based workload control approach was introduced to ensure that users performed appropriate exercise alone.

Exercise Therapy↗