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PubMed1999

Estrogen replacement therapy and colon cancer: a clinical review.

Colorectal cancer is the third leading cause of cancer death in women. Studies on the potential protective effect of postmenopausal hormone replacement on the incidence of colon cancer have been contradictory. To attempt to clarify the potential protective effect of hormone replacement therapy (HRT), an English-language key word (KW) search of MEDLINE, up to August 1999, was performed for KW colon cancer or colorectal adenoma or colon adenoma or adenomatous polyp and KW estrogen replacement or hormone replacement. Additional references were obtained from reading of the reference lists. Thirty-five studies, including 3 meta-analyses, were found. Of these, 23 suggested any degree of protective effect of HRT, 11 reported neutral results, and 1 reported negative impact of hormone replacement. The single prospective randomized controlled trial included small numbers of inpatients taking high-dose estrogen. However, studies did not uniformly specify hormone type, dose, duration, and potential differential effects on right and left colon. Estrogen and progesterone effects were not often considered separately. Many studies had inadequate control of confounders, for example, family history of colon cancer or indication for endoscopy. Therefore, although the majority of studies, especially more rigorously designed recent studies, support the conclusion that postmenopausal estrogen replacement therapy (ERT) has a protective effect against colon adenomas and colon cancer, methodological limitations preclude practical application of study results at present. Prospective studies are needed to confirm the existence and degree of protective effect, as well as to specify the mechanism of protection.

Adenoma↗
PubMedDate not supplied

Acquired alexia in multilingual aphasia and computer-assisted treatment in both languages: issues of generalisation and transfer.

This single-subject study addresses the issue of investigation and remediation of an acquired reading impairment observed in a Spanish-English bilingual speaker. Detailed bilingual reading testing showed parallel disturbances in the two languages, both from a qualitative and a quantitative point of view, with characteristics of letter-by-letter and aphasic alexia. On the basis of this mixed pattern, common to both languages, a two-step computer-assisted remediation programme was designed for English, then for Spanish, using a crossover AB-AB design. Therapy A consisted of tasks aimed at the inhibition of letter-by-letter reading. This was alternated with therapy B, which was designed to address phonological assembly. Results on therapy reveal transfer of gains when common reading processing are involved and language-specific gains with a greater benefit on the mother tongue when phonological representations are required in therapy and assessment. Consequences for language choice in bilingual aphasia therapy are discussed on the basis of these results.

Aphasia↗
PubMed1996

Gyral morphology in the posterior Sylvian region in families affected by developmental language disorder.

This study describes the family aggregation of gyral morphology in the posterior perisylvian region in families that contain one or more children with a developmental language disorder. The probands in these families were 8 male and 2 female children referred through therapy programs and schools for children with language and reading problems. Family members included both biological parents (10 m, 10 f) and all available siblings (6 m, 4 f). Gyral morphology in the members of these families was compared with control subjects (10 m, 10 f) who were without a personal or family history of developmental language disorders. Gyral morphology was evaluated using T1-weighted sagittal scans from a GE Signa 1.5T magnet, 5 mm consecutive slices through the full brain volume. A less common type of Sylvian fissure morphology was more frequently found in the hemispheres of language-disordered subjects and their first-degree relatives than in control subjects. In addition, the pattern of Sylvian fissure morphology across generations within the families suggests that this feature might be inherited from either parent. The elevated rate of extra gyri in the posterior perisylvian region in families affected by language disorder links an anomaly within a language-related brain region with familial risk for this disorder.

Adult↗
PubMed1997

Positive talk training in an adult with traumatic brain injury.

Social skills often create a barrier to placement in less restrictive environments for persons with TBI. This case study illustrated the use of a positive talk program in the treatment of a person with long-standing social skill deficits. Occupational therapy intervention with speech-language consultation began with an evaluation of the cognitive barriers that influenced the client's social behavior. Work with the client's concrete concept formation, decreased memory, and poor generalization skills led to the development of the positive talk training program described. Through an understanding of the underlying cognitive deficits that influenced the client's behavior, the clinical team was able to develop an individual treatment plan. The intervention resulted in modification of behavior that would have required placing the client in a restricted environment. In the final analysis, the client's social skills improved to a level where he could be discharged to a less restrictive environment.

Adult↗
PubMed1986

A survey of speech and language pathology services for Down syndrome: state of the art.

This article summarizes current trends in speech and language pathology services to individuals with Down syndrome. Data was collected through the use of a questionnaire mailed to speech and language pathologists who regularly serve clients with Down syndrome. Most widely used assessment instruments, therapy materials, sources of information, and need for materials to be developed are presented as they relate to services for birth-3 year olds, 3-5 year olds, school-age-14 year olds, prevocational-18 year olds, and above-age-18 adult services. The discussion addresses specific needs for research and needed direction for evaluation and treatment with the Down syndrome population.

Adolescent↗
PubMed1996

Interaction, language and the "narrative turn" in psychotherapy and psychiatry.

The traditional emphasis in psychiatry about "listening to patients" has recently been added to by the development of what we call the "narrative turn" in mental health care where clients' narratives are emphasised. We shall argue however that both approaches tend to embody similar assumptions about therapeutic transactions and roles, and that much work emphasising narratives reveals little about how therapists and researchers work to reconstruct the clients' accounts. It is therefore vital that the emphasis on narratives be supplemented by a more thoroughgoing approach to shared structures of knowledge which act to prefigure clients' distress, how professional records are a profoundly transformative medium, and how therapeutic encounters work to co-construct clients' narratives, rather than simply reflect or explore them. The radical implications of thinking about therapy in terms of narrative and language need to be more fully discussed in the therapy literature, so the narrative turn does not simply reproduce the common-sense assumptions of more conventional approaches.

Communication↗
PubMed1998

The management of ductal carcinoma in situ (DCIS). The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Canadian Association of Radiation Oncologists.

OBJECTIVE: To help physicians and patients arrive at the most clinically effective approach to the management of ductal carcinoma in situ (DCIS). OPTIONS: Mastectomy, wide-excision breast-conserving surgery (BCS) plus radiotherapy and BCS alone. OUTCOMES: Overall survival, local recurrence, cosmesis, complications of therapy. EVIDENCE: Review of English language literature published between 1976 and December 1996; identified through MEDLINE. Nonsystematic review continued to July 1997. Also reviewed were reference lists of books and relevant articles. RECOMMENDATIONS: The first step in the diagnosis of DCIS, after history-taking and clinical examination, is a complete mammographic work-up. Once DCIS is suspected, either image-guided core biopsy or open surgical biopsy must be carried out. At surgical excision, the suspect area should be removed in 1 piece and a specimen radiograph obtained. Tissue should not be sent for frozen-section examination or hormone receptor analysis. The pathology report should address those features that bear on treatment choice. The specimen should, whenever possible, be reviewed by a pathologist experienced in breast disease. Treatment options for DCIS are mastectomy, wide-excision BCS plus radiotherapy or BCS alone. Treatment should aim to achieve a high degree of local control with the first treatment plan. Final decisions on treatment should not be made until the pathological findings have been reviewed and the specimen radiograph compared with the mammogram. Mastectomy is indicated when lesions are so large or diffuse that they cannot be completely removed without causing unacceptable cosmesis or when there is persistent involvement of the margins, especially with high-grade malignant lesions. Subcutaneous mastectomy should not be used to treat DCIS. Mastectomy should not be followed by adjuvant local radiotherapy or systemic therapy. Bilateral mastectomy is not normally indicated for patients with unilateral DCIS. BCS requires wide excision in patients with DCIS. It should be followed by mammography of the involved breast if the specimen radiograph does not clearly include all microcalcifications. BCS should normally be followed by radiotherapy. However, omission of radiotherapy may be considered when lesions are small and are low grade, and when pathological assessment shows clear margins. BCS should be accepted by patients only after they have received a careful explanation of the need for radiotherapy, its side effects and the associated logistic requirements. Axillary surgery, whether as a full or limited procedure, should not usually be performed in women with DCIS. Evidence is not available to support the use of tamoxifen in the treatment of women with DCIS. Patients should be offered the opportunity to participate in clinical trials whenever possible. VALIDATION: Guidelines were reviewed and revised by the Writing Committee, expert primary reviewers, secondary reviewers selected from all regions of Canada and by the Steering Committee. The final document reflects a consensus of all these contributors.

Breast Neoplasms↗
PubMed1996

Theory and practice in speech-language pathology: a review of systemic principles.

Linear, cause-effect reasoning has dominated the training and clinical practice of speech-language pathology for many years. Recently, however, the roles of many speech-language clinicians and the contexts in which they provide their clinical services have been changing, and traditional ways of viewing clinical work no longer seem to apply. This article applies principles of systems theory to such changes and advocates an integration of these principles with those of traditional, linear views to achieve a better understanding of this evolution in the clinical practice of speech-language pathology.

Child, Preschool↗
PubMed1998

Measuring client and carer perspectives.

Speech and language therapists (SLTs) seek to meet the needs of the clients/patients and carers attending therapy. Part of the process of providing appropriate interventions is understanding the areas which the client/patient and their carers perceive as important issues. There is a need to know their views, expectations and desired outcomes if intervention is to be effective. Since the 1980s the National Health Service has placed emphasis on the need to include the views of users of health care in assessing service delivery and the outcomes of care. This paper explores the issues concerning measuring client perceptions, existing approaches to capturing client and carer views and summarises initial work from a pilot project to develop a Client Outcome Measure.

Attitude↗
PubMed1992

Reperfusion and revascularization strategies for coronary artery disease in women.

OBJECTIVE: One third of all deaths in women in the United States each year are attributable to coronary heart disease. Gender differences exist in the course and management of patients with coronary heart disease. Few randomized trials have been conducted in women to evaluate effective therapeutic strategies. With the aim of developing rational approaches to women with coronary heart disease, we review gender-related outcomes with coronary revascularization and reperfusion therapies. DATA SOURCE: English-language journal articles and reviews on the subject of women with coronary heart disease or gender-specific responses to coronary heart disease management, from 1970 through 1992, identified through MEDLINE searching. STUDY SELECTION: Selected studies included only randomized controlled trials for topics related to thrombolysis, and articles considered to contribute significantly to the topic of women with coronary artery disease in the case of angioplasty and coronary artery bypass grafting. DATA EXTRACTION: Two reviewers participated in extracting the data with the aim of presenting a balanced and comprehensive review of the subject. DATA SYNTHESIS: Thrombolysis in acute myocardial infarction reduces mortality in men and women, although women may have a reduced mortality benefit compared with men. Angioplasty and the newer interventional devices result in greater procedural morbidity but similar if not better long-term outcomes in women. Women may have a greater mortality rate than men with coronary artery bypass surgery, although studies suggest that outcome after bypass surgery may depend more on coronary size and preoperative risk factors than on gender itself. CONCLUSIONS: The existence of gender differences in the course of coronary heart disease and response to revascularization and reperfusion strategies suggests the need for unique clinical approaches to the female patient with coronary heart disease and stresses the importance of developing randomized trials that enroll adequate numbers of women and that are designed to answer gender-specific questions.

Aged↗
PubMed1994

Recommendations for clinicians based on parents' experiences.

Three mothers of children with severe communication disabilities describe their experiences with speech-language pathologists and the intervention process. The parents were asked open-ended and descriptive questions. Their responses provide valuable insights and direction for professionals interested in working more closely with families of children with disabilities. The mothers describe their role as primary case managers for their children's treatment programs. They identify the type of speech-language pathologist they prefer to work with their child and the professional guidance they find most helpful. Several recommendations for communication disorders professionals evolved from the discussion.

Child↗
PubMed1989

Local control in rectal cancer. A clinical review and meta-analysis.

We reviewed the factors influencing local control of potentially curable rectal cancer in 106 patients. There was improvement in stage-adjusted local control associated with increasing use of adjuvant radiation therapy. A meta-analysis of the English-language literature through 1988 also supported the effectiveness of adjuvant radiation therapy in all but the lowest-risk patients. No effect on survival was identified in either analysis, but a reduction of up to 40% in local recurrence rates may be achieved with doses of 3000 cGy or more.

Humans↗
PubMed2004

Neurobiology of specific language impairment.

This review summarizes what is known about the neurobiology of specific language impairment. Despite its name, specific language impairment is frequently not specific. It is common to find associated impairments in motor skills, cognitive function, attention, and reading in children who meet criteria for specific language impairment. There is evidence that limitation in phonologic working memory may be a core deficit in specific language impairment. Both genetic and environmental factors have been shown to be important etiologic factors in specific language impairment. Structural neuroimaging studies suggest that atypical patterns of asymmetry of language cortex, white-matter abnormalities, and cortical dysplasia may be associated with specific language impairment. Abnormalities in the later stages of auditory processing have been demonstrated using auditory event-related potentials. Functional neuroimaging may cast further light on the neurobiology of specific language impairment and serve as a means of developing and evaluating therapy. A better understanding of the neurobiology of specific language impairment is critical for the rational development of therapeutic strategies to treat this common disorder.

Brain↗
PubMed1981

Language training: some data on response classes and generalization to an occupational setting.

The study was designed to investigate whether present plural uncontractible forms of auxiliary and copula (are) are members of a single response class. A mentally retarded adult female served as the subject. Within a behavior training, reversal, and reinstatement design, only the uncontractible auxiliary are was trained, reversed, and reinstated using operant training contingencies. On probes, however, sentences involving auxiliary as well as those involving copula were tested. It was found that training the uncontractible auxiliary are was sufficient to induce generalized production of the uncontractible copular are. Subsequently, when the auxiliary production was reversed, the copular production was also reversed. Finally, when the auxiliary production was reinstated, the copular production was automatically reinstated. The results suggest that auxiliary and copula are, although distinct grammatically and developmentally, belong to a single response class. The study also revealed that with the help of operant training and generalization strategies, the subject was able to use the trained features in conversational speech exhibited in her occupational setting.

Adult↗