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PubMed2002

Socioeconomic status and child development.

Socioeconomic status (SES) is one of the most widely studied constructs in the social sciences. Several ways of measuring SES have been proposed, but most include some quantification of family income, parental education, and occupational status. Research shows that SES is associated with a wide array of health, cognitive, and socioemotional outcomes in children, with effects beginning prior to birth and continuing into adulthood. A variety of mechanisms linking SES to child well-being have been proposed, with most involving differences in access to material and social resources or reactions to stress-inducing conditions by both the children themselves and their parents. For children, SES impacts well-being at multiple levels, including both family and neighborhood. Its effects are moderated by children's own characteristics, family characteristics, and external support systems.

Achievement↗
PubMed2001

Neuroscience and morality.

Humans are social animals who use specialized brain mechanisms to assess the actions of others. This system for social cognition can be studied by imaging techniques, and its damage can lead to inappropriate social and moral behavior. Neuroscience can thus enrich our understanding of behaviors traditionally thought to be outside the province of science.

Brain↗
PubMed2002

The maturing of therapy. Some brief psychotherapies help anxiety/depressive disorders but mechanisms of action are unclear.

BACKGROUND: Psychiatric therapy needs assessment regarding its maturation as a therapeutic science. AIMS: Judgement of whether such a science is emerging. METHOD: Four criteria are used: efficacy; identification of responsible treatment components; knowledge of their mechanisms of action; and elucidation of why they act only in some sufferers. RESULTS: Brief behavioural, interpersonal, cognitive, problem-solving and other psychotherapies have a mature ability to improve anxiety and depressive disorders reliably and enduringly, often only with instruction from a manual or a computer. Therapy's cost-effectiveness and acceptability deserve more attention. We know little about which treatment components produce improvement, how they do so and why they do not help all sufferers. CONCLUSIONS: Therapy is coming of age regarding efficacy for anxiety and depression, but is only a toddler regarding the scientific principles to explain its effects.

Anxiety Disorders↗
PubMed1992

Motor symptoms of the Rett syndrome: abnormal muscle tone, posture, locomotion and stereotyped movement.

Amongst the motor, mental, cognitive and emotional symptoms of the Rett syndrome (RS) the motor symptoms stand out as the hallmark in analyzing the essential pathophysiology. Summarizing the motor symptoms and searching into the knowledge of relevant basic sciences, this report aims at stressing the pathophysiological basis of RS which we have reported in previous studies. The core motor symptoms of RS consist of two aspects; firstly the unique developmental abnormalities of the discrepancy of crawling and walking and secondly the pathognomonic symptoms which include the abnormal muscle tone, posture, locomotion and stereotyped movement. The deranged crawling reflects the abnormal locomotive function. The primary responsible neuronal structures of the abnormal muscle tone, posture and locomotion are probably in the brainstem. Aberrantly formed neuronal structures responsible for voluntary movements and modulatory factors from the basal ganglia are the pathophysiological basis of the stereotyped movement of RS. Thus the neuronal structures that underlie the clinical characteristics of RS extend broadly from the motor neurons to the higher cortex, but involve the specific neuronal systems. The most important and primary of these specific neuronal systems are thought to be the monoaminergic systems, originating from the brainstem and midbrain. Abnormally deficient noradrenergic, serotonergic and dopaminergic systems result in the abnormal modulation of ontogeny and function of the higher and lower nervous systems. As we have already stressed, this unique putative pathophysiological basis could explain the very striking set of clinical symptoms of RS and their age dependent appearance despite the lack of major specific findings in neuropathology.

Female↗
PubMedDate not supplied

Learning to think like a user: using cognitive task analysis to meet today's health care design challenges.

The growing role of information technology in our society has changed the very nature of many of the tasks that workers are called on to perform. Technology has resulted in a dramatic reduction in the number of proceduralized, rote tasks that workers must face. The impact of technology on many tasks and functions has been to greatly increase demands on the cognitive skills of workers. More procedural or predictable tasks are now handled by smart machines, while workers are responsible for tasks that require inference, diagnosis, judgment, and decision making. The increase in the cognitive demands placed on workers and the redistribution of tasks have created a need for a better understanding of the cognitive components of many tasks. This need has been recognized by many in the health care domain, including the U.S. Food and Drug Administration (FDA). Recent FDA regulations encourage the use of human factors in the development of medical devices, instruments, and systems. One promising set of methods for filling this need is cognitive task analysis.

Biomedical Engineering↗
PubMed2005

Stories as data, data as stories: making sense of narrative inquiry in clinical education.

BACKGROUND: Narrative inquiry is a form of qualitative research that takes story as either its raw data or its product. Science and narrative can be seen as two kinds of knowing, reflected in the distinction between evidence-based medicine derived from population studies and narrative-based medicine focused upon the single case. A similar tension exists in the field of narrative inquiry between cognitive-orientated analytical methods and affective-orientated methods of synthesis. AIMS: This paper aims to make sense of narrative inquiry in clinical education through definition of 'narrative', articulation of a typology of narrative research approaches, and critical examination in particular of analytical methods, the dominant approach in the literature. The typology is illustrated by research examples, and the role of medical education in developing expertise in narrative inquiry is discussed. An argument is made that the tension between analysis of the structure of stories and empathic use of stories can be seen as productive, stimulating expertise encompassing both approaches. DISCUSSION: Analytical methods tend to lose the concrete story and its emotional impact to abstract categorizations, which may claim explanatory value but often remain descriptive. Stemming from discomfort with more integrative methods derived from the humanities, a science-orientated medical education may privilege analytical methods over approaches of synthesis. Medical education can redress this imbalance through attention to 'thinking with stories' to gain empathy for a patient's experience of illness. Such an approach can complement understanding of story as discourse - how narratives may be used rhetorically to manage both social interactions and identity.

Clinical Medicine↗
PubMed1989

The qualitative-quantitative dualism.

Similarities and differences between qualitative and quantitative research methods are presented; various bases for the choice of a methodology are addressed. Practical solutions to the quandaries posed by the qualitative-quantitative dichotomy are explicated, with supporting methodological examples for nursing research studies. Finally, an ontological-epistemological foundation for a human science approach to nursing research is proposed as a means of obviating the qualitative-quantitative dichotomy.

Analysis of Variance↗
PubMed1989

Ratings of surgical residents by self, supervisors and peers.

Ratings by self, supervisors and peers of surgical residents were compared and contrasted, and the correlation between these ratings and the scores on the American Board of Surgery In-Training Examination (ABSITE) were studied. In addition, comparisons were made between ratings by residents of their peers (n = 32) and of attending surgeons (n = 61) with whom they had worked. The ratings consisted of scores from 1 to 5 in each of ten areas of clinical competence. Results indicated that over-all ratings by peers and supervisors were highly intercorrelated (r = 0.92; p less than 0.001) and that the average of over-all ratings by peers and supervisors correlated moderately with the total raw score on ABSITE (r = 0.58; p less than 0.01). Factor analyses suggested that the dimensions underlying the three sets of ratings differed considerably. It appeared that ratings by supervisors were influenced primarily by the interpersonal skills of the residents and secondarily by ability. In contrast, self-ratings by the residents were apparently mainly influenced by their perceptions of their own ability, followed by interpersonal skills and effort. Ratings by peers, on the other hand, seemed to reflect the over-all impression of the peers of the resident being rated. Comparisons between ratings of peers and attending surgeons by residents revealed that residents view attending surgeons as having a more balanced level of competence, across areas of both ability and interpersonal skills. Ratings of peers were lower than were the ratings of attending physicians by the residents in the areas of technical ability, knowledge of basic science and clinical knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2001

Informational basis for expert intuition.

AIM: Intuition has been cited as an integral part of nursing clinical expertise. Responding to the recent scholarly debate over the status of expert nursing intuition as part of the art or science of nursing, this article proposes an alternative view that may provide an informational basis for what has been described phenomenologically as intuition. RATIONALE: Two reasons for the dispute over the status of nursing intuition as 'art' or 'science' are proposed: The first is methodological. The second relates to intuition's close link with perception and underlying assumptions about perception. By examining intuition through an ecological psychology framework, the problem takes on a different character, one that is no longer focused solely on the expert's cognitive (or perceptual) processes, but also on the information provided by the patient and the context of care. CONCLUSIONS: This perspective has several implications for nursing. By investigating information sources (i.e. higher order variables or constraints) in the nurse-patient encounter, the problem of intuition may be clarified, and perhaps simplified. We may find that what nurse researchers have called 'intuition' is what Gibson (1966, 1986) termed 'direct perception.' Intuition as direct perception is information-based and lawful. Finally, although some aspects of intuition may be hard-wired through evolution, intuition as direct perception can be developed through education and extensive, deliberate practice with appropriate exemplars. Characterized as direct perception, intuition is an observable, lawful phenomenon that is measurable, potentially teachable, and appropriately part of nursing science.

Art↗
PubMed2006

Personalised risk communication for informed decision making about taking screening tests.

BACKGROUND: There is a trend towards greater patient involvement in healthcare decisions. Adequate discussion of the risks and benefits associated with different choices is often required if involvement is to be genuine and effective. Achieving both the adequate involvement of consumers and informed decision making are now seen as important goals for any screening programme. Personalised risk estimates have been shown to be effective methods of risk communication in general, but the effectiveness of different strategies has not previously been examined. OBJECTIVES: To assess the effects of different types of personalised risk communication for consumers making decisions about taking screening tests. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2004), MEDLINE (1985 to December 2005), EMBASE (1985 to December 2005), CINAHL (1985 to December 2005), and PsycINFO (1989 to December 2005). Follow-up searches involved hand searching Preventive Medicine, citation searches on seven authors, and searching reference lists of articles. For the original version of this review (Edwards 2003c) we also searched CancerLit (1985 to 2001) and Science Citation Index Expanded (searched March 2002). SELECTION CRITERIA: Randomised controlled trials addressing the decision by consumers of whether or not to undergo screening, incorporating an intervention with a 'personalised risk communication element' and reporting cognitive, affective, or behavioural outcomes. A 'personalised risk communication element' is based on the individual's own risk factors for a condition (such as age or family history). It may be calculated from an individual's risk factors using formulae derived from epidemiological data, and presented as an absolute or relative risk or as a risk score, or it may be categorised into, for example, high, medium or low risk groups. It may be less detailed still, involving a listing, for example, of a consumer's risk factors as a focus for discussion and intervention. DATA COLLECTION AND ANALYSIS: Two authors independently assessed each trial for quality and extracted data. We extracted data about the nature and setting of the intervention, and relevant outcome data, along with items relating to methodological quality. We then used standard statistical methods of the Consumers and Communication Review Group to combine data using MetaView, including analysis according to different levels of detail of personalised risk communication, different condition for screening, and studies based only on high risk participants rather than people at 'average' risk. MAIN RESULTS: Twenty-two studies were included, nine of which were added in the 2006 update of this review. There was weak evidence, consistent with a small effect, that personalised risk communication (whether written, spoken or visually presented) increases uptake of screening tests (odds ratio (OR) 1.31 (random effects, 95% confidence interval (CI) 0.98 to 1.77). In three studies the interventions showed a trend towards more accurate risk perception (OR 1.65 (95% CI 0.96 to 2.81), and three other trials with heterogenous outcome measures showed improvements in knowledge with personalised risk interventions. There was little other evidence from these studies that the interventions promoted or achieved informed decision making by consumers about participation in screening. More detailed personalised risk communication may be associated with a smaller increase in uptake of tests. That is, for personalised risk communication which used and presented numerical calculations of risk, the OR for test uptake was 0.82 (95% CI 0.65 to 1.03). For risk estimates or calculations which were categorised into high, medium or low strata of risk, the OR was 1.42 (95% CI 1.07 to 1.89). For risk communication that simply listed personal risk factors the OR was 1.42 (95% CI 0.95 to 2.12). Over half of the included studies assessed interventions in the context of mammography. These studies showed similar effects to the overall dataset. The five studies examining risk communication in high risk individuals (individuals at higher risk due to, for example, a family history of breast cancer or other conditions) showed larger odds ratios for uptake of tests than the other studies (random effects OR 1.74; 95% CI 1.05 to 2.88). There were insufficient data from the included studies to report odds ratios on other key outcomes such as: intention to take tests, anxiety, satisfaction with decisions, decisional conflict, knowledge and resource use. AUTHORS' CONCLUSIONS: Personalised risk communication (as currently implemented in the included studies) may have a small effect on increasing uptake of screening tests, and there is only limited evidence that the interventions have promoted or achieved informed decision making by consumers.

Communication↗
PubMed1993

Problems in the case for psychotherapeutic integration.

The arguments in favor of therapeutic integration are summarized and evaluated. Weaknesses of the position are: (1) the false claim that all therapies are equally effective; (2) the lack of a clear and accurate specification of what makes a school of therapy "legitimate"; (3) the lack of a clear case for an accurate and comprehensive list of common elements across therapies; (4) a lack of clarity concerning "clinical strategy"; (5) the incorrect claim that cognitive therapy provides a useful and neutral meta-language; (6) inadequate evidence of trends toward integration; (7) fallacious reasoning based on these alleged trends; and (8) a misunderstanding of the history and philosophy of science.

Behavior Therapy↗
PubMedDate not supplied

Waisman Center.

The Waisman Center MRDDRC supports behavioral, social, and biomedical research on human development, developmental disabilities, and neurodegenerative diseases. Examples of research conducted in each of the four MRDDRC units include: abnormalities in gene expression in human neuronal stem cells and progenitor cells from Down syndrome tissue (from the Molecular and Genetic Sciences Unit), language disorders in adolescents with Down syndrome and Fragile X syndrome (from the Communication Processes Unit); the development of selective visual attention during the first 6 months of life (from the Sensory and Cognitive Processes Unit); and the long-range effects of early intervention on special education placement, delinquency, and high school graduation rates (from the Social and Affective Processes Unit).

Academic Medical Centers↗
PubMed1981

Behaviour therapy for the neuroses: some conceptual and practical problems.

Some problems in reconciling behaviourism as pure science with clinical behaviour therapy for complex neurotic and personality disorders are examined. A major problem is the inability of scientific behaviourism to permit motivation, will and choice to be considered from an intrapsychic perspective. Cognitive behaviour therapy and its derivatives have been developed in an attempt to overcome this problem. Although such therapies have retained a paradigmatic attachment to behaviourism, they have more in common with psychodynamic psychotherapy. Conflict among contemporary behaviourists about the relevance of cognitive theory to behaviourism has obscured more fundamental issues such as the role of the patients-therapist relationship. Both classical and cognitive behaviour therapists view a direct examination of the patient-therapist relationship as therapeutically irrelevant, although there is evidence that such a viewpoint may be anti-therapeutic in some severe neurotic disorders. Behaviourists must acknowledge the central importance of examining the patient-therapist relationship in such disorders if they are to continue their successful dialectic with psychodynamic therapists.

Attitude of Health Personnel↗
PubMed1997

Quality and liability issues with the Papanicolaou smear: lessons from the science of error prevention.

The pathologists and cytologists who study Papanicolaou smears perform a highly successful cancer screening test in a low-prevalence population. This leads to a mathematically inevitable false-negative error rate even in the most competent professional hands. The US judicial system supports a public expectation of perfect performance by civil and, recently, criminal punishment of error. Lessons are sought from a considerable industrial experience with accident prevention for possible insights into process improvement that might mitigate the risk of false-negative errors. The elements that, by system analysis, contribute to accidents are reviewed, and the conditions that enhance the accident potential are outlined. The cognitive functions and aberrations that are involved in the operator component of error analysis are described. As a result of pathologists' activities in the systematic measurement of laboratory performance for the last half century, the College of American Pathologists' accreditation program and its derivative Clinical Laboratory Improvement Act requirements have already laid out the avenues of error minimalization. There are no lessons from the science of error prevention that can affect the public expectation of zero error in a screening test and the consequent punishment of cytology professionals. A thesis is offered that the problem is society's if its goal is eradication of cervical cancer mortality. A call is made for leadership by a prestigious, nonpathologist, national organization to make the public understand that the current cytology liability issue is primarily a threat to women and the public health. To initiate public dialogue, a mechanism is suggested to protect simultaneously a patient's right of access to the judicial system and the general availability of the Papanicolaou smear to reduce cervical cancer mortality and morbidity.

Diagnostic Errors↗
PubMedDate not supplied

Non-AIDS primary CNS lymphoma: first example of a durable response in a primary brain tumor using enhanced chemotherapy delivery without cognitive loss and without radiotherapy.

PURPOSE: Radiographic tumor response and survival were evaluated in patients receiving methotrexate-based chemotherapy with osmotic blood-brain barrier disruption with or without antecedent cranial radiation. PATIENTS AND METHODS: Fifty-eight non-AIDS patients (38 males, 20 females) with histologically confirmed primary central nervous system lymphoma, primarily large cell or immunoblastic, were treated at the Oregon Health Sciences University from January 1982 through March 1992. Group 1 patients (n=19) received cranial radiation prior to referral; Group 2 (n=39) received initial blood-brain barrier disruption chemotherapy. Ages ranged from 5 to 71 years (median, 57); Karnofsky performance status was 40% to 100% on inclusion (median, 80) and all underwent extensive baseline neuropsychological evaluation. RESULTS: There was no significant difference in patient characteristics between the two groups. In 15 evaluable Group I patients, 14 demonstrated objective response and 7 of 14 (50%) achieved complete response. In Group 2, 34 of 35 evaluable patients demonstrated objective response, including 29 of 34 with complete response. Estimated median survival times for Group 1 and Group 2 patients were 16 and 41 months, respectively. Currently, 19 Group 2 patients and 2 Group 1 patients are alive. Extensive neuropsychological follow-up (up to 7 years from baseline) was completed in 23 patients, which demonstrated preservation or improved cognitive function in those receiving initial chemotherapy and blood-brain barrier disruption, most notably in patients older than 60 years. CONCLUSIONS: A plateau in survival curves suggests that a portion of primary central nervous system lymphoma patients may be cured with chemotherapy and blood-brain barrier disruption without the neurologic sequelae associated with cranial radiation.

Adolescent↗
PubMed2003

Cognitive-behavioral profiles of college risk-takers with Type II and psychopathic personality traits.

Prevention efforts would be enhanced by identification of factors that increase the greater relative risk of some college students for dangerous activities such as heavy drinking, illicit drug use, and unsafe sex. Students with Cloninger's [Science 236 (1987) 410.] "Type II" personality characteristics or with psychopathic traits were compared on indices of drinking and risk-taking, and potential mechanisms of unique behavioral patterns were explored. Freshmen (N=331, 50% male) completed self-report measures from which students with Type II and psychopathic traits were identified and compared with the remaining sample. Students with Type II traits reported heavy drinking and frequent intoxicated risk-taking, whereas students with psychopathic traits reported frequent sober risk-taking. Both groups held strong positive outcome expectancies, yet only those with Type II traits reported weak negative outcome expectancies. Moreover, negative outcome expectancies mediated the relation between Type II traits and intoxicated risk-taking. The collective findings suggest that Type II and psychopathic traits underlie differing behavioral profiles, and that students with Type II traits may take risks when intoxicated due to limited recognition of potential negative behavioral consequences.

Adolescent↗
PubMed2002

HIV-1-associated dementia: a basic science and clinical perspective.

HIV-1 associated dementia (HAD) is a metabolic encephalopathy induced by viral infection and fueled by immune activation of brain mononuclear phagocytes (perivascular and parenchymal macrophages and microglia). These same cells serve as reservoirs for persistent infection and sources for soluble neurotoxins. Neurologic impairments are manifested by cognitive, behavioral, and motor abnormalities that occur years after viral exposure and are associated with depletion of CD4+ T lymphocytes and high viral loads. Improvements in antiretroviral and adjunctive therapies have decreased HAD incidence, but cognitive dysfunction remains a cause of morbidity in many infected persons.

AIDS Dementia Complex↗
PubMed1997

Problem-based learning at the University of Southern California School of Dentistry.

Responding to the recent Institute of Medicine report on dental education, the Center for Craniofacial Molecular Biology (CCMB) of the University of Southern California School of Dentistry has developed a parallel track program in dental education leading to the D.D.S. degree. This program was proposed in May of 1995, and the first class of twelve students was admitted in September of that year. Currently two classes are enrolled and plans to admit a further twelve students (Class of 2001) are in place. The educational strategy for this program is totally problem-based. Students work in groups of six with a faculty facilitator, not necessarily a content expert. Facilitators are largely drawn from the multidisciplinary pool of research faculty at the center. All learning is mediated through biomedical and biodental problem cases. No formal lectures or classes are scheduled. The learning of clinical dental skills is promoted through focussed dental patient simulations in which students review clinical charts, radiographs, medical reports and then explore identified, hands-on learning needs using patient simulators in a clinical context. Early patient exposure is obtained through dental office visits and other special patient clinics. Initial experience with this program suggests that the problem-based learning (PBL) students learn as well (if not better) than their traditional program peers and develop excellent group and cognitive analytical skills. The absence of a pool of dentally related biomedical cases suitable for a PBL program has necessitated the use of innovative approaches to their development and presentation. It is believed that this educational approach will produce dental clinicians equipped with the self-motivated, life-long learning skills required in the ever-changing world of bio-dental sciences in the twenty-first century.

California↗