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PubMed2000

Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning.

Two issues concerning sensorimotor EEG operant conditioning, or biofeedback, as a therapeutic modality for the treatment of seizure disorders are the focus of this review. The first relates to the question of whether relevant physiological changes are associated with this procedure. This question is addressed through review of an extensive neurophysiological literature that is likely unfamiliar to many clinicians but that documents both immediate and sustained functional changes that are consistent with elevation of seizure thresholds. The second focuses on the clinical efficacy of this method and whether it should carry the designation of "experimental". This designation is challenged through an assessment of over 25 years of peer-reviewed research demonstrating impressive EEG and clinical results achieved with the most difficult subset of seizure patients.

Anticonvulsants↗

PubMed2004

Care of the dying adolescent: special considerations.

More than 3000 adolescents in the United States die annually from the effects of chronic illness. Providing appropriate end-of-life care for these patients is particularly challenging because of several developmental, ethical, and legal considerations relevant to this age group. Developmental issues relate to the ways in which life-threatening illness alters the normal physical and psychological changes associated with adolescence, including attainment of independence, social skills, peer acceptance, and a healthy self-image. Ethical and legal issues arise from the fact that many terminally ill adolescents <18 years of age lack ordinary legal authority to make binding medical decisions (including discontinuation of their treatment), yet they meet functional criteria for having the competence to do so. In such situations, a broad medical, ethical, and legal consensus supports giving decisional authority to the minor patient. Even when full decisional authority is not appropriate, strong moral arguments exist for taking serious account of the young adolescent's treatment preferences. In supporting the dying adolescent, an atmosphere promoting excellent communication and sound decision-making should be fostered as early as possible during preterminal care and maintained thereafter. Once palliative-care strategies become the clinical focus, psychosocial support sensitive to the adolescent's developmental stage must be provided. Using these principles, clinicians can play a crucial role in helping the adolescent, in the face of death, to experience richness of life and the dignity of self-determination.

Adolescent↗

PubMed2004

Health-related quality of life and metabolic control in children with type 1 diabetes: a prospective cohort study.

OBJECTIVE: To assess change in health-related quality of life (HRQOL) in children with diabetes over 2 years and determine its relationship to change in metabolic control. RESEARCH DESIGN AND METHODS: In 1998, parents of children aged 5-18 years attending a tertiary diabetes clinic reported their child's HRQOL using the Child Health Questionnaire PF-50. Those aged 12-18 years also self-reported their HRQOL using the analogous Child Health Questionnaire CF-80. HbA(1c) levels were recorded. In 2000, identical measures were collected for those who were aged < or =18 years and still attending the clinic. RESULTS: Of 117 eligible subjects, 83 (71%) participated. Parents reported no significant difference in children's HRQOL at baseline and follow-up. However, adolescents reported significant improvements on the Family Activities (P < 0.001), Bodily Pain (P = 0.04), and General Health Perceptions (P = 0.001) scales and worsening on the Behavior (P = 0.04) scale. HbA(1c) at baseline and follow-up were strongly correlated (r = 0.57). HbA(1c) increased significantly (mean 7.8% in 1998 vs. 8.5% in 2000; P < 0.001), with lower baseline HbA(1c) strongly predicting an increase in HbA(1c) over the 2 years (r(2) = 0.25, P < 0.001). Lower parent-reported Physical Summary and adolescent-reported Physical Functioning scores at baseline also predicted increasing HbA(1c). Poorer parent-reported Psychosocial Summary scores were related to higher HbA(1c) at both times but did not predict change in HbA(1c). CONCLUSIONS: Changes in parent and adolescent reports of HRQOL differ. Better physical functioning may protect against deteriorating HbA(1c), at least in the medium term. While the HRQOL of children with diabetes does not appear to deteriorate over time, we should not be complacent, as it is consistently poorer than that of their healthy peers.

Adolescent↗

PubMed2003

Crisis and connection.

Psychiatric interventions for crisis care lie at the center of the conflict between involuntary commitment and recovery/wellness systems in mental health services. Though crisis can mean completely different things to people who have the experience, the general public has been convinced by the media that people with psychiatric disabilities are to be feared. More and more this has led to social control but is erroneously still called treatment. This does nothing to help the person and in fact further confuses people already trying to make meaning of their experience. This paper offers a fundamental change in understanding and working with people in psychiatric crises. Rather than objectifying and naming the crisis experience in relation to illness, people can begin to explore the subjective experience of the person in crisis while offering their own subjective reality to the relationship. Out of this shared dynamic in which a greater sense of trust is built, the crisis can be an opportunity to create new meaning, and offer people mutually respectful relationships in which extreme emotional distress no longer has to be pathologized. The authors, who have had personal experience with psychiatric crises, have provided this kind of successful crisis counseling and planning and have designed and implemented peer support alternatives to psychiatric hospitalizations that support this model.

Crisis Intervention↗

PubMed1992

The NASA Specialized Center of Research and Training (NSCORT) in Gravitational Biology.

The Life Sciences Division of NASA has initiated a NASA Specialized Centers of Research and Training (NSCORT) program. Three Centers were designated in late 1990, as the culmination of an in-depth peer review analysis of proposals from universities across the nation and around the world. Kansas State University was selected as the NSCORT in Gravitational Biology. This Center is headquartered in the KSU Division of Biology and has a research, training, and outreach function that focuses on cellular and developmental biology.

Biological Science Disciplines↗

PubMed1990

Ego identity in mentally retarded adolescents.

Ego identity and the relations between ego identity and adjustment in mentally retarded adolescents were explored. Three groups were formed: 30 mildly retarded adolescents, 30 nonretarded adolescents matched for CA, and 30 nonretarded preadolescents matched for MA. Ego identity was individually assessed using a questionnaire, and social adjustment was assessed by teachers' ratings. The identity profile of the retarded adolescents differed from that of the nonretarded peers and from that of younger preadolescents. Results suggest that identity in retarded adolescents does not reflect a simple developmental lag, but rather a unique profile. Ego identity in the retarded adolescents was also related to their social adjustment and level of functioning, even after controlling for IQ.

Adaptation, Psychological↗

PubMed1989

The psychosocial adjustment of pediatric craniofacial patients after surgery.

The postsurgical psychological status of 25 craniofacial patients, 6 through 16 years of age, was studied using self, teacher, and parent report measures. In contrast to earlier reports of more positive adjustment following corrective surgery, the present study identified several concerns for craniofacial patients, including low self-esteem, impaired peer relationships, and greater dependency on significant adults. Problems were more clearly identified using projective techniques rather than self-report measures. The findings suggest that many children having craniofacial surgery should have supportive psychotherapeutic services. Variables were explored relative to psychosocial functioning. Although few significant correlations were demonstrated, positive psychological adjustment was found to be related to greater physical attractiveness, lower parental stress, and younger age.

Adolescent↗

PubMed1985

Risk factors in stroke.

In the United States, stroke accounts for 160,000 annual deaths; only 16% of the 1.8 million stroke survivors are fully independent. The incidence of stroke increases with age. Hemorrhagic strokes outnumber ischemic strokes before age 15. Japanese men in this country have a lower stroke mortality than their age peers in Japan. Excessive stroke mortality for US nonwhites may not be entirely due to the greater prevalence of hypertension among blacks. Hypertension emerges as the single most powerful and reversible risk factor in stroke and for survival after stroke. Impaired cardiac function is the second most important precursor of stroke. The recurrence of stroke in survivors is high. The frequency of completed stroke is high in persons with transient ischemic attacks, but not in those with asymptomatic carotid bruits. Other reversible risk factors are smoking, the use of oral contraceptives, alcoholic excess, a low level of physical activity, blood hyperviscosity and drug abuse.

Cerebral Hemorrhage↗

PubMed2000

Assessing social dysfunction: the contributions of laboratory and performance-based measures.

Reviewed research studies in which laboratory and performance-based measures were used with success to identify problematic social interaction patterns and social skills deficits associated with poor peer relationships. However, the clinical utility of these measures remains an empirical question. In this article, social competence is conceptualized as an organizational construct, reflecting the child's capacity to integrate behavioral, cognitive, and affective skills to adapt flexibly to diverse social contexts and demands. Correspondingly, performance-based measures of social functioning that include complex social interaction stimuli and require integrative responses appear more likely to demonstrate social validity than measures focused on isolated behaviors or cognitions. Research studies are reviewed that involve observations of children in three types of analogue social situations: play groups, friendship pairs, and social-challenge situations. In addition, studies that have utilized performance-based measures to screen and evaluate children for social skills training programs are reviewed. We conclude that performance-based measures are unlikely to be useful in determining whether a child is experiencing social dysfunction but may enhance the clinical analysis of the nature of the child's social difficulties. We identify gaps in the current knowledge regarding the clinical utility of performance-based measures of social dysfunction, along with directions for future research.

Affect↗

PubMed2005

Usability of a theory of visual attention (TVA) for parameter-based measurement of attention I: evidence from normal subjects.

The present study investigated the usability of whole and partial report of briefly displayed letter arrays as a diagnostic tool for the assessment of attentional functions. The tool is based on Bundesen's (1990, 1998, 2002; Bundesen et al., 2005) theory of visual attention (TVA), which assumes four separable attentional components: processing speed, working memory storage capacity, spatial distribution of attention, and top-down control. A number of studies (Duncan et al., 1999; Habekost & Bundesen, 2003; Peers et al., 2005) have already demonstrated the clinical relevance of these parameters. The present study was designed to examine whether (a) a shortened procedure bears sufficient accuracy and reliability, (b) whether the procedures reveal attentional constructs with clinical relevance, and (c) whether the mathematically independent parameters are also empirically independent. In a sample of 35 young healthy subjects, we found high intraparameter correlations between full- and short-length tests and sufficient internal consistencies as measured via a bootstrapping method. The clinical relevance of the TVA parameters was demonstrated by significant correlations with established clinical tests measuring similar constructs. The empirical independence of the four TVA parameters is suggested by nonsignificant or, in the case of processing speed and working memory storage capacity, only modest correlations between the parameter values.

Adult↗

PubMed1984

The pathologist as a consultant in cancer patient management: a patterns of care study in pathology.

The Committee on the Pathologist as a Consultant in Cancer Patient Management, a committee of the Cancer Committee of the College of American Pathologists, was formed in response to the demands made on pathologists by other medical specialists to function as consultants. The Committee on the Pathologist as a Consultant in Cancer Patient Management has evolved from the Patterns of Care Steering Committee (1979) which in turn was spawned by the Patterns of Care Study initiated by The American College of Radiology (ACR) in 1973. The objective of the ACR was to improve the quality of care by establishing guidelines for the best current management in radiation oncology through a consensus by peers. Pathology is concerned with establishing a diagnosis, providing a rationale for treatment, estimating prognosis, and evaluating outcome. Consequently, the CAP Patterns of Care Study assumed a different form from that of the ACR, adapting itself to the role of the pathologist as a consultant. Its objective, however, remained the same - to improve the quality of care by providing quality assurance of pathology reports dealing with cancer patients. Three task forces, one for each site, have been established. Each is composed of pathologists and other medical specialists from small and large community hospitals, universities, and private office practice. The primary function of each task force is to develop guidelines for data to be included in routine pathology consultation reports. These guidelines include parameters that document adequate examination of the specimen, and those essential elements which can be used to guide selection of therapy, estimate prognosis, and evaluate outcome, such as the pathologic factors required for staging. Data to help establish these guidelines have been obtained in consultation with medical specialists who are members of the task forces, as well as from the medical literature. This entire process will be discussed. Currently there is great concern about improving the quality of medical care, particularly in a cost effective manner. Assuring the quality of consultation reports is yet another way in which pathology can contribute.

Consultants↗

PubMed2006

Screening children with asthma for psychosocial adjustment problems: a tool for health care professionals.

OBJECTIVE: To develop a brief questionnaire for health care professionals to use in screening children with asthma for psychosocial adjustment problems. METHOD: The initial version of the Childhood Asthma Resiliency Questionnaire (CARQ) listed 85 items focusing on self-esteem, medical fears, peer relationships, family relations, stress, and depression. The number of items was reduced after focus groups and pilot testing. In pilot tests, 100 children with asthma completed the CARQ. Parents completed the Child Behavior Checklist (CBCL). Another sample of 73 children with mild asthma was also obtained. RESULTS: The total CARQ score was significantly correlated (p < 0.001) with Total Problems, Internalizing, and Externalizing Problems on the CBCL. Children with more hospitalizations and more days of school missed from asthma had significantly higher scores on the CARQ compared to children with less functional morbidity. CONCLUSION: The CARQ appears to be a useful brief measure to help clinicians identify children at risk for problems adjusting to asthma.

Absenteeism↗

PubMed2002

Efficiency of early and late Class II Division 1 treatment.

The aim of this study was to assess the efficiency of early and late Class II Division 1 treatment in the mixed and permanent dentition. Treatment efficiency was defined as a better result in a shorter treatment time. We examined 204 patients with Class II Division 1 malocclusions treated in the early mixed dentition (n = 54), late mixed dentition (n = 104), and permanent dentition (n = 46). The pretreatment and posttreatment dental casts were evaluated with the peer assessment rating (PAR) index. The duration of treatment decreased with progressing dental development: patients in the early mixed dentition (dental stage [DS] 2) were treated for 57 months, patients in the late mixed dentition (DS 3) for 33 months, and patients in the permanent dentition (DS 4) for 21 months. Patients treated exclusively with fixed appliances had a shorter treatment duration (19 months for Herbst and 24 months for multibracket) than did patients treated with functional appliances or a combination of appliances (38 months for functional appliances and 49 months for a combination). The PAR score reduction (improvement) increased with progressing dental development: DS 2 patients had a PAR score reduction of 64%, DS 3 patients had a reduction of 73%, and DS 4 patients had a reduction of 77%. Patients treated exclusively with fixed appliances had a greater PAR score reduction (77%) than did patients treated with functional appliances or a combination (60% for fixed appliances and 71% for functional or a combination). Based on the results of this investigation, we concluded that treatment of Class II Division 1 malocclusions is more efficient in the permanent dentition (late treatment) than it is in the mixed dentition (early treatment).

Age Factors↗

PubMed1993

Effects of gender and social isolation on electroencephalogram and neuroendocrine parameters in rats.

Social separation/isolation from either maternal or peer influence can induce a biobehavioral response in rodents and nonhuman primates seeming to mimic certain aspects of human psychopathology. To further explore this paradigm, the effects of 6 weeks of social isolation on electroencephalographic (EEG) recordings and hypothalamic-pituitary-adrenal (HPA) functioning were studied in male and female adult rats. Gender differences were observed in EEG and HPA axis functioning in these rats. Female rats, overall, were found to have higher levels of EEG slow-wave activity over the entire recording period, suggesting more intense levels of slow-wave sleep in those animals. Female rats were also observed to have overall higher plasma corticosterone concentrations and a lower anterior pituitary corticotropin-releasing factor (CRF) receptor density compared with male rats. The male rats, however, showed greater changes in response to social isolation than female rats. EEG power was increased as a result of social isolation in the male animals during the first 30-100 min of the recording. Reductions in the number of CRF receptors were also observed in the brains of the socially isolated rats in several cortical areas; however, again this effect was more prominent in the male animals. These studies suggest that gender is an important variable in determining the biobehavioral response to social isolation.

Animals↗

PubMed2004

The efficacy of palatal augmentation prostheses for speech and swallowing in patients undergoing glossectomy: a review of the literature.

This article provides a review of the literature to assist the clinician in determining the efficacy of palatal augmentation prosthesis regarding speech and swallowing for the patient undergoing glossectomy. A MEDLINE search was conducted. Peer-reviewed articles published from 1966 to July 2002 that addressed the question of the efficacy of this prosthesis to improve speech and swallowing after partial or total glossectomy were included. Studies reviewed had to incorporate an objective evaluation of one or both functions. Nine of 130 studies met the selection criteria (4 retrospective, 1 case control, and 4 case reports). A total of 50 subjects were studied, 42 for swallowing and 37 for speech. In 36/42 subjects, treatment was advantageous for swallowing and in 32/37 subjects, it was advantageous for speech. On the basis of the limited evidence available, the functional efficacy of the palatal augmentation prosthesis is supported.

Case-Control Studies↗

PubMed2000

Self-reported disability following distal radius fractures: the influence of hand dominance.

The purpose of this study was to record the spectrum of self-reported disability following distal radius fractures and to gauge for differences in hand dominance in the use of subjective outcome data. Items were generated through patient interviews, literature review, and peer consultation. Fifty-three items were evaluated by a group of 55 patients recovering from a fracture of the distal radius, which established the prevalence, mean severity score, and overall severity score (or impact) of each item as it related to physical function and social/emotional impact. Hand dominance, age, and gender were also recorded. The results confirm that many patients who sustain distal radius fractures experience substantial impairment across a spectrum of quality of life domains. Because patients who sustain a dominant wrist injury are likely to report greater functional impairment across a wider range of activities, they also possess a greater potential for improvement. The practical implication is that outcome studies for the treatment of distal radius fractures should take hand dominance into account.

Activities of Daily Living↗

PubMed2002

Andropause and quality of life: findings from patient focus groups and clinical experts.

OBJECTIVES: To develop a condition-specific quality of life (QoL) questionnaire to assess the symptoms of the decline in testosterone that occurs as men age, otherwise known as the andropause. METHODS: Two focus groups of patients with low testosterone levels and an expert panel of physicians in the treatment of male testosterone deficiency. RESULTS: The patient focus groups confirmed that men are unlikely to realise they have low testosterone levels until this is diagnosed and that they are unlikely to share their experiences with peers. Both patients and physicians considered decreased energy levels and impaired sexual performance had the greatest adverse impact on well-being. Patients generally felt that testosterone replacement therapy led to improved energy levels and, to a lesser extent, improved libido and erectile function. Evaluation of the responses resulted in the identification of seven key domains (energy, emotional, social, social emotional, mental functioning, physical functioning and sexual functioning) that should be considered when assessing the impact of andropause on QoL. CONCLUSIONS: Understanding the impact of low testosterone levels on QoL is critical to diagnosis and effective treatment. The use of an andropause-specific QoL questionnaire will facilitate quantification of patient experiences and may thus improve subsequent therapy.

Aged↗

PubMed2026

Nurse-led acute care post-operative interventions in adult cardiac surgery: a systematic review.

AIMS: The primary aim of this systematic review was to identify nurse-led clinical interventions evaluated in randomized controlled trials (RCTs) for adults who had undergone cardiac surgery. The secondary aim was to assess the effectiveness of these interventions on post-operative clinical and patient-reported outcomes during the acute inpatient phase. METHODS AND RESULTS: A systematic review was undertaken according to an a priori protocol using Joanna Briggs Institute (JBI) methodology and PRISMA guideline for reporting. Eligible studies were RCTs of adult (≥18 years) cardiac surgery, nurse-led inpatient interventions implemented immediately post-surgery and prior to discharge. Six databases were searched from inception to June 2025. Of 2690 records, 19 RCTs were eligible, representing 13 countries, and 3142 participants. Risk of bias varied, with only two low-risk trials. Interventions were grouped into seven domains: behavioural support; temperature management and comfort strategies; pain and symptom management; wound care; infection prevention; respiratory and pulmonary function; and post-operative recovery, mobilization, and hydration. Across these domains, nurse-led interventions were generally feasible, safe, and positively affected patient comfort, physiological stability, symptom relief, and aspects of functional recovery. CONCLUSION: Nurse-led inpatient interventions contribute meaningfully to inpatient post-operative recovery in cardiac surgery, although the broader cardiac surgical nursing scope is underrepresented in RCTs. This review provides a foundation for developing further high-quality research, peer-reviewed interdisciplinary practice guidelines, and strengthening the scope and recognition of cardiac surgical nursing as a distinct specialty. REGISTRATION: PROSPERO-CRD420251063851.

Humans↗