Epidemiology of delirium: an overview of research issues and findings.

This paper provides a review of research issues and findings on the epidemiology of delirium. Despite the fact that research on this important geriatric syndrome has been conducted for many decades, several methodological issues make it difficult to compare findings across studies. In this paper we first discuss broadly methodological issues related to diagnosis, case-finding, and populations studied. We next review data on the occurrence and consequences of the syndrome. A discussion of the design and preliminary results of the Commonwealth-Harvard Study of Delirium in Elderly Hospitalized Patients documents both how we responded to the methodological issues outlined and how these choices influenced our findings. We conclude with a discussion of the needs for further research on the epidemiology of delirium.     

Effectiveness of staff training programs for behavioral problems among older people with dementia

This paper reviewed studies on staff training programs to address the behavioral problems associated with dementia among older people in residential care. The papers were classified according to whether or not the studies included a control group in the research design. The results of the review demonstrate that there has been a wide range of psychosocial and educational interventions to reduce behavioral problems among older people with dementia, with inconsistent results being obtained. However, many of these studies suffer from problems in their research design that make it difficult to evaluate their effectiveness. Problems in conducting research in the nursing home setting are highlighted, and suggestions for future research in this area are discussed.     

Critical appraisal of neuroprotection trials in head injury: What have we learned?

To date, despite very encouraging preclinical results, almost all phase II/III clinical neuroprotection trials in traumatic brain injury (TBI) have failed to show any consistent improvement in outcome for TBI patients. To understand the reasons behind such developments we need to review and evaluate the evolution of trial design as a result of our changing understanding of the pathophysiology of brain cell death and progress of translational research from the laboratory bench to the bedside. This paper attempts to critically appraise these neuroprotection trials, rationalize the paucity of effectiveness, review any recent developments in the field, and try to draw some conclusions on how to move forward.     

A systematic review of nursing home research in three psychiatric journals: 1966–1985

This article presents the results of a systematic review of two decades of research on nursing home populations in three major psychiatric journals. The review indicates that very little psychiatric research has been undertaken in nursing home settings. The work that has been done is more often qualitative: case studies, program reports or reviews of the research, rather than quantitative research studies. The small amount of empirical research that has been published has suffered from sampling, design, and analytic shortcomings. Until recently, there has been little funded psychiatric research in nursing home setting, reflected in a worse than average disapproval rate for NIMH grant submissions involving nursing home populations. The implications of this review are discussed and recommendations are made for advancing this area of study among mental health professionals.     

RT and non-RT methodology for semantic priming research with Alzheimer's disease patients: a critical review

This paper provides a critical review of RT and non-RT methodology for the conduct of research on semantic priming in Alzheimer's disease (AD) compared to elderly normal (EN) individuals. The review is organized by type of semantic priming (or attribute-knowledge) paradigm. Theoretical as well as methodological issues are highlighted insofar as they are relevant to: (1) the design, conduct, and analysis of semantic priming experiments (and closely related types of experiments) with AD compared to EN participants, and (2) the interpretation of findings from these experiments. Recommendations are provided for further research involving semantic priming and related paradigms with AD and certain other neuropsychological populations.     

The biological and behavioral basis of upper limb asymmetries in sensorimotor performance

Asymmetries in upper limb performance are a fundamental aspect of human behavior. This phenomenon, commonly known as handedness, has inspired a great deal of research over the course of the past century garnering interest across a multitude of scientific domains. In the present paper, a thorough review of this literature is provided focusing on the current state of knowledge regarding neuro-anatomical and behavior-based arm asymmetries. It is hoped that this information will provide a basis for new insights regarding the design and implementation of future studies regarding arm laterality.     

RT and Non-RT Methodology for Semantic Priming Research With Alzheimer's Disease Patients: A Critical Review

This paper provides a critical review of RT and non-RT methodology for the conduct of research on semantic priming in Alzheimer's disease (AD) compared to elderly normal (EN) individuals. The review is organized by type of semantic priming (or attribute-knowledge) paradigm. Theoretical as well as methodological issues are highlighted insofar as they are relevant to: (1) the design, conduct, and analysis of semantic priming experiments (and closely related types of experiments) with AD compared to EN participants, and (2) the interpretation of findings from these experiments. Recommendations are provided for further research involving semantic priming and related paradigms with AD and certain other neuropsychological populations.     

Is shortened sleep duration a risk factor for overweight and obesity during adolescence? A review of the empirical literature

This paper reviews 15 adolescent (10-19 yrs) studies that have directly investigated the effects of shortened sleep duration on overweight and obesity. The research studies included in this review inconsistently found significant effects between shortened sleep duration and weight status. This heterogeneity in study findings largely resulted from variability in study design, gender, and the method used to measure sleep duration. Consequently, due to the conflicting research findings, it remains inconclusive as to whether shortened sleep is a risk factor for overweight or obesity during adolescence. This review also identified methodological limitations within the literature and presented alternative methodologies for future research. First, sleep duration measures were identified that had questionable reliability and were possibly less accurate than other recommended sleep measurements. Second, 92% of cross-sectional studies found a significant relationship, yet 0% of prospective studies did. Third, the vast majority of studies neglected to statistically adjust for co-contributions from depression, and approximately half of the studies considered the role of physical activity. Recommendations for future research directions are presented which may help to clarify the conflicting findings and address the methodological concerns identified within this topical area.     

癫痫持续状态预后评分进展

癫痫持续状态具有较高的死亡率,是神经内科常见的危急重症。对患者预后风险进行评 估,对其病情严重程度进行准确分级将有助于临床医师制定个体化的治疗方案,最大限度地使癫痫 持续状态患者获益。目前国际上共有4个癫痫持续状态预后风险的评分：癫痫持续状态严重程度评 分（status epilepticus severity score,STESS）、基于流行病学死亡率的癫痫持续状态评分（epidemiology based mortality score in SE,EMSE）、改良癫痫持续状态严重程度评分（modified STESS,mSTESS）以 及END-IT评分[包括脑炎与否（Encephalitis）、是否合并非惊厥性癫痫持续状态（Nonconvulsive status epilepticus,NCSE）、是否有地西泮抵抗（Diazepam resistance）、神经影像学特征（Image）以及是否进行 气管插管（Tracheal intubation）]。本文回顾了癫痫持续状态预后评分的进展,简述了每个评分的建立 过程及其优势和局限性,以期增强临床医师对癫痫持续状态预后评分的认识、裨益临床研究。     

Regional neuropathology in schizophrenia: Where are we? Where are we going?

This paper presents a neurologic formulation for the clinical features of the schizophrenic syndrome, and tests it against a systematic, region by region review of available postmortem neuroanatomical and neuropharmacological data. Based on this review a model is proposed that postulates a developmental lesion affecting the midline neurotransmitter-specific ascending projection systems. Due to the facilitatory role these systems play in the development of the brain regions to which they project, such a lesion is one parsimonious, and testable, explanation for virtually all the clinical, laboratory, and pathological findings reported to date in schizophrenia research. A case is made for establishing a global antemortem–postmortem collaboration using a Latin square design; the alternative may be that, as has happened in the past, the best efforts of dilligent researchers around the world may lead to little improvement in our understanding of schizophrenia.     

Single‐subject research designs in pediatric rehabilitation: a valuable step towards knowledge translation

Knowledge translation may be particularly challenging in pediatric rehabilitation, where study findings are often ambiguous owing to low statistical power or inconsistent responses to intervention. Disconnection between research protocols and clinical practicality, as well as variability of responsiveness in heterogeneous pediatric populations, may further impede integration of research findings into everyday practice. Use of single‐subject research designs (SSRDs) may bridge the gap between research and practice, with robust design options that better identify and preserve patterns of responsiveness to specific interventions and offer protocols that are more readily implemented in practice settings than can be done in traditional randomized controlled trials. This review defines SSRD, provides examples of research questions that can be answered using SSRD, details the experimental designs that can be used and the level of evidence of each design, and describes statistical analysis approaches and clinical application. This analysis will aid researchers, reviewers, clinicians, and others in better understanding SSRD methodology and its application in everyday practice.     

Methodological challenges in meditation research

Like other complex, multifaceted interventions in medicine, meditation represents a mixture of specific and not-so-specific elements of therapy. However, meditation is somewhat unique in that it is difficult to standardize, quantify, and authenticate for a given sample of research subjects. Thus, it is often challenging to discern its specific effects in order to satisfy the scientific method of causal inferences that underlies evidence-based medicine. Therefore, it is important to consider the key methodological challenges that affect both the design and analysis of meditation research. The goal of this paper is to review those challenges and to offer some practical solutions. Among the challenges discussed are the mismatches between questions and designs, the variability in meditation types, problems associated with meditation implementation, individual differences across meditators, and the impossibility of double-blind, placebo-controlled meditation studies. Among the design solutions offered are aptitude x treatment interaction (ATI) research, mixed quantitative-qualitative methods, and practical (pragmatic) clinical trials. Similar issues and solutions can be applied more generally to the entire domain of mind-body therapies.     

正念疗法在癌症患者治疗中的应用

本文目的是对正念治疗在癌症患者中的应用和效果进行综述,以期为正念治疗在癌症患者中的临床应用和研究提供参考。本文介绍了应用于癌症辅助治疗的正念治疗种类以及其机制和作用,并总结当前研究存在的不足,以期为后续研究提供参考。     

Representative payeeship and mental illness: a review

Representative Payeeship (RP) is intended to help individuals who are unable to manage disability payments appropriately to meet their basic living needs. This paper reviews the literature on whether RP is effective among individuals with mental disorders. We also review RP's mental health effects and its use as leverage in achieving behavioral goals. RP appears to be effective in helping clients meet their basic living needs; it also may decrease hospitalization and improve treatment compliance. Finally, we propose a research design to disentangle the role of clinical leverage from the more basic money-management function of RP.     

The measurement of puberty: a review

This paper has two main objectives. Firstly, to review the feasibility and validity of the various methods that have been used to measure puberty. With an appreciation of these measurement issues, the second objective is to summarize the evidence-base as to whether the age at menarche and the age at onset of puberty has decreased in recent years. In consideration of these methodologies, all of which report different levels of reliability and validity, it is only possible at present to draw inferences about possible changes in pubertal age and onset. Moreover, the wide variations in sample size, selection of participants (usually non-random), and study design reported in the reviewed studies have compounded this situation further. The paper closes by providing a summary of the findings which will be of relevance to those intending to critically review the current evidence surrounding age of puberty, as well as those set on carrying out future research into this area.     

Human factors and environmental support in Alzheimer's disease

Cognitive aging research suggests that environmental support can minimize memory failures in older adults. Similarly, designers of dwellings for frail and dementing older populations try to provide prosthetic environments to support greater independence. We review some of these research issues and design practices from a human factors perspective. Early in the disease process training approaches may be most effective, whereas later on there will need to be more reliance on effective design. We also suggest a framework for optimizing design across stakeholders and discuss some public policy issues.     

Design Elements in Implementation Research: A Structured Review of Child Welfare and Child Mental Health Studies

Implementation science is an emerging field of research with considerable penetration in physical medicine and less in the fields of mental health and social services. There remains a lack of consensus on methodological approaches to the study of implementation processes and tests of implementation strategies. This paper addresses the need for methods development through a structured review that describes design elements in nine studies testing implementation strategies for evidence-based interventions addressing mental health problems of children in child welfare and child mental health settings. Randomized trial designs were dominant with considerable use of mixed method designs in the nine studies published since 2005. The findings are discussed in reference to the limitations of randomized designs in implementation science and the potential for use of alternative designs.     

Psychological correlates in the development of cancer: a review

This review describes the research literature relating the possible psychological precursors to cancer, published between 1978-1987. The studies are grouped, according to their methodological design, to cross-sectional case-control studies, cross-sectional studies using pre-biopsy assessment, and prospective longitudinal studies. A theoretical framework, based on recent psychosomatic investigations, is proposed to integrate the seemingly discrepant findings.     

Considerations in performing and analyzing the responses of cortico‐cortical evoked potentials in stereo‐EEG

This review aims to highlight key considerations when performing cortico‐cortical evoked potentials (CCEPs) using stereo–electroencephalography (SEEG) for network mapping and show its clinical applicability to presurgical evaluations. The parameters for performing stimulation and safety aspects have been investigated in electrocorticography (ECoG) and deep brain stimulation (DBS), but not as extensively in SEEG. A review of current literature was performed, with an attempt made to emphasize practical insights from all modalities of intracranial stimulation. This paper reviews physical stimulation parameters, highlights safety limits, and considers the influence of changing common stimulation parameters. These factors are put into the context of CCEPs in SEEG. Given the paucity of direct research in this area, studies utilizing low frequency stimulation, DBS, and ECoG are incorporated along with the fundamental principles of electrical engineering. In addition, postprocessing considerations are reviewed, including electrode localization, application of digital filters, baseline selection, application of connectivity metrics, and higher order network analysis. The aim is to guide CCEP stimulation as well as to provide an understanding of the underlying principles of this technique. At present, there are few articles detailing the design of low‐frequency stimulation paradigms, especially in the setting of SEEG. Providing a review of the fundamentals and postprocessing considerations when performing CCEPs in SEEG will increase the accessibility of this technique.     

Comparative audit of clinical research in pediatric neurology

Clinical research involves direct observation or data collection on human subjects. This study was conducted to evaluate the profile of pediatric neurology clinical research over a decade. Trends in pediatric neurology clinical research were documented through a systematic comparative review of articles published in selected journals. Eleven journals (five pediatric neurology, three general neurology, three general pediatrics) were systematically reviewed for articles involving a majority of human subjects less than 18 years of age for the years 1990 and 2000. Three hundred thirty-five clinical research articles in pediatric neurology were identified in the 11 journals for 1990 and 398 for 2000, a 19% increase. A statistically significant increase in analytic design (21.8% vs 39.5%; P = .01), statistical support (6% vs 16.6%; P < .0001), and multidisciplinary team (69.9% vs 87%; P = .003) was observed. In terms of specific study design, a significant decline in case reports (34.3% vs 10.3%; P < .0001) and an increase in case-control studies (11.3% vs 22.9%; P = .02) were evident over the 10-year interval. This comparative audit revealed that there has been a discernible change in the methodology profile of clinical research in child neurology over a decade. Trends apparently suggest a more rigorous approach to study design and investigation in this field.