Stroke Inpatient Rehabilitation Team Conferences: Leadership and Structure Improve Patient Outcomes

Consensus on how rehabilitation teamwork and services are optimally coordinated continues to be a work in progress. One area of recent research has been inpatient-rehabilitation team conferences in stroke. The prevalence of Americans living with stroke is expected to gradually increase as the U.S. population ages, as will the related direct and indirect costs. Effective interdisciplinary team conferences during acute-stroke inpatient-rehabilitation are key to managing long-term costs while improving functional outcomes. Effective team conferences help to identify patients at risk for medical complications and institutionalization and help to determine interventions that will focus on patients’ medical, physical, cognitive, emotional, and social barriers to recovery and barriers to a community/home disposition. This scoping review paper identifies and analyzes literature on theory and structure of effective teams with the focus on stroke interdisciplinary rehabilitation team conferences and offers suggestions for improvement. Potential flaws of commonly used team conference formats are described. Studies are outlined showing associations between stroke patient outcomes and better care coordination and leadership in medical teamwork; and 2 examples of successful interdisciplinary team conference models used in stroke inpatient-rehabilitation are provided that support a case for a proactive, conscious structure to team conferences. Given the complexity of many stroke patients’ clinical care, greater attention to team functioning, and especially team conference leadership and structure, may be a promising area of focus to improve the quality of health care services for people with stroke.     

Language in Low-Functioning Children with Autistic Disorder: Differences Between Receptive and Expressive Skills and Concurrent Predictors of Language

Language profiles of children with autistic disorder and intellectual disability (n?=?36) were significantly different from the comparison groups of children with intellectual disability (n?=?26) and typically developing children (n?=?34). The group low-functioning children with autistic disorder obtained a higher mean score on expressive than on receptive language, whereas both comparison groups showed the reverse pattern. Nonverbal mental age, joint attention, and symbolic understanding of pictures were analyzed in relation to concurrent receptive and expressive language abilities. In the group with autistic disorder and intellectual disability, symbol understanding and joint attention were most strongly related to language abilities. Nonverbal mental age was the most important predictor of language abilities in the comparison groups.     

The Effectiveness of Community Mental Health Teams in Relation to Team Cohesion,Authentic Leadership and Size of the Team: A study in the North West of Ireland

Community Mental Health Teams (CMHTs) are increasingly being considered effective models of recovery focused care, however their effectiveness and factors that may affect it have not fully evaluated. Cross-sectional study in Ireland included 106 members from 8 CMHTs. We examined CMHT’s effectiveness and the effects of authentic leadership, team cohesion, team members’ experience and team tenure on effectiveness, by administering the Team Effectiveness Scale, Authentic Leadership Questionnaire, and Organizational Cohesion Scale. Data on demographics, discipline, years of experience, tenure in the same team, full or partial membership, and number of team members were collected. Results from multilevel regression analysis indicated significant association (p?<?0.05) between effectiveness of CMHTs and factors including team cohesion, authentic leadership, size of the team and full membership. Therefore, to increase CMHTs effectiveness, interventions are needed to those areas: a switch to make leadership styles more authentic, to improve team cohesion, smaller team size and full membership.

     

Psychiatric Leadership and the Clinical Team: Simulated In Vivo Treatment Planning Performance as Teamwork Proxy and Learning Laboratory

Leadership is an important consideration at many levels within behavioral healthcare systems. The authors developed a training program in a large public hospital system that focused on psychiatric leadership and clinical team functioning. In a learning laboratory format, they used videotaped patient simulations as a stimulus for multidisciplinary treatment planning sessions. Structured self-assessments were performed using a preliminary Scale for Leadership Assessment and Team Evaluation (SLATE). Videotaping the sessions provided an additional team self-assessment tool. Other educational activities supplemented the sessions, and teams proposed steps for transferring their learning to other units. The authors emphasize that leadership must foster team learning, which involves developing adaptive capacities and applying them to new clinical situations.     

Gender Differences in Relations among Perceived Family Characteristics and Risky Health Behaviors in Urban Adolescents

Background

Research regarding the role of gender in relations between family characteristics and health risk behaviors has been limited.

Purpose

This study aims to investigate gender differences in associations between family processes and risk-taking in adolescents.

Methods

Adolescents (N = 249; mean age = 14.5 years) starting their first year at an urban high school in the northeastern USA completed self-report measures that assessed family characteristics (i.e., parental monitoring, family social support, family conflict) and health behaviors (i.e., tobacco use, alcohol use, marijuana use, sex initiation) as part of a prospective, community-based study. Multivariate logistic regression models were used to investigate gender differences in associations between the family characteristics and health behaviors.

Results

Among males, higher levels of perceived parental monitoring were associated with lower odds of using tobacco and having ever engaged in sex. Among females, higher levels of perceived parental monitoring were associated with lower odds of marijuana use, alcohol use, and having ever engaged in sex. However, in contrast to males, among females (a) higher levels of perceived family social support were associated with lower odds of alcohol use and having ever engaged in sex and (b) higher levels of perceived family conflict were associated with higher odds of marijuana use and having ever engaged in sex.

Conclusion

Family processes were more strongly related to health behaviors among adolescent females than adolescent males. Interventions that increase parental monitoring and family social support as well as decrease family conflict may help to protect against adolescent risk taking, especially for females.

     

Differences of lumbopelvic sagittal parameters among community-dwelling middle-age and elderly individuals: Relations with locomotor physical function

This study aims to establish radiographic parameters of lumbopelvic sagittal alignment, gender related differences, and age-related changes in a middle-aged community, to investigate whether age-related changes of lumbopelvic alignment reflect the risk of locomotive syndrome (LS). This study included 448 healthy Japanese volunteers who attended a basic health checkup supported by the local government. The subjects (184 males and 264 females, mean age: 62.7 years) were grouped according to their age by decade. Sagittal lumbopelvic parameters were collected by lateral spine radiographs including lumbar lordosis (L1–S1, LL), lower lumbar lordosis (L4–S1, LLL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The three tests (stand-up test, two-step test, and 25-question geriatric locomotive function scale [GLFS-25]) composing the LS risk test were performed. LL was significantly lower in males than in the females. A significant decrease of LL and LLL was observed from 60 s to 70 s in the females. PI did not markedly change with aging in either gender but was lower in males. A remarkable increase of PT was seen from 60 s to 70 s in the females. SS did not markedly change with aging and was lower in males in all decades. The prevalence of LS risk in males and females increased gradually with age and was greater in females in any decade. 70 s females with LS risk had significantly lower LL and higher PT compared to them without LS risk. Radiographic parameters of lumbopelvic sagittal alignment were established in community-dwelling middle-age and elderly individuals.     

Expressive Incoherence and Alexithymia in Autism Spectrum Disorder

Expressive incoherence can be implicated in socio-emotional communicative problems in autism spectrum disorder (ASD). The present study examined expressive incoherence in 37 children with ASD and 41 typically developing (TD) children aged 3–13 years old during a frustration task. The role of alexithymia in expressive incoherence was also assessed. Compared to TD children, children with ASD had higher expressive incoherence, such as more neutral and positive emotion expressions during negative behaviors, but not in the expression of negative emotions during positive behaviors. Further analyses revealed that alexithymia moderated the expressions of positive emotions during negative behaviors. These results suggest that children with ASD may benefit from interventions targeting alexithymia to increase emotional coherence, which may improve socio-emotional communication.     

Instrumental vigour in punishment and reward

Recent notions about the vigour of responding in operant conditioning suggest that the long-run average rate of reward should control the alacrity of action in cases in which the actual cost of speed is balanced against the opportunity cost of sloth. The average reward rate is suggested as being reported by tonic activity in the dopamine system and thereby influencing all actions, including ones that do not themselves lead directly to the rewards. This idea is syntactically problematical for the case of punishment. Here, we broaden the scope of the original suggestion, providing a two-factor analysis of obviated punishment in a variety of operant circumstances. We also consider the effects of stochastically successful actions, which turn out to differ rather markedly between appetitive and aversive cases. Finally, we study how to fit these ideas into nascent treatments that extend concepts of opponency between dopamine and serotonin from valence to invigoration.     

Expressive pragmatic skills in pre-school children with and without Down's syndrome: parental perceptions

Parental perceptions of the pragmatic skills of six pre-school children with Down's syndrome were compared to those of six children without cognitive impairment. Children were matched for language comprehension age on the Reynell Developmental Language Scale and parents were interviewed using the Pragmatics Profile of Early Communication Skills. Data from the parental interviews was analysed taking a qualitative approach, using the technique of content analysis. The results showed that the children with and without Down's syndrome had many isimilarities in reported behaviours and responses In addition, five out of the six children with Down's syndrome had some skills which were more advanced than their matched pairs. Possible reasons for these findings are discussed. The evidence suggests that children with Down's syndrome have a normal range of pragmatic skills and communicative intentions compared with children of similar levels of comprehension functioning at an early pre-school level.     

Temporal Relations between Cortical Network Oscillations and Breathing Frequency during REM Sleep

Nasal breathing generates a rhythmic signal which entrains cortical network oscillations in widespread brain regions on a cycle-to-cycle time scale. It is unknown, however, how respiration and neuronal network activity interact on a larger time scale: are breathing frequency and typical neuronal oscillation patterns correlated? Is there any directionality or temporal relationship? To address these questions, we recorded field potentials from the posterior parietal cortex of mice together with respiration during REM sleep. In this state, the parietal cortex exhibits prominent θ and γ oscillations while behavioral activity is minimal, reducing confounding signals. We found that the instantaneous breathing frequency strongly correlates with the instantaneous frequency and amplitude of both θ and γ oscillations. Cross-correlograms and Granger causality revealed specific directionalities for different rhythms: changes in θ activity precede and Granger-cause changes in breathing frequency, suggesting control by the functional state of the brain. On the other hand, the instantaneous breathing frequency Granger causes changes in γ frequency, suggesting that γ is influenced by a peripheral reafference signal. These findings show that changes in breathing frequency temporally relate to changes in different patterns of rhythmic brain activity. We hypothesize that such temporal relations are mediated by a common central drive likely to be located in the brainstem.     

Expressive disclosure and health outcomes in a prostate cancer population

OBJECTIVE: This pilot study explored the feasibility and the efficacy of a brief, well-defined psychosocial intervention (expressive disclosure) in improving behavioral, medical, immunological, and emotional health outcomes in men with diagnosed prostate cancer. METHOD: Thirty prostate cancer patients receiving outpatient oncology care were randomized into experimental (disclosure) and control (non-disclosure) groups. All had been previously treated by surgery or radiation within the last 4 years and were being monitored without further intervention for change in PSA levels. Psychological and physical health surveys were administered and peripheral blood for PSA levels and immune assays was obtained upon study enrollment and again at 3 and 6 months post enrollment. Multivariate analyses were used to examine how the expressive disclosure impacted the hypothesized domains of functioning: physical and psychological symptoms; health care utilization; and immunocompetence. RESULTS: Compared to controls, patients in the expressive disclosure condition showed improvements in the domains of physical symptoms and health care utilization, but not in psychological variables nor in disease relevant aspects of immunocompetence. CONCLUSIONS: Study results support the feasibility of an expressive disclosure intervention for men with prostate cancer. The intervention was well accepted by this population, and participation/adherence was quite high. Results provide only limited support for the hypothesis that a written emotional disclosure task can positively impact health outcomes in a cancer population. However, this pilot study may have lacked adequate power to detect possible intervention benefits. Further studies with larger samples are needed to better assess the intervention's impact on psychological well-being and immunocompetence.     

Expressive and receptive vocabulary in children with Williams and Down syndromes

Background Williams (WS) and Down syndromes (DS) are two genetic disorders that involve intellectual disability (ID) and have been extensively studied over the past decades because of the unique linguistic profiles they exhibit. Recent investigations seek to explore the fractionation of linguistic components within the cognitive system using genetically based neurodevelopmental disorders such as WS and DS and to identify different profiles of linguistic function in these two groups of individuals. Method The ‘expressive vocabulary’, ‘receptive vocabulary’, ‘word opposites’ and ‘word definitions’ subtests (Level 1) of the Test of Word Knowledge (TOWK) were used to assess lexical skills in six children with WS and five children with DS. Results Our findings indicate that the two syndromes exhibit substantial differences on linguistic tasks with individuals with WS performing at a higher level compared to those with DS and producing atypical responses in word definitions. The pattern of errors for each syndrome is qualitatively different suggesting that their underlying linguistic mechanisms are distinctive even though ID is similar. Conclusions This study supports the differential outcome of two chromosomal disorders with similar ID. It also argues in favour of the large within group variability of the two syndromes that is not related to mental age but rather to different underlying mechanisms supporting language. These findings are discussed in the light of the current evidence concerning linguistic knowledge of neurodevelopmental and genetic disorders.     

Expressive inhibition in response to stress: Implications for emotional processing following trauma

Expressive inhibition – the willful restriction of expressed emotion – is documented in individuals reporting trauma-related distress, but its impact on global affective functioning remains unclear. Theoretical models propose that chronic activation of negative emotion and deliberate restriction of affect operate synergistically to produce trauma-related emotional deficits. The current project examined the impact of these factors on subjective experience and physiological activation following exposure to an analog trauma. University students (N = 192; M_age = 20, 57% female, 42% White/Non-Hispanic) viewed a graphic film depicting scenes of a televised suicide. Participants then viewed either a sadness- or humor-eliciting film under instructions to inhibit [n_sadness = 45, n_humor = 52] or naturally express emotion [n_sadness = 48, n_humor = 47]. Expressive inhibition was associated with restricted amusement specifically among participants viewing the humor film. Inhibition also produced attenuated sympathetic and parasympathetic recovery, irrespective of film assignment. Evidence of disruptions in emotional processing supports models identifying inhibition as a possible mechanism in post-trauma affect dysregulation.