Efficacy of the team solutions program for educating patients about illness management and treatment

OBJECTIVE: Despite the demonstrated efficacy of psychosocial approaches to schizophrenia treatment that include a psychoeducational component, such as illness management, the implementation of these approaches into routine mental health treatment has been slow. The authors sought to examine the efficacy of a comprehensive, modularized, psychoeducational program called Team Solutions, which was designed to educate patients with major mental illnesses about their illness and how to manage it. Team Solutions was chosen for study because it is available over the Internet and other venues at no cost and is used by mental health agencies across the United States and Canada. METHODS: Seventy-one persons with schizophrenia or schizoaffective disorder from three day treatment settings participated in this randomized, single-blind study. Participants were randomly assigned to attend one of two interventions: the Team Solutions intervention, which consisted of participating in a 24-week psychoeducational group focused on illness management, or treatment as usual. RESULTS: For participants who attended the experimental group, significant improvement was observed in knowledge about schizophrenia. In addition, client satisfaction was high. However, no changes were observed in symptoms or functioning. CONCLUSIONS: Results indicated that participation in the Team Solutions psychoeducational group improved participants' knowledge. However, participation in the program did not demonstrate superiority over treatment as usual with respect to secondary and tertiary outcomes, such as symptom severity, treatment adherence, and global functioning.     

Left ventricular mural thrombus after anterior ST-segment-elevation acute myocardial infarction in the era of aggressive reperfusion therapy--still a frequent complication

BACKGROUND: Left ventricular mural thrombus (LVMT) is a well-known complication of anterior ST-elevation acute myocardial infraction (AMI). It remains unknown how modern therapies have impacted on its occurrence. OBJECTIVES: To define the frequency of LVMT among contemporary patients with anterior ST-elevation AMI, the clinical and echocardiographic predictors of LVMT formation, and the intermediate-term outcomes of patients with LVMT. METHODS: We retrospectively analysed patients (in the years 1997-2002) with a diagnosis of anterior ST-elevation AMI and no prior AMI, and who underwent a thorough echocardiographic assessment within 72 h of admission. Stepwise logistic regression analysis was used to define predictors of LVMT formation. Survival was calculated by the Kaplan-Meier product-limit method. RESULTS: Of the 153 patients with complete data, LVMT was detected in 36 (23.5%). There were no significant differences in baseline demographic and clinical variables between LVMT and non-LVMT patients, or in treatments (all patients received reperfusion treatment). The mean wall motion score index was higher in LVMT than non-LVMT patients (0.88+/-1.79 versus 0.65+/-0.36, respectively; P=0.01), indicating worse cardiac systolic function. LVMT patients were treated with warfarin for 3-6 months. The incidence of death was similar between the groups (11.1% for LVMT patients versus 12.8% for non-LVMT patients, P=0.79) over a mean follow-up of 71-72 months. The only independent predictor found for LVMT occurrence was worse regional wall motion of the apex (odds ratio, 2.04, 95% confidence interval, 1.39-3.03; P<0.001). CONCLUSIONS: In the contemporary 'real-world scenario', despite aggressive reperfusion treatment and anti-aggregant use, the incidence of LVMT remained high after anterior ST-elevation AMI. LVMT was not related to increased intermediate-term mortality when patients were treated with warfarin, and the only predictor of LVMT occurrence was regional function of the apex.     

Vision, visual-information processing, and academic performance among seventh-grade schoolchildren: a more significant relationship than we thought?

OBJECTIVE: To compare visual and visual-information processing skills between children with and without mild reading and academic problems and examine the incidence of visual deficits among them. METHOD: Seventy-one seventh graders classified as proficient (n = 46) and nonproficient (n = 25) readers were compared with respect to scores on an accepted vision screening, on tests of visual-perception, visual-motor integration, and academic performance. Further, academic performance and visual-information processing were compared between children who failed and passed the vision screening. RESULTS: Visual deficits were found in 68% of the participants, and among significantly more boys than girls. Nonproficient readers had significantly poorer academic performance and vision-screening scores than the proficient readers. Participants who passed the visual screening performed significantly better in visual perception than those who failed. CONCLUSION: Visual function significantly distinguishes between children with and without mild academic problems, as well as on visual-perception scores. The high occurrence of visual deficits among participants warrants consideration of vision deficits among schoolchildren with academic performance difficulties.     

The Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch): a new instrument for assessing learning potential.

OBJECTIVE: To describe the development and psychometric properties of the Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch), a dynamic criterion-referenced assessment of cognitive abilities and learning potential for children with cognitive and learning difficulties. METHOD: A series of studies analyzed the age standards, criterion cutoff scores, and percentage of mediation cues required for typically developing children 6-12 years of age, as well as reliability and validity. RESULTS: MANOVA analyses determined four age groups that best fit the outcome data: 6-6.11, 7-8.11, 9-10.11, and 11-12 years. Criterion cutoff scores of 25% for at-risk and under 10% for deficient performance were obtained for each age group. Dynamic percentage scores were determined. Significant high interrater reliability and moderate to high internal consistency reliability were found. Construct validity was supported by comparing children with traumatic brain injury and learning disabilities to typically developing children, and ecological validity of children with attention deficit hyperactivity disorder by comparing performance on the DOTCA-Ch to the School Function Assessment. CONCLUSIONS: The DOTCA-Ch is a reliable and valid assessment that provides learning potential and can facilitate intervention for cognitive difficulties that manifest themselves in daily functions among school-age children.     

The Effect of Bimanual Training with or Without Constraint on Hand Functions in Children with Unilateral Cerebral Palsy: A Non-Randomized Clinical Trial

Aim: To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP). Methods: Seventeen children aged 6–11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint (“Hybrid”) or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post- and 3-months post-intervention. Results: A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p < 0.01); Bimanual (F2; 16 = 15.4, p < 0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p < 0.01]. Conclusion: Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.     

Trauma Care and Case Fatality during a Period of Frequent, Violent Terror Attacks and Thereafter

Background

From September 1999 through January 2004 during the second Intifada (al-Aqsa), there were frequent terror attacks in Jerusalem. We assessed the effects on case fatality of introducing a specialized, intensified approach to trauma care at the Hebrew University-Hadassah Hospital Shock Trauma Unit (HHSTU) and other level I Israeli trauma units. This approach included close senior supervision of prehospital triage, transport, and all surgical procedures and longer hospital stays despite high patient-staff ratios and low hospital budgets. Care for lower income patients also was subsidized.

Methods

We tracked case fatality rates (CFRs) initially during a period of terror attacks (1999–2003) in 8,127 patients (190 deaths) at HHSTU in subgroups categorized by age, injury circumstances, and injury severity scores (ISSs). Our comparisons were four other Israeli level I trauma centers (n?=?2,000 patients), and 51 level I U.S. trauma centers (n?=?265,902 patients; 15,237 deaths). Detailed HHSTU follow-up continued to 2010.

Results

Five-year HHSTU CFR (2.62?%) was less than half that in 51 U.S. centers (5.73?%). CFR progressively decreased; in contrast to a rising trend in the US for all age groups, injury types, and ISS groupings, including gunshot wounds (GSW). Patients with ISS?>?25 accounted for 170 (89?%) of the 190 deaths in HHSTU. Forty-one lives were saved notionally based on U.S. CFRs within this group. However, far more lives were saved from reductions in low CFRs in large numbers of patients with ISS?Conclusions Sustained reductions in trauma unit CFRs followed introduction of a specialized, intensified approach to trauma care.     

Sensory modulation disorder: a risk factor for participation in daily life activities

Participation in childhood daily functional performance was examined in 78 children: 44 with sensory modulation disorder (SMD); (33 males, 11 females; mean age 7y 6mo [SD 1.20]) and 34 without SMD (18 males, 16 females; mean age 7y 8mo [SD 1.33]). Group classification was determined using two measures: the Short Sensory Profile (SSP) and the Full‐form Sensory Profile. Parents completed a battery of caregiver questionnaires. Children with SMD scored significantly lower on all three participation scales than the control group. A high correlation was observed between level of activity performance of the Participation in Childhood Occupations Questionnaire (PICO‐Q) and the SSP, and a moderate correlation was observed between the Enjoyment of Performance of the PICO‐Q and the SSP. A low correlation was observed between Frequency of Performance of the PICO‐Q and the SSP. Logistic regression indicated that all three participation scales (level of activity performance, level of enjoyment of the activity, and frequency of performance of the activity) are significantly associated with group classification, with odds ratios of 3.13, 2.05, and 1.73 respectively. These findings are the first, to our knowledge, to confirm claims of limited participation in daily activities among children with SMD. Our results have significant clinical implications and provide support for the need for practitioners and caregivers of children with SMD to facilitate participation.     

The fabrication and characterization of linearly oriented nerve guidance scaffolds for spinal cord injury

Strategies to promote axonal extension through a site of injury, including the provision of nervous system growth factors and supportive substrates, produce growth of axons, that is highly random and does not extend past the lesion site and into the host tissue (Brain Res. Bull 57(6) (2002) 833). Physically guiding the linear growth of axons across a site of injury, in addition to providing neurotrophic and/or cellular support, would help to retain the native organization of regenerating axons across the lesion site and into distal host tissue, and would potentially increase the probability of achieving functional recovery. In the present study, a novel procedure was developed for using freeze-dry processing to create nerve guidance scaffolds made from agarose, with uniaxial linear pores. The hydrated scaffolds were soft and flexible, contained linear guidance pores extending through their full length, were stable under physiological conditions without chemical crosslinking, and could be readily loaded with diffusible growth stimulating proteins.