Serial cognitive change patterns across time after temporal lobe resection for epilepsy

Longitudinal cognitive outcome with respect to general cognitive status and memory at the group and individual levels was studied 10 years after temporal lobe resection for epilepsy. Twenty-five patients who had undergone a medium-term follow-up (T2, median = 2.7 years) also underwent a long-term follow-up (T3, median = 9.8 years). At the group level, there was a significant increment across time, partly due to practice, in IQ (P value from 0.049 to <0.0001) but not in memory variables. On the basis of the normative interval of reassessed matched controls, the analysis at the individual level of change from baseline to T2 disclosed decrements in 12-29% of the patients and increments in 8-21%. These proportions diminished at T3 (0-12 and 0-16%) and the dominating pattern of Performance IQ and verbal memory was a return toward baseline. These findings make the interpretation of an initial (T2) postoperative increment or decrement more problematic and underline the need for a comprehensive evaluation across time, including both at the group and individual levels.     

Measures of Spatial Similarity and Response Magnitude in MEG and Scalp EEG

Sensor selection is typically used in magnetoencephalography (MEG) and scalp electroencephalography (EEG) studies, but this practice cannot differentiate between changes in the distribution of neural sources versus changes in the magnitude of neural sources. This problem is further complicated by (1) subject averaging despite sizable individual anatomical differences and (2) experimental designs that produce overlapping waveforms due to short latencies between stimuli. Using data from the entire spatial array of sensors, we present simple multivariate measures that (1) normalize against individual differences by comparison with each individual’s standard response; (2) compare the similarity of spatial patterns in different conditions (angle test) to ascertain whether the distribution of neural sources is different; and (3) compare the response magnitude between conditions which are sufficiently similar (projection test). These claims are supported by applying the reported techniques to a short-term word priming paradigm as measured with MEG, revealing more reliable results as compared to traditional sensor selection methodology. Although precise cortical localization remains intractable, these techniques are easy to calculate, relatively assumption free, and yield the important psychological measures of similarity and response magnitude.     

Liver function after irradiation based on computed tomographic portal vein perfusion imaging

PURPOSE: To determine whether individual and regional liver sensitivity to radiation could be assessed by measuring liver perfusion during a course of treatment using dynamic contrast-enhanced computed tomography scanning. METHODS AND MATERIALS: Patients with intrahepatic cancer undergoing conformal radiotherapy underwent dynamic contrast-enhanced computed tomography (to measure perfusion distribution) and an indocyanine extraction study (to measure liver function) before, during, and 1 month after treatment. We hoped to determine whether the residual functioning liver (i.e., those regions showing portal vein perfusion) could be used to predict overall liver function after irradiation. RESULTS: Radiation doses from 45 to 84 Gy resulted in undetectable regional portal vein perfusion 1 month after treatment. The volume of each liver with undetectable portal vein perfusion ranged from 0 to 39% and depended both on the patient's sensitivity and on dose distribution. There was a significant correlation between indocyanine green clearance and the mean of the estimated portal vein perfusion in the functional liver parenchyma (p < 0.001). CONCLUSION: This study reveals substantial individual variability in the sensitivity of the liver to irradiation. In addition, these findings suggest that hepatic perfusion imaging may be a marker for liver function and has the potential to be a tool for individualizing therapy.     

Assessment of referrals to an OT consultation-liaison service: a retrospective and comparative study

Abstract

The objective was to conduct a retrospective and comparative study of the requests for consultation-liaison (RCLs), during a period of six years, sent to the Occupational Therapy (OT) team that acts as the Consultation-liaison Service in Mental Health. During the studied period 709 RCLs were made and 633 patients received OT consultations. The comparison group was extended to 1 129 consecutive referrals to the psychiatric CL service, within the same period and that were also retrospectively reviewed. Regarding to RCLs to the OT team, most of the subjects were women with incomplete elementary schooling, with a mean age of 39.2 years, and were self-employed or retired. Internal Medicine was responsible for most of the RCLs. The mean length of hospitalization was 51 days and the mean rate of referral was 0.5%, with the most frequent reason for the request being related to the emotional aspects and the most frequent psychiatric diagnosis was mood disorder. It is concluded that there is a clear demand for the development of consultation-liaison in OT, particularly with regard to the promotion of mental health in general hospitals.     

浅谈个别谈话在医德教育中的运用

个别谈话是解决具体医德问题的重要方法，个别谈话必须作到以情感人，真实可信，对症下药，选择时机注意表达方式，才能收到好的医德教育实效，提高医学生的医德水平。     

医院信息化过程如何选择专业咨询公司

国内医院信息化过程已经进入了一个新的阶段,专业信息化咨询参与医院信息化建设的模式逐渐被大家接受.但是,由于这种商业模式在国内前人还鲜有案例参照,尤其在工作的第一步如何选择合作的的咨询公司上,众多医院信息中心主管还存在疑惑.本文作者通过自身在国外实际医院信息化工作经验,结合咨询公司工作特点,给医院CIO出了一个可参照的工作方法,提出了一些需要注意的问题.     

上海市社区临终患者的安宁疗护服务需求研究*

目的从需方出发研究安宁疗护需求,进一步完善安宁疗护服务内容。方法基于便利采样法由4名安宁疗护执行人对20位需方进行半结构化访谈,采集资料后分析确定需方对安宁疗护的需求,再邀请15名专家对需方的安宁疗护服务需求进行适宜性评价,并对评价结果进行数据分析。结果需方在症状控制、舒适照护、心理支持和人文关怀方面有44项需求,经专家咨询结果,适宜在社区安宁疗护中满足的需求有42项,另外2项不符合安宁疗护理念。结论除提供专科会诊和抢救服务两项需求与安宁疗护理念不匹配外,其他需方需求都有可行性,可纳入安宁疗护服务目录。