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Patients' Ability (patient + ability)
Selected AbstractsAssessment of functional vision and its rehabilitationACTA OPHTHALMOLOGICA, Issue 2 2010August Colenbrander Abstract. This article, based on a report prepared for the International Council of Ophthalmology (ICO) and the International Society for Low Vision Research and Rehabilitation (ISLRR), explores the assessment of various aspects of visual functioning as needed to document the outcomes of vision rehabilitation. Documenting patient abilities and functional vision (how the person functions) is distinct from the measurement of visual functions (how the eye functions) and also from the assessment of quality of life. All three areas are important, but their assessment should not be mixed. Observation of task performance offers the most objective measure of functional vision, but it is time-consuming and not feasible for many tasks. Where possible, timing and error rates provide an easy score. Patient response questionnaires provide an alternative. They may save time and can cover a wider area, but the responses are subjective and proper scoring presents problems. Simple Likert scoring still predominates but Rasch analysis, needed to provide better result scales, is gaining ground. Selection of questions is another problem. If the range of difficulties does not match the range of patient abilities, and if the difficulties are not distributed evenly, the results are not optimal. This may be an argument to use different outcome questions for different conditions. Generic questionnaires are appropriate for the assessment of generic quality of life, but not for specific rehabilitation outcomes. Different questionnaires are also needed for screening, intake and outcomes. Intake questions must be relevant to actual needs to allow prioritization of rehabilitation goals; the activity inventory presents a prototype. Outcome questions should be targeted at predefined rehabilitation goals. The Appendix cites some promising examples. The Low Vision Intervention Trial (LOVIT) is an example of a properly designed randomized control study, and has demonstrated the remarkable effectiveness of vision rehabilitation. It is hoped that further similar studies will follow. [source] Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adultsJOURNAL OF ADVANCED NURSING, Issue 1 2009Céline Gélinas Abstract Title.,Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adults. Aim., This paper is a report of the item selection process and evaluation of the content validity of the Critical-Care Pain Observation Tool for non-verbal critically ill adults. Background., Critically ill patients experience moderate to severe pain in the intensive care unit. While critical care clinicians strive to obtain the patient's self-report of pain, many factors compromise the patient's ability to communicate verbally. Pain assessment methods often need to match the communication capabilities of the patient. In non-verbal patients, observable behavioural and physiological indicators become important indices for pain assessment. Method., A mixed method study design was used for the development of the Critical-Care Pain Observation Tool in 2002,2003. More specifically, a four-step process was undertaken: (1) literature review, (2) review of 52 patients' medical files, (3) focus groups with 48 critical care nurses, and interviews with 12 physicians, and (4) evaluation of content validity with 17 clinicians using a self-administered questionnaire. Results., Item selection was derived from different sources of information which were convergent and complementary in their content. An initial version of the Critical-Care Pain Observation Tool was developed including both behavioural and physiological indicators. Because physiological indicators received more criticism than support, only the four behaviours with content validity indices >0·80 were included in the Critical-Care Pain Observation Tool: facial expression, body movements, muscle tension and compliance with the ventilator. Conclusion., Item selection and expert opinions are relevant aspects of tool development. While further evaluation is planned, the Critical-Care Pain Observation Tool appears as a useful instrument to assess pain in critically ill patients. [source] Women's perceptions of chemotherapy-induced cognitive side affects on work ability: a focus group studyJOURNAL OF CLINICAL NURSING, Issue 9-10 2010Fehmidah Munir Aims and objectives., To investigate women's awareness of chemotherapy-induced cognitive changes, their perception of cognitive limitations in carrying out daily tasks and subsequent return to work decisions and perceptions of work ability. Background., Evidence suggests that women diagnosed with breast cancer experience cognitive changes as a consequence of chemotherapy treatment. Although these changes tend to be subtle deficits in memory, concentration and the ability to organise information, there has been no published research identifying how they can impact patient's ability to work and subsequent employment decisions. Design., This was a qualitative study. Method., Data were collected from breast cancer survivors using semi-structured interviews with two focus groups (n = 6, n = 7). Interviews were transcribed verbatim and analysed using template analysis. Results., Data were categorised into four main themes: (1) awareness of cognitive changes during and following chemotherapy, (2) cognitive ability and confidence in return to work, (3) impact of cognitive changes on work ability and (4) information on the cognitive side effects of chemotherapy. Conclusions., The views and experiences of breast cancer survivors towards returning to work and subsequent work ability were affected by chemotherapy-induced cognitive impairment. More specifically the appraisal of returning to work and ability to manage work were influenced by three interrelated factors: (1) actual cognitive ability following chemotherapy, (2) awareness of cognitive failures by the women and their families and (3) the subsequent impact on their confidence in carrying out daily tasks including work tasks. Relevance to clinical practice., More information and support is needed to help patients with cancer to manage chemotherapy-induced cognitive impairments in home and workplace. Nurses are increasingly asked about the impact of cancer and its treatment on work and are therefore well positioned to offer this advice. Subsequently, nurses require additional knowledge and guidance to provide this information and support. [source] Toward Evidence-Based Prescribing at End of Life: A Comparative Analysis of Sustained-Release Morphine, Oxycodone, and Transdermal Fentanyl, with Pain, Constipation, and Caregiver Interaction Outcomes in Hospice PatientsPAIN MEDICINE, Issue 4 2006BCPS, Douglas J. Weschules PharmD ABSTRACT Objective., The primary goal of this investigation was to examine selected outcomes in hospice patients who are prescribed one of three sustained-release opioid preparations. The outcomes examined include: pain score, constipation severity, and ability of the patient to communicate with caregivers. Patients and Settings., This study included 12,000 terminally ill patients consecutively admitted to hospices and receiving pharmaceutical care services between the period of July 1 and December 31, 2002. Design., We retrospectively examined prescribing patterns of sustained-release morphine, oxycodone, and transdermal fentanyl. We compared individual opioids on the aforementioned outcome markers, as well as patient gender, terminal diagnosis, and median length of stay. Results., Patients prescribed a sustained-release opioid had similar average ratings of pain and constipation severity, regardless of the agent chosen. Patients prescribed transdermal fentanyl were reported to have more difficulty communicating with friends and family when compared with patients prescribed either morphine or oxycodone. On average, patients prescribed transdermal fentanyl had a shorter length of stay on hospice as compared with those receiving morphine or oxycodone. Conclusion., There was no difference in observed pain or constipation severity among patients prescribed sustained-release opioid preparations. Patients receiving fentanyl were likely to have been prescribed the medication due to advanced illness and associated dysphagia. Diminished ability to communicate with caregivers and a shorter hospice course would be consistent with this profile. Further investigation is warranted to examine the correlation between a patient's ability to interact with caregivers and pain control achieved. [source] CASE REPORTS: Penile Constriction Devices: Case Report, Review of the Literature, and Recommendations for ExtricationTHE JOURNAL OF SEXUAL MEDICINE, Issue 7 2008Jonathan Silberstein ABSTRACT Introduction., Penile constriction devices often present significant challenges to urologic surgeons. Failure to remove such devices can lead to significant ischemia and loss of tissue. Patients often present after several days of ischemia and swelling have developed. Aim., This article reviews previously published data on penile constriction devices and strategies for their removal. Additionally, we present new methodologies for extrication. Methods., A comprehensive review of the English language literature was performed using MEDLINE. "Penile incarceration" and "penile strangulation" were used as search terms, and a manual bibliographic review of cross-referenced items was performed. Publications prior to 1970 were excluded from our search. Main Outcome Measures., Review of published literature on penile constriction devices and their removal. Results., Penile incarceration is frequently described in the literature as an isolated case report or small series describing the approach of a single physician or group of physicians for dealing with these problems. Penile incarceration has been reported in a wide spectrum of age groups, with the incarcerating object most frequently placed for erotic or autoerotic purposes. While the most commonly reported devices causing incarceration are metal rings, higher-grade penile injuries are more frequently sustained by nonmetallic objects. Patients who present with incarceration after 72 hours are more likely to sustain higher-grade injuries than those who seek more timely treatment. Strategies for extrication depend on the type of device used, the length of time of incarceration, the patient's ability to remain calm, and the tools available to the presenting physicians. Conclusion., Penile incarceration is a urologic emergency with potentially severe clinical consequences. With rapid intervention and removal of the foreign body, most patients do extremely well and need no further intervention. Removal of such devices can be challenging and often requires resourcefulness and a multidisciplinary approach. Silberstein J, Grabowski J, Lakin C, and Goldstein I. Penile constriction devices: Case report, review of the literature, and recommendations for extrication. J Sex Med 2008;5:1747,1757. [source] Pathways to care for patients with bipolar disorderBIPOLAR DISORDERS, Issue 3 2005Dinesh Bhugra Bipolar disorder is a chronic, debilitating psychiatric illness with serious ramifications for patients, their families, and society. Despite the availability of effective treatments, this disease often goes untreated due to medical, financial, legal/governmental, and cultural barriers. In this review we explore possible reasons for this problem. Misdiagnosis of bipolar disorders is a common medical barrier. One pathway to care for individuals with bipolar disorder is through referral from primary care, but primary care physicians generally have not received special training in the recognition and management of bipolar disorder. This often leads to diagnostic delays or errors, which prevents timely ,filtering' of patients into specialized care. Using data bases we explored these pathways. Legislation in the USA, such as the Emergency Medical Treatment and Active Labor Act (EMTALA), designed to ensure access to inpatient mental health care, has instead given hospitals financial incentives to limit inpatient mental health care capacities. Reimbursement of mental health care expenses is a significant issue impacting a patient's ability to gain access to care, as bipolar disorder is a costly disease to treat. Improving access to care among the bipolar community will require multilateral strategies to influence the actions and attitudes of patients, communities, providers, health care systems, and state/national governments. In other cultures, barriers to care differ according to a number of factors such as type of services, explanatory models of illness, misdiagnosis and perceptions of care givers. It is essential that clinicians are aware of pathways and barriers so that appropriate and accessible care can be provided. [source] Measuring visual diasability in glaucomaACTA OPHTHALMOLOGICA, Issue 2009A KOTECHA Quantification of the visual disability experienced by the glaucoma patient is currently limited to the use of clinician-based measures of disease status; that is, measurement of retinal nerve fibre layer thickness, visual field sensitivity and intraocular pressure. However, whilst these tests provide information to the clinician regarding patient management requirements, they provide very little information about the patient's ability to function on a day-to-day basis. There have been attempts to measure the glaucoma patient's experience using vision-specific ,quality of life' questionnaires. However, it is apparent that no two patients with the same disease status will report the same quality of life experience. The purpose of this talk is to present new work examining how glaucoma patients perform specific, day-to-day tasks in the presence of the disease, with a view to understanding what specific visual factors might explain the difficulties they encounter at different stages of the disease. [source] Emotional issues after kidney transplantation: a prospective psychotherapeutic studyCLINICAL TRANSPLANTATION, Issue 6 2002Lyndsay S Baines Abstract:,Background:, Negative emotional states are the single most influential factor in determining quality of life after a successful kidney transplant. We designed a prospective study using psychotherapeutic principles to understand and intervene in emotional issues in adult recipients of first cadaver kidney transplants. Methods:, Forty-nine recipients of first cadaver kidney transplants were subjected to 12 sessions (at weekly intervals) of psychotherapy within 3 months of receiving their transplant. The Beck Depression Inventory (BDI) was utilized as a measure of change in emotional state, pretherapy, at 3, 6, 9 and 12 months. A higher score on BDI was suggestive of psychological dysfunction. In the first instance, data was analysed within a quantitative framework, by virtue of the BDI. In the second instance, data was considered in terms of recurring themes described by patients during psychotherapy and was analysed qualitatively. In the third instance, both qualitative and quantitative data was considered in terms of individual patient's ability to achieve some feeling of having implemented some social, relational and vocational equilibrium into their everyday life. Recipients of live kidneys, paediatric transplants and patients who received more than one transplant were excluded, as emotional issues are different in this cohort of patients. All patients have completed 1 yr of follow up. None of the patients were on antidepressant medication before or after therapy. Results:, This is an ongoing study in which we are comparing individual vs. group therapy vs. controls (who receive no therapy). The total number of patients recruited will be 120 and the final report will be available in 2003,04. The results reported in this paper form the 49 patients in the individual arm of the study. All the patients in our study happened to be white people. There was significant improvement in the BDI scores following therapy. The mean score was 26.3 ± 7.9 before and 20.5 ± 8.8 after therapy (p = 0.001); the lowering of the scores remained sustained at 12 months. Multivariate analysis of age, gender, employment status, duration of dialysis (if in dialysis for more than 3 yrs) and psychotherapy given before transplantation did not affect the results of our study. For the qualitative aspect of the study, we grouped the emotional problems as expressed by the patients into three recurring themes (i) fear of rejection, (ii) feelings of paradoxical loss post-transplant despite having received a successful transplant and (iii) the psychological integration of the newly acquired kidney. Conclusions:, Psychotherapeutic intervention was an effective means of addressing emotional problems in recipients of kidney transplants. The recurring themes as identified above provided a baseline for psychotherapeutic exploration and resolution of these issues. Successful resolution of these issues was associated with lower BDI scores and the redefinition of normality in daily living post-transplant. [source] EFNS task force on management of amyotrophic lateral sclerosis: guidelines for diagnosing and clinical care of patients and relativesEUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2005An evidence-based review with good practice points Despite being one of the most devastating diseases known, there is little evidence for diagnosing and managing patients with amyotrophic lateral sclerosis (ALS). Although specific therapy is lacking, correct early diagnosis and introduction of symptomatic and specific therapy can have a profound influence on the care and quality of life of the patient and may increase survival time. This document addresses the optimal clinical approach to ALS. The final literature search was performed in the spring of 2005. Consensus recommendations are given graded according to the EFNS guidance regulations. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. People affected with possible ALS should be examined as soon as possible by an experienced neurologist. Early diagnosis should be pursued and a number of investigations should be performed with high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. PEG is associated with improved nutrition and should be inserted early. The operation is hazardous in patients with vital capacity <50%. Non-invasive positive pressure ventilation improves survival and quality of life but is underused. Maintaining the patients ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end of life care are important and should be fully discussed early with the patient and relatives respecting the patients social and cultural background. [source] Diabetes management in the new millennium using insulin pump therapyDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2002Bruce W. Bode Abstract Current goals of therapy of type 1 and 2 diabetes are to achieve near normal glycemia, minimize the risk of severe hypoglycemia, limit excessive weight gain, improve quality of life and delay or prevent late vascular complications. As discussed in this review, insulin pump or continuous subcutaneous insulin infusion (CSII) therapy provides a treatment option that can dramatically aid in achieving all of these goals. In comparison to multiple daily injections (MDI), CSII uses only rapid-acting insulin, provides greater flexibility in timing of meals and snacks, has programmable basal rates to optimize overnight glycemic control, can reduce the risk of exercise-induced hypoglycemia, and enhances patients' ability to control their own diabetes. Most important, in adults and adolescents with type 1 diabetes, CSII has been shown to lower HbA1c levels, reduce the frequency of severe hypoglycemia and limit excessive weight gain versus MDI without increasing the risk of diabetic ketoacidosis. Similarly positive results are being seen with CSII in adults with type 2 diabetes. The effectiveness of CSII and improvements in pump technology have fueled a dramatic increase in the use of this therapy. Practical guidelines are presented for selection of patients, initiation of treatment, patient education, follow-up assessments and troubleshooting. The recent introduction of methods for continuous glucose monitoring provides a new means to optimize the basal and bolus capabilities of CSII and offers the hope of the development of a feedback-controlled artificial pancreas. Copyright © 2002 John Wiley & Sons, Ltd. [source] Opioid-taking tasks and behaviours in Taiwanese outpatients with cancerJOURNAL OF CLINICAL NURSING, Issue 15 2008Shu-Yuan Liang PhD Candidate Aim., The aim of this study was to describe those tasks and behaviours that contribute to self-efficacy in the context of opioid-taking in Taiwanese outpatients with cancer and to explore those factors that influence a patient's self-efficacy with engaging in these behaviours. Background., Self-management with prescribed opioid regimen has become a necessary component of the cancer pain experience at home. Tailoring prescribed regimens is a complex and continuing effort for cancer pain control. Few studies, however, have explored the specific skills and behaviours required by patients to manage their opioid analgesics effectively. Design., A qualitative approach was used to explore those behaviours that contribute to patients' ability to self-manage medication for their cancer pain. Method., Ten Taiwanese cancer patients aged between 41,75 years attending two oncology outpatient departments, who were prescribed opioid analgesics, were interviewed. All interviews were tape-recorded and were transcribed verbatim. Qualitative content analysis was undertaken to identify categories. Results., Five main categories of behaviours were identified, which reflected patient's perceptions of the actions required for effective opioid-taking. These behavioural domains included communicating about pain and analgesic-taking, taking analgesics according to schedule, obtaining help, tailoring medication regimens and managing treatment-related concerns. In addition, patients described various situations in which performance of these behaviours was more or less difficult. Conclusions., Our results suggest that self-efficacy with opioid-taking includes not only beliefs about the ability to communicate, but also the ability to fulfil more complex tailoring of medication regimens and management of treatment-related concerns. Relevance to clinical practice., Health professionals need to incorporate strategies to assist cancer patients' ability to engage in these behaviours and to manage situational impediments that may influence this ability. More importantly, clinicians need to assist patients to enhance their beliefs in their ability in overcoming various situation impediments for opioid-taking. [source] Family support, perceived self-efficacy and self-care behaviour of Turkish patients with chronic obstructive pulmonary diseaseJOURNAL OF CLINICAL NURSING, Issue 8 2007Magfiret Kara Ka Aim., The purpose of this study was to describe family support, self-efficacy perception and self-care behaviour among patients with chronic obstructive pulmonary disease and to ascertain the relationship between these variables. Background., It is important to work at improving confidence in the patients' ability to follow a self-care regimen by increasing self-efficacy. Family support also plays an important role in self-care activities. Method and design., The study design is descriptive and correlational. Of 230 patients with chronic obstructive pulmonary disease who were recruited for the study, 200 agreed to participate. The patients were recruited by the first author from an outpatient clinic in the Department of Chest Disease of a university hospital and a pulmonary hospital in Erzurum, eastern Turkey. Data were collected by using a demographic data form, the Perceived Social Support from Family Scale, the Chronic Obstructive Pulmonary Disease Self-efficacy Scale and the Alberto Chronic Obstructive Pulmonary Disease Self-care Behaviour Inventory. Results., Although most participants (91·5%) perceived that they had family support and more than three quarters (73·0%) of the participants engaged in an adequate amount of self-care behaviours, only twenty five participants' (12·5%) perceived self-efficacy as high. There were statistically significant positive relationships between family support and self-care behaviour (r = 0·302; p = 0·01) and between self-efficacy and self-care behaviour (r = 0·186; p = 0·01). There was also a statistically significant positive relationship between family support and self-efficacy (r = 0·412; p = 0·01). Conclusion., The results of the study demonstrated weak to moderate, but statistically significant, relationships between family support and self-care behaviours, self-efficacy and self-care behaviour and family support and self-efficacy in Turkish patients with chronic obstructive pulmonary disease. Relevance to clinical practice., The assessment of the family support, self-efficacy and self-care behaviours of the patients with chronic obstructive pulmonary disease should be an essential part of nursing practice. The study also provides the foundation for the conduct of future studies of self-care training for managing patients with chronic obstructive pulmonary disease. [source] Effects of Alcohol Cue Exposure on Response Inhibition in Detoxified Alcohol-Dependent PatientsALCOHOLISM, Issue 9 2010Siegfried Gauggel Background:, There is evidence that exerting self-control during alcohol craving can diminish performance on subsequent tasks that require self-control. Based on the resource depletion model (Muraven and Baumeister, 2000), we examined the influence of alcohol cue exposure on detoxified alcohol-dependent patients' ability to inhibit ongoing responses. Methods:, Twenty alcohol-dependent patients were randomly assigned to an alcohol-cue exposure and a control-cue exposure condition and thereafter had to perform an inhibition task (i.e., stop-signal task). Results:, Participants who sniffed alcohol before performing the inhibition task reported a stronger urge to drink alcohol than the control group that sniffed water. Participants who sniffed alcohol were also impaired in their inhibitory performance but not in their noninhibitory performance on the stop-signal task. Conclusions:, The urge to drink presumably reduced participants' self-control, and this interfered with their ability to inhibit responding. [source] Increased Interleukin-10 and Cortisol in Long-term Alcoholics after Cardiopulmonary Bypass: A Hint to the Increased Postoperative Infection Rate?ALCOHOLISM, Issue 9 2005Michael Sander Background: Previous studies have shown that 20% of all patients admitted to the hospital abuse alcohol and have increased morbidity after surgery. Long-term alcoholic patients are shown to suffer from immune alterations, which might be critical for adequate postoperative performance. Cardiac surgery with cardiopulmonary bypass (CPB) also leads to pronounced immune alteration, which might be linked with patients' ability to combat infections. Therefore, the aim of our study was to investigate the perioperative levels of TNF-alpha, interleukin-6, interleukin-10, and cortisol in long-term alcoholic and nonalcoholic patients undergoing cardiac surgery to elucidate a possible association with postoperative infections. Methods: Forty-four patients undergoing elective cardiac surgery were included in this prospective study. Long-term alcoholic patients (n= 10) were defined as having a daily ethanol consumption of at least 60 g and fulfilling the Diagnostic and Statistical Manual of Mental Disorders for alcohol abuse. The nonalcoholic patients (n= 34) were defined as drinking less than 20 g ethanol per day. Blood samples were obtained to analyze the immune status upon admission to hospital, the morning before surgery and on admission to the ICU, the morning of days one and three after surgery. Results: Basic characteristics of patients did not differ between groups. Long-term alcoholics had a fourfold increase in postsurgery infection rate and prolonged need for ICU treatment and mechanical ventilation. Postoperative levels of interleukin-10 and cortisol were significantly increased in long-term alcoholic patients compared with nonalcoholic patients. These observations were in line with postoperative interleukin-10 being predictive for postoperative infectious complications. Conclusions: The increased infection rate in long-term alcoholics strengthens the urgent need for interventional approaches providing modulation of the perioperative immune and HPA response in these high-risk patients to counteract their postoperative immune suppression. [source] Increased patient co-payments and changes in PBS-subsidised prescription medicines dispensed in Western AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2009Anna Hynd Abstract Objective: To determine whether a 24% increase in patient co-payments in January 2005 and two related co-payment changes for medicines subsidised under the Australian Pharmaceutical Benefits Scheme (PBS) were associated with changes in dispensings in Western Australia (WA). Method: We analysed aggregate monthly prescription counts and defined daily dose per 1,000 population per day (DDD/1,000/day) for atypical antipsychotics, combination asthma medicines, HmgCoA reductase inhibitors (statins) and proton-pump inhibitors (PPIs). Trends pre and post the co-payment increase in January 2005 were compared. Results: In three of the four categories examined, prescription counts were significantly lower following the increase in co-payment thresholds. Compared with dispensings prior to the co-payment increase, prescriptions fell by 8% for combination asthma medicines (p<0.001), 9% for PPIs (p<0.001) and 5% for statins (p<0.001). Following the rise in co-payments, DDD/1,000/day decreased for all four categories. Decreases in dispensings to concessional beneficiaries were between 4% and 5% larger than for general beneficiary patients. Conclusions and Implications: The reduction in the both prescription counts and DDD/1,000/day observed for combination asthma medicines, PPIs and statins, which all remained above co-payment thresholds, suggests the increase in PBS co-payments has affected utilisation of these subsidised medicines. The results indicate that increases in patient contributions particularly impact on concessional patients' ability to afford prescription medicines. [source] Cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis with EDSS , 3.5ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2003R. M. Ruggieri Objectives , Previous papers have mainly demonstrated the presence and the frequency of cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis. The purpose of this study was to investigate subjects with the relapsing-remitting form of the disease and mild clinical disability (EDSS , 3.5), so as to quantify this deficit when the illness does not yet interfere with daily living and the ability to work. Methods , Fifty patients and 50 healthy controls were submitted to a wide neuropsychological battery, including Wechsler Memory Scale , I- (WMS), Benton Visual Retention Test , D- (BVRT), Raven Coloured Progressive Matrices (RCPM), Kohs' test (KT), Judgement of Lines Orientation , H- (JLO), Facial Recognition (FR) and Aachner Aphasie Test (AAT). They also underwent Clinical Depression Scale (CDQ) and State-Trait Anxiety Inventory (STAI). Results , The results show the presence of significant memory impairment on both WMS (P = 0.000) and BVRT (P = 0.000) in patients compared with controls. Patients were also impaired in abstract reasoning and problem-solving deficit (KT P = 0.003; RCPM P = 0.000) and in FR (P = 0.019). Cognitive decline correlated with illness duration (r = 0.761), but was independent of EDSS (r = 0.085). Conclusion , Cognitive decline was present even when physical disability was not yet severe, but it was mild and did not limit patients' ability to work. The cognitive impairment outlined was of the subcortical type and correlated with illness duration. This study emphasizes the importance of cognitive examination in clinical practice. It is suggested that a complete neurological examination include tests on memory and abstract reasoning. [source] Method for coronary angiography in morbidly obese patientsCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2005William G. Kussmaul III MD Abstract Cardiac catheterization in morbidly obese patients is difficult. In addition to problems regarding vascular access and radiographic penetration of the chest, the engineering parameters and physical limitations of the table and its supporting structures may limit these patients' ability to undergo clinically indicated coronary angiography. We describe a method for cardiac catheterization in which much of the obese patient's body weight is supported on a stretcher placed at right angles to the catheterization table, with only the thorax on the table under the image intensifier. Using this method, five consecutive successful diagnostic procedures and one coronary stent procedure have been performed without complication. Limitations of this procedure include inability to achieve the normal variety of angiographic views due to constraints on image intensifier rotation and skew. © 2005 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||