Estimated pre-morbid IQ effects on cognitive and functional outcomes in Alzheimer disease: a longitudinal study in a treated cohort

Abstract Background Cognitive reserve is thought to influence the degree of neuropathology needed for diagnosis of Alzheimer disease (AD). Cognitive reserve can be operationally defined as the hypothesized capacity of the mature adult brain to sustain the effects of disease or injury without manifesting clinical symptoms of AD, but sufficient to cause clinical dementia in an individual possessing less cognitive reserve. Its effect on the subsequent course of AD is less clear. Pre-morbid IQ is a useful measure of cognitive reserve. Methods We studied 659 consecutive patients with AD at a tertiary referral memory clinic. Patients were assessed on six cognitive tests at baseline. Activities of Daily Living (ADL) were measured on the Instrumental Activities of Daily Living (IADL) scale and Physical Self-Maintenance Scale (PSMS). The National Adult Reading Test (NART) was used to estimate pre-morbid IQ. Patients were followed up after starting a cholinesterase inhibitor over 78 weeks. Mixed general linear models estimated the effects of NART on cognition and ADL. Results Three hundred and fifty-five patients had NART scored with a mean estimated pre-morbid IQ of 104.7 (standard deviation 18.5). NART increased overall cognitive ability by 2.7% for every 10 IQ points (p Conclusion Our data support the hypothesis that cognitive reserve continues to have a limited influence on cognition after AD has been diagnosed and thus, indirectly, has an impact on ADL.</p

Analytic philosophy for biomedical research: the imperative of applying yesterday's timeless messages to today's impasses

The mantra that "the best way to predict the future is to invent it" (attributed to the computer scientist Alan Kay) exemplifies some of the expectations from the technical and innovative sides of biomedical research at present. However, for technical advancements to make real impacts both on patient health and genuine scientific understanding, quite a number of lingering challenges facing the entire spectrum from protein biology all the way to randomized controlled trials should start to be overcome. The proposal in this chapter is that philosophy is essential in this process. By reviewing select examples from the history of science and philosophy, disciplines which were indistinguishable until the mid-nineteenth century, I argue that progress toward the many impasses in biomedicine can be achieved by emphasizing theoretical work (in the true sense of the word 'theory') as a vital foundation for experimental biology. Furthermore, a philosophical biology program that could provide a framework for theoretical investigations is outlined

Outcome of crisis intervention for borderline personality disorder and post traumatic stress disorder: a model for modification of the mechanism of disorder in complex post traumatic syndromes

<p>Abstract</p> <p>Background</p> <p>This study investigates the outcome of crisis intervention for chronic post traumatic disorders with a model based on the theory that such crises manifest trauma in the present. The sufferer's behavior is in response to the current perception of dependency and entrapment in a mistrusted relationship. The mechanism of disorder is the sufferer's activity, which aims to either prove or disprove the perception of entrapment, but, instead, elicits more semblances of it in a circular manner. Patients have reasons to keep such activity private from therapy and are barely aware of it as the source of their symptoms.</p> <p>Methods</p> <p>The hypothesis is that the experimental intervention will reduce symptoms broadly within 8 to 24 h from initiation of treatment, compared to treatment as usual. The experimental intervention sidesteps other symptoms to engage patients in testing the trustworthiness of the troubled relationship with closure, thus ending the circularity of their own ways. The study compares 32 experimental subjects with 26 controls at similar crisis stabilization units.</p> <p>Results</p> <p>The results of the Brief Psychiatric Rating Scale (BPRS) supported the hypothesis (both in total score and for four of five subscales), as did results with Client Observation, a pilot instrument designed specifically for the circular behavior targeted by the experimental intervention. Results were mostly non-significant from two instruments of patient self-observation, which provided retrospective pretreatment scores.</p> <p>Conclusions</p> <p>The discussion envisions further steps to ascertain that this broad reduction of symptoms ensues from the singular correction that distinguishes the experimental intervention.</p> <p>Trial registration</p> <p>Protocol Registration System NCT00269139. The PRS URL is <url>https://register.clinicaltrials.gov</url></p

The use of Eriksonian Hypnosis to improve patient outcomes in pharmacy practice: A novel communication skill for pharmacists

© 2016 Elsevier Inc. Motivational Interviewing, pharmacist-based health coaching and traditional patient counseling techniques all show merit in improving communication between patients and health care providers. However, in order to effectively utilize these techniques one should have the ability to draw upon internal cognitive and psychological resources. Some patients have difficulty obtaining optimal health outcomes due to an unconscious inability to learn and connect with psychological resources. When this is the case, other methods of communication may need to be considered. With the appropriate training, Eriksonian Hypnosis or the use of techniques such as hypnotic language patterns (HLP) have the potential to be implemented into pharmacy practice settings and assist those patients who have previously failed to make positive behavior changes and act upon their health issues

How do mental health first aid ™ interventions influence patient help-seeking behaviours? A dilemma for pharmacist mental health first aid responders

© 2018 Elsevier Inc. In any given year approximately 34% of the 130 million adults in the United States suffer from a mental health condition or disorder. Anxiety and depressive disorders are the most common followed by substance use disorder. Many people who suffer from a mental illness do not seek help. Studies have shown that the stigma of being perceived as having a mental illness prevents many adults from seeking help. Mental Health First Aid ™ (MHFA) is an educational program geared towards educating MHFA responders to assist those who may be experiencing a mental health condition or disorder. Pharmacists are the most accessible healthcare professionals, and many are trained in delivering MHFA. The literature on MHFA suggests that it is an effective educational program for those that take the training course. What is lacking is evidence that MHFA interventions positively affect help-seeking behaviours after an intervention has occurred between a mental health first air responder and an individual requiring MHFA. This paper highlights this issue and provides suggestions for future research

The role of reflective practice in healthcare professions: Next steps for pharmacy education and practice.

Reflective practice strategies can enable healthcare practitioners to draw on previous experiences to render more effective judgment in clinical situations. The central argument presented in this commentary is that education programs and structures for continuing professional development (CPD) and revalidation of professionals sharpen their focus regarding self-assessment to identify gaps in skills and attitudes rather than merely as a means of on-going monitoring. Pharmacy undergraduate and professional education need to promote reflective practice strategies that foster self-evaluation to promote pharmacists' readiness for practice change and advance patient care within rapidly expanding roles and scope of practice

Pharmacy students’ perceptions of ePortfolios in pharmacy education

© 2019 FIP. All rights reserved. Aims: To investigate perceptions of an ePortfolio structure, its utility to support pharmacy student learning, development of reflective capacity, and attainment of professional competencies. Methods: Mixed-methods two-phase study: Phase 1 (Quantitative): pre- and post-use, 6-item student survey; Phase 2 (Qualitative): 45-minute student focus group. Survey (n=49, RR 82%) and focus group respondents (n=12) provided their perceptions of ePortfolios. Statistically significant findings between Week 1 and Week 14 indicated that in addition to a time consuming exercise, students perceived that the current structure of the ePortfolio did not fully support their learning; development of their reflective capacity; self-directed learning skills; and professional practice. Conclusions: Pharmacy students perceived the ePortfolio needed improvements to reach its full potential. Students indicated that maintaining an ePortfolio is a useful tool to track professional competencies, linking digital evidence and reflections. Proposed suggestions were identified for improvement that would enable them to meet curricular competencies

Pharmacist-based health coaching: A new model of pharmacist-patient care

© 2016 Elsevier Inc. This paper describes a provider-patient communication process, which although not new to health care in general, is new to the pharmacy profession. Health coaching is a technique that empowers patients to make lasting health behavior changes that improve overall well-being. It provides patients with health care implementation options that better suit their lifestyle and abilities. Health coaching programs have the potential to foster better health outcomes, especially with patients who are chronically ill or represent an at risk population for medication non-adherence (e.g. elderly, patients on psychotropic medications). Other health professions (e.g. nursing and medicine) have had success with the implementation of health coaching models. For example, nurse coaching is recognized by the American Nurse Association and recent statistics show 3.1 million nurses in the U.S.A are also trained in nurse coaching. The pharmacy profession has yet to tap the patient-related benefits of health coaching. This commentary will discuss (i) The theoretical foundations of health coaching (ii) Distinctions between health coaching, motivational interviewing and traditional medication therapy counseling (iii) Training necessary for health coaching; and (iv) How pharmacists can use health coaching in practice

Assessing Pharmacy Student Self-Reported Empathic Tendencies

Objectives. The objective of this study was to analyze pharmacy students&apos; self-reported empathy scores before and after empathy training. Methods. In a communication skills course, the La Monica Empathy Profile (LEP) was administered to a convenience sample of fourth-year pharmacy students before and after they received empathy education. Outcome measures in this study were changes in any of the 5 LEP modes of empathy. A control group was not used. Results. Of the 92 students in the course, 83 (90.2%) completed the study. A significant increase in the LEP dimension of &quot;perceiving feelings and listening&quot; (p = 0.019), as well as &quot;respect of self and others&quot; (p = 0.006) was observed. There was a significant decrease in the dimension of &quot;openness, honesty and flexibility&quot; (p = 0.002). Conclusions. There may be an association between empathy training and changes in pharmacy students&apos; self-reported empathic attitudes and behaviors