A Longitudinal Study Evaluating the Effects of Interferon-Alpha Therapy on Cognitive and Psychiatric Function in Adults with Chronic Hepatitis C

Objective: To prospectively evaluate for changes in objective cognitive performance (attention, memory, and executive function) and psychiatric symptom severity (depression, anxiety, fatigue, and pain) in patients before, during and after interferon-alpha based therapy (IFN) for chronic hepatitis C virus infection (HCV). Methods: 33 HCV+ adults were evaluated two months before IFN initiation (baseline), three months into IFN, and six months following IFN termination (IFN+ Group). 31 HCV+ adults who did not undergo IFN therapy were evaluated at baseline and six months later (IFN− Group). At each evaluation, participants completed the Neuropsychological Assessment Battery (NAB) Attention, Memory and Executive Functions Modules, the Beck Depression Inventory, Second Edition (BDI), Generalized Anxiety Disorder Inventory (GADI), Fatigue Severity Scale (FSS), and Brief Pain Inventory (BPI). Results: Compared with the IFN− Group, the IFN+ Group experienced significantly (p b 0.050) increased symp-toms of depression, anxiety, fatigue and pain during IFN therapy relative to baseline. In the IFN+ Group, psychi-atric symptoms generally returned to baseline levels following IFN termination. Sustained viral response was associated with significantly lower depression and fatigue. No significant changes in cognitive performance were observed. Conclusions: During IFN, patients with HCV evidence significantly increased psychiatric symptoms, including symptoms of depression, anxiety, fatigue and pain. These psychiatric symptoms are generally short-term and remit following IFN termination, with increased benefit if viral clearance is achieved. However, IFN is not associated with significant declines in objective cognitive performance during or following IFN

Iconic dishes, culture and identity: the Christmas pudding and its hundred years’ journey in the USA, Australia, New Zealand and India

Asserting that recipes are textual evidences reflecting the society that produced them, this article explores the evolution of the recipes of the iconic Christmas pudding in the United States, Australia, New Zealand and India between the mid-nineteenth and the mid-twentieth centuries. Combining a micro-analysis of the recipes and the cookbook that provided them with contemporary testimonies, the article observes the dynamics revealed by the preparation and consumption of the pudding in these different societies. The findings demonstrate the relevance of national iconic dishes to the study of notions of home, migration and colonization, as well as the development of a new society and identity. They reveal how the preservation, transformation and even rejection of a traditional dish can be representative of the complex and sometimes conflicting relationships between colonists, migrants or new citizens and the places they live in

Models of classroom assessment for course-based research experiences

Course-based research pedagogy involves positioning students as contributors to authentic research projects as part of an engaging educational experience that promotes their learning and persistence in science. To develop a model for assessing and grading students engaged in this type of learning experience, the assessment aims and practices of a community of experienced course-based research instructors were collected and analyzed. This approach defines four aims of course-based research assessment—(1) Assessing Laboratory Work and Scientific Thinking; (2) Evaluating Mastery of Concepts, Quantitative Thinking and Skills; (3) Appraising Forms of Scientific Communication; and (4) Metacognition of Learning—along with a set of practices for each aim. These aims and practices of assessment were then integrated with previously developed models of course-based research instruction to reveal an assessment program in which instructors provide extensive feedback to support productive student engagement in research while grading those aspects of research that are necessary for the student to succeed. Assessment conducted in this way delicately balances the need to facilitate students’ ongoing research with the requirement of a final grade without undercutting the important aims of a CRE education

Acceptability and Face Validity of a Geriatric Self-Medication Assessment Tool

ABSTRACTBackground: A majority of community-dwelling older adults manage their own medication regimens. This study describes the development and first phase of testing of the Self-Medication Assessment Tool (SMAT), designed to screen for cognitive and functional deficits in relation to medication self-management among community-dwelling geriatric patients.Objective: To evaluate the face validity of the SMAT and to determine its acceptability among pharmacists.Methods: An instrument was designed, with 5 assessment scales to measure function, cognition, medication recall, and 2 aspects of adherence. The instrument included a standardized test kit and instructions for testers. Focus groups interviews, individual interviews, and surveys were used to determine the reactions of community and hospital-based pharmacists to the tool. Transcripts of the focus group and individual interviews were coded for main themes. Pharmacists’ ratings of usefulness, thoroughness, and ease of use, as well as their willingness to use the instrument, were compared with a neutral rating on a 7-point scale by means of 1-sample t tests.Results: Focus group interviews or individual interviews were conducted with 17 pharmacists and 3 pharmacy students (out of a potential population of about 300) who responded to an invitation to participate. The pharmacists felt that the tool would be useful in identifying difficulties with medication management and potential interventions, and they expressed a willingness to use it in their respective practices. Pharmacists working in hospital settings were slightly more willing than community pharmacists to use the tool. Interviewees highlighted ways to improve the tool before testing of its psychometric properties in the planned second phase of this project.Conclusions: The SMAT had strong face validity and was particularly acceptable for use by pharmacists in hospital settings.RÉSUMÉContexte : Une majorité d’adultes âgés vivant dans la communauté gèrent eux-mêmes la prise de leurs médicaments. Cette étude décrit la mise au point et la phase initiale de la validation d’un outil d’évaluation de l’automédication (OEAM) conçu pour dépister les déficits cognitifs et fonctionnels relatifs à l’augotestion des médicaments chez les patients gériatriques vivant dans la communauté.Objectif : Évaluer la validité apparente de l’OEAM et déterminer son acceptabilité chez les pharmaciens.Méthodes : Un outil comportant cinq échelles d’évaluation a été conçu pour mesurer les capacités fonctionnelles, la cognition, le rappel des connaissances sur les médicaments et deux aspects de l’observance. L’outil était pourvu d’une trousse de validation standardisée et d’instructions pour les essayeurs. Des entrevues de groupe, des entrevues individuelles et des sondages ont été utilisés pour déterminer les réactions des pharmaciens communautaires et hospitaliers face à l’outil. Les transcriptions des entrevues de groupe et des entrevues individuelles ont été codées pour ce qui est des principaux thèmes. Les notations des pharmaciens quant à l’utilité, à la rigueur et à la facilité d’emploi, ainsi qu’à leur propension à l’utilisation ont été comparées à une notation objective sur une échelle de sept points à l’aide de tests t pour échantillon unique.Résultats : Les entrevues de groupe ou individuelles ont été menées chez 17 pharmaciens et trois étudiants en pharmacie (provenant d’une population potentielle d’environ 300) qui ont accepté l’invitation à participer. Les pharmaciens ont estimé que l’outil serait utile pour cerner les difficultés de gestion des médicaments et les interventions potentielles, et ils ont exprimé leur propension à l’utiliser dans leur milieu d’exercice respectif. Les pharmaciens en milieu hospitalier étaient un peu plus enclins à utiliser l’outil que leurs collègues du secteur communautaire. Les interviewés ont souligné des façons d’améliorer l’outil avant d’en tester les propriétés psychométriques dans la deuxième phase anticipée de ceprojet.Conclusions : L’OEAM avait une validité apparente élevée et son utilisation était particulièrement acceptable par les pharmaciens en milieu hospitalier

Creating a New Social Emergency Medicine Curriculum: A Needs Assessment

Learning Objectives: We sought to understand social EM curricular needs.Background: Addressing social determinants of health is a crucial part of emergency medicine (EM). However, training in social EM is variable. Objective: We sought to understand social EM curricular needs.Methods: We performed a mixed methods needs assessment of residents and faculty at two academic training sites. Residents were emailed an online survey of multiple choice, rating scale, and free response items that was piloted prior to use. We conducted semi-structured interviews with faculty. We performed descriptive analysis on survey data. Two qualitative researchers independently analyzed interview data using a thematic approach. Discrepancies were resolved by in-depth discussion and negotiated consensus. Results: 43 out of 120 residents completed the online survey and 6 faculty were interviewed. 34 residents (79%) stated they were “Not knowledgeable” or “Somewhat knowledgeable” about the field of Social EM. 34 (79%) reported that education in Social EM is “Very” or “Extremely” important to them, and 37 (86%) responded that Social EM is “Very” or “Extremely” important to the field of EM. Faculty reported that Social EM is crucial given its importance to patient health. They felt this education should be longitudinal and begin early in medical training. Faculty recommended core content, hands-on experiences, and partnering with local community resources. They also noted that leadership support and faculty buy-in was important to the success of Social EM education.Conclusion: Residents and faculty believe Social EM is a cornerstone of emergency medicine. Important curricular areas and educational strategies were identified. These results can inform the development of formal Social EM curricula

Compulsively seeking certainty: Clarifying the association between intolerance of uncertainty and compulsion severity in OCD

Intolerance of uncertainty (IU), the dispositional tendency to fear the unknown, has clinical implications across a variety of disorders. While research has linked IU and OCD, relatively little is known about this association. Previous studies have focused on IU’s association with overall OCD severity and specific symptom dimensions, but we do not yet understand to what degree this cognitive vulnerability is associated with each of the two cardinal symptoms: obsessions and compulsions. Additionally, few studies have examined the established IU subtypes—prospective and inhibitory IU—as unique contributors to OCD severity. Given the ubiquity of uncertainty in daily life and the potential for IU to influence obsessive-compulsive processes, further investigation of this cognitive vulnerability in OCD is warranted. In a sample of patients diagnosed with OCD, partial correlations were conducted to determine the association between OCD severity (separately examining obsessions and compulsions) and IU (separately examining prospective and inhibitory IU). These analyses revealed positive correlations between IU and compulsion severity, specifically. And of the IU subtypes, this link was specifically associated with prospective IU. The results of this correlational study contribute to the literature on IU in OCD, suggesting prospective IU as a cognitive mechanism that may be involved in the maintenance of compulsions

ARTICLE Acceptability and Face Validity of a Geriatric Self-Medication Assessment Tool

Background: A majority of community-dwelling older adults manage their own medication regimens. This study describes the development and first phase of testing of the Self-Medication Assessment Tool (SMAT), designed to screen for cognitive and functional deficits in relation to medication self-management among community-dwelling geriatric patients. Objective: To evaluate the face validity of the SMAT and to determine its acceptability among pharmacists. Methods: An instrument was designed, with 5 assessment scales to measure function, cognition, medication recall, and 2 aspects of adherence. The instrument included a standardized test kit and instructions for testers. Focus groups interviews, individual interviews, and surveys were used to determine the reactions of community and hospital-based pharmacists to the tool. Transcripts of the focus group and individual interviews were coded for main themes. Pharmacists’ ratings of usefulness, thoroughness, and ease of use, as well as their willingness to use the instrument, were compared with a neutral rating on a 7-point scale by means of 1-sample t tests. Results: Focus group interviews or individual interviews were conducted with 17 pharmacists and 3 pharmacy students (out of a potential population of about 300) who responded to an invitation to participate. The pharmacists felt that the tool would be useful in identifying difficulties with medication management and potential interventions, and they expressed a willingness to use it in their respective practices. Pharmacists working in hospital settings were slightly more willing than community pharmacists to use the tool. Interviewees highlighted ways to improve the tool before testing of its psychometric properties in the planned second phase of this project. Conclusions: The SMAT had strong face validity and was particularly acceptable for use by pharmacists in hospital settings. Key words: medication therapy management, geriatric assessment, self-care, medication adherence, validation studie