ASSESSING CANDIDACY FOR INTENSIVE LANGUAGE THERAPY: A PRELIMINARY STUDY

The goal of the present study was to examine changes in the speech and language performance of patients with chronic, non-fluent aphasia over the course of a three-hour group speech and language treatment session, a time allotment comparable to intensive therapy practices. Nine participants, (three groups of three), with chronic, non-fluent aphasia were seen for a single group therapy session three hours in length. Therapeutic activities were designed to be as similar as possible for each group of participants. Each participant was individually assessed before (time 1), during (time 2), and after (time 3) the group treatment session. Assessments included four verbal tests: function, naming, sentence completion, and repetition, similar to those used with the Porch Index of Communicative Ability (PICA; Porch, 1981). Results indicated that participants performed significantly poorer on two of the four verbal tests (naming and repetition), and on an overall measure of verbal communication on the Time 2 assessment as compared to the Time 1 assessment. Findings have clinical implications for selecting candidates for intensive language therapy regimes

Assessment of chronic postsurgical pain after knee replacement : a systematic review

Objective: Approximately 20% of patients experience chronic pain after total knee replacement (TKR), yet there is no consensus about how best to assess such pain. This systematic review aimed to identify measures used to characterise chronic pain after TKR. Methods: MEDLINE, Embase, PsycINFO, Cochrane Library and CINAHL databases were searched for research articles published in all languages from January 2002- November 2011. Articles were eligible for inclusion if they assessed knee pain at a minimum of 3-months after TKR, yielding a total of 1,164 articles. Data extracted included study design, country, timings of assessments, and outcome measures containing pain items. Outcome measures were compared with domains recommended by IMMPACT for inclusion in assessment of chronic pain related outcomes within clinical trials. Temporal trends were also explored. Results: The review found use of a wide variety of composite and single-item measures, with the American Knee Society Score most common. Many measures used in published studies do not capture the multi-dimensional nature of pain recommended by IMMPACT; of those commonly used, the WOMAC and Oxford Knee Score are most comprehensive. Geographical trends were evident, with nation-specific preferences for particular measures. A recent reduction in use of some clinically-administered tools was accompanied by increased use of patient-reported outcome measures. Conclusion: There was wide variation in methods of pain assessment alongside nation-specific preferences and changing temporal trends in pain assessment after TKR. Standardisation and improvements in assessment is needed to enhance the quality of research and facilitate the establishment of a core outcome set

Comparing Substance Use Social Issues in Appalachian and non-Appalachian Regions in Kentucky

Substance use and abuse is not a uniquely Appalachian problem, but it remains a prevalent social problem for the geographical region. Kentucky has been one of the central states experiencing generations of substance abuse, ranging from methamphetamines to OxyContin to heroin. Eastern Kentucky, which includes a portion of Central Appalachia, has been a focal point for the proposed war against substance use. What remains undemonstrated in studies is exactly how substance abuse differs between the Central Appalachian counties of Eastern Kentucky and the remainder of the state, if any difference exists at all. In this study, the researchers examine how drug mortality, nonfatal overdoses, emergency room substance abuse diagnoses, and inpatient hospital substance abuse rates vary between Appalachian and non-Appalachian counties in Kentucky. Results indicate that there is a marginal difference in drug fatalities and a statistical difference in both emergency room and inpatient diagnoses of substance abuse. However, the non-fatal overdose rate is nearly identical for Appalachian and non-Appalachian counties across the state. The authors argue this can be explained through Relative Deprivation Theory, persistent underdevelopment of Kentucky’s Appalachian counties, and medical use practices in the region. The researchers close with recommendations on reconsidering how substance use is treated

Towards a conceptual framework demonstrating the effectiveness of audiovisual patient descriptions (patient video cases): a review of the current literature

Background: Technological advances have enabled the widespread use of video cases via web-streaming and online download as an educational medium. The use of real subjects to demonstrate acute pathology should aid the education of health care professionals. However, the methodology by which this effect may be tested is not clear. Methods: We undertook a literature review of major databases, found relevant articles relevant to using patient video cases as educational interventions, extracted the methodologies used and assessed these methods for internal and construct validity. Results: A review of 2532 abstracts revealed 23 studies meeting the inclusion criteria and a final review of 18 of relevance. Medical students were the most commonly studied group (10 articles) with a spread of learner satisfaction, knowledge and behaviour tested. Only two of the studies fulfilled defined criteria on achieving internal and construct validity. The heterogeneity of articles meant it was not possible to perform any meta-analysis. Conclusions: Previous studies have not well classified which facet of training or educational outcome the study is aiming to explore and had poor internal and construct validity. Future research should aim to validate a particular outcome measure, preferably by reproducing previous work rather than adopting new methods. In particular cognitive processing enhancement, demonstrated in a number of the medical student studies, should be tested at a postgraduate level

Counselling in primary care : a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost-effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non-specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost-effectiveness trials are needed together with surveys of more typical users of primary care services

Near-IR spectroscopy of PKS1549-79: a proto-quasar revealed?

We present a near-IR spectrum of the nearby radio galaxy PKS1549-79 (z=0153). These data were taken with the aim of testing the idea that this object contains a quasar nucleus that is moderately extinguished, despite evidence that its radio jet points close to our line-of-sight. We detect broad Paschen Alpha emission (FWHM ~1745 km/s), relatively bright continuum emission, and a continuum slope consistent with a reddened quasar spectrum (3.1 < Av < 7.3), all emitted by an unresolved point source. Therefore we conclude that we have, indeed, detected a hidden quasar nucleus in PKS1549-79. Combined with previous results, these observations are consistent with the idea that PKS1549-79 is a young radio source in which the cocoon of debric left over from the triggering events has not yet been swept aside by circumnuclear outflows.Comment: 6 pages, 4 figures, accepted for publication in MNRA

Hip disability and osteoarthritis outcome score (HOOS) – validity and responsiveness in total hip replacement

BACKGROUND: The aim of the study was to evaluate if physical functions usually associated with a younger population were of importance for an older population, and to construct an outcome measure for hip osteoarthritis with improved responsiveness compared to the Western Ontario McMaster osteoarthritis score (WOMAC LK 3.0). METHODS: A 40 item questionnaire (hip disability and osteoarthritis outcome score, HOOS) was constructed to assess patient-relevant outcomes in five separate subscales (pain, symptoms, activity of daily living, sport and recreation function and hip related quality of life). The HOOS contains all WOMAC LK 3.0 questions in unchanged form. The HOOS was distributed to 90 patients with primary hip osteoarthritis (mean age 71.5, range 49–85, 41 females) assigned for total hip replacement for osteoarthritis preoperatively and at six months follow-up. RESULTS: The HOOS met set criteria of validity and responsiveness. It was more responsive than WOMAC regarding the subscales pain (SRM 2.11 vs. 1.83) and other symptoms (SRM 1.83 vs. 1.28). The responsiveness (SRM) for the two added subscales sport and recreation and quality of life were 1.29 and 1.65, respectively. Patients ≤ 66 years of age (range 49–66) reported higher responsiveness in all five subscales than patients >66 years of age (range 67–85) (Pain SRM 2.60 vs. 1.97, other symptoms SRM 3.0 vs. 1.60, activity of daily living SRM 2.51 vs. 1.52, sport and recreation function SRM 1.53 vs. 1.21 and hip related quality of life SRM 1.95 vs. 1.57). CONCLUSION: The HOOS 2.0 appears to be useful for the evaluation of patient-relevant outcome after THR and is more responsive than the WOMAC LK 3.0. The added subscales sport and recreation function and hip related quality of life were highly responsive for this group of patients, with the responsiveness being highest for those younger than 66