Suppressed Working Memory on the WMS-III as a Marker for Poor Effort

The purpose of this study was to examine the clinical utility of memory minus Working Memory Index (memory-WMI) discrepancy scores on the WMS-III for detecting poor effort in 145 personal injury litigants (19 poor effort, 126 adequate effort). On average, participants in the poor effort group performed significantly lower on all WMS-III memory indexes and demonstrated larger memory-WMI discrepancy scores compared to participants in the adequate effort group. Discriminant function analyses using memory-WMI discrepancy scores as independent variables revealed poor overall classification rates (60.0% to 63.4%). Based on the prevalence of unusually suppressed attention-concentration ability relative to memory functioning using unidirectional memory-WMI discrepancy scores, high specificity and negative predictive power values were found. However, there was unacceptably low sensitivity and positive predictive power. These results suggest that memory-WMI discrepancy scores on the WMS-III do not provide clinically useful information regarding response set and should be used cautiously as an indicator of poor effort.

Host cell tropism of equine herpesviruses: glycoprotein D of EHV-1 enables EHV-4 to infect a non-permissive cell line

Equine herpesviruses 1 and 4 (EHV-1 and EHV-4) cause equine respiratory disease worldwide. However, only EHV-1 is a cause of abortion and neurological disease, despite the two viruses having all 76 genes in common. In addition EHV-1 has a broader host range in cell culture than EHV-4, as exemplified by the rabbit kidney (RK) cell line that is permissive for EHV-1, but not for EHV-4. Here we describe that when EHV-4 produced in equine cells was inoculated onto RK cells expressing glycoprotein D of EHV-1 (RKgD1), infection developed as clusters of rounded cells, and this infectivity could be passaged in RKgD1 cells. The progeny virus could also infect single RK cells, consistent with EHV-4 acquiring EHV1 gD from the complementing cell line. No such infection was observed for EHV-4 in RK cells expressing EHV-1 glycoprotein C. The results are consistent with gD homologues being major determinants of host cell tropism and raise the possibility that gD may be a factor in the differential pathogenicity of EHV-1 and EHV-4.

What about the carers?: Exploring the experience of caregivers in a chemotherapy day hospital setting

Interest in the concerns of cancer patients' carers has been growing steadily over the last decade reflected in key cancer service policy documents [DOH, 1995. A Policy Framework for Commissioning Cancer Services (Calman-Hine Report). London, HMSO; DOH, 2002. The NHS Cancer Plan]. Despite this acknowledgement, it can be argued that less is known about carers' experience in the cancer treatment context. Carers can be defined as someone who shares the experience of cancer with the patient. The aim of this study was to explore the lived experience of caregivers in a chemotherapy day hospital and how this compared with their experience of inpatient care. Using a phenomenological approach, face-to-face interviews were conducted with a purposive sample of ten caregivers. Data were analysed using Polkinghorne's [1995. Narrative Knowing & the Human Sciences. University of New York Press, Albany] two stages of narrative analysis. The findings indicated that the caregivers experienced similar transitions to the patients with regards to health-illness transition and organisational transitions. The caregivers adopted various roles in the day hospital such as Companion 'being with' their relative, Protector 'keeping an eye'; Practical Caregiver and assuming an Advocate Role. The findings of this study are important for cancer nursing practice as health professionals need to acknowledge the role of carers in the chemotherapy day hospital setting and facilitate their involvement in care.

Ecological Validity of the WMS-III Rarely Missed Index in Personal Injury Litigation

The purpose of this study was to evaluate the clinical utility of the Rarely Missed Index (RMI) to detect cognitive exaggeration in 78 nonlitigant patients (i.e., Mixed Clinical group) and 158 personal injury litigants (i.e., 20 Suspected Exaggerators, 12 Borderline Exaggerators, 126 Genuine Responders). The base rate for probable malingered neurocognitive dysfunction in the litigant sample was 12.7%. The false positive error rate of the RMI in the Genuine Responder and Mixed Clinical group ranged from 5.4% to 8.6%. Positive RMI scores were found in 25% and 41.7% of the Suspected Exaggerator and Borderline Exaggerator groups respectively. The clinical utility of the RMI to identify Suspected Exaggerators versus individuals in the Genuine Responder and Mixed Clinical groups revealed low sensitivity (sensitivity = .25), very high specificity (range = .91 to .95), moderate positive predictive power (range = .50 to .71), and moderate to high negative predictive power (range = .68 to .83). These results do not support the use of the RMI as a reliable predictor of cognitive exaggeration.

FBN1, TGFBR1, and the Marfan-craniosynostosis/mental retardation disorders revisited

The recent identification of TGFBR2 mutations in Marfan syndrome II (MFSII) [Mizuguchi et al. (2004); Nat Genet 36:855-860] and of TGFBR1 and TGFBR2 mutations in Loeys-Dietz aortic aneurysm syndrome (LDS) [Loeys et al. (2005); Nat Genet 37:275-281] [OMIM 609192] has provided direct evidence of abnormal signaling in transforming growth factors beta (TGF-beta) in the pathogenesis of Marfan syndrome (MFS). In light of this, we describe the phenotypes and genotypes of five individuals. Patient 1 had MFS and abnormal cranial dura. Patient 2 had severe early onset MFS and an abnormal skull. Patients 3 and 4 had probable Furlong syndrome (FS). Patient 5 had marfanoid (MD) features, mental retardation (MR), and a deletion of chromosome 15q21.1q21.3. All patients had a condition within the MFS, MD-craniosynostosis (CS) or MD-MR spectrum. The names of these entities may become redundant, and instead, come to be considered within the spectrum of TGF-beta signaling pathway disorders. Two recurrent heterozygous FBN1 mutations were found in Patients 1 and 2, and an identical novel heterozygous de novo TGFBR1 mutation was found in Patients 3 and 4, in whom altered fibrillin-1 processing was demonstrated previously [Milewicz et al. (2000); Am J Hum Genet 67:279]. A heterozygous FBN1 deletion was found in Patient 5. These findings support the notion that perturbation of extracellular matrix homeostasis and/or remodeling caused by abnormal TGF-beta signaling is the core pathogenetic mechanism in MFS and related entities including the MD-CS syndromes.

Patients with head and neck cancer prefer individualized cognitive behavioural therapy

Cognitive behaviour therapy (CBT) is a widely practiced and approved form of psychotherapy for many psychosocial difficulties. As the efficacy of CBT is recognized, its demand has increased and today exceeds the availability of qualified practitioners. Therefore, the effectiveness of delivering CBT using less labour-intensive modes than individualised therapy has been explored. These include group therapy, bibliotherapy and computer assisted therapy. Given the UK Government's impetus towards patient choice and involvement in the planning of healthcare, it was thought essential to ascertain the preferred delivery mode of patients with head and neck cancer for a CBT based intervention. Therefore, a small retrospective cohort (n= 28) of patients following treatment for head and neck cancer were sent postal questionnaires to ascertain their preferences on mode of CBT delivery. Simultaneously, the views of accredited cognitive behaviour therapists (n= 14) were determined on the optimal mode of CBT delivery to these patients. Findings indicated that patients preferred the more individualized mode of CBT delivery, namely one-to-one therapy, followed closely by bibliotherapy, with group format being the least preferred option. Professionals concurred with patients, in that one-to-one interaction was considered an optimal mode of CBT delivery, but professionals considered it equal to group therapy.

Exploring the ethical issues of the research interview in the cancer context

This paper sets out to reflect on ethical issues in the context of a study exploring cancer patients', relatives' and nurses' experience of a day hospital chemotherapy service. Interviewing can be considered as a well-used approach within qualitative methodology, yet little attention has been paid to a many of the ethical deliberations that are inherent when adopting this approach, particularly in the context of cancer. It is the intention of the authors that this paper might raise awareness of these issues, contribute to the ongoing debate about conducting research interviews on sensitive topics and provide a 'real-world' application of these principles. It is considered that the article potentially raises more questions that answers and illustrates that there are not always quick-fix solutions for the 'real-world' problems qualitative researchers' experience.

Impact of animal health and welfare research within the CRC for Cattle and Beef Quality on Australian beef production

Research within the health and welfare program of the Cooperative Research Centre for Cattle and Beef Quality has delivered important improvements to the Australian cattle industry. Vaccines to assist with the control of bovine respiratory disease were developed and commercialised from Australian isolates of Mannheimia haemolytica and pestivirus (mucosal disease). Our understanding of the benefits of weaning cattle by confinement and hand feeding in yards (yard weaning) has been consolidated, and yard weaning has been adopted as ‘best practice’ for cattle production in the temperate zones of Australia. The importance of good temperament for improved growth rates and reduced morbidity during feedlot finishing, and for adaptation to stressors such as road transport, has been demonstrated. In response to this knowledge, industry is increasingly measuring flight time for use in breeding programs and feedlot management. The risk to meat quality of stressors such as mixing unfamiliar cattle in the weeks preceding slaughter or acute stress in the last 15 min before slaughter has been described. Adoption of these findings through Quality Assurance schemes will assist in assurance for the community and for export markets of the welfare standards of the Australian cattle and beef industry. This review provides details of the experiments that led to these achievements and to some improved understandings of temperament and behaviour of beef cattle.

Attitudes towards the diagnosis of Alzheimer's disease among carers and non-carers

This article provides some preliminary data on preferences among non-carer older adults regarding disclosure of Alzheimer's disease (AD) diagnosis, and compares these preferences to those of carers of people with AD (AD carers). Reasons underlying disclosure preference among carers and non-AD carers are investigated. The authors then explore the level of AD knowledge among carer and non-carer samples and investigate its relationship with disclosure preferences.

Participants were 20 elderly adults (aged 60–88 years) who were not caring for a relative with AD and 16 older adults (aged 51–79 years) who were caring for a relative with AD and who had attended a carer education programme. Participants completed a modified AD knowledge test and a test designed to measure the reasons for and against disclosure of an AD diagnosis.

AD knowledge among AD carers was significantly higher than that among non-carers. Views about disclosure of AD diagnoses did not differ between groups and generally, opinions were for disclosure. No significant differences were found when preferences for disclosure for oneself vs a significant other were compared. Similar reasons for disclosure were given by carers and non-carers, and included factors such as the person's right to know his or her diagnosis.

Alternate forms of prose passages for the assessment of auditory-verbal memory

Logical memory (LM) is the most frequently administered subtest from the Wechsler Memory Scale; however, the lack of alternate equivalent forms for this subtest may limit its clinical utility. Six new paragraphs modelled on LM stories were developed. Stories were matched on attributes such as number of words and readability. Passage attributes for the six stories were compared with those of standard LM stories (WMS-R and WMS-III versions) to examine story equivalence. The psychometric properties of new passages were also calculated to assess task difficulty and interrater reliability. Results from these analyses suggest a high degree of overlap between the attributes of the new stories and some interesting discrepancies between passage attributes of WMS-R and WMS-III LM stories. In addition, interrater reliability of new passages was found to be excellent (at least .97), and when combined into three sets of passage-pairs, these pairs were found have equivalent difficulty. To reduce the potential for practice effects by use of alternate forms, these new logical memory-style passages may facilitate repeat assessment of auditory-verbal memory.

Two new tools for assessing patients' knowledge and beliefs about obstructive sleep apnea and continuous positive airway pressure therapy

BACKGROUND AND PURPOSE

Patients' knowledge and beliefs about their illnesses are known to influence a range of health related variables, including treatment compliance. It may, therefore, be important to quantify these variables to assess their impact on compliance, particularly in chronic illnesses such as Obstructive Sleep Apnea (OSA) that rely on self-administered treatments. The aim of this study was to develop two new tools, the Apnea Knowledge Test (AKT) and the Apnea Beliefs Scale (ABS), to assess illness knowledge and beliefs in OSA patients.

PATIENTS AND METHODS

The systematic test construction process followed to develop the AKT and the ABS included consultation with sleep experts and OSA patients. The psychometric properties of the AKT and ABS were then investigated in a clinical sample of 81 OSA patients and 33 healthy, non-sleep disordered adults.

RESULTS

Results suggest both measures are easily understood by OSA patients, have adequate internal consistency, and are readily accepted by patients. A preliminary investigation of the validity of these tools, conducted by comparing patient data to that of the 33 healthy adults, revealed that apnea patients knew more about OSA, had more positive attitudes towards continuous positive airway pressure (CPAP) treatment, and attributed more importance to treating sleep disturbances than non-clinical groups.

CONCLUSIONS

Overall, the results of psychometric analyses of these tests suggest these measures will be useful clinical tools with numerous beneficial applications, particularly in CPAP compliance studies and apnea education program evaluations.

Frequency of insomnia report in patients with obstructive sleep apnoea hypopnea syndrome (OSAHS)

BACKGROUND AND PURPOSE

Insomnia and Obstructive Sleep Apnoea Hypopnea Syndrome (OSAHS) are the two most common sleep disorders, and both have significant associated health costs. Despite this, relatively little is known about the prevalence or impact of insomnia in those with OSAHS, although a recent study suggested there may be substantial comorbidity between these disorders [Chest 120 (2001) 1923-9]. The primary aim of this study was to further explore the prevalence of insomnia in OSAHS. A secondary aim was to assess the effect of factors that may impact on both conditions, including mood and sleep-beliefs.

PATIENTS AND METHODS

Consecutive patients referred to an accredited Sleep Investigations Unit [n = 105] completed a brief standardized battery of validated questionnaires assessing sleep-related variables and mood.

RESULTS

Results showed a high rate of prevalence of clinical insomnia in this OSAHS population, and a strong positive correlation between OSAHS and insomnia symptom severity. Further, OSAHS patients with comorbid insomnia had increased levels of depression, anxiety and stress compared to patients with OSAHS-only, and both patient groups reported similar and significant levels of dysfunctional beliefs about sleep. Findings in relation to habitual sleep, assessed using subjective (diary) and objective criteria (polysomnogram), were mixed but generally showed greater sleep disturbance among those with OSAHS-insomnia compared to those with OSAHS-only.

CONCLUSIONS

Overall these findings suggest that comorbidity of insomnia in OSAHS patients may lead to increased OSAHS severity and that patients with both conditions may experience more symptoms relating to depression, anxiety and stress. These findings underscore the need for insomnia assessment and management services, even in clinics that primarily service patients with OSAHS.

Neuropsychological Assessment of Mental Capacity

The assessment of mental capacity to assist legal determinations of competency is potentially a growth area for neuropsychology, although to date neuropsychologists have published relatively little in this area. In this paper a systematic review of methods used to assess capacity is presented, including coverage of specialized tests and interviews used for this purpose. A neuropsychological model for conducting capacity assessments is proposed. This model involves comprehensive assessment of a wide range of cognitive abilities as well as assessment of specific skills and knowledge related to the type of capacity being assessed. The purpose of proposing this model is to stimulate further discussion and debate about the contribution neuropsychologists might make in this area.

Community partnerships for an LPN to BSN career mobility project

Based on a 6-year, learn and earn curriculum, the authors report on a year-old project that assists licensed practical nurses (LPNs) to obtain a baccalaureate degree in nursing (BSN). Partnerships with 4 area healthcare agencies employing LPNs were developed to support students with full or partial tuition reimbursement and work schedules to accommodate classes. Key university staff in the offices of admissions, financial aid, adult programs and services, and nursing advisement are assigned to this student group to provide individualized assistance. The authors discuss unique components of the project including regularly scheduled role transition seminars, faculty mentors, BSN and nurse practitioner clinical mentors, and clinical experiences in nurse-managed clinics.

A readability analysis of Australian stroke information

The aims of this study were to document the readability of a stroke education brochure and to illustrate how the readability of this document might be improved. Readability analyses using three different formulas were conducted on a stroke education brochure from the Australian National Stroke Foundation. Consistent with previous studies of the readability of written health information, results indicated that the overall level of difficulty of the material was too complex for the average member of the public to read and understand. Revision of a randomly selected section of text using established guidelines for writing patient information, and subsequent reanalysis of this section, showed that simple revisions of health literature can dramatically improve readability. Given the importance of effective communication of preventative information about stroke, we present these results as a model of how future revisions of difficult to read stroke-related literature might be conducted to improve public education.

Ataxia-telangiectasia: the pattern of cerebellar atrophy on MRI

We describe MRI of the brain in 19 patients with ataxia-telangiectasia (AT) and correlate the appearances with the degree of neurologic deficit. We examined 10 male and nine female patients; 17 were aged between 2 and 12 years (mean 8 years) but a woman and her brother were 35 and 38 years old, and had a variant of AT. Ataxia was the first recognized sign of the disease in every patient. We detected the following patterns of cerebellar atrophy: in the youngest patient, aged 2 years, the study was normal; in the five next youngest patients 3-7 years of age, the lateral cerebellum and superior vermis showed the earliest changes of atrophy; and all but one of the other patients had moderate to marked diffuse atrophy of vermis and cerebellar hemispheres. There were 12 patients aged 9 years and above; one, who was normal, was 9 years old. The five patients who at the time of examination were unable to walk all had diffuse atrophy involving both vermis and cerebellar hemispheres.