Living With the Burden of Pseudobulbar Affect: A Qualitative Analysis of the Effects of Education on Patient Experience

The testamentary capacity in acute stroke. A cross-sectional study

Succession law, which governs the creation and validity of wills, is closely tied to testamentary capacity (TC), the cognitive competence required for a valid will. This study explores TC in acute stroke patients and its connections to demographic and clinical characteristics. The research included first-time stroke patients admitted within 24 hours of symptom onset, meeting specific criteria. Data were collected, and assessment tools like the Addenbrooke's Cognitive Examination III (ACE-III) and Testamentary Capacity Assessment Tool (TCAT) were used. The study found that TCAT scores were not significantly affected by age or gender but positively correlated with education, the Barthel Index and ACE-III scores. They were negatively associated with National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores. Specific cognitive domains, particularly memory and attention, were independent determinants of TCAT scores. This research introduces TCAT as a valuable tool for evaluating testamentary capacity in stroke patients and highlights the multifaceted nature of TC, emphasizing the need for a nuanced approach. As the population ages and complex medical conditions become more prevalent, understanding the interplay between cognitive functioning and testamentary capacity becomes increasingly crucial for both legal and medical professionals.

Pathological laughter and crying in neurological disorders: recognition and treatment

Pathological laughter and crying is a disabling symptom complex associated with damage to various central nervous system pathways that control the reflex motor component of emotional expression. Many underlying conditions-including neurodegenerative diseases, CNS inflammation, vascular lesions and traumatic brain injury-can be associated with disinhibition of emotional reflex control. This suggests a disruption of anatomical and functional networks, rather than any specific unifying pathological process. There is a wide differential diagnosis, including depression, dementia and other forms of behavioural disturbance. Diagnostic criteria and rating scales can help with clinical assessments and facilitate clinical trials. There is now good-quality evidence for a combination of dextromethorphan and quinidine, with weaker evidence for tricyclic and selective serotonin reuptake inhibitor antidepressants. Pathological laughter and crying is disabling and underdiagnosed but potentially treatable, and its wider recognition is important.

Qualitative Outcomes in CME/CPD: Exploring Non-Linear Contexts and Lived Experiences in Patient-Directed Interventions

Qualitative analysis is often used to gather insights about learning, behavioural and practice change. Given the rich detail that qualitative data delivers, we are puzzled at the relative absence of qualitative approaches to outcomes assessment in the field of CME/CPD, especially as patient-directed education becomes increasingly tethered or adjunctive to CME/CPD programmes as a way to directly engage patients in disease self-management and improve health outcomes. Education outcomes for both clinicians and patients are contextualised by norms, motivations, and values that shape how learners interact with education activities and materials. These properties are linked to and shape the mechanisms that drive education outcomes but are rarely the focus of assessments that are often rooted in quantitative, positivist frameworks. In order to illustrate the role that qualitative methodologies can play in outcomes assessment, we describe insights from three education programmes designed to improve the health of patients with specific conditions and outline a range of qualitative methodologies appropriate for outcomes evaluation.