Integrating multiple co-morbidities in guidelinesGuíaSalud
Presentación realizada por Holger Schünemann, profesor y director del Departamento de Epidemiología Clínica y Bioestadísticas en la Universidad McMaster de Hamilton, Canadá, en las Jornadas Científicas "Guías de Práctica Clínica y Pluripatología" de GuíaSalud, Madrid, 21 de febrero de 2013.
Efficacy of Mindfulness-Based Cognitive Therapy in Relation to Prior History ...Tejas Shah
Mindfulness-based cognitive therapy reduces residual depressive symptoms irrespective of the number of previous episodes of major depression.
Presented by Tejas Shah (www.healingstudio.in)
Course 2 the need for a careful and thorough historyNelson Hendler
The medical literature reports that 40%-80% of chronic pain patients are misdiagnosed. Clearly, misdiagnosis leads to ordering the wrong tests, and thereby obtaining an incorrect diagnosis, or overlooking a diagnosis totally, which results in mistreatment. Many reports in the medical literature indicate the best way to get an accurate diagnosis, is to obtain a complete and thorough history. However, this is a time consuming process, and most physicians don’t spend the needed time with a patient. Therefore, a team of doctors from Johns Hopkins Hospital developed a 72 question test, with 2008 possible answers, available over the Internet. When a patient completes the questionnaire, diagnoses are returned within 5 minutes. These diagnoses have a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This is the highest level of accuracy of any expert system available. The efficacy of this approach is proven by outcome studies, which prove that this approach results in a far higher return to work rate and reduced use of medication and doctors visits, when compared to other techniques. This is similar to the techniques used by Johns Hopkins Hospital to reduce their workers compensation payments by 54%.
Integrating multiple co-morbidities in guidelinesGuíaSalud
Presentación realizada por Holger Schünemann, profesor y director del Departamento de Epidemiología Clínica y Bioestadísticas en la Universidad McMaster de Hamilton, Canadá, en las Jornadas Científicas "Guías de Práctica Clínica y Pluripatología" de GuíaSalud, Madrid, 21 de febrero de 2013.
Efficacy of Mindfulness-Based Cognitive Therapy in Relation to Prior History ...Tejas Shah
Mindfulness-based cognitive therapy reduces residual depressive symptoms irrespective of the number of previous episodes of major depression.
Presented by Tejas Shah (www.healingstudio.in)
Course 2 the need for a careful and thorough historyNelson Hendler
The medical literature reports that 40%-80% of chronic pain patients are misdiagnosed. Clearly, misdiagnosis leads to ordering the wrong tests, and thereby obtaining an incorrect diagnosis, or overlooking a diagnosis totally, which results in mistreatment. Many reports in the medical literature indicate the best way to get an accurate diagnosis, is to obtain a complete and thorough history. However, this is a time consuming process, and most physicians don’t spend the needed time with a patient. Therefore, a team of doctors from Johns Hopkins Hospital developed a 72 question test, with 2008 possible answers, available over the Internet. When a patient completes the questionnaire, diagnoses are returned within 5 minutes. These diagnoses have a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This is the highest level of accuracy of any expert system available. The efficacy of this approach is proven by outcome studies, which prove that this approach results in a far higher return to work rate and reduced use of medication and doctors visits, when compared to other techniques. This is similar to the techniques used by Johns Hopkins Hospital to reduce their workers compensation payments by 54%.
A Test Review: Children’s Depression Rating Scale, Revised (CDRS-R) Sidney Gaskins
The instrument is considered a clinician-rating scale as opposed to self-reported instrument. When assessing for the depression in children that takes a specific tool created specifically for that population and construct. All assessment instruments have a purpose and there are technical considerations an assessor must consider when using it. The assessor must be familiar with the tool, understand the purpose for which it is used, how reliable and valid it is, the way it is scored and items needed for assessment, whether the measure has generalizable results, and something about the population on which the instrument was normalized. The Children’s Depression Rating Scale, Revised (CDRS-R) is used to assess depression in children and adolescents ages 6-18 using 17 different areas of assessment. This paper will present a detailed overview of this instrument.
Background: Recently our group performed a cross-sectional study in which 930 general practitioners (GP) in Germany and Denmark received a newly developed questionnaire concerning lower urinary tract symptoms. We developed the questionnaire on the basis of cognitive interviews with GPs and tested the reliability of the German version of the questionnaire in a test-retest process. Methods: 16 GPs took part in the test-retest process and completed the questionnaire twice with a time period of about four weeks between each attempt. The questionnaire consists of 28 questions. The given-answer categories and description fields sum up to a total of 60 items (answers). We assessed the reliability of answers by calculating and interpreting the absolute agreement and Cohen´s Kappa with a 95%-confidence interval for data that were nominal scaled and Pearson´s correlation coefficient for data that were interval scaled, respectively. Results: A total of 27 questions with 59 answer items were included in the analysis. Of them, 13 questions dealt with “management of UI”, six questions addressed the “communication about UI”, four questions asked for the “structure of the practice”, and five questions assessed personal data of the GP. Each more than 50% of the items in the subject areas “management of UI” (53.1%), “communication about UI” (66.6%), “structure of the practice” (57%), and “personal data” (100%) were rated as having high reliability. In summary, 35 of the analyzed items were rated a having a high reliability and 22 items were rated as having a moderate reliability. Conclusion: Given the low number of study participants our results have to be interpreted with caution, but is seems that the developed questionnaire is – for the vast majority of items – a reliable tool for assessing the communication about and the management of female urinary incontinence during a general practitioners’ consultation hour. Before application in future studies we recommend revising one item of the questionnaire in order to gain a higher reliability of this item.
Assessment MeasuresA growing body of scientific evidence favors .docxfestockton
Assessment Measures
A growing body of scientific evidence favors dimensional concepts in the diagnosis of mental disorders. The limitations of a categorical approach to diagnosis include the failure to find zones of rarity between diagnoses (i.e., delineation of mental disorders from one another by natural boundaries), the need for intermediate categories like schizoaffective disorder, high rates of comorbidity, frequent not-otherwise-specified (NOS) diagnoses, relative lack of utility in furthering the identification of unique antecedent validators for most mental disorders, and lack of treatment specificity for the various diagnostic categories.
From both clinical and research perspectives, there is a need for a more dimensional approach that can be combined with DSM’s set of categorical diagnoses. Such an approach incorporates variations of features within an individual (e.g., differential severity of individual symptoms both within and outside of a disorder’s diagnostic criteria as measured by intensity, duration, or number of symptoms, along with other features such as type and severity of disabilities) rather than relying on a simple yes-or-no approach. For diagnoses for which all symptoms are needed for a diagnosis (a monothetic criteria set), different severity levels of the constituent symptoms may be noted. If a threshold endorsement of multiple symptoms is needed, such as at least five of nine symptoms for major depressive disorder (a polythetic criteria set), both severity levels and different combinations of the criteria may identify more homogeneous diagnostic groups.
A dimensional approach depending primarily on an individual’s subjective reports of symptom experiences along with the clinician’s interpretation is consistent with current diagnostic practice. It is expected that as our understanding of basic disease mechanisms based on pathophysiology, neurocircuitry, gene-environment interactions, and laboratory tests increases, approaches that integrate both objective and subjective patient data will be developed to supplement and enhance the accuracy of the diagnostic process.
Cross-cutting symptom measures modeled on general medicine’s review of systems can serve as an approach for reviewing critical psychopathological domains. The general medical review of systems is crucial to detecting subtle changes in different organ systems that can facilitate diagnosis and treatment. A similar review of various mental functions can aid in a more comprehensive mental status assessment by drawing attention to symptoms that may not fit neatly into the diagnostic criteria suggested by the individual’s presenting symptoms, but may nonetheless be important to the individual’s care. The cross-cutting measures have two levels: Level 1 questions are a brief survey of 13 symptom domains for adult patients and 12 domains for child and adolescent patients. Level 2 questions provide a more in-depth assessment of certain domains. These measures were ...
Relationship of Attention Deficit Hyperactivity Disorder with Substance AbuseHafiz Saad Salman
The attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders affecting 3% to 6% of children1 and almost 5% of adults2. Across population, Prevalence rates vary from 2.2% to 16.1% in clinical versus community cohorts. Its frequency has been reported as high as 34% ADHD in clinical setting in Pakistan3. There was a myth for many years that the disorder remits during adolescence, but it is now well established that it can be experienced by a patient in adulthood as well. There is a bidirectional overlap between ADHD and drug abuse and dependence4 and affect 27% of adult population5. The co-occurrence of ADHD and addiction is very common. Previous studies have shown that adults with ADHD are a risk for substance use disorder (SUD) and almost 52% of adult had a lifetime history of SUD2, 3. The co-morbidity between ADHD and SU shows relativity and relevant to research and clinical development in psychiatry, pediatrics and psychology5. The diagnosing and specific risk factor associated with SU within ADHD may lead to a better targeted pharmacotherapy and psychotherapeutic treatments for both the disorders upon expression at early stage of their lives7, 8. Higher rates of ADHD have been reported in patients having SUD relative to controls9, 10. 15% to 25% adults with SUD history have been estimated to have ADHD9. Studies have conducted in juvenile adolescents for assessing ADHD and other disorders in substance abusing groups had overrepresentation of ADHD10, 11. ADHD predominates from 15% to 25% in individuals with SUD12, 13. Two studies showed that the 24% of 201 inpatients14 and 10% cocaine abusers for drug detoxification treatment had ADHD15. The treatment of ADHD is usually done with stimulants like methylphenidate, amphetamine etc., with the behavioral therapy of the patient and family counseling.
Name Professor Course Date Sexual Harassment .docxroushhsiu
Name
Professor
Course
Date
Sexual Harassment Essay Outline
I. Introduction
A. Background
1. Despite ongoing public campaigns designed to prevent sexual harassment,
this destructive behavior continues to be a widespread issue in the United
States. Sexual harassment is particularly rampant on college campuses,
where 62% of female students and 61% of male students report having
been victims of this form of mistreatment, according to the AAUW
Educational Foundation. Most of the harassment is noncontact, but about
one-third of students are victims of physical harassment.
B. Thesis Statement
1. Although mass media and news outlets alike tend to shy away from the
sexual harassment problem occuring across our campuses nationwide,
universities are failing to protect their students from sexual harassment
resulting in mental health damage of both males and females in all parts of
the nation
II. Body
A. Sexual Harassment Amongst Both Genders
1. Female Sexual Harassment In Comparison
a) Statistics Regarding Harassment Committed Against
b) General Concerns Over Safety Amongst Females
2. Male Sexual Harassment In Comparison
a) Statistics Regarding Harassment Committed Against
b) Lack of Awareness That Men Can Also Experience Harassment
On College Campuses
B. Sexual Harassment Being Neglected Nationwide
1. Lack of Media Coverage & Lack of Awareness
a) Disregard Of A Widespread Issue Going On In Our Nation
b) People Not Taking Sexual Harassment Seriously/Not Being Aware
of It
2. Lack of Knowledge Regarding Universities Legal Duty to Protect
Students
a) Title XI Law of 1972
b) Title VII of the Civil Rights Act of 1964
C. Sexual Harassment’s Effect on Students Experiencing It
1. Short Term Mental Effects
a) People Disregarding and Neglecting People Who Claim Sexual
Harassment Can Cause Them Insecurity and Hopelessness
b) People Tend To Blame Themselves For Being Harrassed
2. Long Term Mental Effects
a) Depression and Inability To Trust Others
b) Can Lead To Drastic Effects Like Turning To Drugs Or
Committing Suicide, It is Afterall A Form Of Bullying
III. Conclusion
A. The failure of our nations awarness and our universities inability to abide to the
law by protecting our students has resulted in many students being permanently
damaged from sexual harassment
B. We the people of the United States have gone through all the proper legal
measures in order to guarantee the youths safety when attending college
universities; yet these laws along with their $60,000 tuitions do not seem to be
enough motivation for these universities to abide to the law. Does a student need
to be found dead in the middle of the campus in order to get the message across?
Psychiatric Diagnostic Screening Questionnaire
Review of The Psychiatric Diagnostic Screening Questionnaire by MICHAEL G. KAVAN, Associate Dean for Student Affairs and Associate Professor of Family Medicine, Creighton University Sch ...
Criterios diagnosticos de enfermedad de parkinson, esta version es comparada con los criterior diagnosticos del Banco de cerebros de londres, y se encuentra que es mas sensible y especifica
A Test Review: Children’s Depression Rating Scale, Revised (CDRS-R) Sidney Gaskins
The instrument is considered a clinician-rating scale as opposed to self-reported instrument. When assessing for the depression in children that takes a specific tool created specifically for that population and construct. All assessment instruments have a purpose and there are technical considerations an assessor must consider when using it. The assessor must be familiar with the tool, understand the purpose for which it is used, how reliable and valid it is, the way it is scored and items needed for assessment, whether the measure has generalizable results, and something about the population on which the instrument was normalized. The Children’s Depression Rating Scale, Revised (CDRS-R) is used to assess depression in children and adolescents ages 6-18 using 17 different areas of assessment. This paper will present a detailed overview of this instrument.
Background: Recently our group performed a cross-sectional study in which 930 general practitioners (GP) in Germany and Denmark received a newly developed questionnaire concerning lower urinary tract symptoms. We developed the questionnaire on the basis of cognitive interviews with GPs and tested the reliability of the German version of the questionnaire in a test-retest process. Methods: 16 GPs took part in the test-retest process and completed the questionnaire twice with a time period of about four weeks between each attempt. The questionnaire consists of 28 questions. The given-answer categories and description fields sum up to a total of 60 items (answers). We assessed the reliability of answers by calculating and interpreting the absolute agreement and Cohen´s Kappa with a 95%-confidence interval for data that were nominal scaled and Pearson´s correlation coefficient for data that were interval scaled, respectively. Results: A total of 27 questions with 59 answer items were included in the analysis. Of them, 13 questions dealt with “management of UI”, six questions addressed the “communication about UI”, four questions asked for the “structure of the practice”, and five questions assessed personal data of the GP. Each more than 50% of the items in the subject areas “management of UI” (53.1%), “communication about UI” (66.6%), “structure of the practice” (57%), and “personal data” (100%) were rated as having high reliability. In summary, 35 of the analyzed items were rated a having a high reliability and 22 items were rated as having a moderate reliability. Conclusion: Given the low number of study participants our results have to be interpreted with caution, but is seems that the developed questionnaire is – for the vast majority of items – a reliable tool for assessing the communication about and the management of female urinary incontinence during a general practitioners’ consultation hour. Before application in future studies we recommend revising one item of the questionnaire in order to gain a higher reliability of this item.
Assessment MeasuresA growing body of scientific evidence favors .docxfestockton
Assessment Measures
A growing body of scientific evidence favors dimensional concepts in the diagnosis of mental disorders. The limitations of a categorical approach to diagnosis include the failure to find zones of rarity between diagnoses (i.e., delineation of mental disorders from one another by natural boundaries), the need for intermediate categories like schizoaffective disorder, high rates of comorbidity, frequent not-otherwise-specified (NOS) diagnoses, relative lack of utility in furthering the identification of unique antecedent validators for most mental disorders, and lack of treatment specificity for the various diagnostic categories.
From both clinical and research perspectives, there is a need for a more dimensional approach that can be combined with DSM’s set of categorical diagnoses. Such an approach incorporates variations of features within an individual (e.g., differential severity of individual symptoms both within and outside of a disorder’s diagnostic criteria as measured by intensity, duration, or number of symptoms, along with other features such as type and severity of disabilities) rather than relying on a simple yes-or-no approach. For diagnoses for which all symptoms are needed for a diagnosis (a monothetic criteria set), different severity levels of the constituent symptoms may be noted. If a threshold endorsement of multiple symptoms is needed, such as at least five of nine symptoms for major depressive disorder (a polythetic criteria set), both severity levels and different combinations of the criteria may identify more homogeneous diagnostic groups.
A dimensional approach depending primarily on an individual’s subjective reports of symptom experiences along with the clinician’s interpretation is consistent with current diagnostic practice. It is expected that as our understanding of basic disease mechanisms based on pathophysiology, neurocircuitry, gene-environment interactions, and laboratory tests increases, approaches that integrate both objective and subjective patient data will be developed to supplement and enhance the accuracy of the diagnostic process.
Cross-cutting symptom measures modeled on general medicine’s review of systems can serve as an approach for reviewing critical psychopathological domains. The general medical review of systems is crucial to detecting subtle changes in different organ systems that can facilitate diagnosis and treatment. A similar review of various mental functions can aid in a more comprehensive mental status assessment by drawing attention to symptoms that may not fit neatly into the diagnostic criteria suggested by the individual’s presenting symptoms, but may nonetheless be important to the individual’s care. The cross-cutting measures have two levels: Level 1 questions are a brief survey of 13 symptom domains for adult patients and 12 domains for child and adolescent patients. Level 2 questions provide a more in-depth assessment of certain domains. These measures were ...
Relationship of Attention Deficit Hyperactivity Disorder with Substance AbuseHafiz Saad Salman
The attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders affecting 3% to 6% of children1 and almost 5% of adults2. Across population, Prevalence rates vary from 2.2% to 16.1% in clinical versus community cohorts. Its frequency has been reported as high as 34% ADHD in clinical setting in Pakistan3. There was a myth for many years that the disorder remits during adolescence, but it is now well established that it can be experienced by a patient in adulthood as well. There is a bidirectional overlap between ADHD and drug abuse and dependence4 and affect 27% of adult population5. The co-occurrence of ADHD and addiction is very common. Previous studies have shown that adults with ADHD are a risk for substance use disorder (SUD) and almost 52% of adult had a lifetime history of SUD2, 3. The co-morbidity between ADHD and SU shows relativity and relevant to research and clinical development in psychiatry, pediatrics and psychology5. The diagnosing and specific risk factor associated with SU within ADHD may lead to a better targeted pharmacotherapy and psychotherapeutic treatments for both the disorders upon expression at early stage of their lives7, 8. Higher rates of ADHD have been reported in patients having SUD relative to controls9, 10. 15% to 25% adults with SUD history have been estimated to have ADHD9. Studies have conducted in juvenile adolescents for assessing ADHD and other disorders in substance abusing groups had overrepresentation of ADHD10, 11. ADHD predominates from 15% to 25% in individuals with SUD12, 13. Two studies showed that the 24% of 201 inpatients14 and 10% cocaine abusers for drug detoxification treatment had ADHD15. The treatment of ADHD is usually done with stimulants like methylphenidate, amphetamine etc., with the behavioral therapy of the patient and family counseling.
Name Professor Course Date Sexual Harassment .docxroushhsiu
Name
Professor
Course
Date
Sexual Harassment Essay Outline
I. Introduction
A. Background
1. Despite ongoing public campaigns designed to prevent sexual harassment,
this destructive behavior continues to be a widespread issue in the United
States. Sexual harassment is particularly rampant on college campuses,
where 62% of female students and 61% of male students report having
been victims of this form of mistreatment, according to the AAUW
Educational Foundation. Most of the harassment is noncontact, but about
one-third of students are victims of physical harassment.
B. Thesis Statement
1. Although mass media and news outlets alike tend to shy away from the
sexual harassment problem occuring across our campuses nationwide,
universities are failing to protect their students from sexual harassment
resulting in mental health damage of both males and females in all parts of
the nation
II. Body
A. Sexual Harassment Amongst Both Genders
1. Female Sexual Harassment In Comparison
a) Statistics Regarding Harassment Committed Against
b) General Concerns Over Safety Amongst Females
2. Male Sexual Harassment In Comparison
a) Statistics Regarding Harassment Committed Against
b) Lack of Awareness That Men Can Also Experience Harassment
On College Campuses
B. Sexual Harassment Being Neglected Nationwide
1. Lack of Media Coverage & Lack of Awareness
a) Disregard Of A Widespread Issue Going On In Our Nation
b) People Not Taking Sexual Harassment Seriously/Not Being Aware
of It
2. Lack of Knowledge Regarding Universities Legal Duty to Protect
Students
a) Title XI Law of 1972
b) Title VII of the Civil Rights Act of 1964
C. Sexual Harassment’s Effect on Students Experiencing It
1. Short Term Mental Effects
a) People Disregarding and Neglecting People Who Claim Sexual
Harassment Can Cause Them Insecurity and Hopelessness
b) People Tend To Blame Themselves For Being Harrassed
2. Long Term Mental Effects
a) Depression and Inability To Trust Others
b) Can Lead To Drastic Effects Like Turning To Drugs Or
Committing Suicide, It is Afterall A Form Of Bullying
III. Conclusion
A. The failure of our nations awarness and our universities inability to abide to the
law by protecting our students has resulted in many students being permanently
damaged from sexual harassment
B. We the people of the United States have gone through all the proper legal
measures in order to guarantee the youths safety when attending college
universities; yet these laws along with their $60,000 tuitions do not seem to be
enough motivation for these universities to abide to the law. Does a student need
to be found dead in the middle of the campus in order to get the message across?
Psychiatric Diagnostic Screening Questionnaire
Review of The Psychiatric Diagnostic Screening Questionnaire by MICHAEL G. KAVAN, Associate Dean for Student Affairs and Associate Professor of Family Medicine, Creighton University Sch ...
Criterios diagnosticos de enfermedad de parkinson, esta version es comparada con los criterior diagnosticos del Banco de cerebros de londres, y se encuentra que es mas sensible y especifica
Cognitive Behavioral Treatments for Anxietyin Children With WilheminaRossi174
Cognitive Behavioral Treatments for Anxiety
in Children With Autism Spectrum Disorder
A Randomized Clinical Trial
Jeffrey J. Wood, PhD; Philip C. Kendall, PhD; Karen S. Wood, PhD; Connor M. Kerns, PhD;
Michael Seltzer, PhD; Brent J. Small, PhD; Adam B. Lewin, PhD; Eric A. Storch, PhD
IMPORTANCE Anxiety is common among youth with autism spectrum disorder (ASD), often
interfering with adaptive functioning. Psychological therapies are commonly used to treat
school-aged youth with ASD; their efficacy has not been established.
OBJECTIVE To compare the relative efficacy of 2 cognitive behavioral therapy (CBT) programs
and treatment as usual (TAU) to assess treatment outcomes on maladaptive and interfering
anxiety in children with ASD. The secondary objectives were to assess treatment outcomes
on positive response, ASD symptom severity, and anxiety-associated adaptive functioning.
DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial began recruitment in
April 2014 at 3 universities in US cities. A volunteer sample of children (7-13 years) with ASD
and maladaptive and interfering anxiety was randomized to standard-of-practice CBT,
CBT adapted for ASD, or TAU. Independent evaluators were blinded to groupings. Data
were collected through January 2017 and analyzed from December 2018 to February 2019.
INTERVENTIONS The main features of standard-of-practice CBT were affect recognition,
reappraisal, modeling/rehearsal, in vivo exposure tasks, and reinforcement. The CBT
intervention adapted for ASD was similar but also addressed social communication and
self-regulation challenges with perspective-taking training and behavior-analytic techniques.
MAIN OUTCOMES AND MEASURES The primary outcome measure per a priori hypotheses was
the Pediatric Anxiety Rating Scale. Secondary outcomes included treatment response on the
Clinical Global Impressions–Improvement scale and checklist measures.
RESULTS Of 214 children initially enrolled, 167 were randomized, 145 completed treatment,
and 22 discontinued participation. Those who were not randomized failed to meet eligibility
criteria (eg, confirmed ASD). There was no significant difference in discontinuation rates
across conditions. Randomized children had a mean (SD) age of 9.9 (1.8) years; 34 were
female (20.5%). The CBT program adapted for ASD outperformed standard-of-practice CBT
(mean [SD] Pediatric Anxiety Rating Scale score, 2.13 [0.91] [95% CI, 1.91-2.36] vs 2.43 [0.70]
[95% CI, 2.25-2.62]; P = .04) and TAU (2.93 [0.59] [95% CI, 2.63-3.22]; P < .001). The CBT
adapted for ASD also outperformed standard-of-practice CBT and TAU on parent-reported
scales of internalizing symptoms (estimated group mean differences: adapted vs
standard-of-practice CBT, −0.097 [95% CI, −0.172 to −0.023], P = .01; adapted CBT vs TAU,
−0.126 [95% CI, −0.243 to −0.010]; P = .04), ASD-associated social-communication
symptoms (estimated group mean difference: adapted vs standard-of-practice CBT, −0.115
[95% CI, −0223 to −0 ...
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Instrument to screen cases of pervasive
developmental disorder – a preliminary
indication of validity
Instrumento para rastreamento dos casos de
transtorno invasivo do desenvolvimento – estudo
preliminar de validação
Abstract
Objective: To translate into Portuguese, back-translate, culturally adapt and validate a screening instrument for pervasive developmental
disorder, the Autism Screening Questionnaire, for use in Brazil. Method: A sample of 120 patients was selected based on three groups
of 40: patients with a clinical diagnosis of pervasive developmental disorder, Down syndrome, or other psychiatric disorders. The self-
administered questionnaire was applied to the patients’ legal guardians. Psychometric measures of the final version of the translated
questionnaire were tested. Results: The score of 15 had sensitivity of 92.5% and specificity of 95.5% as a cut-off point for the diagnosis
of pervasive developmental disorder. Internal validity for a total of 40 questions was 0.895 for alpha and 0.896 for KR-20, ranging from
0.6 to 0.8 for both coefficients. Test and retest reliability values showed strong agreement for most questions. Conclusions: The final
version of this instrument, translated into Portuguese and adapted to the Brazilian culture, had satisfactory measurement properties,
suggesting preliminary validation proprieties. It was an easy-to-apply, useful tool for the diagnostic screening of individuals with pervasive
developmental disorder.
Descriptors: Pervasive development disorders; Autistic disorder; Validation studies; Questionnaires; Diagnosis, clinical
Resumo
Objetivo: Tradução, retro-versão, adaptação cultural e validação do Autism Screening Questionnaire para a língua portuguesa e para
o seu uso no Brasil. Método: Foi selecionada uma amostra inicial de 120 pacientes, encaminhados de duas clínicas privadas e uma
pública, divida em três grupos de 40 pacientes distintos: pacientes com diagnóstico clínico de transtornos globais do desenvolvimento
ou transtornos invasivos do desenvolvimento; de síndrome de Down e de outros transtornos psiquiátricos. O questionário foi aplicado
aos responsáveis legais dos pacientes seguindo os padrões de um questionário auto-aplicável. As medidas psicométricas do questio-
nário traduzido, na sua versão final, foram testadas. Resultados: Valores de sensibilidade de 92,5% e especificidade de 95,5% foram
encontrados para uma pontuação de 15, como sendo um valor discriminativo para os sujeitos com características de transtornos
globais do desenvolvimento/transtornos invasivos do desenvolvimento. A validade interna para o total das 40 questões foi de 0,895,
com uma variação entre 0,6 a 0,8. Os valores de confiabilidade obtidos pelo teste e re-teste demonstraram que a maioria das questões
obteve alta concordância. Conclusões: A versão final do instrumento de pesquisa, traduzido e adaptado à cultura brasileira, apresentou
propriedades de medida satisfatórias, sugerindo adequadas propriedades preliminares de validação. É um instrumento de fácil aplica-
ção e uma ferramenta útil para a realização de um screening diagnóstico em indivíduos com transtornos globais do desenvolvimento/
transtornos invasivos do desenvolvimento.
Descritores: Transtornos globais do desenvolvimento; Transtorno autístico; Estudos de validação; Questionários; Diagnóstico clínico
Fábio Pinato Sato1
, Cristiane Silvestre Paula2
, Rosane Lowenthal2
,
Eduardo Yoshio Nakano3
, Décio Brunoni2
, José Salomão Schwartzman2
,
Marcos Tomanik Mercadante4
Correspondence
Fábio Pinato Sato
Rua Capote Valente, 432/24
05409-001 São Paulo, SP, Brazil
Phone/Fax: (+55 11) 3064-1278
E-mail: fpsato@uol.com.br
Rev Bras Psiquiatr. 2009;31(1):30-3
1
Graduate Program, Department of Psychiatry, Universidade de São Paulo (USP), São Paulo (SP), Brazil
2
Graduate Program in Developmental Disorders, Universidade Presbiteriana Mackenzie, São Paulo (SP), Brazil
3
Department of Statistics, Universidade de Brasília (UNB), Brasília (DF), Brazil
4
Department of Psychiatry, Child and Adolescent Medical Psychiatric Unit, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil
Submitted: April 16, 2008
Accepted: July 14, 2008
30 BRIEF REPORT
Artigo 06_RBP 290_V07.indd 30 09.03.09 11:37:47
2. Rev Bras Psiquiatr. 2009;31(1):30-3
Instrument to screen PDD 31
Introduction
Pervasive developmental disorders (PDD) are a series of conditions
characterized by deficits in the development of sociability and
communication and by a restricted behavioral pattern. A prevalence
of 1% has been reported when expanded diagnostic criteria were
used1
. A pilot study conducted in our region suggested a prevalence
close to the lower limit of rates found in the literature2
.
There are two partially validated instruments for the diagnosis
of PDD in Brazil: The Autistic Traits of Evaluation Scale (ATA)3
and
Autism Behavior Checklist (ABC)4
. The widespread use of ASQ in
the literature and its good performance in discriminating individuals
with PDD from others5
were the main reasons to choose this
instrument. This study was conducted to translate into Portuguese,
back-translate, culturally adapt and validate the Autism Screening
Questionnaire (ASQ)5
for use in Brazil.
Method
The original ASQ was translated into Portuguese and adapted by
specialists in the medical area. After this stage, the questionnaire
was back-translated by a bilingual professional. The material was
presented to three child and adolescent psychiatrists, who are not
participating in the study. At the end of the process, translators
and the committee agreed that semantic, idiomatic and cultural
equivalence was satisfactory, as previously suggested by others6,7
.
The semantic structure of ASQ was not altered either in the
translation process into Portuguese or in the back-translation into
English (exception for minor changes in questions 14 and 33).
After this process, the instrument was applied to the legal
guardians of 120 children divided into three groups of three different
work settings (two private and one public) in which patients were
receiving medical care. Based on the lack of internationally validated
instruments for the diagnosis of PDD in Brazil, clinical criteria,
according to DSM-IV, were chosen to classify all the subjects.
The three groups were comprised of 40 children with a clinical
diagnosis of PDD (PDDG), 40 children with Down syndrome (control
for cognitive performance – DownG), and 40 children meeting
diagnostic criteria for other psychiatric disorders (anxiety, depression,
attention deficit disorder with or without hyperactivity, without PDD –
PchG). All 120 children were selected based on order of presentation
at these three clinics during a 4 week period of time. A pretest was
applied to evaluate children with Down syndrome8
.
The participants’ guardian was contacted by phone and the
investigator explained that the study consisted of 40 yes/no
questions about the patient’s life history. As all selected cases
agreed to participate, we sent a written informed consent by mail
and an investigator applied the questionnaire (mean time was 20
minutes). The patient’s guardian signed the form and mailed it back
to the investigator. The study was approved by the Institutional
Research Ethics Committee from Universidade de São Paulo
Medical School.
After 6 months, the questionnaire was applied again by the same
investigator to 10 randomly selected participants in each group.
The Statistical Package for the Social Sciences 11.5 (SPSS) for
Windows was used for statistical analyses. Mean scores (MS) for
each diagnosis were calculated, and the ANOVA and Tukey post-hoc
test were used to compare these means. A ROC (Receiver Operating
Characteristics) curve was obtained indicating several cut-off points
according to sensitivity and specificity levels. The Kuder-Richardson
KR-209
and Cronbach’s alpha coefficients10
were used to assess
internal consistency of the entire questionnaire and of the three
domains individually. Cohen’s kappa coefficient11
was used to
measure questionnaire reliability. Frequencies were compared using
the chi-square test. The level of significance was set at α = 0.05
or 5% for all statistical tests.
Results
Each group had 40 participants, and their mean ages were 11.1
years in the PchG (27 boys), 9.9 years in the DownG (22 boys),
and 9.8 years in the PDDG (34 boys).
MS varied according to diagnosis. In patients in the PchG, MS
was 7.2 (SD = 4.1); in the DownG, 9.0 (SD = 4.2); and in the
PDDG, 21.7 (SD = 5.4). ANOVA revealed a significant difference
between means (F = 116.7; p < 0.001). According to the post-
hoc test, only PDDG had an MS significantly greater than that of
the other groups (p < 0.001 for DownG and p < 0.001 for PchG).
The DownG had an MS slightly greater than that of the PchG, but
the difference was not statistically significant (p = 0.203).
Sensitivity and specificity analysis showed that the area under the
ROC curve was 0.981 (SE = 0.011; p < 0.001). The cut-off point
of 14.5 (individuals were classified as having PDD if their score was
≥ 15) had sensitivity of 92.5% and specificity of 95.0%. This cut-off
point presented balanced levels of sensitivity and specificity.
1. Analysis of both control groups
In individuals with PDD, MS was 21.7 (SD = 5.4); for the total
control group (TCG = DownG + PchG), it was 8.1 (SD = 4.2).
The t test confirmed a significant difference between these means
(t = 13.85; p < 0.001).
2. Internal validity
The analysis of internal validity showed alpha = 0.895 and
KR-20 = 0.896 for the entire questionnaire. Alpha values varied
from 0.621 to 0.838 when questions were separated according to
domains: language (0.687); behavior (0.621); sociability (0.838),
while KR-20 values varied from 0.625 to 0.840: language (0.685);
behavior (0.625) and sociability (0.840).
3. Retest reliability (Cohen’s kappa coefficient)
The questionnaire was applied again to PchG and PDDG
after about 240 days and to DownG at about 730 days
after the initial test. No control patients had a score above
the cut-off point, and all patients had scores that indicated
PDD at retest. Only one patient in the DownG, who had
scored 18 in the first ASQ application (the patient was not
able to talk then), scored 7 in the retest application. The
MS DownG was 7.7 (SD = 4.373; SE = 1.383) at time
point 1 and 6.6 (SD = 2.914; SE = 0.921) at time point 2
(t = 0.884; df = 9; p = 0.421); for PchG, 7.2 (SD = 2.898;
SE = 0.917) at time point 1 and 5.7 (SD = 3.302; SE = 1.044),
at time point 2 (t = 0.183; df = 9; p = 0.859); and for PDDG, 21.7
(SD = 5.971; SE = 1.888) at time point 1 and 24.1
(SD = 6.082; SE = 1.923) at time point 2 (t = 1.500;
df = 9; p = 0.168).
Question 5 had the weakest agreement (kappa = 0.374;
p = 0.045), and question 16 the strongest (kappa = 0.927;
p < 0.001). Only nine questions had kappa below 0.6
(# 5 = 0.374; 9 = 0.426; 22 = 0.426; 7 = 0.485; 25 = 0.533;
11 = 0.561; 31 = 0.571; 21 = 0.583; 24 = 0.598).
The comparison of each question in all three groups showed that
questions 1, 5, 7, 13 and 23 had no significant prevalence (or
absence) of answer “1” for one of the diagnosis (p > 0.05); they
were, therefore, questions with lower classification power.
Artigo 06_RBP 290_V07.indd 31 09.03.09 11:37:48
3. Rev Bras Psiquiatr. 2009;31(1):30-3
Sato FP et al.32
Disclosures
Writting group
member
Employment Research
grant1
Other research grant or
medical continuous
education2
Speaker’s
honoraria
Ownership
interest
Consultant/
Advisory board
Other3
Fábio Pinato Sato IpQ-HC-FMUSP
Universidade
Presbiteriana Mackenzie
--- --- --- --- --- ---
Cristiane Silvestre
Paula
Universidade
Presbiteriana Mackenzie
--- --- --- --- --- ---
Rosane Lowenthal Universidade
Presbiteriana Mackenzie
--- --- --- --- --- ---
Eduardo Yoshio
Nakano
UNB --- --- --- --- --- ---
Décio Brunoni Universidade
Presbiteriana Mackenzie
--- --- --- --- --- ---
José Salomão
Schwartzman
Universidade
Presbiteriana Mackenzie
--- --- --- --- --- ---
Marcos Tomanik
Mercadante
UNIFESP --- --- --- --- --- ---
* Modest
** Significant
*** Significant. Amounts given to the author's institution or to a colleague for research in which the author has participation, not directly to the author.
Note: Ipq-HC-FMUSP = Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo; UNB = Universidade de Brasília; UNIFESP =
Universidade Federal de São Paulo.
For more information, see Instructions for authors.
Discussion
The analysis of ASQ psychometric properties revealed that it has
good sensitivity and specificity and that it can discriminate cases of
PDD from cases of other psychiatric disorders or mental deficiency.
Moreover, the values found in retesting, which showed 100%
diagnostic agreement in tests applied at least 8 months after the
initial application, suggest excellent agreement12,13
.
The ATA3
and the ABC4
were the only scales available in Portuguese
before this study. The ATA was applied to a sample of 61 children
aged 2-18 years, 30 with autism and 31 with moderate mental
deficiency. The analysis of external validity showed that the agreement
with DSM-IV criteria was weak (kappa = 0.04); therefore, the
data obtained with that instrument could not be generalized for the
general population. Conversely, internal validity was 100%, which
indicated strong agreement between clinical diagnosis and the
diagnosis provided by that scale. That scale had a sensitivity of 0.96
according to DSM-IV criteria, and Cronbach’s alpha was 0.7110
. The
ABC was applied to three groups, 38 mothers of children diagnosed
with autism; 43 mothers of children with language disorders other
than autism and 52 mothers of children who had no linguistic or
behavioral complaints. The ABC correctly identified 81.6% of the
autistic children. The cut-off value was 49, sensitivity was 92.1%
and specificity was 92.6%. Few studies in the literature used these
scales, which limits the comparison of results.
ASQ, conversely, has been widely used. Two studies conducted
by our research team demonstrated its applicability. A study that
evaluated all patients with Down syndrome in the city of Curitiba,
southern Brazil8
, showed that ASQ was capable of identifying all
cases of PDD in that population. In the first epidemiologic study of
PDD in Latin America, a prevalence of 0.3% was found2
. In both
studies, ASQ was a reliable instrument that discriminated PDD
cases from non-PDD cases.
The validation of an instrument with good psychometric
properties is essential for the advancement of research and
public health programs in Brazil. The translated version of
ASQ was appropriate for use in our country. The formerly ASQ,
currently Social Communication Questionnaire (SCQ)14
, a
copyrighted instrument, however, is one of its limitations, since
its use is not free of costs.
Conclusions
The current study is a preliminary indication of validity. Other
limitations were related to sample size, lack of IQ scores of the
subjects, and lack of gold-standard diagnostic instruments. Further
studies are required to improve the validation proprieties of the
Brazilian version of ASQ.
Acknowledgments
The authors wish to acknowledge the translation and back-translation
team, the Revision Committee and the undergraduate Psychology students
of Universidade Presbiteriana Mackenzie for all their assistance in this
study.
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