Crystallized and fluid intelligence in elderly patients with mild dementia of the Alzheimer type

OBJECTIVE: To describe a systematic procedure for adapting, or 'tailoring' the World Health Organisation's 'global guidelines for the management of HIV/AIDS in adults and children' for use in two developing countries: Malawi and Barbados. DESIGN: In order for these guidelines to achieve reproducibility, clinical flexibility, and clinical applicability, a systematic procedure is needed to tailor the guidelines to the local practice conditions of specific settings. METHODS: A group of local experts in each country used a nominal group process to modify the global program on AIDS (GPA) guidelines for local use. Semantic analysis techniques, known as clinical algorithm nosology (CAN), were used to compare the two modified guidelines with the global ones to determine the extent and type of differences between sets of guidelines. RESULTS: Standard, locally-tailored algorithm map guidelines (AMG) were developed within 4 months. CAN semantic analysis showed that guideline structure was maintained; 572/858 (66.6%) decision nodes were found to be the same in the GPA/Malawi, GPA/Barbados and Malawi/Barbados comparisons. However, different guideline versions managed patients quite differently, as evidenced by clinical algorithm patient abstraction (CAPA) scores of between 0 and 8.46 (0 = different; 8 = similar; 10 = identical). Analysis of the 197 specific differences found in these abstractions showed that 83% were in approaches to diagnosis and therapy, while the remaining 17% related to disease prevalence. CONCLUSIONS: Standard techniques involving consensus used to develop clinical guidelines can also be employed to tailor these guidelines to local settings. Semantic analysis shows that the tailoring preserves structure but may involve significant modification to the processes of clinical care that could in turn affect care outcomes.     

Conflict of roles: On the difficulties of being both scientist and practitioner in one life.

Articulates some of the conflicts inherent in the orientations of scientist and clinician. First, in the scientific orientation, Ss are asked to accommodate to the experimenter's goals; in the clinical orientation, the clinician is expected to accommodate to the patient's goals. Second, scientists rely on categorization as the primary mode of understanding; for the clinician categorization is subordinated to empathy. Because of these fundamental differences, the traditional notion that the clinician merely "applies" the findings of the scientist is rejected. Rather, integration of these 2 divergent orientations is facilitated when the researcher's categories are based on questions that the clinician encounters with patients. In such a strategy, the clinician can use such categories as flexible guidelines in support of empathic understanding. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culture, gender, and self: A perspective from individualism-collectivism research.

Individualism and collectivism are often equated with independent vs. interdependent, agentic vs. communal, and separate vs. relational self-construals. Although these same concepts have been used to characterize both cultural and gender differences, a perspective of cultural evolution suggests it is unlikely. A division of labor within society may produce gender differences, but this cannot explain cultural differences. A study of self-construal involving 5 cultures (Australia, the United States, Hawaii, Japan, and Korea) shows that differences between these cultures are captured mostly by the extent to which people see themselves as acting as independent agents, whereas gender differences are best summarized by the extent to which people regard themselves as emotionally related to others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrin receptor signaling: the propagation of an alpha-helix model

Improper assessment and treatment of asthma attacks have been identified as causes of increased morbidity and mortality: several pneumological societies have therefore created and published guidelines for facilitating decision making and for preventing unnecessary failures of therapy. The objective of this study was to examine emergency department compliance with such guidelines in our hospital, comparing the performance of pneumologists and other specialists. We reviewed the records of 117 patients treated for acute asthma attacks in 1994 (87 women and 30 men, mean age 46 years); 37 patients were treated by pneumologists and 80 by other specialists. The two physician groups differed significantly with respect to initial assessment of severity, particularly in the recording of vital signs (p < 0.05) and in the examination of some signs such as the use of accessory musculature (38% versus 10%, for pneumologists and other specialists, respectively) or the presence of cyanosis (81% versus 55%). Other factors associated with risk of death were noted only occasionally. Peak flow meters were used with only 5 patients, all examined by pneumologists; on the other hand, arterial blood samples for gasometric measurements were taken from 97%, although only 24% met the criteria stipulated in the guidelines. Treatment evaluated against the guidelines was incorrect in 24%, with no significant differences between pneumologists and other specialists. We conclude that: 1) the emergency clinical assessment and treatment of patients presenting with acute asthma attack is inadequate for a large proportion of patients, as the recommendations of consensual guidelines are habitually ignored, and 2) although there are differences in the management of these patients by pneumologists and other emergency room specialists, the former do not generally do a better job of following the guidelines.     

Cultural competence and psychotherapy: Applying anthropologically informed conceptions of culture.

The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinman's (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlor's (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

1998 revision to the British HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals. BHIVA Guidelines Writing Committee

When the British HIV-1 Association (BHIVA) guidelines on the treatment of HIV-seropositive individuals with antiretrovirals were published in The Lancet in April 1997, it was clear that they would require updating on a frequent basis. The guidelines have been useful in ensuring that viral-load testing and combination therapy is widely available in the UK. However, standards of treatment are rapidly changing as new evidence becomes available. Since formulation of the guidelines, data from two large clinical endpoint studies have been presented that show superior clinical benefit for the use of triple therapy compared with dual therapy in treatment of both naive individuals and patients who have been given zidovudine. Here we update the BHIVA guidelines with a consensus drawn from a wide range of UK medical opinion. The guidelines include input from groups representing individuals living with HIV-1. A more detailed reflection of these views may be found in publications such as the National AIDS Manual and the AIDS Treatment Project's Doctor fax.     

Retention in situ and spectral analysis of fluorescent vacuole components in sections of plant tissues

This paper describes an educational programme where clinical guidelines are used in dental education and assesses the value of these guidelines as perceived by undergraduate students. It presents a comparison of students' own assessments of their performance with those of their instructors, according to such guidelines. The educational programme at the Faculty of Odontology, Lund University, is described through 3 main principles: problem-based learning, adoption of a holistic attitude to patient care and the promotion of oral health. The dental curriculum occupies 5 years comprising 10 semesters. 41, 5th semester students (16 male and 25 female) participated in the study. Students were introduced to guidelines in group discussions at the beginning of the semester. At the completion of a patient's planned course of treatment, the outcome was formally assessed both by students and clinical instructors. Performance was scored in various categories as "excellent", "acceptable" or "unacceptable" according to the standards defined. A total of 1373 scores were made by both students and instructors. 88% cent of students used the guidelines often or almost always and found them useful. Overall, no students received an "unacceptable" score and 40% of students achieved a score of "excellent". Female students tended towards a higher score, but this was not significant. Instructors' and students' scores agreed in almost 90% of instances. Students under-scored their performance more frequently than they over-scored it. It appears that the use of clinical guidelines may encourage an increased awareness of the decision-making processes involved in clinical practice, but it must be acknowledged that these guidelines are complex both in derivation and application.     

In Defense of Cultural Competency in Psychotherapy and Treatment.

Cultural competency guidelines and policies are being widely established. Yet some critics have challenged the evidence for cultural competency and the lack of efficacy studies that demonstrate its outcomes. Various positions are examined that discuss cultural competency research. They include the need for more resources for research, scientific practices that overlook ethnic research findings, fruitfulness of theory-driven rather than population-based research, problems in defining cultural competency as a technique, and development of policies in the absence of research. Implications of these positions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Critical Issues and Possible Solutions for Motivating Foreign Construction Workers

A shortage of construction field workers has been a serious and chronic problem, both in developed and developing countries. As a solution to the increasing demands of the workforce, use of foreign workers has been a common practice for a country to gain laborers from nearby less-developed countries. While it can contribute to lessening the labor deficiency, foreign workers are typically less productive and often encompass diverse risks due to cultural differences, communication difficulties, and different work ethics and customs. Despite these facts, construction films do not address these issues and lag in establishing appropriate management strategies to improve the performance of foreign workers. This paper investigates key issues with respect to foreign laborers through a series of focused interviews and field surveys. Then, it draws the primary causes of low performance and presents effective general guidelines for improving foreign workers’ performance. The writers also provide an analysis of case studies in South Korea for motivating foreign workers in connection with the proposed practical guidelines.     

Pharmacologic approaches to chronic pain in the older adult

A key aspect of chronic pain management in the older adult is pharmacologic. Although not every elderly person has a chronic condition that leads to pain, these illnesses are more frequent in the later years as a consequence of the aging process. An understanding of physiologic changes and suggested pharmacologic interventions for dealing with issues related to chronic pain is essential. The psychosocial, cultural, and cost variables surrounding pain management of the older adult are also important to consider. A brief review of pain types and terminology precedes discussion of the key principles of pain management for the older adult. These principles are based on the guidelines published and distributed by the Agency for Health Care Policy and Research and the American Pain Society and are presented with a clinical focus aimed at improving clinician practice patterns related to pain management in the older adult. Concise, user-friendly medication information is presented to supplement the current knowledge base of practicing clinicians who prescribe analgesics and adjuvant medications for their patients with pain.     

Using Online Groups to Provide Support to Asian American Men: Racial, Cultural, Gender, and Treatment Issues.

A theoretical framework and practical guidelines are provided for practitioners to implement online groups to address issues related to race, culture, class, gender, and sexuality in working with Asian American men. Specific gender, racial, and cultural considerations are presented for working with Asian American men. Ethical guidelines are discussed in reference to American Psychological Association (2002) principles, and practical guidelines are given for facilitating online groups that provide support, guidance, and information to Asian American men. Finally, treatment and research implications are discussed for providing online groups to diverse populations so that practitioners will be able to apply these guidelines in working with other groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues and Implications of Deaf Culture in Therapy.

In the United States, it is estimated that between 200,000 and 500,000 individuals are culturally Deaf. Deaf culture provides unique challenges that can impact standard therapeutic techniques. Issues regarding the ability of hearing therapists to effectively work with Deaf clients are addressed, and a number of guidelines are offered to assist hearing therapists in bridging language barriers and cultural gaps with Deaf clients. Additionally, concerns about the selection and inclusion of sign language interpreters are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heparin therapy in pediatric patients

Advances in tertiary care pediatrics have resulted in heparin being one of the most frequently prescribed drugs in children's hospitals. Heparin is essential for cardiopulmonary bypass, extracorporeal membrane oxygenation, renal dialyses, maintenance of patency of venous and arterial catheters, and treatment of thromboembolic events. Currently, protocols validated in adults are used for children. However, optimal use of heparin in pediatric patients will likely differ from adults because of age-dependent physiologic and pathologic differences in hemostasis that influence the activities of heparin. The following review summarizes the influence of age on heparin anticoagulant activities, and pharmacokinetics. The indications, monitoring, therapeutic range, factors influencing dose-response relationships, and side effects of heparin therapy in pediatric patients are discussed. Finally the current and future indications for low-molecular-weight heparins in pediatric patients are summarized. Multi-centered, international clinical trials are urgently needed to assess and optimize the use of heparin in pediatric patients in a variety of clinical settings. Until these studies are completed, recommendations for adults provide guidelines for children.     

Cross-cultural similarity and difference in interpersonal behavior.

It is suggested that certain aspects of interpersonal behavior are common to different cultures while certain other aspects change from culture to culture. 8 types of interpersonal behavior are defined; it is predicted that they can be arranged in a circular order according to the size of their coefficients of intercorrelation. The population investigated consists of a sample of 633 married couples living in Jerusalem, Israel, and belonging to 2 cultural groups: one originating from Europe and the other from the Middle East. It was found that the predicted circular order is the same in both groups. On the other hand the size of specific correlation coefficients varies for the 2 groups and appears to be related to group differences in cultural values. Cross-cultural similarity and difference are traced to the sequence of development of interpersonal concepts during socialization and to the influence of cultural values on the formation of these concepts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultures of Moderation and Expression: Emotional Experience, Behavior, and Physiology in Chinese Americans and Mexican Americans.

Ethnographic accounts suggest that emotions are moderated in Chinese cultures and expressed openly in Mexican cultures. The authors tested this notion by comparing subjective, behavioral, and physiological aspects of emotional responses to 3 (warned, unwarned, instructed to inhibit responding) aversive acoustic startle stimuli in 95 Chinese Americans and 64 Mexican Americans. Subjective reports were consistent with ethnographic accounts; Chinese Americans reported experiencing significantly less emotion than Mexican Americans across all 3 startle conditions. Evidence from a nonemotional task suggested that these differences were not artifacts of cultural differences in the use of rating scales. Few cultural differences were found in emotional behavior or physiology, suggesting that these aspects of emotion are less susceptible to cultural influence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A house divided? The psychology of red and blue America.

Recently it has become commonplace in America for commentators and the public to use the terms "red" and "blue" to refer to perceived cultural differences in America and American politics. Although a political divide may exist in America today, these particular terms are inaccurate and reductive. This article presents research from social psychology demonstrating that the increased use of these terms is likely to increase the conflict between political groups in America by making political conflict salient in nonpolitical contexts, reducing the ability of Americans to form multifaceted complex identities, pushing Americans to misperceive political in-groups and out-groups, and contributing to a "spiral of silence." An alternative model for discussing cultural differences is proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the AHCPR Depression in Primary Care guidelines: Further considerations for practitioners.

The majority of cases of clinical depression go unrecognized and untreated, despite the fact that depression is an eminently treatable disorder. The Agency for Health Care Policy and Research (AHCPR) recently published a set of clinical practice guidelines focused on depression in primary care settings. The review of the literature on which the guidelines are based is thorough and appropriate and should enhance the detection of depression and the quality of pharmacotherapy for depression. However, the guidelines encourage primary care physicians to provide pharmacotherapy to their depressed patients as the 1st line of treatment. The wisdom of this recommendation is questioned and revisions to the guidelines are suggested. Specifically, patients should be informed of the broad array of treatment options available and provided with a more balanced presentation of the potential benefits of psychotherapy for depression. Patients should decide which treatment alternative they wish to undergo. (PsycINFO Database Record (c) 2010 APA, all rights reserved)