Rehabilitative neuropsychological approach for severe traumatic brain-injured patients.

Points out that individuals who sustain severe traumatic brain injury frequently suffer diminished, lost, or altered intellectual cognitive, social, and emotional functioning that is long lasting. Unfortunately, a significant number of psychologists who see these patients may only view their role as diagnostic rather than rehabilitative and may adhere to a philosophy of "therapeutic nihilism." This attitude appears in part to be based on the long-held assumption that brain damage is permanent and irreversible, on the widespread use of neuropsychological tests that place little emphasis on rehabilitation, on the failure in the past of clinical training programs in psychology to offer training in the rehabilitation of the brain-injured patient, and on the invidious dichotomy frequently made between psychological and organic causes of behavior. A neuropsychological rehabilitative model for the assessment, treatment, and rehabilitation of the brain-injured patient within a private practice setting is presented that emphasizes the quality of the interaction between the patient's strengths and deficits and the demand characteristics of the environment. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antimicrobial susceptibility of periodontopathic bacteria associated with failing implants

Histological, immunohistochemical, and flow cytometric characteristics of three unusual parotid gland tumors are described. The patients were adult white men with carcinoma ex pleomorphic adenoma, true malignant mixed tumor, and primary parotid gland chondrosarcoma. The carcinoma ex pleomorphic adenoma showed evidence of simultaneous epithelial, myoepithelial, and mesenchymal differentiation by immunohistochemistry. The true malignant mixed tumor exhibited variable positivity for two keratins, vimentin, proliferating cell nuclear antigen, Ki67, and p53. The chondrosarcoma initially stained for vimentin, S100, muscle-specific actin, proliferating cell nuclear antigen, and Ki67, but it lost actin expression in its first recurrence, accompanied by more extensive Ki67 staining. DNA ploidy varied from diploid to aneuploid with intratumoral variation in the carcinosarcoma. S-phase fractions ranged from 2.43% to 13.9%. The findings underscore the diversity of tumors that may be pathogenetically related to, and at times derived from, pleomorphic adenoma.     

Attitudes of psychiatrists toward elderly patients

A group of 179 psychiatrists responded to a questionnaire requesting their opinions concerning four clinical vignettes. Analysis of their responses indicated that these psychiatrists, at a highly statistically significant level, regarded older patients as less ideal for their practices than younger patients with identical symptoms. The respondents viewed the older patients as having a poorer prognosis, and their treatment plans for them were less likely to emphasize psychotherapy. In general, there was a negative correlation between the age of the respondent psychiatrists and their estimate of the "idealness" of and favorable prognosis for older patients.     

The psychologist as a consultant in a nursing home: Effect on staff morale and turnover.

Many elderly patients have been transferred from long-term psychiatric hospitals to nursing homes, where knowledge of psychological aspects of patient care is generally poor and where emotional and behavioral disorders are poorly tolerated by staff. One solution to this problem is for psychologists to provide in-service training to nursing-home staff in the psychological aspects of patient care, but this approach ignores such problems as poor staff morale and high staff turnover. A 188-bed skilled nursing home was selected for a 12-wk consultation program based on a mental health and organizational development approach. Turnover rates fell from 73.4%, during the quarter prior to consultation, to 27.8%, during the period of consultation, and averaged 33.6% for the next 3 quarters. Staff morale also improved. Results indicate that before training nursing-home staff in the psychological aspects of geriatric care, problems such as high staff turnover and poor morale should be resolved. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are the subjective complaints of traumatically brain injured patients reliable?

The present study was designed to compare the subjective complaints of 50 traumatically brain injured (TBI) patients with the observations of their significant others. The complaints of the TBI patients and their significant others were contrasted according to the severity of the TBI and the type of complaint (physical, cognitive/behavioural and emotional). While no differences were found in physical complaints, the cognitive/behavioural and emotional complaints of TBI patients, regardless of the severity of the initial TBI, were significantly under-reported in comparison to the observations of their significant others. The data suggests that while this finding was most likely due to the TBI patients' poor awareness, it was unlikely to be the result of psychological denial since all of these individuals were evaluated in the context of being a plaintiff in personal injury litigation or a claimant in a Workers' Compensation claim. The data suggests that the cerebral trauma these patients sustained played a major role in their ability to recognize their cognitive, behavioural and emotional symptoms. Finally, the data suggests that clinicians should obtain information about the TBI patients' cognitive/behavioural and emotional functioning from their significant others, rather than rely entirely on the TBI patients' subjective assessment of these problems.