A medical diagnostic index for rehabilitation

This paper records the developments of a computerized database suitable for recording the history, signs and symptoms of handicapping conditions, monitoring recovery, and measuring the impact of different forms of treatment. The original model described was designed for stroke and the paper describes its integration into the routine use of a stroke and rehabilitation unit in a district general hospital.     

Patellofemoral disorders: a classification system and clinical guidelines for nonoperative rehabilitation

Patellofemoral disorders are among the most common clinical conditions managed in the orthopaedic and sports medicine setting. Nonoperative intervention is typically the initial form of treatment for patellofemoral disorders; however, there is no consensus on the most effective method of treatment. Although numerous treatment options exist for patellofemoral patients, the indications and contraindications of each approach have not been well established. Additionally, there is no generally accepted classification scheme for patellofemoral disorders. In this paper, we will discuss a classification system to be used as the foundation for developing treatment strategies and interventions in the nonsurgical management of patients with patellofemoral pain and/or dysfunction. The classification system divides the patellofemoral disorders into eight groups, including: 1) patellar compression syndromes, 2) patellar instability, 3) biomechanical dysfunction, 4) direct patellar trauma, 5) soft tissue lesions, 6) overuse syndromes, 7) osteochondritis diseases, and 8) neurologic disorders. Treatment suggestions for each of the eight patellofemoral dysfunction categories will be briefly discussed.     

Coding medical information: classification versus nomenclature and implications to the Israeli medical system

OBJECTIVE: Quantification of photosensitizer concentration in tissue improves the planning and, subsequently, the outcome of photodynamic therapy. This study was designed to determine if the method of photosensitizer evaluation influences the accuracy of pharmacokinetic results. MATERIALS AND METHODS: In vivo 13(2)-Hydroxy-bacteriopheophorbide a methyl ester (13(2)-OH-BPME) pharmacokinetics in mice bearing LEWIS lung carcinoma was studied using fluorescence in situ and absorption spectroscopy (following photosensitizer chemical extraction) as photosensitizer quantification methods. The correlation of 13(2)-OH-BPME fluorescence intensity and its concentration using the absorption spectroscopy were determined for each tissue. RESULTS: The parenchymatous organs showed maximum 13(2)-OH-BPME concentration and fluorescence intensity at 2 h post-injection (lung, liver, spleen), and at 2 h post-injection in the kidney with both quantification methods (identical correlation). There was a difference in the time of maximum photosensitizer fluorescence intensity and its concentration in tumor, muscle, and skin (low correlation). The time of maximum fluorescence intensity in muscle, skin, and tumor was at 4 h, 12 h, and 12 h post injection respectively while its maximum concentration was at 2 h, 4 h, and 8 h post-injection. CONCLUSION: The method of photosensitizer evaluation affects the accuracy of its pharmacokinetic results.     

A classification for incidents and accidents in the health-care system

Problems that arise from health-care management, rather than from a disease process, are now recognized as making a substantial contribution to patient morbidity and mortality and to the cost of health care. However, most classifications of these problems do not provide sufficient detail to allow comparisons or to develop better strategies for the prevention, detection and management of these problems. A 'Generic Occurrence Classification' was developed to record their salient features, place them in context and elicit any system or human error-based contributing factors. This was done by an iterative process in which 'natural categories', identified from over 2000 incidents and 800 adverse events, were placed in a hierarchical structure created using software written in Microsoft Visual Basic; data were stored in a Microsoft Access database. This was shown to be a valid and reliable way to compare incidents and accidents from different sources and to allow sufficient detail to be retrieved to develop preventive strategies.     

Measuring avoidance in medical rehabilitation.

Objective: To establish psychometric properties of the Acceptance and Action Questionnaire (AAQ), a measure of avoidance, in medical rehabilitation populations. Study Design: Cross-sectional and longitudinal. Setting: Three acute, inpatient rehabilitation units. Participants: One hundred thirty-nine adults with spinal cord dysfunction, stroke, amputation, or orthopedic surgery. Measures: AAQ, Hope Scale, Spiritual Well-Being Scale, Positive and Negative Affect Scale, Brief Symptom Inventory, Hopkins Rehabilitation Engagement Rating Scale, Functional Independence Measure, Craig Handicap Assessment and Reporting Technique, Satisfaction with Life Scale. Results: The AAQ has adequate internal consistency (α = .70), is best understood with a two-factor solution, is positively correlated with depression (r = .36, p r = .41, p r = ?.51, p r = ?.33, p r = ?.32, p     

A preliminary classification system for homeless veterans with mental illness.

The purpose of this study was that of defining psychiatric profiles among veterans based on a structured interview of 3,595 individuals administered by outreach mental health clinicians to individuals who were presently or recently homeless. The interview included ratings of presence or absence of current psychiatric disorders; alcoholism, drug abuse, psychosis, mood disorders, personality disorders, PTSD, and adjustment disorders. We identified three subgroups using cluster analysis each showing different diagnostic profiles that were characterized as "addiction" (n = 3,061), "psychosis" (n = 218), and "personality" disorders (n = 54). Cluster membership was related to demographic characteristics, living situation, length of homelessness, and symptoms and complaints including cognitive difficulties, suicidality, violence, and depression. Group comparison statistics were used to compare intercluster differences in demographics, homeless situation, symptoms, and subjective complaints. There were no major intercluster differences in socioethnic, demographic, and homeless situation variables. Differences occurred in complaints of depression, positive symptoms of psychosis, and suicidality. It was concluded that despite the disproportionate sizes of the clusters homeless veterans with mental illness are nevertheless heterogeneous with regard to their psychiatric profiles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consolidation of the inpatient medical rehabilitation industry

Liver transplantation has evolved over the past 35 years from an experimental procedure with high perioperative mortality to an accepted form of treatment with an approximate 85% one-year and 80% three-year patient survival rate. Following the success and acceptance of transplantation in the treatment of end-stage liver disease, there has been a progressive increase in the number of patients seeking a limited supply of donor organs. The ethical focus, on a microallocation level, has therefore changed from that of the 1960s, when the question was whether the procedure should be offered at all, to that of the 1990s and beyond, when the focus is on the proper allocation of a scarce, life-saving resource. The ethical issues concerning fair allocation surrounding liver transplantation are explored, from both the referring physician's perspective and the perspective of the transplant physician. In particular, the contrasting viewpoints of bioethicists Nicholas Rescher and James Childress, with respect to nonmedical and social criteria in the selection of patients for scarce, life-saving therapies are explored. Lastly, some alternative ethical models for patients selection are reviewed.     

A voice-enabled, structured medical reporting system

Kurzweil Applied Intelligence received a research grant from the National Institute of Standards and Technology (NIST) Advanced Technology Program to develop a prototype voice-enabled, structured medical reporting system. In typical usage, the physician dictates to the system, which then uses automatic speech recognition and medical knowledge bases to produce a structured report. This report can then be formatted and viewed on a computer screen, stored in databases of patient information, transmitted to other systems, used to support outcome studies, or viewed on a Web browser. The output reports are structured according to two standard, platform-independent formats: SGML and CORBA. These formats represent the data in a way that can be read by both computers and humans, and efficiently communicated to a wide range of databases and communications protocols.     

The role of religion in medical rehabilitation outcomes: A longitudinal study.

ABSTRACT. Objective: To investigate the protective and consolation models of the relationship between religion and health outcomes in medical rehabilitation patients. Design: Longitudinal study, data collected at admission, discharge, and 4 months postadmission. Measures: Religion measures were public and private religiosity, acceptance, positive and negative religious coping, and spiritual injury. Outcomes were self-report of activities of daily living (ADL), mobility, general health, depression, and life satisfaction. Participants: 96 medical rehabilitation inpatients; diagnoses included joint replacement, amputation, stroke, and other conditions. Results: The protective model of the relationship between religion and health was not supported; only limited support was found for the consolation model. In regression analyses, negative religious coping accounted for significant variance in follow-up ADL (5%) over and above that accounted for by admission ADL, depression, social support, and demographic variables. Subsequent item analysis indicated that anger with God explained more variance (9%) than the full negative religious coping scale. Conclusions: Religion did not promote better recovery or adjustment… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Streamlining assessments and treatments for geriatric mental health in medical rehabilitation.

The past decade has seen dramatic health care changes that profoundly affect the way rehabilitation psychologists are able to provide care for older adults. Increased medical comorbidities and decreased lengths of stay have made it necessary for rehabilitation psychologists to streamline their services. This commentary shares the authors' experience in creating new tools to increase efficiency while retaining effectiveness. The four areas the authors discuss include (a) a tool for triaging cases, (b) a brief battery for cognitive evaluations, (c) a treatment approach for depression that can be delivered in the hospital or outpatient clinic setting, and (d) increased interdisciplinary team communication and function. Each of these approaches has been researched, validated, and cross-validated in geriatric settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Use of sequential medical trials in rehabilitation research

We tested the hypotheses that the hostility and anger scales of the Buss and Perry (1992) [Buss, A. H. & Perry, M. (1992). The Aggression Questionnaire. Journal of Personality and Social Psychology, 63, 452-459.] Aggression Questionnaire would predict anger in college students in response to mistreatment. We found low and high hostility groups did not differ in anger at baseline or after completing a task without provocation, but the high hostility group reported greater anger than the low group after the onset of provocation, which required all students to redo completed tasks because some students (confederates) were observed cheating. Hostility also influenced anxiety and depression, but only anger was greater as a result of the provocation in the high than in the low hostility group. The anger scale did not predict anger in response to provocation, but anger was higher in the high than the low anger group before the provocation. These findings support the construct validity of the Aggression Questionnaire hostility scale as a measure of suspicion, resentment and sensitivity to mistreatment.     

Factors affecting return to living alone after medical rehabilitation: A cross-validation study.

Objective: To cross validate and extend the authors' finding that cognition is one of the best predictors of return to living alone after medical rehabilitation. Design: A prospective sample of live-alone older medical rehabilitation patients followed from admission to discharge. Logistic regression identified significant predictors of return to living alone, and measures of predictive power were calculated. Setting: Stroke and geriatric units of a free-standing urban medical rehabilitation hospital. Participants: One hundred ninety-four older consecutively admitted medical rehabilitation patients 60 years old or older. Main Outcome Measure: Return to living alone versus discharge to living with others. Results: Consistent with the authors' original findings, both cognition and self-care motor skills were significant predictors of return to living alone. Cognition acted as a suppressor variable, leading to age and education effects only when entered into the regression equation. New variables did not add significantly to prediction. Conclusion: The value of rehabilitation psychologists' role in making cognition-based recommendations about discharge disposition in live-alone older adults is supported by findings from this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A proposal for the development of a psychological classification system for children (and adults).

Discusses inadequacies in systems available for the classification of children's psychological (psychiatric, behavioral, emotional) disorders. The development of a classification system based on measures of psychological functioning is advocated, and the advantages of such a system are presented. (French abstract) (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A medical expert system approach using artificial neural networks for standardized treatment planning

PURPOSE: Many radiotherapy treatment plans involve some level of standardization (e.g., in terms of beam ballistics, collimator settings, and wedge angles), which is determined primarily by tumor site and stage. If patient-to-patient variations in the size and shape of relevant anatomical structures for a given treatment site are adequately sampled, then it would seem possible to develop a general method for automatically mapping individual patient anatomy to a corresponding set of treatment variables. A medical expert system approach to standardized treatment planning was developed that should lead to improved planning efficiency and consistency. METHODS AND MATERIALS: The expert system was designed to specify treatment variables for new patients based upon a set of templates (a database of treatment plans for previous patients) and a similarity metric for determining the goodness of fit between the relevant anatomy of new patients and patients in the database. A set of artificial neural networks was used to optimize the treatment variables to the individual patient. A simplified example, a four-field box technique for prostate treatments based upon a single external contour, was used to test the viability of the approach. RESULTS: For a group of new prostate patients, treatment variables specified by the expert system were compared to treatment variables chosen by the dosimetrists. Performance criteria included dose uniformity within the target region and dose to surrounding critical organs. For this standardized prostate technique, a database consisting of approximately 75 patient records was required for the expert system performance to approach that of the dosimetrists. CONCLUSIONS: An expert system approach to standardized treatment planning has the potential of improving the overall efficiency of the planning process by reducing the number of iterations required to generate an optimized dose distribution, and to function most effectively, should be closely integrated with a dosimetric based treatment planning system.     

The quota system in burn rehabilitation

BACKGROUND: The aim of this study was to investigate the expression of hepatocyte growth factor (HGF) and its receptor (c-met) during bladder tumorigenesis. METHODS: HGF and c-met expression were analyzed immunohistochemically in matched samples of normal, dysplastic, and carcinoma specimens from 49 human bladders resected at the time of radical cystectomy for nonmetastatic transitional cell carcinoma (TCC). The tumors were composed of papillary (n = 22), nodular (n = 16) or mixed papillary and nodular (mixed; n = 11) components. RESULTS: The normal urothelium showed no significant immunoreactivity to HGF. Expression of HGF was observed in 45.5%, 77.3% and 90.9% of specimens demonstrating mild, moderate, and severe dysplastic lesions adjacent to papillary TCCs, respectively, whereas all of the papillary TCC samples were positive for HGF. No immunoreactivity for HGF was found in dysplastic lesions from nodular tumors, and only 2 specimens had positive immunostaining for HGF in the tumor areas (1 showed weak immunostaining and 1 showed HGF immunostaining only in the deeper invasive compartment). Additionally, 3 nodular lesions taken from mixed tumors showed weak immunostaining for HGF while the concurrent papillary lesions were HGF-positive. There was a significant difference of HGF immunoreactivity between papillary and nodular tumors (P < 0.01). c-met immunostaining was consistently detected in all specimens. HGF and c-met immunoreactivity did not significantly correlate with tumor stage and grade, nor with overall patient survival irrespective of the tumor growth pattern. CONCLUSION: These results suggest that HGF expression may play a significant role in the development of papillary TCC.