Diagnosis of ADHD in Adults Solanto, Mary V.; Wasserstein, Jeanette; Marks, David J. ...
Journal of attention disorders,
11/2012, Letnik:
16, Številka:
8
Journal Article
Recenzirano
Objective: To empirically identify the appropriate symptom threshold for hyperactivity-impulsivity for diagnosis of ADHD in adults. Method: Participants were 88 adults (M SD age = 41.69 11.78 years, ...66% female, 16% minority) meeting formal DSM-IV criteria for ADHD combined or predominantly inattentive subtypes based on a structured diagnostic interview keyed to DSM-IV (Conners’ Adult ADHD Diagnostic Interview for DSM-IV CAADID). All participants also completed the Conners’ Adult ADHD Rating Scale (CAARS), which was normed on the general adult population and includes subscales for DSM-IV inattentive and DSM-IV hyperactive-impulsive symptoms. A T-score threshold of 65 (at least 1.5 SD above population mean) on the CAARS DSM-IV hyperactive-impulsive dimension was used to identify participants with empirically elevated symptom severity. Results: Of 88 participating adults, 48 (55%) had a T-score of at least 65 (1.5 SD) on the CAARS DSM-IV Hyperactive-Impulsive scale. Of these, only 25 (52%) met the DSM-IV cutoff of six hyperactive-impulsive symptoms on the CAADID. Thus, approximately half of those who reported empirically elevated hyperactive-impulsive complaints on the CAARS did not concurrently meet the six-symptom DSM-IV cutoff on the CAADID. An alternative cutoff of four hyperactive-impulsive symptoms on the CAADID captured 39 (81%) cases identified by the CAARS. Conclusion: In adults, mandating at least six hyperactive-impulsive symptoms excludes a significant percentage (almost half) of adults who are at least 1.5 SD above the population mean on a dimensional measure of hyperactivity-impulsivity. These data provide a compelling basis for lowering the symptom threshold of hyperactivity-impulsivity for adults in the DSM-5.
The ratio of intragraft venous limb pressure (VLP) to systemic pressure (S) has been proposed to help determine the endpoint of hemodialysis access interventions. It was hypothesized that physical ...examination of the access could be used in the same way and these techniques were compared as predictors of outcome.
With use of a quality-assurance database, records from 117 hemodialysis access interventions were retrospectively reviewed. Only interventions in grafts were included. The database included physical examination (to establish thrill, thrill with slight pulsatility TSP, pulse with slight thrill PST, and pulse) at three locations along the graft (proximal, midportion, and distal), normalized pressure ratio calculated with S from a blood pressure cuff (S(cuff)) and S within the graft with outflow occluded (S(direct)), graft configuration and location, indication, operator, and time to next intervention (outcome of primary patency). Only procedures with complete follow-up data were included in the analysis (n = 97; declotting, n = 51; prophylactic percutaneous transluminal angioplasty PTA, n = 46). Statistical analysis was performed with use of Cox proportional-hazards regression.
Graft configuration, location, side, VLP, S(direct), and S(cuff) did not affect outcomes. An operator effect was noted for two physicians and was adjusted for in all analyses. Pressure ratios were weak predictors of outcome (VLP/S(direct), P =.07; VLP/S(cuff), P =.08) and suggested that patency increased with increasing pressure ratio, contrary to earlier studies. Procedure type predicted outcome (declotting, median patency of 50 days; PTA, median patency of 105 days; P =.01). Thrill at distal physical examination was predictive of outcome (P =.04) and even more so when thrill and TSP combined were compared with PST and pulse combined (P =.03). Similar but less-pronounced effects were seen at midportion and proximal physical examinations.
The presence of a thrill or slightly pulsatile thrill at the distal (venous) end of a dialysis graft is the best predictor of outcome after percutaneous intervention. Based on the present study, the authors believe that physical examination of dialysis access should supplant pressure measurements as an endpoint of intervention and should serve as an essential component of quality assurance of access interventions.
Recombinant human erythropoeitin (rhEPO) is a highly effective but expensive drug used for the treatment of certain anemias. We considered opportunities to curtail inpatient rhEPO utilization in ...light of therapeutic alternatives, the drug's delayed onset of action, and the available literature.
A retrospective review of rhEPO administration in a large academic medical center between February and June 2000 was conducted by using administrative databases.
The computerized inpatient pharmacy transaction file of the Hospital of the University of Pennsylvania was queried to determine trends for rhEPO administration. We then employed CaduCIS (CareScience, Philadelphia, PA) to determine the clinical diagnoses and resources used for each inpatient receiving rhEPO.
In the study period, 248 inpatients received at least 1 rhEPO dose. More than 100 different physicians, representing 20 departments and divisions, ordered approximately 17 million units of rhEPO. Hematology/Oncology accounted for 33% of all units ordered, and Surgery and General Medicine ordered 16% and 14%, respectively. The usual length of stay for patients receiving rhEPO varied considerably: 34% of patients remained in hospital for < or = 7 days, while 31% remained > or = 3 weeks. As many as 34% of patients began rhEPO therapy as inpatients. Of inpatients receiving rhEPO, only 49% met labeled indications for rhEPO administration.
At our institution, approximately one half of all inpatient rhEPO usage is for an off-label indication. Utilization patterns may suggest strategies for conserving this scarce resource.
This study investigated two major theories of unilateral neglect utilizing the ipsilaterally innervated olfactory sense. The sensory theory states that unilateral neglect is due to a diminished or ...attenuated sensory input. The representational theory states that unilateral neglect is due to a disordered internal representation, which is not dependent on sensory input. Results of the study revealed that right hemisphere lesion patients with left unilateral neglect failed to respond to their left contralateral nostril on olfactory double simultaneous stimulation, consistent with the representational theory because the left nostril has no direct sensory input to the right hemisphere.
Unilateral neglect is a syndrome primarily occurring with right hemisphere--particularly right parietal lobe--brain damage and involving the failure to respond to stimuli presented to the left side ...of the body and space. Unilateral displacement (a less severe manifestation of the neglect syndrome) involves the accurate identification of a stimulus, but the displacement or mislocalization of that stimulus to the opposite side of the body and space. This study investigated two major theories of unilateral neglect utilizing the primarily ipsilaterally innervated olfactory sense. The sensory theory states that unilateral neglect is due to a diminished sensory input, whereas the representational theory states that it is due to a disordered internal representation which is not dependent on sensory input. Results revealed that right hemisphere lesion patients with left unilateral neglect exhibited a significantly greater number of displacements in their left nostril on olfactory double simultaneous stimulation, consistent with the representational theory.
Book reviews Moorhouse, Sharon; Hartman, David; Goldberg, David ...
Anthropology & Medicine,
19/8/1/, Letnik:
5, Številka:
2
Book Review
Recenzirano
Psychotherapy Research and Practice: Bridging the Gap P. F. Talley, H. H. Strupp & S. F. Butler London, Basic Books, 1994, 300 pp.
Scientific Racism in Modern South Africa Saul Dubow Cambridge, ...Cambridge University Press, 1995
Social Suffering Arthur Kleinman, Veena Das & Margaret Lock (eds) Berkley, University of California Press, 1997, ISBN 0-520-20995-8, paperback
Mania and Literary Style: The Rhetoric of Enthusiasm from the Ranters to Christopher Smart Clement Hawes (Cambridge Studies in eighteenth-century English literature and thought 27) Cambridge, Cambridge University Press, 1996, 241 pp.
Dangerous Pleasures: Prostitution and Modernity in Twentieth-Century Shanghai Gail Hershatter Berkeley, University of California Press, 1977, xii + 591 pp., photographs, tables, index. $45/£35 cloth.
Food Preferences and Taste Helen MacBeth (ed.) Berghaus Books, 1997, £30.00 (hbk), & £12.95 (pbk). xii + 218 pp., maps, tables, bibliographies.
Facial nerve paralysis developed in a man with tumor-stage mycosis fungoides (MF). Mastoidectomy disclosed that MF had involved the mastoid and middle ear. Meningeal lymphoma, confirmed by the ...finding of Sézary cells in the CSF, was subsequently established. Autopsy disclosed MF lymphoma in the leptomeninges, medulla, spinal cord, and cranial nerves. A unique feature was the formation of a communicating hydrocephalus. Case reports of 23 patients with MF of the CNS, including 21 autopsies, are reviewed. Practically all had tumor-stage or erythrodermic MF. Atypical mononuclear cells were found ante mortem in the CSF in eight patients. In contrast to other CNS lymphomas, bone marrow involvement was uncommon. Cranial, especially facial, nerve paralyses were often premonitory signs of meningeal lymphomas. Patients with MF having such symptoms should have cytologic examination of the CSF.
To be continued Smiley, Jane; Parini, Jay; Wallace, David Foster ...
Harper's (New York, N.Y.),
08/1992, Letnik:
285, Številka:
1707
Magazine Article
Six noted writers present sequels to their favorite literary works: 'Metamorphosis,' 'The Great Gatsby,' 'Rabbit at Rest,' 'Death in Venice,' 'Franny and Zooey' and 'Gulliver's Travels.'
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