The association between the behavior rating inventory of executive functioning and cognitive testing in children diagnosed with a brain tumor

Pediatric brain tumor survivors (PBTS) suffer from cognitive late effects, such as deteriorating executive functioning (EF). We explored the suitability of the Behavior Rating Inventory of Executive Function (BRIEF) to screen for these late effects. We assessed the relationship between the BRIEF and EF tasks, and between the BRIEF-Parent and BRIEF-Teacher, and we explored the clinical utility. Eighty-two PBTS (8–18 years) were assessed with EF tasks measuring attention, cognitive flexibility, inhibition, visual-, and working memory (WM), and with the BRIEF-Parent and BRIEF-Teacher. Pearson’s correlations between the BRIEF and EF tasks, and between the BRIEF-Parent and BRIEF-Teacher were calculated. The BRIEF-Parent related poorly to EF tasks (rs < .26, ps > .01), but of the BRIEF-Teacher the WM-scale, Monitor-scale, Behavioral-Regulation-Index, and Meta-cognition-Index, and Total-score (rs > .31, ps < .01) related significantly to some EF tasks. When controlling for age, only the WM scale and Total score related significantly to the attention task (ps < .01). The inhibit scales of the BRIEF-Parent and BRIEF-Teacher correlated significantly (r = .33, p < .01). Children with clinically elevated scores on BRIEF scales that correlated with EF tasks performed worse on all EF tasks (ds 0.56–1.23, ps < .05). The BRIEF-Teacher Total and Index scores might better screen general EF in PBTS than the BRIEF-Parent. However, the BRIEF-Teacher is also not specific enough to capture separate EFs. Solely relying on the BRIEF as a screening measure of EFs in BPTS is insufficient. Questionnaires and tasks give distinctive, valuable information.     

La « préparation magistrale » en droit français : un lot exclusif par patient ?

Outpatient pharmaceutical needs are not always met by industrial products and do not necessarily justify hospitals activation. Preparing in advance and storing a batch of compounded drugs for one or more patients with identical/recurrent needs – as part of compound outsourcing in ambulatory sector – raises issues. While the french law does not expressly provide (and according to prevailing interpretations excludes) this hypothesis, it seems to us to be possible – in contrast to the prominent french judicial and administrative courts, as well as to the European Court of justice. We here propose to reset the debate within both the existing laws and a systemic perspective, and call for a normative clarification.     

The Brief Cognitive Impairment Scale (BCIS): preliminary investigation of a severe-stage dementia test emphasizing cognitive processing and interpersonal tolerance

We describe the development and validation of The Brief Cognitive Impairment Scale (BCIS), a cognitive screening instrument designed for persons with severe-stage dementia. Psychometric analyses were performed on neuropsychological data from long-term care residents (N = 247) who completed a brief battery of tests, including the BCIS. A principle component analysis yielded three factors that provide insight into how persons with severe dementia cognitively process information and may tolerate specific aspects of social stimulation, such as during personal care. A BCIS cut score can be used to identify severe dementia with a sensitivity of .82, a specificity of .84, and an area under the curve of .89. It may be used by clinicians or caregivers when advanced dementia is suspected, as an alternative to measures with suspected floor effects, when residents cannot tolerate more demanding assessment tools, and as part of non-pharmacologic treatment plans for behavior disturbances associated with dementia.     

Identifying Students at Risk: An Examination of Computer-Adaptive Measures and Latent Class Growth Analysis

Multitiered systems of support depend on screening technology to identify students at risk. The purpose of this study was to examine the use of a computer-adaptive test and latent class growth analysis (LCGA) to identify students at risk in reading with focus on the use of this methodology to characterize student performance in screening. Participants included 3,699 students in Grades 3–5. Three time points of administration (fall, winter, and spring) of the computer-adaptive reading measure were selected. LCGA results indicated 6–7 classes, depending on grade, informed by level and growth in student performance that significantly predicted failure on the statewide test administered at the end of the year. The lowest-performing classes had failure rates above 90% across all grades. The results indicate that identifying homogeneous groups of learners through LCGA may be valuable as an approach to determining students who need additional instruction. Practical implications and future directions are discussed.     

How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores

Some older adults cannot meaningfully participate in the testing portion of a neuropsychological evaluation due to significant cognitive impairments. There are limited empirical data on this topic. Thus, the current study sought to provide an operational definition for a futile testing profile and examine cognitive severity status and cognitive screening scores as predictors of testing futility at both baseline and first follow-up evaluations. We analysed data from 9,263 older adults from the National Alzheimer’s Coordinating Center Uniform Data Set. Futile testing profiles occurred rarely at baseline (7.40%). There was a strong relationship between cognitive severity status and the prevalence of futile testing profiles, χ²(4) = 3559.77, p < .001. Over 90% of individuals with severe dementia were unable to participate meaningfully in testing. Severity range on the Montreal Cognitive Assessment (MoCA) also demonstrated a strong relationship with testing futility, χ²(3) = 3962.35, p < .001. The rate of futile testing profiles was similar at follow-up (7.90%). There was a strong association between baseline dementia severity and likelihood of demonstrating a futile testing profile at follow-up, χ²(4) = 1513.40, p < .001. Over 90% of individuals with severe dementia, who were initially able to participate meaningfully testing, no longer could at follow-up. Similarly, there was a strong relationship between baseline MoCA score band and likelihood of demonstrating a futile testing profile at follow-up, χ²(3) = 1627.37, p < .001. Results can help to guide decisions about optimizing use of limited neuropsychological assessment resources.     

Information du patient par le pharmacien en officine

The pharmacist, practicing in city pharmacy, has a duty of information of the patient, what is not easy within the framework of a sale of medicine in the presence of other customers. His duty exists that the medicine was prescribed or not, and his responsibility can be committed in both cases. These last years, the profession evolves with new perspectives as for the missions and for the role of the pharmacist. Since the law Hospital patients health territory (HPST) of 2009, in particular, the pharmacists mobilize to widen their missions with the patients so that their activity overtakes the simple dispensation of medicine. The pharmacist has to participate in the cooperation between healthcare professionals, in the mission of public service of the office of the care, in the therapeutic education and in the actions of support of the patients. So numerous novelties spread within pharmacies, either by a political will, through new regulations, or by initiatives appropriate to the pharmacists, in particular in the ordinal plan, with the pharmaceutical file.     

Religious and spiritual struggle: prevalence and correlates among older adults with depression in the BRIGHTEN Program

Older adults (OA) are more religious and/or spiritual (R/S) than younger adults, but some experience R/S struggle which is associated with poorer quality of life. Little is known about R/S struggle in community dwelling OA. This study examines prevalence, correlates, the association with depression for R/S struggle, and a desire for spiritual care in community dwelling OA with depression. In a programme for integrating care for these OA, 188 participants provided demographic information along with the Geriatric Depression Scale and a tool screening for potential R/S struggle. Prevalence of potential R/S struggle was 50%. The younger OA and Caucasian individuals vs. Hispanic individuals were more likely to experience potential R/S struggle. A relationship of potential R/S struggle with depression persisted with the inclusion of controls. Of those with potential struggle, 52% wanted to see a chaplain. Screening for potential R/S struggle can play an important role in choosing specific interventions for OA with depression.     

L’acceptation située des technologies dans et par l’activité : premiers étayages pour une clinique de l’usage

The aim of this paper is to consider that a complementary way to evaluate the acceptance of technology in the work is possible; the acceptance situated. From a critical review of the classical models of acceptability (social and practical) on the one hand, and relying on models of the activity and theories of appropriation on the other hand, we show that it is necessary to insert the ICT in its social thickness, that is to say in a more comprehensive and complex as richer activity system (real). We will discuss the four dimensions to be considered to evaluate this acceptance situated. We also indicate how this approach can become an instrument of the development of activity and can contribute to a process of (re)creation of technical instruments, laying the foundations of what we have named a clinical usage.     

Ethical issues in genetic counseling: A comparison of M.S. counselor and medical geneticist perspectives

New technologies available in the field of medical genetics have increased the importance of responsible ethical decision-making among genetic counselors. A 1985 national survey of M.D. and Ph.D. genetic counselors assessed ethical attitudes using case scenarios designed to simulate dilemmas faced in genetic counseling (Wertz and Fletcher, 1988b). The current study focuses on attitudes of M.S. genetic counselors using similar scenarios, allowing for effective comparisons. M.S. counselors were more willing than M.D. and Ph.D. counselors to maintain patient confidentiality when screening for Huntington's Disease and occupational diseases, and a greater number would agree to counsel patients pursuing prenatal testing for sex selection. A majority of M.S. counselors would disclose an XY karyotype to a phenotypically female patient. M.S. counselors reasoned that respect for patient autonomy and patient confidentiality justified their decisions in many cases. The importance of these principles is discussed and questioned.