Visual Hallucinations in Older People: Appraisals but not Content or Phenomenology Influence Distress.

BACKGROUND: A previous study (Gauntlett-Gilbert and Kuipers, 2005) has suggested that distress associated with complex visual hallucinations (CVHs) in younger adults with psychosis may more strongly relate to appraisals of meaning than to the content of the hallucination. However, visual hallucinations are most commonly seen in the disorders of later life, where this relationship has not been investigated. AIM: To establish if there is a relationship between appraisals of CVHs and distress in older, non-psychotic people with CVHs. METHOD: All variables were measured using a semi-structured interview and were compared between a high distress group (n = 16) and a low distress group (n = 19). RESULTS: The high distress group rated their hallucinations as more malevolent and omnipotent, with greater negative implications for physical and mental health. There was no significant difference between groups on ratings of hallucination content (independently rated), frequency, awareness or control. CONCLUSION: Appraisals of CVHs are linked to distress.

Parallel walk test: its correlation with balance and motor functions in people with chronic stroke.

OBJECTIVES: To investigate (1) the intrarater, interrater, and test-retest reliability of the times and scores generated in the parallel walk test (PWT); (2) their correlations with impairments and activity limitations of individuals with stroke; and (3) the cutoff times that best discriminate individuals with stroke from healthy elderly subjects. DESIGN: Cross sectional study. SETTING: University-based rehabilitation center. PARTICIPANTS: Participants (N=72) comprised individuals with stroke (n=37) and healthy individuals (n=35). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The PWT was administered along with the Fugl-Meyer Motor Assessment of the Lower Extremities (FMA-LE), handheld dynamometer measurements of ankle dorsiflexor and plantarflexor muscle strength, the 5-Times-Sit-to-Stand Test, the Berg Balance Scale (BBS), a limits of stability (LOS) test, the 10-m walk test (10-MWT), and the timed Up and Go (TUG) test. RESULTS: PWT times and scores showed good to excellent intrarater, interrater, and test-retest reliability in individuals with stroke. PWT times using paths of 3 different widths significantly correlated with FMA-LE scores, 5-Times-Sit-to-Stand Test times, BBS scores, some LOS test results, 10-MWT gait speed, and TUG test times. PWT times of 6.30 to 7.48 seconds, depending on the path width, were shown reliably to discriminate individuals with stroke from healthy individuals. CONCLUSION: The PWT is a reliable, easy-to-administer clinical tool for assessing dynamic walking balance in individuals with chronic stroke.

A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible Esophagoscopy.

BACKGROUND: Tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold standard of surgical voice restoration in postlaryngectomy patients. The conventional technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone, with technical limitations encountered in patients with cervical abnormalities - in particular those with free or rotational flap reconstructions and postradiotherapy strictures. We report our technique using flexible endoscopy which we show to be feasible and without major safety events, as a possible consideration in the anticipated difficult TEP. METHODS: Our study describes a multidisciplinary approach to secondary TEP involving a combined upper gastrointestinal (UGI) and (Ear, Nose, and Throat) ENT procedure, under the guidance of flexible esophagoscopy, with intraoperative involvement of the speech pathologist to guide VP insertion and placement. The procedure was performed with ease without major complications. RESULTS: We identified nine postlaryngectomy and laryngopharyngectomy patients in our institution who underwent secondary TEP with VP insertion using flexible esophagoscopy and multidisciplinary intra-operative involvement. All patients had pharyngeal reconstruction, including radial forearm free flap (n = 4), pectoralis major rotational flap (n = 3), and anterolateral thigh flap (n = 2). Eight out of nine patients underwent adjuvant radiotherapy. The technique was successfully performed in all patients. There were three cases of early TEP displacement in two patients, of which one patient had a successful repeat procedure. We found the technique advantageous in terms of feasibility and practicality compared to the conventional approach, and without intraoperative difficulties encountered in achieving the desired field of views or navigating the challenging anatomy in a free flap and post-radiotherapy patients. This includes distorted cervical anatomy, the presence of bulky and hair-bearing flap skin, and stricture formation. Minor complications in our cohort included pharyngo-esophageal spasm, TEP displacement, granulation tissue, and peri-prosthetic leaks. CONCLUSION: Our multidisciplinary approach to secondary TEP was performed with flexible esophagoscopy without major related complications. The technique is advantageous in the surgical approach to VP insertion in postlaryngectomy and laryngopharyngectomy patients who have had radiotherapy or pharyngeal reconstruction. It allows for safe anatomical insertion and thorough evaluation of the upper aerodigestive tract for comorbid benign or malignant esophageal pathology.

Does the relative silicone content of different syringes affect the stability of foam in sclerotherapy?

BACKGROUND: Sclerotherapy has become the gold standard in the treatment of varicose veins. Foam sclerosing solution with sodium tetradecyl sulfate (STS) is one of the most popular agents used. This study examined the possibility that relative silicone content of different syringes may affect the overall foam stability. MATERIALS AND METHODS: A double-syringe system (DSS) technique to make sclerosing foam (STS 0.5% and air) was applied. Four different brands of syringes were tested. The time required for half of the original volume of sclerosing solution to settle was recorded. RESULTS: The time for the sclerosing solution to settle to half of its initial volume varied with each brand of syringes. CONCLUSION: The type of syringe used in the DSS technique to produce foam for sclerotherapy is a determinant of foam stability. Whether this will affect the result of sclerotherapy requires further investigation.

Validating the Use of D for Measuring Lexical Diversity in Low-Income Kindergarten Children.

PURPOSE: Children from low-socioeconomic status families often perform poorly on standardized vocabulary assessments. The primary purpose of the study was to determine whether lexical diversity as measured by D (Malvern, Richards, Chipere, & Durán, 2004) serves as a valid measure of vocabulary in at-risk, low-income, predominantly African American kindergartners. METHOD: Kane's (1992) argument-based approach was used to validate D. Six assumptions were examined. Kindergartners (N = 210) from a high-poverty, low-achievement region of the United States were recorded narrating a wordless picture book and assessed using the Expressive Vocabulary Test, Second Edition (Williams, 2007), and the Kaufman Test of Educational Achievement, Second Edition-Listening Comprehension subtest (Kaufman & Kaufman, 2004). RESULTS: D was distributed normally and did not vary as a function of language sample length or child ethnicity. D was significantly but weakly related to the Expressive Vocabulary Test, Second Edition, indicating some distinction between D and the Expressive Vocabulary Test, Second Edition, scores. Further, D was only marginally related to the Kaufman Test of Educational Achievement, Second Edition-Listening Comprehension subtest. CONCLUSIONS: Although evidence was somewhat mixed, the study supported the view that D is a potentially valid measure of lexical diversity among low-income, predominantly African American kindergartners and could be a useful supplement to standardized vocabulary measures.

Aging well socially through engagement with life: adapting Rowe and Kahn's model of successful aging to Chinese cultural context.

Although aging well socially (engagement with life) is as important as aging well personally (illness avoidance and functioning) (Rowe & Kahn, 1998), it has received less research attention. A caring (CE) and a productive (PE) form of engagement were derived from an analysis of Chinese cultural meanings of engagement, and combined with illness avoidance and functioning to form a 4-factor model. Confirmatory factor analysis based on 2970 Hong Kong Chinese (40 to 74 years) showed a good model fit that was replicated a year later with 2120 of the original sample. Further analysis led to a more parsimonious model where illness avoidance and functioning converged into a single second-order factor whereas CE and PE remained as distinct first-order factors. The results supported the differentiation of Rowe and Kahn's engagement with life component into caring and productive engagements.

Treatment of facial reticular veins with dynamically cooled, variable spot-sized 1064 nm Nd:YAG laser.

BACKGROUND: Facial reticular veins are often seen on the temple and periorbital areas in patients with genetic predisposition or after facial cosmetic surgery. AIM: The purpose of this study was to evaluate the efficacy and safety of dynamically cooled, variable spot sized 1064 nm Nd:YAG laser in the treatment of facial reticular veins. PATIENTS/METHODS: This is a retrospective study. Twenty patients with facial reticular veins who underwent treatment with dynamically cooled, variable spot sized 1064 nm Nd:YAG laser were evaluated. Patients were followed up 1 month to 2 years after the procedure. RESULTS: Objective and subjective improvement scores after one or two treatments of dynamically cooled, variable spot sized 1064 nm Nd:YAG laser were nearly 100% when appropriate parameters were used. CONCLUSION: Dynamically cooled, variable spot sized 1064 nm Nd:YAG laser is a safe and effective treatment for facial reticular veins. Most patients responded to one treatment and experienced no significant side effects other than tolerable pain associated with the procedure.