RESUMEN
The Mini-mental State Examination (MMSE) is a commonly used screening tool for cognitive impairment. Lenient scoring of spatial orientation errors (SOEs) on the MMSE is common and negatively affects its diagnostic utility. We examined the effect of lenient SOE scoring on MMSE classification accuracy in a consecutive case series of 103 older adults (age 60 or above) clinically referred for neuropsychological evaluation. Lenient scoring of SOEs on the MMSE occurred in 53 (51.4%) patients and lowered the sensitivity by 7% to 18%, with variable gains in specificity (0% to 11%) to psychometrically operationalized cognitive impairment. Results are consistent with previous reports that lenient scoring is widespread and attenuates the sensitivity of the MMSE. Given the higher clinical priority of correctly detecting early cognitive decline over specificity, a warning against lenient scoring of SOEs (on the MMSE and other screening tools) during medical education and in clinical practice is warranted.
Asunto(s)
Disfunción Cognitiva , Orientación Espacial , Humanos , Anciano , Persona de Mediana Edad , Sensibilidad y Especificidad , Empatía , Disfunción Cognitiva/diagnóstico , Pruebas NeuropsicológicasRESUMEN
PURPOSE OF PROGRAM: Given the growing interest in patient-oriented research (POR) initiatives, there is a need to provide relevant training and education on how to engage with patients as partners on research teams. SOURCES OF INFORMATION: As part of its mandate to develop appropriate training materials, the patient-oriented renal research network, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), established a training and Mentorship Committee (TMC). METHODS: The committee brings together a unique combination of Indigenous and non-Indigenous patient partners (including caregivers, family members, and living donors), researchers, as well as patient engagement and knowledge translation experts, combining a multitude of perspectives and expertise. Following an assessment of training needs within the network, the TMC undertook the co-development of 5 learning modules to address the identified gaps. Subsequently, the committee divided into working groups tasked with developing content using a consultive and iterative approach informed by the DoTTI framework for building web-based tools for patients. In addition, the TMC embodied the guiding principles of inclusiveness, support, mutual respect, and co-building as set out by the Patient Engagement Framework through the Strategy for Patient-Oriented Research (SPOR) of the Canadian Institutes of Health Research. KEY FINDINGS: The 5 new modules include: A Patient Engagement Toolkit, Storytelling for Impact, Promoting Kidney Research in Canada (KidneyPRO), Wabishki Bizhiko Skaanj Learning Pathway, and Knowledge Translation. The TMC's approach to developing these modules demonstrates how a diverse group of stakeholders working together can create tools to support high-quality POR. This also provides a roadmap for other health research entities interested in developing similar tools within their unique domains. LIMITATIONS: The landscape of patient engagement in research is constantly evolving. This underscores the need for sustained resources to keep POR tools and training relevant and up-to-date. Sustaining such resources may not be feasible for all research entities. IMPLICATIONS: Collaborative approaches integrating patients in the development of POR tools ensure the content is relevant and meaningful to patients. Broader adoption of such approaches has great potential to address existing gaps and enhance the Canadian POR landscape.
OBJECTIF DU PROGRAM: L'intérêt croissant pour les initiatives de recherche axée sur le patient met en évidence le besoin de sensibiliser les chercheurs et d'offrir une formation pertinente sur les façons d'impliquer les patients comme partenaires dans les équipes de recherche. SOURCES: Dans le cadre de son mandat consistant à élaborer des documents de formation appropriés, le réseau dédié à l'avancement de la recherche en santé rénale axée sur le patient, le réseau CAN-SOLVE CKD (Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease), a créé un Comité de formation et de mentorat (CFM). MÉTHODOLOGIE: Le CFM réunit une combinaison unique de patients partenaires autochtones et non autochtones (incluant soignants, membres des familles, donneurs vivants), des chercheurs et des experts de l'application des connaissances et de l'implication des patients à la recherche, ce qui permet de conjuguer une multitude de points de vue et d'expertises. Après une évaluation des besoins en formation dans le réseau, le CFM a entrepris l'élaboration conjointe de cinq modules d'apprentissage pour combler les lacunes mises en évidence. Le comité s'est ensuite divisé en groupes de travail chargés d'en élaborer les contenus par le biais d'une approche consultative et itérative guidée par le cadre de perfectionnement DoTTI pour la création d'outils Web destinés aux patients. De plus, le CFM a intégré les principes directeurs d'inclusion, de soutien, de respect mutuel et de co-création énoncés dans le Cadre d'engagement des patients de la stratégie de recherche axée sur le patient (RAP) des Instituts de recherche en santé du Canada. PRINCIPAUX RÉSULTATS: Les cinq nouveaux modules sont: une trousse d'outils sur l'implication des patients, le partage de récits qui ont un impact, la promotion de la recherche dans le domaine rénal au Canada (KidneyPRO -Promoting Kidney Research in Canada), le cheminement d'apprentissage Wabishki Bizhiko Skaanj et l'application des connaissances. L'approche adoptée par le CFM pour développer ces modules a montré comment un groupe diversifié d'intervenants qui travaille ensemble peut mener à la création d'outils pour soutenir une RAP d'excellente qualité. Ces travaux ont également fourni une feuille de route pour d'autres entités de recherche en santé qui souhaiteraient élaborer des outils similaires dans leurs domaines respectifs. LIMITES: L'implication des patients dans la recherche est en constante évolution. Cette étude souligne le besoin de ressources durables pour garder les outils et les formations en RAP pertinents et à jour. Le maintien de telles ressources pourrait ne pas être possible pour toutes les entités de recherche. IMPLICATIONS: Les approches collaboratives qui impliquent les patients dans le développement d'outils de RAP garantissent que les contenus soient pertinents et significatifs pour les patients. L'adoption à plus grande échelle de telles approches a le potentiel de combler les lacunes existantes et d'améliorer le domaine de la RAP au Canada.
RESUMEN
This research examined how instructions to focus on the concrete details (experience focus) versus broader life significance (coherence focus) influence present perceptions of transitional impact and self-relevance for past and future transitional events. Participants (Study 1, N = 119; Study 2, N = 251) selected a past or future transition and wrote about it using either an experiential or coherence focus. Participants then rated the event on transitional impact, self-relevance, and other phenomenological characteristics. Individuals instructed to use a coherence focus on a past transition reported higher levels of material and psychological impact and rated the event as more self-relevant, compared to those instructed to use an experiential focus. The manipulation did not influence ratings for future events. Controlling for temporal distance and emotional valence did not alter the findings. Future transitions were regarded as more personally important than past transitions. Appraisals of the impact and self-relevance of transformative past events (but not future events) are affected by the mental focus adopted at retrieval. The findings are considered in light of essential differences between remembering and forecasting and support the notion that a coherence focus promotes adaptive self-reflection by affording people the cognitive means with which to reconcile transitional experiences.
Asunto(s)
Acontecimientos que Cambian la Vida , Autoimagen , Sentido de Coherencia , Adolescente , Adulto , Anciano , Emociones , Femenino , Predicción , Humanos , Masculino , Memoria Episódica , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Previous studies have shown that many people hold personal memories for events that they no longer believe occurred. This study examines the reasons that people provide for choosing to reduce autobiographical belief in vividly recollected autobiographical memories. A body of non-believed memories provided by 374 individuals was reviewed to develop a qualitatively derived categorisation system. The final scheme consisted of 8 major categories (in descending order of mention): social feedback, event plausibility, alternative attributions, general memory beliefs, internal event features, consistency with external evidence, views of self/others, personal motivation and numerous sub-categories. Independent raters coded the reports and judged the primary reason that each person provided for withdrawing belief. The nature of each category, frequency of category endorsement, category overlap and phenomenological ratings are presented, following which links to related literature and implications are discussed. This study documents that a wide variety of recollective and non-recollective sources of information influence decision-making about the occurrence of autobiographical events.