Meningitis due to a "Bartonella washoensis"-like human pathogen.

We report the second human case of infection caused by an organism identified as the proposed Bartonella species, "B. washoensis." The organism was isolated from a blood sample from a patient presenting with meningitis and early sepsis. Oropsylla montana fleas were implicated as the vector for disease transmission in this case.

Cognitive rehabilitation in the elderly: effects on memory.

This study reports the effects of a 12-week multimodular cognitive rehabilitation training program on memory performance in two groups of older adults. In the Memory Training module, participants were instructed on the nature of memory and how to improve memory performance; internal and external strategies were described and practiced over the training sessions. Memory performance was assessed by four tests: Alpha Span, Brown-Peterson, Hopkins Verbal Learning Test - Revised (HVLT-R), and Logical Stories. One group received training on entry into the study (Early Training Group, ETG), the other after a 3-month delay (Late Training Group, LTG). The results showed no training-related improvement in working memory (Alpha Span), primary memory (Brown-Peterson, HVLT-R), or recognition memory (HVLT-R). While the most direct analyses of a training effect (analyses of covariance) rarely demonstrated significant effects, exploratory analyses provided some evidence for a training benefit in several measures of secondary memory (Logical Stories; HVLT-R) and strategic processing (Brown-Peterson; Logical Stories; HVLT-R). Positive results were largely restricted to the ETG, possibly because the LTG lost motivation as a consequence of their delayed training. The results need to be treated with caution, but are promising for the rehabilitation of memory functioning in older adults.

Cognitive rehabilitation in the elderly: a randomized trial to evaluate a new protocol.

This study provides an introduction to, and overview of, several papers that resulted from a randomized control trial that evaluated a new cognitive rehabilitation protocol. The program was designed to improve general strategic abilities in ways that would be expressed in a broad range of functional domains. The trial, which was conducted on a sample of older adults who had experienced normal age-related cognitive decline, assessed performance in the following domains: memory, goal management, and psychosocial status. The general rationale for the trial, the overall experimental design, and the approach to statistical analyses that are relevant to each paper are described here. The results for each functional domain are reported in separate papers in this series.

Cognitive rehabilitation in the elderly: an evaluation of psychosocial factors.

In this study, we report changes in psychosocial function in two groups of older adults that participated in the experimental trial of our cognitive rehabilitation program. The results, based on tests that measured a range of psychosocial attributes, showed that, following training, participants improved in terms of overall well-being, as well as in specific areas that included perceived happiness, coping strategies, and quality of life. An important finding was that improvements were also observed in long-term follow-up testing. Both groups benefited from training, but the effect was greater in the group that received training before undergoing a control procedure. The results, which show that the benefits of our rehabilitation program extend into the psychosocial domain, underscore the potentially important relationship between psychosocial factors and cognitive performance in older adults.

Cognitive rehabilitation in the elderly: overview and future directions.

This study provides an overview of the papers emanating from the experimental trial that evaluated a new cognitive rehabilitation program in older adults who were experiencing normal cognitive decline. The main features of the design are summarized, along with evidence that the training produced long-lasting improvement in memory performance, goal management, and psychosocial status. The benefits were attributed to several factors, including the program's emphasis on techniques that promoted efficient strategic processing. Limitations of the program and directions for future research are discussed.

Selecting indicators for the quality of cardiac care at the health system level in Organization for Economic Co-operation and Development countries.

BACKGROUND: Cardiovascular (CV) diseases are major causes of morbidity and death in adults in the world. Major differences have been reported in the management strategies and the outcome of CV diseases within and between countries. To better understand and address these differences, there is a need for quantitative information on patient management, outcome, and prognosis. OBJECTIVE: This article describes the development of a set of quality indicators for cardiac care and summarizes work undertaken by the Cardiac Care Panel of the OECD Health Care Quality Indicators Project. METHODS: A list of 61 potential indicators was identified through a literature search, review of national measurement systems, and nomination from countries participating in the project. The Cardiac Care Panel then used a modified Delphi process developed originally by RAND to select indicators. Panel members individually rated each indicator on a scale of 1-9 for scientific soundness and importance. All indicators receiving scores of 7 or more for both importance and soundness were included in the final set. RESULTS: Seventeen cardiac indicators were selected for the final set of indicators from the following areas: acute coronary syndromes, cardiac interventions, secondary prevention, and congestive heart failure. CONCLUSIONS: The final set of 17 indicators selected by the Cardiac Care Panel constitutes a comprehensive set of measures for the most relevant domains of CV care. Nevertheless, gaps remain in the area of primary prevention and in particular in areas with rapidly changing technology and improving treatment options.

Achieving consensus across diverse stakeholders on quality measures for mental healthcare.

OBJECTIVE: Quality-improvement efforts are hindered by a lack of consensus on meaningful and feasible measures of care. The objective of this study was to develop a core set of quality measures for mental health and substance-related care that are meaningful to stakeholders, feasible to implement, and broadly representative of diverse dimensions of the mental health system. METHOD: A 12-member panel of stakeholders from national organizations evaluated 116 process measures in a 2-stage modified Delphi consensus development process. Drawing on a conceptual framework and literature review, panelists rated each measure on 7 domains using a 9-point scale (1 = best). Measures were then mapped to a framework of system dimensions to identify a core set with the highest ratings for system characteristics within each dimension. RESULTS: Twenty-eight measures were identified assessing treatment (12), access (2), assessment (2), continuity (4), coordination (2), prevention (1), and safety (5). Overall, mean ratings for meaningfulness were: clinical importance 2.29; perceived gap between actual and optimal care 2.59; association between improved performance and outcome 2.61. For feasibility, mean ratings were clarity of specifications 3.39; acceptability of data collection burden 4.77; and adequacy of case mix adjustment 4.20. The measures address a range of treatment modalities, clinical settings, diagnostic categories, vulnerable populations, and other dimensions of mental healthcare. CONCLUSIONS: A structured consensus process identified a core set of quality measures that are meaningful and feasible to multiple stakeholders, as well as broadly representative of the mental healthcare system. By yielding quantitative assessments of meaningfulness, feasibility and degree of consensus among stakeholders, these results can inform ongoing national efforts to adopt common quality measures for mental healthcare.