Token Economy: A Systematic Review of Procedural Descriptions.

The token economy is a well-established and widely used behavioral intervention. A token economy is comprised of six procedural components: the target response(s), a token that functions as a conditioned reinforcer, backup reinforcers, and three interconnected schedules of reinforcement. Despite decades of applied research, the extent to which the procedures of a token economy are described in complete and replicable detail has not been evaluated. Given the inherent complexity of a token economy, an analysis of the procedural descriptions may benefit future token economy research and practice. Articles published between 2000 and 2015 that included implementation of a token economy within an applied setting were identified and reviewed with a focus on evaluating the thoroughness of procedural descriptions. The results show that token economy components are regularly omitted or described in vague terms. Of the articles included in this analysis, only 19% (18 of 96 articles reviewed) included replicable and complete descriptions of all primary components. Missing or vague component descriptions could negatively affect future research or applied practice. Recommendations are provided to improve component descriptions.

The evaluation of premenopausal women with anemia: what is the yield of gastrointestinal endoscopy?

Anemia is not uncommon in premenopausal women. The purpose of this study was to determine the yield of endoscopy in premenopausal women with anemia. We identified and reviewed the medical records of 168 premenopausal women who underwent upper endoscopy and/or colonoscopy for the indication of iron deficiency anemia (IDA) during the years 1996 through 2005. Of the 168 patients, 100 (59.5%) underwent upper endoscopy and 155 (92.3%) underwent colonoscopy. Eighty-seven (51.8%) patients underwent both procedures. The mean age was 43.1 +/- 5.8 years. The mean hemoglobin was 10.2 +/- 1.3 g/dl. Upper gastrointestinal (GI) lesions potentially causative for anemia were found in 7 of 100 patients who underwent upper endoscopy (7%). Significant lower GI lesions were found in 6 of 155 (3.9%) of those who had a colonoscopy. Our data suggest that both upper endoscopy and colonoscopy were useful in the detection of significant gastrointestinal lesions in premenopausal women with anemia.

Dysphagia and advancing age: are manometric abnormalities more common in older patients?

The universal process of aging may result in physiologic deterioration. Dysphagia may be more common in older patients. The effect of aging on esophageal manometry is not well established. The aim of this study was to determine if esophageal motility studies and associated symptoms in older patients with dysphagia differ significantly from younger patients. Patients who were 65 years of age or older (N = 53) were compared with patients who were 18-45 years of age (N = 53). Presenting symptoms, manometric findings, and diagnoses were compared between the two groups. In the older group, there were 29 women (55%), in the younger group there were 35 women (66%). The mean age of the older group was 75 +/- 7 years, the mean age in the younger group was 34 +/- 7 years. All patients reported dysphagia to solids. No significant differences were found in the reporting of associated symptoms. There were no significant differences in average lower esophageal sphincter (LES) resting pressure, residual LES pressure, LES relaxation, or peristalsis between groups. Older patients were as likely to have a normal study as younger patients (18% vs 23%, P = NS) and were also as likely to have the diagnosis of achalasia (32% vs 34%, P = NS). In conclusion, older and younger patients referred for manometric study of dysphagia have similar manometric findings. Esophageal manometry can be helpful in determining abnormalities in motility in both older and younger patients.

Irritable bowel syndrome. Diagnosis is based on clinical criteria.

Irritable bowel syndrome is one of several functional bowel disorders. As the data about this common syndrome increase, so does the understanding that it is a disorder with complex pathophysiologic factors. In this article, Drs Morgan and Robson provide the latest information about IBS and its diagnosis and outline a strategy for cost-effective treatment and improved quality of life for patients with this disorder.