Use of Gilliam Asperger's disorder scale in differentiating high and low functioning autism and ADHD.

Little is known about the validity of Gilliam Asperger's Disorder Scale (GADS), although it is widely used. This study of 199 children with high functioning autism or Asperger's disorder, 195 with low functioning autism, and 83 with attention deficit hyperactivity disorder (ADHD) showed high classification accuracy (autism vs. ADHD) for clinicians' GADS Quotients (92%), and somewhat lower accuracy (77%) for parents' Quotients. Both children with high and low functioning autism had clinicians' Quotients (M=99 and 101, respectively) similar to the Asperger's Disorder mean of 100 for the GADS normative sample. Children with high functioning autism scored significantly higher on the cognitive patterns subscale than children with low functioning autism, and the latter had higher scores on the remaining subscales: social interaction, restricted patterns of behavior, and pragmatic skills. Using the clinicians' Quotient and Cognitive Patterns score, 70% of children were correctly identified as having high or low functioning autism or ADHD.

Leadership of United States academic anesthesiology programs 2006: chairperson characteristics and accomplishments.

BACKGROUND/METHODS: We conducted an Internet-based survey of all current academic anesthesiology chairpersons to benchmark their characteristics and accomplishments, as well as to gain insights that might be useful to aspirant department chairs. RESULTS: The response rate was 55%; chairs were predominantly male (92%), with a mean age of 55 yr and an average time in post of 6.5 yr. They were American medical graduates (82%), had undergone a research (31%) or a clinical fellowship (57%), were full professors (86%) and practiced most commonly as generalists and in intensive care. Chairs had a significant record of scholarship, including a median of 30 peer-reviewed papers, and an average of 11.0 industry and 2.7 federal grants. Thirty-two percent served as editors of peer-reviewed journals and 42% have served as president/chairman of national committees. Fully 30% of current chairs had previous experience as a chair. Sixty-eight percent of current chairs decided early in their career (at the resident/fellow or assistant professor level) that they wished to be a chair. In advising aspirant chairs, the most helpful experience to being a chair was that of having served as a vice chair, and the highest rated advice was to become a division director. Chairs were predominantly satisfied with their position (median 3 of 10) and 44% would return to clinical anesthesiology after chairmanship. CONCLUSIONS: The survey suggests that anesthesiology chairs value peer-reviewed research, scholarship, and academic achievement, but do not believe that significant research experience is of great benefit to functioning as a chair.

"What's in a name?" Delirium by any other name would be as deadly. A review of the nature of delirium consultations.

INTRODUCTION: Delirium is often underdiagnosed, resulting in adverse clinical outcomes. The goal of this study was to identify how patients correctly diagnosed with delirium differ from those who are misdiagnosed. METHODS: A retrospective chart review was conducted using a database of 1,000 consecutive psychiatric consultation requests. Patients were identified based on a diagnosis of delirium made by the consultation team. Charts were then reviewed for data on race, gender, age, time and month of the consultation, documented diagnosis of mental illness, and information that would help establish a delirium diagnosis based on DSM-IV-TR criteria. Univariate and multivariate analyses were performed. RESULTS: Cases were judged to be diagnostically concordant (consultation requested for delirium or encephalopathy, n = 30) or discordant (n = 81). The two groups did not differ significantly in age, sex, race, time and month of the consultation, or documentation of mental illness. The concordant group had a significantly greater number of identifiable diagnostic criteria compared to the discordant group (mean 3.0 ± 0.8 criteria vs. 1.9 ± 1.3 criteria, P < 0.001). Identification of individual diagnostic criteria was greater in the concordant group, with significant differences for two of four categories, namely acute onset (100.0% vs. 50.6%, P < 0.001) and fluctuating course (93.3% vs. 66.7%, P = 0.004). Multivariate analysis suggested increased odds of identifying delirium if more diagnostic criteria were identifiable (OR: 2.355, P < 0.001, confidence interval [CI] 1.502-3.690), and increased likelihood of the delirium diagnosis being missed if there was documentation of psychiatric illness (OR: 0.387, P = 0.049, CI: 0.151-0.995). CONCLUSION: This study highlights the need for educational programs and easy to implement screening tools to ensure delirium is not overlooked.

Use of breast simulators compared with standardized patients in teaching the clinical breast examination to medical students.

OBJECTIVE: Simulators have replaced some standardized patients in medical student teaching, and their use seems to decrease anxiety related to the clinical breast examination (CBE). We compared learning the CBE on a breast palpation simulator with learning on a standardized patient with respect to skill acquisition and comfort level. METHODS: At Penn State College of Medicine, the class of 2008 (historical control group, n = 113) learned the CBE on a standardized patient, whereas the class of 2009 (experimental group, n = 131) learned on the breast palpation simulator. We used measures of the process (conducting the CBE) and measures of the outcome (examination scores and detection of abnormal findings). During their third-year surgical clerkship, students in both groups completed a questionnaire reporting the number of CBEs performed and confidence in performing the CBE. The students then performed an observed examination on the simulator, and the number of positive findings detected was recorded. The mean number of positive findings was compared between groups, and an economic analysis was conducted. RESULTS: The experimental group had a significantly higher mean examination score than the historical control. In subgroups, this difference was significant for those who reported performing 0-5 clinical examinations but for not those who had performed >6 examinations. On individual items, the experimental group scored significantly higher in examining for neck nodes, nipple retraction, skin changes, and axillary evaluation. The 2 groups did not differ significantly in the mean number of positive findings detected or in ratings of comfort level. CONCLUSIONS: Medical students who learned the CBE on breast palpation simulators performed as well or better than those who learned on standardized patients; however, a subgroup analysis revealed that the benefit was limited to students with less clinical experience.

Comparison of scores on the Checklist for Autism Spectrum Disorder, Childhood Autism Rating Scale, and Gilliam Asperger's Disorder Scale for children with low functioning autism, high functioning autism, Asperger's disorder, ADHD, and typical development.

Reliability and validity for three autism instruments were compared for 190 children with low functioning autism (LFA), 190 children with high functioning autism or Asperger's disorder (HFA), 76 children with attention deficit hyperactivity disorder (ADHD), and 64 typical children. The instruments were the Checklist for Autism Spectrum Disorder (designed for children with LFA and HFA), Childhood Autism Rating Scale (CARS) for children with LFA, and Gilliam Asperger's Disorder Scale (GADS). For children with LFA or ADHD, classification accuracy was 100% for the Checklist and 98% for the CARS clinician scores. For children with HFA or ADHD, classification accuracy was 99% for the Checklist and 93% for the GADS clinician scores. Clinician-parent diagnostic agreement was high (90% Checklist, 90% CARS, and 84% GADS).