bluuebunny/crossref_metadata_2025 huggingface dataset:
WPPSI-R/WISC-R: A Comparative Study
Authors: Urbina Susana P. , Clayton Julia P.
Published: November 2009

Twenty-five girls and 25 boys, whose ages ranged from 72 to 86 months, were administered the WPPSI-R and WISC-R to obtain comparative and validity data and investigate the effects of administration order. For the total sample, WISC-R scores were higher on all measures, and correlations between comparable subtests were positive and significant for all but three subtest pairs. The effect of administration order, as expected, added to the differences in favor of the WISC-R in half of the interscale comparisons. Two deviations from the expected pattern were significant. On Information, a practice effect attributed to items shared by both scales resulted in higher scores on the WPPSI-R (p < .01). On Arithmetic, a reversal of the expected order effect, tentatively linked to motivational factors, resulted in higher scores on whichever scale was administered first (p < .01). More studies that compare the two scales, especially with children of varied socioeconomic and ability levels, are suggested.
Confirmatory Factor Analysis of the WPPSI-R at the Extreme End of the Age Range
Authors: Stone Brian J. , Gridley Betty E. , Gyurke James S.
Published: November 2009

This study investigated the adequacy of a two-factor interpretation of the WPPSI-R for the upper- and lower-most age groupings of the standardization sample. Previous research has shown that a two-factor model best represents the underlying structure of the WPPSI-R for the standardization sample taken as a whole. However, the two extreme age bands that are most likely to stray from this interpretation have not been investigated. Past confirmatory factor-analytic research on tests of cognitive abilities generally has shown that fewer factors are supported for very young age groups, while additional factors may be supported for older age groups. Therefore, maximum likelihood confirmatory factor analyses were conducted separately on the WPPSI-R standardization sample for the two extreme age groupings (ages 3 and 7). A one-, two-, and three-factor solution was imposed on the data. A comparison of underlying theory and goodness-of-fit statistics revealed that the two-factor solution provided the best fit to the data for both samples. In addition, the fit improved when Picture Completion was allowed to load on both the Verbal and Performance factors. The results support the interpretation of two consistent factors across the entire age range of the WPPSI-R.
Factor Analysis of Community Adjustment Outcome Measures for Young Adults with Mild to Severe Disabilities
Authors: McGrew Kevin S. , Johnson David R. , Bruininks Robert H.
Published: November 2009

This investigation was designed to refine, extend, and cross-validate a multidimensional community adjustment measurement system. A sample of 173 young adults with mild to severe disabilities, located 1 to 6 years after leaving school, was administered 21 measures of community adjustment. Using exploratory and confirmatory factor analyses, six different factors of community adjustment were identified: Personal Satisfaction, Employment Stability, Employment-Economic Integration, Recreation-Leisure Integration, Social Network Integration, and Residential Integration. When combined with similar research, evidence appears to support the identification of at least eight factors of community adaptation.
WAIS-R Digit Symbol Patterns for Persons 75 Years and Older
Authors: Paolo Anthony M. , Ryan Joseph J.
Published: November 2009

This study addressed the hypothesis that elderly individuals display a “warm-up” pattern on the Digit Symbol subtest when performance is recorded at 30, 60, and 90 seconds (Kaplan, Fein, Morris, & Delis, 1991). Patterns of performance for the three intervals were explored in a sample of 221 normal persons 75 years and older. Means for age, education, and Full Scale IQ were 80.54 years (SD = 4,85), 10.94 years (SD = 2.89), and 103.73 (SD = 14.27), respectively. Two methods were used to derive patterns of Digit Symbol performance: (1) Ward's hierarchical cluster analysis and (2) simple difference scores between the three time periods. The “warm-up” pattern emerged infrequently and cannot be considered characteristic of persons 75 years and older.
An Exploration of School Membership among Middle- and High-School Students
Authors: Hagborg Winston J.
Published: November 2009

A personalized school environment is one of the guiding principles of many recent school reform plans. One useful model of school personalization, school membership, is proposed by Wehlage as part of his theory of drop-out prevention. Recently, Goodenow (1993) constructed a measure of school membership, the Psychological Sense of School Membership Scale (PSSM). The PSSM was employed with two samples of adolescents to investigate the scale's reliability and delineate its factor structure, while also extending its use to high school age youth. Consistent with the author's hypotheses, the PSSM was associated closely with students' self-concepts and ratings of school climate. Findings were integrated into Wehlage's model of school membership, and the relevance of this model for typical secondary school youth is described.
Psychological Test Usage in the People's Republic of China
Authors: Ryan Joseph J. , Dai Xiao-Yang , Zheng Lixin
Published: November 2009

A survey of 315 medical, educational, and psychiatric facilities was undertaken to provide information on the selection and utilization of psychological tests, rating scales, and composite batteries in the People's Republic of China. One hundred eighty-three (58%) of the returned questionnaires were considered usable. Of these, 70% were completed by physicians; only 18.5% of the respondents were psychologists. The four most widely used tests were the WAIS-Revised for China, Eysenck Personality Questionnaire for Adults (EPQ), MMPI, and WISC-Chinese Revision. The most popular neuropsychological tests were the Wechsler Memory Scale and Halstead-Reitan Battery for Adults. Projective tests, such as the Rorschach, were employed relatively infrequently. Results were contrasted with those from similar surveys completed in the United States and Hong Kong.
Current Test Usage by Practicing School Psychologists: A National Survey
Authors: Stinnett Terry A. , Havey J. Michael , Oehler-Stinnett Judy
Published: November 2009

A random sample of members of the National Association of School Psychologists was surveyed to examine the assessment activity of practicing school psychologists. Test-usage estimates and importance ratings for well-established standardized instruments, newly revised or released instruments, and informal procedures such as interview and curriculum-based assessment were examined. Estimates of time involved in various service delivery activities also were obtained. Results indicated that assessment activities still account for about 50% of the practice hours of school psychologists, followed by consultation (20%) and treatment (19%). School psychologists reported frequent use of intellectual, behavior-social-emotional, achievement, and perceptual assessment methods, but were less likely to be involved in vocational or preschool assessment. Familiar instruments, such as the Wechsler scales, the Woodcock-Johnson Psycho-educational Battery-Revised, the Wide Range Achievement Test-Revised, the Bender-Visual Motor Gestalt, the Beery Developmental Test of Motor Integration, and the Vineland Adaptive Behavior Scales, were the most used tests. However, in the social-emotional domain, direct assessment methods, such as interview and observation, were more frequently used and rated as more important than standardized measures. These results, and the limitations of the study, are discussed.
Speed of Performance on the WAIS-R among Persons 75 Years of Age and Older
Authors: Ryan Joseph J. , Bohac Daryl L. , Trent Daniel
Published: November 2009

The role of response time on WAIS-R subtest scores was investigated in a sample of 213 normals 75 years or older. Means for age, education, and Full Scale IQ were 80.6 years (SD = 4.97), 10.9 years (SD = 2.97), and 97.6 (SD = 12.9). A total response time score was gleaned from each of the Picture Arrangement (PAT), Block Design (BDT), and Object Assembly (OAT) subtests. A principal components analysis on the 11 subtest scores, response time measures, and age yielded three robust factors. Factors 1 and 2 represented the well-known Verbal-Comprehension and Perceptual-Organization constructs, respectively. Factor 3 consisted of BDT, PAT, and Picture Arrangement and was designated as a measure of response time. A second principal components analysis was run after time effects on the Block Design and Object Assembly subtest scores were eliminated. Results were ambiguous and judged to be inferior to those of the initial analysis.
A Comparison of Four WAIS-R Short Forms in Patients Referred for Psychological Neuropsychological Assessments
Authors: Satterfield William A. , Martin Clinton W. , Leiker Mark
Published: November 2009

In recent years, several short forms of the Wechsler Adult Intelligence Scale-Revised have been developed to provide a more cost-effective means of estimating intellectual abilities. The present study examined the ability of four short forms to estimate intellectual functioning in a sample of medical center (61 male) and state hospital (69 female) patients referred for psychological/neuropsychological assessments. Although all four short forms obtained high correlations with Full Scale IQ, the seven-subtest short form (Ward, 1990) provided greater accuracy with respect to IQ estimation and intelligence classification based on Wechsler's (1981) schema.
Convergent Validity of the School Social Behavior Scales with the Child Behavior Checklist and Teacher's Report Form
Authors: Emerson Ellen N. , Crowley Susan L. , Merrell Kenneth W.
Published: November 2009

The School Social Behavior Scales (SSBS) is a relatively new teacher-report instrument for assessing social competence and antisocial behavior. The present study investigated the convergent validity of SSBS data with a sample of nonreferred school children. Teachers of participating children (N = 210) completed the SSBS and the Child Behavior Checklist-Teacher's Report Form, and parents completed the Child Behavior Checklist. Internal consistency reliability of SSBS subscale and total scale data were all high. Correlations between subscale and total scores of the SSBS, CBCL, and TRF were moderate and in the expected direction. Results of the present study provide additional support for the reliability and validity of SSBS data. Additionally, results suggest that the SSBS can be used with confidence for accurate, time-efficient assessment of social behavior in a school setting.
Effects of Dynamic Testing on the Classification of Learning Disabilities: The Predictive and Discriminant Validity of the Swanson-Cognitive Processing Test (S-CPT)
Authors: Swanson H. Lee
Published: November 2009

This study assessed the criterion-related and discriminant validity of the Swanson-Cognitive Processing Test (S-CPT). The S-CPT is an individually administered standardized battery of information processing tasks that assess performance under initial (static) and dynamic testing (testing-the-limits) conditions. In Experiment 1, children's ( N = 61) performance on the S-CPT under initial and dynamic testing conditions was compared to the WISC-R in predicting performance on Reading and Mathematics subtests of the WRAT-R. Gain scores established during dynamic testing conditions were the best predictors of reading and mathematics performance (14% and 26% of the variance, respectively). In Experiment 2, 156 children with reading deficits and 35 skilled readers were compared on the S-CPT under static and dynamic testing conditions. As expected, skilled readers performed better than learning-disabled readers across all subtests, but the results were qualified when subgroups were analyzed. The cluster analysis indicated that approximately 25% of the sample with learning disabilities was misdiagnosed, and better reflected slow learners (poor readers) or instructionally responsive children. The results support the notion that dynamic assessment contributes significant variance in the prediction of academic achievement and that such assessment procedures discriminate the processing potential of children with reading disabilities from children with other types of learning problems.
An Investigation of the Relationship between Social Skills and Internalizing Problems in Early Childhood: Construct Validity of the Preschool and Kindergarten Behavior Scales
Authors: Merrell Kenneth W.
Published: November 2009

Research findings on possible links between the constructs of social skills and internalizing disorders during early childhood are presented. Developmental research data from a new child behavioral rating instrument, the Preschool and Kindergarten Behavior Scales (PKBS), were utilized to explore the social skills/internalizing problems link and to identify some important behavioral characteristics of young children who are at high risk for developing internalizing type social-emotional problems. Social skills scores on the PKBS were found to be associated negatively with internalizing problem scores on three different criterion measures. Using the criterion of 1.5 standard deviations or higher than the normative mean on the Internalizing Problems broad band score on the PKBS, a base rate of approximately 6.8% of a large national normative sample of preschool-age children was identified as having moderately high to significant .internalizing problem ratings. This group of “internalizers” was found to have significantly poorer social skills than non-internalizing children in the same normative group and could be classified with a relatively high degree of accuracy based on discriminant function analysis of the PKBS scores alone. Implications of these findings, potential clinical uses of the PKBS, and possible directions for future research are discussed.
Evaluating Predictive Validity by Using Different Scales of the Stanford Achievement Test for the Hearing Impaired
Authors: Kishor Nand
Published: November 2009

It has been suggested that percentile ranks on the subtests of Stanford Achievement Test for the Hearing Impaired yield stronger predictive validity coefficients for the Performance Scale of the Wechsler Intelligence Scale for Children (Revised). This issue of the best criterion scale was re-examined in this study. The predictive validities were evaluated in relation to the two scales of six SAT-HI subtests and three sample sizes. Contrary to previous suggestions, the results indicated that scaled scores of SAT-HI subtests should be used in predictive validity investigations. Scaled scores were found to be consistent and efficient; that is, the validity coefficients approached the true coefficients with increasing sample size.
A Reply to Kishor: Choosing the Right Metric
Authors: Braden Jeffery P. , Wollack James A. , Allen Thomas E.
Published: November 2009

Kishor (this issue) claims that the Stanford Achievement Test normed on deaf children (SAT-d) scaled scores offer the best metric for estimating IQ-Achievement correlations in samples of deaf children. We argue that he is partly right and mainly wrong. We agree with Kishor that SAT-d grade equivalents are inappropriate, although we could not replicate his results. However, Kishor's simulations are logically and empirically flawed and, therefore, cannot address the relative value of SAT-d metrics. More appropriate simulations show (a) that in homogeneous age samples, all SAT-d metrics yield similar results, and (b) in heterogeneous age samples, age-referenced scores are superior to scaled scores and grade equivalents for estimating “true” IQ-Achievement correlations. Our results suggest two practical implications: (1) researchers should use age-based percentiles for achievement if they also use age-referenced IQs, and (b) available studies underestimate IQ-Achievement correlations in samples of deaf children.
Evaluating Predictive Validity: A Rejoinder to Braden et al. (1995)
Authors: Kishor Nand
Published: November 2009

Braden et al. (1995) argued that percentile rank scores from the subtests of SAT-d yield accurate predictive validity coefficients for the Performance scale of WISC. In doing so they have reiterated their rationale and think my investigation was flawed in some respects. I have examined their misconceptions about my study and conclude that there is nothing flawed. I have re-evaluated their rationale and find it unacceptable. I propose the study of age and other factors as moderator variables in validity inquiry with the goal of validity generalization.
Intrasubtest Scatter on the WISC-Ill For Various Clinical Samples vs. The Standardization Sample: An Examination of WISC Folklore
Authors: Dumont Ron , Willis John O.
Published: November 2009

Intrasubtest scatter indices for five verbal and three performance subtests of the WISC-II were cormputed for the 2,220 children in the WISC-III norming sample (data supplied by the Psychological Corporation), for a sample of children born pre-maturely, and for subgroups of children referred for evaluation. Contrary to popular belief, comparisons among the subgroups and the norming sample, further subdivided by test-age scores, revealed only a few instances in which various subgroups showed significantly more intrasubtest scatter than the norming sample. There were no consistent patterns, and in some instances the referred students showed less scatter than the WISC-III norming sample. These findings are discussed in reference to WISC folklore.
Preliminary Validation of the Positive and Negative Affect Schedule with Adolescents
Authors: Huebner E. Scott , Dew Tammy
Published: November 2009

This study assessed the psychometric properties of the Positive and Negative Affect Schedule (PANAS) with a sample of 266 adolescent students. The results provided preliminary support for the usefulness of the scale with adolescents for research purposes. Similar to studies with adults, support was provided for the independence of the negative and positive affect dimensions in adolescents. Recommendations for additional validation research with adolescents were made.
The School Readiness Composite of the Bracken Basic Concept Scale as an Intellectual Screening Instrument
Authors: Laughlin Timothy
Published: November 2009

The efficacy of the School Readiness Composite (SRC) of the Bracken Basic Concept Scale (BBCS) as an intellectual screening instrument was investigated. The concurrent validity of the SRC and the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) was examined along with the predictive capabilities of the SRC. The factor structure of the SRC and WPPSI-R in combination also was investigated. Data from both instruments were gathered from 83 suburban children, who ranged in age from 4 years 7 months to 4 years 10 months. Psychoeducational evaluations were conducted using a counterbalanced test administration procedure. Results indicated that the SRC correlated .77 with the WPPSI-R Full Scale IQ and evidenced 59% shared variance. A principal components factor analysis indicated a two-factor solution for the two instruments with the SRC loading highly on the g factor.
General Factor and Uniqueness Characteristics of the Kaufman Adolescent and Adult Intelligence Test (KAIT)
Authors: McGrew Kevin S. , Untiedt Stephanie A. , Flanagan Dawn P.
Published: November 2009

When new or revised intelligence batteries are published, it is important to know the general factor loading and uniqueness information of the individual subtests prior to using them for clinical interpretation. Recently, Kaufman and Kaufman (1993) presented this information for 8 of the 10 subtests at 6 broad age groups for the new Kaufman Adolescent and Adult Intelligence Test (KAIT). This study investigated the general factor and uniqueness characteristics of all 10 individual KAIT subtests for all 13 KAIT technical age groups. Findings showed that all but one (Auditory Delayed Recall) of the 10 KAIT subtests consistently had “good” average general factor loading characteristics. Similarly, the KAIT subtests had either “adequate” or “ample” average uniqueness classifications for all ages. Only one (Auditory Delayed Recall) of the 10 KAIT subtests had “inadequate” uniqueness at all ages. Comparisons to the test authors' reported values revealed a number of differences, particularly for the KAIT subtest uniqueness classifications. Implications for clinical interpretation are discussed.
Changes in Ability and Achievement Scores Over Time: Implications for Children Classified as Learning Disabled
Authors: Gaskill Frank W. , Brantley John C.
Published: November 2009

This study examined the effects of WISC-III IQ changes on the IQ-achievement discrepancy required for special education eligibility in the area of Specific Learning Disabled. Within a sample of 224 students with learning disabilities, WISG-III scores were significantly lower when compared to WISC-R scores. No significant changes occurred in achievement scores as measured by the Woodcock-Johnson Revised and the Wechsler Individual Achievement Test. As a result, fewer children retested with the WISC-III qualified for LD services. This drop in eligibility rates was evidenced by both the simple difference and regression methods. The possibility that a significant number of students no longer qualify for LD services should raise concern among psychologists and educators alike. In response to these results, emphasis should be placed upon consultation and pre-assessment intervention designed to serve those students who may no longer qualify for services.
Reliability and Validity of the Self-Perception Profile for Children with Mexican American Elementary-Age Children
Authors: Hess Robyn S. , Petersen Scott J.
Published: November 2009

The internal consistency and concurrent validity of the Self-Perception Profile for Children (SPPC) were investigated for 107 elementary-age Mexican American children. The results indicated a high degree of similarity between the responses of this population and those of the original norm group. The internal consistency coefficients for the entire instrument (.89) as well as the individual subscales (.62 to .74) were sufficiently strong to support the use of this instrument. To establish the concurrent validity of the Scholastic Competence subscale of the SPPC, the results were compared to the children's responses to the School Attitude Measure (SAM) and to their most recent math achievement scores. Significant, moderate correlations for attitude toward school (.58) and achievement scores (.31) were found. Preliminary support for the use of the SPPC with Mexican American children was provided. Further work is needed to establish the validity of the other subscales with this population.
School Psychologists' Assessment Practices with Bilingual and Limited-English-Proficient Students
Authors: Ochoa Salvador Hector , Powell M. Paige , Robles-Piiia Rebecca
Published: November 2009

This study, a survey of 859 National Association of School Psychologist (NASP) members from eight states, identified school psychologists' assessment practices with bilingual and limited-English-proficient (LEP) students and compared test usage frequencies between English-only and bilingual psychoeducational assessment. Cognitive, achievement, and adaptive behavior domains were examined. In the area of cognitive assessment, the WISC-R or WISC-III administered in English only was the measure most frequently used. Moreover, the use of nonverbal intelligence tests appeared to be a common practice. With respect to achievement testing in English and Spanish, the Woodcock instruments were used by approximately three-fourths of the respondents. Curriculum-based assessment was employed significantly more often in bilingual psychoeducational assessment than in traditional English-only assessment. For assessing adaptive behavior, 90% of the sample used at least one of the Vineland Adaptive Behavior Survey Scales. Across all three domains, there was much more diversity in test usage in bilingual psychoeducational assessment in comparison to assessment conducted with English-speaking pupils. An evaluation of and recommendations for assessment practices with LEP and bilingual students are provided.
Neonatal Extracorporeal Membrane Oxygenation: A Review
Authors: Short BillieLou , Pearson Gail D.
Published: November 2009

The history of extracorporeal membrane oxygenation (ECMO) therapy is summarized. The adult and pediatric experiences are described, but emphasis is placed on the development of neonatal ECMO, now an accepted therapy for newborns with severe respiratory failure. The technical aspects of neonatal ECMO are outlined, as are the clinical criteria for its use. Experience at Children's Hospital National Medical Center, Washington, DC, is reported. Promising new technological developments, and their implications for future applications of neonatal ECMO, are presented.
Analytic Review: Treatment of Coronary Artery Spasm and Variant Angina
Authors: Conti C. Richard , Hill James A. , Feldman Robert L. , Mehta Jawahar L. , Pepine Carl J.
Published: November 2009

Coronary artery spasm is an abnormal constriction of the conductive arteries that produces myocardial ischemia in the absence of any marked increase in heart rate or blood pressure. Ischemia is a transient phenomenon and is promptly reversed spontaneously or by nitroglycerine. The so-called "hallmark of spasm"—ST segment elevation—is evidence for severe myocardial ischemia rather than conclusive evidence for coronary artery spasm. Any process that transiently or permanently restricts coronary blood flow (e.g., transient occlusion by thrombus) will produce similar electrocardiogram (EKG) abnormalities.

Most patients with symptoms and EKG changes related to coronary artery spasm respond to sublingual nitrates. Thus, their use for relief of the acute ischemic episode remains the initial treatment of choice. When symptoms are moderate in severity or unacceptably controlled in frequency using nitrates alone, other pharmacologic measures are needed.

When spasm is superimposed upon hemodynamically important atherosclerotic obstruction, the favorable response to calcium antagonist may not be as great as that seen when spasm occurs alone. One possible explanation is that spasm is not really occurring. The ST segment elevation may be related to transient total occlusion from platelet aggregation or thrombosis. Thus, aspirin may be the drug of choice. However, if spasm is the culprit, recommendations for surgery and angioplasty require proof that spasm is occurring in and around the area of fixed atherosclerotic obstruction and not in other vessels or over the entire course of the distal vessel.
Dilemmas in Intensive Care Medicine: An Ethical and Legal Analysis
Authors: Paris John J. , Reardon Frank E.
Published: November 2009

The high-technology medicine available in today's intensive care setting not only provides near miraculous benefits for some patients, but it also creates new and troublesome ethical and legal dilemmas for patients and practitioners. Standards for access to and discharge from the intensive care unit, "do not resuscitate" orders, determination of death, organ retrieval, advanced directives, decision-making capacity, and substantive and procedural guidelines for termination of treatment in incompetent patients are among the problems. Those issues, along with the emerging question of withholding nutrition and fluids, are discussed in this article.
Disorders of Temperature Control: Hyperthermia, Part II
Authors: Curley Frederick J. , Irwin Richard S.
Published: November 2009

Malignant hyperthermia and neuroleptic malignant syndrome, two hyperthermic syndromes, are discussed with respect to their pathogenesis, pathophysiological factors, diagnosis, differential diagnosis, and treatment. Malignant hyperthermia is a drug- or stress-induced hypermetabolic syndrome characterized by vigorous muscular contractures and cardiovascular collapse. Neuroleptic malignant syndrome results primarily from an imbalance of central neurotransmitters caused by neuroleptic drug use and characterized by mental status changes and muscular rigidity. Recognition and prompt treatment of these disorders reduces their morbidity and mortality.
Legal Issues in Critical Care Medicine
Authors: Richards Edward P. , Rathbun Katharine C.
Published: November 2009

This article introduces some of the legal problems facing physicians practicing critical care medicine. Although there is considerable scholarship dealing with the legal and ethical consequences of withdrawing life-sustaining care from terminally ill or irreversibly comatose patients, little has been written about the legal problems that are the inevitable consequence of the pressure to reduce expenditures for intensive care. Because this is a new area of inquiry, this article draws lessons from analogous situations such as anesthesia care. It is important to stress that legal standard setting may be influenced by concerted action by critical care practitioners; however, if the profession is silent on standards, the law will impose standards that it arrives at in an ad hoc fashion.
Evaluation and Treatment of Agitation in the Intensive Care Unit
Authors: Tesar George E. , Stern Theodore A.
Published: November 2009

Agitation in the intensive care unit (ICU) patient is a complication of severe medical illness that requires prompt attention and treatment. The first step in managing an agitated ICU patient is a thorough investigation for factors that may cause or predispose to the agitated state. This entails detailed review of the history and available laboratory data as well as examination of the patient's physical and mental status. Important factors that may contribute to the development of agitation include (1) the presence of delirium or psychosis; (2) the type of ICU setting (e.g., coronary, surgical, respiratory, or medical); (3) a history of psychiatric disorder; (4) a history of central nervous system disorder; and (5) patients' personalities, which affect their reactions to illness and its treatment. The treatment of agitation is then based on its identified causes. The principles of treatment include (1) correction of metabolic and systemic abnormalities, (2) elimination of drug toxicity, (3) treatment of drug withdrawal, (4) maximization of the patient's comfort, and (5) use of neuroleptic medication. Medically oriented psychiatric consultants can help to organize the evaluation and management of the agitated patient and can assist staff members in dealing with their emotional reactions to difficult management problems.
Hypoglycemia in the Critically Ill Patient
Authors: Liggett Stephen B. , Cryer Philip E.
Published: November 2009

Hypoglycemia is diagnosed convincingly when typical symptoms are associated with a low plasma glucose concentration and are relieved by glucose administration. It requires urgent treatment (usually with intravenous glucose in the hospital setting), diagnostic explanation, and long-term prevention. The latter is based upon an understanding of the pathogenesis of hypoglycemia in the affected patient. Postabsorptive (fasting) hypoglycemia is often caused by drugs (especially insulin, a sulfonylurea, or alcohol); it can also result from endogenous hyperinsulinism (insulinoma, autoimmune hypoglycemia), a non-β-cell tumor, hormonal deficiencies, or a variety of clinical syndromes including sepsis, cardiac, renal, and hepatic failure, and even inanition per se. Hypoglycemia is a treatable cause of acute morbidity. It is sometimes a cause of chronic morbidity and even mortality that could have been prevented.
Dermatologic Problems in the Intensive Care Unit: Part III
Authors: Berman Rita S. , Silvestri Dianne L.
Published: November 2009

In this third part of our review of skin problems seen in critically ill patients, we focus on a number of life-threatening systemic disorders in which cutaneous findings are prominent. We discuss purpura fulminans, toxic shock syndrome, systemic lupus erythematosus, acquired immunodeficiency syndrome, Lyme disease, graft-versus-host disease, and Rocky Mountain spotted fever.
Update in Injection Sclerotherapy of Esophageal Varices
Authors: Camara Daniel S.
Published: November 2009

Injection sclerotherapy has recently become a first-line treatment modality for bleeding varices of the esophagus. In this report the technique and complications, as well as the results of controlled and uncontrolled studies, are reviewed and discussed.
Analytic Review: Ischemic Cerebrovascular Disease: Diagnosis and Management
Authors: Tegeler Charles , Sherman David
Published: November 2009

Ischemic stroke is the most common cause of neurologic morbidity and mortality. The proper management of a stroke patient is dictated by the underlying pathophysiology. An ischemic stroke may occur as a result of restricted flow or thrombosis from atherosclerosis, artery-to-artery embolization, cardiac-to-brain embolization, or disorders of coagulation, to mention a few of the most common causes. Determining the relevant cause of stroke is made more difficult by the coexistence of many possible factors such as hypertension, atherosclerosis, and cardiac disease. Nevertheless, judgments are based on the clinical presentation, computed tomographic scans, cerebral angiograms, and results of echocardiography and electrocardiographic monitoring.

Therapy of the ischemic stroke patient is aimed primarily at preserving areas of potentially recoverable ischemic brain. This is accomplished by correcting or avoiding circumstances that can promote further impairment of ischemic brain. These include proper management of blood pressure, cardiac function, oxygenation, and fluid balance. The role of anticoagulation, hemodilution therapy, and other proposed forms of therapy is often unclear.
Causes and Complications of Fulminant Hepatic Failure
Authors: Payne John A.
Published: November 2009

Fulminant hepatic failure can be caused by a number of viral, metabolic, toxic, and vascular factors. Identification of the cause can lead to specific intervention in some conditions. Care of the patient with fulminant hepatic failure resulting from diverse causes requires intensive monitoring to prevent death from a variety of complications. Cerebral edema, gastrointestinal hemorrhage, sepsis, coagulopathy, and hypoglycemia are potentially catastrophic complications that must be anticipated and preempted whenever possible. Liver transplantation has emerged as a reasonable therapeutic option; survival rates in small series are approximately 50%.
Dermatologic Problems in the Intensive Care Unit: Part IV
Authors: Berman Rita S. , Silvestri Dianne L.
Published: November 2009

In this final section of our review, we discuss a variety of skin disorders often acquired during hospitalization in the intensive care unit. Environmental, nutritional, immunologic, and pharmacologic factors, among others, place patients at risk for drug eruptions, including leukocytoclastic vasculitis and anticoagulant-induced necrosis; moniliasis; acquired zinc deficiency; recurrent herpes simplex labialis; seborrheic dermatitis; contact dermatitis; and pressure sores.
Disorders of Temperature Control: Hypothermia, Part III
Authors: Curley Frederick J. , Irwin Richard S.
Published: November 2009

Hypothermia, defined as a body core temperature below 35°C, results from exposure to cold, drugs, metabolic dysfunction, or nervous system or skin disorders. The diagnosis and clinical assessment of patients with hypothermia should be based on a thorough knowledge of the characteristic physiologic changes that accompany hypothermia and affect all organ systems. Morbidity and mortality resulting from hypothermia may be reduced when physicians anticipate the well-known complications of hypothermia and carefully rewarm the patient. The rate and method of rewarming must be individualized, taking into account available resources and the patient's cardiopulmonary status and underlying disease.
Hypercalcemia in the Critically Ill Patient
Authors: Reasner Charles , Mundy Gregory R.
Published: November 2009

Hypercalcemia is now frequently recognized in hospitalized patients, including those who are critically ill. Hypercalcemia in critically ill patients may be life threatening or an indication of an underlying but unsuspected disease process. All of the common causes of hypercalcemia can occur in the critically ill patient and are reviewed here. As in the general patient population, the two most common causes are probably malignant disease and primary hyperparathyroidism. Hypercalcemia is now readily reversible in most patients, particularly when the underlying pathophysiologic mechanisms responsible are recognized, and it should be treated actively.
Acute Mitral Regurgitation
Authors: Crawford Michael H.
Published: November 2009

The mitral apparatus is a complex structure with many components. Diseases affecting any part of this apparatus may result in acute mitral regurgitation. The most common causes are ruptured chordae tendineae and ischemic dysfunction of the papillary muscles. Sudden disruption of the mitral apparatus markedly elevates pulmonary capillary pressure and results in acute pulmonary edema. Consequently, patients with acute mitral regurgitation usually are admitted to acute care facilities. The physical examination sometimes is misleading because the characteristic holosystolic murmur may be absent. In some patients with acute mitral regurgitation, such high left atrial pressures develop during the latter part of systole that the pressure gradient between the left ventricle and atrium is obliterated, resulting in cessation of the murmur in late systole. This regurgitant v wave in the left atrial or pulmonary capillary pressure tracing is the characteristic hemodynamic finding in acute mitral regurgitation, but it may not always be present. Currently, the best diagnostic technique is two-dimensional and Doppler echocardiography. The former provides anatomic detail of the mitral apparatus, and the latter confirms and quantifies the mitral regurgitation. Although left ventricular angiography can be used to make the diagnosis, Doppler echocardiographs provide more information, are equally sensitive, and are noninvasive. Cardiac catheterization is now largely used to define the coronary anatomy prior to valvar operation. Management of patients with acute mitral regurgitation includes the use of vasodilators, mechanical circulatory support, and finally valvoplasty or replacement.
Pituitary Infarction and Apoplexy: The Need for Early Recognition in Intensive Care Units
Authors: Daughaday William H.
Published: November 2009

Pituitary infarction can occur after prolonged shock, usually from peripartum hemorrhage. With good obstetrical care and prompt transfusion therapy, it is largely preventable. Spontaneous pituitary infarction is much less common. It can be recognized in diabetic patients by the sudden appearance of a severe, usually retroorbital, headache and frequent episodes of hypoglycemia from an abrupt decrease in insulin requirement. When hemorrhage occurs with a pituitary tumor of sufficient expansion to produce acute parasellar manifestations, it is called pituitary apoplexy. Many patients, particularly men, are unaware of a preexisting pituitary tumor, but some will have features of acromegaly and others will have a history of sexual dysfunction. In the more severe cases, early diagnosis is imperative so that prompt neurosurgical evacuation can be undertaken.
Thrombotic Thrombocytopenic Purpura
Authors: Bartholomew John R. , Bell William R.
Published: November 2009

Thrombotic thrombocytopenic purpura (TTP) is classically highlighted by a pentad of features: fever, hemolytic anemia, thrombocytopenia purpura, transient or permanent central nervous system signs, and renal disease. The antemortem diagnosis is reliant upon the multisystem clinical signs and symptoms in conjunction with severe hemolytic anemia and thrombocytopenia. Relapse is common within the first six months after initial presentation. Laboratory findings have been generally nonspecific per se, and antemortem tissue biopsy findings are frequently unrewarding. Recently, however, unusually large multimers of the Factor VIII:Ag molecule (von Willebrand protein) have been identified in the plasma of patients with TTP who have recovered from an acute attack. This observation is very important because it may lead to essential information on the nature of the inciting event in this devastating illness. The differential diagnosis includes several multisystem disease processes such as the hemolytic uremic syndrome, toxemia of pregnancy, systemic lupus erythematosus, subacute bacterial endocarditis, nonbacterial thrombotic endocarditis, immune thrombocytopenic purpura, and the postpartum renal failure syndrome. The hemolytic uremic syndrome, toxemia of pregnancy, and TTP may resemble each other, exhibit many overlapping features, and are probably related. The cause of TTP remains unknown; the overwhelming majority of cases occur in otherwise healthy people without any recognizable underlying illness. Since 1965 45 to 70% of patients survive, a significant improvement in contrast to the early 1900s when the mortality rate was greater than 90%. The most dramatic advance has been observed in therapeutics, namely the utilization of some mode of plasma therapy (either infusion alone or plasmapheresis followed by plasma infusion). Corticosteroids remain very important in the management of patients with TTP. Vincristine may be very helpful, but additional studies are needed. The efficacy of vinca alkaloids, chronic immunosuppressive therapy, and sple. nectomy remains undefined. At present there is very little, if any, evidence that antiplatelet agents, aspirin, and prostacyclin are beneficial to patients with TTP. Prompt diagnosis and vigorous aggressive therapy is critical for successful management of TTP patients.
Person-Oriented Methods in Partner Violence Research: Distinct Biopsychosocial Profiles Among Battered Women
Authors: Nurius Paula S. , Macy Rebecca J.
Published: November 2009

Violence researchers have called for the use of person-oriented methods to understand differences that have been found in biopsychosocial consequences among those who experience intimate partner violence (IPV). To address this issue, we apply a person-oriented statistical method, latent profile analysis (LPA), to test for meaningful subgroups of a sample of 448 battered women based on participants’ appraisals of their vulnerability relative to their violent partner, depressive symptoms, physical injuries, overall physical health functioning, and their positive and negative social relationships with friends and family. The LPA established five significantly distinct subgroups. Using MANOVA, we examined these subgroups and their respective IPV exposure, both concomitant and separate incidents within the past year. Those with the most intensive violence exposure show the greatest level of challenge and impairment. However, the groups with comparable levels of IPV exposure manifest distinctly different configurations of biopsychosocial profiles, indicating a need for adaptive interventions commensurate with these profiles. We discuss the implications these findings have for developing adaptive interventions for battered women, as well as the potential utility of person-oriented tools for violence researchers.
The Trauma of Child Sexual Abuse
Authors: Finkelhor David
Published: November 2009

This article examines two models of the traumatic impact of child sexual abuse, the Post-Traumatic Stress Disorder Model and the Four Traumagenic Dynamics Model. PTSD, in spite of its salutary contributions, has three major problems when applied to sexual abuse. It fails to account for all the symptoms. It does not apply to all victims. And its explanation for the source of trauma does not fit with many types of sexual abuse. The alternative, Four Traumagenic Dynamics Model is more complex and accounts for more of the variety of effects. It posits four dynamics—traumatic sexualization, betrayal, stigmatization, and powerlessness—that cause trauma by distorting a child's self-concept, worldview, and affective capacities. The four dynamics are described, and are matched to specific symptoms that have been noted in the literature.
Children from Sexually Abusive Families
Authors: Friedrich William N. , Beilke Robert L. , Urquiza Anthony J.
Published: November 2009

The sexually abused child has been described as more fearful, anxious, depressed, and guilty in comparison to normal children. However, these descriptions are largely derived from clinical impressions and little systematic exploration of the nature and extent of behavior problems among these children. The present study investigated the problem behaviors of a group of preschool and elementary-aged sexually abused children (N = 93) in comparison with a sample of nonabused children from a psychiatric outpatient clinic (N = 64) and a sample of nonabused children from a well child clinic (N = 78). Behavioral strengths and weaknesses in these children were examined by administering the Achenbach Child Behavior Checklist to their mothers. Sexually abused children displayed a significantly greater number of behavior problems than normals but were not as significantly disturbed as the psychiatric outpatients. The sexually abused children did display significantly more sexual problems than either comparison group. Caseworkersl therapists for the sexually abused child provided ratings of family conflict, cohesion, and support of the child. These were significantly related to the extent of behavior problems in the sexually abused children. This relationship equaled or exceeded the relationship of severity of sexual abuse to behavior problems.
Ameliorating the Effects of Child Sexual Abuse
Authors: Wyatt Gail Elizabeth , Mickey M. Ray
Published: November 2009

This study examines the support of nonabusing parents and others as it affects subsequent adjustment to childhood victimization and women's attitudes toward men. A form of log linear analyses on the data from 61 women 18 to 36 years of age in Los Angeles County revealed that as a result of child sexual abuse, negative attitudes toward men tended not to be related to the severity of the experience(s), if nonabusing parents and others supported victims upon the disclosure of the incident(s). The importance of support to the disclosure process is discussed in helping victims to regain control of their lives and in lessening the lasting effects of child sexual abuse.
The Multifaceted Aspects of Child Sexual Abuse
Authors: Powell Gloria Johnson
Published: November 2009

This article surveys findings on the lasting effects of child sexual abuse on individuals and on the family, child care, education, social service, health care, and legal systems. Child sexual abuse clearly has immediate identifiable effects, consistent symptom patterns, and adverse long-term effects on both boys and girls. It is suspected as the underlying ideology of a number of mental health disorders that have been resistent to treatment, including borderline and multiple personalities. There are, however, difficulties in establishing a linear relationship between sexual abuse in childhood and a specific outcome in adulthood. More work is needed to develop one conceptual model adequate to describe sexual abuse. Since 1976, the incidents of reported child sexual abuse has risen an estimated 27%. The role of reconstituted families in the increased incidents, and the effect of increased awareness of sexual abuse on teachers and other child care providers are discussed. It is recommended that effort be directed to locating the underlying causes of child sexual abuse, so social policy for prevention of child sexual abuse can take accurate aim at the source of the problem. It is necessary that prevention programs directed to children not prevent development of crucial trust. Specific recommendations for future research are made.