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1.
J Geriatr Psychiatry Neurol ; 35(4): 544-549, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-33977812

RESUMO

OBJECTIVE: We compared the cognitive functions of Alzheimer disease (AD) patients who were robust, frail or pre-frail and hypothesized that declines in frontal cortex-related neuropsychological function would be associated with frailty. METHOD: One hundred and sixty outpatients aged 65 years or older with mild AD were enrolled. Cognitive function was assessed using the Cognitive Ability Screening Instrument and further classified into 4 clusters (recent memory, frontal cortex cluster, posterior cortex cluster, and orientation). Other variables included depressive mood, daily activities, body mass index, handgrip strength (HGS), and normal gait speed (NGS). RESULTS: Performance in daily activities, and slower NGS than robust group. Both the frail and pre-frail groups had lower HGS and more depressive symptoms than robust group. Generalized linear with ordinal logistic analysis showed that increment in age, slowing in NGS, and worse frontal cortex cluster function associated with being in a higher level of frailty. The patients with depression symptoms were the odds of being in a higher level of frailty compared to those without depression symptoms. CONCLUSIONS: In addition to physical and psychological symptoms, frailty is associated with specific cognitive domains in patients with AD. A multidimensional approach should be used to assess the impact of intervention programs focusing on frail patients with AD.


Assuntos
Doença de Alzheimer , Fragilidade , Doença de Alzheimer/complicações , Cognição , Fragilidade/complicações , Fragilidade/diagnóstico , Lobo Frontal , Força da Mão , Humanos
2.
Psychogeriatrics ; 20(6): 858-864, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32767523

RESUMO

AIM: Few studies have investigated sarcopenia in patients with cognitive impairment. However, identifying the characteristics and factors associated with sarcopenia in these patients may help to decrease the risk of falls, prevent disabilities, and maintain an independent life, all of which can affect the quality of life of both patient and caregiver. Therefore, the aim of this study was to investigate associated factors of sarcopenia in patients with mild to moderate Alzheimer's disease. METHODS: This cross-sectional study enrolled 125 outpatients aged 65 to 89 years (mean age 79.5 ± 7.9 years) from January 2018 to December 2018. In addition to demographic characteristics, cognitive status, depressive mood, activities of daily living, body mass index (BMI), handgrip strength, gait speed, muscle mass, and serum levels of 25-hydroxyvitamin D (Vit D), haemoglobin (Hb), albumin and creatinine were assessed. Sarcopenia was defined based on the presence of low muscle mass and either low muscle strength or low physical performance. RESULTS: Overall, 29.6% of the patients had sarcopenia. The patients with sarcopenia were mostly male, significantly older, and had a lower BMI and lower levels of Vit D. The female patients with sarcopenia were more likely to have lower levels of Hb. Multiple logistic regression showed that sarcopenia was associated with BMI in both genders. The level of Vit D was associated with sarcopenia in the female patients, whereas age was associated with sarcopenia in the male patients. CONCLUSIONS: A low BMI may be a dementia-related risk factor for sarcopenia. The female patients with sarcopenia were more likely to have lower levels of Hb and Vit D. There may be different risk profiles for sarcopenia in men and women with Alzheimer's disease. Further studies are needed to devise different nutritional support for muscle weakness in patients with cognitive decline by gender.


Assuntos
Doença de Alzheimer/sangue , Doença de Alzheimer/complicações , Hemoglobinas/análise , Sarcopenia/sangue , Sarcopenia/complicações , Caracteres Sexuais , Vitamina D/análogos & derivados , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Doença de Alzheimer/fisiopatologia , Índice de Massa Corporal , Estudos Transversais , Feminino , Força da Mão , Humanos , Masculino , Debilidade Muscular/sangue , Debilidade Muscular/complicações , Debilidade Muscular/fisiopatologia , Sarcopenia/fisiopatologia , Vitamina D/sangue
3.
Arch Gerontol Geriatr ; 89: 104067, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32335425

RESUMO

OBJECTIVES: This study aimed to investigate factors associated with frailty in patients with mild to moderate Alzheimer's disease (AD). METHODS: One hundred fifty-seven outpatients aged 65 years or older with mild to moderate AD were enrolled from January 2018 to December 2018. Cognitive status, depressive mood, activities of daily livings (ADLs), body mass index, handgrip strength (HGS), usual gait speed (UGS), and serum levels of 25-hydroxyvitamin D, hemoglobin (Hb), albumin, and creatinine were assessed. Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: fatigue, resistance, ambulation, illness, and unintentional weight loss. RESULTS: The prevalence of frailty was 15.9%. Those classified as being frail were significantly older, had worse cognitive function, worse ADLs, slower UGS, and lower level of Hb compared to those classified as being pre-frail and those robust, respectively. The pre-frail group was significantly older, had worse ADLs, and slower UGS compared to the robust group. Both the frail and pre-frail groups had more depressive symptoms and weaker HGS than the robust group. Multiple logistic regression analysis showed that cognitive function, UGS, level of Hb, and depressive symptoms were associated with frailty, and that only depressive symptoms were associated with pre-frailty. CONCLUSIONS: Depressive symptoms were a common risk factor for pre-frailty and frailty in patients with AD. Hb levels and UGS were associated with being frail. Preventing frailty in patients with AD should be approached from both physiological and psychological aspects.


Assuntos
Doença de Alzheimer , Depressão , Fragilidade , Idoso , Doença de Alzheimer/complicações , Doença de Alzheimer/epidemiologia , Estudos Transversais , Depressão/complicações , Depressão/epidemiologia , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/epidemiologia , Avaliação Geriátrica , Força da Mão , Humanos , Fatores de Risco
4.
BMC Neurosci ; 19(1): 36, 2018 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-29929471

RESUMO

BACKGROUND: Cholinergic hypothesis has been advanced as an etiology of Alzheimer disease (AD) on the basis of the presynaptic deficit found in the diseased brains, and cholinesterase inhibitors (ChEIs) are the treatment of choice for these patients. However, only about half of treatment efficacy was found. Because increasing evidence supports an extensive interrelationship between thyroid hormones (THs), cortisol level and the cholinergic system, the aim of the present study was to evaluate thyroid function and cortisol level in patients with mild to moderate AD before and after ChEIs treatment, and to identify possible variations in response. This was a prospective, case-control, follow-up study. Levels of cortisol and THs were evaluated in 21 outpatients with mild to moderate AD and 20 normal controls. All patients were treated with 5 mg/day of donepezil (DPZ) and were reevaluated after 24-26 weeks of treatment. RESULTS: The patients had worse cognitive function, higher cortisol level, and lower levels of triiodothyronine (T3) and its free fraction than the controls. There were no significant differences in global cognitive function or cortisol level after treatment, however, significant reductions in T3 and thyroxin (T4) levels were observed. Responders had higher levels of T4 than non-responders, followed by a significant reduction after treatment. CONCLUSIONS: These results suggest that relatively higher levels of T4 may predict a favorable response to DPZ treatment. Further studies are warranted to confirm the relationship between THs and ChEIs therapy in AD and to explore new therapeutic strategies. On the other hand, cortisol levels are more likely to respond to interventions for stress-related neuropsychiatric symptoms in patients with AD rather than ChEIs treatment. Further studies are warranted to investigate the association between cortisol level and the severity of stress-related neuropsychiatric symptoms in patients with AD.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Inibidores da Colinesterase/farmacologia , Donepezila/farmacologia , Tiroxina/metabolismo , Tri-Iodotironina/metabolismo , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cognição/efeitos dos fármacos , Feminino , Seguimentos , Humanos , Masculino
5.
Ergonomics ; 61(1): 162-168, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28498029

RESUMO

Fast rotation three-shift working schedules are common in the medical field in Taiwan. This study investigated whether 24 h off is sufficient for re-adaptation to a daytime routine after working two night shifts (NSs) by comparing changes in cognitive function, anxiety state and objectively measured sleep propensity between those working two NSs followed by 24 h off (n = 21, 2NS-off) and an off-duty group (n = 21, OD). The results showed that nurses in the 2NS-off group were less alert and had decreased visual attention performance and executive function ability than the OD group during the daytime. One day off appeared to be insufficient to adapt back to a daytime shift after two NSs. Further studies are warranted to investigate whether a longer sequence of consecutive NSs (e.g. four NSs) followed by two days off is suitable for a fast rotation three-shift work schedule to allow for optimal performance throughout the next daytime shift. Practitioner Summary: The medical field in Taiwan mandates at least 24 h off between night and day shifts, but this appears to be insufficient for re-adapting to a daytime shift after two night shifts. A longer sequence of consecutive night shifts followed by two days off may be more suitable.


Assuntos
Adaptação Fisiológica , Adaptação Psicológica/fisiologia , Recursos Humanos de Enfermagem Hospitalar/psicologia , Jornada de Trabalho em Turnos/psicologia , Tolerância ao Trabalho Programado/psicologia , Trabalho/psicologia , Adulto , Ansiedade/psicologia , Atenção/fisiologia , Estudos de Casos e Controles , Ritmo Circadiano , Cognição/fisiologia , Feminino , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Doenças Profissionais/psicologia , Sono/fisiologia , Transtornos do Sono do Ritmo Circadiano/psicologia , Fatores de Tempo , Tolerância ao Trabalho Programado/fisiologia
6.
Hum Factors ; 59(6): 925-936, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28581353

RESUMO

OBJECTIVE: In this case control study, we investigated the process of adaptation to night shift (NS) work and recovery back to a day schedule among nurses working a fast-rotation three-shift schedule. BACKGROUND: There is limited knowledge of how specific patterns of a fast-rotation shift affect nurses' performance. METHOD: The cognitive performance of off-duty nurses (OD; n = 21), those working the first night of an NS (1NS; n = 21) and the last night of two ( n = 21), three ( n = 20), and four (4NS; n = 21) successive NSs were compared. Changes in sleep propensity, cognitive function, and anxiety were compared in the daytime after working four successive NSs followed by 24 hr off (4NS-off; n = 18) and in those off duty. RESULTS: The visual attention task (VAT) of cognitive function was significantly worse in the 1NS group and significantly better on the last night in the 4NS group than in the other NS groups. The nurses in the 4NS-off group were less alert and had poorer VAT performance than the OD group during the daytime. CONCLUSION: The nurses working on NS experienced a decrease in VAT performance due to acute changes in circadian rhythm but also significant performance adaptation after four consecutive NSs. One off-duty day was insufficient to recover back to a daytime shift after four consecutive NSs. APPLICATION: In a fast-rotation three-shift schedule, performance adaptation occurred in the nurses who worked four consecutive NSs, and more than one off-duty day are needed to recover back to daytime shift after those NSs.


Assuntos
Adaptação Fisiológica/fisiologia , Enfermeiras e Enfermeiros , Desempenho Psicomotor/fisiologia , Jornada de Trabalho em Turnos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino
7.
Appl Ergon ; 48: 104-8, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25683536

RESUMO

Shift workers frequently experience acute sleep deprivation on first night shift. This study compared the efficacy of 30-min nap (between 2 and 3 a.m.) on the visual attention ability of the nurses working at first 8-h night shift at the time of maximum fatigue (between 3 and 4 a.m.). In addition, we measured cognitive function (between 9 and 10 a.m.) in nurses working on daytime shift, which we defined as baseline wakefulness. The results showed that working on the night shift groups was associated with sleep loss, leading to a decrease in visual attention performance compared to the daytime shift group. There was no statistically significant difference in the visual attention performance between those taking and not taking a nap during the night shift, however the effect size was medium in the information process. It was still needed increase sample size to draw the conclusion regarding a 30-min nap break have positive benefits on perceptual speed during the first night shift.


Assuntos
Cognição , Recursos Humanos de Enfermagem Hospitalar/psicologia , Sono , Tolerância ao Trabalho Programado , Adulto , Atenção , Humanos , Testes Psicológicos , Privação do Sono/psicologia , Fatores de Tempo , Vigília , Tolerância ao Trabalho Programado/psicologia
8.
Psychogeriatrics ; 15(1): 7-13, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25515355

RESUMO

BACKGROUND: This study was to investigate the prescribing patterns for antipsychotic drugs in elderly hospitalized patients with a diagnosis of schizophrenia or dementia at a psychiatric hospital in Taiwan from 2007 to 2012. This study also explored the predictors of antipsychotic polypharmacy (APP). METHODS: We collected patients' demographic data, including year of admission, age, gender, and length of hospital stay, and drug-related information. RESULTS: Second-generation antipsychotic (SGA) monotherapy was the most common type of therapy in both those with dementia and with schizophrenia, and quetiapine and risperidone were the most commonly prescribed drugs for these conditions, respectively. In late-life schizophrenia, 33.8% of the patients used first-generation antipsychotics (FGA) alone. Regarding APP, a combination of FGA and SGA and combinations of SGA were most commonly noted in schizophrenia patients and dementia patients, respectively. Overall, APP increased from 2007 to 2012. It was significantly more common in patients with dementia (odds ratio: 3.49, 95% confidence interval: 1.29-9.39, P = 0.014), less concurrent use of hypnotics and sedatives (odds ratio: 0.41, 95% confidence interval: 0.17-0.99, P = 0.046), and a higher-than-recommended dose of antipsychotic drugs (odds ratio: 4.98, 95% confidence interval: 2.75-9.02, P < 0.001). CONCLUSIONS: FGA are still commonly used for the late-life schizophrenia at our hospital. Given their potentially hazardous side effects, FGA must be employed with caution. The use of APP involving SGA increased over the 6 years of the study period, especially among patients with dementia. However, the use of SGA in dementia began to decline after the US Food and Drug Administration's 2005 warning about SGA being associated with increased mortality in dementia patients, which contrasts with the trends examined in this study. Further controlled trials exploring the efficacy, safety, and tolerability of APP in this population are warranted to gain an additional insight into this practice.


Assuntos
Antipsicóticos/uso terapêutico , Demência/tratamento farmacológico , Hospitalização , Hospitais Psiquiátricos , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/efeitos adversos , Demência/diagnóstico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/uso terapêutico , Risperidona/efeitos adversos , Risperidona/uso terapêutico , Esquizofrenia/diagnóstico , Taiwan
9.
BMC Psychiatry ; 14: 218, 2014 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-25091387

RESUMO

BACKGROUND: We investigated circadian changes and effects on mood, sleep-related hormones and cognitive performance when nurses worked consecutive night shifts in a rapidly rotating shift system. Daytime cognitive function, sleep propensity and sleep-related hormones (growth hormone, cortisol, prolactin, thyrotropin) were compared after participants worked two and four consecutive night shifts. METHODS: Twenty-three off-duty nurses, 20 nurses working two consecutive night shifts and 16 nurses working four consecutive night shifts were enrolled. All participants completed the Maintenance of Wakefulness Test, State-Trait Anxiety Inventory, Stanford Sleepiness Scale, visual attention tasks (VAT), Wisconsin Card Sorting Test, and modified Multiple Sleep Latency Test. Hormone levels were also measured four times throughout the day, at 2-h intervals. RESULTS: During the day, the participants in the night shift groups were less able to maintain wakefulness, had poor performance on VAT, and higher thyrotropin levels than did those in the off-duty group. Participants who worked two night shifts were better able to maintain wakefulness, had higher anxiety scale scores, poorer initial performance and lack of learning effect on VAT, and higher prolactin levels compared with those who worked four night shifts. There were no differences in cortisol levels between the two- and four- shift groups. CONCLUSIONS: Rotating night shifts too quickly may cause anxiety and decreased attentional performance, and may impact daytime prolactin levels after night shifts. It is possible that the two-shift group had a higher cortisol level than did the four-shift group, which would be consistent with the group's higher state anxiety scores. The negative findings may be due to the small sample size. Further studies on the effects of consecutive night shifts on mood and cortisol levels during the daytime after sleep restriction would be valuable.


Assuntos
Transtornos de Ansiedade/etiologia , Atenção/fisiologia , Ritmo Circadiano/fisiologia , Enfermeiras e Enfermeiros/psicologia , Prolactina/sangue , Sono/fisiologia , Tolerância ao Trabalho Programado/psicologia , Adulto , Afeto/fisiologia , Estudos de Casos e Controles , Cognição , Feminino , Humanos , Testes Neuropsicológicos , Polissonografia , Vigília/fisiologia , Adulto Jovem
10.
J Clin Neurophysiol ; 31(1): 81-5, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24492450

RESUMO

PURPOSE: To evaluate the effect of donepezil, one of the cholinesterase inhibitors, on P300 measurements in patients with Alzheimer's disease (AD) and investigate the relationship between the subfactors of cognitive performance and P300 components. METHODS: One hundred outpatients with AD were evaluated for cognitive function (cognitive ability screening instrument) and event-related potentials before and after 22 to 23 weeks of treatment with donepezil (5 mg/day). Twenty age-matched normal control subjects were recruited. RESULTS: The patients with AD showed prolonged P300 and N200 latency, no significant differences in N100 and P200 components, and poor performance in neuropsychological assessments compared with control subjects at baseline. After donepezil treatment, the patients with AD had reduction in P300 latency at Pz lead, which was associated with a parallel improvement in cognitive function in terms of remote memory, recent memory, visual instruction, and orientation. The pre-post treatment difference of P300 latency significantly correlated with the cognitive ability screening instrument score difference and recent memory score difference, respectively. CONCLUSIONS: The patients with AD still had intact early sensory processing but impaired higher-level cognitive processes that could influence behavior deviation. The donepezil treatment, which enhances higher-level cognitive processing time, revealed that P300 latency decreases as cognitive capability increases, especially improved in recent memory.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Inibidores da Colinesterase/uso terapêutico , Cognição/efeitos dos fármacos , Potenciais Evocados P300/efeitos dos fármacos , Indanos/uso terapêutico , Piperidinas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/fisiopatologia , Estudos de Casos e Controles , Cognição/fisiologia , Donepezila , Potenciais Evocados P300/fisiologia , Potenciais Evocados/efeitos dos fármacos , Potenciais Evocados/fisiologia , Feminino , Humanos , Masculino
11.
Kaohsiung J Med Sci ; 29(11): 611-6, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24183355

RESUMO

The aim of this study was to explore changes in cognitive function, sleep propensity, and sleep-related hormones (growth hormone, cortisol, prolactin, and thyrotropin) and to investigate the factors related to the ability to maintain wakefulness in the daytime after one block of fast forward rotating shift work (2 days, 2 evenings, and 2 nights). Twenty female nurses (mean age: 26.0 ± 2.0 years; range: 22-30 years) were recruited from an acute psychiatric ward. The nurses completed the Maintenance of Wakefulness Test (MWT), State Anxiety Inventory (SAI), Stanford Sleepiness Scale (SSS), Digit Symbol Substitution Test, Symbol Searching Test, Taiwan University Attention Test, Wisconsin Card Sorting Test (WCST), and Multiple Sleep Latency Test (MSLT) four times throughout the day at 2-hour intervals, and their hormone levels were measured at the same time. There was no time of day effect on sleep propensity as measured by the MWT or MSLT despite an increase in self-reported sleepiness. Anxiety state and neuropsychological tasks, including executive function, attention, and perceptual and motor abilities were not affected during the daytime sleep restriction period. The number of omissions and perceptual and motor abilities showed a practice effect. The thyrotropin levels were significantly elevated, and cortisol levels significantly decreased during the daytime sleep restriction period. There were no significant changes in growth hormone or prolactin throughout the daytime period. Age was negatively associated with the mean sleep latency (MSL) of the MWT and positively associated with the MSL of the MSLT. The perseverative errors in WCST and SSS scores were negatively associated with the MSL of the MWT. SAI scores and thyrotropin levels were positively associated with the MSL of the MWT. In conclusion, there was no change in sleep propensity in the daytime after one block of rotating shift work. An attempt to preserve daytime alertness was also related to maintaining neuropsychological performance. Maintaining this ability was related to thyrotropin and age, and this cognition required a high attentive load.


Assuntos
Vigília , Tolerância ao Trabalho Programado , Adulto , Feminino , Humanos , Testes Neuropsicológicos , Taiwan , Adulto Jovem
12.
Sleep Med ; 14(7): 605-13, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23643653

RESUMO

OBJECTIVES: The objective of our study was to explore changes in cognitive functions, sleep propensity, and sleep-related hormones (growth hormone [GH], cortisol, prolactin [PRL], thyrotropin [TSH]) in the daytime of nurses working on fast rotating shifts. METHODS: Twenty nurses who worked two consecutive night shifts and 23 off-duty nurses were recruited from an acute psychiatric ward. The maintenance of wakefulness test (MWT), Stanford sleepiness scale (SSS), visual attention tasks, Wisconsin card sorting test (WCST), multiple sleep latency test (MSLT), and measuring hormones were administered four times throughout the daytime at 2-hour intervals. RESULTS: The subjects in the off-duty group were more able to maintain wakefulness than those in the night-shift group; however, there were no differences in self-reported total sleep time or sleep latency on the MSLT and SSS scores between the two groups. The subjects in the night-shift group had poorer performances on visual attentive tasks and higher levels of TSH than those in the off-duty group, and this resulted in a lack of a learning effect on the tasks that required a high attentive load. CONCLUSIONS: Nurses working on fast rotating shifts overestimate the cognitive functions and capacity of maintaining wakefulness following daytime sleep restriction. Attention performance depended on the attentive load requirement and was possibly related to TSH level.


Assuntos
Cognição/fisiologia , Distúrbios do Sono por Sonolência Excessiva/fisiopatologia , Recursos Humanos de Enfermagem Hospitalar/psicologia , Enfermagem Psiquiátrica , Transtornos do Sono do Ritmo Circadiano/fisiopatologia , Vigília/fisiologia , Adulto , Ansiedade/fisiopatologia , Ansiedade/psicologia , Atenção/fisiologia , Atitude do Pessoal de Saúde , Distúrbios do Sono por Sonolência Excessiva/psicologia , Feminino , Humanos , Masculino , Admissão e Escalonamento de Pessoal , Autorrelato , Transtornos do Sono do Ritmo Circadiano/psicologia , Adulto Jovem
14.
Acad Psychiatry ; 35(5): 307-11, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22007087

RESUMO

BACKGROUND: No single assessment method can successfully evaluate the clinical ability of medical students in psychiatric clerkships; however, few studies have examined the efficacy of multiple assessments, especially in psychiatry. The aim of this study was to examine the relationship among different types of assessments of medical students' clinical ability in psychiatric clerkships and whether it is reasonable to use multiple assessments. METHOD: A group of 196 students were enrolled during their psychiatric clerkship between September 2008 and May 2009 in Kaohsiung, Taiwan. The mini-clinical evaluation exercise (mini-CEX) and standardized patient (SP)-based test were used to evaluate "does" and "show how" in psychiatric clinical ability. A multiple-choice examination was used to evaluate knowledge of psychiatry. RESULTS: There were statistically significant but weak correlations among the scores on the multiple-choice examination, SP-based test, and overall clinical competence domain on the mini-CEX. CONCLUSION: A blended assessment composed of a multiple-choice examination, mini-CEX, and SP-based test can evaluate different dimensions of clinical ability. It is reasonable to use multiple methods to assess medical students' competency in psychiatric clerkships.


Assuntos
Estágio Clínico/normas , Competência Clínica/normas , Avaliação Educacional/métodos , Psiquiatria/educação , Estágio Clínico/métodos , Avaliação Educacional/normas , Feminino , Humanos , Masculino , Psiquiatria/normas , Estudantes de Medicina
15.
Sleep Med ; 12(9): 866-9, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21925944

RESUMO

OBJECTIVE: A three-shift work schedule with fast rotation is common among healthcare workers in Taiwan. This study compared cognitive performance at the time of maximum fatigue (3-4am on the last night shift of the rotation) between nurses working two, three, and four consecutive night shifts. METHODS: Sixty-two nurses [mean age 26.4 (standard deviation 2.0) years] were recruited from the acute psychiatric ward and assigned at random to three groups: two, three, and four consecutive night shifts. The exclusion criteria were: current use of hypnotic drugs, regular consumption of coffee, psychiatric illness, major systemic disease, and sleep disorders. Cognitive performance was assessed using the State-Trait Anxiety Inventory, Stanford Sleepiness Scale, Wisconsin Card Sorting Test, Taiwan University Attention Test, Digit Symbol Substitution Test, and Symbol Searching Test. RESULTS: Greater impairment of perceptual and motor ability was seen among subjects who worked two consecutive night shifts compared with those who worked four consecutive night shifts. No differences in demographic data, executive function or attention were found between the three groups. CONCLUSION: The main duties of nurses working night shifts at the study hospital include checking medical orders and prescriptions, which require perceptual and motor abilities. The results of this study suggested that a fast shift rotation may increase the risk of medical errors.


Assuntos
Adaptação Fisiológica/fisiologia , Transtornos Cognitivos/etiologia , Transtornos das Habilidades Motoras/etiologia , Recursos Humanos de Enfermagem Hospitalar , Transtornos do Sono do Ritmo Circadiano/complicações , Transtornos do Sono do Ritmo Circadiano/fisiopatologia , Adulto , Ansiedade/etiologia , Atenção/fisiologia , Função Executiva/fisiologia , Feminino , Humanos , Testes Neuropsicológicos , Admissão e Escalonamento de Pessoal , Enfermagem Psiquiátrica , Taiwan , Adulto Jovem
16.
Psychiatry Clin Neurosci ; 63(2): 176-9, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19335387

RESUMO

AIM: Schizophrenia patients present both reduced slow wave sleep (SWS) and shortened rapid eye movement latency (REML) in polysomnographic (PSG) profiles, which have been linked to dopaminergic and muscarinic impairment, respectively. Two main selective attentional systems involve different anatomical structures. The first system is the parietal cortical areas and thalamic areas, which are linked to cholinergic neurotransmission. This is responsible for automatic attention response. The second system is the frontal regions, which are linked to dopaminergic neurotransmission. This is responsible for voluntary control of attentional resources. It was hypothesized that low attentional performance in schizophrenia patients is associated with shortened REML and reduced SWS. METHODS: The PSG profile was correlated with the continuous performance test (CPT) in 15 schizophrenia inpatients under treatment with risperidone. Schizophrenia was diagnosed according to DSM-IV criteria, and clinical symptoms were evaluated on the Brief Psychiatric Rating Scale. RESULTS: REML was negatively correlated with errors of omission (P < 0.05), reaction time (RT; P < 0.05) and positively correlated with hit rate (HR; P < 0.05). No association was found between SWS and CPT performance. CONCLUSIONS: The significant indicators of CPT represent different attention processes. Errors of omission, which are linked to the problems with automatic attention processing, RT, which represent the speed of automatic processing, and HR, are involved in the integration of autonomic and voluntary attention control. The present results suggest that REML is associated with thalamus-related automatic attention response. Due to study limitations, however, confirmation of these findings in a large-scale controlled study of drug-naïve patients is needed.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Psicologia do Esquizofrênico , Sono REM/fisiologia , Sono/fisiologia , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Escalas de Graduação Psiquiátrica , Desempenho Psicomotor/fisiologia , Adulto Jovem
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