After weeks of chronic recurrence, we finally provided her with samples of Durezol and, as we expected, this quickly suppressed her uveitis. Once controlled, we had to switch her back to the generic prednisolone acetate because we had no more samples available for her. Plan B: In either case, a viable option is to prescribe the two generic ingredient drugs. Clearly instruct the patient to wait 10 minutes between the use of these two drops. Of note, while brinzolamide is in Simbrinza, when prescribing an individual carbonic anhydrase inhibitor, we default to the generic dorzolamide because it is less expensive and is a solution, thus it requires no shaking before instillation. Problem: You prescribe Lotemax gel drops off label for a patient with dry eye disease, only to be told that it is either too expensive or not on the formulary. Be sure to advise the patient that the fluorometholone must be shaken before each instillation. Plan B: Offer coupons if they are available, or default to generic Maxitrol if it will be used for less than two weeks. Be aware that there is a slight potential for prednisone allergic reaction, or increased intraocular pressure from the dexamethasone, which may occasionally be bothersome. Zylet, generic TobraDex and generic Maxitrol are all suspensions, and must be shaken before each use. Problem: You prescribe prednisolone acetate for an episcleritis, but the patient is dismayed by its high price. Plan B: Consider generic Maxitrol, ignoring the antibiotic component; it is a cheap way to get access to a decent steroid when push comes to shove. Another option is generic prednisolone sodium phosphate, which works well for ocular surface conditions and requires no shaking. Plan B: Try generic Blephamide ointment or Maxitrol ointment, ignoring the antibiotic components of these two drugs. Note: Kenalog (triamcinolone) is commonly injected intravitreally and we have never seen a problem with use of triamcinolone cream, even if some happens to get in the eyes. This often requires thinking outside the box, and you must have a comprehensive knowledge of all available drugs. The history is important for the diagnosis and subsequent management of this disease. In addition, the occupational, avocational, and environmental history must all be carefully reviewed. In addition to exposure to a single agent, simultaneous exposure to multiple irritants and contact allergens may produce additive, synergistic, or antagonistic responses. Simultaneous exposure to both an irritant and a contact allergen or 2 contact allergens can reduce the clinical threshold concentration for elicitation of response to a given allergen due to irritant disruption of the skin barrier and immunologic activation of the skin. In addition, attention should be given to specific anatomical sites, particularly the eyelids, neck, scalp, axillae, lower extremities, and anogenital area. Patients presenting with acute or chronic hand eczema should undergo patch testing. Acute or chronic inflammation of the lips manifested as eczematous cheilitis can be characterized by itching, burning, redness, edema, and fissuring. This is most commonly caused by physical (eg, cold, dryness, wind) or chemical irritants (eg, saliva, lip cosmetics, or other oral products). Other conditions that should be considered in patients with oral mucosal inflammation include burning mouth syndrome, lichenoid tissue reactions, stomatitis, gingivitis, orofacial granulomatosis, recurrent aphthous stomatitis, precancerous and cancerous lesions, viral and fungal infections and lichen planus. The gender difference is likely due to greater exposure of the neck, hands, and ears to nickel in jewelry and body piercing practices. Among patients with cosmetic allergies, fragrances, preservatives, and emulsifiers are the most common causative allergens. Para-tertiary butylphenol formaldehyde resin (in adhesives), potassium dichromate, cobalt chloride, and carbamates are among the most common allergens.
Systemic corticosteroids were required in 18% (4/22) of patients with thyroiditis. Approximately 86% of patients with hypophysitis received hormone replacement therapy. Systemic corticosteroids were required in 88% (37/42) of patients with hypophysitis. Approximately 71% (25/35) of patients with adrenal insufficiency received hormone replacement therapy, including systemic corticosteroids. Approximately 26% of patients with hyperthyroidism received methimazole and 21% received carbimazole. Systemic corticosteroids were therefore required in 100% (26/26) of patients with immune-mediated pneumonitis. Approximately 8% required coadministration of another immunosuppressant with corticosteroids. Systemic corticosteroids were required in 100% of patients with pneumonitis followed by a corticosteroid taper. Immune-mediated pneumonitis led to permanent discontinuation or withholding of treatment in 2. Systemic corticosteroids were therefore required in 100% (27/27) of patients with immune-mediated nephritis with renal dysfunction. Interrupt or slow the rate of infusion in patients with mild or moderate infusion reactions [see Dosage and Administration (2. In animal reproduction studies, administration of ipilimumab to cynomolgus monkeys from the onset of organogenesis through delivery resulted in higher incidences of abortion, stillbirth, premature delivery (with corresponding lower birth weight) and higher incidences of infant mortality in a dose-related manner. The effects of ipilimumab are likely to be greater during the second and third trimesters of pregnancy. Refer to the nivolumab Full Prescribing Information for additional risk information that applies to the combination use treatment. Adverse Reaction All All Grades Grades All Grades Grades Grades 3-4 3-4 (%) (%) (%) (%) (%) General Fatiguea Pyrexia Gastrointestinal Diarrhea Nausea Vomiting 62 40 54 44 31 7 1. The most frequent serious adverse reactions reported in 2% of patients were colitis/ diarrhea, hepatic events, abdominal pain, acute kidney injury, pyrexia, and dehydration. Forty-seven percent of patients were exposed to treatment for >6 months, and 35% of patients were exposed to treatment for >1 year. Treatment was discontinued in 29% of patients and delayed in 65% of patients for an adverse reaction. The trial excluded patients with untreated brain metastases, carcinomatous meningitis, active autoimmune disease, or medical conditions requiring systemic immunosuppression. The population characteristics were: median age 64 years (range: 26 to 87); 48% were 65 years of age, 76% White, and 67% male. The most frequent (2%) serious adverse reactions were pneumonia, diarrhea/colitis, pneumonitis, hepatitis, pulmonary embolism, adrenal insufficiency, and hypophysitis. The most common (20%) adverse reactions were fatigue, rash, decreased appetite, musculoskeletal pain, diarrhea/colitis, dyspnea, cough, hepatitis, nausea, and pruritus. The most frequent (>2%) serious adverse reactions were pneumonia, diarrhea, febrile neutropenia, anemia, acute kidney injury, musculoskeletal pain, dyspnea, pneumonitis, and respiratory failure. Fatal adverse reactions occurred in 7 (2%) patients, and included hepatic toxicity, acute renal failure, sepsis, pneumonitis, diarrhea with hypokalemia, and massive hemoptysis in the setting of thrombocytopenia. The most common (>20%) adverse reactions were fatigue, musculoskeletal pain, nausea, diarrhea, rash, decreased appetite, constipation, and pruritus. The most frequent (2%) serious adverse reactions were pneumonia, pyrexia, diarrhea, pneumonitis, pleural effusion, dyspnea, acute kidney injury, infusion-related reaction, musculoskeletal pain, and pulmonary embolism. The most common (20%) adverse reactions were fatigue, musculoskeletal pain, rash, diarrhea, dyspnea, nausea, decreased appetite, cough, and pruritus. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. For these reasons, comparison of the incidence of antibodies in the studies described below with the incidences of antibodies to other studies or to other products may be misleading.
The Ocular Immunology and Uveitis Foundation published preferred practice patterns for uveitis management in 2015. A step-wise approach to medical therapy is recommended, starting with the lowest but appropriately aggressive therapy and escalating as needed when the treatment fails to control inflammation or the patient becomes intolerant to the treatment. This first step is often topical corticosteroids, especially in the case for anterior uveitis, as was used in the case report above. However, it is important to note that topical corticosteroids may also be effective in the management of vitritis or macular edema in pseudophakic, aphakic, or status-post vitrectomy patients. This route of administration is effective when the desired site of action is more posterior in the globe, such as those with intermediate or posterior uveitis, or in cases of cystoid macular edema, as in the patient in this case report. One benefit of periocular steroids is that while delivering a therapeutic dose in approximation with the site of inflammation, they have few systemic side effects in adults. A single pars plana intravitreal injection of 4 mg triamcinolone may produce sustained visual acuity improvement for three to at six plus months. Corticosteroid implants can be inserted via intravitreal injection or surgical fixation to the sclera via the pars plana, often combined with a vitrectomy. Retisert is sustained release non-biodegradable implant containing fluocinolone acetonide 0. Both of these procedures can be performed multiple times, but keeping in mind the high rate of cataract formation in phakic patients. Oral systemic corticosteroid therapy is used when chronic uveitis becomes vision threatening and topical corticosteroids are insufficient or when the underlying systemic disease also requires therapy. Standard initial dosing is prednisone 1mg/kg/day with a taper usually by five to ten mg each week. Patients on high-dose oral corticosteroids should be on histamine-2 receptor blockers or proton pump inhibitors to reduce the risk of gastric and peptic ulcers as side effects from corticosteroids. Common antimetabolites include methotrexate, azathioprine, and mycophenolate mofetil. Calcineurin inhibitors, such as cyclosporine, interrupt T-cell activity and growth by inhibiting calcineurin, which down regulates transcription of interleukin-2. Biologic response modifiers, also known as "biologics", are typically antibodies used to target specific cytokines within the immune response. These medications carry risks, 19 such as latent infection, so it is vital that patients are screened for infection prior to initiating therapy. Other risks include hepatotoxicity, anaphylaxis, demyelinating disease, drug-induced autoimmune disease, and secondary malignancies. These are used in cases of severe or refractory uveitis, or when patients cannot tolerate other medications. Patients on these agents must be monitored weekly or bi-weekly for toxicity and bone marrow suppression. In some cases, combinations of immunomodulatory agents may be used to target inflammation via two different pathways. New advances are on the horizon and further studies are needed to explore these modalities. Transscleral iontophoresis is a drug delivery system that uses a small electrical current to help diffusion of the drug across the sclera. The benefit of this therapy is that it is non-invasive and has fewer systemic side effects compared to systemic therapy. This subgroup of uveitis has unique characteristics including a non-granulomatous and anterior involvement that is typically acute or recurrent in duration. The diagnostic work-up of patients with uveitis should be guided by clinical characteristics as well as anatomic location, with recommended laboratory and imaging studies based on consensus among the current literature. Treatment should follow a step-wise approach, escalating therapy as needed when the current treatment fails to control inflammation or the patient becomes intolerant to the treatment.
Alteration in goblet cell numbers and mucin gene expression in a mouse model of allergic conjunctivitis. Using osmolarity to diagnose dry eye: a compartmental hypothesis and review of our assumptions. Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. Flow cytometric analysis of, inflammatory markers in conjunctival epithelial cells of patients with dry eyes. Ocular surface changes and discomfort in patients with meibomian gland dysfunction. Altered traffic to the lysozyme in an ex vivo lacrimal acinar cell model for chronic muscarinic receptor stimulation. Reflex lacrimation in patients with glaucoma and healthy control subjects by fluorophotometry. Relation between corneal innervation with confocal microscopy and corneal sensitivity with noncontact esthesiometry in patients with dry eye. Histopathological effects of, topical ophthalmic preservatives on rat corneoconjunctival surface. Effects of benzalkonium, chloride on growth and survival of Chang conjunctival cells. Comparison of the short-term effects on the human corneal surface of topical timolol maleate with and without benzalkonium chloride. Conjunctival proinflammatory and, proapoptotic effects of latanoprost and preserved and unpreserved timolol: an ex vivo and in vitro study. Toxicity of preserved and, unpreserved antiglaucoma topical drugs in an in vitro model of conjunctival cells. Ocular surface inflammatory changes induced by topical antiglaucoma drugs: human and animal studies. Comparing goblet cell densities in patients wearing disposable hydrogel contact lenses versus silicone hydrogel contact lenses in an extended-wear modality. Morphological changes of the, conjunctival epithelium in contact lens wearers evaluated by impression cytometry. Contents List of original publications Abbreviations Abstract 1 Introduction 2 Literature review 2. Pipsa Kulovesi, Jelena Telenius, Artturi Koivuniemi, Gerald Brezesinski, Ilpo Vattulainen and Juha M. Holopainen 2012 the impact of lipid composition on the stability of the tear fluid lipid layer. Holopainen 2014 a Surface properties of artificial tear film lipid layers: Effect of wax esters Invest Ophth Vis Sci 55: 4448-4454 the publications have been reprinted with the kind permission of their copyright holders. It gradually mixes with the aqueous layer that contains mostly water, proteins, and electrolytes. The aqueous film is covered by a thin lipid layer which is composed of polar and nonpolar lipids. Polar lipids, such as phospholipids, are surfactants with polar and nonpolar components. Lipids are thought to prevent the collapse of the tear film onto the ocular surface and to retard evaporation from the tears. It can be caused by a lack of tear production or increased evaporation of the tears. Several methods were used in vitro to study the surface properties and organization of different lipid mixtures. Phosphatidylcholine, phosphatidylethanolamine, and free fatty acids were used as the polar lipids and cholesterol oleate, triglycerides, and wax esters were used as the nonpolar lipids. Langmuir film technique was used to examine the behavior of the lipid films during compressions and de-compression. The results of experimental studies were compared with coarse-grained molecular dynamics simulations.
This is probably an underestimate, as many cases are not diagnosed and leishmaniasis is not reportable in some countries. The consequences of infection seem to vary with the species of Leishmania, host factors. This form often heals spontaneously, although some lesions may persist for long periods or leave scars. In particular, the mucocutaneous form in South America rarely heals spontaneously, is disfiguring, and may be fatal if lesions occur in the nasopharynx. Immunosuppressed patients often develop skin lesions that are similar to those in immunocompetent hosts, but the risk of disseminated infections, diffuse (anergic) cutaneous leishmaniasis, mucosal or visceral involvement, and severe or atypical cases is higher. Some surveys suggest that, in this region, 1-23% of asymptomatically infected people develop visceral leishmaniasis within a year, while 33-87% become seronegative and are likely to have eliminated the organism. Asymptomatic infections with this organism are common, and illnesses tend to occur mainly in young children, or in people who are malnourished or immunosuppressed. Cases in immunocompetent individuals can usually be cured; however, the parasites may persist and symptoms reappear if the individual later becomes immunosuppressed. Visceral leishmaniasis tends to be more severe and more difficult to treat in people who are immunocompromised. Low seroprevalence of Leishmania infantum and Toxoplasma gondii in the horse population in Israel. A Historical overview of the classification, evolution, and dispersion of Leishmania parasites and sandflies. Asymptomatic infection with American cutaneous leishmaniasis: epidemiological and immunological studies. Experimental infection of domestic sheep with culture-derived Leishmania donovani promastigotes. Value of the oral swab for the molecular diagnosis of dogs in different stages of infection with Leishmania infantum. Serologic and molecular evaluation of Leishmania infantum in cats from Central Spain. Canine leishmaniosis - new concepts and insights on an expanding zoonosis: part one. Canine leishmaniosis caused by Leishmania major and Leishmania tropica: comparative findings and serology. Mucocutaneous Leishmania tropica infection in a dog from a human cutaneous leishmaniasis focus. Leishmania and the leishmaniases: a parasite genetic update and advances in taxonomy, epidemiology and pathogenicity in humans. Visceral leishmaniasis caused by Leishmania infantum in Salta, Argentina: Possible reservoirs and vectors. Beck A, Beck R, Kusak J, Gudan A, Martinkovic F, Artukovic B, Hohsteter M, Huber D, Marinculic A, Grabarevic Z. Ben Slimane T, Chouihi E, Ben Hadj Ahmed S, Chelbi I, Barhoumi W, Cherni S, Zoghlami Z, Gharbi M, Zhioua E. Occurrence of Leishmania infantum and associated histological alterations in the genital tract and mammary glands of naturally infected dogs. Natural infection of North African gundi (Ctenodactylus gundi) by Leishmania tropica in the focus of cutaneous leishmaniasis, Southeast Tunisia. Leishmania in synanthropic rodents (Rattus rattus): new evidence for the urbanization of Leishmania (Leishmania) amazonensis. Seroprevalence of Leishmania infection and molecular detection of Leishmania tropica and Leishmania infantum in stray cats of zmir, Turkey. Sporotrichoid leishmaniasis: a cross-sectional clinical, epidemiological and laboratory study in Rio de Janeiro State, Brazil. Natural infection of Algerian hedgehog, Atelerix algirus (Lereboullet 1842) with Leishmania parasites in Tunisia.
Local adverse reactions such as atrophy, irritation, and allergic contact dermatitis are more likely to occur with occlusive use. Common adverse effects include pruritus, worsening of psoriasis, erythema, and burning sensation. Topical tazarotene is contraindicated in patients who are pregnant or who have a documented hypersensitivity reaction to any component of the formulation. Additionally, increased photosensitivity may occur with concurrent administration of fluoroquinolones, phenothiazines, sulfonamides, tetracyclines, and thiazides. Patients should be cautioned to take protective measures (eg, sunscreens, protective clothing) against exposure to sunlight or ultraviolet light (eg, tanning beds) until tolerance is determined. Discontinue tazarotene until skin integrity is restored, or reduce the dosing interval or switch to a lower concentration. Warnings include hypothalamicpituitary-adrenal axis suppression and photosensitivity. Common adverse effects include contact dermatitis, application site pain, folliculitis, skin atrophy, and excoriation. Topical anthralin is contraindicated in acute or actively inflamed psoriatic eruptions. Additionally, the agent should not be used if there is a hypersensitivity to the active ingredient or any of its components. The most common side effects of anthralin are skin irritation and staining of lesional and adjoining skin, nails, and clothing. It is intended for internal use only and should be disseminated only to authorized recipients 87 Acitretin is teratogenic and its use, therefore, is limited to male and female patients of nonchildbearing potential. Acitretin should only be considered for women of childbearing potential with severe psoriasis unresponsive to other therapies or whose clinical condition contraindicates the use of other treatments. Other contraindications for acitretin include severe liver or kidney impairment, chronic elevation of lipid profile, and use in combination with methotrexate or tetracyclines. Potential adverse effects of acitretin include dry skin and mucus membranes, alopecia, skin peeling, pruritus, cheilitis, rhinitis, hyperlipidemia, liver toxicity, and teratogenicity. Periodic monitoring of bones, lipid profile, liver function, and eyes is recommended. Methoxsalen is contraindicated with a history of light sensitivity, melanoma, invasive squamous cell carcinoma or aphakia. Due to the potential for serious adverse reactions in the nursing infant, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother. It is not known if calcipotriene/betamethasone is excreted in breast milk; caution is advised. The decision to continue or discontinue breastfeeding during therapy should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. Acitretin is a known teratogen and use is contraindicated in females who are or may become pregnant. Due to the potential for serious adverse reactions in the breastfeeding infant, the manufacturer does not recommend acitretin prior to or during breastfeeding. It is not known if methoxsalen (systemic) is excreted in breast milk; either methoxsalen ingestion or nursing should be discontinued. For scalp psoriasis, comb hair to remove scalar debris; wet and part hair; rub cream into lesions. It is intended for internal use only and should be disseminated only to authorized recipients 88 Drug Sorilux (calcipotriene) Available Formulations Foam Usual Recommended Frequency Apply a thin layer twice daily to the affected areas and rub in gently and completely. Apply a thin layer to affected area 1 to 2 times per day and rub in gently and completely. Comb hair to remove scaly debris and apply twice daily, only to lesions, and rub in gently and completely. Calcipotriene ointment Calcipotriene scalp solution Ointment Solution Do not spread to forehead. Avoid use on face, groin, axillae, or if skin atrophy is present at treatment site.
Diseases
Because receiving feedback on academic performance is particularly important for first semester freshmen, an early- in the -semester additional exam was added to two of the general education psychology courses. The intent was to expose freshman earlier to a college level examination as well as to give them additional opportunities to improve their grade over the course of the semester f. One of the psychology faculty members is currently teaching a live online class to high school students enrolled in a collaborative effort with regional high schools and the University labeled, "Early College. It is hoped that this early educational experience may generate interest in future attendance at the University 4. Several previously recommended initiatives that we believe could improve successful recruitment of students as well as retention at the University have not been implemented for various reasons: a. A psychology laboratory would be particularly attractive to potential students who are considering coming to Lake State and majoring in psychology. It is important to recognize that many institutions that are competing with Lake State for undergraduate students do have facilities of this type. It was recommended in the recent past that we offer a forensic psychology course and more recently,a forensic psychology concentration that would be the equivalent of a minor. One of the current full-time faculty has the qualifications to teach a course of this type. However, again, faculty numbers and accompanying demands of required courses have not permitted this plan to be implemented. In the recent past, there also appeared to be a reluctance for new courses to be approved c. Again, as recommended in the previous program review, hiring two full-time faculty representing specializations not currently represented by the two full-time faculty would also likely draw more students to the University as Psychology majors. Explain how the program ensures that degree program-level and courselevel learning outcomes are at an appropriate level. As is evident from the responses to questions 13 and 14 as well as issues raised in the 2015 Psychology Program Review, the resources and support for a high quality psychology program are ongoing areas of great concern. We firmly believe that the quality of the program could certainly be improved in a number of areas but would require additional faculty, laboratory space, support for research, and support for new courses. Both of the two current full-time psychology faculty members regularly attend national and international conferences devoted to undergraduate teaching as well as teaching of undergraduate psychology (The annual National Institute on the Teaching of Psychology; European Psychology Learning and Teaching Conference; International Congress on Psychology Education; the Lilly Conference). As A result of involvement in these conferences as well as related organizations,(Division 2-American Psychological Association- Teaching of Psychology; International Association of Psychology Educators) we believe that our faculty maintain currency in issues and trends in undergraduate psychology education. Olson-Pupek has significantly revamped several of her upper level courses to provide students with educational experiences that are integrative and require multiple modes of inquiry as well as creative work. These include presenting posters and oral presentations in psychology 459 (Physiological Psychology), scientific posters and a virtual laboratory experience in Learning Theory (Psych 311) and laboratory activities in Cognition (Psych 457). These are all integrative experiences which prepare students for the capstone senior project in psychology. The senior project integrates content from multiple courses ranging from introductory psychology to experimental psychology to personality theory to statistics, etc. Olson-Pupek has recently taught Psychology 212 (Experimental Psychology) online and included virtual laboratory exercises. Explain What the program does to engage students in collecting, analyzing, and communicating information; mastering modes of inquiry or creative work; developing skills integral to the degree program. A number of students have co-authored journal articles and chapters in edited books with a Psychology faculty member. Olson-Pupek has received specialized training in the ethical conduct of research using animals. She plans to have more students conducting animal research after a successful undergraduate study that she supervised in spring, 2018. As a research-based discipline with strong philosophical roots, it is both a liberal arts discipline and a science. Russell Searight Program Outcomes Assessment Criteria & Procedures Assessment Results Finding Reporting Year: 2017-2018 Goal met: No Result of Major Field Test-psychology-mean score; 44th percentile nationally Scores range from 14th to 99th percentile (09/19/2018) Related Documents: mft subtest area scores.
Data from assessments may also be used in the interpretation of intervention study findings to understand how family caregiver factors relate to study outcomes. Irrespective of the assessment instrument, the rationale for conducting a family caregiver assessment is based on the recognition that family caregivers are highly diverse and that services and supports need to be tailored to address the unique and varying needs of caregivers (Brodaty et al. Well-being of the caregiver: encompasses self-rated health, health conditions and symptoms, depression or emotional distress and life satisfaction or quality of life. Potential resources that caregiver could choose to use: describes services, education and training provided by formal and informal networks to assist in supporting the care recipient, caregiver, or both. Importantly, caregiver assessments should also include an assessment of family structures, dynamics and resources. Understanding the characteristics and resources of the family can also help service providers work effectively with multiple caregiver families (or groups) and suggest strategies for sharing caregiving responsibilities. As the disease progresses, the caregiving responsibilities of families increase and include advocacy, hands-on assistance with personal care and mobility tasks, emotional and social support, medical care, surrogacy, as well as ensuring safety and quality of life and preventing and managing behavioral symptoms (Black et al. Overall, an estimated 200 interventions have been tested using randomized designs (Gitlin et al. Unfortunately, there is no agreed-on categorization system for classifying caregiver interventions by their content. Multicomponent interventions tend to target caregivers of individuals at the moderate disease stage and include combinations of approaches such as dementia education, care management, environmental modification, counseling, skills training, and/or referral to community resources, all tailored to the identified unmet needs of caregivers identified via a systematic assessment. Outcome measures for dementia caregiver interventions are wide ranging and have primarily included caregiver knowledge, burden, self-efficacy, psychological morbidity (anxiety/depression), upset, confidence, skills, and desire or time to caregiver placement of the person with dementia in assisted living or nursing homes. Many interventions, using rigorous trial designs, demonstrate effectiveness for one or more outcomes that are targeted in the trial such as reducing caregiver burden and for some interventions, reducing institutionalization and other care recipient-related outcomes such as symptomatology (Brodaty and Arasaratnam, 2012; Gitlin et al. However, the outcomes that are positively or not positively impacted vary vastly among studies. For the most part, multi-component interventions show the largest effects for most outcomes. Also, most studies report positive effects on outcomes such as increased confidence in dealing with challenging situations with very few showing no benefits at all and no studies reporting worsening or adverse effects. It was unique in that it included roughly equal numbers of white, African American, and Hispanic caregivers and, thus had the potential to measure racial or ethnic differences in the effectiveness of the intervention. Department of Health and Human Services, including the Administration for Community Living, hospital systems such as Baylor Scott and White, several state agencies, and social service programs in Hong Kong. Results: Hispanic and white caregivers in the intervention group had a significantly larger improvement in quality of life compared to the control group. For African-American caregivers, only spousal caregivers showed a significant improvement when compared to the control group. Only a few studies directly target people with dementia and also evaluate the potential benefits of the intervention for family caregivers. Of these, there are inconsistent outcomes with some studies showing benefits for caregivers and others not. Although the literature is limited, interventions may also target the family or social networks of the caregiver, neighbors, neighborhoods, churches or community-level groups such as senior centers. Family group interventions providing psychoeducation and/or counseling show positive benefits for families including reductions of caregiver negative reactions to behavioral symptoms in persons with dementia and caregiver depression (Eisdorfer et al. Home-Based Supportive Services programs that provide stipends to families to offset care expenses of individuals with disability of all ages demonstrate a wide range of benefits to family caregivers including fewer out-of-pocket care expenses, better mental health and access to health care, improved self-efficacy, than caregivers on a waitlist for this service (Caldwell, 2006; Heller and Caldwell, 2006; Heller et al. The community represents a largely untapped resource for supporting families for which there are no tested interventions (see Box 5-3 for an example). Each of these could provide a range of emotional and logistical supportive services for families including support groups, friendly visitors, chore services, education, and serve as a supportive network for families. However, the benefit of these resources for family caregivers has not been evaluated. Future research needs to be conducted concerning models for supporting family caregivers using these naturally occurring resources and other models of livable communities. There is also a lack of community-engaged interventions targeting ethnic/racial groups through outreach to ethnic media, churches, and community-based organizations that serve ethnic communities. The community can also play an important role in terms of providing support and services to "hard to reach" caregivers, such as those who live in rural locations, ethnic/racial minorities, or those who have no other source of support for the care recipient, and are often aware or have difficulty accessing available resources and sources of caregiver support. Specifically, community programs or workers may help identify and "recruit" caregivers into educational or support programs by marketing these programs in newsletters, through service providers or other forms of community engagement using targeted, culturally appropriate messaging.
Limited technology access is an issue for some subgroups, such as minority and rural caregivers. Training programs that actively involve caregivers in learning a particular skill result in better outcomes compared to didactic, prescriptive approaches such as handing out information sheets. Numerous barriers have stymied translation of research successes into everyday settings. Many interventions have not been evaluated in or integrated into real world settings where third party reimbursement rules and financial and other organizational constraints prevail. Wider dissemination of effective caregiver interventions will also require attention to the limitations of the available evidence. Future trials should assess whether existing models are effective across diverse populations to determine if further modifications or cultural adaptations are needed. Although the lessons learned from these studies likely applies to a variety of caregiving contexts, additional research on caregivers of older adults with other impairments is needed. Potential impact of incorporating a patient-selected support person into mHealth for depression. Psychosocial interventions for patients and caregivers in the age of new communication technologies: Opportunities and challenges in cancer care. Evidence for stroke family caregiver and dyad interventions: A statement for healthcare professionals from the American Heart Association and American Stroke Association. Caregiver outcomes of Partners in Dementia Care: Effect of a care coordination program for veterans with dementia and their family members and friends. The use of technology in behavioral intervention research: Advantages and challenges. Unmet needs of community residing persons with dementia and their informal caregivers: Findings from the Maximizing Independence at Home Study. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Meta-analysis of psychosocial interventions for caregivers of people with dementia. Cash and Counseling improving the lives of Medicaid beneficiaries who need personal care or home and communitybased services. Dementia care management in an underserved community: the comparative effectiveness of two different approaches. Development of the Risk Appraisal Measure: A brief screen to identify risk areas and guide interventions for dementia caregivers. Care coordination assisted by technology for multiethnic caregivers of persons with dementia: A pilot clinical demonstration project on caregiver burden and depression. The effect of a family therapy and technology-based intervention on caregiver depression. Selected caregiver assessment measures: A resource inventory for practitioners, 2nd ed. Assessing the impact of mobile health apps on family caregiver burden levels and the factors predicting mobile health app use. Caregivers as therapeutic agents in dementia care: the evidence-base for interventions supporting their role. A randomized, controlled trial of a home environmental intervention effect on efficacy and upset in caregivers and on daily function of persons with dementia. Targeting and managing behavioral symptoms in individuals with dementia: A randomized trial of a nonpharmacological intervention. Impact of a consumer-directed family support program on adults with developmental disabilities and their family caregivers.
A randomized controlled trial of acceptance-based behavior therapy and cognitive therapy for test anxiety: A pilot study. Support for the reliability and validity of a six-item state anxiety scale derived from the state-trait anxiety inventory. Lowering stress while teaching research: A creative arts intervention in the classroom. Testing the efficacy of a creative-arts intervention in family caregivers of patients with cancer. Rumination and anxiety mediate the effect of loneliness on depressed mood and sleep quality in college students. While comparative research is limited, there have been suggestions that reading material in an electronic format is associated with greater fatigue and increased aversive mood compared with traditional printed books. The current study compared reading comprehension and mood changes between printed and electronic versions of the same material selected from a college textbook. Participants were 25 university students randomly assigned to read the same material from a traditional printed book or an e-textbook. The results indicated there was no significant difference in comprehension or mood based on the textbook condition. While requiring replication, the findings of this study suggest that reading from electronic or traditional texts does not differentially impact comprehension or mood. A less expensive option has been the availability of e-textbooks which can be rented or purchased as Bidwell (1) has noted. The trend towards electronic textbooks is likely to continue with some publishers offering only e-textbooks instead of an option of printed versus electronic texts. E-textbooks also offer unique advantages to college students such as easy portability, keyword searching, and reduced prices. While young adults have indicated comfort with e-book technology, many university students still prefer print versions (2). Given current trends, students who do not wish to use an e-textbook may find themselves with limited options. While it has been assumed that e-books offer significant benefits, research on fundamental issues such as reading comprehension has been limited. Anecdotal information suggests that compared with traditional texts, reading an e-book may be associated with greater fatigue and a higher level of frustration and aversive emotion. An underlying factor accounting for these possible differences may be the novelty and minimal experience with using e-books for academic work. While not directly addressing text format, a recent study by Bohn-Gettler and Rapp (3) examined the impact of mood on reading. Through a mood stimulation procedure, a sad, happy, or neutral mood was deliberately induced before participants read a selected passage. Results indicated that participants with an induced positive mood state recalled more of the important text details and engaged in more in-text inferences than the neutral or sad mood group. Even when an electronic version of a textbook was available for no cost, a majority of university students indicated that they were willing to pay a fee for a printed text (4). Self-reported study time was slightly greater with paper compared with electronic texts (5). It is possible that more experience with e-books leads to greater acceptance and use. While students still preferred printed to electronic texts, prior experience with e-texts was associated with a slightly greater preference for the electronic versus printed format (6). Besides prior exposure to the electronic format, there are suggestions that the physical demands of electronic texts may be greater than for print. While reading speed has been found to be slower with computer screens versus paper, greater experience with the electronic format may reduce this disparity.
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