Книги з теми "Diagnostic Expectations"

This chapter will summarize contemporary models and methods used for the assessment of adaptive behavior functioning in children and adolescents. This chapter will also emphasize how to best use such assessment information for diagnostic and eligibility purposes and in developing interventions and support plans. We will review the use of traditional, norm-referenced adaptive behavior assessment tools as well as what will be referred to as “supplemental methods,” including the direct observation of adaptive skill functioning. The assessment of adaptive behavior with respect to developmental expectations, cultural expectations, systems of care, and legislation will also be discussed. Lastly, case studies will be presented to illustrate the usefulness of these methods in assessing individuals and planning effective interventions and services.

This chapter will summarize contemporary models and methods used for the assessment of adaptive behavior functioning in children and adolescents. This chapter will also emphasize how to best use such assessment information for diagnostic and eligibility purposes and in developing interventions and support plans. We will review the use of traditional, norm-referenced adaptive behavior assessment tools as well as what will be referred to as “supplemental methods,” including the direct observation of adaptive skill functioning. The assessment of adaptive behavior with respect to developmental expectations, cultural expectations, systems of care, and legislation will also be discussed. Lastly, case studies will be presented to illustrate the usefulness of these methods in assessing individuals and planning effective interventions and services.

The proportion of children who are deaf or hard of hearing and also have other medical, neurodevelopmental, behavioral, or psychosocial conditions is increasing. Prevalence estimates run as high as 50% to 70%. The shifting complexity challenges not only the learners but also the teachers, administrators, and policymakers responsible for the education of deaf students. Documentation of diagnostic profiles contributes to understanding the learning profile of deaf students with concomitant conditions. This may also inform policy decisions, programmatic design, calibration of parental expectations, and implementation of effective teaching strategies. Through illustrative case examples, this chapter explores the principles of differential diagnosis and the implications of various conditions. Topics covered include genetic syndromes, vestibular dysfunction, intrauterine viral infection with associated congenital hearing loss, autism spectrum disorder, reactive attachment disorder, complex medical histories resulting in severe neurologic compromise, intellectual disabilities, cerebral palsy, and nonsyndromic genetic conditions.

This chapter on obtaining an assessment begins by considering why, when, and where to obtain an assessment. Sources of referrals can be from child services (transition referral), primary care, other specialist colleagues, and occasionally other agencies such as social care, education (e.g. higher and further education), and the criminal justice system. Assessment services may be limited to performing a basic diagnostic function or may have access to more sophisticated needs assessment methods. A reasoned case for referral needs to be considered and developed. Alternative ways of meeting needs such as short-term problem-solving should also be considered. Information required for a referral for an assessment, whether brief or lengthy, is important. Pre-assessment tests and their evaluation should be considered. Experiences and expectations of the process of referral are also covered.

The final chapter summarizes the benefits of clinician support for students and families who experience academic challenges and learning problems. A review of issues covered in this volume includes the definition of learning disability, challenges in understanding differences between school and external evaluations, differences in terminology, and the lack of congruence between parental expectations for schools and what schools may actually (and appropriately) offer. Recommendations for clinicians include the importance of obtaining a thorough academic history and consideration of school performance as a critical piece of the diagnostic and treatment picture. The impact of related disorders, such as ADHD and executive function deficits, is discussed. Clinicians are advised to become familiar with school-based legal requirements, evaluations, and identification procedures for the benefit of students and their parents.

This chapter summarizes career counseling with diverse, and often marginalized, adult populations and reviews career development and adjustment theories and their application to practice. Diagnostic schemes for vocational problems and expectations for career counseling are reviewed in the context of client characteristics. Career counseling criteria, outcomes, and process components are discussed along with an overview of the integration of career and personal counseling. The section on current trends focuses on the use of career intervention with the unemployed, domestic violence survivors, ex-offenders, people with mental illness, immigrant and migrant populations, military veterans, individuals with physical disabilities, older adults transititoning to retirement, and adults in educational settings. Strength based and relational interventions, executive and career coaching, therapeutic assessment, behavioral intervention technologies, and the expanding role of career counseling in workplace and corporate settings also are summarized.

People with disorders of intellectual development (DID) have a diversity of abilities and consequent support needs. Adjustment difficulties give rise to mental distress and behavioural concerns when expectations are more than can be managed in the absence of needed supports. People with DID also experience a disturbing range of negative life events, trauma, and adversity, all of which can trigger adjustment disorder. Unless such stressors are identified, the individual with DID may be diagnosed with more serious psychiatric disorder, and the opportunity to remove the stressor and offer psychological treatment that both minimizes the emotional impact of the stressor and enhances coping (best practice) is lost. Chronic adjustment disorder, other serious psychiatric disorders, and challenging behaviours may develop and be perceived as treatment resistant (as long as the stressor remains). These diagnostic and treatment issues, in the context of the lives of people with DID, are explored in this chapter.

Percutaneous transluminal coronary angioplasty (PTCA) transformed the cardiac catheter from a diagnostic tool into a treatment tool. The technology involved a special catheter fitted with a balloon near its tip that could be blown up to expand a narrowed coronary artery segment. For patients with angina, the procedure was an attractive alternative to coronary bypass surgery. Mayo cardiologists were among the first to adopt angioplasty and to call for controlled clinical trials to compare it to bypass surgery. Initially, cardiologists (who already performed coronary angiography) learned to perform PTCA informally. After attending one or more live demonstration courses, many began to perform angioplasty in their local hospitals. The philosophy in many contexts was “see one, do one.” By the mid-1980s, however, more rigorous training expectations were elaborated. Heart specialists who performed PTCA were described as “interventional cardiologists,” a phrase that acknowledged that this catheter-based treatment had immediate effects.

Adjustment disorder is a psychiatric diagnosis that has undergone numerous iterations within the Diagnostic and Statistical Manual of Mental Disorders and is characterized by an immediate or almost immediate maladaptive or pathologic psychological response to a stressor. When the stressor is removed, there is the expectation that the patient returns to his or her previous level of functioning. This chapter provides an overview of its historical development, diagnostic criteria, potential controversies, epidemiology, neurobiology, comorbidities, and other differential diagnostic and treatment considerations such as ruling out depression and using assessment instruments. The chapter closes with the presentation of a case illustrating application of the criteria and clinical characteristics of adjustment disorder.The views expressed in this chapter are those of the authors and do not reflect the official policy of the Department of Army/Navy/Force, Department of Defense, or U.S. Government. The identification of specific products or scientific instrumentation is considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of the author, DoD, or any component agency.

This chapter discusses key components of cardiovascular physiology applicable to clinical practice in the field of anaesthesiology. From theory development to ground-breaking innovations, the history of cardiac and vascular anatomy, as well as physiology, is presented. Utilizing knowledge of structure and function, parameters created have allowed adequate patient clinical assessment and guided interventions. A review of concepts reveals the impact of multiple physiological variables on a patient’s haemodynamic state and the need for more accurate and efficient measurements. In particular, it is noted that a more reliable index of ventricular contractility is the end-systolic elastance rather than the ejection fraction. Constant direct preload assessment has not yet been achieved but continues to be determined through surrogate variables, and continuous cardiac output monitoring for oxygen delivery, although advancing, has limitations. Considering the effect of compound factors perioperatively, especially heart failure, modifies the goals and interventions of anaesthetists to achieve improved outcomes. Therefore, medical management prior to surgery and complete assessment through history, physical examination, and diagnostic tests are a priority. This chapter also details the expectations following volume expansion to augment haemodynamics during surgery, the concept of functional haemodynamic monitoring, and limitations to the parameters applied in assessing fluid responsiveness. Challenging the accuracy of conventional indices to predict volume status led to the use of goal-directed therapy, reducing morbidity and minimizing length of hospital stay. The mainstay of this chapter is to reinforce the relevance of advances in haemodynamic monitoring and homeostasis optimization by anaesthetists during surgery, using fundamental concepts of cardiovascular physiology.

This book identifies and names the phenomenon of metagnosis: the experience of newly learning in adulthood of a long-standing condition. It can occur when the condition has remained undetected (e.g., colorblindness) and/or when the diagnostic categories themselves have shifted (e.g., ADHD). More broadly, it can occur with unexpected revelations bearing upon selfhood, such as surprising genetic test results. This phenomenon has received relatively scant attention, yet learning of an unknown condition is frequently a significant and bewildering revelation, subverting narrative expectations and customary categories. In addressing the topic this book deploys an evolution of narrative medicine as a robust research methodology comprising interdisciplinarity, narrative attentiveness, and creating a writerly text. Beginning with the author’s own experience of metagnosis, it explores the issues it raises—from communicability to narrative intelligibility to different ways of seeing. Next, it traces the distinctive metagnostic narrative arc through the stages of recognition, subversion, and renegotiation, discussing this trajectory in light of a range of metagnostic experiences, from Blade Runner to real-world midlife diagnoses. Finally, it situates metagnosis in relation to genetic revelations and the broader discourses concerning identity. Proposing that the figure of blindsight—drawn from the author’s metagnostic experience—offers a productive model for negotiating such revelations, the book suggests that better understanding metagnosis will not simply aid those directly affected but will also serve as a bellwether for how we will all navigate advancing biomedical and genomic knowledge, and how we may fruitfully interrogate the very notion of identity.

Spinal accessory nerve (SAN) injuries can be idiopathic or iatrogenic. Providers who understand the essential anatomy of the SAN can direct the history, physical exam, and ancillary studies to localize the lesion, while considering the differential diagnosis. The differential diagnosis includes both traumatic and atraumatic causes, including penetrating or blunt trauma to the neck, fracture malunion, glenohumeral instability, brachial neuritis, progressive neuromuscular disease, and cerebrovascular accident. The chapter discusses the timing of, and indications for, operative exploration, with or without nerve repair, as well as the details of the surgical procedure. The authors provide instructive pearls for initial management, establishing patient expectations, and potential complications.

Human beings have been migrant for millennia. Reasons for migration vary from economic, financial, and educational reasons to persecution on religious or other discriminations. Push and pull factors for migration can produce inordinate amount of stress on individuals, families, or groups. Migrant psychiatry is a new discipline bringing together professionals from humanities, arts, sciences, and medicine, including psychiatry and psychology, together to understand the impact of migration on mental illnesses, mental health and well-being of migrant individuals. The Oxford Textbook of Migrant Psychiatry brings together constructs related to theories of migration, the impact of migration on mental health and adjustment, collective trauma, individual identity, and diagnostic fallacies. The book also covers practical aspects of management, including cultural factors, ethnopsychopharmacology, therapeutic interaction, and therapeutic expectation and psychotherapy.

This book presents cases in peripheral nerve surgery divided into four distinct areas of pathology: entrapment and inflammatory neuropathies, peripheral nerve pain syndromes, peripheral nerve tumors, and peripheral nerve trauma. Each chapter also presents pearls for the accurate diagnosis of, successful treatment of, and effective complication management for each clinical entity. The latter three focus areas will be especially helpful to neurosurgeons preparing to sit for the American Board of Neurological Surgery oral examination, which bases scoring on the three areas. Finally, each chapter contains a review of the medical evidence and expected outcomes, which is helpful for counseling patients and setting accurate expectations. Rather than exhaustive reference lists, the authors provide selected references recommended to deepen understanding.

Sex and gender are emotionally charged concepts in society. Never before has there been more interest in the sciences of sex and gender. In the past, sex and gender were primarily the domain of the humanities, especially literature, painting, and music. Greater political and sociological expectations for the rights of women and the emergence of increased tolerance for alternative lifestyles have reverberated throughout societies globally—with mixed results. Women, in particular, have suffered from lack of appreciation for the inescapable, well-documented biopsychosocial sexual dimorphisms that are all too often overshadowed by politics, fear, and ignorance. Without a more evolved understanding of and engagement in the unique characteristics and potentials of women and men, from cell to society, cancer science would have remained a “hidden hostage” to societal ignorance. The emergence of strategic or tailored cancer medicine cannot exist without integrating sex into prevention, diagnosis, and the development of new treatments.

The narrative of Bill Wheeler expresses his sense of betrayal and neglect. There was a great divide between the life experiences of Mr. Wheeler and his caregivers. He was angry that his late diagnosis was related to being poor and uninsured. He resented that his doctors did not communicate with him effectively. He felt they misrepresented things, failed to listen attentively, and disregarded his suffering and needs. The decision to treat his cancer aggressively despite its advanced stage initially provided hopeful expectations but ultimately led to shattered hope, greater anger, and late enrollment in hospice. The result is that Mr. Wheeler went to his death feeling neglected and uncared for. The negative impact of poor communication is magnified due to inadequate resources, low literacy, and mistrust of the medical system. Emotional handling of patients in vulnerable populations is crucial because these patients often mistrust physicians and the healthcare system at large.

Cancer diagnosis and treatment can have a significant negative impact on patients’ well-being, body image, sexuality, and sense of self. Reconstructive surgery is commonly assumed to offer improved body image and quality of life to patients whose appearance has altered as a result of cancer treatment, but deciding whether or not to undergo reconstructive surgery can be difficult. This chapter uses the example of breast reconstruction to consider the ways in which patients faced with complex decisions about appearance-altering reconstructive surgery might be helped to make the choice that is best for them. It outlines typical options around the type and timing of breast reconstruction, considers patients’ motivation for surgery, and satisfaction with the outcome. It then explores ways of helping them make their decision, highlighting the use of decision aids and interventions focused around patients’ expectations of surgery as a way of facilitating shared decision-making in this context.

The doctor-patient relationship is besieged by several forces transforming the health care system at the present time, particularly the introduction of retail thinking that seeks to turn patients into consumers. This book examines how the relationship has changed and continues to evolve within a care delivery context that is more corporatized, value-driven, metric-oriented, and transactional than ever before. Through the voices of doctors and patients, combined with an in-depth analysis of bigger system trends, it finds that relational care characterized by proven interpersonal and humane features like trust, empathy, and mutual respect has withered over time, succumbing to a hostile delivery environment in which physicians are increasingly isolated from patients; the organization seeks to garner the allegiances of patients; and patients develop lowered expectations that leave them susceptible to cheapened forms of care delivery. Both doctors and patients still emphasize the importance of relational care for effective diagnosis and treatment, and for maintaining strong emotional bonds that enhance both parties’ experiences. However, the findings suggest that the rise of transactional care delivery in the health system must be offset by greater physician advocacy for relational medicine; a sharp focus on measuring relational care delivery in all its forms; and monetizing relational care so that it becomes something of value to the large organizations in which doctors and patients now find themselves interacting.

Las actividades de investigación tienen varios propósitos generales en las universidades, el principal, es ampliar el conocimiento generado y enlazarlo con el currículo para enriquecer el contenido de los cursos y ofrecer una formación de calidad. En la misma línea, con la difusión de los resultados de investigación, es posible la apropiación de conocimiento y tecnología no solo de los estudiantes sino también por parte de la sociedad. Para la institución académica, esto último representa un factor diferenciador entre las universidades, además de brindar soluciones a las problemáticas empresariales. Ahora bien, la investigación en ingeniería es relevante porque facilita examinar de manera crítica la productividad y competitividad de las organizaciones abarcando diversas disciplinas, lo cual permite llenar los vacíos de conocimiento y desarrollar nuevos productos, a la vez que mejora la eficiencia y el crecimiento de la empresa. Por tanto, es pertinente estudiar e identificar las tendencias investigativas y los desarrollos sobre las aplicaciones de las ramas de la ingeniería para estar al tanto de la evolución temática y los adelantos relacionados con la ciencia, tecnología e innovación. De lo anterior, es necesario traer a colación la definición de ingeniería, la cual es comprendida como una expresión del ingenio humano basado en conocimientos científicos y tecnológicos que se orientan hacia la transformación de la sociedad. En este contexto, si bien este libro no aborda a profundidad todas las aplicaciones de la ingeniería, hace un importante esfuerzo por diagnosticar e identificar problemas, factores, elementos, modelos y ciertas necesidades del entorno para diseñar posibles soluciones. De igual modo, este libro es importante para los estudiantes de ingeniería, ya que es una opción versátil para los profesionales que buscan desempeñarse a futuro en variados campos, es por ello que, para la comunidad universitaria, incluyendo los docentes, este libro proporciona elementos para mejorar el desarrollo de entornos de aprendizajes basados en las necesidades de la industria y actualización de las asignaturas. También, para las organizaciones este texto aporta información para afrontar los cambios tecnológicos, alcanzar el éxito mediante el aprovechamiento de sus recursos y capacidades, y brinda herramientas que aumentan sus habilidades en la toma de decisiones eficaces. En este punto, es posible que el lector tenga en mente que este libro trata fundamentalmente de herramientas, procesos, materiales y temas convencionales en la ingeniería, sin embargo, conforme avance su lectura encontrará de manera grata la presencia de temáticas hoy en día cada vez más relevantes como el e-commerce (comercio electrónico), aplicaciones en el campo de la ingeniería industrial, la realidad aumentada y el diseño de comunicación de internet inalámbrico, que pueden ser importantes en el marco de la industria 4.0; y temas asociados a la adopción de techos verdes, arquitectura e ingeniería sostenibles y el aprovechamiento del subproducto del café, relacionados con la sostenibilidad ambiental. Este libro también resulta novedoso en cuanto a sus enfoques y aproximaciones en cada una de las temáticas que describe. Por un lado, por la utilización de casos de estudio e investigaciones aplicadas que se ejemplifican como casos exitosos y que exponen, además, lecciones aprendidas; por otro lado, presenta contribuciones teóricas y análisis estadísticos mediante el desarrollo de indicadores que miden la calidad de la producción científica mundial en el campo de las ingenierías. En otras palabras, discute sobre las diferentes aplicaciones de la ingeniería en la industria, entre ellas el estudio de tendencias investigativas a través de análisis bibliométricos para la medición de la literatura escrita. Por último, un elemento común que es abordado en los capítulos del presente libro es la contextualización de diversos campos de la ingeniería a través de estudios regionales y globales. En este sentido, conocer hacia donde se dirige la ingeniería es de vital importancia porque orienta los esfuerzos investigativos en las organizaciones, ya que este reconocimiento de tendencias en ocasiones no es un ejercicio fácil, dado que parte de un análisis del pasado y de la evolución de los contenidos temáticos con miras a plantear expectativas y prospectivas de temas de interés.