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Je joue donc je pense : remédiation cognitive chez lesenfants au Centre Hospitalier Sainte-Anne
- C. Doyen, V. Risler, Y. Contejean, I. Amado, C. Launay, P. De Bois Redon, I. Burnouf, K. Kaye
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- Journal:
- European Psychiatry / Volume 28 / Issue S2 / November 2013
- Published online by Cambridge University Press:
- 16 April 2020, p. 66
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L’intérêt de la remédiation cognitive (RC) s’appuie sur l’observation de défaillances des fonctions exécutives dans de nombreux troubles psychiatriques. L’hypothèse est celle d’une restructuration cognitive du fait de la plasticité cérébrale et de la possibilité de remaniements cellulaires neurologiques stimulo-dépendants. Chez les enfants et les adolescents, des essais ont été réalisés chez des sujets cérébro-lésés et chez des sujets présentant un trouble déficit de l’attention/hyperactivité, un trouble du spectre autistique, un trouble des apprentissages ou une anorexie mentale [2–5]. Les programmes de remédiation cognitive s’appuient sur des tâches informatisées ou papier–crayon ou sur des jeux de société ciblant les déficits des fonctions exécutives. Le Centre Hospitalier Sainte-Anne a développé, depuis 2010, un centre psychiatrique de référence de remédiation cognitive et de réhabilitation psychosociale (C3RP) qui propose à des sujets adultes des programmes de Cognitive Remediation Therapy (CRT) [1]. En outre, depuis 2011, notre équipe réalise un travail clinique préliminaire de faisabilité en proposant à des enfants, en complément d’approches classiques appliquées en routine (rééducatives et/ou psychothérapiques), une prise en charge en RC. Nous utilisons des tâches « papier–crayon » de la CRT adaptées à l’enfant ainsi que des jeux de société issus des programmes anglo-saxons qui permettent à l’enfant d’utiliser différentes ressources cognitives. Notre but est d’améliorer les performances cognitives de ces enfants dans les domaines suivants : la flexibilité mentale, l’attention, la mémoire et la planification ainsi que l’estime de soi. Une évaluation neuropsychologique incluant un WISC-IV ; une figure de Rey et des sub-tests de la NEPSY mettent en avant des résultats prometteurs, illustrés par une vignette clinique portant sur un enfant qui a fait de nets progrès dans quatre dimensions sur cinq ciblées (Fig. 1). Ces résultats doivent être étendus à d’autres patients et sur d’autres centres pour envisager la généralisation de cette approche.
Fig. 1
Altered interoceptive activation before, during, and after aversive breathing load in women remitted from anorexia nervosa
- L. A. Berner, A. N. Simmons, C. E. Wierenga, A. Bischoff-Grethe, M. P. Paulus, U. F. Bailer, A. V. Ely, W. H. Kaye
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- Journal:
- Psychological Medicine / Volume 48 / Issue 1 / January 2018
- Published online by Cambridge University Press:
- 17 July 2017, pp. 142-154
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Background
The neural mechanisms of anorexia nervosa (AN), a severe and chronic psychiatric illness, are still poorly understood. Altered body state processing, or interoception, has been documented in AN, and disturbances in aversive interoception may contribute to distorted body perception, extreme dietary restriction, and anxiety. As prior data implicate a potential mismatch between interoceptive expectation and experience in AN, we examined whether AN is associated with altered brain activation before, during, and after an unpleasant interoceptive state change.
MethodsAdult women remitted from AN (RAN; n = 17) and healthy control women (CW; n = 25) underwent functional magnetic resonance imaging during an inspiratory breathing load paradigm.
ResultsDuring stimulus anticipation, the RAN group, relative to CW, showed reduced activation in right mid-insula. In contrast, during the aversive breathing load, the RAN group showed increased activation compared with CW in striatum and cingulate and prefrontal cortices (PFC). The RAN group also showed increased activation in PFC, bilateral insula, striatum, and amygdala after stimulus offset. Time course analyses indicated that RAN responses in interoceptive processing regions during breathing load increased more steeply than those of CW. Exploratory analyses revealed that hyperactivation after breathing load was associated with markers of past AN severity.
ConclusionsAnticipatory deactivation with a subsequent exaggerated brain response during and after an aversive body state may contribute to difficulty predicting and adapting to internal state fluctuation. Because eating changes our interoceptive state, restriction may be one method of avoiding aversive, unpredictable internal change in AN.
Routine non-thyroid head and neck cytology in a large UK centre: clinical utility and pitfalls
- P V Kaye, M Pigera, M M Khan, P Hollows, N Beasley
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- Journal:
- The Journal of Laryngology & Otology / Volume 129 / Issue 7 / July 2015
- Published online by Cambridge University Press:
- 08 July 2015, pp. 682-687
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- July 2015
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Objective:
This study aimed to examine the performance of head and neck cytology at Nottingham University Hospitals between 2009 and 2010.
Methods:Cases were extracted from the Winpath pathology reporting system and correlations were investigated between results and the histological and clinical outcomes. Specimen adequacy and the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the cytology tests were calculated.
Results:In all, 19.7 per cent of aspirates were judged to be inadequate. The absolute and relative sensitivities of head and neck cytology were 87.0 per cent and 89.0 per cent, respectively, and the absolute and relative specificities were 99.0 per cent and 97.0 per cent, respectively. The positive predictive values were 99.0 per cent and 96.0 per cent and the negative predictive values were 92.0 per cent and 92.0 per cent for a diagnostic accuracy of 94.5 per cent and 93.0 per cent. The performance was consistent with previous reports and superior to that of a recent UK series. The high rate of inadequate samples is, however, a concern.
Conclusion:Head and neck cytology is a robust technique at our institution, although there are certain problem areas. There is room for improvement in the technical quality of fine needle aspiration.
Contributors
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- By Naila A. Ahmad, Dua M. Anderson, Jennifer Aunspaugh, Sabrina T. Bent, Adam Broussard, Staci Cameron, Rahul Dasgupta, Ravinder Devgun, Ofer N. Eytan, Sean H. Flack, Terry G. Fletcher, Charles James Fox, Mary Elise Fox, Scott Friedman, Louise K. Furukawa, Sonja Gennuso, Stanley M. Hall, Hani Hanna, Jacob Hummel, James E. Hunt, Ranu Jain, Joe R. Jansen, Deepa Kattail, Alan David Kaye, David J. Krodel, Gregory J. Latham, Sungeun Lee, Michael G. Levitzky, Alexander Y. Lin, Carl Lo, Hoa N. Luu, Camila Lyon, Kelly A. Machovec, Lizabeth D. Martin, Maria Matuszczak, Patrick S. McCarty, Brenda C. McClain, J. Grant McFadyen, Helen Nazareth, Dolores B. Njoku, Christina M. Pabelick, Shannon M. Peters, Amit Prabhakar, Michael Richards, Kasia Rubin, Joel A. Saltzman, Lisgelia Santana, Gabriel Sarah, Katherine Stammen, John Stork, Kim M. Strupp, Lalitha V. Sundararaman, Rosalie F. Tassone, Douglas R. Thompson, Nicole C. P. Thompson, Paul A. Tripi, Jacqueline L. Tutiven, Navyugjit Virk, Stacey Watt, B. Craig Weldon, Maria Zestus
- Edited by Alan David Kaye, Louisiana State University, Charles James Fox, Tulane University School of Medicine, Louisiana, James H. Diaz, Louisiana State University
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- Book:
- Essentials of Pediatric Anesthesiology
- Published online:
- 05 November 2014
- Print publication:
- 16 October 2014, pp ix-xii
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Contributors
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- By Magdalena Anitescu, Charles E. Argoff, Arash Asher, Nyla Azam, Nomen Azeem, Sachin K. Bansal, Jose E. Barreto, Rodrigo A Benavides, Niteesh Bharara, Justin B. Boge, Robert B. Bolash, Thomas K. Bond, Christopher Centeno, Zachariah W. Chambers, Jonathan Chang, Grace Chen, Hamilton Chen, Jeffry Chen, Jianguo Cheng, Natalia Covarrubias, Claire J. Creutzfeldt, Gulshan Doulatram, Amirpasha Ehsan, Ike Eriator, Jeff Ericksen, Mark Etscheidt, Frank J. E. Falco, Jack Fu, Timothy Furnish, Annemarie E. Gallagher, Kingsuk Ganguly, Eugene Garvin, Cliff Gevirtz, Scott E. Glaser, Brandon J. Goff, Harry J. Gould, Christine Greco, Jay S. Grider, Maged Guirguis, Qiao Guo, Justin Hata, John Hau, Garett J. Helber, Eric R. Helm, Lori Hill Marshall, Dean Hommer, Jeffrey Hopcian, Eric S. Hsu, Jakun Ing, Tracy P. Jackson, Gaurav Jain, Chrystina Jeter, Alan David Kaye, James Kelly, Soorena Khojasteh, Ankur Khosla, Daniel Krashin, Monika A. Krzyzek, Prasad Lakshminarasimhiah, Steven Michael Lampert, Garrett LaSalle, Quan D. Le, Ankit Maheshwari, Edward R. Mariano, Joaquin Maury, John P. McCallin, John Michels, Natalia Murinova, Narendren Narayanasamy, Rebekah L. Nilson, Elliot Palmer, Vikram B. Patel, Devin Peck, Donald B. Penzien, Danielle Perret Karimi, Tilak Raj, Michael R. Rasmussen, Mohit Rastogi, Rahul Rastogi, Nashaat N. Rizk, Rinoo V. Shah, Paul A. Sloan, Julian Sosner, A. Raj Swain, Minyi Tan, Natacha Telusca, Santhosh A. Thomas, Andrea Trescot, Michael Truong, Jason Tucker, Richard D. Urman, Brandon A. Van Noord, Nihir Waghela, Irene Wu, Jiang Wu, Jijun Xu, Jinghui Xie, William Yancey
- Edited by Alan David Kaye, Louisiana State University, Rinoo V. Shah
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- Book:
- Case Studies in Pain Management
- Published online:
- 05 October 2014
- Print publication:
- 16 October 2014, pp xi-xv
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Effect of Nurse Staffing and Antimicrobial-Impregnated Central Venous Catheters on the Risk for Bloodstream Infections in Intensive Care Units
- Juan Alonso-Echanove, Jonathan R. Edwards, Michael J. Richards, Patrick Brennan, Richard A. Venezia, Janet Keen, Vivian Ashline, Kathy Kirkland, Ellen Chou, Mark Hupert, Abigail V. Veeder, Janice Speas, Judy Kaye, Kailash Sharma, Aliki Martin, V. Dianne Moroz, Robert P. Gaynes
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 24 / Issue 12 / December 2003
- Published online by Cambridge University Press:
- 02 January 2015, pp. 916-925
- Print publication:
- December 2003
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Background:
Defining risk factors for central venous catheter (CVC)-associated bloodstream infections (BSIs) is critical to establishing prevention measures, especially for factors such as nurse staffing and antimicrobial-impregnated CVCs.
Methods:We prospectively monitored CVCs, nurse staffing, and patient-related variables for CVC-associated BSIs among adults admitted to eight ICUs during 2 years.
Results:A total of 240 CVC-associated BSIs (2.8%) were identified among 4,535 patients, representing 8,593 CVCs. Antimicrobial-impregnated CVCs reduced the risk for CVC-associated BSI only among patients whose CVC was used to administer total parenteral nutrition (TPN, 2.6 CVC-associated BSIs per 1,000 CVC-days vs no TPN, 7.5 CVC-associated BSIs per 1,000 CVC-days; P = .006). Among patients not receiving TPN, there was an increase in the risk of CVC-associated BSI in patients cared for by “float” nurses for more than 60% of the duration of the CVC. In multivariable analysis, risk factors for CVC-associated BSIs were the use of TPN in non-antimicrobial-impregnated CVCs (P = .0001), patient cared for by a float nurse for more than 60% of CVC-days (P = .0019), no antibiotics administered to the patient within 48 hours of insertion (P = .0001), and patient unarousable for 70% or more of the duration of the CVC (P = .0001). Peripherally inserted central catheters (PICCs) were associated with a lower risk for CVC-associated BSI (P = .0001).
Conclusions:Antimicrobial-impregnated CVCs reduced the risk of CVC-associated BSI by 66% in patients receiving TPN. Limiting the use of float nurses for ICU patients with CVCs and the use of PICCs may also reduce the risk of CVC-associated BSI.
Looking Backward, Looking Forward: MLA Members Speak
- April Alliston, Elizabeth Ammons, Jean Arnold, Nina Baym, Sandra L. Beckett, Peter G. Beidler, Roger A. Berger, Sandra Bermann, J.J. Wilson, Troy Boone, Alison Booth, Wayne C. Booth, James Phelan, Marie Borroff, Ihab Hassan, Ulrich Weisstein, Zack Bowen, Jill Campbell, Dan Campion, Jay Caplan, Maurice Charney, Beverly Lyon Clark, Robert A. Colby, Thomas C. Coleman III, Nicole Cooley, Richard Dellamora, Morris Dickstein, Terrell Dixon, Emory Elliott, Caryl Emerson, Ann W. Engar, Lars Engle, Kai Hammermeister, N. N. Feltes, Mary Anne Ferguson, Annie Finch, Shelley Fisher Fishkin, Jerry Aline Flieger, Norman Friedman, Rosemarie Garland-Thomson, Sandra M. Gilbert, Laurie Grobman, George Guida, Liselotte Gumpel, R. K. Gupta, Florence Howe, Cathy L. Jrade, Richard A. Kaye, Calhoun Winton, Murray Krieger, Robert Langbaum, Richard A. Lanham, Marilee Lindemann, Paul Michael Lützeler, Thomas J. Lynn, Juliet Flower MacCannell, Michelle A. Massé, Irving Massey, Georges May, Christian W. Hallstein, Gita May, Lucy McDiarmid, Ellen Messer-Davidow, Koritha Mitchell, Robin Smiles, Kenyatta Albeny, George Monteiro, Joel Myerson, Alan Nadel, Ashton Nichols, Jeffrey Nishimura, Neal Oxenhandler, David Palumbo-Liu, Vincent P. Pecora, David Porter, Nancy Potter, Ronald C. Rosbottom, Elias L. Rivers, Gerhard F. Strasser, J. L. Styan, Marianna De Marco Torgovnick, Gary Totten, David van Leer, Asha Varadharajan, Orrin N. C. Wang, Sharon Willis, Louise E. Wright, Donald A. Yates, Takayuki Yokota-Murakami, Richard E. Zeikowitz, Angelika Bammer, Dale Bauer, Karl Beckson, Betsy A. Bowen, Stacey Donohue, Sheila Emerson, Gwendolyn Audrey Foster, Jay L. Halio, Karl Kroeber, Terence Hawkes, William B. Hunter, Mary Jambus, Willard F. King, Nancy K. Miller, Jody Norton, Ann Pellegrini, S. P. Rosenbaum, Lorie Roth, Robert Scholes, Joanne Shattock, Rosemary T. VanArsdel, Alfred Bendixen, Alarma Kathleen Brown, Michael J. Kiskis, Debra A. Castillo, Rey Chow, John F. Crossen, Robert F. Fleissner, Regenia Gagnier, Nicholas Howe, M. Thomas Inge, Frank Mehring, Hyungji Park, Jahan Ramazani, Kenneth M. Roemer, Deborah D. Rogers, A. LaVonne Brown Ruoff, Regina M. Schwartz, John T. Shawcross, Brenda R. Silver, Andrew von Hendy, Virginia Wright Wexman, Britta Zangen, A. Owen Aldridge, Paula R. Backscheider, Roland Bartel, E. M. Forster, Milton Birnbaum, Jonathan Bishop, Crystal Downing, Frank H. Ellis, Roberto Forns-Broggi, James R. Giles, Mary E. Giles, Susan Blair Green, Madelyn Gutwirth, Constance B. Hieatt, Titi Adepitan, Edgar C. Knowlton, Jr., Emanuel Mussman, Sally Todd Nelson, Robert O. Preyer, David Diego Rodriguez, Guy Stern, James Thorpe, Robert J. Wilson, Rebecca S. Beal, Joyce Simutis, Betsy Bowden, Sara Cooper, Wheeler Winston Dixon, Tarek el Ariss, Richard Jewell, John W. Kronik, Wendy Martin, Stuart Y. McDougal, Hugo Méndez-Ramírez, Ivy Schweitzer, Armand E. Singer, G. Thomas Tanselle, Tom Bishop, Mary Ann Caws, Marcel Gutwirth, Christophe Ippolito, Lawrence D. Kritzman, James Longenbach, Tim McCracken, Wolfe S. Molitor, Diane Quantic, Gregory Rabassa, Ellen M. Tsagaris, Anthony C. Yu, Betty Jean Craige, Wendell V. Harris, J. Hillis Miller, Jesse G. Swan, Helene Zimmer-Loew, Peter Berek, James Chandler, Hanna K. Charney, Philip Cohen, Judith Fetterley, Herbert Lindenberger, Julia Reinhard Lupton, Maximillian E. Novak, Richard Ohmann, Marjorie Perloff, Mark Reynolds, James Sledd, Harriet Turner, Marie Umeh, Flavia Aloya, Regina Barreca, Konrad Bieber, Ellis Hanson, William J. Hyde, Holly A. Laird, David Leverenz, Allen Michie, J. Wesley Miller, Marvin Rosenberg, Daniel R. Schwarz, Elizabeth Welt Trahan, Jean Fagan Yellin
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- Journal:
- PMLA / Publications of the Modern Language Association of America / Volume 115 / Issue 7 / December 2000
- Published online by Cambridge University Press:
- 23 October 2020, pp. 1986-2078
- Print publication:
- December 2000
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