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Abstract
BACKGROUND Cannabis and opioid use are associated with cognitive impairment, whether preexisting or substance-induced, but there have been few substance-specific assessments of cognitive functioning in adolescent substance users. Working memory impairment may be particularly important, as it has been linked to poorer performance in substance abuse treatment. METHODS Working memory (Wechsler Intelligence Scale for Children-IV or Adult Intelligence Scale-IV) and baseline substance use were assessed in 42 youth (mean age = 17.9 years, SD = 1.3, range: 16-20; 65% Caucasian, 30% female) 1-2 weeks after admission to residential treatment with supervised abstinence, 19 for primary cannabis dependence and 23 for primary opioid dependence. RESULTS There were substantial deficits in working memory in both groups, with significant differences (P < .001) between the opioid (M = 39.1th%ile, SD = 25.6) and cannabis (M = 16.3th%ile, SD = 13.6) groups. The primary opioid group had high rates of cannabis use, with no significant difference in past-month days of cannabis use from the primary cannabis group. The opioid group was older and had completed more years of formal education. Seventy-nine percent of the cannabis group had public health care coverage (mostly Medicaid), compared with 24% of the opioid sample. CONCLUSIONS Working memory impairment was substantial in treatment-seeking youth with primary cannabis and opioid dependence (the latter actually having comparable rates of cannabis use), and significantly more pronounced in the primary cannabis-dependent group. Without an assessment of working memory prior to substance exposure, the differential contributions of substance-induced vs. preexisting impairment are unclear. Lower scores in the cannabis group may reflect lower socioeconomic status (SES), which is typically correlated with cognitive performance. These findings highlight underrecognized cognitive impairment in youth with SUDs, especially inner-city cannabis-dependent youth. Modification of treatments to account for cognitive capacity and/or cognitive remediation interventions may be indicated to improve treatment outcomes.
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Affiliation(s)
- Hoa T Vo
- a Mountain Manor Treatment Center , Baltimore , Maryland , USA
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Davis KK, Mintzer M, Himmelfarb CRD, Hayat MJ, Rotman S, Allen J. Targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment. Eur J Heart Fail 2014; 14:1041-9. [DOI: 10.1093/eurjhf/hfs096] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Karen K. Davis
- Johns Hopkins Hospital; Baltimore MD USA
- Johns Hopkins University School of Nursing; Baltimore MD USA
| | - Miriam Mintzer
- Johns Hopkins University School of Medicine; Baltimore MD USA
| | | | | | | | - Jerilyn Allen
- Johns Hopkins University School of Medicine; Baltimore MD USA
- Johns Hopkins University School of Nursing; Baltimore MD USA
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Davis K, Dennison-Himmelfarb C, Allen J, Mintzer M, Hayat M, Rotman S. 5. Targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment. Heart Lung 2012. [DOI: 10.1016/j.hrtlng.2012.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Curtis P, Mintzer M, Morrell D, Resnick JC, Hendrix S, Qaqish BF. Characteristics and quality of Papanicolaou smears obtained by primary care clinicians using a single commercial laboratory. Arch Fam Med 1999; 8:407-13. [PMID: 10500513 DOI: 10.1001/archfami.8.5.407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Few data are available on factors associated with the quality of Papanicolaou smears performed in primary care. OBJECTIVE To identify the patterns and proficiency of cervical cancer screening among different primary care specialties. MATERIALS AND METHODS Clinical and cytologic data from 21,833 Papanicolaou smears, submitted to a single large commercial laboratory by 176 clinicians during a 7-month period, were correlated with individual clinician and specialty characteristics according to indexes of specimen quality. RESULTS Obstetrician-gynecologists, nurse practitioners, and physician assistants provided screening to a younger population of women compared with family physicians, internists, and general practitioners. Factors positively associated with a greater probability of a "satisfactory" smear or the presence of endocervical cells (as a marker of adequate sampling) were increasing patient age, use of the cytobrush, and the specialty of the obstetrician-gynecologist. Satisfactory smears were not associated with any increased identification of cytologic abnormalities compared with "limited" smears. In contrast, smears with endocervical cells showed a higher proportion of abnormalities compared with specimens without such cells. CONCLUSIONS Differences in the performance of obtaining Papanicolaou smears exist between primary care specialties, but need further clarification. The use of the cytobrush and the presence of endocervical cells are criteria that reflect clinician proficiency more realistically than the laboratory criterion of satisfactory smear.
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Affiliation(s)
- P Curtis
- Department of Family Medicine, School of Public Health, University of North Carolina at Chapel Hill, USA.
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5
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Mintzer M, Curtis P, Resnick JC, Morrell D. The effect of the quality of Papanicolaou smears on the detection of cytologic abnormalities. Cancer 1999; 87:113-7. [PMID: 10385441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Controversy continues regarding the relation between the quality of Papanicolaou (Pap) smears, especially the presence of endocervical cells (ECC), with the finding of cytologic abnormalities. METHODS As part of a study regarding performance feedback on the quality of Pap smears, data from 56,475 Pap smears obtained by 176 participating clinicians over a 20-month period were analyzed to assess the relation between the presence of ECC, the categorization of global specimen adequacy as "satisfactory" or "satisfactory with limitations," and the prevalence of atypia and squamous intraepithelial lesions (SILs). RESULTS Atypia was less likely to be found in "satisfactory" Pap smears than in "satisfactory with limitations" quality Pap smears (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.5-0.6; P < 0.001), even though the latter could contain ECC. No association was found between satisfactory Pap smears and cytologic abnormalities. Compared with specimens with no ECC, an ECC count of > or = 50 on a slide was associated positively with the detection of atypia (OR, 2.1; 95% CI, 1.8-2.4; P < 0.001) or SILs (OR, 1.7; 95% CI, 1.3-2.2; P < 0.001). A similar relation existed between ECC counts of 25-50 (OR, 1.9; 95% CI, 1.1-2.2; P = 0.01) and the detection of SILs. No relation was found between specimens with < 25 ECC and the presence of atypia or abnormalities. CONCLUSIONS The global adequacy criterion of "satisfactory" assigned to a Pap smear does not indicate that there is a greater likelihood of detecting cytologic abnormalities compared with lower quality Pap smears. To the authors' knowledge, previous studies regarding the link between ECC in the Pap smear and cytologic abnormalities have not addressed the relevance of how many ECC are needed to maximize the identification of abnormalities. The data from the current study support the value of obtaining at least 25 ECC as a quality indicator of sampling.
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Affiliation(s)
- M Mintzer
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill 27514, USA
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Curtis P, Morrell D, Hendrix S, Mintzer M, Resnick JC, Qaqish BF. Recall and treatment decisions of primary care providers in response to Pap smear reports. Am J Prev Med 1997; 13:427-31. [PMID: 9415787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Although the frequency of cervical cancer screening has been extensively studied, little is known about how clinicians decide to screen or recall patients for Pap smears. This study reports the management decisions made by office-based clinicians for 10 different Pap smear reports describing adequacy limitations and cytological diagnoses. METHODS We surveyed 186 clinicians using a commercial laboratory in the southeastern United States and analyzed results by frequency and comparison statistics. RESULTS Our respondents were 148 clinicians (79.6% response rate) from different specialties. There was variation in reported management of inflammation, atypia, and low-grade abnormalities (LGSIL), in regard to recall for repeat or routine testing as well as arranging colposcopy. In only 3 of 10 Pap smear results did more than 50% of respondents agree on a specific test recall interval. CONCLUSIONS The variation in responses from office-based clinicians suggests either uncertainty or different opinions in making recall and treatment decisions for smears of limited quality even when associated with cytologic abnormalities. These differences may have relevance to outcomes, clinician workload, and costs of care in cervical cancer screening.
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Affiliation(s)
- P Curtis
- Department of Family Medicine, School of Public Health, University of North Carolina at Chapel Hill 27514, USA.
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Frasier PY, Slatt L, Kowlowitz V, Kollisch DO, Mintzer M. Focus groups: a useful tool for curriculum evaluation. Fam Med 1997; 29:500-7. [PMID: 9232413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Focus group interviews have been used extensively in health services program planning, health education, and curriculum planning. However, with the exception of a few reports describing the use of focus groups for a basic science course evaluation and a clerkship's impact on medical students, the potential of focus groups as a tool for curriculum evaluation has not been explored. Focus groups are a valid stand-alone evaluation process, but they are most often used in combination with other quantitative and qualitative methods. Focus groups rely heavily on group interaction, combining elements of individual interviews and participant observation. This article compares the focus group interview with both quantitative and qualitative methods; discusses when to use focus group interviews; outlines a protocol for conducting focus groups, including a comparison of various styles of qualitative data analysis; and offers a case study, in which focus groups evaluated the effectiveness of a pilot preclinical curriculum.
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Affiliation(s)
- P Y Frasier
- Department of Family Medicine, University of North Carolina, Chapel Hill, USA.
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Morrell D, Curtis P, Mintzer M, Resnick JC, Hendrix S, Qaqish BF. Perceptions and opinions on the performance of Pap smears: a survey of clinicians using a commercial laboratory. Am J Prev Med 1996; 12:271-6. [PMID: 8874691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Office-based clinicians play a major role in cervical cancer screening in the United States, but little is known about their specific knowledge and understanding of the technical aspects of obtaining an adequate Pap smear. We surveyed 186 office-based clinicians using a major commercial laboratory for cytology services to obtain their opinions regarding the technical adequacy of Pap smears, collection procedures, and methods of communicating test results to patients. There was an 80.1% response rate. Two thirds of the respondents were men. Cytobrush use was reported significantly more by female clinicians. Respondents varied in reported rotation of the cytobrush, from 90 degrees to greater than 360 degrees. More female than male clinicians appropriately indicated that inflammation and heavy vaginal discharge caused sampling difficulties. Approximately half of the respondents believed that errors in cervical screening most often resulted from sampling the cervix or preparation of the Pap smear. Nineteen percent reported that ectocervical cells were not necessary for an adequate smear to be reported. Just over 25% of respondents indicated they did not report normal Pap smear results to the patient. The results indicate differences between clinicians by gender and specialty in reported knowledge, understanding, and technique in cervical cancer screening. The differences suggest that targeted education in this population may be important to improve the quality of cervical cancer screening. Medical Subject Headings (MeSH): screening; neoplasms, cervical; Papanicolaou smear; diagnosis, laboratory.
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Affiliation(s)
- D Morrell
- Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill 27599-7595, USA
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Abstract
The bulk of cervical cancer screening is performed by primary care providers; mostly nurses and physicians. The literature regarding the quality of this screening is largely described from three perspectives; clinical, laboratory, and public health. This article describes the primary care perspective regarding issues of quality in cervical cancer screening and suggests areas for improvement. The authors discuss how effectiveness of the test, sampling methods, interpretation by the laboratory, and reporting results impact on the quality of cervical cancer screening. Other factors which influence the quality of screening such as access to care, recall intervals, communication with the patient, costs of testing, and organizational issues are also reviewed.
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Affiliation(s)
- P Curtis
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill 27599-7595, USA
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Wilkinson S, Peebles-Kleiger MJ, Buchele B, Bartlett AB, Nathan S, Benalcazar-Schmid R, Mintzer M, Everhart D. Can we be both women and analysts? J Am Psychoanal Assoc 1996; 44 Suppl:529-55. [PMID: 9170077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors, candidates at a psychoanalytic institute that has not had a woman training analyst for more than 20 years, have a unique vantage point from which to examine the woman's development as an adult female and as a psychoanalyst. Our group has engaged in a series of discussions asking: Can we be both women and analysts? Comparing and contrasting our experiences with feedback from colleagues across the United States and abroad, we had to accept that our unique situation could not be a foil for the training dilemmas facing women. Our insights into the challenges involved with training, expression of sexuality, family ties, formation of an analytic identity, creative contributions to the field, and career progression have caused us to arrive at some sobering observations and hard-hitting questions which we present here. We hope that as we describe our discussions about the woman analyst's experience an active dialogue will arise within the reader's mind, and subsequently with colleagues.
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Curtis P, Mintzer M, Hendrix S, Resnick J, Morrell D. Cervical smears. Br J Gen Pract 1994; 44:94-5. [PMID: 8179957 PMCID: PMC1238794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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12
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Abstract
In five experiments, in which subjects were to identify a target word as it was gradually clarified, we manipulated the target's frequency of occurrence in the language and its neighborhood size--the number of words that can be constructed from a target word by changing one letter, while preserving letter position. In Experiments 1-4, visual identification performance to screen-fragmented words was measured. In Experiments 1 and 2, we used the ascending method of limits, whereas Experiments 3 and 4 presented a fixed-level fragment. In Experiment 1, there was no relation between overall accuracy and neighborhood size for words between three and six letters in length. However, more errors of commission (guesses) were made for high-neighborhood words and more errors of omission (blanks) were made for low-neighborhood words. Letter errors within guesses occurred at serial positions having many neighbors, and these positions were also likely to contain consonants rather than vowels. In Experiment 2, a small facilitatory effect of neighborhood size on both high- and low-frequency words was found. In contrast, in Experiments 3 and 4, using the same set of words, inhibitory effects of neighborhood size, but only for low-frequency words, were found. Experiment 5, using a speeded identification task, showed results parallel to those of Experiments 3 and 4. We suggest that whether neighborhood effects are facilitatory or inhibitory depends on whether feedback allows subjects to disconfirm initial hypotheses that the target is a high-frequency neighbor.
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Affiliation(s)
- J G Snodgrass
- Department of Psychology, New York University, NY 10003
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Mintzer M, Mintzer M. Bridging the generation gap in prevention. Dent Manage 1972; 12:67-8 passim. [PMID: 4507364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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