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Previous studies have suggested that cognitive assessments of adult psychiatric patients can be carried out as reliably via teleconsultation as they can face to face. However, the designs of these studies have often been less than satisfactory. The present study used videoconferencing at 128 kbit/s for the cognitive assessment of individuals with a history of alcohol abuse. Twenty-seven participants were given a range of assessments with two equivalent forms. One of the forms was given via videoconferencing and the other face to face. All participants were assessed using both media and the order of presentation was balanced across participants. Aspects of participant satisfaction with teleconsultations were also assessed, on 10-point scales. The teleconsultations were significantly longer (mean 40.7 min, SD 6.4) than the face-to-face sessions (mean 33.0 min, SD 5.3). For most of the outcome measures, cognitive assessment via teleconsultation produced similar results to face-to-face assessment. Most participants expressed high overall satisfaction with the teleconsultation (mean rating 8.2). The average ratings for the sound quality (mean 7.6) and visual quality of the equipment (mean 7.9) were also high. The findings imply that it is not necessary for patients and neuropsychologists to be present at the same location for cognitive assessments to be carried out.

ABSTRACT. Objectives. To compare language development in infants and young children with human immunodeficiency virus (HIV) infection to language development in children who had been exposed to HIV but were uninfected, and (among subjects with HIV infection) to compare language development with cognitive and neurologic status.Design. Prospective evaluation of language development in infected and in exposed but uninfected infants and young children.Setting. Pediatric Infectious Disease Clinic, State University of New York-Health Science Center at Syracuse.Subjects. Nine infants and young children infected with HIV and 69 seropositive but uninfected infants and children, age 6 weeks to 45 months.Results. Mean Early Language Milestone Scale, 2nd edition (ELM-2) Global Language scores were significantly lower for subjects with HIV infection, compared with uninfected subjects (89.3 vs 96.2, Mann-Whitney U test). The proportion of subjects scoring >2 SD below the mean on the ELM-2 on at least one occasion also was significantly greater for subjects with HIV infection, compared with uninfected subjects (4 of 9 infected subjects, but only 5 of 69 uninfected subjects; Fisher's exact test). Seven of the 9 subjects with HIV infection manifested deterioration of language function. Four manifested unremitting deterioration; only 1 of these 4 demonstrated unequivocal abnormality on neurologic examination. Three subjects with HIV infection and language deterioration showed improvement in language almost immediately after the initiation of antiretroviral drug treatment. Magnetic resonance imaging or computed tomography of the brain were performed in 6 of 7 infected subjects with language deterioration, and findings were normal in all 6. ELM-2 Global Language scaled scores showed good agreement with the Bayley Mental Developmental Index or the McCarthy Global Cognitive Index (r ‫؍‬ 0.70). Language deterioration, or improvement in language after initiation of drug therapy, coincided with or preceded changes in global cognitive function, at times by intervals of up to 12 months.Conclusions. Language deterioration occurs commonly in infants and young children with HIV infection, is seen frequently in the absence of abnormalities on neurologic examination or central nervous system imag-

Introduction: Pulmonary rehabilitation (PR) is a core component of Chronic Obstructive Pulmonary Disease (COPD) management with well recognized benefits. While suggestions for educational content within pulmonary rehabilitation have been detailed in clinical guidance, it is unclear what educational content is delivered as part of pulmonary rehabilitation, who delivers it, and how it is delivered.Methods: A systematic review was conducted to identify what educational content is delivered as part of pulmonary rehabilitation, how is this delivered and who delivers it. Databases were searched from 1981 -2017 using multiple search terms related to "pulmonary rehabilitation" and "education".Results: Fourteen studies were identified. This included 6 survey studies, 5 quasi-experimental studies and 3 RCTs. Five key topics that were consistently included within PR programmes were identified as: 1) Anxiety/depression and stress management 2) Early recognition of signs of infection 3) Dyspnea and symptom management 4) Nutrition 5) Techniques using inhalers and nebulizersBroader topics such as welfare/benefits, sexuality, and advance care directives did not frequently feature. Only four studies used tools to measure knowledge or learning pre and post rehabilitation in an attempt to evaluate the effectiveness of the education delivered as part of PR.Conclusions: The delivery of education in PR programmes is variable and does not follow suggested educational topics. Education needs to take a patient centered motivational approach to ensure effective delivery. Further research into appropriate educational outcome measures are needed, in order to evaluate the changes in behaviour associated with education.

Telemedicine may be useful in the delivery of clinical psychology services in the Highlands of Scotland, where geographical size and sociodemographic factors can hinder service delivery. The Highlands have a population of 210,000 at a density of approximately 8 people/km2, one of the lowest in the European Union. Despite a general lack of formal evaluation of telemedicine, especially in mental health, descriptive studies and patient satisfaction reports give grounds for optimism. There are several current applications of telemedicine in the Highlands, including cognitive-behavioural therapy, a comparative evaluation of neuropsychological assessments, and the treatment of children and their families. The projects are being formally evaluated and early results are encouraging.