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Selected AbstractsThe Prognostic Value of the Modified Glasgow Coma Scale in Head Trauma in DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2001Simon R. Platt A clinical coma scale modified from the Glasgow Coma Scale used for humans has been suggested as a useful predictor of outcome in the head trauma patient. The objective of this study was to correlate the modified Glasgow Coma Scale (MGCS) score of dogs with head trauma with their probability of survival. Thirty-eight dogs with head trauma were selected and retrospectively evaluated. The information retrieved from the medical record of each dog included signalment, body weight, cause of head trauma, MGCS, presence of concurrent neck pain, and outcome (dead or alive) after 48 hours. Logistic regression was used to model survival in the 1st 48 hours as a function of MGCS, gender, weight, and calvarial fractures. The MGCS ranged from 5 to 18. Seven dogs died within 48 hours of the head trauma. The MGCS could predict the probability of survival in the 1st 48 hrs after head trauma with 50% probability in a patient with a score of 8. Gender, weight, and presence of skull fractures did not predict survival. In conclusion, the MGCS is a useful index for prediction of outcome in dogs with head trauma. [source] Measurement Scales Used in Elderly CareJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2009JOHN KEADY phd rmn rnt [source] Development of the Bipolar Inventory of Symptoms Scale: concurrent validity, discriminant validity and retest reliabilityINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2008Jodi M. Gonzalez Abstract Scales used in studies of bipolar disorder have generally been standardized with major depressive or hospitalized manic patients. A clinician rated scale based on a semi-structured interview for persons with bipolar disorder, with comprehensive coverage of bipolar symptomatology, is needed. We report concurrent, divergent and convergent psychometric reliability, discriminant validity and relationship to a measure of overall function for a new psychometric rating instrument. A primarily outpatient sample of 224 subjects was assessed using the Bipolar Inventory of Symptoms Scale (BISS). The BISS total score and depression and mania subscales were compared to the Young Mania Rating Scale (YMRS), the Montgomery Asberg Depression Rating Scale (MADRS) and the Global Assessment of Functioning Scale (GAF). Clinical mood states were also compared using the BISS. The BISS scores demonstrated good concurrent validity, with estimates (Pearson correlations) ranging from 0.74 to 0.94 for YMRS and MADRS and test,retest reliability from 0.95 to 0.98. BISS concurrent validity with the GAF was significant for four clinical states, but not mixed states. The BISS discriminated primary bipolar mood states as well as subjects recovered for eight weeks compared to healthy controls. In conclusion, the BISS is a reliable and valid instrument broadly applicable in clinical research to assess the comprehensive domains of bipolar disorder. Future directions include factor analysis and sensitivity to change from treatment studies. Copyright © 2008 John Wiley & Sons, Ltd. [source] Can distribution models help refine inventory-based estimates of conservation priority?DIVERSITY AND DISTRIBUTIONS, Issue 4 2010A case study in the Eastern Arc forests of Tanzania, Kenya Abstract Aim, Data shortages mean that conservation priorities can be highly sensitive to historical patterns of exploration. Here, we investigate the potential of regionally focussed species distribution models to elucidate fine-scale patterns of richness, rarity and endemism. Location, Eastern Arc Mountains, Tanzania and Kenya. Methods, Generalized additive models and land cover data are used to estimate the distributions of 452 forest plant taxa (trees, lianas, shrubs and herbs). Presence records from a newly compiled database are regressed against environmental variables in a stepwise multimodel. Estimates of occurrence in forest patches are collated across target groups and analysed alongside inventory-based estimates of conservation priority. Results, Predicted richness is higher than observed richness, with the biggest disparities in regions that have had the least research. North Pare and Nguu in particular are predicted to be more important than the inventory data suggest. Environmental conditions in parts of Nguru could support as many range-restricted and endemic taxa as Uluguru, although realized niches are subject to unknown colonization histories. Concentrations of rare plants are especially high in the Usambaras, a pattern mediated in models by moisture indices, whilst overall richness is better explained by temperature gradients. Tree data dominate the botanical inventory; we find that priorities based on other growth forms might favour the mountains in a different order. Main conclusions, Distribution models can provide conservation planning with high-resolution estimates of richness in well-researched areas, and predictive estimates of conservation importance elsewhere. Spatial and taxonomic biases in the data are essential considerations, as is the spatial scale used for models. We caution that predictive estimates are most uncertain for the species of highest conservation concern, and advocate using models and targeted field assessments iteratively to refine our understanding of which areas should be prioritised for conservation. [source] Using DCE and ranking data to estimate cardinal values for health states for deriving a preference-based single index from the sexual quality of life questionnaireHEALTH ECONOMICS, Issue 11 2009Julie Ratcliffe Abstract There is an increasing interest in using data derived from ordinal methods, particularly data derived from discrete choice experiments (DCEs), to estimate the cardinal values for health states to calculate quality adjusted life years (QALYs). Ordinal measurement strategies such as DCE may have considerable practical advantages over more conventional cardinal measurement techniques, e.g. time trade-off (TTO), because they may not require such a high degree of abstract reasoning. However, there are a number of challenges to deriving the cardinal values for health states using ordinal data, including anchoring the values on the full health,dead scale used to calculate QALYs. This paper reports on a study that deals with these problems in the context of using two ordinal techniques, DCE and ranking, to derive the cardinal values for health states derived from a condition-specific sexual health measure. The results were compared with values generated using a commonly used cardinal valuation technique, the TTO. This study raises some important issues about the use of ordinal data to produce cardinal health state valuations. Copyright © 2009 John Wiley & Sons, Ltd. [source] Estimating areal snowmelt infiltration into frozen soilsHYDROLOGICAL PROCESSES, Issue 16 2001D. M. Gray Abstract An algorithm for estimating areal snowmelt infiltration into frozen soils is developed. Frozen soils are grouped into classes according to surface entry condition as: (a) Restricted,water entry is impeded by surface conditions, (b) Limited,capillary flow predominates and water entry is influenced primarily by soil physical properties, and (c) Unlimited,gravity flow predominates and most of the meltwater infiltrates. For Limited soils cumulative infiltration over time is estimated by a parametric equation from surface saturation, initial soil moisture content (water + ice), initial soil temperature and infiltration opportunity time. Total infiltration into Unlimited and Limited soils is constrained by the available water storage capacity. This constraint is also used to determine when Limited soils have thawed. The minimum spatial scale of the infiltration model is established for Limited soils by the variabilities in surface saturation, snow water equivalent, soil infiltrability, soil moisture (water + ice) and depth of soil freezing. Since snowmelt infiltration is influenced by other processes and factors that affect snow ablation, it is assumed that the infiltrability spatial scale should be consistent with the scales used to describe these variables. For open, northern, cold regions the following order in spatial scales is hypothesized: frozen ground , snowmelt , snow water equivalent , frozen soil infiltrability , soil moisture (water + ice) and snow water. For mesoscale application of the infiltration model it is recommended that the infiltrability scale be taken equal to the scale used to describe the areal extent and distribution of the water equivalent of the snowcover that covers frozen ground. Scaling the infiltrability of frozen soils in this manner allows one to exploit established landscape-stratification methodology used to derive snow accumulation means and distribution. Scaling of soil infiltrability at small scales (microscale) is complicated and requires information on the association(s) between the spatial distributions of soil moisture (water + ice) and snow water. A flow chart of the algorithm is presented. Copyright © 2001 John Wiley & Sons, Ltd. [source] Sorption and Diffusion of Propylene and Ethylene in Heterophasic Polypropylene CopolymersMACROMOLECULAR SYMPOSIA, Issue 1 2007Michael Bartke Abstract Summary: Sorption experiments of ethylene and propylene in different polypropylene powder samples, both homopolymer and heterophasic copolymers with different rubber content, have been carried out in a high-pressure magnetic suspension balance at 10 bars pressure and 70,°C. The gross solubilities measured can be well correlated with the rubber content of the polymer samples. Solubility of ethylene and propylene in the rubber phase differ from solubility in the amorphous fraction of the homopolymer, especially the concentration ratio of propylene to ethylene differs significantly between rubber phase and amorphous fraction of the homopolymer. From the slope of monomer uptake, information on kinetics of mass-transfer can be gained. No significant differences were observed in terms of mass-transfer for ethylene and propylene. With increasing rubber content, effective diffusion coefficients increased slightly. By combined sorption studies with powder samples and compressed films, information about both effective diffusion coefficients and the effective length scale of diffusion could be gained. It could be shown, that the particle radius is not the characteristic length of diffusion in the studied powder samples. Mass transfer of nearly all samples could be described by a constant diffusion length of 120 to 130 µm, independently on particle size. This indicates that the effective scale of diffusion in polymer particles is in between microparticle and macroparticle scale used in classical particle modeling. [source] Seven young star clusters in the inner region of the Small Magellanic CloudMONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 1 2008Andrés E. Piatti ABSTRACT We present CCD photometry in the Washington system C and T1 passbands down to T1, 22 in the fields of L35, L45, L49, L50, L62, L63 and L85, seven poorly studied star clusters in the inner region of the Small Magellanic Cloud (SMC). We measured T1 magnitudes and C,T1 colours for a total of 114 826 stars distributed throughout cluster areas of 13.7 × 13.7 arcmin2 each. Cluster radii were estimated from star counts distributed throughout the entire observed fields. The seven clusters are generally characterized by a relatively small angular size and by a high field star contamination. We performed an in-depth analysis of the field star contamination of the colour,magnitude diagrams (CMDs), and statistically cleaned the cluster CMDs. Based on the best fits of isochrones computed by the Padova group to the (T1, C,T1) CMDs, we derive ages for the sample, assuming Z= 0.004, finding ages between 25 Myr and 1.2 Gyr. We then examined different relationships between positions in the SMC, age and metallicity of a larger sample of clusters including our previous work whose ages and metallicities are on the same scale used in this paper. We confirm previous results in the sense that the further a cluster is from the centre of the galaxy, the older and more metal poor it is, with some dispersion; although clusters associated with the Magellanic Bridge clearly do not obey the general trend. The number of clusters within , 2° of the SMC centre appears to have increased substantially after ,2.5 Gyr ago, hinting at a burst. [source] The pull test: A historyMOVEMENT DISORDERS, Issue 7 2006Ann L. Hunt DO Abstract The pull test (PT) is used as a measure of postural instability in Parkinson's disease (PD) and other movement disorders. In 1987, it was incorporated into the Unified Parkinson's Disease Rating Scale (UPDRS), a scale used to measure the severity and treatment response in PD both in research studies and in clinical practice. However, the origins of the observation of postural instability in movement disorders and the attempt to quantify it are much older. Here, we trace the history of postural instability first described as a feature of PD by Romberg in 1853. Attempts to evaluate postural instability began with the first measurement by Charcot in the 1880s by pulling the clothes of patients and progressed to the push on the sternum by Hoehn and Yahr in the 1960s. Eventually, this evolved into the formal PT proposed by Fahn in the 1980s. Despite the widespread use of the PT as part of the UPDRS, variability exists in its execution. Recommendations have been made for training of examiners in clinical trials to improve its accuracy in assessing postural instability. We agree with improving PT technique for clinical trials and advocate for its routine use in clinical practice when diagnosing and treating movement disorders. Further, we propose the name "Fahn pull test" for the maneuver based on his significant contribution to its development. © 2006 Movement Disorder Society [source] Factors of positive appraisal of care among Japanese family caregivers of older adults,RESEARCH IN NURSING & HEALTH, Issue 5 2003Noriko Yamamoto-Mitani Abstract The purpose of this study was to examine factors of positive appraisal of care among Japanese family caregivers of older adults. The Positive Appraisal of Care (PAC) scale used in this study is a multidimensional Japanese measure and has four domains: relationship satisfaction, consequential gain, role confidence, and normative fulfillment. Three hundred and thirty-seven caregivers participated in this survey. Multiple regression analyses revealed that social support and caregiver belief in caregiving had a consistent impact on all domains of the PAC, whereas the impact of caregiver and care recipient characteristics varied among the domains. For example, caregiver age had a significant impact on role confidence and normative fulfillment but not on relationship satisfaction and consequential gain. The differential impact of caregiver and care recipient characteristics on the domains of the PAC underlines the usefulness of a multidimensional measurement. © 2003 Wiley Periodicals, Inc. Res Nurs Health 26:337,350, 2003 [source] A Comparison of Income and Expenditure Inequality Estimates: The Australian Evidence, 1975,76 to 1993,94THE AUSTRALIAN ECONOMIC REVIEW, Issue 4 2000Paul Blacklow Using Australian unit record data this paper compares income and expenditure inequalities over the period 1975,76 to 1993,94. The study finds inconsistencies between the two inequality movements over much of this period. We also observe differences in the nature of income and consumption disparities. Both approaches show that the ,within group' inequality dominates the ,between group' component when the population is divided into household types. The inequality estimates are sensitive to the equivalence scale used as the household size deflator but not to the cost of living index used as the price deflator. [source] Rural generalist nurses' perceptions of the effectiveness of their therapeutic interventions for patients with mental illnessAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2005Chanelle Clark Abstract Objective:,To explore generalist nurses' perceptions of their efficacy in caring for mentally ill clients in rural and remote settings, and their educational needs in the area of mental health care. Design:,A self-administered questionnaire adapted from the Mental Health Problems Perception Questionnaire; a Likert scale used to rate the perceptions of nursing staff of their own ability to adequately treat and care for patients experiencing mental illness. Setting:,The Roma and Charleville Health Service Districts, Queensland, Australia. Subjects:,Nurses (Registered Nurses, Assistants in Nursing and Enrolled Nurses) in the Roma and Charleville health service districts (n = 163). Main outcome measures:,Generalist nurses' perceptions regarding their therapeutic commitment, role competency and role support. Results:,Seventy per cent of respondents indicated that limited knowledge of mental health problems was an issue preventing nursing staff in rural and remote settings from providing optimum care to patients with mental illness. Twenty-nine per cent of respondents indicated that they had never received or undertaken training or education in relation to the care, treatment or assessment of patients with mental illness. Conclusion:,Rural nurses do not feel competent, nor adequately supported, to deal with patients with mental health problems. In addition, the nurses' education and ongoing training do not adequately prepare them for this sphere. [source] Social functioning as an outcome measure in schizophrenia studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2007T. Burns Objective:, Deficits in social functioning are a core feature of schizophrenia. Method:, A literature search of English language articles published between January 1990 and December 2006 was undertaken to identify: i) scales used most frequently to assess social functioning in schizophrenia; and ii) the most frequently used social functioning scales in randomized, controlled trials of antipsychotics. A further search (without time limits) examined their psychometric properties. Results:, A total of 301 articles employed social functioning scales in the assessment of schizophrenia. These contained 87 potentially relevant measures. Only 14 randomized, controlled studies of antipsychotic agents were identified that examined social functioning. Scales varied greatly in terms of measurement approach, number and types of domains covered and scoring systems. A striking lack of data on psychometric properties was observed. Conclusion:, Limited consensus on the definition and measurement of social functioning exists. The Personal and Social Performance Scale is proposed as a useful tool in future research. [source] Estimating areal snowmelt infiltration into frozen soilsHYDROLOGICAL PROCESSES, Issue 16 2001D. M. Gray Abstract An algorithm for estimating areal snowmelt infiltration into frozen soils is developed. Frozen soils are grouped into classes according to surface entry condition as: (a) Restricted,water entry is impeded by surface conditions, (b) Limited,capillary flow predominates and water entry is influenced primarily by soil physical properties, and (c) Unlimited,gravity flow predominates and most of the meltwater infiltrates. For Limited soils cumulative infiltration over time is estimated by a parametric equation from surface saturation, initial soil moisture content (water + ice), initial soil temperature and infiltration opportunity time. Total infiltration into Unlimited and Limited soils is constrained by the available water storage capacity. This constraint is also used to determine when Limited soils have thawed. The minimum spatial scale of the infiltration model is established for Limited soils by the variabilities in surface saturation, snow water equivalent, soil infiltrability, soil moisture (water + ice) and depth of soil freezing. Since snowmelt infiltration is influenced by other processes and factors that affect snow ablation, it is assumed that the infiltrability spatial scale should be consistent with the scales used to describe these variables. For open, northern, cold regions the following order in spatial scales is hypothesized: frozen ground , snowmelt , snow water equivalent , frozen soil infiltrability , soil moisture (water + ice) and snow water. For mesoscale application of the infiltration model it is recommended that the infiltrability scale be taken equal to the scale used to describe the areal extent and distribution of the water equivalent of the snowcover that covers frozen ground. Scaling the infiltrability of frozen soils in this manner allows one to exploit established landscape-stratification methodology used to derive snow accumulation means and distribution. Scaling of soil infiltrability at small scales (microscale) is complicated and requires information on the association(s) between the spatial distributions of soil moisture (water + ice) and snow water. A flow chart of the algorithm is presented. Copyright © 2001 John Wiley & Sons, Ltd. [source] Multi-way models for sensory profiling dataJOURNAL OF CHEMOMETRICS, Issue 1 2008Rasmus Bro Abstract One of the problems in analyzing sensory profiling data is to handle the systematic individual differences in the assessments from different panelists. It is unavoidable that different persons have, at least to a certain degree, different perceptions of the samples as well as a different understanding of the attributes or of the scales used for quantifying the assessments. Hence, any model attempting to describe sensory profiling data needs to deal with individual differences; either implicitly or explicitly. In this paper, a unifying family of models is proposed based on (i) the assumption that latent variables are appropriate for sensory data, and (ii) that individual differences occur. Based on how individual differences occur, various mathematical models can be constructed, all aiming at modeling simultaneously the sample-specific variation and the panelist-specific variation. The model family includes Principal Component Analysis (PCA) and PARAllel FACtor analysis (PARAFAC). The paper can be viewed as extending the latent variable approach commonly based on PCA to multi-way models that specifically take certain panelist-variations into account. The proposed model family is focused on analyzing data from quantitative descriptive analysis with fixed vocabulary, but it also provides a foundation upon which comparisons, extensions and further developments can be made. An example is given which shows that even for well-working data, models handling individual differences can shed important light on differences between the quality of the data from individual panelists. Copyright © 2007 John Wiley & Sons, Ltd. [source] Temporal Changes in Brain Volume and Cognition in a Randomized Treatment Trial of Vascular DementiaJOURNAL OF NEUROIMAGING, Issue 1 2001Joseph P. Broderick MD ABSTRACT Objective. To measure changes in brain and ischemic volume over time by magnetic resonance imaging (MRI) as part of a randomized treatment trial of vascular dementia. Methods. Participants who met criteria for vascular dementia underwent comprehensive neurological and neuropsychological testing on entrance, during, and at completion of the 1-year study. For those centers who had easily available MRI, MRI of the brain was to be performed on entry and completion of the study. Image analysis was performed on all balanced and T2-weighted MR films to determine ventricular, sulcal, ischemic, and hemispheric brain volumes. Results. Of the 105 patients who met the criteria for vascular dementia, 40 had a baseline MRI study that met protocol requirements and was of excellent image quality. The baseline ventricular volume in these 40 patients with high-quality MR correlated with most measures of cognitive and behavioral function, including the total Alzheimer's Disease Assessment Score (ADAS) (r= 0.51, P= .0024), as well as activities of daily living (r= 0.61, P= .0002). The baseline ischemic brain volume correlated well only with the gait and postural stability scale (r= 0.74, P= .009). Of the 40 participants, 25 had MRI studies at baseline and at completion of the study that were comparable and of excellent image quality. For these 25 patients, the mean ventricular volumes increased by 9% over the study year (P= .001) and the mean ischemic brain volume increased by 18% (P= .01). Temporal changes in the sulcal and nonischemic brain volume did not reach significance. None of the 14 clinical score measures changed significantly between baseline and completion of the study in these 25 patients. Conclusion. In summary, ventricular volume correlated well with cognitive measures in patients with vascular dementia and was a more sensitive marker for change during the study year than the clinical scales used in this study. This study also points out the practical limitations of brain imaging as a surrogate measure of clinical outcome in multicenter randomized treatment trials of brain disease. [source] Further Conventions for NMR Shielding and Chemical Shifts (IUPAC Recommendations 2008),MAGNETIC RESONANCE IN CHEMISTRY, Issue 6 2008Applied Chemistry Physical, Biophysical Chemistry Division, International Union of Pure Abstract IUPAC has published a number of recommendations regarding the reporting of nuclear magnetic resonance (NMR) data, especially chemical shifts. The most recent publication [Pure Appl. Chem.73, 1795 (2001)] recommended that tetramethylsilane (TMS) serve as a universal reference for reporting the shifts of all nuclides, but it deferred recommendations for several aspects of this subject. This document first examines the extent to which the 1H shielding in TMS itself is subject to change by variation in temperature, concentration, and solvent. On the basis of recently published results, it has been established that the shielding of TMS in solution [along with that of sodium-3-(trimethylsilyl)propanesulfonate, DSS, often used as a reference for aqueous solutions] varies only slightly with temperature but is subject to solvent perturbations of a few tenths of a part per million (ppm). Recommendations are given for reporting chemical shifts under most routine experimental conditions and for quantifying effects of temperature and solvent variation, including the use of magnetic susceptibility corrections and of magic-angle spinning (MAS). This document provides the first IUPAC recommendations for referencing and reporting chemical shifts in solids, based on high-resolution MAS studies. Procedures are given for relating 13C NMR chemical shifts in solids to the scales used for high-resolution studies in the liquid phase. The notation and terminology used for describing chemical shift and shielding tensors in solids are reviewed in some detail, and recommendations are given for best practice. © 2008 IUPAC. Reprinted with permission from Pure Appl. Chem. 2008; 80: 59. This article can be freely downloaded from http://www.iupac.org/publications/pac/80/1/0059/ and can be copied, provided acknowledgement to IUPAC is given. [source] Systematic evaluation of rating scales for impairment and disability in Parkinson's diseaseMOVEMENT DISORDERS, Issue 5 2002Claudia Ramaker MD Abstract We assessed the clinometric characteristics of rating scales used for the evaluation of motor impairment and disability of patients with Parkinson's disease (PD), conducting a systematic review of PD rating scales published from 1960 to the present. Thirty studies describing clinometrics of 11 rating scales used for PD were identified. Outcome measures included validity (including factor structure), reliability (internal consistency, inter-rater, and intrarater) and responsiveness. We traced three impairment scales (Webster, Columbia University Rating Scale [CURS] and Parkinson's Disease Impairment Scale), four disability scales (Schwab and England, Northwestern University Disability Scale [NUDS], Intermediate Scale for Assessment of PD, and Extensive Disability Scale), and four scales evaluating both impairment and disability (New York University, University of California Los Angeles, Unified Parkinson's Disease Rating Scale [UPDRS], and Short Parkinson Evaluation Scale). The scales showed large differences in the extent of representation of items related to signs considered responsive to dopaminergic treatment or to those signs that appear late in the disease course and lack responsiveness to treatment. Regardless of the scale, there was a conspicuous lack of consistency concerning inter-rater reliability of bradykinesia, tremor, and rigidity. Overall disability items displayed moderate to good inter-rater reliability. The available evidence shows that CURS, NUDS, and UPDRS have moderate to good reliability and validity. In contrast to their widespread clinical use for assessment of impairment and disability in PD, the majority of the rating scales have either not been subjected to an extensive clinometric evaluation or have demonstrated clinometric shortcomings. The CURS, NUDS, and UPDRS are the most evaluated, valid, and reliable scales currently available. © 2002 Movement Disorder Society [source] Bilateral Motor Cortex Stimulation for the Relief of Central Dysesthetic Pain and Intentional Tremor Secondary to Spinal Cord Surgery: A Case ReportNEUROMODULATION, Issue 4 2002Roberto Fabian Rodríguez MD Abstract Objectives. Our objective was to describe and analyze through a third party disinterested observer the results obtained by using motor cortex stimulation (MCS) for the treatment of central dysesthetic diffuse-distal type of paraplegic pain and intentional tremor secondary to the total removal of a cervical ependymoma. Design. Retrospective case report with discussion. Methods. A 69-year-old female, who after satisfactory removal of a cervical ependymoma, developed a central dysesthetic diffuse-distal type of paraplegic pain and intentional tremor associated with mild cerebellar deficit. Neurologic compromise became so intense that it prevented the patient from leading an independent lifestyle. Conservative treatments failed and a unilateral trial of MCS was performed. After a four-day satisfactory unilateral trial, a bilateral electrode, Resume II (Medtronic, Inc., Minneapolis, MN), was inserted through a small craniotomy and a dual-channel RF activated receiver was implanted. During the second month of follow-up an independent observer personally interviewed the patient and assessed results through a multimodal approach, encompassing several analog scales used to measure the different components of the painful experience; a daily life activities scale and drug intake. Results. Evoked painful phenomena were dramatically improved, but the steady component of pain was only moderately relieved. The patient's tremor improved to allow for the performance of simple movements such as independent eating. Conclusion. In this single case report MCS was extremely useful in eliminating almost all of the patient's pain-evoked phenomena. Both steady burning pain and tremor were also improved. This is only one case report and MCS warrants further investigation as to its utility in controlling central dysesthetic pain in paraplegia and postchordotomy dysesthesias. [source] A cognitive aid for neonatal resuscitation: a randomized controlled trialPEDIATRIC ANESTHESIA, Issue 7 2009M.D. Bould Introduction:, Anaesthetists are among several health care practitioners responsible for neonatal resuscitation in Canada. The Neonatal resuscitation program (NRP) courses are the North American educational standard. NRP has been shown to be an effective way of learning skills and knowledge but retention has been found to be problematic [1]. The use of cognitive aids is mandatory in industries such as aviation, to avoid dependence on memory when decision making in critical situations. Visual cognitive aids have been studied retrospectively in resuscitation and performance was found to correlate to the frequency of use of the aid [2]. Cognitive aids have been found to be of benefit in an unblinded prospective study [3]. We aimed to conduct the first blinded study on the effect of a cognitive aid on the performance of simulated resuscitation. Methods:, We conducted a single-blind randomized controlled trial to investigate whether the presence of a cognitive aid improved performance in a simulated neonatal resuscitation. After ethics board approval we recruited 32 anaesthesia residents who had previously passed the NRP. Subjects were randomized to an intervention group that had a poster detailing the NRP algorithm and a control group without the poster. The cognitive aid was positioned so that it could not be seen on the video recordings of the simulation that was used to assess performance. The scenario was piloted to confirm adequate blinding. Both groups had their performance in a simulated neonatal resuscitation recorded and subsequently analyzed by a peer, an expert anaesthetist and an expert neonatologist, using a previously validated checklist. A further rater observed the scenario in real time to examine frequency of use of the cognitive aid. Results:, The inter-rater reliability of the checklist was excellent with an intraclass correlation coefficient of 0.88. Consequently the mean of the scores assigned by all three raters was used for analysis. The median checklist score in the control group 18.2 [15.0,20.5 (10.7,25.3)] was not significantly different from that in the intervention group 20.3 [18.3,21.3 (15.0,24.3)] (P = 0.08). Retention of NRP skills and knowledge of was poor: when evaluated by the neonatologist none of the subjects correctly performed all life-saving interventions necessary to pass the checklist. Although only one subject in the intervention group did not use the aid at all, only 26.7% used the aid frequently and none used it extensively. Discussion:, Retention of skills after NRP training was poor. Our study confirms previous findings of poor retention of skills after NRP training: Kaczorowski et al. investigated family medicine trainees and found that none of 44 residents that were retested 6,8 months after an NRP course would have passed the course due to errors in life-saving interventions [1]. Previous research has shown that the presence of a cognitive aid can improve performance in the simulated management of a rare, high stakes scenario: malignant hyperthermia [3]. Our negative findings contrast with this and another previous study [2]. A potential reason for this discrepancy is that the raters in the previous studies were not blinded to group allocation, nor were the rating scales used validated. The infrequent use of the cognitive aid may be the reason that it did not improve performance in. Further research is required to investigate whether cognitive aids can be useful if their use is incorporated into NRP training. Conclusion:, A randomized single-blinded trial found that a cognitive aid did not improve performance at simulated resuscitation, in contrast to previous retrospective and unblended studies. Retention of skills and knowledge after resuscitation training remains an ongoing challenge for medical educators. [source] Assessment of treatment response in mania: commentary and new findingsBIPOLAR DISORDERS, Issue 2 2003Ross J Baldessarini Background:, Assessment of therapeutic interventions in bipolar disorder is complicated by rapid, complex clinical changes, high placebo-response rates, and varying times to specific levels of clinical recovery that may not be adequately reflected in averaged rating-scale scores particularly in acute mania, calling for improved methods to evaluate treatment responses. Chengappa et al. (1) propose operational criteria for specific outcomes based on rating-scale data from two placebo-controlled trials of olanzapine in mania. Methods:, These trials and other recent research were considered in commenting on the design, conduct, analysis and interpretation of experimental therapeutic trials in mania and to optimize olanzapine versus placebo contrasts by systematically varying end-point criteria for mania (YMRS) and depression (HDRS) ratings. Results:, Olanzapine versus placebo responses were optimally separated at scores of 10 for final paired mania and depression ratings, or 5 for each rating scale considered separately. Conclusions:, Use of empirically determined end-points derived from standard rating scales used in experimental therapeutics research in mood disorders can improve both outcome-assessment and separation of active treatment from placebo responses in acute mania. [source] | ||||||||||||||||||||||||||||