MS in a word Rae-Grant, Alexander; Miller, Deborah
Momentum (National Multiple Sclerosis Society (U.S.)),
06/2009, Letnik:
2, Številka:
3
Magazine Article
We developed a new EEG rating scale for electrographic assessment of head injured patients. Phenomena present in posttraumatic EEG were scored as dichotomous variables (present or absent). These ...phenomena included background activity (alpha, beta, theta, delta), sleep spindles, focal abnormalities, reactivity and variability, epileptiform activity, and specific comatose patterns. Each variable was weighted according to its perceived prognostic value: i.e., normal alpha 10, flat EEG -10, spindles 4, etc. Combinations of possible scores ranged from +23 to -10. Fifty-seven EEGs from different head injured patients were independently and retrospectively analyzed by two investigators. There was a high correlation for intra- (r = 0.95) and inter- (r = 0.85) observer rating using the dichotomous test. When patients with scores over 15 (i.e., with reactive alpha) and patients with scores of -10 (i.e., ECI records) were excluded, the intra-rater and inter-rater correlations were still high (0.81 and 0.76, respectively). There was a high correlation between Glasgow outcome score at discharge and the dichotomous EEG score. This EEG scale scores most major categories of EEG activity, utilizes a multipoint scale for correlation purposes, and allows data to be analyzed in sub-categories (i.e., spindles in coma). The separate weighting score allows for refinement of the scale after data collection (i.e., to fit prospective outcome). We feel that this scale is reproducible and valid, and may be applicable to other patient groups with severely altered EEGs.
We screened all head-injured trauma patients admitted to Lehigh Valley Hospital during a 2-year period. From 725 screened patients, 69 patients in a coma on the second day after trauma were entered ...into this study. During the first week, these patients underwent electroencephalography (EEG), evoked potentials, ocular pneumoplethysmography, and transcranial Doppler (TCD) sonography. Clinical examinations were undertaken 2 and 7 days after trauma. Test results were correlated with functional clinical outcome at 6 months. In a multiple regression analysis, EEG was the major independent variable that significantly predicted 6-month outcome based on Glasgow Outcome Scale score. Transcranial Doppler sonography contributed a small additional component. Though EEG was the most significant predictive factor in this neurophysiological battery, it did not add significantly to the predictive power of Glasgow Coma Scale score determined at day 7. These findings suggest that neurophysiologic testing in this type of patient is not useful in improving predictive outcome data.
Abstract Background High quality human biosamples with associated high quality clinical data are essential for successful translational research. Despite this, the traditional approach is for the ...surgeon to act as a technician in the tissue collection act. Biomarker research presents multiple challenges and the field is littered with failures. Tissue quality, poor clinical information, small sample numbers and lack of validation cohorts are just a few reasons for failure. It is clear that the surgeon involved in tissue acquisition must be fully engaged in the process of biosampling for a specific condition, as this will negate many of the issues for translational research failure due to an inadequate bioresource. Approach In this Matter for Debate paper, the Scottish Collaboration On Translational Research into Renal Cell Cancer (SCOTRRCC) is discussed as an example of a urological surgery lead bioresource which has resulted in a National collection of renal cancer tissue and blood (from over 900 patients to date), negating all of the traditional issues with biobanks because of close enagagement and acknowledgement of urologists and uropathologists from seven centres around Scotland. SCOTRRCC has leveraged renal cancer research in Scotland resulting in several high impact publications and providing a springboard for future research in this disease in Scotland and beyond. Conclusions The SCOTRRCC model presented here can be transferred to other surgical disciplines for success in translational research.
The authors administered questionnaires to participants in a Tay-Sachs screening clinic. They received 322 responses. Although the majority of the respondents expressed anxiety about the possibility ...that they might be carriers, most indicated that this anxiety brought them to the clinic. The authors conclude that a well-publicized and well-organized screening clinic can function successfully and deal with the issue of anticipated loss without producing mass fear. An important factor in their clinic was the fact that they were able to offer an alternative to a Tay-Sachs child through amniocentesis.
Tay-Sachs disease is a genetic disorder, leading to death in early childhood. The recent advent of carrier screening programs and of amniocentesis have made it possible to detect affected children in ...utero, and to provide a medical indication for the interruption of pregnancy. We have observed Tay-Sachs screening clinics and interviewed 95 families, approximately two years after the screening program. Our findings indicate that people face the problem of anticipated loss and heightened anxiety while being tested; however, there were no long-term detrimental effects. La maladie de Tay-Sachs est une maladie génétique qui conduit très tôt à la mort de l'enfant. L'avènement récent de programmes d'examen des porteurs ainsi que de l'amniocentose a permis de détecter la maladie chez un foetus dans l'utérus et de donner une justification médicale à l'interruption de la grossesse. Nous avons observé des centres de consultation et services cliniques sur la maladie de Tay-Sachs et interviewé 95 familles environ 2 ans après l'institution du programme d'examen. Nos découvertes indiquent que les gens prennent conscience du risque de la perte de l'enfant et manifestent une certaine anxiété au cours du test. Cependant, on n'a pu déceler d'effets négatifs à long terme.
