A new method for selective measurement of joint movement in hand tremor in Parkinson's disease patients.

Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system with tremor being one of its four main clinical features. Currently used methods can directly evaluate tremor amplitude and frequency but not joint movement in the affected limb. Measurement of joint movement facilitates the location of muscle groups that participate in PD tremor and this is important for treatment with local botulinum toxin injections. We developed and tested a method that measured tremor amplitude and frequency in a specific joint of the hand in PD patients. The tremor analysis method was based on force transducers adapted to record rest tremor of the wrist and metacarpophalangeal joints in two degrees of freedom for each joint. Direct measurements of joint movement in the hand can evaluate tremor amplitude and frequency and also locate the muscle groups that are most active in tremor movement, thus enabling their local treatment.

Postural stability of Parkinson's disease patients is improved by decreasing rigidity.

Postural instability has a big impact on the quality of life of patients with Parkinson's disease (PD) as it often leads to an insecure stance and fall. We investigated if postural stability in these patients improves by decreasing rigidity with a dopaminergic agonist. In our study, we tested eight PD patients with no concomitant diseases. Their age was 61 +/- 2 years (mean +/- SE) and their Hoehn-Yahr score was 3 +/- 0.1. The patients were evaluated according to the Unified Parkinson's Disease Rating Scale for motor function (mUPDRS) and with stabilometric measurements of forward-backward and side-to-side body oscillations during free stance with eyes open. Both evaluations were performed in an "off "state and in an apomorphine-induced "on" state. As expected, the mUPDRS score was significantly decreased in the "on" state with posture being improved in six patients, gait in eight patients and postural stability in seven of eight patients. In addition, apomorphine caused a significant reduction of the relative amplitude of lower frequencies and an increase of the relative amplitude of higher frequencies of forward-backward body oscillations. The results of stabilometry and mUPDRS evaluations are in agreement with the effect of apomorphine on rigidity, indicating that postural stability of PD patients is improved by decreasing rigidity.

Analysis of data as information: quality assurance approach.

Describes a prototype module for data analysis of the healthcare delivery system. It consists of three main parts: data/variable selection; algorithms for the analysis of quantitative and qualitative changes in the system; and interpretation and explanation of the results. Such a module designed for primary health care has been installed on a PC in the health manager's office. Data enter the information system through the standard DBMS procedures, followed by calculating a number of different indicators and the time series, as the ordered sequences of indicators, according to demands of the manager. The last procedure is "the change analysis" with estimation of unexpected differences between and within some units, e.g. health-care teams, as well as some unexpected variabilities and trends. As an example, presents and discusses the diagnostic pattern of neurotic cases, referral patterns and preventive behaviour of GP's teams as well.