Assessment of executive function impairments in adults with acquired brain injury across single-case experimental design: A scoping review of primary outcomes.

The use of single-case experimental design (SCED) to evaluate cognitive remediation is growing. SCEDs require rigorous methodology and appropriate choice of primary outcomes. To review primary outcomes that assess executive function impairments in patients with acquired brain injury (ABI). A scoping review was conducted using the Arksey and O'Malley framework and the PRISMA extension for scoping review (PRISMA-ScR). Five databases were searched resulting in the inclusion of twenty-one studies. Primary outcomes were extracted and classified according to the type of measure, ecological setting and sources of possible bias. A wide variety of primary outcomes were identified; the majority of which evaluated behavioural performance during a real-life activity or in a real-life simulated setting. The most frequent bias observed across outcomes was the coaching effect. The findings of this scoping review highlight the importance of selecting appropriate outcomes for repeated measures in SCED studies. Direct observation of the target behaviour is a potential gold standard for assessing the effectiveness of a cognitive intervention.

Syndrome of inappropriate anti-diuresis induces volume-dependent hypercalciuria.

Hyponatremia is associated with bone demineralization. We hypothesized that, during hyponatremia, calciuria and calcium balance depend on volemic status. We evaluated calciuria in patients with hyponatremia, secondary to SIAD or hypovolemia. Patients with SIAD exhibited a volemic expansion that was associated with hypercalciuria. Calciuria was proportional to markers of volemia. INTRODUCTION: Chronic mild hyponatremia has been associated with bone demineralization of unknown mechanisms. During chronic hyponatremia, arginine-vasopressin secretion can result from hypovolemia or from syndrome of inappropriate anti-diuresis (SIAD) that leads to a slightly volemic expansion. Since volemia determines renal calcium excretion and balance, we evaluated calcium homeostasis in patients with chronic hyponatremia, related to SIAD or to hypovolemia. METHODS: We retrospectively included all patients referred to our Department between May 2006 and May 2014 for hyponatremia, resulting from SIAD or chronic hypovolemia. None had edema, cirrhosis, cardiac, or renal insufficiency. Exploration included estimation of volemia, extracellular fluid volume (ECFV) measurement with inulin, and calcium homeostasis. RESULTS: In total, the SIAD and hypovolemic groups included 22 and 7 patients, respectively. The SIAD group exhibited signs of increased volemia: higher glomerular filtration rate, higher fractional excretion of uric acid, and lower plasma renin. ECFV exceeded that of the hypovolemic group and was above usual values. There was no difference between the two groups regarding plasma calcium, PTH, and vitamin D. However, in the SIAD group, calciuria was higher than in the hypovolemic group, reaching levels of hypercalciuria. Furthermore, there was a positive correlation between calciuria and markers of volemia. CONCLUSIONS: Our results show that SIAD results in a volemic expansion tendency that is associated with a decrease in renal calcium reabsorption and thus hypercalciuria, whereas in the hypovolemic group, calciuria was not increased. Therefore, renal loss of calcium and bone demineralization in SIAD patients could be partly induced by volemic expansion.