Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

PRIMARY OBJECTIVE: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) with people following acquired brain or spinal cord injury. RESEARCH DESIGN: A retrospective case note review assessed total rehabilitation unit admission. METHODS AND PROCEDURES: Assessment of 52 consecutive patients with acquired brain/spinal injury and neuropathy in an in-patient neuro-rehabilitation unit of a UK university hospital. Data analysed included: Northwick Park Dependency Score (NPDS), Rehabilitation complexity Scale (RCS), Functional Independence Measure and Functional Assessment Measure FIM-FAM (UK version 2.2), LOS and ACB. Outcome was different in RCS, NPDS and FIM-FAM between admission and discharge. MAIN OUTCOMES AND RESULTS: A positive change was reported in ACB results in a positive change in NPDS, with no significant effect on FIM-FAM, either Motor or Cognitive, or on the RCS. Change in ACB correlated to the length of hospital stay (regression correlation = -6.64; SE = 3.89). There was a significant harmful impact of increase in ACB score during hospital stay, from low to high ACB on NPDS (OR = 9.65; 95% CI = 1.36-68.64) and FIM-FAM Total scores (OR = 0.03; 95% CI = 0.002-0.35). CONCLUSIONS: There was a statistically significant correlation of ACB and neuro-disability measures and LOS amongst this patient cohort.

Concordance between a neuroradiologist, a consultant radiologist and trained reporting radiographers interpreting MRI head examinations: An empirical study.

INTRODUCTION: This study assessed agreement between MRI reporting radiographers and a consultant radiologist compared with an index neuroradiologist when reporting MRI head (brain/internal auditory meati [IAMs]) examinations. The effect on patient management of any discordant reports was also examined. METHODS: Two trained MRI reporting radiographers (RRs), a consultant radiologist (CR) and an index neuroradiologist (INR) reported on a random sample of 210 MRI examinations. The radiographers reported during clinical practice and the radiologists in clinical practice conditions. Two independent consultant physicians (neuro-rehabilitation and neuropsychiatry) compared these reports with the index neuroradiologist report for agreement and the clinical importance of discrepant reports. RESULTS: Overall observer agreement between the RRs and CR was comparable in relation to agreement with the INR: RR; 93/210 (44.3%); and the CR; 83/210 (39.4%) for all head MRI examinations (p = 0.32). For brain examinations the difference was similar: RR; 64/180 (35.6%); and CR; 54/190 (30.0%), p = 0.26. Agreement rates for the IAMs examinations were identical, 29/30 (97.7%). For all head MRI examinations (n = 210) there was a very small observed difference of <0.5% in mean agreement between the reporting radiographers and the consultant radiologist (p = 0.92) for examinations where a major disagreement would have been likely to have led to a change in patient management. CONCLUSION: MRI reporting radiographers reported during clinical practice on MRI head examinations to a level of agreement comparable with a consultant radiologist. IMPLICATIONS FOR PRACTICE: This is an area in which radiographers could provide additional reporting roles to the reporting service to increase capacity. Wider potential benefits include cost-effectiveness and role development/retention of radiographers.

Amyotrophic lateral sclerosis in South-East England: a population-based study. The South-East England register for amyotrophic lateral sclerosis (SEALS Registry).

BACKGROUND/AIMS: We aimed to estimate the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in the South East of England. The reported incidence of ALS varies between 0.44 and 3.2 per 100,000 person years. This can partly be explained by differences in design and diagnostic criteria used. There is little population data concerning England, particularly the South East. METHODS: A population study of South-East England (total population: 2,890,482) was carried out and multiple sources including our tertiary centre and district general hospitals were used for complete case ascertainment. RESULTS: Between 1 January 2002 and 30 June 2006 we identified 138 people (76 males; 62 females) with a new diagnosis of ALS, giving a crude incidence of 1.06 per 100,000 person years. The projected age- and gender-adjusted annual incidence rate for England and Wales was 1.10 (95% CI 0.80-1.40). 142 people were alive on 30 June 2006, giving a point prevalence of 4.91 per 100,000 population. CONCLUSION: Our incidence and prevalence rates are similar to those reported in comparable studies from other countries. This argues against the role of a specific exogenous factor in the aetiology of ALS in South-East England.

Evaluation of vision-based head-trackers for assistive devices.

This paper presents a new evaluation methodology for assistive devices employing head-tracking systems based on an adaptation of the Fitts Test. This methodology is used to compare the effectiveness and performance of a new vision-based head tracking system using face, skin and motion detection techniques with two existing head tracking devices and a standard mouse. The application context and the abilities of the user are combined with the results from the modified Fitts Test to help determine the most appropriate devices for the user. The results suggest that this modified form of the Fitts test can be effectively employed for the comparison of different access technologies.

Neuroimaging assessment of spasticity developed after acquired brain injuries and multiple sclerosis.

This study evaluated whether different imaging techniques correlate with specific variables routinely used to grade the types and complexities of patient conditions in neurorehabilitation services and their clinical outcomes, and if there are radiological patterns, topography or distribution of the lesions correlated to spasticity. The cohort studied included 75 patients, 38 patients with multiple sclerosis (MS) and 37 patients with acquired brain injuries (ABI) referred to the neurorehabilitation department from April 2009 to March 2010. Data included age, gender, diagnoses, complications, spasticity, length of stay, Rehabilitation Complexity Scale (RCS) and Northwick Park Dependency (NPDS) scores on admission and discharge. Forward stepwise multiple regressions were performed considering Spasticity as dependent and considering NPDS, RCS on admission and discharge, age, gender and length of stay as independent variables. Standardized intra-axial lesions in those with spasticity were fused with standardized axial DTIs from normal controls obtained under 3 T and 1.5 T MRI scanners. Spasticity was present in 36 patients. Regression was found between spasticity and all the other variables with r = 0.42, r(2) = 0.17, adjr(2) = 0.12(r), F(4,66) = 3.53, p < 0.01. Residuals were acceptable. If the same is calculated excluding MS patients the results are higher with: r = 0.59, r(2) = 0.35, adjr(2) = 0.30, F(2,27) = 7.1885, p < 0.003. In MS subjects, spasticity appeared if lesions affected pyramidal tracts, callosal radiations extensively or brainstem. Those with ABI did develop spasticity if the lesion involved the internal capsules, pericommissural areas, optochiasmatic cistern or brainstem. Findings suggest that NPDSa and discharge and RCSd are higher in those developing spasticity. No obvious correlation between spasticity and RCSa was found. Subjects with MS are more likely to develop spasticity especially if the lesions are numerous and affect the corticospinal tracts, callosal radiations extensively or brainstem. In patients with ABI lesions affecting pyramidal tracts, pericommissural areas and optochiasmatic cisterns seem more likely to develop spasticity.