Assessment of the effect of pharmacotherapy in common cold/acute bronchitis - the Bronchitis Severity Scale (BSS).

BACKGROUND: Acute bronchitis (AB) is a highly contagious infection of the airways, presenting mostly in connection with common cold (CC). There is a high variance in duration and course of symptoms which, sooner or later, also may disappear spontaneously and change during the course of the disease. Therefore, assessment of treatment outcome is difficult. METHODS: Composite outcome measures are commonly used to examine the effects of pharmacotherapy in complex diseases. We discuss the features of the Bronchitis Severity Scale (BSS) on the basis of the available literature. RESULTS: For the BSS the five most important symptoms of AB are rated by the patient and the physician. Since its introduction in 1996, the BSS has been used in many clinical trials evaluating treatment effects of AB. Its score correlates well with clinical findings. As thorough validation analyses revealed, this applies even more to the BSS subscales "cough domain" and "sputum domain". CONCLUSION: The validated BSS appears to be a reliable tool to assess therapeutic effects in CC/AB. The BSS and its subscales are recommended as outcome measures for future drug trials in CC/AB, but also help physicians to focus their consultation in patients with CC/AB.

[Diurnal frequency patterns of errors made in ophthalmo-surgery. A clinical analysis related to evidence based medicine]. / Tageszeitlich bedingte Fehlerhäufigkeiten in der Ophthalmochirurgie. Eine klinische Untersuchung mit Bezug zur evidenzbasierten Medizin.

BACKGROUND AND OBJECTIVES: Three factors are usually considered in determining optimal patient care, the goal of evidence based medicine (EBM): (1) approximation to the best medical knowledge, (2) clinical competence of the doctor and self reflection, (3) taking into account the individual values and beliefs of the patient. Must the limited loading capacity of the doctor also be considered as the fourth factor in ophthalmic surgery? METHODS: Follow-up examination of 8,212 cataract operation reports was carried out. We recorded complications (active errors) and specific intra-operative features (latent errors). RESULTS: The errors were not distributed evenly between 07.45 h and 13.14 h (chi(2)-test: P<0.001). They reach a maximum around 11 h. CONCLUSIONS: Usual recommendations by EBM claim a surgeon to be a machine. They should, however, take into account systematic changes in efficiency that can probably be reduced by simple nutritive interventions.

What contribution can the Hachinski Ischemic Scale make to the differential diagnosis between multi-infarct dementia and primary degenerative dementia?

Five research studies in which clinical diagnoses using the Hachinski Ischemic Scale (HIS) underwent neuropathological verification were analysed. These studies reveal that the HIS differentiates between multi-infarct dementia (MID) and dementia of the Alzheimer type (DAT) with only limited accuracy. To some extent, there are considerable differences between the studies as regards the methodology and the patient population. However, there are indications that some items of the ischemic scale clearly distinguish between MID and DAT, whereas others hardly do so or some do not distinguish at all between these two conditions. If the HIS is revised according to the present findings, it can become a more valid differential diagnostic instrument. Such a diagnostic instrument which may be applied without any other technical equipment is required today, since epidemiological data and demographic prognoses show that the prevalence of dementing illnesses will markedly increase in the future.

[Cataract-related changes of intelligence. An innovative aspect]. / Kataraktbedingte Anderungen der Informationsverarbeitung. Ein innovativer Aspekt.

BACKGROUND: On average, the intelligence level of adults decreases with age. Since loss of vision increases in parallel and, according to a review of literature, impairment of vision corresponds to cognitive deterioration, age-related reduction of intelligence could partially be explained by restricted vision. QUESTION: Are late-acquired cataracts closely related to reduction in intelligence levels? AIM. If it is substantiated that late-acquired cataracts cause mental impairment, a frequent disorder of vision will be identified that principally may be treated quickly and successfully. By this means ophthalmologists were able to improve intelligence, "the" key variable in modern information societies. METHODS: An open controlled longitudinal study in five samples of seniors with and without cataract surgery. RESULTS: The actual mental efficiency and the knowledge of cataract patients reached a lower level than a "normal" population. A few weeks after an IOL implantation the actual intelligence level increased relevantly and statistically significantly in all samples, whereas controls displayed no systematic changes. CONCLUSION: Cataracts and removal by surgery can change the IQ considerably which is of great importance for the patient and for the social and medical environment.

[Systemic diagnostic error of senile dementia by cataract-related impairment of information processing?]. / Systematische Fehleinschätzung von Altersdemenz durch kataraktbedingte Minderung der Informationsverarbeitung?

PURPOSE: According to several investigations, late-acquired diagnostically unspecified visual impairments lead to reduced intelligence levels. In cataracts, in particular, we measured reductions in IQ prior to IOL implantation. QUESTION: Do cataract-related IQ impairments reach the level of senile dementia? OBJECTIVE: To examine if cataracts and their removal have a particular relevance in senile dementia. METHODS: The IQ reduction measured in cataract samples in four studies are compared with normal values of dementia. In addition, research of the literature on diagnostic problems. RESULTS: Compared with the post-surgical score the IQ was much lower before IOL implantation. The difference corresponds to that of dementia with moderate to medium severity. Controls, however, displayed no change of IQ. According to ICD-10 and DSM-IV the cataract patients met the criteria of senile dementia. A review of the literature suggested statistical associations of prevalence of cataract and senile dementia, but did not deal with diagnostic problems. CONCLUSIONS: One component of the psychometrically obtained cognitive impairment in late-acquired cataracts seems to be a methodical artifact. The remaining component, however, cannot be distinguished from that of a "senile dementia" and leads to an increase in severity. In this case, cataract surgery may lower or even abolish the symptoms of dementia within a few weeks which would be of great importance to the patients, their relatives and health insurance.

[Does hearing loss in adults diminish intelligence?] / Führen erworbene Hörverluste bei Erwachsenen zu Intelligenzminderungen?

BACKGROUND AND OBJECTIVE: Mean curves of the age course of intelligence drop shortly after early adulthood.This is particularly true of fluid intelligence, which corresponds to the immediate management of information. Less affected is crystallized intelligence, i.e. acquired knowledge.Overviews indicate that visual impairment such as cataracts explain a large portion of this intelligence loss, and that the restitution of visual capacity conspicuously increases fluid intelligence. The question also arises as to whether hearing loss acquired in adulthood can cause a similar loss in mental efficiency. METHODS: This question was investigated by reviewing the relevant literature. RESULTS: Several studies were found involving aspects of the relationship between acquired hearing loss and the impairment of intelligence. In general, the expected association was confirmed. CONCLUSIONS: By and large,we can expect acquired hearing loss to lead to an impairment of fluid intelligence. In the long-term, such a loss can also reduce the crystallized intelligence. Such decreases are disadvantageous in many areas of an information based society.

Advancement of physical process by mental activation: a prospective controlled study.

According to the literature, patients who are significantly impaired by physical mobility limitations can be rehabilitated if the patient's working memory is used to capacity. The conclusion that periodic mental activity improves physical rehabilitation should be evaluated. This is a prospective, controlled, and randomized open study of patients who underwent a total hip arthroplasty (THA). Sixteen patients who played the video game Dr. Kawashima's Brain Training: How Old Is Your Brain? were compared in terms of rehabilitation progress to 16 individuals who did not play. Harris Hip and Merle d'Aubigné scores were evaluated 1 d preoperation and again 12 +/- 1 d postoperation. Preoperation, no significant differences in hip scores between the gaming and control groups were found (median Harris Hip score: 39 vs 33, respectively, p = 0.304; median Merle D'Aubigné score: 12 vs 9, respectively, p = 0.254). Postoperation, there were significant differences between the gaming and control groups (median Harris Hip score: 76.0 vs 56.5, respectively, p = 0.001; median Merle D'Aubigné score: 16.0 vs 13.5, respectively, p = 0.014). Within both groups, the posttest scores significantly improved; however, the increase for the gaming group was greater for both measures. Because the influence of age, sex, and level of education can be excluded, it can be assumed that mental activities can improve physical rehabilitation after THA.

Short-term influence of elevation of plasma homocysteine levels on cognitive function in young healthy adults.

BACKGROUND: Acute homocysteine elevation has been shown to have a significant impact on cognitive function in animal models. OBJECTIVES: Investigation of the short-term impact of elevation of plasma homocysteine levels through a dietary intervention on cognitive abilities of young healthy adults. PARTICIPANTS: 100 healthy medical students of both genders were enrolled in the study. DESIGN AND MEASUREMENTS: Homocysteine levels and cognitive abilities were measured at 08:30 (before breakfast) and at 15:00 (two hours after lunch and six hours after breakfast). Food intake was restricted to specified comestibles. The cognitive assessment comprised a version of the Short Test for General Intelligence, three subtests of the Syndrome Short Test and the Stroop test. RESULTS: At 15:00 plasma homocysteine was significantly elevated in 56 participants (P < 0.00001), whilst in 44 it was decreased (P < 0.00001) in comparison to baseline (08:30). The decrease was however of limited clinical significance. The differences in the changes in cognitive performance between the two groups did not attain statistical significance (P > 0.05) and the direction of the changes did not differ between them. Accordingly, the multiple linear regression analysis did not reveal an important influence of homocysteine elevation on cognitive performance variations. CONCLUSIONS: Significant increase of plasma homocysteine is not associated with a straightforward inhibitory or facilitatory short-term effect on physiological cognitive parameters in young healthy adults.

Blue light improves cognitive performance.

A newly discovered system of photoreceptors for circadian rhythms works non-visual and responds to blue light (460 nm). We report a longitudinal study in 44 adults, showing that a significant increase in alertness and speed of information processing could be achieved by blue light as compared to normal light.

[The citation frequency for prominent researchers in HNO medical science. Scientometric follow-up of German scientists over 10 years]. / Längsschnittuntersuchung zur Zitierhäufigkeit Gelehrter in der HNO-Heilkunde. Szientometrische Nachuntersuchung deutscher Wissenschaftler nach 10 Jahren.

BACKGROUND: In 1995, 18 scientists involved in research on otorhinolaryngology in Germany (median of age 55 years; one woman) entered the Who is Who of German medical research because of their top citation rates in the worldwide Science Citation Index (SCI). Their publications were cited about 12 times as often as those of colleagues with an habilitation or professorship. Are their publications equally important in international research activity 10 years later? METHODS: Investigations were carried out using SCI 2002. RESULTS: Seventeen of the former stars still publish from Germany. Their total citation rate has remained almost unchanged. CONCLUSIONS: The stability and the large individual differences in citation rates indicate that a personal dimension is present, here called "research-talent", i.e. the ability to produce research of high quality. Internationally highly successful researchers reach their maximum productivity at about 40 years of age and maintain it even after official retirement. Therefore, there is little risk in promoting them and their projects. Moreover, they serve as examples for their colleagues and the rising scientific generation on how to do internationally successful research.

[The first hearing aid increases mental capacity. Open controlled clinical trial as a pilot study]. / Erste Hörhilfe erhöht die geistige Leistungsfähigkeit Offene kontrollierte Anwendungsbeobachtungsstudie als Pilotstudie.

BACKGROUND: According to the scientific literature, a hearing impairment which is acquired late reduces mental efficiency. OBJECTIVE: To determine by empirical examination whether hearing aids increase mental efficiency. PERSONS AND METHODS: An open controlled application study was carried out on the capacity of working memory in 15 first users of hearing aids. RESULTS: The working memory's capacity in the 15 users (age: 72+/-12 years; six females; crystallized IQ: 100+/-13; test-retest period: 74+/-35 days) increased 13+/-19% (IQ-increment 3.4+/-6.3 points), while the capacity of the 15 controls (age: 71+/-11 years; seven females; crystallized IQ: 103+/-12; test-retest period: 58+/-21 days) remained unchanged: 0+/-12% (IQ-change: -0.3+/-5.1 points). The difference between the samples is significant (p=0.012 one-tailed). The visually and auditively administered subtests yielded equal changes. According to self-reports, the daily wearing time was 6.7+/-3.5 h. Daily wearing times of the hearing aids (self-reports) of between 4-8 h showed the multiple IQ-gain compared to lesser or longer times. The audiometric gain in hearing without noise on the right (rho=0.58; significant), left (0.48; not significant), and on both sides (0.68; significant) correlated with IQ-gain. CONCLUSIONS: Under a more favourable usage a still more striking benefit is to be expected in mental efficiency.

[Two psychosis-specific test systems (author's transl)]. / Zwei psychosespezifische Testsysteme.

Psychopathological procedures for assessment of severity of mental disorders will often be applied in follow-up studies of drugs. Their application can be performed relatively economically because the nosological and syndromal allocation of patients has usually been accomplished before the measurement of severity. In order to facilitate and establish economy, empirically testable conceptions on the relationship between the severity of the psychic disorder in question and the results of measurement are to be favoured. In addition they help avoiding systematic misjudgements as they sometimes occur in application of self-assessment scales in functional psychoses (physically induced reversible psychosis) or endogenous depression. According to this rule two economic psychopathometric testing systems have been developed for endogenous depression and functional psychosis. Both are introduced briefly.

[The impact factor as an assessment criterion of scientific achievements--the right to equal chances]. / Der Impact-Faktor als Bewertungskriterium wissenschaftlicher Leistungen--das Recht auf Chancengleichheit.

BACKGROUND: Regularly the Institute of Scientific Information publishes the impact factor (IF) that plays an increasing role when the scientific quality of scientific performances of journals, single publications, scientists, and research groups have to be evaluated in order to support them. QUESTIONS: How valid is the IF assigned to journals, single publications, scientists, and research groups? Have all these the same chance to be evaluated? How can fairness of evaluation be increased? Can its validity be improved? RESULTS: The value of IF equals the average number of citations per article published in the preceding 2 calendar years in a journal. The criteria for selection of citing journals and of those with an "official" IF are not fully explicated. Although the citations have no equal units of measurement, empirical findings confirm their pragmatic applicability. IF of journals and even the citation rates of its articles are skewedly distributed to right hand. Additionally, the citation rates of the articles within a journal vary. Therefore, the IF of journals rarely equal the actual citation rates of their articles. Usually, IF overestimates the citation rate and quality of the articles. Its tendency not to recognize low and high quality even increases when IF is administered to individual scientists and small research groups, whereas it decreases in large research groups. Under the premise that the extent of scientific quality corresponds to the amount of information a paper adds to the state of science, language, actuality etc. are confounders because English, reviewing, biomedical, and actual articles have preferred citation rates. CONCLUSIONS: Evaluation of scientific performances by IF is to be restricted to journals and large research groups. Fairness demands comparisons to homogeneous journals with respect to confounders such as language. Principally, no journal should be excluded to obtain an IF if it fulfills the minimum criteria of an internationally communicating science. For this purpose they have to provide a title, key words, and an abstract in English, a peer review system etc. Often journals are the centre of science cultures that are able to generate research of highest levels. The users can contribute to increase the IF of "their" journal and to care for the valid application of this indicator.