bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing Sensitivity Diagnostics for Qualitative Comparative Analysis: A Combinatorial Approach
Authors: Thiem Alrik , Spöhel Reto , Duşa Adrian
Published: December 2015

Sensitivity diagnostics has recently been put high on the agenda of methodological research into Qualitative Comparative Analysis (QCA). Existing studies in this area rely on the technique of exhaustive enumeration, and the majority of works examine the reactivity of QCA either only to alterations in discretionary parameter values or only to data quality. In this article, we introduce the technique of combinatorial computation for evaluating the interaction effects between two problems afflicting data quality and two discretionary parameters on the stability of QCA reference solutions. In this connection, we challenge a hitherto unstated assumption intrinsic to exhaustive enumeration, show that combinatorial computation permits the formulation of general laws of sensitivity in QCA, and demonstrate that our technique is most efficient.
Serial Analgesic Consumptions and Predictors of Intravenous Patient-controlled Analgesia with Cluster Analysis
Authors: Lin Shih-Pin , Chang Kuang-Yi , Tsou Mei-Yung , Chen Tony Hsiu-Hsi
Published: December 2015

Objectives:

To elucidate the dynamics of analgesic consumption regarding intravenous patient controlled analgesia (IVPCA) during postoperative period is rather complex partly due to between-patient variation and partly due to within-patient variation. A statistical method was proposed to classify serial analgesic consumption into different classifications that were further taken as the multiple outcomes on which to explore the associated predictors.

Methods:

We retrospectively included 3284 patients administrated by IVPCA for 3 days after surgery. A repeated measurement design corresponding to serial analgesic consumption variables defined as six-hour total analgesic consumptions was adopted. After determining the numbers of clusters, serial analgesic consumptions were classified into several homogeneous subgroups. Factors associated with new classifications were identified and quantified with a multinominal logistic regression model.

Results:

Three distinct analgesic classifications were aggregated, including “high”, ”middle” and “low” level of analgesic consumption of IVPCA. The mean analgesic consumptions on 12 successive analgesic consumptions at 6-hour interval of each classification consistently revealed a decreasing trend. As the trends were almost parallel with time, this suggests the time-invariant proportionality of analgesic consumption between the levels of analgesic consumption of IVPCA. Patient’s characteristics, like age, gender, weight, height, and cancer status, were significant factors associated with analgesic classifications. Surgical sites had great impacts on analgesic classifications.

Discussion:

The serial analgesic consumptions were simplified into 3 analgesic consumptions classifications. The identified predictors are useful to recognize patient’s analgesic classifications before using IVPCA. This study explored a new approach to analysing dynamic changes of postoperative analgesic consumptions.
Optimizing Nociceptive Flexion Reflex (NFR) Scoring Criteria by Adjusting for Noise and Reflex Properties and Sampling Rate
Authors: Lichtner Gregor , Hösl Teresa M. , Jakuscheit Axel , Jurth Carlo , von Dincklage Falk
Published: December 2015

Objective:

To reanalyze scoring criteria for automatic detection of nociceptive flexion reflexes (NFRs) in electromyography (EMG) recordings and to improve detection accuracy by accounting for multiple characteristics of the recordings, such as baseline noise level or sampling rate.

Methods:

Single scoring criteria for the NFR were reanalyzed and validated against an independent data set. To account for influences on the single scoring criteria, such as the baseline noise, multivariate classification models were derived.

Results:

Reanalysis of single scoring criteria yielded significantly lower threshold values than previously reported. The threshold value of the best-performing single scoring criterion, the NFR Interval Peak z score, was found to be strongly dependent on the level of baseline noise and the EMG sampling rate. Multivariate classification models could reduce the number of incorrectly classified recordings in an independent data set by 25% to 37% compared with the best-performing single scoring criterion.

Discussion:

The automatic detection of reflex responses in electromyograms can be significantly improved by including multiple reflex, baseline, and EMG characteristics into a classification model. These findings should help to improve the accuracy of currently used standard measurement algorithms and algorithms engineered toward specific properties, such as short measurements or less induced pain for the patients.
Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the Management of Low Back Pain
Authors: Slade Susan C. , Kent Peter , Patel Shilpa , Bucknall Tracey , Buchbinder Rachelle
Published: December 2015

Introduction:

Despite the availability of evidence-based guidelines for the management of low back pain (LBP) that contain consistent messages, large evidence-practice gaps in primary care remain.

Objectives:

To perform a systematic review and metasynthesis of qualitative studies that have explored primary care clinicians’ perceptions and beliefs about guidelines for LBP, including perceived enablers and barriers to guideline adherence.

Methods:

Studies investigating perceptions and beliefs about LBP guidelines were included if participants were primary care clinicians and qualitative methods had been used for both data collection and analysis. We searched major databases up to July 2014. Pairs of reviewers independently screened titles and abstracts, extracted data, appraised method quality using the CASP checklist, conducted thematic analysis, and synthesized the results in narrative format.

Results:

Seventeen studies, with a total of 705 participants, were included. We identified 3 key emergent themes and 8 subthemes: (1) guideline implementation and adherence beliefs and perceptions; (2) maintaining the patient-clinician relationship with imaging referrals; and (3) barriers to guideline implementation. Clinicians believed that guidelines were categorical, prescriptive, and constrained professional practice; however, popular clinical practices superseded the guidelines. Imaging referrals were used to manage consultations and to obtain definitive diagnoses. Clinicians’ perceptions reflected a lack of content knowledge and understanding of how guidelines are developed.

Discussion:

Addressing misconceptions and other barriers to uptake of evidence-based guidelines for managing LBP is needed to improve knowledge transfer and close the evidence-practice gap in the treatment of this common condition.
Parent Attitudes Toward Pain Management for Childhood Immunizations
Authors: Connelly Mark , Wallace Dustin P. , Williams Kristi , Parker JoLynn , Schurman Jennifer V.
Published: December 2015

Objectives:

Evidence-based pain-limiting strategies for pediatric immunizations remain underutilized, with barriers identified to date mostly pertaining to health care providers and systems of care. The present study sought to quantify and investigate parent attitudes toward pain management as another potential barrier to the routine use of pain-mitigating strategies during immunizations.

Materials and Methods:

Questionnaires measuring parent attitudes, willingness to pay, and perceived barriers for using pain management for immunizations were completed by 259 parent/guardians of children ages 0 to 5 years attending appointments at an urban primary care clinic in the Midwestern United States.

Results:

Parent attitudes toward pain management for immunization were relatively normally distributed and varied from strongly positive to negative, with 33% of parents disagreeing that they were concerned about the pain their child may experience and 50% agreeing that there are no lasting negative effects from immunization pain. Negative parent attitudes were associated with willingness to spend less in money or time for pain management and with greater perceived significance of cost, time, and other barriers for using pain-mitigating strategies.

Discussion:

Some parents perceive limited value in trying to reduce pain during immunizations such that they may be hesitant to invest much time or effort in interventions. Greater success of translating evidence-based pain management into practice therefore may require accounting for differences in parent attitudes by tailoring educational efforts and pain management options accordingly.
Coping is Important for Spouses Too
Authors: Suso-Ribera Carlos , Yakobov Esther , Ribera-Canudas Mª Victoria
Published: December 2015

Introduction:

Living with a patient with chronic pain is now known to have a negative impact on physical and mental health of the caregivers. Research indicates that adaptive coping strategies can reduce the burden that pain has on patients. Yet, it is unknown whether coping strategies can also affect the physical and mental health of the spouses of patients with chronic pain. In the present research, we investigated the role of coping strategies used by spouses of patients with pain in the relationship between the pain intensity of the patients and the physical and mental health of their spouses.

Methods:

The study comprised 195 heterosexual couples. About 41% of spouses were females.

Results:

Our results showed that being older, having a lower educational level, having a negative orientation toward problems, and using impulsive strategies to cope when in difficult situations contributed to poorer physical health of spouses. A poorer mental health status of spouses was associated with being negatively oriented toward problems, being a female, and being a caregiver of mentally distressed patient. In addition, it was found that the impulsive-careless coping strategy used by the spouses moderated the relationship between patients’ pain severity and physical health of their spouses. At low levels of patients’ pain intensity as rated by spouses, spouses reported similar levels of physical health irrespective of coping ratings. Conversely, at high levels of patients’ pain intensity as rated by spouses, poorer physical health was reported by spouses scoring high on impulsive-careless coping.

Discussion:

Implications for clinical practice are discussed. Our findings suggest that screening for coping strategies used by spouses of patients with pain might complement clinical interventions aimed at promoting the physical and mental health of patients and their partners.
Sleep Problems are Associated With Chronic Pain Over and Above Mutual Associations With Depression and Catastrophizing
Authors: Roberts Mary B. , Drummond Peter D.
Published: December 2015

Introduction:

Pain, mood problems, and sleeping difficulties are often comorbid and contribute to reduced physical function and quality of life for those with chronic pain. However, the way in which these factors interact is unclear. Until recently it was thought that the effect of sleep on pain and physical function was simply a result of its common association with mood problems. However, a growing body of research suggests that sleep may have a unique contribution.

Objectives:

The aim of this study was to determine whether sleep disturbances were associated with pain and poor physical function independent of psychological distress in patients attending a tertiary pain medicine unit.

Materials and Methods:

101 patients with chronic pain completed a set of questionnaires measuring pain, sleep, and mood, and also completed a selection of physical assessments conducted by a physiotherapist.

Results:

In total, 75.2% of participants had insomnia and 84.3% reported the presence of at least 1 sleep problem. Significant positive correlations with pain were detected for depression, catastrophizing, insomnia, short sleep duration, and poor sleep quality. Sleep duration had a significant independent association with pain after accounting for depression and catastrophizing. Sleep duration also had an independent association with physical function after accounting for pain and catastrophizing.

Conclusions:

Given that sleep has an important and unique contribution to pain and physical function, it is important that sleep disturbances are addressed both in the assessment and treatment of chronic pain.
Comparison Between the Effects of Intravenous Morphine, Tramadol, and Ketorolac on Stress and Immune Responses in Patients Undergoing Modified Radical Mastectomy
Authors: Bakr Mohamed A.-E.-M. , Amr Samy A.-E. R. , Mohamed Sahar A. , Hamed Hosny B. , Abd EL-Rahman Ahmad M. , Mostafa Mohamed A. M. , El Sherif Fatma A.
Published: December 2015

Objectives:

Analgesics had been suspected of impairing various immune functions either directly or indirectly. Our primary objective was to compare the effects of intravenous (IV) morphine, tramadol, and ketorolac on stress and immune responses in patients who underwent modified radical mastectomy.

Patients:

Sixty patients randomly assigned to receive IV morphine 5 mg (group M, n=20), tramadol 100 mg (group T, n=20), or ketorolac 60 mg (group K, n=20) at the end of surgery.

Methods:

Serum cortisol, prolactin were measured immediately, 40 minutes, and 24 hours postoperatively. Expressions of peripheral T lymphocytes (CD3+, CD3+CD4+, CD3+CD8+) and natural killer cells (CD3+, CD56+) were measured as percentages of total lymphocytes by flow cytometry immediately, 90 minutes, and 24 hours postoperatively.

Results:

After 40 minutes, cortisol level increased but prolactin decreased significantly (P=0.001), then both decreased after 24 hours (P=0.001) compared with baseline within the 3 groups. CD3, CD4, CD8, and CD56 significantly decreased at 90 minutes and 24 hours (P≤0.033) compared with baseline in the 3 groups. CD4, CD8, and CD56 significantly decreased in group M, compared with group T and K (P≤0.016) and CD3, CD8, and CD56 in group T compared with group K at 90 minutes (P≤0.024) postoperatively. After 24 hours, CD4, and CD8 decreased in group M compared with group T (P≤0.048) and CD4 and CD56 in groups M and T compared with group K (P≤0.049).

Conclusions:

IV morphine, tramadol, and ketorolac suppressed stress and immune responses. Ketorolac was the least immunosuppressive among the 3 drugs.
Does Evidence Support the Use of Neural Tissue Management to Reduce Pain and Disability in Nerve-related Chronic Musculoskeletal Pain?
Authors: Su Yunfeng , Lim Edwin Choon Wyn
Published: December 2015

Objectives:

In nerve-related chronic musculoskeletal (MS) disorders, neural tissue management is used to relieve pain by balancing the relative movement of neural tissues and their surrounding tissues. To date, there has not been any review evaluating the magnitude of this treatment effect in nerve-related chronic MS pain. The aim of this review was to compare pain and disability in individuals with nerve-related chronic MS pain who were treated with neural tissue management with those who received minimal or other treatment approaches.

Methods:

Searches of 8 major electronic databases were conducted, and data on pain and disability scores were extracted. Meta-analyses (where possible) with either a fixed-effect(s) or random-effect(s) model, standardized mean differences (SMDs), and tests of heterogeneity were performed.

Results:

Twenty clinically controlled trials were identified and included in the meta-analyses. When compared with minimal intervention, neural mobilization provided superior pain relief (pooled SMD=−0.77; 95% confidence interval [CI], −1.11 to −0.42; P<0.0001), and reduction in disability (pooled SMD=−1.06; 95% CI, −1.97 to −0.14; P=0.02), after post hoc sensitivity analyses. No significant differences were found when comparing neural mobilization with other treatment approaches for pain (pooled SMD=−0.67; 95% CI, −2.03 to 0.69; P=0.33), after post hoc sensitivity analysis, and disability (pooled SMD=−0.03; 95% CI, −0.54 to 0.59; P=0.93).

Discussion:

Neural tissue management is superior to minimal intervention for pain relief and reduction of disability in nerve-related chronic MS pain. Existing evidence does not establish superiority of neural mobilization over other forms of intervention in reducing pain and disability in individuals with nerve-related chronic MS pain.
Does Topical Lidocaine Reduce the Pain Associated With the Insertion of Nasal Continuous Positive Airway Pressure Prongs in Preterm Infants?
Authors: Soliman Hasnaa , Elsharkawy Ashraf , Abdel-Hady Hesham
Published: December 2015

Objective:

To evaluate the efficacy of topical lidocaine 2% gel in reducing the pain associated with the insertion of nasal continuous positive airway pressure (nCPAP) prongs in preterm infants.

Materials and Methods:

A pilot randomized controlled trial. Sixty preterm infants, categorized into lidocaine (n=30) and control groups (n=30). The primary outcome was Premature Infant Pain Profile (PIPP) score, secondary outcomes included salivary cortisol, presence of cry, the duration of first cry, and adverse effects of lidocaine.

Results:

There were no statistically significant differences between lidocaine and control groups regarding PIPP scores (mean±SD: 7.2±2.3 vs. 9.3±3.0, respectively, P=0.086). None of the infants in the lidocaine group had severe pain defined as a PIPP score>12, compared with 3 (10%) infants in the control group (P=0.056). Salivary cortisol concentrations were not significantly different between the lidocaine and control groups (mean±SD: 2.57±1.79 vs. 4.82±1.61 μg/dL, respectively, P=0.11). Standardized effect sizes for topical lidocaine were medium to large for reduction in PIPP scores and large for reduction in salivary cortisol (Cohen d=−0.78 and −1.32, respectively). No adverse effects were reported in infants receiving lidocaine.

Discussion:

Our data suggest that topical lidocaine did not reduce the pain associated with the insertion of nCPAP prongs in preterm infants. However, the trends for lower PIPP scores in the lidocaine group and the effect sizes for lidocaine on PIPP scores and salivary cortisol were large enough so that a large-scale randomized clinical trial is warranted to confirm or refute our results. Such a study should compare 2 or more active pain interventions during nCPAP application, rather than evaluating a single intervention versus placebo or no treatment.
Duloxetine in Painful Diabetic Neuropathy
Authors: Hossain Sultana Mehbuba , Hussain Sultana Monira , Ekram A.R.M.S.
Published: December 2015

Objective:

To systematically review the evidence for duloxetine in the management of painful diabetic neuropathy (PDN).

Methods:

Electronic searches of Medline and PubMed were performed from 2005 till October 2015 using medical subject headings and free-text words. Two independent reviewers extracted the data and assessed the methodological quality of the selected studies.

Results:

Twenty-three studies met our inclusion criteria and 8 were considered of high quality and were included to this review. Because of heterogeneity of the studies included in this review, statistical pooling of the data was not possible. We found good evidence for use of duloxetine in PDN over placebo and pregabalin but there was no benefit of duloxetine over amitriptyline.

Conclusions:

Duloxetine has a beneficial effect over placebo. Nevertheless, the evidence of superiority of duloxetine over pregabalin and amitriptyline should be explored further as there was only 1 trial for each category. Provided majority of the PDN patients share cardiovascular complications, use of duloxetine will be a good option for treating pain associated with PDN over amitriptyline. Future randomized controlled trials should be designed keeping this in mind.
Central Poststroke Pain Can Occur With Normal Sensation
Authors: Kumar Ajit , Bhoi Sanjeev K. , Kalita Jayantee , Misra Usha K.
Published: December 2015

Objective:

In view of the paucity of studies on central poststroke pain (CPSP), in this hospital-based prospective study, we evaluated the frequency, the spectrum, imaging, and quantitative sensory testing in a cohort of stroke patients with CPSP.

Methods:

Stroke patients who developed CPSP at onset or during follow-up were included. Patients were subjected to clinical evaluation and sensory testing. The severity of stroke was defined by the Modified Rankin Scale and disability by the Barthel Index. Quantitative sensory testing included monofilament testing and evaluation for static and dynamic mechanical allodynia, punctuate hyperalgesia, temporal summation, cold allodynia, and cold hyperalgesia. Sleep, anxiety, and depression were also evaluated. Patients were treated with pregabalin 150 to 600 mg/d and good response was defined as >50% improvement in the VAS score. CPSP symptoms were correlated with demographic information, sensory findings, and imaging findings.

Results:

A total of 319 patients with stroke were evaluated. CPSP occurred in 66 (20.7%) of them. The median age of the CPSP patients was 55 years (range, 25 to 80 y). About 31.8% patients were female. The onset, the duration, and the distribution of pain were variable. The severity of symptoms did not correlate with demographic variables and the site of lesion. Spinothalamic sensations were normal in 42.3% patients. On treatment with pregabalin (150 to 600 mg), half of the patients had a good response.

Discussion:

CPSP was present in 20.7% of the stroke patients. Spinothalamic tract dysfunction may not be necessary for the development of CPSP, and it can also be seen with normal spinothalamic sensation. The location of the stroke, its type and quality, and the severity of CPSP were not related.
A Systematic Review of Knowledge Translation (KT) in Pediatric Pain
Authors: Gagnon Michelle M. , Hadjistavropoulos Thomas , Hampton Amy J. D. , Stinson Jennifer
Published: December 2015

Objectives:

Pain is inadequately managed in pediatric populations across health care settings. Although training programs to improve health care provider knowledge and skills have been developed and evaluated, clinical practices have not always kept pace with advancing knowledge. Consequently, the goal of this review was to systematically examine the pediatric pain literature of knowledge translation (KT) programs targeting health care providers.

Materials and Methods:

Systematic searches of PubMed, Web of Science, CINAHL, and PsycINFO were undertaken. KT initiatives directed toward health care providers and in which the primary focus was on pediatric pain were included. Primary outcomes, intervention characteristics, and risk of bias were examined across studies. Study outcomes were conceptually organized and a narrative synthesis of results was conducted.

Results:

A total of 15,191 abstracts were screened for inclusion with 98 articles retained on the basis of predetermined criteria. Across studies, KT approaches varied widely in format and focus. Knowledge-level changes and self-reported increases in comfort or confidence in skills/knowledge were consistently achieved. Practice-level changes were achieved in many areas with varying success. Design and reporting issues were identified in the majority of studies. Examination of patient-related outcomes and of the long-term impact of pediatric pain KT programs was limited across studies.

Discussion:

KT programs vary in quality and impact. Although several successful programs have been developed, many studies include a high risk of bias due to study quality. Evidence-based KT program implementation and a focus on sustainability of outcomes must be given greater consideration in the field of pediatric pain.
Cortical Activation Patterns Correlate with Speech Understanding After Cochlear Implantation
Authors: Olds Cristen , Pollonini Luca , Abaya Homer , Larky Jannine , Loy Megan , Bortfeld Heather , Beauchamp Michael S. , Oghalai John S.
Published: December 2015

Objectives:

Cochlear implants are a standard therapy for deafness, yet the ability of implanted patients to understand speech varies widely. To better understand this variability in outcomes, the authors used functional near-infrared spectroscopy to image activity within regions of the auditory cortex and compare the results to behavioral measures of speech perception.

Design:

The authors studied 32 deaf adults hearing through cochlear implants and 35 normal-hearing controls. The authors used functional near-infrared spectroscopy to measure responses within the lateral temporal lobe and the superior temporal gyrus to speech stimuli of varying intelligibility. The speech stimuli included normal speech, channelized speech (vocoded into 20 frequency bands), and scrambled speech (the 20 frequency bands were shuffled in random order). The authors also used environmental sounds as a control stimulus. Behavioral measures consisted of the speech reception threshold, consonant-nucleus-consonant words, and AzBio sentence tests measured in quiet.

Results:

Both control and implanted participants with good speech perception exhibited greater cortical activations to natural speech than to unintelligible speech. In contrast, implanted participants with poor speech perception had large, indistinguishable cortical activations to all stimuli. The ratio of cortical activation to normal speech to that of scrambled speech directly correlated with the consonant-nucleus-consonant words and AzBio sentences scores. This pattern of cortical activation was not correlated with auditory threshold, age, side of implantation, or time after implantation. Turning off the implant reduced the cortical activations in all implanted participants.

Conclusions:

Together, these data indicate that the responses the authors measured within the lateral temporal lobe and the superior temporal gyrus correlate with behavioral measures of speech perception, demonstrating a neural basis for the variability in speech understanding outcomes after cochlear implantation.
Completion of Multidisciplinary Treatment for Persistent Postconcussive Symptoms Is Associated With Reduced Symptom Burden
Authors: Janak Jud C. , Cooper Douglas B. , Bowles Amy O. , Alamgir Abul H. , Cooper Sharon P. , Gabriel Kelley P. , Pérez Adriana , Orman Jean A.
Published: December 2015

Objective:

To investigate the pre- to posttreatment changes in both posttraumatic stress disorder (PTSD) and persistent postconcussive symptoms (PPCSs).

Setting and Participants:

We studied 257 active-duty patients with a history of mild traumatic brain injury (mTBI) who completed multidisciplinary outpatient treatment at Brooke Army Medical Center TBI Clinic from 2008 to 2013. This treatment program included cognitive rehabilitation; vestibular interventions; headache management; and integrated behavioral healthcare to address co-occurring psychiatric conditions such as PTSD, depression, and sleep disturbance.

Design:

A 1-group; preexperimental, pre- to posttreatment study.

Main Measures:

The Neurobehavioral Symptom Inventory (NSI) was used to assess PPCSs, and the PTSD Checklist–Military Version (PCL-M) was used to asses PTSD symptoms.

Results:

Global PPCS resolution (mean NSI: 35.0 pre vs 23.8 post; P < .0001; d = 0.72) and PTSD symptom resolution (mean PCL-M: 43.2 pre vs 37.7 post; P < .0001; d = 0.34) were statistically significant. Compared with those with only mTBI, patients with mTBI and PTSD reported greater global PPCS impairment both pretreatment (mean NSI: 48.7 vs 27.9; P < .0001) and posttreatment (mean NSI: 36.2 vs 17.4; P < .0001). After adjusting for pretreatment NSI scores, patients with comorbid PTSD reported poorer PPCS resolution than those with mTBI alone (mean NSI: 27.9 pre vs 21.7 post; P = .0009).

Conclusion:

We found a reduction in both self-reported PPCSs and PTSD symptoms; however, future studies are needed to identify specific components of care associated with symptom reduction.
Computerized Cognitive Rehabilitation of Attention and Executive Function in Acquired Brain Injury: A Systematic Review
Authors: Bogdanova Yelena , Yee Megan K. , Ho Vivian T. , Cicerone Keith D.
Published: December 2015

Objective:

Comprehensive review of the use of computerized treatment as a rehabilitation tool for attention and executive function in adults (aged 18 years or older) who suffered an acquired brain injury.

Design:

Systematic review of empirical research.

Main Measures:

Two reviewers independently assessed articles using the methodological quality criteria of Cicerone et al. Data extracted included sample size, diagnosis, intervention information, treatment schedule, assessment methods, and outcome measures.

Results:

A literature review (PubMed, EMBASE, Ovid, Cochrane, PsychINFO, CINAHL) generated a total of 4931 publications. Twenty-eight studies using computerized cognitive interventions targeting attention and executive functions were included in this review. In 23 studies, significant improvements in attention and executive function subsequent to training were reported; in the remaining 5, promising trends were observed.

Conclusions:

Preliminary evidence suggests improvements in cognitive function following computerized rehabilitation for acquired brain injury populations including traumatic brain injury and stroke. Further studies are needed to address methodological issues (eg, small sample size, inadequate control groups) and to inform development of guidelines and standardized protocols.
Development and Preliminary Validation of the Coma Arousal Communication Scale
Authors: Garin Julie , Reina Margot , DeiCas Paula , Rousseaux Marc
Published: December 2015

Objective:

To develop a Coma Arousal Communication Scale and perform preliminary validation.

Methods:

A group of experts developed a questionnaire to assess communication between patients emerging from coma and caregiver (participation, communication modes, and themes) and the strategies used to facilitate communication. To assess the scale's psychometric characteristics, it was presented to the caregivers of 40 inpatients admitted to 5 coma units and (to obtain reference data) to 29 control participants.

Results:

The Coma Arousal Communication Scale displayed good intra- and interrater reliability as judged by intraclass correlation coefficients (between 0.76 and 0.98) and Bland and Altman plots. Cohen κ coefficient revealed moderate to almost perfect levels of agreement for most individual items and slight levels for a few items dealing with compensatory strategies. We observed good internal consistency, relations with the Wessex Head Injury Matrix, and sensitivity to change for patients who had sustained brain injury in the previous 6 months.

Conclusion:

The Coma Arousal Communication Scale provides accurate information about communication skills of individuals emerging from coma. However, some compensatory strategies adopted by caregivers are difficult to characterize.
Building Statewide Infrastructure for the Academic Support of Students With Mild Traumatic Brain Injury
Authors: Gioia Gerard A. , Glang Ann E. , Hooper Stephen R. , Brown Brenda Eagan
Published: December 2015

Objectives:

To focus attention on building statewide capacity to support students with mild traumatic brain injury (mTBI)/concussion.

Method:

Consensus-building process with a multidisciplinary group of clinicians, researchers, policy makers, and state Department of Education personnel.

Results:

The white paper presents the group's consensus on the essential components of a statewide educational infrastructure to support the management of students with mTBI. The nature and recovery process of mTBI are briefly described specifically with respect to its effects on school learning and performance. State and local policy considerations are then emphasized to promote implementation of a consistent process. Five key components to building a statewide infrastructure for students with mTBI are described including (1) definition and training of the interdisciplinary school team, (2) professional development of the school and medical communities, (3) identification, assessment, and progress monitoring protocols, (4) a flexible set of intervention strategies to accommodate students' recovery needs, and (5) systematized protocols for active communication among medical, school, and family team members. The need for a research to guide effective program implementation is stressed.

Conclusion:

This guiding framework strives to assist the development of support structures for recovering students with mTBI to optimize academic outcomes. Until more evidence is available on academic accommodations and other school-based supports, educational systems should follow current best practice guidelines.
Groupings of Persons With Traumatic Brain Injury: A New Approach to Classifying Traumatic Brain Injury in the Post-Acute Period
Authors: Sherer Mark , Nick Todd G. , Sander Angelle M. , Melguizo Maria , Hanks Robin , Novack Thomas A. , Tulsky David , Kisala Pamela , Luo Chunqiao , Tang Xinyu
Published: December 2015

Objective:

To (1) identify groups of persons with traumatic brain injury (TBI) who differ on 12 dimensions of cognitive function: cognitive, emotional, and physical symptoms; personal strengths; physical functioning; environmental supports; and performance validity; and (2) describe patterns of differences among the groups on these dimensions and on participation outcome.

Setting:

Three centers for rehabilitation of persons with TBI.

Participants:

A total of 504 persons with TBI living in the community who were an average (standard deviation) of 6.3 (6.8) years postinjury and who had capacity to give consent, could be interviewed and tested in English, and were able to participate in an assessment lasting up to 4 hours.

Design:

Observational study of a convenience sample of persons with TBI.

Main Measures:

Selected scales from the Traumatic Brain Injury Quality of Life measures, Neurobehavioral Symptom Inventory, Economic Quality of Life Scale, Family Assessment Device General Functioning Scale, measures of cognitive function, Word Memory Test, and Participation Assessment with Recombined Tools–Objective (PART-O) scale.

Results:

Cluster analysis identified 5 groups of persons with TBI who differed in clinically meaningful ways on the 12 dimension scores and the PART-O scale.

Conclusion:

Cluster groupings identified in this study could assist clinicians with case conceptualization and treatment planning.
Utility of the Neurobehavioral Symptom Inventory As an Outcome Measure: A VA TBI Model Systems Study
Authors: Belanger Heather G. , Silva Marc A. , Donnell Alison J. , McKenzie-Hartman Tamara , Lamberty Greg J. , Vanderploeg Rodney D.
Published: December 2015

Objective:

To examine the utility of the Neurobehavioral Symptom Inventory (NSI)—a measure of postconcussion symptoms used within the Veterans Health Administration—as an index of rehabilitation outcome.

Setting:

Veterans Administration Polytrauma Rehabilitation Centers Traumatic Brain Injury (TBI) Model Systems program.

Participants:

A total of 159 Veterans (14% with mild TBI; 86% with moderate-severe TBI).

Main Measures:

Disability Rating Scale; Functional Independence Measure; Glasgow Outcome Scale–Extended; NSI; Participation Assessment with Recombined Tools–Objective; Posttraumatic Stress Disorder Checklist–Civilian Version; Satisfaction With Life Scale; Supervision Rating Scale.

Analyses:

Correlations and exploratory factor analyses examined the interrelations among outcome measures. Hierarchical regression analyses were utilized to determine if the NSI predicted rehabilitation outcome measures after controlling for demographic variables, TBI severity, and time since injury. NSI reliable changes from pretreatment to 1-year follow-up were examined. Receiver operating characteristics curve analyses were conducted to evaluate the ability of changes in the NSI to predict meaningful change in functioning and employment status.

Results:

The NSI correlated with psychological distress measures. The NSI administered prior to brain injury rehabilitation had limited predictive utility beyond satisfaction with life. A minority of patients (32%) demonstrated reliable changes on the NSI from baseline to 1-year follow-up. Changes on the NSI were not predictive of meaningful change in employment or functioning.

Conclusion:

The NSI was not useful for assessing meaningful change in a sample of mixed severity TBI patients.
Predictors of the On-Road Driving Assessment After Traumatic Brain Injury: Comparing Cognitive Tests, Injury Factors, and Demographics
Authors: McKay Adam , Liew Carine , Schönberger Michael , Ross Pamela , Ponsford Jennie
Published: December 2015

Objectives:

(1) To examine the relations between performance on cognitive tests and on-road driving assessment in a sample of persons with traumatic brain injury (TBI). (2) To compare cognitive predictors of the on-road assessment with demographic and injury-related predictors.

Participants:

Ninety-nine people with mild-severe TBI who completed an on-road driving assessment in an Australian rehabilitation setting.

Design:

Retrospective case series.

Main Measures:

Wechsler Test of Adult Reading or National Adult Reading Test—Revised; 4 subtests from the Wechsler Adult Intelligence Scale-III; Rey Auditory Verbal Leaning Test; Rey Complex Figure Test; Trail Making Test; demographic factors (age, sex, years licensed); and injury-related factors (duration of posttraumatic amnesia; time postinjury).

Results:

Participants who failed the driving assessment did worse on measures of attention, visual memory, and executive processing; however, cognitive tests were weak correlates (r values <0.3) and poor predictors of the driving assessment. Posttraumatic amnesia duration mediated by time postinjury was the strongest predictor of the driving assessment—that is, participants with more severe TBIs had later driving assessments and were more likely to fail.

Conclusion:

Cognitive tests are not reliable predictors of the on-road driving assessment outcome. Traumatic brain injury severity may be a better predictor of on-road driving; however, further research is needed to identify the best predictors of driving behavior after TBI.
Characterization of Upper Eyelid Tarsus and Lid Wiper Dimensions
Authors: Navascues-Cornago Maria , Maldonado-Codina Carole , Gupta Ruchi , Morgan Philip B.
Published: December 2015

Objectives:

To measure various dimensions of the upper tarsal plate and the area of upper lid wiper staining. The repeatability of the method of measurement was investigated.

Methods:

Thirty-five healthy non–contact lens wearers were enrolled. The following parameters were measured from digital images of the upper eyelid captured with a slitlamp camera: length, height, and total area of the tarsal plate and area of lid wiper staining (lissamine green). Measurements were performed in a randomized and masked fashion on two separate occasions by the same investigator using ImageJ (National Institutes of Health). Coefficients of repeatability (COR) were calculated.

Results:

The dimensions (mean±SD) of the tarsal plate were 20.6±1.9 mm length, 7.9±0.8 mm height, and 103.3±18.8 mm2 total area. The area of lid wiper staining was 2.7±2.0 mm2. No association was found between tarsal dimensions and lid wiper staining (all P>0.05). Image analysis COR values were 0.6 mm tarsal length, 0.1 mm tarsal height, 1.2 mm2 tarsal area, and 0.4 mm2 lid wiper staining. There was no significant difference between repeated measurements for any parameter (all P>0.05). Limits of agreement were narrow for all parameters, indicating good agreement between repeated measurements.

Conclusions:

This work has demonstrated that there is a wide range in the dimensions of the upper tarsal plate in an urban UK population. No association was found between the upper tarsal dimensions and lid wiper staining. ImageJ was shown to be a repeatable method to measure the dimensions of the upper tarsal plate and upper lid wiper staining.
Post-LASIK Visual Quality With a Corneoscleral Contact Lens to Treat Irregular Corneas
Authors: Porcar Esteban , España Enrique , Montalt Juan Carlos , Benlloch-Fornés Josefa Isabel , Peris-Martínez Cristina
Published: December 2015

Objective:

To evaluate the visual quality results of fitting a corneoscleral contact lens with multiaspheric geometry design (MAGD CScL) in subjects with irregular corneas after laser-assisted in situ keratomileusis (LASIK) surgery.

Methods:

From a database of patients evaluated for scleral contact lenses, we identified those with irregular corneas and visual problems after they underwent LASIK surgery for correcting myopia. They manifested unsatisfactory visual quality with their current contact lenses or glasses. Therefore, a MAGD CScL was fitted and monitored according to standardized fitting methodology. A diagnostic trial set was used in the fitting process. Visual acuity (VA), subjective visual quality (SVQ), and ocular aberrations were evaluated. A new re-evaluation of these parameters was performed after 1 year wearing MAGD CScL.

Results:

Eighteen eyes of 18 patients (10 male and 8 female) with irregular cornea after LASIK surgery participated in this study; their ages ranged from 27 to 39 years (mean±SD, 32.6±3.8 years). All patients showed good fitting characteristics: optimal values were seen for lens position and lens movement. Statistically significant differences were found between before and after fitting MAGD CScL in the VA (mean±SD, 0.14±0.03 logMAR and 0.01±0.06 logMAR, respectively; P<0.001); ocular aberrations of second-order, coma, spherical; and the total higher-order aberrations (HOAs) (all P<0.001). The total HOAs decreased by approximately 78% to normal levels after fitting MAGD CScL. In addition, SVQ was also significantly improved after fitting MAGD CScL (16 eyes were favorable or very favorable). After 1 year wearing MAGD CScL, no statistically significant differences were found in the total HOAs and VA in regard to the initial fitting.

Conclusions:

Corneoscleral contact lens with multiaspheric geometry design is proposed as an effective procedure, providing a good VA and an optimal visual quality on irregular corneas after LASIK surgery in myopic subjects.
Early Glaucoma Screening Using the Ibopamine Provocative Test
Authors: Domínguez-Dueñas Francisca , Plaza-Espinosa Leticia , Mundo-Fernández Eva E. , Jiménez-Reynoso Celeste A. , Barojas-Weber Everardo , Barrientos-Gutiérrez Tonatiuh
Published: December 2015

Purpose:

To evaluate the diagnostic ability of the ibopamine provocative test for early glaucoma detection.

Method:

A sample of 44 patients with suspicious optic discs was recruited and compared with 37 controls with normal optic discs and no ocular pathology. The ibopamine test was performed in all patients who were then followed up with diagnostic tests for glaucoma, visual fields, and spectral-domain optical coherence tomography.

Results:

Early glaucoma was diagnosed in 26 patients. The sensitivity of the ibopamine test to discriminate patients who had early glaucoma was 78.7%, with a specificity of 71.6%. In multivariable analyses adjusted for demographic and clinical variables, participants with a positive ibopamine test at baseline had an 8-fold higher risk of glaucoma compared with those who had a negative test; glaucoma risk was highest among ibopamine-positive subjects with initial clinical diagnostic impression of glaucoma.

Conclusions:

The ibopamine test showed an adequate diagnostic performance to detect individuals at increased risk of glaucoma in a very early stage of the disease. While further studies are required, the provocative ibopamine test for the diagnosis of early glaucoma is promissory.
Clinical Evaluation of Methods to Correct Intraocular Pressure Measurements by the Goldmann Applanation Tonometer, Ocular Response Analyzer, and Corvis ST Tonometer for the Effects of Corneal Stiffness Parameters
Authors: Bao FangJun , Huang ZiXu , Huang JinHai , Wang JunJie , Deng ManLi , Li LinNa , Yu AYong , Wang QinMei , Elsheikh Ahmed
Published: December 2015

Purpose:

To evaluate the effectiveness of methods to correct intraocular pressure (IOP) measurements obtained using the Goldmann applanation tonometer (GAT), the ocular response analyzer (ORA), and the Corvis ST tonometer (CVS) for the effects of corneal stiffness parameters: central corneal thickness (CCT), corneal curvature (R), and age in a Chinese population.

Patients and Methods:

Data were collected for 99 eyes of 99 participants. Whereas cornea-corrected IOP was obtained directly from ORA (ORA-IOPcc), cornea correction in GAT and CVS was implemented using multiparameter equations developed earlier. The study also included IOP measurements by the dynamic contour tonometer, which is thought to be less affected by corneal stiffness parameters than other tonometers. Statistical analyses were performed to determine the association of both uncorrected and corrected IOP with the main stiffness parameters: CCT, R, and age.

Results:

After correction, a significantly decreased association between the GAT (from r=0.15 to r=−0.02), ORA (from r=0.24 to r=−0.19), and CVS (from r=0.47 to r=0.004) IOP measurements and the CCT was found, to levels below that with the dynamic contour tonometer-IOP (r=0.11). The IOP measurements made by the 4 tonometers, both uncorrected and corrected, did not correlate with age. The same was true for R except with ORA-IOPcc (r=0.23).

Conclusions:

CCT accounted for the majority of variance in IOP, whereas age and R had a much smaller effect. The IOP correction processes studied were successful in reducing reliance of IOP measurements, especially those by GAT and CVS, on CCT in a healthy Chinese population.
Long-term Outcomes of Mitomycin-C Trabeculectomy in Exfoliative Glaucoma Versus Primary Open-Angle Glaucoma
Authors: Lim Su-Ho , Cha Soon Cheol
Published: December 2015

Purpose:

To compare long-term surgical outcomes in exfoliative glaucoma (XFG) versus primary open-angle glaucoma (POAG) after primary trabeculectomy with mitomycin-C.

Methods:

This retrospective, case-control study included 32 eyes of XFG and 64 eyes of POAG matched by propensity score analysis. Surgical success was defined according to 3 different criteria: (1) intraocular pressure (IOP)<18 mm Hg and IOP reduction ≥20% without medication; (2) IOP<15 mm Hg and IOP reduction ≥25% without medication; and (3) IOP<18 mm Hg and IOP reduction ≥20% with or without medication. Cumulative probabilities of success were compared using Kaplan-Meier survival analysis, and risk factors of surgical failure were analyzed.

Results:

Cumulative success rates were 84.4% at 1 year and 19.9% at 5 years for XFG, and 82.3% and 64.7%, respectively, for POAG by criterion A. Complete success rates were significantly lower for XFG than for POAG by criteria A and B. However, qualified success, as determined by criterion C, did not show a statistically significant difference. Postoperative hyphema was more frequent for XFG. The risk factors associated with surgical failure were a young age (<60 y; hazard ratio=2.58, P=0.047, criterion A) and exfoliation syndrome (hazard ratio=3.01, 2.96, P=0.006, 0.005, criteria A and B).

Conclusions:

Although trabeculectomy for XFG had success rates similar to POAG at 1 year, XFG showed poorer long-term IOP control from 2 years postoperatively. This study indicates that it is more difficult to achieve long-term low target IOP control in eyes with XFG than in eyes with POAG after trabeculectomy with mitomycin-C.