bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstructive Sleep Apnea and the Recurrence of Atrial Fibrillation
Authors: Kanagala Ravi , Murali Narayana S. , Friedman Paul A. , Ammash Naser M. , Gersh Bernard J. , Ballman Karla V. , M. Shamsuzzaman Abu S. , Somers Virend K.
Published: May 2003

Background—

We tested the hypothesis that patients with untreated obstructive sleep apnea (OSA) would be at increased risk for recurrence of atrial fibrillation (AF) after cardioversion.

Methods and Results—

We prospectively obtained data on history, echocardiogram, ECG, body mass index, hypertension, diabetes, NYHA functional class, ejection fraction, left atrial appendage velocity, and medications in patients with AF/atrial flutter referred for DC cardioversion. Forty-three individuals were identified as having OSA on the basis of a previous sleep study. Data regarding the use of continuous positive airway pressure (CPAP) and recurrence of AF were obtained for 39 of these patients. Follow-up data were also obtained in 79 randomly selected postcardioversion patients (controls) who did not have any previous sleep study. Twenty-seven of the 39 OSA patients either were not receiving any CPAP therapy (n=25) or were using CPAP inappropriately (n=2). Recurrence of AF at 12 months in these 27 patients was 82%, higher than the 42% recurrence in the treated OSA group (n=12,
P
=0.013) and the 53% recurrence (n=79,
P
=0.009) in the 79 control patients. Of the 25 OSA patients who had not been treated at all, the nocturnal fall in oxygen saturation was greater (
P
=0.034) in those who had recurrence of AF (n=20) than in those without recurrence (n=5).

Conclusions—

Patients with untreated OSA have a higher recurrence of AF after cardioversion than patients without a polysomnographic diagnosis of sleep apnea. Appropriate treatment with CPAP in OSA patients is associated with lower recurrence of AF.
Incomplete Resolution of ST-Segment Elevation Is a Marker of Transient Microcirculatory Dysfunction After Stenting for Acute Myocardial Infarction
Authors: Feldman Laurent J. , Coste Pierre , Furber Alain , Dupouy Patrick , Slama Michel S. , Monassier Jean-Pierre , Tron Christophe , Lafont Antoine , Faraggi Marc , Le Guludec Dominique , Dubois-Randé Jean-Luc , Steg P. Gabriel
Published: May 2003

Background—

Incomplete ST-segment resolution (STR) after successful primary angioplasty for acute myocardial infarction (AMI) is associated with a poor prognosis. We used intracoronary Doppler velocimetry to investigate whether incomplete STR after primary angioplasty is a marker of severe microcirculatory dysfunction.

Methods and Results—

Fifty patients with ≤12-hour AMI underwent successful primary angioplasty and systematic stenting with a Doppler guidewire. Patients with incomplete (<50%) STR 60 minutes after TIMI 3 flow was restored had flow velocity features suggestive of severe microcirculatory dysfunction, including a higher incidence of early systolic retrograde flow (41% versus 9%,
P
=0.007) and lower coronary flow velocity reserve (CVR, 1.3 versus 1.6,
P
<0.001). CVR improved immediately after stenting in patients with ≥50% STR but not in patients with <50% STR. There was a significant correlation between STR and poststent CVR. At 3 months, CVR was similar in patients with <50% and ≥50% STR. However, left ventriculography indicated lower global (42% versus 55%,
P
=0.001) and regional (16% versus 20%,
P
=0.03) left ventricular ejection fractions and
201
Tl rest-redistribution scintigraphy indicated a larger infarct size (34% versus 16%
201
Tl defect,
P
=0.007) in patients with <50% STR.

Conclusions—

After successful primary angioplasty with systematic stenting, <50% STR is a marker of severe albeit transient microcirculatory dysfunction in patients with AMI and is associated with more extensive myocardial damage.
Elevated Plasma Levels of the Atherogenic Mediator Soluble CD40 Ligand in Diabetic Patients
Authors: Varo Nerea , Vicent David , Libby Peter , Nuzzo Rebecca , Calle-Pascual Alfonso L. , Bernal María Rosa , Fernández-Cruz Arturo , Veves Aristidis , Jarolim Petr , Varo Jose Javier , Goldfine Allison , Horton Edward , Schönbeck Uwe
Published: May 2003

Background—

Considerable evidence implicates the proinflammatory cytokine CD40 ligand (CD40L) in atherosclerosis and accumulating data link type 1 and 2 diabetes, conditions associated with accelerated atherosclerosis, to inflammation. This study therefore evaluated the hypothesis that diabetic patients have elevated plasma levels of soluble CD40L (sCD40L) and that treatment with the insulin-sensitizing thiazolidinediones lowers this index of inflammation.

Methods and Results—

Subjects with type 1 (n=49) or type 2 diabetes (n=48) had higher (
P
<0.001) sCD40L plasma levels (6.56±3.27 and 6.67±2.90 ng/mL, respectively) compared with age-matched control groups (1.40±2.21 and 1.32±2.68 ng/mL, respectively). Multiple regression analysis demonstrated a significant (
P
<0.001) association between plasma sCD40L and type 1 as well as type 2 diabetes, independent of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, body mass index, gender, C-reactive protein, and soluble intracellular adhesion molecule-1. Furthermore, in a pilot study, administration of troglitazone (12 weeks, 600 mg/day), but not placebo, to type 2 diabetics (n=68) significantly (
P
<0.001) diminished sCD40L plasma levels by 29%. The thiazolidinedione lowered plasma sCD40L in type 2 diabetic patients with long-standing disease (>3 years) with or without macrovascular complications (−34% and −29%, respectively) as well as in type 2 diabetic patients with more recent (<3 years) onset of the disease (−27%; all
P
<0.05).

Conclusions—

This study provides new evidence that individuals with type 1 or 2 diabetes have a proinflammatory state as indicated by elevated levels of plasma sCD40L. Troglitazone treatment of type 2 diabetic patients diminishes sCD40L levels, suggesting a novel antiinflammatory mechanism for limiting diabetes-associated arterial disease.
Hypercapnic Acidosis Activates K
ATP
Channels in Vascular Smooth Muscles
Authors: Wang Xueren , Wu Jianping , Li Li , Chen Fuxue , Wang Runping , Jiang Chun
Published: May 2003

ATP-sensitive K
+
channels (K
ATP
) couple intermediary metabolism to cellular activity, and may play a role in the autoregulation of vascular tones. Such a regulation requires cellular mechanisms for sensing O
2
, CO
2
, and pH. Our recent studies have shown that the pancreatic K
ATP
isoform (Kir6.2/SUR1) is regulated by CO
2
/pH. To identify the vascular K
ATP
isoform(s) and elucidate its response to hypercapnic acidosis, we performed these studies on vascular smooth myocytes (VSMs). Whole-cell and single-channel currents were studied on VSMs acutely dissociated from mesenteric arteries and HEK293 cells expressing Kir6.1/SUR2B. Hypercapnic acidosis activated an inward rectifier current that was K
+
-selective and sensitive to levcromakalim and glibenclamide with unitary conductance of ≈35pS. The maximal activation occurred at pH 6.5 to 6.8, and the current was inhibited at pH 6.2 to 5.9. The cloned Kir6.1/SUR2B channel responded to hypercapnia and intracellular acidification in an almost identical pattern to the VSM current. In situ hybridization histochemistry revealed expression of Kir6.1/SUR2B mRNAs in mesenteric arteries. Hypercapnia produced vasodilation of the isolated and perfused mesenteric arteries. Pharmacological interference of the K
ATP
channels greatly eliminated the hypercapnic vasodilation. These results thus indicate that the Kir6.1/SUR2B channel is a critical player in the regulation of vascular tones during hypercapnic acidosis.
Low Vitamin B6 but Not Homocyst(e)ine Is Associated With Increased Risk of Stroke and Transient Ischemic Attack in the Era of Folic Acid Grain Fortification
Authors: Kelly Peter J. , Shih Vivian E. , Kistler J. Philip , Barron Megan , Lee Hang , Mandell Roseann , Furie Karen L.
Published: May 2003

Background and Purpose—

The introduction of cereal grain folic acid fortification in 1998 has reduced homocyst(e)ine (tHcy) concentrations in the US population. We performed a case-control study to determine the risk of stroke and transient ischemic attack (TIA) associated with tHcy and low vitamin status in a postfortification US sample.

Methods—

Consecutive cases with new ischemic stroke/TIA were compared with matched controls. Fasting tHcy, folate, pyridoxal 5′-phosphate (PLP), B12, and MTHFR 677C→T genotype were measured.

Results—

Mean PLP was significantly lower in cases than controls (39.97 versus 84.1 nmol/L,
P
<0.0001). After stroke risk factors were controlled for, a strong independent association was present between stroke/TIA and low PLP (adjusted odds ratio [OR], 4.6; 95% CI, 1.4 to 15.1;
P
<0.001) but not elevated tHcy (OR, 0.92; 95% CI, 0.4 to 2.1).

Conclusions—

Low B6 but not tHcy was strongly associated with cerebrovascular disease in this postfortification, folate-replete sample.
Community-Based Thrombolytic Therapy of Acute Ischemic Stroke in Helsinki
Authors: Lindsberg Perttu J. , Soinne Lauri , Roine Risto O. , Salonen Oili , Tatlisumak Turgut , Kallela Mikko , Häppölä Olli , Tiainen Marjaana , Haapaniemi Elena , Kuisma Markku , Kaste Markku
Published: May 2003

Background and Purpose—

Thrombolysis with alteplase is used in acute ischemic stroke within 3 hours after symptom onset in many stroke centers, but experience remains limited in Europe.

Methods—

Using eligibility and management criteria similar to those published by the American Heart Association, we treated 75 consecutive patients aged 21 to 83 years (mean age, 63.6 years; median Scandinavian Stroke Scale score, 32/58) with hemispheric infarction with alteplase in 1998–2001. Their neuroradiological findings (ischemic and hemorrhagic changes) and functional outcome at 3 months were evaluated.

Results—

Sixty-one percent of the patients had recovered functional independence (Barthel Index 95 to 100) at the 3-month follow-up. On the modified Rankin Scale (
mRS
), 37% (28/75) of patients had no or minimal symptoms (mRS 0 to 1), while 17% (13/75) remained dependent (mRS 4 to 5) and 5% (4/75) died. Cerebral parenchymal hematomas occurred in 8% (6/75) and hemorrhagic transformation in 8% (6/75) of the patients. Low initial diastolic blood pressure and administration of intravenous antihypertensive medication were associated with unfavorable outcome (mRS 3 to 6).

Conclusions—

We conclude that our management protocol for thrombolytic therapy is safe. These rates of functional outcome, case fatality, and hemorrhagic cerebral events compare favorably with those of other published series of stroke thrombolysis with similar time windows and management guidelines. Associations between blood pressure and its treatment during thrombolysis with functional outcome deserve further analysis.
Reasoning, Models, and Images: Behavioral Measures and Cortical Activity
Authors: Knauff Markus , Fangmeier Thomas , Ruff Christian C. , Johnson-Laird P. N.
Published: May 2003

The goal of this study was to investigate the neurocognitive processes of mental imagery in deductive reasoning. Behavioral studies yielded four sorts of verbal relations: (1) visuospatial relations that are easy to envisage both visually and spatially; (2) visual relations that are easy to envisage visually but hard to envisage spatially; (3) spatial relations that are hard to envisage visually but easy to envisage spatially; and (4) control relations that are hard to envisage both visually and spatially. In three experiments, visual relations slowed the process of reasoning in comparison with control relations, whereas visuospatial and spatial relations yielded inferences comparable to those of control relations. An experiment using functional magnetic resonance imaging showed that in the absence of any correlated visual input (problems were presented acoustically via headphones), all types of reasoning problems evoked activity in the left middle temporal gyrus, in the right superior parietal cortex, and bilaterally in the precuneus. In the prefrontal cortex, increased activity was found in the middle and inferior frontal gyri. However, only the problems based on visual relations also activated areas of the visual association cortex corresponding to V2. The results indicate that cortical activity during reasoning depends on the nature of verbal relations. All relations elicit mental models that underlie reasoning, but visual relations in addition elicit visual images. This account resolves inconsistencies in the previous literature.
Human Cerebellum: Surface-Assisted Cortical Parcellation and Volumetry with Magnetic Resonance Imaging
Authors: Makris Nikos , Hodge Steven M. , Haselgrove Christian , Kennedy David N. , Dale Anders , Fischl Bruce , Rosen Bruce R. , Harris Gordon , Caviness Verne S. , Schmahmann Jeremy D.
Published: May 2003

We describe a system of surface-assisted parcellation (SAP) of the human cerebellar cortex derived from neural systems functional and behavioral anatomy. This system is based on MRI and preserves the unique morphologic and topographic features of the individual cerebellum. All major fissures of the cerebellum were identified and traced in the flattened representation of the cerebellar cortex using the program “Free Surfer.” Parcellation of the cerebellar cortex followed using the fissure information in conjunction with landmarks using the program “Cardviews” to create 64 gyral-based cerebellar parcellation units. Computer-assisted algorithms enable the execution of the cerebellar parcellation procedure as well as volumetric measurements and topographic localization. The SAP technique makes it possible to represent multimodal structural and functional imaging data on the flattened surface of the cerebellar cortex as illustrated in one functional MRI experiment.
Openly Gay Athletes
Authors: ANDERSON ERIC
Published: May 2003

This research provides the first look into the experiences of openly gay male team sport athletes on ostensibly all-heterosexual teams. Although openly gay athletes were free from physical harassment, in the absence of a formal ban against gay athletes, sport resisted their acceptance and attempted to remain a site of orthodox masculine production by creating a culture of silence surrounding gay athleticism, by segmenting gay men's identities, and by persistently using homophobic discourse to discredit homosexuality in general. Sports attempt to tolerate gay male athletes when they contribute to the overarching ethos of sport—winning—but try to taint the creation of a gay identity within sport that would see homosexuality and athleticism as compatible. Still, by proving themselves successful in sport, and meeting most other mandates of hegemonic masculinity except for their sexual identity, gay male athletes show that hegemony is not seamless and that there is a possibility of softening hegemonic masculinity in the sporting realm.
Drug-induced thrombocytopenia: localization of the binding site of GPIX-specific quinine-dependent antibodies
Authors: Asvadi Parisa , Ahmadi Zohra , Chong Beng H.
Published: May 2003

Immune thrombocytopenia is a common complication of therapy with a large number of drugs. The most widely studied drug-induced immune thrombocytopenia (DIT) is caused by quinine. In most cases of DIT, antibodies bind to the platelet membrane glycoprotein (GP) Ib-IX complex in a drug-dependent fashion and bring about increased platelet clearance by the reticuloendothelial system resulting in thrombocytopenia. Here, we report the characterization of the quinine-dependent antibody activity of sera from 13 patients with quinine-induced thrombocytopenia. In our series of patients, GPIX was the most prevalent target of quinine-dependent antibodies. To identify the structural determinants of GPIX recognized by quinine-dependent antibodies, 4 chimeric mouse/human GPIX constructs and stable Chinese hamster ovary (CHO) cell lines that expressed the chimeras in association with GPIbα and GPIbβ were produced. The analysis of 6 patient sera with the chimeric cell lines provided evidence for localization of the anti-GPIX quinine-dependent antibody binding site to the C-ext region (amino acid [aa] 64-135) of human GPIX. Further characterization of the C-ext region of the GPIX indicated that replacement of the Arg110 and Gln115 of the human GPIX with the corresponding residues from mouse (Gln and Glu, respectively) resulted in a significant reduction in the binding of GPIX antibodies in our series of patients, with Arg110Gln, giving a more pronounced effect than Gln115Glu. Hence, these 2 residues, particularly Arg110, play an important role in the structure of the antigenic site on GPIX recognized by anti-GPIX antibodies.
Mithramycin induces fetal hemoglobin production in normal and thalassemic human erythroid precursor cells
Authors: Fibach Eitan , Bianchi Nicoletta , Borgatti Monica , Prus Eugenia , Gambari Roberto
Published: May 2003

We report in this paper that the DNA-binding drug mithramycin is a potent inducer of γ-globin mRNA accumulation and fetal hemoglobin (HbF) production in erythroid cells from healthy human subjects and β-thalassemia patients. Erythroid precursors derived from peripheral blood were grown in 2-phase liquid culture. In this procedure, early erythroid progenitors proliferate and differentiate during phase 1 (in the absence of erythropoietin) into late progenitors. In phase 2, in the presence of erythropoietin, the latter cells continue their proliferation and mature into Hb-containing orthochromatic normoblasts. Compounds were added on days 4 to 5 of phase 2 (when cells started to synthesize Hb), and cells were harvested on day 12. Accumulation of mRNAs for γ-globin, β-globin, α-globin, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and β-actin were measured by real-time quantitative reverse transcription–polymerase chain reaction (RT-PCR); induction of HbF was analyzed by high-performance liquid chromatography (HPLC) and, at cellular level, by flow cytometry. We demonstrated that mithramycin was able to up-regulate preferentially γ-globin mRNA production and to increase HbF accumulation, the percentage of HbF-containing cells, and their HbF content. Mithramycin was more effective than hydroxyurea, being, in addition, not cytotoxic. This was shown by the lack of cytotoxicity on erythroid and myeloid in vitro primary cell cultures treated with mithramycin at concentrations effective for HbF induction. These results are of potential clinical significance because an increase of HbF alleviates the symptoms underlying β-thalassemia and sickle cell anemia. The results of this report suggest that mithramycin and its analogs warrant further evaluation as potential therapeutic drugs.
Sustained phenotypic correction of canine hemophilia A using an adeno-associated viral vector
Authors: Scallan Ciaran D. , Lillicrap David , Jiang Haiyan , Qian Xiaobing , Patarroyo-White Susannah L. , Parker Amy E. , Liu Tongyao , Vargas Joseph , Nagy Dea , Powell Sharon K. , Wright J. Fraser , Turner Patricia V. , Tinlin Shawn J. , Webster Sandra E. , McClelland Alan , Couto Linda B.
Published: May 2003

Gene therapy for hemophilia A requires efficient delivery of the factor VIII gene and sustained protein expression at circulating levels of at least 1% to 2% of normal. Adeno-associated viral type 2 (AAV2) vectors have a number of advantages over other viral vectors, including an excellent safety profile and persistent gene expression. However, a major disadvantage is their small packaging capacity, which has hampered their use in treating diseases such as hemophilia A, cystic fibrosis, and muscular dystrophy, which are caused by mutations in large genes. Here we demonstrate that this can be overcome by using small regulatory elements to drive expression of a B-domain–deleted form of FVIII. The use of this vector for hepatic gene transfer in a canine model of hemophilia A resulted in the sustained (> 14 months) expression of biologically active FVIII. FVIII activity levels of 2% to 4% were achieved. These levels correlated with a partial correction in the whole-blood clotting time and cuticle bleeding time. In addition, immunoprecipitation analysis demonstrated the expression of canine FVIII of the predicted size in the plasma of injected animals. These data support the use of AAV2 vectors in human clinical trials to treat hemophilia A patients.
Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis
Authors: Moviat MAM , van Haren FMP , van der Hoeven JG
Published: May 2003

Introduction

Metabolic acidosis is the most frequent acid–base disorder in the intensive care unit. The optimal analysis of the underlying mechanisms is unknown.

Aim

To compare the conventional approach with the physicochemical approach in quantifying complicated metabolic acidosis in patients in the intensive care unit

Patients and methods

We included 50 consecutive patients with a metabolic acidosis (standard base excess ≤ -5). We measured sodium, potassium, calcium, magnesium, chloride, lactate, creatinine, urea, phosphate, albumin, pH, and arterial carbon dioxide and oxygen tensions in every patient. We then calculated HCO3-, the base excess, the anion gap, the albumin-corrected anion gap, the apparent strong ion difference, the effective strong ion difference and the strong ion gap.

Results

Most patients had multiple underlying mechanisms explaining the metabolic acidosis. Unmeasured strong anions were present in 98%, hyperchloremia was present in 80% and elevated lactate levels were present in 62% of patients. Calculation of the anion gap was not useful for the detection of hyperlactatemia. There was an excellent relation between the strong ion gap and the albumin-corrected and lactate-corrected anion gap (r2 = 0.934), with a bias of 1.86 and a precision of 0.96.

Conclusion

Multiple underlying mechanisms are present in most intensive care unit patients with a metabolic acidosis. These mechanisms are reliably determined by measuring the lactate-corrected and albumin-corrected anion gap. Calculation of the more time-consuming strong ion gap according to Stewart is therefore unnecessary.
A Delphi study of self-care in a community population of people with multiple sclerosis
Authors: O'Hara Louise , De Souza Lorraine H , Ide Lorely
Published: May 2003

Objective: The aim of the study was to obtain the views and priorities of people with multiple sclerosis (MS) to inform the design of a professionally guided self-care programme.

Design: A three-round postal Delphi survey was used as a research tool.

Setting: The study was conducted at the Centre for Research in Rehabilitation at Brunel University in London.

Subjects: The respondent panel consisted of 200 volunteers with MS of whom 136 responded to the survey (68%). Respondents were recruited through voluntary organizations throughout the UK. The only selection criterion was that the diagnosis of MS was confirmed by the general practitioner.

Main outcome measures: The results from each of the three rounds of the Delphi survey were the outcome measures.

Results: One hundred and one people used ten or more self-care strategies (74%). Round 1 data revealed the diversity of practices reported, crossing many domains of life such as daily chores, leisure, relationships and physical and mental health. The top five priorities identified in rounds 2 and 3 concerned coping strategies, social support, independence in daily living, rest and mobility. Complete consensus about priorities was not achieved. However, agreement about priorities approached stability across rounds 2 and 3 and a highly significant Kendall's coefficient of concordance indicated there was good agreement within round 3 group rankings (W = 0.46, chi-squared = 499.37, df = 9, p<0.001, N = 122).

Conclusion: Self-care practices were widespread, and those most commonly used could be identified. This survey method allows the views and priorities of this consumer group to be revealed. The information obtained can be used to develop services where the professional guides and encourages appropriate self-management based upon the issues that people with MS consider to be most important.
A questionnaire assessment of unmet needs for rehabilitation services and resources for people with multiple sclerosis: results of a pilot survey in five European countries
Authors: Kersten P , McLellan D L , Gross-Paju K , Grigoriadis N , Bencivenga R , Beneton C , Charlier M , Ketelaer P , Thompson A J
Published: May 2003

Objective: To develop an international services and needs assessment instrument (SUN) for people with multiple sclerosis and their carers and to pilot this in different countries of the European Community.

Design: Interview study of people with multiple sclerosis, their carers and nominated key professionals examining the unmet needs of patients and carers.

Setting: Belgium, Estonia, Greece, Italy and the United Kingdom.

Main outcome measures: Needs assessment questionnaire.

Results: The study comprised 137 people with multiple sclerosis, 125 carers and 111 professionals. Patients reported on average 2.9 unmet needs for themselves; their carers and professionals reported on average 2.4. Needs were categorized into seven broad categories. Due to difficulties experienced by the local researchers in distinguishing between needs and objectives a large proportion of needs had to be assigned to the ‘other’ category.

Conclusions: The SUN is a valuable and practicable tool for the identification of unmet needs for people with multiple sclerosis and their carers. Formal validation and reliability testing of the different language versions is recommended.
Change in identity and self-concept: a new theoretical approach to recovery following a stroke
Authors: Ellis-Hill Caroline S , Horn Sandra
Published: May 2003

Objective: To determine whether respondents reported a change in identity following stroke.

Design: A cross-sectional comparison study of perceived changes in the self-concept of stroke respondents and matched hospital volunteers. A questionnaire was administered to stroke respondents in their own homes and to hospital volunteers in their work setting.

Participants: Twenty-six first-time stroke survivors who had no severe communication, cognitive or perceptual difficulties or previous physical disability, and who had returned home from hospital up to two years previously. The comparison group were 26 hospital volunteers matched for age, gender and the time from which past self-concept was considered.

Main outcome measures: Included the Hospital Anxiety and Depression Scale, Frenchay Activity Index and the Head Injury Semantic Differential Scale to assess past and present self-concept.

Results: Overall, individuals described themselves in more negative terms than prior to their stroke. They saw themselves as less interested, capable and independent, (p < 0.001) and less in control, satisfied and active (p < 0.05). They still saw themselves as friendly, calm, caring, hopeful and talkative. The overall self-concept of the comparison group remained positive and stable over a comparable time period.

Conclusions: The stroke respondents reported a negative sense of self, reduced social activity and psychological morbidity despite inpatient and outpatient rehabilitation. Individuals following stroke may settle for a restricted future because of their expectations of life with a disability. Clinicians need to be aware of the meaning of the stroke within the life of each individual.
Unpacking the ‘black box’ of a nurse-led stroke support service
Authors: Dowswell George , Lawler John , Young John
Published: May 2003

Objectives: To describe in detail the nature of the specialist nurse interventions; to increase understanding of the principal problems facing stroke patients and their care-givers in the first year following stroke and to demonstrate how these problems may change over time; and to investigate the value of qualitative research methodologies within the context of a randomized trial.

Methods: Specialist nurses providing support in the year following stroke were asked to maintain comprehensive written records of their involvement with all patients and care-givers participating in a randomized controlled trial. Qualitative methods were used to examine the problems faced by stroke patients and their care-givers, and the actions taken by nurses in response.

Results: Specialist nurses commenced 120 records. As 19 patients died or left the area during the year-long interventions, we obtained 101 complete records. The problems encountered by stroke patients and their care-givers were numerous, diverse, complex and changed over time. Initially, practical difficulties were noted; over time, these were accompanied by growing numbers of psychological needs. The nurses responded by providing information, advice, support and monitoring using a flexible, individualized approach. The nurses also collaborated or liaised with 17 other professional groups and provided direct support to care-givers.

Conclusion: The need for many stroke patients and their care-givers to be professionally supported during the stages of stroke adjustment, for at least the first year and probably beyond, was emphasized by this study.
A randomized controlled trial of the Geriatric Depression Scale in an inpatient ward for older adults
Authors: Weatherall Mark
Published: May 2003

Objectives: To measure the prevalence of high scores on the Geriatric Depression Scale in an inpatient unit for older people and assess whether administration of this instrument increased the use of antidepressant medication.

Design: Randomized controlled trial.

Setting: Inpatient unit for assessment, treatment and rehabilitation of older adults in a district hospital.

Subjects: Consecutive admissions to the inpatient unit were approached. Of 198 people, 100 gave consent and were randomized to receive the intervention.

Interventions: The Geriatric Depression Scale and the Folstein Mini-mental State Examination were administered to the intervention group. The Nottingham Instrumental Activities of Daily Living questionnaire and the Folstein Mini-mental State Examination were administered to the placebo group. The scores of these instruments and a copy of the completed instrument were placed in the subject's case notes. For those subjects randomized to receive the Geriatric Depression Scale an interpretation of the score was written in the case notes.

Main outcome measures: The primary outcome measure was whether antidepressant medication was listed on the discharge summary for the admission. Other outcome measures were death, readmission and use of antidepressant medication three months after administration of the instruments.

Results: There was a prevalence of Geriatric Depression Scale scores greater than 10 of 52% in the 50 people administered this instrument. Six out of 46 people administered the Geriatric Depression Scale, who were discharged in the study period, were on antidepressant medication at discharge. Three out of 47 people administered the placebo instrument were on antidepressant medication at discharge. The absolute difference in proportions was 6.7%, 95% confidence interval 19 to – 5.3%.

Conclusions: A high proportion of patients admitted to an inpatient unit for assessment, treatment and rehabilitation scored in the depressed range on the Geriatric Depression Scale; however, use of the Geriatric Depression Scale in this clinical setting did not increase the use of antidepressant medication. This may be because the instrument is too nonspecific.
Weight-bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights
Authors: Laufer Yocheved , Dickstein Ruth , Resnik Sarit , Marcovitz Emanuel
Published: May 2003

Objective: To examine and compare the effect of stepping on stairs of various heights on lower extremity weight bearing in hemiparetic patients.

Setting: Flieman Geriatric Rehabilitation Hospital, Haifa, Israel.

Subjects: Fifteen ambulatory hemiparetic patients following an acute cerebrovascular accident, and 16 age-matched healthy controls.

Interventions: Each subject was tested twice on two consecutive days in five weight-bearing positions which included level stance and stepping with either leg on 10-cm- and 17-cm-high steps. Data concerning weight distribution on the lower extremities were collected by two computerized forceplates.

Main outcome measure: Weight borne by each foot expressed as percentage of overall body weight.

Results: In the attempted symmetrical level stance, the percentage of body weight borne by the paretic limb of the stroke patients was significantly lower than that of the nonparetic limb. Placing one foot on a step induced a weight shift to the foot placed on the floor regardless of step height. Weight shifting to the paretic limb was, however, significantly lower than to the nonparetic limb. Weight shifting to the nonparetic limb was significantly lower than to the corresponding limb of healthy individuals. Step height had no significant effect on weight distributions on the feet.

Conclusions: Raising a foot on a step appears to be an appropriate strategy for weight shift training of stroke patients. Since weight shifting to both the paretic and nonparetic limb of stroke patients is impaired, treatment strategies should include training in weight shifting to both lower extremities.
Accuracy of physical and occupational therapists' early predictions of recovery after severe middle cerebral artery stroke
Authors: Kwakkel Gert , van Dijk Gabriella M , Wagenaar Robert C
Published: May 2003

Methods: Within the second and fifth week after stroke onset, 364 predictions were made by 59 PTs and 47 OTs about walking ability, dexterity, activities of daily living (ADL), need for additional care in ADL, time required to achieve independent walking ability and maximal level of ADL, and destination of discharge at six months after stroke. The functional recovery patterns of stroke patients were assessed by an independent observer. The accuracy of the therapists' predictions was compared with that of derived prediction models. In addition, the influence of characteristics of patients and therapists on the accuracy of the predictions was investigated.

Results: Compared to observed outcomes at six months after stroke, therapists' lowest accuracies of prediction were found for the moment at which maximal ADL score was achieved (rs = 0.07; p = NS), and highest accuracy was for level of dexterity of the hemiplegic arm (rs = 0.78; p <0.01). Therapists' predictions of functional outcome at six months tended to be too pessimistic. No significant differences were observed for dexterity and walking ability when the predictions by PTs and OTs were compared with those of regression models, whereas significant differences were found for the accuracies of OTs and PTs’ first prediction of destination of discharge and second predictions of outcome in ADL and need for additional care in ADL. No significant differences were found between the accuracy of PTs' and OTs' predictions, and their ability to predict functional outcome was not significantly influenced by the characteristics of patient and therapists.

Conclusions: At two and five weeks after stroke, OTs and PTs can accurately predict level of walking ability and dexterity at six months. The prediction of time required for achieving maximal level of recovery, destination of discharge, outcome of ADL as well as need for additional care in ADL leaves room for improvement.
Evaluation of three methods to rate impairment in patients with complex regional pain syndrome I of one upper extremity
Authors: Oerlemans H Margreet , Oostendorp Rob Ab , de Boo Theo , Goris R Jan A
Published: May 2003

Objective: To gain insight into the best way of obtaining an impairment rating in complex regional pain syndrome I (CRPS I) of the upper extremity. This syndrome can potentially result in permanent impairment.

Design: Comparison of three evaluation methods to obtain impairment scores. Each patient was seen by one tester; two testers in total participated in the research.

Setting: Outpatient clinic of a university hospital.

Subjects: Seventy-four patients (27 men, 47 women, mean age 52 years) with CRPS I of one upper extremity.

Main outcome measures: Methods I and II were conducted according to the American Medical Association's Guides to the evaluation of permanent impairment: method I according to the general guidelines, and method II according to the methodology specificially described for CRPS I. Method III was developed by the Dutch Association of Neurologists. For comparison, differences between methods were plotted against their mean ratings, with the limits of agreement. Also the paired t-statistics were calculated (= 0.05/3).

Results: The mean difference between methods I and II was – 0.7% whole body impairment, between methods II and III 8.1% and between methods I and III 7.3%. Outcomes obtained with method III differed significantly from the other outcomes.

Conclusions: Method I most accurately and objectively reflected the permanent impairment level resulting from CRPS I.
A comparison of three measures of progress in early lower limb amputee rehabilitation
Authors: Panesar B S , Morrison P , Hunter J
Published: May 2003

Objective: To assess the responsiveness to change and validity of three established outcome measures in relation to early lower limb vascular amputee rehabilitation: the Functional Independence Measure (FIM), the Office of Population Censuses and Surveys Scale (OPCS) and the Amputee Activity Score (AAS).

Design: Prospective observational study. Setting: Inpatient amputee rehabilitation unit. Subjects: Fifty-one consecutive patients admitted for rehabilitation following lower limb amputation for vascular disease.

Procedure: To study the responsiveness to change differences between total scores and between subsection scores at different times were analysed. To assess validity, comparisons of the total scores of the measures were made with each other, and the total scores for each measure were compared with other outcomes.

Results: Complete scores were obtained on 34 subjects. All measures showed significant change between admission and discharge (p < 0.00001) but only the AAS showed change between discharge and follow-up (p < 0.0001). Subsection analysis revealed expected improvements in mobility. During the inpatient stage progress was also detected in certain activities of daily living in the FIM and OPCS. The measures correlated with each other (p < 0.001). All of the measures’ admission scores correlated with duration of stay (OPCS p < 0.005, AAS p < 0.006, FIM p < 0.009) and admission OPCS also correlated with discharge placement (p < 0.036).

Conclusion: The FIM and OPCS are suitable for the inpatient stage but the AAS would appear to be the best measure at time of discharge and thereafter, and further studies are justified.
Cross-cultural validation of the London Handicap Scale in Hong Kong Chinese
Authors: Lo Raymond , Harwood Rowan , Woo Jean , Yeung Fai , Ebrahim Shah
Published: May 2003

Study objective: To investigate the cross-cultural validity of London Handicap Scale in Hong Kong Chinese.

Design: Ratings of the utility of 10 hypothetical health scenarios were given by groups of HK Chinese subjects. Measured scores were compared with calculated scores from published scale weights of London Handicap Scale, which were based on utility ratings made by UK subjects.

Setting: A rehabilitation hospital in Hong Kong.

Subjects: A total of 164 HK Chinese, comprising doctors, medical students, nonmedical hospital staff, geriatric day hospital stroke and nonstroke patients, community day-care centre elderly, old age hostel elderly, young disabled inpatients and young community-dwelling disabled citizens.

Main results: There was a close correlation between the mean scores of HK subjects and the calculated scores derived from the published UK scale weights, apart from one scenario (Pearson's correlation coefficient r = 0.87 p = 0.001). The correlations were high for all subgroups, between which there was good consensus. Measured utilities were significantly different between subgroups for only one scenario. For this scenario of moderate to severe handicap in mobility, physical dependence, occupation and social integration, but with excellent orientation and economic self sufficiency: (1) older age groups gave better scores than younger age groups (p < 0.0005); (2) subjects with poor subjective health status gave better scores than those with good subjective health status (p = 0.002); (3) subjects related to the medical or hospital field, i.e. doctors, medical students and nonmedical hospital staff, gave worse scores than other subject groups (p < 0.0005).

Conclusion: The concept of handicap applies across cultures. Perception of severity of selected real life handicap scenarios by HK Chinese were well estimated using scale weights from UK populations developed for the London Handicap Scale. Significant differences in perception of certain handicap scenarios by different population subgroups deserve further study.
Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test
Authors: Wright D J , Khan K M , Gossage E M , Saltissi S
Published: May 2003

Objective: To examine the utility of the six-minute walk test (6′WT), in assessing the effectiveness of a six-week cardiac rehabilitation programme, of which exercise training was an integral part.

Setting: Royal Liverpool and Broad Green Hospitals Rehabilitation Unit.

Design: Two hundred and thirty-nine consecutive patients referred for cardiac rehabilitation were allocated to one of two groups. In group A 209 entered and 159 completed the usual rehabilitation programme whilst group B patients (n = 30) acted as a control by deferring entry to the programme for six weeks, continuing only activities of daily living.

Outcome measures: Both groups were assessed using the 6′WT, peak expiratory flow rate (PEFR) and isometric grip strength at enrolment and six weeks.

Results: At baseline, groups A and B were demographically identical without significant differences in terms of 6′WT, PEFR or grip strength. Following the study period, group A showed a significant increase in 6′WT from 314.7 ± 76.2 to 377.3 ± 78.6 m, in PEFR from 406.9 ± 115.9 to 437.8 ± 118.6 litres per minute and in grip strength from 28.8 ± 9.31 to 30.3 ± 8.93 kg, all p < 0.001. There were no significant changes in group B.

Conclusions: The 6′WT proved to be a simple and effective measurement of functional capacity in patients performing cardiac rehabilitation. The clinical programme investigated successfully increased patients' functional capacity as assessed by the 6′WT. Significant improvement in PEFR and grip strength was also demonstrated, compared with a control population.
Developing a disease-specific quality of life measure for people with multiple sclerosis
Authors: Ford H L , Gerry E , Tennant A , Whalley D , Haigh R , Johnson M H
Published: May 2003

Objectives: To develop a patient-completed disease-specific measure of quality of life in multiple sclerosis and to validate the measure in a community-based population of people with multiple sclerosis.

Methods: The items in the scale were selected in focus group sessions of people with multiple sclerosis. The initial scale included 25 items and was tested in subgroups of 150 people from a population register of people with multiple sclerosis in Leeds. Following further developmental phases, a restructured 16-item scale was tested on a random sample of 200 people with multiple sclerosis from the population register, stratified according to disease course. This led to a final eight-item unidimensional scale, the Leeds Multiple Sclerosis Quality of Life (LMSQoL) scale.

Results: After initial development a 16-item scale was found to be both reliable and valid. Cronbach' s alpha for the 16-item scale was 0.86. The test–retest correlation was 0.74, using a two-week retest interval. However, convergent validity with the General Well Being Index was 0.67 and with the SF-36 Physical Function Scale was 0.68. This suggested that the scale straddled these two concepts and was confirmed by fit of the data to the Rasch measurement model. This revealed the potential for a reduced eight-item version of the scale. The eight-item scale had a closer association to well-being (0.83) than to physical function (0.39), had good internal consistency (0.79) and test–retest reliability (0.85). There were virtually no floor or ceiling effects for the scale.

Conclusions: The study presents a disease-specific measure of quality of life in multiple sclerosis, the Leeds Multiple Sclerosis Quality of Life (LMSQoL) scale. The instrument is brief, easy to use and practical to administer in clinic or as a postal questionnaire. It measures a construct related to well-being, and provides an important adjunct to the measurement of outcome in multiple sclerosis.
A comparison of mobility assessments in a geriatric day hospital
Authors: Spilg Edward G , Martin Brendan J , Mitchell Sarah L , Aitchison Tom C
Published: May 2003

Objective: To assess the sensitivity of the Elderly Mobility Scale (EMS) to detect improvements in mobility after physiotherapy in comparison with the Barthel Index (BI) and Functional Ambulation Category (FAC) in routine clinical day hospital practice.

Subjects: Eighty-three patients who completed a course of physiotherapy were studied.

Methods: Each was assessed by an independent physiotherapist before and after a programme of physiotherapy, using the EMS, BI and FAC.

Results: The mean age was 79 years (SD 7.7). Fifty-three out of 83 (64%) patients were female and 92% were community dwelling. The median number of physiotherapy sessions undergone by each patient was 9 (range 3–51). All three scales detected an improvement in mobility with physiotherapy (p < 0.001). However, using the EMS, 68 out of 82 (83%) patients had a detectable improvement in mobility compared with only 34 out of 80 (42%) using the BI and 28 out of 81 (35%) using the FAC. Using a matched-pairs comparison, the EMS was significantly more likely to detect an improvement in mobility following physiotherapy within the study group than the BI (p < 0.001) or the FAC (p < 0.001).

Conclusion: Although all three scales detected improvements in mobility, the EMS detected mobility improvements in a significantly greater number of patients.
Adaptation of the Functional Independence Measure for use in Turkey
Authors: Küçükdeveci Ayse A , Yavuzer Günes , Elhan Atilla H , Sonel Birkan , Tennant Alan
Published: May 2003

Objective: To adapt the Functional Independence Measure (FIM) for use in Turkey and to assess its validity and reliability.

Design: After the translation procedure, reliability was assessed using internal consistency, inter-rater reliability (kappa) and the intraclass correlation coefficient (ICC). Construct validity was tested by association with impairments and by fit of data to the Rasch model.

Setting: The study was undertaken in an inpatient rehabilitation unit of the Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ankara.

Subjects: Consecutive stroke (n = 51) and spinal cord injury (SCI) (n = 62) patients admitted for rehabilitation over a period of three years were assessed at admission and discharge.

Results: Internal consistency was good for stroke, and for SCI. The level of agreement between two raters was sufficient with kappa levels of above 0.48 for SCI and above 0.44 for stroke. Minimum ICC found was 0.90. Construct validity showed expected associations with the impairment scales. However, Rasch analysis showed that bladder and bowel items compromise unidimensionality in the motor scale.

Conclusion: Adaptation of the FIM has been successful and it can be used in Turkey as long as the limitations are recognized.