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Biomedical subjects

Henry C Weinstein

Publications and source records attributed to Henry C Weinstein.

5 recordsLinked to original sources
PubMed2004

Validation of the HIV Dementia Scale in an elderly cohort of patients with subcortical cognitive impairment caused by subcortical ischaemic vascular disease or a normal pressure hydrocephalus.

INTRODUCTION: Most cognitive screening instruments are tailored to detect symptoms of cortical dysfunction in the elderly. Therefore, subcortical cognitive dysfunction may be missed using these tests. The aim of this study was to validate the Human Immunodeficiency Virus (HIV) Dementia Scale (HDS), a screening test developed to detect subcortical cognitive dysfunction in young HIV-infected patients, in a group of elderly patients with subcortical cognitive impairment (SCI) caused by subcortical ischaemic vascular disease (SIVD) or a normal pressure hydrocephalus (NPH). MATERIALS AND METHODS: 53 patients with SCI caused by SIVD or an NPH and 54 age-matched control subjects without cognitive impairment were included. All subjects underwent the HDS and the Mini-Mental State Examination (MMSE). A neuropsychological examination was used as the best reference test for the diagnosis of SCI. RESULTS: The mean HDS score (maximum 16) was 5.1 +/- 3.5 in the SCI patients and 13.0 +/- 2.4 in the controls (p < 0.0001). The mean MMSE score (maximum 30) was 26.5 +/- 3.1 in the SCI group and 28.6 +/- 1.4 in the controls (p < 0.0001). Among subjects who had an MMSE score of more than 26 points, SCI patients (n = 35) also scored significantly lower on the HDS than controls (n = 50), mean scores being 6.2 +/- 3.4 and 13.0 +/- 2.4, respectively (p < 0.0001). A receiver-operating characteristics curve was used to detect the optimal sensitivity and specificity of the HDS. A cut-off score of 9 yielded 91% sensitivity (95% CI: 79-97) and 96% specificity (95% CI: 87-99). With this cut-off score, the positive predictive value was 96% (95% CI: 86-99) and the negative predictive value was 91% (95% CI: 81-97). CONCLUSIONS: These results suggest that the HDS is able to detect SCI in an elderly population with SIVD or NPH and a normal MMSE score, and warrant its further development as a screening tool for SCI.

AIDS Dementia Complex↗
PubMed2003

Operational definitions for the NINDS-AIREN criteria for vascular dementia: an interobserver study.

BACKGROUND AND PURPOSE: Vascular dementia (VaD) is thought to be the most common cause of dementia after Alzheimer's disease. The commonly used International Workshop of the National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) criteria for VaD necessitate evidence of vascular disease on CT or MRI of the brain. The purposes of our study were to operationalize the radiological part of the NINDS-AIREN criteria and to assess the effect of this operationalization on interobserver agreement. METHODS: Six experienced and 4 inexperienced observers rated a set of 40 MRI studies of patients with clinically suspected VaD twice using the NINDS-AIREN set of radiological criteria. After the first reading session, operational definitions were conceived, which were subsequently used in the second reading session. Interobserver reproducibility was measured by Cohen's kappa. RESULTS: Overall agreement at the first reading session was poor (kappa=0.29) and improved slightly after application of the additional definitions (kappa=0.38). Raters in the experienced group improved their agreement from almost moderate (kappa=0.39) to good (0.62). The inexperienced group started out with poor agreement (kappa=0.17) and did not improve (kappa=0.18). The experienced group improved in both the large- and small-vessel categories, whereas the inexperienced group improved generally in the extensive white matter hyperintensities categories. CONCLUSIONS: Considerable interobserver variability exists for the assessment of the radiological part of the NINDS-AIREN criteria. Use of operational definitions improves agreement but only for already experienced observers.

Brain↗
PubMed2002

Ethics issues in security hospitals.

The term 'security hospital' is used for a variety of facilities including forensic hospitals and prison hospitals, which, because of their mission, the nature of their work, and the populations they serve-or because of the authority under which they operate-place the staff at considerable risk of ethical violations related to either clinical care or to forensic activities. The problem of divided loyalties is of special concern in security hospitals. Ethics principles particularly at risk are confidentiality and informed consent. Where there are cultural disparities between the staff and the patients, differences in background, socioeconomic class, education, and other types of diversity, cultural awareness is required and must be reflected in appropriate treatment and evaluation. To counteract the risks of ethical violations, a security hospital should create an ethical climate and develop means to anticipate, prevent, and deal with ethical violations. These might include detailed and specific policies and procedures, programs of orientation, education, consultation, and liaison as well as its own ethics committee.

Ethics, Institutional↗