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Biomedical subjects

M Sherer

Publications and source records attributed to M Sherer.

At least 37 records · Page 2Linked to original sources
PubMed1996

Prospective assessment of presenting serum markers for cardiac risk stratification.

OBJECTIVE: To quantify the association of initial ED serum cardiac markers with the risk for life-threatening events (LEs) or need for lifesaving interventions (LIs) or administration of IV nitroglycerin. METHODS: A prospective, observational study was performed using a cohort of hemodynamically stable, hospitalized patients (age > or = 25 years) presenting with nontraumatic chest discomfort. Patients with ST-segment elevation on their initial ECGs were excluded. Presenting serum samples were assayed for serum myoglobin and creatine kinase-MB isomer (CK-MB) using the Opus and Stratus systems. Target cases were defined as patients having LEs (e.g., cardiogenic shock, ventricular fibrillation, cardiac arrest), requiring LIs (e.g., intubation, cardioversion, pacing, reperfusion therapy), or needing IV nitroglycerin within 48 hours. Manufacturer's thresholds defined abnormal marker levels. Abnormal ECGs were defined using the Brush criteria. RESULTS: Of the 178 eligible patients, 44 (25%) were target cases. Most (55%) target cases had blood drawn for assays within four hours of chest discomfort onset. The relative risk and sensitivity of the serum markers and the ECG for target cases follow: [table: see text] Of the seven patients with an LE/LI, six had blood drawn four hours or less after symptom onset; two LE/LI patients had abnormal myoglobin levels--no LE/LI patient had an abnormal CK-MB level. CONCLUSIONS: Isolated serum myoglobin and CK-MB levels obtained at patient ED presentation were not strongly associated with the 48-hour risk for LEs, LIs, or the use of IV nitroglycerin. Future studies of risk stratification should address the merits of serial serum marker measurements that extend up to 12 hours beyond patient symptom onset.

Adult↗
PubMed1996

Neuropsychological findings in a patient with Kernohan's notch.

This case report describes the use of neuropsychological testing to Iocalize and diagnose lesions The testing was instrumental in disentangling contradictory symptoms to reveal a Kernohan's notch (later confirmed by MRI), thus ruling out incorrect diagnoses We describe the case of a 36-year-old right-handed man who developed a left epidural hematoma after suffering head trauma from a blunt instrument Sequelae 2 months post-injury included left hemiparesis (ipsilateral to the lesion), dysphonic speech, severe naming/word-finding deficits, and severe memory impairment This patient's symptom pattern presented somewhat of a mystery as his cognitive deficits appeared consistent with left hemisphere damage, while his left motor symptoms suggested right hemisphere damage Medical records were inconsistent Deficits on neuropsychological testing at 3 months post-injury included impairment in verbal and visual memory, confrontation naming, and left-sided motor function Attention, visual-spatial skills, nonverbal problem solving, and right motor speed and coordination were intact A herniation syndrome, Kernohan's notch, was considered to be the most likely explanation This phenomenon occurs when a mass occupying lesion causes significant midline shift of the midbrain, pressing the contralateral cerebral peduncle against the tentorium This pressure produces an ischemic infact in the region of the corticospinal (motor) pathways Subsequent MRI confirmed a lesion in the right cerebral crus The pattern of neuropsychological finding in this patient is discussed.

Journal Article↗
PubMed1995

Do recognition-free recall discrepancies detect retrieval deficits in closed-head injury? An exploratory analysis with the California verbal learning test.

The present study examined the validity of the Recognition Discriminability-Long Delay Free Recall discrepancy from the California Verbal Learning Test (CVLT) as a sign of retrieval deficits in closed-head injury (CHI). Discrepancy and nondiscrepancy groups who differed in their Recognition Discriminability performance but were equated on Long-Delay Free Recall were compared on indices hypothesized to reveal performance patterns consistent with retrieval deficits. Results showed that the discrepancy group produced fewer intrusions. The two groups did not differ in their consistency of recall or relative degree of benefit from semantic cuing. Additional analysis using a discrepancy group with normal Recognition Discriminability scores but abnormal Long-Delay Free Recall performance did not alter these results. The hypotheses were not supported when patients with language deficits were excluded. The findings did not support the use of this discrepancy from the CVLT as a marker for retrieval deficits in CHI.

Adult↗
PubMed1995

Comparison of the California Verbal Learning Test and the Rey Auditory Verbal Learning Test in head-injured patients.

Performances of moderate and severe closed-head-injury patients were compared on the California Verbal Learning Test (CVLT) and Rey Auditory Verbal Learning Test (RAVLT). Results showed that raw scores were highly correlated between tests. There were no significant between-test differences in mean raw scores. However, standard scores calculated from existing CVLT and RAVLT norms were significantly lower on the CVLT than on the RAVLT. Furthermore, there were differences between the various RAVLT norm sets. The results indicate that although the CVLT and RAVLT measure similar cognitive processes in closed-head-injury patients, there are major discrepancies in test interpretation using existing norms. Test and norm set selection significantly influence the likelihood of a patient being classified as memory-impaired.

Adolescent↗
PubMed1995

A comparison of indices of premorbid intelligence in clinical populations.

Estimation of premorbid intelligence using the regression formula developed by Barona et al. (1984) was compared with prorated IQ's based on the higher of the Vocabulary or Picture Completion subtests from the WAIS-R. Actual and predicted premorbid IQ's of 50 brain-damaged patients were compared to those of 35 non-brain-damaged patient controls equated on age and education. For both groups, the Barona et al. (1984) formula produced mean IQ's close to 100, though greatly restricted the range. The prorated IQ's tended to be over-estimated in the patient control group, but not the brain-damaged group. Compared with the regression based formula, the distribution of these prorated IQ's was more consistent with the WAIS-R standardization sample.

Journal Article↗
PubMed1995

Interpretive significance of variability of performance on neuropsychological tests.

The interpretive significance of variability of performance on neuropsychological measures was investigated in groups of brain-damaged and non-brain-damaged subjects. The 39 brain-damaged subjects were matched on Full Scale IQ and age with 39 non-brain-damages subjects. The two groups failed to differ on a measure of level of performance, but did differ on variability of performance. The results were interpreted as providing support for the clinical utility of measures of variability of performance and indicating the need for additional investigation of such measures.

Journal Article↗
PubMed1994

Relative sensitivity of the WAIS-R subtests and selected HRNB measures to the effects of brain damage.

Reitan has argued that Halstead-Reitan Neuropsychological Battery measures are more sensitive to the effects of brain damage than are measures from the Wechsler intelligence scales. This proposal was investigated in groups of 65 brain-damaged subjects and 45 nonbrain-damaged controls equated for age and level of education and subgroups of 34 brain-damaged subjects and 34 nonbrain-damaged controls closely matched on age and WAIS-R full Scale IQ. Differences on Halstead-Reitan measures found in the larger groups were not found in the subgroups matched on age and IQ. Further, discriminant analyses showed that 11 Halstead-Reitan measures were equivalent to the 11 WAIS-R subtests in discriminating brain-damage and nonbrain-damaged subjects. Thus, the proposal for poorer sensitivity of the WAIS-R subtests was not supported.

Journal Article↗
PubMed1993

The development of verbal and nonverbal factorially derived memory measures.

Sets of verbal and nonverbal memory tests were subjected to a factor analysis, and the factor composite scores were used to discriminate between 57 brain-damaged and 34 non-brain-damaged subjects. The derived factors clearly represented verbal and nonverbal factors. The brain-damaged group performed significantly less well on both the verbal and nonverbal factor composite scores. It is suggested that a battery of verbal and nonverbal scales be used to discriminate left and right lateralized brain-damaged patient groups.

Adult↗
PubMed1993

Cross-validation of Reitan and Wolfson's Neuropsychological Deficit Scales.

Reitan and Wolfson developed and presented validity data on their Neuropsychological Deficit Scales and offered them as alternatives to Halstead's Impairment Index and Russell, Neuringer, and Goldstein's Average Impairment Rating. An initial cross-validation study of the scales was conducted with 73 brain-damaged subjects and 41 pseudoneurologic controls. Brain-damaged and pseudoneurologic subjects differed on the General Neuropsychological Deficit Scale. Groups of left hemisphere, diffuse, and right hemisphere brain-damaged subjects differed on the Left and Right Neuropsychological Deficit Scales. The General Neuropsychological Deficit Scale, Impairment Index, and Average Impairment Rating did not differ in accuracy of subject classification. Our findings provide limited support for the validity of these new scales with patients commonly seen in clinical practice.

Journal Article↗
PubMed1992

Eldercare foodservice: responding to the age of maturity.

America is rapidly aging. In response, foodservice professionals are breaking all precedents as they expand & market meal programs to accommodate the growing number of seniors in need of nutrition services. Five case studies illustrate how directors & dietitians are improving the quality of life for this nation's elders.

Aged↗