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Biomedical subjects

W Koopman

Publications and source records attributed to W Koopman.

10 recordsLinked to original sources
PubMed1999

The natural history of multiple sclerosis: a geographically based study. 7. Progressive-relapsing and relapsing-progressive multiple sclerosis: a re-evaluation.

Classifications of multiple sclerosis subtypes have been largely based on clinical phenomenology. Nevertheless, definitions of relapse, remission and progression have been imprecise. Recently an international consensus group, as part of a reclassification of disease subtypes, recommended dropping the term 'relapsing-progressive' (RP) and retaining the term 'progressive-relapsing' (PR) multiple sclerosis. The term 'RP' multiple sclerosis had been applied when the early course combined both relapses and progression and was believed to identify some patients with a worse than average outcome. The PR group consisted of patients with primary progressive disease who later in their course developed relapses. Since the terminology has been largely arbitrary, we have evaluated the validity of the terms 'RP' and 'PR' multiple sclerosis in the context of long-term outcome within a large population-based cohort of progressive multiple sclerosis patients seen at the London Multiple Sclerosis Clinic (Canada) between 1972 and 1984. Mean follow-up of the entire cohort was 25 years. Designation of RP multiple sclerosis did identify a more rapidly progressive subgroup. To realign these natural history data with consensus recommendations, these patients were reassigned to secondary progressive (SP) or to primary progressive (PP) multiple sclerosis, with progression defined as at least 1 year of progressive deterioration. PP multiple sclerosis patients with relapses after a year were designated as having PR multiple sclerosis. Relapses in primary progressive multiple sclerosis occurred in 27.8% of patients at some point even two to three decades after onset. In general these relapses were mild and remitting, but served to blur the distinction between progressive and relapsing-remitting disease. The long-term outcomes of time to Kurtzke disability scores (DSS) of 3, 6, 8 and 10 were compared among the progressive subtypes. Times to these disability end-points and to death were not different between PR and PP multiple sclerosis. Survival curves for progressive patients have been amended to incorporate the reassignment of PR multiple sclerosis patients into the PP group and the RP multiple sclerosis patients into the PP and SP subgroups. The time to reach DDS 3, 6, 8 and 10 for a population-based cohort of primary and secondary progressive patients resulting from the elimination of the categories of RP multiple sclerosis and PR multiple sclerosis has been established. These results provide justification for retaining only PP and SP multiple sclerosis as the subgroups of progressive disease.

Adult↗
PubMed1999

The journey to multiple sclerosis: a qualitative study.

The diagnosis of multiple sclerosis (MS) often creates more questions than answers. It is not uncommon to hear about individuals who receive the diagnosis with relief and surprise, However, the implications of being diagnosed with a chronic illness like MS is complex. There is no known cure for this disease that has remissions, relapses and possible continued progression. For individuals diagnosed with MS, responding to the physical and psychological stresses of a condition with an unknown cause and no cure is challenging. The purpose of this study was to explore the individual's experience of having symptoms for a period of time and then to be told they have MS. The phenomenological qualitative research method was used to illuminate the nature of their experiences. The time course spanned before diagnosis, at diagnosis and following diagnosis. Interviews were conducted with five purposefully selected participants. The process of data analysis highlighted common threads and patterns among informants. Four major themes emerged: Whispered Beginnings, Echoes of Silence, The Spoken Words, and Recreating Voice. The experiences of individuals recently diagnosed with MS are illuminated in order to provide insight and information to health care providers who are faced with telling a person the diagnosis of MS.

Activities of Daily Living↗
PubMed1996

Respiratory electrophysiological studies in Guillain-Barré syndrome.

Respiratory failure is a common and potentially life threatening complication in patients with Guillain-Barré syndrome. The incidence of phrenic nerve involvement and the predictive value of phrenic nerve conduction and diaphragmatic needle EMG were studied in 40 patients with Guillain-Barré syndrome within the first three days of admission to hospital. The negative peak onset latency of the diaphragmatic compound muscle action potential (CMAP), and its amplitude, duration, and area were abnormal in 83%. The need for ventilation was correlated with diaphragmatic CMAP amplitude (P = 0.005), and area (P = 0.001), but not with latency or duration. Abnormalities in diaphragmatic needle EMG were found in 45%, mainly a decreased number of motor unit potentials. The abnormalities correlated with the need for ventilation (P = 0.013). Of the 40% who required ventilation, all had either abnormal phrenic conduction, abnormal diaphragmatic needle EMG, or both. Eighty one per cent of the ventilated patients had abnormal forced vital capacity on the day of the electrophysiological examination. The results indicate that phrenic nerve conduction studies and diaphragmatic EMG are useful in detecting respiratory involvement in patients with Guillain-Barré syndrome and in identifying those at risk of respiratory failure.

Adolescent↗
PubMed1995

Identifying nursing research priorities: general and neuroscience specific at an acute care hospital.

As a result of economic and health care changes the role of the nurse continues to expand and research-based practice is changing its focus. Limited resources and staff shortages have revealed new areas for research study. Clinical nurses have valuable questions to share that can form the basis of future nursing research. The purposes of the study were to: (a) Determine the priorities for nursing research within a single acute care teaching hospital; (b) Promote nurses' awareness of the importance of research-based practice; (c) Facilitate the development of future nursing research. It was assumed that nurses who carry out direct and indirect patient care roles are "experts" and therefore, are in a position to identify what they see as important questions and in need of further investigation. Three hundred and sixty-six nurses (24%) responded to round #1 of the open ended survey and submitted a total of 912 clinical practice issues. Initially, issues were broadly categorized into clinical and indirect clinical themes in a series of subcategories. Round #2 was conducted to identify nurses' ratings of the priority of the final 123 research issues for future clinical research and practice improvement efforts. Results of the two rounds will be presented, including issues identified by neuroscience nurses. This information will provide a valuable source for additional neuroscience research at either the local or international level.

Acute Disease↗
PubMed1991

Local IgA and IgM rheumatoid factor production in autoimmune MRL/lpr mice.

Spontaneous local immunoglobulin (IgA, IgG, IgM) as well as IgA and IgM rheumatoid factor (RF) production in salivary glands, lymph nodes, and spleen was analyzed at various ages in autoimmune MRL/Mp-lpr/lpr (MRL/lpr) mice by using an ELISPOT assay. The longitudinal design of the study permitted correlations with severity of disease in salivary glands (sialadenitis). Local production of immunoglobulins in salivary glands and lymph nodes occurred with a pattern of IgG much greater than IgM greater than IgA. This isotype pattern differed from that simultaneously observed in spleen where IgG did not predominate to the same extent. Moreover, the spleen was the major site of IgM production. Rheumatoid factors constituted a significant fraction of local IgA and IgM in involved salivary glands. The pattern of IgA RF isotype expression in salivary glands contrasted with that observed in spleen. While the number of IgA and IgG secreting cells increase at an early age, the peak of RF production in salivary glands occurs in older mice. Furthermore, the level of immunoglobulin secretion was positively correlated with disease severity in salivary glands. The results suggest that local RF production is a secondary event in salivary gland inflammation in MRL/1pr mice rather than an initiating factor in this process.

Animals↗
PubMed1990

Elucidating the pathogenesis of autoimmune disease: recent advances at the molecular level and relevance to oral mucosal disease.

Humoral and/or cellular immune responses directed against self antigen are currently thought to underlie a wide spectrum of systemic and organ-specific human and animal autoimmune diseases. Although the immunopathology of these diseases has been well characterized in most cases, the etiology still remains obscure. In order to gain a more fundamental insight of the abnormal processes leading to autoimmunity, efforts are currently being directed toward defining these diseases at a molecular level. Because of the clinical diversity and immunological complexity of these diseases, several directions are being pursued. Relevant to autoimmune oral disease, this review will focus on antigen processing and recognition (immunoglobulin and T cell receptor genes), the key role of the major histocompatibility complex, and the involvement of the cytokine network. Advances made in these fields have clear relevance for future diagnostic and therapeutic strategies related to autoimmune diseases affecting oral tissues.

Animals↗