PubMed · 12140652
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Rosemary Martino. 2002. When to PEG?. https://doi.org/10.1007/s00455-002-0061-8
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Cerebrovascular pathology in infancy is, unlike in adults, infrequent. However, this must not lead us to think it is unimportant. There are a number of different vascular processes that exert an influence to varying degrees on the neurological and psychological future of our young patients. These sequelae can be of more or less importance and, on some occasions, can be lesions that will accompany them throughout the rest of their lives, in spite of the therapeutic methods we have available today. We basically differentiate vascular organic lesions that are pre-established or due to malformations from other causes acquired as a consequence of an anomalous situation inherent to other pathologies and that have an extravascular origin. The most striking of these, because of their frequency, gravity and cellular pathology, are peri/intraventricular haemorrhages (PIVH) in those born premature and those weighing very little at birth. The causes from malformations remain and are relatively rare with a stable frequency, while the number of cases of PIVH has risen sharply in recent years due to different causes, the most notable of which is the increase in preterm multiple births, at around 30-32 weeks of gestation. This group of the population requires early and continuous neuropaediatric monitoring. Some of the sequelae are detected and dealt with quickly; others may appear later and will need the joint, coordinated attention of neuropaediatricians, psychologists, educators and physiotherapists.
To provide a scientific rationale for choosing an optimal stroke surveillance method, the authors compared active surveillance with passive surveillance. The methods involved ascertaining cerebrovascular events that occurred in Nueces County, Texas, during calendar year 2000. Active methods utilized screening of hospital and emergency department logs and routine visiting of hospital wards and out-of-hospital sources. Passive means relied on International Classification of Diseases, Ninth Revision (ICD-9), discharge codes for case ascertainment. Cases were validated by fellowship-trained stroke neurologists on the basis of published criteria. The results showed that, of the 6,236 events identified through both active and passive surveillance, 802 were validated to be cerebrovascular events. When passive surveillance alone was used, 209 (26.1%) cases were missed, including 73 (9.1%) cases involving hospital admission and 136 (17.0%) out-of-hospital strokes. Through active surveillance alone, 57 (7.1%) cases were missed. The positive predictive value of active surveillance was 12.2%. Among the 2,099 patients admitted to a hospital, passive surveillance using ICD-9 codes missed 73 cases of cerebrovascular disease and mistakenly included 222 noncases. There were 57 admitted hospital cases missed by active surveillance, including 13 not recognized because of human error. This study provided a quantitative means of assessing the utility of active and passive surveillance for cerebrovascular disease. More uniform surveillance methods would allow comparisons across studies and communities.
The information revolution of recent years, the general accessibility of computers and especially the Internet, provided the possibility of immediate access to the newest and most reliable results of clinical research in everyday medical practice. When a question arises regarding the care of a certain patient, we can have answers within minutes. Summaries of systematic reviews of the Cochrane Library and abstracts of papers of several thousand journals indexed on MEDLINE are available free of charge. In addition, over 70,000 Internet home pages provide some sort of health care information. The fast accessibility of information made it possible to apply a new method, called evidence-based medicine, in everyday practice. This method implies the effective search of an answer to a well formed question, and the critical evaluation of the results found during the search. This paper summarises the most important electronic databases that can be used in the care of patients with cerebrovascular diseases. The paper emphasises the advantages and dangers of the use of the Internet. Enlisted are the most important English- and Hungarian-language home pages with information on cerebrovascular diseases. Internet addresses of home pages providing methodological help in critically evaluating the literature are also given. The paper summarises the most important questions to consider when we want to evaluate the validity and importance of papers on diagnostic methods, on prognosis, on treatment effect, when we read systematic reviews, economic evaluations, clinical decision analyses and guidelines.