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PubMed2001

Interrater reliability of the Glasgow Coma Scale scoring among nurses in sub-specialties of critical care.

The Glasgow Coma Scale (GCS) is used as an assessment tool to measure the levels of consciousness and coma in patients. This research investigated the reliability of scoring the GCS among registered nurses (RNs) working in five different sub-specialty clinical areas of critical care; general intensive care, neurosurgical intensive care, coronary care, emergency room and post anaesthetic recovery room. Seven video recordings were made of six patients (one patient was recorded twice) having their level of neurological response assessed utilising the GCS. Seventy five RNs (15 from each sub-specialty) viewed each of the GCS assessments on the videotape and rated each patient on the scoring sheet provided. Analysis was performed for all RN subjects as a single group as well as separately for each of the five groups under investigation. The ratings for the first six videos were used to test interrater reliability and the scores from videotape four and seven (same patient) were used to calculate intrarater reliability. Based on comparison with expert scores, of the 75 participants, 38 responded correctly to eye opening responses; only 26 responded correctly to the motor response ratings. However, a better accuracy was achieved in the verbal response category with 67 participants responding correctly. Education qualifications and previous neurosurgical experience were statistically significant with regard to the nurses' accuracy of GCS assessment with p values of 0.004 and 0.043 respectively. The results were consistent with previously published studies demonstrating the motor response rating is most problematic in relation to rate accuracy.

Adult↗

PubMed2001

Investigation of the sleep electrocorticogram of the common marmoset (Callithrix jacchus) using radiotelemetry.

OBJECTIVE: To evaluate the use of a totally implantable radiotelemetry system for recording the sleep electrocorticogram (ECoG) of a small new world primate, the common marmoset (Callithrix jacchus) without restraint during data collection. METHODS: Under anaesthesia a telemetry transmitter, which allowed the recording of a single ECoG channel, was implanted intraperitoneally. This system allowed ECoG data to be recorded overnight from animals living in pairs within their habitual laboratory environment over a period of 12 months. Data were subsequently scored using modified Rechtschaffen and Kales criteria (A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles, UCLA Brain Information Service/Brain Research Institute, 1968) into stages of waking, light sleep, deep sleep and probable rapid eye movement sleep (pREM). Concurrent video recording was used to assist in the categorising of pREM. RESULTS: Results showed that, as in man, the marmoset exhibits sleep cycles with stages alternating between non-REM (deep sleep and light sleep) and pREM sleep throughout the night. In common with other non-human primates the duration of each of the sleep stages was relatively short and punctuated with frequent waking. CONCLUSIONS: These data suggest that sleep in marmosets housed under laboratory conditions (a) can be recorded without restraint and (b) has potential to be used as a model for human sleep.

Animals↗

PubMed2001

[Applications and advantages of a multimedia system for autopsies ].

This work evaluates the benefits and applications of computers and multimedia systems in post-mortem examination practice and, more in particular, in the definition of data collection protocols. We examined issues concerning the different aims of autopsy (e.g. diagnostic, scientific, educational, legal), and found that the pathologist's main duty is to acquire a large amount of data in the best possible way. However, despite the will to carry out detailed post-mortem examinations, many pathologic anatomy services face objective difficulties in doing so, especially due to understaffing, lack of time and high costs. The Institute for Pathologic Anatomy of the University of Genoa has developed software for data handling and for outcome reporting, a particularly important aspect in fetal-perinatal diagnosis. The system consists of a relational database in a client-server environment (Fourth Dimension) with two integrated parts. The first part, with unrestricted access, contains patients' personal data, including gender, age, time and date of death, hospital department of origin, person and department requiring the post-mortem examination, hour and time of autopsy, pathologist's name, and clinical diagnosis of death. Using a scanner, a copy of the autopsy application is also field, together with the patient's medical file and any diagnostic images useful to document the case history. The second part of the information system is accessible by pathologists only, and contains the autopsy report. This part is organized to balance two different needs: it allows sufficient space and freedom for autopsy description while providing guidelines for presentation of the report. The structure of the conventional autopsy protocol has been maintained, with subdivisions for all the organs and apparatuses according to topographic criteria. Before this part, a section is dedicated to external cadaver examination and anthropometric data; weight, shape, volume and texture are described for each organ, together with external and cut-surface features. A third section allows the examiner to report other observations not requested previously, while a final section is also provided for the epicrisis and for the formulation of the final diagnosis, the same as that reported in the first form. The database is coupled with an interactive system for collecting voice comments, thereby replacing the need for tape-recorders in the autopsy room. The user can recall a dictation window, dictate a text, check spelling and insert additional text. The database is also coupled to an image acquisition system, on the assumption that moving images allow a more faithful documentation of reality. Therefore, all rooms in which autopsies are carried out on fetuses or neonates have been equipped with a fixed camera linked to a monitor and a video-recorder. A PCB, used for image digitalization, recognizes up to 16,000,000 different colors. Guided by dedicated software, image files are transferred to a computer and then saved with the autoptic report. The database can be consulted and queried in two principle ways: by key words in the contents or main disease descriptions, or by individual words or phrases contained within the complete text of the reports. The present database system for autopsy reporting has proved itself useful in a pathological anatomy service. The combined presence of images and texts renders the system useful also as a research tool. By linking to a Web site dedicated to pathologic anatomy, it will be possible to display online rare cases involving diagnostic difficulties. The system offers great advantages for present and retrospective diagnostics, as well as for research and education purposes.

Archives↗

PubMed1998

A biomechanical study of occupational loads in the shoulder and elbow in dentistry.

OBJECTIVE: The aim was to demonstrate that when electromyographic (EMG) recordings are supplemented by biomechanical calculations more detailed information on shoulder loads are produced. DESIGN: Shoulder and elbow moments were calculated for three work situations of arm abduction (> 30 degrees, < 30 degrees and < 30 degrees with force on the hand) and were related to EMG. BACKGROUND: Prolonged arm elevation may result in shoulder pain and information on shoulder loads is needed to avoid development of musculoskeletal disorders. METHODS: Three-dimensional coordinates from video recordings of eight working dentists were used in a static link segment model based on orthopaedic axes. Moments and EMG (trapezius muscle) were related. Results: Working with the upper arm abducted more than 30 degrees produced 1.7 Nm (440%) higher moments of shoulder abduction, 0.5 Nm (100%) higher moments of outward upper arm twisting and 0.3 Nm (18%) smaller moments of elbow flexion than working with the upper arm abducted less than 30 degrees. Trapezius muscle activity did not increase with increased arm abduction. Force on the hand (20 N) recorded during cavity filling altered moments of the shoulder and elbow but not the activity level of the trapezius muscle. CONCLUSION: Supplementing EMG with biomechanical calculations of moments results in more detailed information on shoulder loads. This is important for over-all risk identification.

Journal Article↗

PubMed2000

Web-delivery of anatomy video clips using a CD-ROM.

Until recently, anatomists had no doubt that the teaching of anatomy had to include cadaver dissection. However, due to a changing academic environment as well as challenged financial institutional resources, computer-assisted instruction was introduced into medical curriculum in an attempt to reduce the cost and the time committed to cadaver dissection. Computer-assisted instruction included locally created or commercially available anatomy software, Internet sites, and databases of digital images of cadaveric structures such as the Virtual Human Project. However, until now, bandwidth limitations have not allowed effective visualization in real-time over the Internet of recorded videos or 3D animations reconstructed from a database. We describe how to successfully link and display large video clips stored on a CD-ROM in support of lectures saved in HTML format on the Internet. This process, described in its totality, allows students to access audiovisual files on a CD-ROM through the Internet, from any location, with either Macintosh or Windows computers, using the Netscape browser. This process allowed us to circumvent one of the most significant limitations of the computer-assisted instruction on the Internet by delivering full audio and visual information on demand, as it would happen in a traditional classroom.

Anatomy↗

PubMedDate not supplied

Upper extremity tendon transfers in cerebral palsy: electromyographic and functional analysis.

This study was undertaken to evaluate tendon transfers in a group of children with spastic hemiplegia. Muscle grading, video recordings of function, and electromyographs were performed on 12 patients preoperatively. Postoperative electromyograms were obtained on 16 transferred tendons in eight patients as the children performed assigned tasks. Clinical evaluation demonstrated improvement in all patients at follow-up, which averaged 20 months. Four of the 16 muscles showed changes in their electrical activity postoperatively. Three muscles that fired continuously became phasic, and one muscle changed phase to match its recipient. Pre- and postoperative electromyography with video analysis provided a more complete understanding of the characteristics of tendon function with tendon transfers in cerebral palsy.

Adolescent↗

PubMed1985

Circadian rhythms in hippocampal responsiveness to perforant path stimulation and their relation to behavioral state.

Male rats were chronically implanted with electrodes to record the monosynaptic granule cell response in the dentate gyrus of hippocampus to perforant path stimulation while the animals were unrestrained. Samples of the dentate response were collected every 15 min for up to 14 days under various lighting conditions including constant light (LL) and constant darkness (DD). Circadian rhythms in the slope of evoked population EPSPs were found in all records. EPSP rhythms reached peak values during subjective night. Circadian rhythms in the height of the population spike were found in 8 out of the 12 animals studied. Spike rhythms reached peak values during the subjective day at times when EPSPs were at a daily minimum. Rhythms were confirmed statistically by periodogram. Rhythms followed changes in the LD cycle and persisted under LL or DD. The behavioral state associated with each sample was determined by EEG and video records of 4 animals. Day-night differences in EPSPs were found within the active awake, still alert, slow-wave and paradoxical sleep states. Day-night differences in the spike were detected during the still alert and paradoxical sleep states.

Animals↗

PubMed1997

Clozapine versus placebo in Huntington's disease: a double blind randomised comparative study.

OBJECTIVES: To establish the effect of the atypical neuroleptic clozapine on chorea, voluntary motor performance, and functional disability in patients with Huntington's disease. METHODS: Thirty three patients with Huntington's disease participated in a double blind randomised trial. A maximum of 150 mg/day clozapine or placebo equivalent was given for a period of 31 days. Assessments were performed in the week before and at the last day of the trial. Chorea was scored using the abnormal involuntary movement scale (AIMS), the chorea score of the unified Huntington's disease rating scale (UHDRS), and judgement of video recordings. Voluntary motor performance was assessed using the UHDRS motor scale. Patients and their partners completed a questionnaire regarding functional disability. Twelve patients already used other neuroleptic medication, which was kept unchanged during the trial period. Results of neuroleptic naive and neuroleptic treated patients were analysed separately. RESULTS: Clozapine tended to reduce chorea in neuroleptic naive patients only (AIMS); improvement seemed more pronounced in patients receiving higher doses of clozapine. Other measures of chorea (UHDRS chorea score, video ratings) showed no improvement. Clozapine had no beneficial effect on chorea in patients already receiving neuroleptic medication. Voluntary motor performance did not improve with clozapine. Neuroleptic naive patients reported aggravation of functional disability, possibly reflecting the frequent occurrence of side effects. Adverse reactions forced trial termination in six patients and dose reduction in another eight, and consisted mainly of drowsiness, fatigue, anticholinergic symptoms, and walking difficulties. CONCLUSIONS: Clozapine has little beneficial effect in patients with Huntington's disease, although individual patients may tolerate doses high enough to reduce chorea. Because adverse reactions are often encountered, clozapine should be used with restraint in this patient group.

Acute Disease↗

PubMed2002

Development of an assessment tool to measure the influence of clinical software on the delivery of high quality consultations. A study comparing two computerized medical record systems in a nurse run heart clinic in a general practice setting.

A rating scale was developed to assess the contribution made by computer software towards the delivery of a quality consultation, with the purpose of informing the development of the next generation of systems. Two software programmes were compared, using this scale to test their ability to enable or inhibit the delivery of an ideal consultation with a patient with heart disease. The context was a general practice based, nurse run clinic for the secondary prevention of heart disease. One of the programmes was customized for this purpose; the other was a standard general practice programme. Consultations were video-recorded, and then assessed by an expert panel using the new assessment tool. Both software programmes were oriented towards the implementation of the evidence, rather than facilitating patient-centred practice. The rating scale showed, not surprisingly, significantly greater support from the customized software in the consultation in five out of eight areas. However, the scale's reliability measured by Cronbach's Alpha, was sub-optimal. With further refinement, this rating scale may become a useful tool that will inform software developers of the effectiveness of their programmes in the consultation, and suggest where they need development.

Ambulatory Care↗

PubMed2003

Legal and ethical issues in the use of anonymous images in pathology teaching and research.

The privacy of patients' health information is of paramount importance. However, it is equally important that medical staff and students have access to photographs and video recordings of real patients for training purposes. Where the patient can be identified from such images, his or her consent is clearly required to both obtain the image and to use it in this way. However, the need for consent, both legally and ethically, is much less convincing where the patient cannot, by the very nature of the image, be identified from it. This is the case for many images used in the teaching of clinical medicine, such as videos taken of laparoscopies, images of internal organs and unlabelled X-rays.

Biomedical Research↗

PubMed1995

A portable ergonomic observation method (PEO) for computerized on-line recording of postures and manual handling.

A new portable ergonomic observation method (PEO) is presented. It is applicable to most professions and work tasks and requires only moderate human resources for data collection and analysis. Observations are made in real time directly at the workplace using a portable personal or hand-held computer, and data are accessible for immediate analysis and presentation. Duration and number of events are calculated for postures at four body regions (arms, neck, trunk and knee) as well as for manual handling. An evaluation of the PEO method, assessing some important aspects of internal validity as well as intra- and inter-observer reliability, was carried out using video recordings. It showed acceptable validity for some types of physical exposure, and high intra- and inter-observer reliability. Practical experiences from using the PEO method in a field study and further improvements of the method are discussed.

Journal Article↗

PubMed2005

Sensitivity and specificity of procedures for the differential diagnosis of epileptic and non-epileptic seizures: a systematic review.

OBJECTIVES: Non-epileptic seizures (NES) present a considerable challenge in clinical practice. This paper reviews published evidence for the reliability of a number of procedures for the differential diagnosis of NES and epilepsy. METHODS: Papers identified from MEDLINE and PsychInfo Databases (1980-2001) and additional hand searches were independently reviewed using methods for evaluating evidence in systematic reviews [Liddle, J., Williamson, M. Irwig, L. Method for evaluating research guideline evidence. New South Wales Department of Health; 1996 [State Health publication no. (CEB) 96-204]; SIGN. An introduction to SIGN methodology for the development of evidence based clinical guidelines. Scottish Intercollegiate Network; 1999]. Included studies had to have an NES group and a control group of people with epilepsy (each n> or =10), allocated using EEG linked video-recording of concurrent behaviour, and sensitivity and specificity values had to be stated or be calculable. RESULTS: Thirty-three papers were identified, of which 13 satisfied criteria. Excluded studies are briefly described. Those retained comprised a range of procedures [seizure induction, MMPI assessment, physiological assessment (prolactin, SPECT), pre-ictal pseudosleep, and ictal/post-ictal characteristics]. No procedure emerged with both high sensitivity and specificity and adequately replicated findings, although high levels of specificity were more commonly reported than high levels of sensitivity. This suggests that procedures were generally better at excluding a possible diagnosis. CONCLUSIONS: No procedure attains reliability equivalent to EEG video-telemetry. Further rigorous evaluation, using standardised and replicable methodologies, is required. The range of symptoms presented in NES suggests that a multi-method approach may be required. This too would require evaluation.

Databases as Topic↗

PubMed1998

Full polysomnography in the home.

STUDY OBJECTIVES: To evaluate unattended full polysomnography (PSG) recorded in the home by the DigiTrace Home Sleep System (DHSS) and to assess the ability to acquire, store and analyze polysomnographic data using the DHSS compared to standard paper PSG. DESIGN: Part 1 used a prospective, cross-over design. Part 2 consisted of a prospective concurrent collection of polysomnographic data. SETTING: Sleep Disorders Center in a university medical center. PARTICIPANTS: All adult patients who required standard clinical PSG as part of their clinical evaluation, regardless of suspected diagnosis, except patients requiring video recording for abnormal behaviors. MEASUREMENTS AND RESULTS: The DHSS is a digital recording system with miniature preamplifiers and the capacity to record 18 channels of polysomnographic data, including 4 channels of EEG (C3-A2, C4-A1, C3-O1 and C4-O2), right and left EOG, two channels of chin EMG, ECG naso-oral airflow, respiratory effort (piezo crystal thoracic and abdominal belts and bilateral interacostal EMG), snore microphone, bilateral anterior tibialis EMG, and body-position sensor. In part 1,77 DHSS home recordings were evaluated. No recordings were lost due to equipment failure and each parameter was scorable in greater than 95% of all epochs. Most of the subjective assessments by questionnaire following each study revealed no difference between the two testing situations. However, patients reported more sleep time and a better overall test experience in the lab. Assessments of sleep quality and morning alertness compared to usual were rated higher in the lab. After completing both studies, more patients preferred the lab study (p < .01), mostly because of minor inconveniences and apprehension regarding acquisition of data during the home study. There was no difference in the assessment of which test most accurately represented their sleep. In Part 2, the DHSS recorded concurrently with paper PSG in the laboratory in 16 patients. The results show no significant differences for any parameter and strong positive correlations for all parameters. CONCLUSION: Using the DHSS, unattended full PSG can be performed in the home with reliable and high quality recordings. Full PSG can be extended to a larger patient population, because it is no longer limited by the number of beds, and there is a reduction in cost due to elimination of overnight staff and facility cost.

Adolescent↗

PubMed2006

Validation of a microwave radar system for the monitoring of locomotor activity in mice.

BACKGROUND: The general or spontaneous motor activity of animals is a useful parameter in chronobiology. Modified motion detectors can be used to monitor locomotor activity rhythms. We modified a commercial microwave-based detection device and validated the device by recording circadian and ultradian rhythms. METHODS: Movements were detected by microwave radar based on the Doppler effect. The equipment was designed to detect and record simultaneously 12 animals in separate cages. Radars were positioned at the bottom of aluminium bulkheads. Animal cages were positioned above the bulkheads. The radars were connected to a computer through a digital I/O board. RESULTS: The apparatus was evaluated by several tests. The first test showed the ability of the apparatus to detect the exact frequency of the standard moving object. The second test demonstrated the stability over time of the sensitivity of the radars. The third was performed by simultaneous observations of video-recording of a mouse and radar signals. We found that the radars are particularly sensitive to activities that involve a displacement of the whole body, as compared to movement of only a part of the body. In the fourth test, we recorded the locomotor activity of Balb/c mice. The results were in agreement with published studies. CONCLUSION: Radar detectors can provide automatic monitoring of an animal's locomotor activity in its home cage without perturbing the pattern of its normal behaviour or initiating the spurt of exploration occasioned by transfer to a novel environment. Recording inside breeding cages enables long-term studies with uninterrupted monitoring. The use of electromagnetic waves allows contactless detection and freedom from interference of external stimuli.

Journal Article↗

PubMed1998

Complex behavior of self-propagating reaction waves in heterogeneous media.

Self-propagating high temperature reaction waves, leading to the synthesis of advanced materials, are investigated in a variety of heterogeneous reaction systems by using a digital high-speed microscopic video recording technique. It is shown that, although on the macroscopic length and time scales, the reaction appears to move in a steady mode, on the microscopic level it has a complex character that is related to the reaction mechanism.

Aluminum↗

PubMed1988

Balloon sphincterography. Clinical findings after 200 patients.

There are two muscular mechanisms of fecal continence. The anal sphincter squeezes the anal canal, thus lengthening it and increasing its resistance. The puborectalis kinks the distal rectum, preventing the transmission of intra-abdominal pressures into the anal canal. Balloon sphincterography simultaneously records the shape of the anal canal and distal rectum and measures the strength of the puborectalis and anal sphincter muscles. This allows the physician to evaluate the function of these important muscles in patients with symptomatic defecation disorders such as constipation, incontinence, and rectal prolapse. A cylindrical balloon is connected by a hose to a fluid reservoir filled with liquid barium. The deflated balloon is placed into the anal canal and inflated by raising the fluid reservoir in increments. Fluoroscopy visualizes the balloon's shape and video records the results. Quantitative sphincterogram measurements in patients with defecation disorders include (the three measurements in each category refer respectively to incontinent patients [N = 87], prolapse patients without incontinence [N = 26], and constipated patients [N = 65]); anorectal angle (degrees + S.D.): 114 + 28, 103 + 18, 95 + 19; anal canal length (mm + S.D.): 33 + 11, 38 + 10, 39 + 10; squeeze pressure (cm H2O + S.D.): 68 + 23, 80 + 16, 91 + 22, and opening pressure (cm H2O + S.D.): 52 + 25, 67 + 22, 81 + 24. The method is useful in identifying specific defects, such as paradoxic puborectalis contractions, that can cause constipation, and injuries to the sphincters that can cause incontinence. In over 280 patients with a wide variety of defecation disorders, sphincterography has yielded information not available by standard manometric techniques. It augments the findings of defecography.

Anal Canal↗

PubMed2001

Effects of inhalatory abdominal wall movement on vertical laryngeal position during phonation.

The configuration of the body resulting from inhalatory behavior is sometimes considered a factor of relevance to voice production in singing and speaking pedagogy and in clinical voice therapy. The present investigation compares two different inhalatory behaviors: (1) with a "paradoxical" inward movement of the abdominal wall, and (2) with an expansion of the abdominal wall, both with regard to the effect on vertical laryngeal position during the subsequent phonation. Seventeen male and 17 female healthy, vocally untrained subjects participated. No instructions were given regarding movements of the rib cage. Inhaled air volume as measured by respiratory inductive plethysmography, was controlled to reach 70% inspiratory capacity. Vertical laryngeal position was recorded by two-channel electroglottography during the subsequent vowel production. A significant effect was found; the abdomen-out condition was associated with a higher laryngeal position than the abdomen-in condition. This result apparently contradicted a hypothesis that an expansion of the abdominal wall would allow the diaphragm to descend deeper in the torso, thereby increasing the tracheal pull, which would result in a lower laryngeal position. In a post-hoc experiment including 6 of the subjects, body posture was studied by digital video recordings, revealing that the two inhalatory modes were clearly associated with postural changes affecting laryngeal position. The "paradoxical" inward movement of the abdominal wall was associated with a recession of the chin toward the neck, such that the larynx appeared in a lower position in the neck, for reasons of a postural change. The results suggest that the laryngeal position can be affected by the inhalatory behavior if no attention is paid to posture, implying that instructions from clinicians and pedagogues regarding breathing behavior must be carefully formulated and adjusted in order to ensure that the intended goals are reached.

Abdominal Muscles↗

PubMed1994

Differential phasic modulation of short and long latency afferent sensory transmission to single neurons in the primary somatosensory cortex in behaving rats.

Single neurons were recorded in the forepaw area of the primary somatosensory (SI) cortex of awake rats during rest and running behavior. Locomotor step cycle dependent changes of the transmission of the short (4.5 +/- 0.1-10.5 +/- 0.1 ms, SEURs) and the long (10.6 +/- 0.6-28.5 +/- 2.3 ms, LEURs) latency evoked unit responses were tested by generating post-stimulus time histograms of these neurons' responses to stimulation through electrodes chronically implanted under the skin of the forepaw. Times of footfall were determined by way of frame-by-frame analyses of video recordings, and peri-footfall histograms were generated to differentiate a total of 55 SI cortical neurons into two types: footfall responsive (n = 37) and footfall unresponsive (n = 18) neurons. Peri-footfall gating patterns were determined for both types of cells. The SEURs and the LEURs showed significantly different phasic sensory modulation patterns. A major difference in sensory modulations between footfall responsive and footfall unresponsive cells was noted during the swing phase of the locomotor step cycle. In footfall responsive cells, the SEURs were suppressed most strongly just after footfall, while the LEURs were phasically suppressed following both footfall and footoff. The SEURs were disinhibited during the swing phase. In footfall unresponsive cells, the SEURs were tonically suppressed during the whole locomotor step cycle phases. However, the LEURs were phasically facilitated during the early swing phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Afferent Pathways↗