Rasch analysis of the upper-limb subscale of the stroke rehabilitation assessment of movement (STREAM) tool in an acute stroke cohort Rasch analysis of the upper-limb subscale of the STREAM tool in an acute stroke population

Background: Stroke is a leading cause of disability worldwide. The most common impairment resulting from stroke is upper-limb weakness.

Objectives: To determine the usefulness and psychometric validity of the upper-limb subscale of the STREAM in an acute stroke population.

Methods: Rasch Analysis, including unidimensionality assumption testing, determining model fit, and analysis of: reliability, residual correlations, and differential item functioning.

Results: 125 individuals were assessed using the upper-limb subscale of the Stroke Rehabilitation Assessment of Movement (STREAM) tool. Rasch analysis suggests the STREAM is a unidimensional measure. However, when scored using the originally proposed method (0–2), or using the response pattern (0–5) neither variant fit the Rasch model (p < 0.05). Although, the reliability was good (Person-Separation Index – 0.847 and 0.903, respectively). Correcting for the disordered thresholds, and thereby producing the new scoring pattern, led to substantial improvement in the overall fit (chi-square probability of fit – 22%), however, the reliability was slightly reduced (PSI – 0.806).

Conclusions: The study proposes a new scoring method for the upper-limb subscale of the STREAM outcome measure in the acute stroke population.     

Neurological Complications Following Adult Lung Transplantation

The full spectrum of neurologic complications and their impact on survival in lung recipients has not been reported. A retrospective cohort review of the Mayo Clinic Lung Transplant Registry (1988–2008) was performed to determine the range of neurologic complications in a cohort of adult lung recipients. Cox regression models were used to assess risk factors for neurological complications and death posttransplant. One hundred and twenty lung transplant recipients (53% women, median age at transplantation 53 years, range 21–73, median survival 4.8 years) were identified, of whom 95 had a neurological complication posttransplantation (median time to complication 0.8 years). Neurological complications were severe in 46 patients (requiring hospitalization or urgent care and evaluation) and were most often perioperative stroke or encephalopathy. Age predicted neurological complications of any type, whereas lung allocation score, bilateral lung transplantation, sex, underlying lung disease, elevated hemoglobin A1C, renal insufficiency and smoking history did not. Neurological complications of any severity (HR 4.3, 95% CI 2.2–8.6, p < 0.001) and high severity (HR 7.2, 95% CI 3.5–14.6, p < 0.001) were associated with increased risk of death. Neurological complications are common after lung transplantation, affecting 92% of recipients within 10 years. Severe neurologic complications are also common, affecting 53% of recipients within 10 years.     

Colonic perforations in enteric fever

We report a case of multiple colonic perforations in a 5-year-old boy due to typhoid fever. The main objective is to present the occurrence of this complication and discuss the management. The patient was admitted with nine days history of high-grade fever and abdominal pain. On examination, he was very sick looking child with acute abdomen. After initial workup and resuscitation, laparotomy was performed which revealed multiple colonic perforations with feacal peritonitis. The case revealed that one must not forget to inspect entire intestine including colon, as there may be perforations present in the large bowel.     

Infant feeding practices in the urban slum of Karad in west Maharashtra

Infant feeding practices have been studied amongst 181 women residing in a semiurban area of Maharashtra. Information on socio-economic status of the family with special reference to maternal literacy and occupation was collected. Data pertaining to the type of prelacteal feed, time of beginning of breast feeding, age at introduction and type of supplementary food were obtained. Instead of colostrum, 73.49% mothers used various inaugural feeds. Social factors viz, lack of education, poverty, lack of knowledge about the nutritional requirement of the infant and feeding of infants by elder sister or brother (foster mother) were the major determinants for erroneous feeding practices.     

The clinical spectrum of stereotypies in frontotemporal lobar degeneration

We clinically assessed patients meeting international criteria for frontotemporal lobar degeneration (FTLD) for the presence and characteristics of stereotypies. Of 32 subjects with FTLD (50% women), 19 (60%) had stereotypies. The majority of patients with stereotypies were female (68%). The median age of symptom onset suggestive of FTLD was 58 years (range: 37–74), with a mean time to stereotypy onset of 2.1 years. In all cases, the stereotypies were simple. There were no differences in the age of FTLD onset, functional imaging results, neuropsychological test scores or frequency of mood disorders or psychoses between those with and without stereotypical movements. However, compulsive behavior was noted more often in those with stereotypies (58% vs. 15%, P = 0.02). Of the 19 patients with stereotypies, three had vocal stereotypies, and three had both vocal and motor stereotypies. Of the 16 subjects with motor stereotypies, 9(56%) were appendicular and 7 (44%) were craniocervical. © 2009 Movement Disorder Society     

Detecting patient allergy: beware the LIE

INTRODUCTION

Allergy detection is important in surgical patients. Historically, the focus has been on drug allergies. There is increasing focus on non-drug allergy, specifically latex, iodine and elastoplast.

PATIENTS AND METHODS

The practice and knowledge of 24 pre-registration house officers was evaluated, with regard to patient allergy. For the second phase of the study, the cohort of 367 consecutive patients presenting to the orthopaedic pre-assessment clinic was prospectively assessed.

RESULTS

This prospective study demonstrates that standard history-taking misses a large number (38%) of such allergies.

CONCLUSIONS

With regard to allergy detection, we are living a LIE (by ignoring latex, iodine, elastoplast allergy). We suggest junior doctors should employ the mnemonic LIED (latex, iodine, elastoplast and drugs) when taking a medical history.     

Neurological disorders in complex humanitarian emergencies and natural disasters

Complex humanitarian emergencies include the relatively acute, severe, and overwhelming health consequences of armed conflict, food scarcity, mass displacement, and political strife. Neurological manifestations of complex humanitarian emergencies are important and underappreciated consequences of emergencies in populations worldwide. This review critically assesses the existing knowledge of the range of neurological disorders that accompany complex humanitarian emergencies and natural disasters in both the acute phase of crisis and the “long shadow” that follows. Ann Neurol 2010;68:282–294