Treatment of minor head injuries

The results of various forms of treatment of patients with minor head injuries have been examined. The number and frequency of post-concussional sequelae was markedly reduced by treatment which included information, explanation and encouragement. Dizziness, loss of hearing and loss of balance were related to external lesions to the vestibular system caused by injuries to the parieto-temporal region of the skull. PTA proved to be a reliable indicator of the severity of cerebral concussion and correlated with post-concussional sequelae and periods of disability. Other factors which increased the number and frequency of post-traumatic sequelae, especially those related to stress before the accident, could be counteracted by better treatment of the patient. The results bear out the hypothesis that post-concussional sequelae start off on an organic basis (PTA) and that persistent sequelae after minor head injuries are also caused by psychogenic, and especially by iatrogenic factors.     

Offering a treatment choice in the irradiation of prostate cancer leads to better informed and more active patients, without harm to well-being

PURPOSE: To examine, in prostate cancer patients, the effect of (1) being offered a choice between radiation doses in three-dimensional conformal radiotherapy, and of (2) accepting or declining the possibility to choose. METHODS AND MATERIALS: A total of 150 patients with localized prostate cancer (T1-3N0M0) were offered a choice with a decision aid between two radiation doses (70 and 74 Gy). A control group of 144 patients received a fixed radiation dose without being offered a choice. Data were collected at baseline (before choice), before treatment (after choice), and 2 weeks and 6 months after treatment completion. RESULTS: Compared with the control group, the involvement group, receiving the decision aid, showed increased participation in decision making (p < 0.001), increased knowledge (p < 0.001), and improved risk perception (p < 0.001); they were more satisfied with the quality of information (p = 0.002) and considered their treatment a more appropriate treatment (p = 0.01). No group differences were found in well-being (e.g., general health, European Organization for Research and Treatment of Cancer quality of life, anxiety). Within the involvement group, accepting or declining the option to choose did not affect well-being either. CONCLUSIONS: Offering a choice of radiation dose, with a decision aid, increased involvement in decision making and led to a better-informed patient. In contrast to earlier suggestions, a strong increase in involvement did not result in improved well-being; and in contrast to clinical concerns, well-being was not negatively affected either, not even in those patients who preferred to leave the decision to their physician. This study shows that older patients, such as prostate cancer patients, can be informed and involved in decision making.     

Evolving perspectives on genetic discrimination in health insurance among health care providers

Previous studies have documented that concerns about genetic discrimination (GD) may influence access to and participation in medically necessary care. We sought to characterize how GD issues influence current cancer genetics professional (CGP) practice, determine if their attitudes regarding GD have changed over time, and compare their knowledge and attitudes regarding laws prohibiting GD to a contemporary cohort of non-genetics clinicians. Members of the National Society of Genetic Counselors Familial Cancer Special Interest Group were invited to complete a 39 item online survey, adapted from previously published instruments. The resulting data were compared to a survey of CGPs published in 2000 and to a contemporary cohort of non-genetics clinicians (n = 1,181). There were 153 qualified respondents. Compared to the historical CGP cohort (n = 163), a significantly greater proportion said they would bill insurance for the cost of genetic testing for themselves (P < 0.0001). Most CGPs (94%) considered the risk of GD to be low to theoretical, concordant with 64% who expressed confidence in existing federal laws prohibiting GD. The mean knowledge score of CGPs regarding GD protective laws was significantly greater than that of non-genetics clinicians (P < 0.001). As barometers of change, CGPs show a migration in opinion over the past 8 years, with decreased fear of GD and greater knowledge of laws prohibiting GD compared to non-genetics clinicians. Better knowledge of GD and protective legislation, may facilitate non-genetics clinician utilization of genetics and personalized medicine.     

Univariate comparisons given aggregated normative data

Abstract

Objective: Normative comparison is a method to compare an individual to a norm group. It is commonly used in neuropsychological assessment to determine if a patient’s cognitive capacities deviate from those of a healthy population. Neuropsychological assessment often involves multiple testing, which might increase the familywise error rate (FWER). Recently, several correction methods have been proposed to reduce the FWER. However these methods require that multivariate normative data are available, which is often not the case. We propose to obtain these data by merging the control group data of existing studies into an aggregated database. In this paper, we study how the correction methods fare given such an aggregated normative database. Methods: In a simulation study mimicking the aggregated database situation, we compared applying no correction, the Bonferroni correction, a maximum distribution approach and a stepwise approach on their FWER and their power to detect genuine deviations. Results: If the aggregated database contained data on all neuropsychological tests, the stepwise approach outperformed the other methods with respect to the FWER and power. However, if data were missing, the Bonferroni correction produced the lowest FWER. Discussion: Overall, the stepwise approach appears to be the most suitable normative comparison method for use in neuropsychological assessment. When the norm data contained large amounts of missing data, the Bonferroni correction proved best. Advice of which method to use in different situations is provided.     

A mathematical approach to the temporal stationarity of background noise in MEG/EEG measurements

The general spatiotemporal covariance matrix of the background noise in MEG/EEG signals is huge. To reduce the dimensionality of this matrix it is modeled as a Kronecker product of a spatial and a temporal covariance matrix. When the number of time samples is larger than, say, J = 500, the iterative Maximum Likelihood estimation of these two matrices is still too time-consuming to be useful on a routine basis. In this study we looked for methods to circumvent this computationally expensive procedure by using a parametric model with subject-dependent parameters. Such a model would additionally help with interpreting MEG/EEG signals. For the spatial covariance, models have been derived already and it has been shown that measured MEG/EEG signals can be understood spatially as random processes, generated by random dipoles. The temporal covariance, however, has not been modeled yet, therefore we studied the temporal covariance matrix in several subjects. For all subjects the temporal covariance shows an alpha oscillation and vanishes for large time lag. This gives rise to a temporal noise model consisting of two components: alpha activity and additional random noise. The alpha activity is modeled as randomly occurring waves with random phase and the covariance of the additional noise decreases exponentially with lag. This model requires only six parameters instead of 12 J(J + 1). Theoretically, this model is stationary but in practice the stationarity of the matrix is highly influenced by the baseline correction. It appears that very good agreement between the data and the parametric model can be obtained when the baseline correction window is taken into account properly. This finding implies that the background noise is in principle a stationary process and that nonstationarities are mainly caused by the nature of the preprocessing method. When analyzing events at a fixed sample after the stimulus (e.g., the SEF N20 response) one can take advantage of this nonstationarity by optimizing the baseline window to obtain a low noise variance at this particular sample.     

Lymphotoxin in nonspecific inflammatory bowel disease lymphocytes

We have confirmed the finding that cell-free filtrates of disrupted, freshly obtained inflammatory bowel disease lymphocytes were cytotoxic in vitro for human colonic epithelial cells. Furthermore, we have shown that the properties of the cytotoxic factor in these filtrates conformed exactly to those described for lymphotoxin released by the incubation in vitro of inflammatory bowel disease lymphocytes with colonic target cells. In addition, the properties conformed very closely to those described by others in their characterization of lymphotoxin released by stimulation of lymphocytes in vitro by phytohemagglutinin except for the action of trypsin.This work was supported in part by Grant AM12808 from the National Institutes of Health, USPHS.     

Do prostate cancer patients want to choose their own radiation treatment?

PURPOSE: The aims of this study were to investigate whether prostate cancer patients want to be involved in the choice of the radiation dose, and which patients want to be involved. METHODS AND MATERIALS: This prospective study involved 150 patients with localized prostate cancer treated with three-dimensional conformal radiotherapy. A decision aid was used to explain the effects of two alternative radiation doses (70 and 74 Gy) in terms of cure and side effects. Patients were then asked whether they wanted to choose their treatment (accept choice), or leave the decision to the physician (decline choice). The treatment preference was carried out. RESULTS: Even in this older population (mean age, 70 years), most patients (79%) accepted the option to choose. A lower score on the designations Pre-existent bowel morbidity, Anxiety, Depression, Hopelessness and a higher score on Autonomy and Numeracy were associated with an increase in choice acceptance, of which only Hopelessness held up in multiple regression (p < 0.03). The uninformed participation preference at baseline was not significantly related to choice acceptance (p = 0.10). CONCLUSION: Uninformed participation preference does not predict choice behavior. However, once the decision aid is provided, most patients want to choose their treatment. It should, therefore, be considered to inform patients first and ask participation preferences afterwards.