Improvement of Decreased Critical Flicker Frequency (CFF) in Headache Patients With Drug Abuse After Successful Withdrawal

A considerable proportion of headache patients fulfill the criteria of "drug abuse" (definition according to the International Headache Society [IHS] criteria). These patients exhibit markedly reduced vigilance and continuous performance, as shown by the results of critical flicker frequency (CFF) analysis.
The present study deals with the question whether this impairment of vigilance and continuous performance is reversible. Forty-eight headache patients with drug abuse were investigated three times by means of CFF analysis: immediately before (A), immediately after (B), and 3 weeks after having finished (C) inpatient drug withdrawal.
Immediately after withdrawal, a significant decrease of headache intensity was observed. The CFF values, however, remained unchanged at a depressed level, probably due to withdrawal medication and the initial sedative side effects of thymoleptic agents (given as prophylaxis).
Three weeks after withdrawal, however, the CFF values were significantly improved, and were now within a range not far from the normal values known from a healthy general population. Thus, even after many years of drug abuse, headache patients have a good chance to improve their vigilance and continuous performance and to reach normal or close to normal levels.     

Multimarker approach to evaluation of cardiac toxicity during preparative regimen and hematopoietic cell transplantation

Cardiac toxicity of preparative regimen (PR) containing high-dose Cyclophosphamide (120 mg/kg) followed by hematopoietic cell transplantation (HCT) was evaluated with 6 biomarkers of cardiac injury: N-terminal pro brain natriuretic peptide (NT-proBNP), creatine kinase MB (CK-MB mass), cardiac troponins (cTnT, cTnI), heart-type fatty acid binding protein (H-FABP), glycogen phosphorylase BB (GPBB). Twenty-three patients (mean age 44.5+/-10.6 years, 15 males) with acute leukemia were studied. All biomarkers were measured the day before PR, the day after PR, the day after HCT and 14 days after HCT. We found NT-proBNP elevations above 500 ng/L in 6 (26.1 %) patients after PR, in 9 (39.1 %) after HCT and in 7 (30.4 %) 14 days after HCT. GPBB became elevated (above 7.30 microg/L) in 5 (21.7 %) patients after PR, remained elevated in 5 (21.7 %) after HCT and in 2 (8.7 %) 14 days after HCT. A significant correlation between elevation in NT-proBNP and GPBB was found. Other markers remained within the reference range early after PR and HCT. Our findings show that administration of PR and HCT for acute leukemia is associated with acute neurohumoral activation of cardiac dysfunction (significant rise in NT-proBNP) and may lead to GPBB elevation. These changes could indicate acute cardiac toxicity due to treatment and require further follow-up. The predictive value for development of cardiomyopathy in the future is unclear. Further studies will be needed to define the potential role of new biomarkers in this context.     

Validity of self-reports of breast cancer treatment in low-income, medically underserved women with breast cancer

Few studies have assessed the agreement between subjects’ self-report and medical records among patients with breast cancer (BC), and none has addressed this issue in low-income women with BC. We assessed the level of agreement between self-report and medical records data for key BC treatment and prognostic characteristics using correct proportion and the Kappa statistic, among 726 low-income BC patients. Unconditional regression was used to investigate the association between accuracy of self-report and potential explanatory factors. Overall agreement between self-report and medical records was 95.3–99.6% for BC treatments including surgery, chemotherapy, radiotherapy and hormone therapy (Kappa = 0.79–0.99). Specific agreement was 87–89.5% for surgery type (Kappa = 0.51–0.96); 86.3% for chemotherapy completion (Kappa = 0.46) and 98.7% for radiotherapy completion (Kappa = 0.43); 95.2% for medical oncologist consultation (Kappa = 0.59) and 96% for radiation oncologist consultation; 97.3% for metastasis (Kappa = 0.56); and 93.6% for recurrence (Kappa = 0.30). When accepting answers within 15 days of the medical record date, 78.2% of women correctly reported surgery date, yet only around 55% of women correctly reported the start and/or end date of radiotherapy. Older age, less education, BC recurrence and poor patient–physician communication were associated with the lesser accuracy of patients’ self-report compared to medical records (P < 0.05). The results of this study suggest that self-reporting of key treatment and prognostic information is relatively accurate among low-income women with BC. Self-report seems to be a reliable source for accurate information when medical record review is unavailable or unfeasible. Interventions to enhance patient–physician communication may facilitate more accurate information reporting among vulnerable populations.     

Patients with osteoarthritic knees have shorter orientation and tangent indicatrices during gait

BackgroundThis study introduces two novel outcomes that could be used to identify people with knee osteoarthritis from healthy controls. These outcomes examine the lengths of paths on a sphere derived from knee angle and knee position during gait.MethodsParticipants with moderate knee osteoarthritis (n = 47) and no knee pathology (n = 51) walked overground. The time-varying orientation matrices and position vectors of the knee (leg relative to the thigh) were measured, then arclength (constant speed) parameterized. The orientation matrix column aligned with the long axis of the leg, and the tangent, normal and binormal vectors (Frenet Frame) along the position vectors were calculated. These unit length vectors all scribe paths (indicatrices) on a unit sphere. The path lengths of these indicatrices, for all or part of a gait cycle, were the novel outcomes. A stepwise discriminant analysis defined a linear function that included those outcomes that best allocated a participant to the osteoarthritis or control group.FindingsGroup differences were best detected with the indicatrix lengths associated with the orientation of the leg’s long axis over a gait cycle (P < 0.001) and the tangent vector over the stance phase (P = 0.014). Both outcomes were smaller in the knee osteoarthritis compared to control group. Walking speed was poorly correlated with all indicatrix lengths (ρ < |0.484|) and a discriminate analysis correctly classified 83.7% of the participants.InterpretationSmaller indicatrix measures distinguished those with knee osteoarthritis from healthy controls. These outcomes introduce a promising new kinematic approach when examining gait data.     

The family history in family practice: a questionnaire study

OBJECTIVES: Our aims were to investigate family medical history taking in general practice, and to evaluate the value attached to the family medical history as an aid to decision making in general practice. METHOD: A postal questionnaire survey was conducted among all 291 GPs working within the Calderdale and Kirklees Health Authority area. Each questionnaire was followed by a reminder. The main outcome measures were answers to questions on routine and opportunistic family history taking and a question about transmitting knowledge about genetic risk to other members of the family. Questions were also posed about the value attached to the family medical history as an aid to decision making. RESULTS: A total of 193 GPs returned the questionnaire (response rate 66.3%). On registration, 94.3% of GPs indicated that enquiries were made about a family history of coronary heart disease. Breast and colorectal cancer were specifically asked about by 48.4% and 30.7% of GPs, respectively. One-fifth of respondents indicated that they asked a general question about family medical history. A little over one-quarter of respondents indicated that they made opportunistic enquiries about the family history or suggested that the patient should inform other members of the family about possible risks. In the scenarios highlighted in this study, the majority of respondents felt that the family medical history had value as an aid to decision making. This was particularly the case for checking a patient's cholesterol (92.1%) and for initiating referrals in younger patients with possible cancer-related symptoms (three-quarters of respondents). CONCLUSION: GPs value the family medical history as an aid to decision making. Unfortunately, apart from enquiries about coronary heart disease, routine or opportunistic family history taking is not occurring in practice. Mechanisms need to be sought to extract information from the family medical history so that it can be more effectively used by GPs.