Ascertainment Of Symptoms Research Articles

Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19

Current Knowledge and Research Priorities in the Digestive Manifestations of COVID-19

Clinical features and early detection of sport-related concussion.

AimAthletes who suffer sport‐related concussions but continue playing have a high probability of experiencing more severe symptoms with any subsequent concussion. This study used data from the authors’ clinical department to retrospectively investigate the clinical characteristics of sport‐related concussion and factors associated with delays in examinations.MethodsThe study included 38 patients with sport‐related concussions who were treated at the authors’ hospital. The sports during which the injuries occurred, occasions of injury, factors affecting the time from injury until examination at hospital, and prognoses were evaluated retrospectively.ResultsSport‐related concussions most frequently occurred in rugby and judo, where tackling, throwing, and other types of physical contact can result in impacts to the head region at high angular or linear velocity with acceleration. Some subjects showed consciousness disturbance and/or clear subjective symptoms immediately after the injury and were therefore examined at the hospital rapidly. However, other subjects who suffered amnesia or less obvious symptoms continued to play after the injury and had delayed examinations. In addition, there was a tendency for examinations to be delayed when an on‐site physician was present.ConclusionsIn contact sports where injury‐resulting events occur, such as impacts to the head at high angular or linear velocity with acceleration, athletes should be immediately withdrawn from play and evaluated for concussion, even if there are no obvious head injuries or symptoms. The immediate ascertainment of symptoms after physical contact would improve the rapid detection of sport‐related concussion.

Urinary Tract Infections in Patients with Spinal Injuries

Urinary tract infection remains an important problem for patients with spinal cord injury. Interventions used to promote bladder emptying and maintain low-pressure voiding have variable risks for urinary tract infection. Asymptomatic bacteriuria is common in this population and should not be treated. However, identification of symptomatic infection is compromised by difficulties in ascertainment of symptoms. Use of hydrophilic coated catheters for intermittent catheterization does not influence the frequency of symptomatic urinary tract infection. Botulinum toxin injection in the detrusor muscle or the urethral sphincter improves bladder emptying and does not influence the frequency of urinary infection. Asymptomatic bacteriuria is a common finding in pregnant women with spinal cord injury, but optimal management is not clear. Other research needs include further development and evaluation of interventions to decrease the frequency of infection, improve diagnostic precision, and limit the emergence of resistant organisms.

Clinical and Biological Interactions in Affective and Cognitive Geriatric Syndromes

Clinical and biological complexity is the rule rather than the exception in geriatric psychiatric syndromes. Typically, geriatric psychopathology develops in the context of medical and neurological disorders. Under these circumstances, ascertainment of symptoms and signs is difficult. Moreover, behavioral abnormalities, cognitive deficits, and physical symptoms and signs are often contributed by more than one psychiatric, neurological, or medical condition. Finally, symptoms change over time as various coexisting disease processes progress or subside, further complicating clinical assessment and diagnosis. Complexity has been viewed as an obstacle to medical research, which by necessity depends on reduction. Biological and psychosocial hypotheses are nothing but logical reductions, designed to permit understanding of a small part of a larger problem. Experimental design is an operational reduction intended at giving the best chance for hypothesis testing. Such reduction processes become complicated by the clinical intricacies of geriatric psychiatry syndromes. Despite the logical and experimental challenges posed by geriatric syndromes, their complexity has begun to provide meaningful clinical and biological information. Studying depression in Alzheimer’s disease patients exemplifies how comorbid geriatric syndromes can help address clinical and biological questions. In the study by Zubenko et al. in this issue [May 2003], the high prevalence of depression in patients with probable Alzheimer’s disease was confirmed. The study also observed that the depressive syndrome of Alzheimer’s patients is of mild severity and characterized by indecisiveness and diminished ability to concentrate but with limited depressive ideation and sleep disturbances. This symptom profile is difficult to distinguish from an uncomplicated dementia syndrome, thereby contributing to the underrecognition of depression. The increased frequency of psychotic symptoms in depressed Alzheimer’s disease patients further complicates ascertainment of depression. The difficulty in diagnosing depression is evidenced by the wide differences in depression prevalence estimates among patients with Alzheimer’s disease. Improving the methods of ascertainment (1) and treatment of depression in Alzheimer’s patients is critical, since depression contributes to excess disability, personal suffering, family disruption, and premature institutionalization. In addition to highlighting an important clinical problem, the comorbidity of depression and dementia has served as the stimulus for answering both clinical and biological questions. The early concept of “pseudodementia” was based on the assumption that the biological abnormalities of depression were the unitary cause of reversible Clinical and Biological Interactions in Affective and Cognitive Geriatric Syndromes George S. Alexopoulos, M.D.