Patients In Clinical Group Research Articles

Symptom and performance validation in patients with subjective cognitive decline and mild cognitive impairment

Nonauthentic symptom claims (overreporting) and invalid test results (underperformance) can regularly be expected in a forensic context, but may also occur in clinical referrals. While the applicability of symptom and performance validity tests in samples of dementia patients is well studied, the same is not true for patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). A sample of 54 memory-clinic outpatients with evidence of SCD or MCI was studied. We evaluated the rate of positive results in three validity measures. A total of 7.4% of the patients showed probable negative response bias in the Word Memory Test. The rate of positive results on the Structured Inventory of Malingered Symptomatology was 14.8% while only one participant (1.9%) scored positive on the Self-Report Symptom Inventory using the standard cutoff. The two questionnaires were moderately correlated at .67. In a combined analysis of all results, five of the patients (9.3%) were judged to show evidence of probable negative response bias (or probably feigned neurocognitive impairment). In the current study, a relatively small but nontrivial rate of probable response distortions was found in a memory-clinic sample. However, it remains a methodological challenge for this kind of research to reliably distinguish between false-positive and correct-positive classifications in clinical patient groups.

Muscle fibre activation and fatigue with low-load blood flow restricted resistance exercise-An integrative physiology review.

Blood flow-restricted resistance exercise (BFRRE) has been shown to induce increases in muscle size and strength, and continues to generate interest from both clinical and basic research points of view. The low loads employed, typically 20%-50% of the one repetition maximum, make BFRRE an attractive training modality for individuals who may not tolerate high musculoskeletal forces (eg, selected clinical patient groups such as frail old adults and patients recovering from sports injury) and/or for highly trained athletes who have reached a plateau in muscle mass and strength. It has been proposed that achieving a high degree of muscle fibre recruitment is important for inducing muscle hypertrophy with BFRRE, and the available evidence suggest that fatiguing low-load exercise during ischemic conditions can recruit both slow (type I) and fast (type II) muscle fibres. Nevertheless, closer scrutiny reveals that type II fibre activation in BFRRE has to date largely been inferred using indirect methods such as electromyography and magnetic resonance spectroscopy, while only rarely addressed using more direct methods such as measurements of glycogen stores and phosphocreatine levels in muscle fibres. Hence, considerable uncertainity exists about the specific pattern of muscle fibre activation during BFRRE. Therefore, the purpose of this narrative review was (1) to summarize the evidence on muscle fibre recruitment during BFRRE as revealed by various methods employed for determining muscle fibre usage during exercise, and (2) to discuss reported findings in light of the specific advantages and limitations associated with these methods.

ALS drug development guidances and trial guidelines: Consensus and opportunities for alignment.

The US Food and Drug Administration (FDA) developed a draft guidance for drug development in amyotrophic lateral sclerosis (ALS) that was issued in February 2018. The FDA draft guidance considered the recommendations developed by the ALS community that incorporated the views of a large group of clinical investigators, industry representatives, advocacy groups, patients, and caregivers. This external input from the ALS community reviewed the current state of clinical research in ALS, made suggestions over a wide range of drug development topics, and served as an educational tool to provide the agency with additional inputs about ALS, the state of the science, and the community's views on key topics. In parallel to this effort, there was an independent effort to revise and update the ALS Clinical Trial Guidelines. We discuss the areas of agreement of these 3 documents and the areas that provide opportunities to improve the efficiency of drug development in ALS. It is likely that further research into biomarkers, efficacy endpoints, and predictive algorithms will provide greater alignment among community stakeholders and increase clarity on drug development efforts going forward. Continued patient engagement and inclusion of patient experience data in every aspect of the drug development process will further facilitate the approval of new treatments.

PECULIARITY OF SKELETAL DAMAGES IN OBESE PATIENTS SUFFER POLYTRAUMA

On the clinical material 107 patients with combined body injury found the characteristic features of skeletal injuries depending on the body mass indexwere revealed, while the specific physiological processes of obesity form the basis for more serious injuries due to the resulting injury, in particular skeletal, and high risk degrees of developing complications, often even to the fatal consequences. The studies were conducted in two stages, at the first stageskeletal lesions divided depending on their shockogenic effect on the body into three categories. The first category included fractures of the bones of the upper limb, leg bones and feet (25; 23.4 %); the second one were fractures of the thigh (37; 34.6 %); the third – fractures of the pelvic bones (33; 30.8 %). At the second stage, the obtained results were structured in clinical groups of patients. The latter showed the severity of the resulting skeletal damage depending on the body mass index. Thus, the patients of the I group dominated by fractures of the upper limb bones (11 patients, 10.3 %), and in 5 cases (4.7 %), fractures of the tibia were determined. Femur fractures were prevalent in the 2-nd clinical group, and the least in patients with normal body weight. Patients sufferof the II-III obesity degree(3-rd clinical group) was dominated by severe skeletal trauma, in particular, thigh fracture was diagnosed in 9 (8.4%), and fracture of the pelvic bones - in 18 (16.8 %) patients. In the process of treatment, the stabilization of thigh fractures and pelvic bones was initially carried out by means of external fixation devices, which allowed the skeletal damage to be immobilized as quickly as possible. The mentioned manipulations were an integral part of the program of differentiated complex treatment in the first period of traumatic illness, which created the basis for obtaining positive results of treatment. The obtained results showed that severity of skeletal injuries is directly proportional to the body mass increase increasing.

Point-of-care blood tests in decision-making for people over 65 with acute frailty

Background: National ‘see, treat and discharge’ rates for paramedics have increased. However, despite the rise in demand on paramedic decision-making, there have been few improvements to prehospital diagnostics. Patients aged over 65 years presenting with acute frailty syndromes are a notably complex clinical patient group for whom informed risk stratification in clinical reasoning is paramount. Methods: This was a single-site quality improvement project using point-of-care blood testing (POCbT) to help inform decision-making for patients aged above 65 years with acute frailty syndromes. Results: This quality improvement project showed a self-reported improved confidence in clinician decision-making and patient disposition with the use of POCbT. This confidence was validated by improved discharge on scene and recontact rates. An unintended outcome of the project was the accumulation of practical knowledge on the use of POCbT in the prehospital arena. Conclusion: Continued use of POCbT in the prehospital environment has promise but this is not without limitations. Prehospital services wishing to implement POCbT should focus on demographic identification, staff training and interpretation of results.

Myofascial pain syndrome in the dysfunction of the temporomandibular joint

Selection of the clinical characteristics of pain syndrome in the orofacial region in temporomandibular joint pain dysfunction syndrome (TMJ PDS). One hundred and two patients with TMJ PDS were examined using the Verbal Descriptive Pain Rating Scale of the orofacial area. The Clinical Index of TMJ dysfunction (CID) by Helkimo M. was used for objectification of the level of musculo-tonic disorders in the area of the chewing muscles. The psychopathological status of patients with TMJ PDS was assessed with HRDS and SCL-90-R. A significant proportion of patients with TMJ PDS, in addition to algic symptoms, have hypertonus of the facial muscles, the nature and severity of which require not only a special diagnostic assessment, but also follow-up treatment. The analysis of data allowed us to identify three clinical groups of patients: with isolated (muscular-tonic), neurological symptoms; with mixed (combination of muscular-tonic and somatoform manifestations) neurological and psychopathological symptoms and with somatoform symptoms. Patients with TMJ PDS are clinically heterogeneous and require clinical differentiation, distinguishing the common group of patients with muscular dysfunction accompanied by pain and emotional response to it (anxiety and minor depressive symptoms) and the group of patients with a somatoform disorder (and manifestations as general anxiety).

Comparative evaluation of markers of inflammation and fibrosis in patients with various clinical forms of atrial fibrillation

Aim. To identify and assess the significance of clinical and functional data characterizing cardiac remodeling, as well as inflammatory and fibrosis markers in patients with various clinical forms that promote the progression of atrial fibrillation (AF).Material and methods. We observed 213 patients with arterial hypertension or in combination with coronary artery disease, who were diagnosed with AF. For the clinical and functional assessment of various clinical forms of AF, the significance of certain clinical, hemodynamic, structural, functional, and immunological risk factors for AF was studied. We used the method of binary logistic regression and calculated the significance of the risk factors odds ratio (OR).Results. We made a database consisting of 33 indicators characterizing the clinical, hemodynamic and structural-functional heart condition, inflammatory and fibrosis markers, the significance of which was ambiguous in various clinical groups of AF patients. We identified enough informativeness of the OR significance for indicators of atrial electrical remodeling, which significantly increases from the paroxysmal AF to the persistent form. It confirms a significant role for the heterogeneity of pulses in the atria during the progression of AF. The degree of structural remodeling of both the atria and ventricles also significantly increases with the progression of AF. We also noted that inflammatory markers have statistically significant role with paroxysmal AF. With persistent AF, the significance of OR for inflammatory markers increases, and with permanent AF, their significance decreases. The significance of the OR in fibrosis marker is significantly high with AF and in the further AF progression, and it significantly increases with the persistent AF form.Conclusion. We determined different degrees of electrical and structural remodeling of the atria and ventricles in patients with various clinical forms of AF. At the same time, there is an increase in the reliability of OR in inflammatory and fibrosis markers. However, in patients with persistent AF, the duration of AF and increase in the significance of the OR in fibrosis marker come to the fore.

Monitoring of the Effectiveness of Intensive Care and Rehabilitation by Evaluating the Functional Activity of the Autonomic Nervous System in Patients with Brain Damage

Purpose: evaluation of the clinical significance of parametric monitoring of the effectiveness of intensive care and rehabilitation based on the analysis of the functional state of the autonomous nervous system in patients with brain damage of different genesis.Materials and methods. The study included 66 patients on day 20—50 after the traumatic brain injury; anoxic damage; and stroke consequences. The isolation of clinical groups and subsequent analysis of clinical status is based on the analysis of the functional state of the autonomic nervous system based on the dynamics of the heart rate variability (HRV) parameters. Findings obtained in studies of 500 patients in the postoperative period with a 5-minute HRV were tested as normal and abnormal ANS parameters [1]. Parasympathetic hyperactivity was measured within the limits for SDNN (standard deviation of all normal-to-normal R-R intervals) > 41.5 ms; for rMSSD (root-meansquare of the successive normal sinus R-R interval difference) > 42.4 ms; for pNN50% (the percentage of interval differences in successive NN intervals greater than 50 ms (NN50) / total number of NN intervals) > 8.1%; for SI (Baevsky stress index, in normalized units) < 80 n. u.; for TP (total power of variance of all NN intervals) > 2000 ms2. Sympathetic hyperactivity was determined within the limits for following parameters: SDNN, < 4.54 ms; rMSSD, < 2.25 ms; pNN50%, < 0.109%; SI, > 900 n. u.; TP < 200 ms2. Normal HRV parameters were selected within the limits of the values for: SDNN [13.31-41.4ms]; rMSSD [5.78—42.3 ms]; pNN50% [0.110—8.1%]; SI [80—900 nu]; for TP [200—2000 ms2]. To verify the parasympathetic or sympathetic hyperactivity within these limits, 3 of 5 parameters were chosen [1].Results. Based on the dynamics of the HRV parameters before the intensive care and on days 30—60 of the intensive therapy and rehabilitation of patients with traumatic and non-traumatic brain injuries, 5 main clinical groups of patients were identified. Group 1 (n=27) consisted of patients with normal parameters of the ANS functional activity (both at the time of admission to the hospital and on the 30—60th day of the intensive therapy and rehabilitation). Group 2 (n=9) included patients with the baseline sympathetic hyperactivity of the ANS at admission to the intensive care unit and normal functional activity of the ANS on the 30—60th day of the intensive care and rehabilitation. Group 3 (n=8) included patients with baseline normal functional state of the ANS and the signs of sympathetic hyperactivity of the ANS on the 30—60th day of the intensive care and rehabilitation. Group 4 (n=15) consisted of patients with signs of sympathetic hyperactivity of the ANS both initially and on the 30—60th day of the intensive care and rehabilitation. Group 5 (n=7) included patients with signs of parasympathetic hyperactivity of the ANS (according to the parameters of HRV) both at baseline, at admission to the intensive care unit, and on the 30—60th day of the intensive care and rehabilitation.Conclusion: The normalization of HRV parameters is accompanied by patients’ recovery from the vegetative state and coma to minimal consciousness or normal consciousness; the index of disability rate decreases, the social reintegration grows, according to the DRS scale (M. Rappaport, 1982); dependence on mechanical ventilation reduces, and the muscle tone normalizes.

Body attitude, body satisfaction and body awareness in a clinical group of depressed patients: An observational study on the associations with depression severity and the influence of treatment

BackgroundApart from changes in mood and cognition, depressive disorders are also characterized by changes in body experience, changes that largely influence daily functioning and aggravate distress. In order to gain more insight into this important issue, three domains of body experience - body attitude, body satisfaction and body awareness - and their associations with symptom severity of depression were studied pre- and post-treatment in a clinical sample of depressed patients in a multidisciplinary setting. MethodsBody attitude (Dresden Body Image Questionnaire), body satisfaction (Body Cathexis Scale), body awareness (Somatic Awareness Questionnaire) and severity of depressive symptoms (Inventory of Depressive Symptomatology) were measured. Differences between pre-treatment and post-treatment scores were studied with paired t-tests. Associations between body experience and depression were analysed with Pearson correlations and partial correlations. ResultsAt the start of treatment, patients scored significantly lower than a healthy comparison sample on body attitude and body satisfaction, but not on body awareness. After treatment, depression scores decreased with large effect sizes, scores for body attitude and body satisfaction increased with medium effect sizes and body awareness scores increased slightly. Medium pre-treatment and strong post-treatment associations were found between depression severity and body attitude and between depression severity and body satisfaction. LimitationsThe design does not allow to draw causal conclusions. Because of the multidisciplinary treatment no information is available on the specific contribution of interventions targeting body experience. ConclusionsThe study provides evidence for medium to strong associations in clinically depressed patients between body attitude, body satisfaction and depression.

Improvement of the Liver Steatosis Diagnostics Algorithm with Application of the Ultrasound Wave Attenuation Coefficient Estimation

Pilot results of new quantifying ultrasound methodic of liver steatosis evaluation in dB/cm are presented in this article. Main stages of the methodic standardization are tested in control group of patients (n=90). Liver biopsy (n=40) and dual-energy X-ray absorbtiometry in “Whole body†regime (n=148) were reference methods in clinical group of patients (n=148) with overweight and non-alcoholic fatty liver disease. The correlation of ultrasound liver steatosis diagnostics and liver biopsy was r=0.86 at S0 and r=0.84 at S3.

Burosumab: At Long Last, an Effective Treatment for FGF23-Associated Hypophosphatemia.

Burosumab: At Long Last, an Effective Treatment for FGF23-Associated Hypophosphatemia.

Role of asthma and intolerance to acetylsalicylic acid on the redox profile in nasal polyp tissue.

Nasal polyposis is a chronic inflammatory disease of the mucosa of the nasal cavity and paranasal sinuses. The etiology of nasal polyposis is unclear; however, it may be associated with asthma and intolerance to acetylsalicylic acid, possibly altering the redox profile. The study intends to compare the redox profile in polyps surgically removed from three clinical groups of patients with nasal polyposis who were divided according to the presence of asthma and intolerance to acetylsalicylic acid. Patients were divided into three groups: nasal polyposis only (n = 30); nasal polyposis and asthma (n = 19); and nasal polyposis, asthma and intolerance to acetylsalicylic acid (n = 10). The following redox evaluations were performed: enzymatic antioxidant activity of superoxide dismutase, glutathione peroxidase, hydrogen peroxide consumption and glutathione S-transferase; non-enzymatic antioxidant levels of vitamin C, vitamin E and glutathione; levels of the oxidative damage biomarkers carbonyl groups (measuring protein damage) and malondialdehyde (measuring lipid peroxidation); and nitrite and nitrate levels. Compared with the polyposis only group, hydrogen peroxide consumption, glutathione S-transferase, vitamin E and malondialdehyde were lower in the asthma group. Total glutathione (0.12 ± 0.01 vs. 33.34 ± 10.48µmol/mg) and nitrite and nitrate (0.06 ± 0.01 vs. 15.95 ± 1.38nmol/mg) levels were higher in the nasal polyposis, asthma and intolerance to acetylsalicylic acid group. In patients with nasal polyposis, asthma may alter the redox profile associated with the hydrogen peroxide and lipid damage pathways, whereas asthma and intolerance to acetylsalicylic acid increase nitrite and nitrate and total glutathione levels.

Posterior Tibial Tendon Dysfunction: What does the single heel raise test mean in assessment?

This paper aims to review the literature pertaining to single heel raise test, which is used for the assessment of PTTD. Whilst there is little published information relating to the origins of this test, there is also a clear paucity of information pertaining to the interpretation of the test findings. Understanding why clinicians utilize this test in the assessment of this debilitating pathology and how the result is interpreted is important in helping to bridge the remaining knowledge gap surrounding this condition. This review will contribute to the body of knowledge that is helping to explain why PTTD is an under recognized and underdiagnosed condition. Databases that were searched include PubMed, MEDLINE 1990-present, SportDiscus, AMED 1990-present, CINAHL 1990-present, BMJ Clinical Evidence, Cochrane Library, ISI Web of Knowledge (science) 1990 to present, Ingentaconnect, Science Citation Index, Science Direct and Wiley Interscience. Until recently there has been very little work isolating the tibialis posterior muscle activity in dysfunction. There has been even less work surrounding the individual elements of the assessment this condition such as the single heel rise test. Areas covered within the review are the history of the test, validity and reliability of the test, kinematic changes associated with the test in the presence of PTTD and the biomechanical changes in the presence of PTTD and how this may impact of the execution and interpretation of the test findings. The results from this review are inclusive in relating the single heel raise test to the assessment and diagnosis of PTTD. There is variable use of this test in clinical practice in addition to the clinical setting and patient groups where it is utilized. Further work is indicated surrounding validity and interpretation of the test findings.

Collagen-associated syntropy in children with functional disorders of the digestive system

Objective. The aim of this study was to determine the features of collagen-associated syntropic pathology in children with functional gastrointestinal disorders. Materials and methods . 63 children with functional gastrointestinal disorders aged 2.5 to 16 years were examined. Two clinical groups of patients depending on the leading clinical manifestations were identified: children with irritable bowel syndrome – 39 patients (61.9 %) and children with functional disorders of the biliary tract – 24 (38.1 %) of patients. All children, except for the general clinical examination, were evaluated for individual phenotypic signs of connective tissue dysplasia using diagnostic criteria for the severity of connective tissue dysplasia by L. N. Abbakumova, and collagen type III alpha 1 polymorphism (rs1800255 2092G>A) by PCR-RFLP (restriction fragment length polymorphism) method was determined. Results. Digestive system syntropic pathology was defined in 84.13 % (95 % CI 74.93 – 93.33) of the examined patients. A statistically significant association was found between the frequency of gallbladder anomalies (χ 2 = 8.75; P = 0.003), pancreas exocrine function violation (χ 2 = 8.97, P = 0.003), metabolic disturbances presence in the form of secondary acetonemic syndrome (χ 2 = 8.5; P = 0.001) and functional disorders of the biliary tract. The severity of connective tissue dysplasia in preschool children was characterized by mild and moderate manifestations (OR = 4.27 (95 % CI 1.32 – 13.82; P = 0.025)), there were severe manifestations of dysplasia in the older children group (OR = 0.23 (95 % CI 0.07 – 0.76, P = 0.025)). By the results of molecular-genetic test the most of children – 47.62 % (95 % CI 35.04 – 60.2) were genotyped for heterozygous rs1800255, COL3A1 G/A polymorphism, with significant prevalence of patients with the biliary tract functional disorders group (P = 0.008), which associated with wide range of accompanying pathology (P = 0.002) and severe dysplastic signs (P = 0.034). Conclusions. The wide prevalence of the syntropic pathology in children with functional gastrointestinal disorders has been determined. Genetic polymorphism with predominance of the G / A genotype has been revealed. The statistically significant correlation of the G / A genotype with severe phenotypic signs of connective tissue dysplasia has been shown. The association of genetic polymorphism with age and functional disorders of the biliary tract has been established.

Indication of whole body computed tomography in pediatric polytrauma patients—Diagnostic potential of the Glasgow Coma Scale, the mechanism of injury and clinical examination

ObjectiveTo evaluate the diagnostic potential of the Glasgow Coma Scale (GCS), the mechanism of injury (MOI) and clinical examination (CE) for the indication of whole body computed tomography (WBCT) in pediatric polytrauma patients. Materials & methods100 pediatric polytrauma patients with WBCT were analysed in terms of age, gender, (MOI), GCS, detected injury, FAST, CE and Injury Severity Score (ISS). Correlations between all clinical variables and patient groups with (p+) and without (p−) injury were assessed. ResultsMean age was 9.13 ± 4.4 years (28% female patients). Injury was detected in 71% of the patients, most commonly of the head (43%). There was no significant correlation between type or severity of MOI and ISS (p > 0.1). None of the clinical variables had a significant predictive effect on p+. The optimum discrimination threshold of GCS was at 12.5 relating to craniocerebral injuries. Severity of MOI and FAST showed best predictive effects on thoracic and abdominal pathologies, respectively, but with only low sensitivities (<20%). ConclusionThere is no clinical variable, which can be used as sole indication for WBCT in pediatric polytrauma patients. GCS had a significant predictive value for craniocerbral injuries and CCT is recommended at GCS ≤ 13.

Transcranial sonography in Parkinson’s disease

Despite a broad discussion of the results of ultrasound in Parkinson disease, the dynamics of hyperechoinality of the substantia nigra based on the clinical forms and stages of the disease remains controversial. The purpose of this study is to study thechanges in the substantia nigra of the brain based on the clinical form and stage using an ultrasound in patients with Parkinson’s disease. Materials and methods. The study involved 100 patients with Parkinson’s disease whom were scanned using transcranial sonography through the temporal window with the use of ultrasound scanner Toshiba Aplio 500 (Japan) with a sector transducer with a frequency of 2,5 мGz. Results. It was found that the asymmetric variant of changes in the black substance prevailed in each clinical group of patients and was more often recorded with akinetic-rigid form and the greatest changes were observed in the stages II and III of the disease.

Features of the proteome of the urine in chronic pyelonephritis.

Clinical observation and examination of 12 patients with chronic pyelonephritis (CPN) were performed. The first group (GI) included patients with exacerbation of the disease. In the comparison group (GII)- the same patients after 1.5-3 months after completion of treatment, without clinical manifestations of exacerbation of CPN. Laboratory signs of acute renal damage were not revealed in all examined patients. Additionally, urine was collected in the afternoon after Breakfast, in the form of a freely separated 2nd fraction and its sample preparation, consisting of the stages: recovery, alkylation, protein deposition and proteolysis using trypsin. The resulting polypeptide mixture was separated by liquid chromatography in three repetitions and analyzed on a system consisting of Agilent 1100 chromatograph and ltq-FT ultra hybrid mass spectrometer. A list of proteins was obtained, indicating the number of peptides by which they were identified, and the parameters of its reliability. Most of the information about the obtained proteins was obtained from UniProt databases. Identified and analyzed 10 proteins that differ significantly in occurrence in the clinical group of patients in the period of exacerbation of PN. The appearance of these proteins in urine in 1patients with exacerbation of chronic PH allows us to consider them as potential biomarkers directly associated with inflammation and damage to the epithelial lining of the renal tubules.

Эмоциональное состояние и стратегии совладания подростков с онкогематологическими заболеваниями

The article presents data on the study of emotional state characteristics and coping strategies of adolescents in the stressful situation of oncohematological diseases treatment. Two equalized by socio-demographic and clinical parameters groups of patients 11-18 were examined. The experimental group consisted of 28 adolescents undergoing treatment with hemopoietic stem cell transplantation (HSCT) (M = 14.25, SD = 2.20, M: 57.1%, F: 42.9%). The control group consisted of 30 adolescents undergoing chemotherapy (M = 13.71, SD = 2.12, M: 53.3%, F: 46.7%). The psychological state of adolescents in the course of treatment by НSCТ, in comparison with the state of adolescents of the control group, which is characterized by a significantly higher level of distress and anxiety. Significant differences in the use of coping strategies with stress in patients of the two groups were obtained. Adolescents of the experimental group use a less extensive repertoire of productive coping strategies, often use such an ineffective strategy as "discharge" These differences may be associated with less availability, as well as an increase in depletion of various coping resources under special treatment conditions by the НSCТ. The results of the study confirmed that НSCТ is objectively and subjectively more stressful, which indicates the need for additional monitoring of both the psychological state and the need for psychological care for patients in this group, the development of specialized programs for psychological support for transplantation.

Approaches to alcohol screening in secondary care: a review and meta-analysis

BackgroundAlcohol misuse is common among patients accessing secondary care and an important cause of premature disability and death. The objective of this review was to summarise approaches to alcohol screening in secondary care, including the diagnostic accuracy, uptake, yield, and implementation challenges. MethodsSearch terms for alcohol, screening, and secondary care were combined in Medline, EMBASE, and other bibliographic databases for English language studies published from Jan 1, 2000, to Sept 4, 2015. We included studies and reviews of any design that evaluated alcohol screening with questionnaires or biochemical tests among adolescents and adults in secondary care. The primary outcomes were the diagnostic accuracy, uptake, and yield of alcohol screening. A random-effects proportion meta-analysis summarised screening uptake and yield, stratified by clinical setting. Findings97 articles met the inclusion criteria and were included, with data from 1 213 761 screened patients. The Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) were the most widely validated screening tests and demonstrated high diagnostic accuracy and uptake. Overall, uptake for alcohol screening in secondary care was 79% (95% CI 74–84; n=45 studies, 477 533 of 604 471 screened patients) and the highest uptake was in outpatient clinics at 91% (82–96; n=8, 208 245 of 228 841). Overall, the proportion of patients screening positive for alcohol misuse was 28% (23–32, n=44; 135 741 of 484 788) with the highest yield in outpatient clinics of 31% (22–41; n=7, 72 270 of 233 128). However, there was significant heterogeneity in estimates of both uptake and yield of alcohol screening (I2>90%). InterpretationAlcohol screening in secondary care is likely to have a high uptake and yield, particularly in outpatient clinics. AUDIT and AUDIT-C are the most widely validated screening tools for alcohol misuse in secondary care and have high diagnostic accuracy and uptake. The review included a large number of studies, and a range of clinical settings and patient groups, strengthening the generalisability of the findings. However, a systematic assessment of risk of bias was not conducted and study selection was performed by one reviewer. Further research is needed to evaluate the cost-effectiveness of alcohol screening in secondary care. FundingNone.

Eyetracking metrics reveal impaired spatial anticipation in behavioural variant frontotemporal dementia

Eyetracking technology has had limited application in the dementia field to date, with most studies attempting to discriminate syndrome subgroups on the basis of basic oculomotor functions rather than higher-order cognitive abilities. Eyetracking-based tasks may also offer opportunities to reduce or ameliorate problems associated with standard paper-and-pencil cognitive tests such as the complexity and linguistic demands of verbal test instructions, and the problems of tiredness and attention associated with lengthy tasks that generate few data points at a slow rate. In the present paper we adapted the Brixton spatial anticipation test to a computerized instruction-less version where oculomotor metrics, rather than overt verbal responses, were taken into account as indicators of high level cognitive functions. Twelve bvFTD (in whom spatial anticipation deficits were expected), six SD patients (in whom deficits were predicted to be less frequent) and 38 healthy controls were presented with a 10 × 7 matrix of white circles. During each trial (N = 24) a black dot moved across seven positions on the screen, following 12 different patterns. Participants’ eye movements were recorded. Frequentist statistical analysis of standard eye movement metrics were complemented by a Bayesian machine learning (ML) approach in which raw eyetracking time series datasets were examined to explore the ability to discriminate diagnostic group performance not only on the overall performance but also on individual trials. The original pen and paper Brixton test identified a spatial anticipation deficit in 7/12 (58%) of bvFTD and in 2/6 (33%) of SD patients. The eyetracking frequentist approach reported the deficit in 11/12 (92%) of bvFTD and in none (0%) of the SD patients. The machine learning approach had the main advantage of identifying significant differences from controls in 24/24 individual trials for bvFTD patients and in only 12/24 for SD patients. Results indicate that the fine grained rich datasets obtained from eyetracking metrics can inform us about high level cognitive functions in dementia, such as spatial anticipation. The ML approach can help identify conditions where subtle deficits are present and, potentially, contribute to test optimisation and the reduction of testing times. The absence of instructions also favoured a better distinction between different clinical groups of patients and can help provide valuable disease-specific markers.