A study of patients who leave without notice in an A & E department

Neuronal degradation accompanied with axonal degeneration has been known to occur in spinal motor neurons after an upper level of spinal cord lesion. In the present study, the functional integrity of neuromuscular transmission was assessed by utilizing a sensitive electrodiagnostic method comprising of stimulated single-fiber electromyography (SFEMG), along with axonal microstimulation, in paralytic muscles of patients with spinal cord injury (SCI). Neuromuscular jitter was measured in anterior tibial muscles for 30 patients with SCI and also for 12 normal controls. Mean jitter of 37.4 +/- 14.7 (mean +/- SD) micros, as obtained in SCI patients, was found to be significantly greater than the results of 20.1 +/- 8.4 micros in normal controls (P < 0.01). Jitter measurement was not significantly different in varied functional scales of SCI. A positive correlation was noted between the increased jitter and the disease duration from the onset of cord lesion till the time of stimulated SFEMG test (r = 0.68; P < 0.01). The present abnormal finding of neuromuscular jitter provides an electrophysiologic evidence for axonal degeneration and suggests that transsynaptic degeneration of motor neuron may occur below the level of cord lesion in SCI patients. Furthermore, the neuronal degradation in SCI was positively correlated with the course duration of the disease.     

The moderating effect of spinal cord injury on MMPI-2 profiles: A clinically derived T score correction procedure.

Applied a retrospective pretest-posttest design to examine the extent to which the physical sequelae of spinal cord injury (SCI) affected mean T scores on the MMPI-2. 32 men with quadriplegia and 10 with paraplegia answered the MMPI-2, then, after recalling their status prior to injury, reanswered 28 MMPI-2 items judged by 12 psychiatrists to reflect the physical sequelae of SCI. The original MMPI-2 scores were compared with corrected scores based upon the 28 preinjury responses. Significant differences were found on scales F, K, 1, 2, 3, 4, 7, 8, and 9. Significant differences between the MMPI-2 male normative group and the SCI group were found on scales 1, 2, 3, 4, 5, 8, 9, and 0 when conventional scoring was used but only on scales 5 and 0 when the correction procedure was used. The correction procedure changed interpretive statements associated with the SCI group mean profile. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of depressive symptoms during inpatient rehabilitation for spinal cord injury: Is there an underlying somatic factor when using the PHQ?

Objective: To test the hypothesis that a 2-factor solution, including a somatic factor, best accounts for the response pattern to the Patient Health Questionnaire-9 (PHQ-9) during inpatient rehabilitation after spinal cord injury (SCI). Research Design: 568 adults with traumatic SCI were administered the PHQ-9 during inpatient rehabilitation. The PHQ-9 was developed to identify depressive disorders based on DSM-IV criteria. Results: Maximum likelihood confirmatory factor analysis was used to compare unidimensional and alternative 2-factor models. The results suggested that the 2-factor solution with 3 somatic items (sleep disturbance, poor energy, appetite change) was a better solution than either a unidimensional model or 2-factor model that included psychomotor retardation as a fourth somatic item. The root mean square error of approximation with 3 somatic items fell within the acceptable range of less than .08 (.073). The 2 factors were highly correlated (.76) but within the acceptable range (less than .80). Conclusions: There may be 2 underlying factors with the PHQ-9, including a somatic factor, when measuring depressive symptoms during inpatient rehabilitation for SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological problems of spinal cord injury patients: Emotional distress as a function of time and locus of control.

A scale assessing psychological problems was developed and administered to 136 male VA hospital spinal cord injury (SCI) patients (under 30 yrs of age). Results suggest that reaction to SCI was dominated by emotional distress and was best predicted by external locus of control and by recent injury. The scale was correlated with self-reports of anxiety, adjustment, affiliation, and sociability in a college population. Results do not support a simple stage theory of reaction to SCI but are consistent with other studies of coping patterns in SCI patients. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving measurement properties of the Patient Health Questionnaire–9 with rating scale analysis.

Objective: The goal of this study was to explore the psychometric properties of the Patient Health Questionnaire–9 (PHQ-9; R. L. Spitzer, K. Kroenke, & J. B. W. Williams, 1999). Method: Factor analysis and Rasch rating scale analysis were used to examine the psychometric properties of the PHQ-9. The sample consisted of 202 adults with spinal cord injury (SCI). Results: The PHQ-9 items appear to form a usefully unidimensional scale. One “double-barreled” item, “Moving or speaking so slowly that other people could have noticed or being so fidgety or restless that you’ve been moving around a lot more than usual,” misfit the Rasch model. Category probability curves indicate respondent difficulty in distinguishing between the 2 intermediate rating scale categories: several days and more than half the days. Combining these categories eliminated this problem and resulted in all items fitting the measurement model. Conclusions: The measurement properties of the PHQ-9 can be improved by collapsing rating scale categories and by restructuring several double- and triple-barreled items. Adopting these changes may improve sensitivity in measuring depression after SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of fine-needle aspiration cytology and flow cytometry in the diagnosis and subclassification of primary and recurrent lymphoma

The aim of this study was to assess and compare spinal cord injured (SCI) and traumatic brain injured (TBI) persons and people from the general population concerning partner relationships, functioning, mood and global quality of life. One hundred and sixty seven SCI persons, 92 TBI persons and 264 controls participated in the study. The median age was: SCI persons 33 years (range 19 to 79 years), TBI persons 40 years (range 20 to 70 years), and controls 31 years (range 19 to 79 years). Age at injury ranged among SCI persons from 14 to 76 years (Md 28 years), and among TBI persons from 16 to 56 years (Md 32 years). Half of the SCI group (51%), 58% of the TBI group and 59% of the controls had a stable partner relationship at the time of the investigation. Many of these SCI and TBI relationships (38% and 55% respectively) were established after injury. Both SCI and TBI persons showed significantly more depressive feelings compared with the controls. Perceived quality of life (global QL rating) was significantly lower in the SCI group compared with the controls, whereas the ratings of TBI persons and controls did not differ significantly. SCI and TBI persons did not differ significantly in level of education, perceived quality of life or distress. In all three groups, global quality-of-life ratings were significantly lower among single persons compared to those with a partner relationship. It was concluded that both SCI and TBI appear to affect overall quality of life and mental well-being negatively. The number of partner relationships contracted after injury among both SCI and TBI persons indicates, however, that the injury is not a major barrier to establishing close partner relationships. Being in good spirits, that is, lack of depressive feelings has a profound impact on the perception of a high quality of life in all three groups. For the SCI and TBI persons, a high level of physical and social independence were further positive determinants of a perceived high quality of life.     

Brief Symptom Inventory norms for spinal cord injury.

Investigated the effects of spinal cord injury (SCI) upon a person's response to the Brief Symptom Inventory (BSI) by analyzing differences across item-response distributions from 225 Ss with SCI (aged 17–68 yrs) vs a nonpatient normative sample of 719 Ss. The study also developed more appropriate BSI normative data for persons with SCI. Because Ss' time since injury varied at time of BSI administration, normative scores were provided within 3 groupings: at discharge from the hospital; 0–24 mo post-discharge; and beyond 24 mo. Results show that SCI Ss had higher BSI scores when compared with Ss in the normative sample. These differences were particularly significant across 8 BSI items that reflected actual SCI physical and psychosocial symptoms. SCI Ss reported more distress during the period immediately following discharge to 24 mo. Overall, BSI scores tended to be lower at discharge and after 24 mo post-discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of subjective well-being after spinal cord injury: an empirical analysis by gender and race/ethnicity

OBJECTIVE: The purpose of this study was twofold: (1) to identify the underlying dimensions of subjective well-being after spinal cord injury (SCI), and (2) to develop reliable scales based on measurement of these dimensions. DESIGN: A field study was conducted by surveying the subjective well-being of two large samples of participants with SCI. Principal axis factor analysis with varimax rotation was applied to participant responses to 50 subjective well-being items. SETTING: All participants were selected from the outpatient files of two midwestern rehabilitation hospitals and from a large southeastern rehabilitation hospital. PARTICIPANTS: There were a total of 1,032 participants, 435 from the Midwest and 597 from the Southeast. MAIN OUTCOME MEASURES: The Life Situation Questionnaire-revised version (LSQ-R) was used to measure subjective well-being. It included two prominent sections, one for life satisfaction (20 items) and the other for self-reported problems (30 items). RESULTS: Seven subjective well-being factor scales were identified across the full participant sample: Engagement, Negative Affect, Health Problems, Career Opportunities, Finances, Living Circumstances, and Interpersonal Relations. The average alpha coefficient was .86 for the factor scales. Separate analyses of the midwestern and southeastern samples suggested stability of the factor structure, although gender and race/ ethnicity were related to subtle differences in subjective well-being. CONCLUSIONS: The results suggest that rehabilitation professionals need to pay attention to multiple aspects of subjective well-being after SCI.     

Life satisfaction and self-reported problems after spinal cord injury: Measurement of underlying dimensions.

Objective: Evaluate the utility of the current 7-scale structure of the Life Situation Questionnaire—Revised (LSQ–R) using confirmatory factor analysis (CFA) and explore the factor structure of each set of items. Design: Adults (N = 1,543) with traumatic spinal cord injury (SCI) were administered the 20 satisfaction and 30 problems items from the LSQ–R. Results: CFA suggests that the existing 7-scale structure across the 50 items was within the acceptable range (root-mean-square error of approximation [RMSEA] = 0.078), although it fell just outside of this range for women. Factor analysis revealed 3 satisfaction factors and 6 problems factors. The overall fit of the problems items (RMSEA = 0.070) was superior to that of the satisfaction items (RMSEA = 0.80). RMSEA fell just outside of the acceptable range for Whites and men on the satisfaction scales. All scales had acceptable internal consistency. Conclusion: Results suggest the original scoring of the LSQ–R remains viable, although individual results should be reviewed for special population. Factor analysis of subsets of items allows satisfaction and problems items to be used independently, depending on the study purpose. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Plasma leptin is directly related to body adiposity in subjects with spinal cord injury

We addressed the relationship between plasma leptin and body mass index in 48 able-bodied male controls and 34 male subjects with spinal cord injury, as well as the association between plasma leptin with body fat by dual energy x-ray absorptiometry in those with spinal cord injury. In subjects with spinal cord injury, the effect of an oral glucose tolerance test and the relationship of the serum lipid profile with plasma leptin levels were determined. Body mass index was not significantly different between the spinal cord injury and control groups. Plasma leptin was significantly higher in the group with spinal cord injury than in the control group (12.7 +/- 1.7 vs. 7.6 +/- 0.9 ng/ml, p < 0.005). A linear relationship was found between plasma leptin and body mass index in both groups separately (spinal cord injury: r = 0.59, p < 0.0002; control: r = 0.67, p < 0.0001). In those with SCI, a polynomial relationship was evident between plasma leptin and percent fat (r = 0.82, p < 0.0001). After an oral glucose load, plasma insulin levels and serum glucose concentrations were not related to plasma leptin levels. Serum triglycerides were found to be weakly correlated with plasma leptin levels (r = 0.35, p < 0.05). The higher plasma leptin levels in the group with spinal cord injury compared with the control group was probably due to a relatively increased percentage of adiposity in those with spinal cord injury.     

Subjective well-being after spinal cord injury: Relationship to gender, race–ethnicity, and chronologic age.

Compared subjective well-being (SWB) scores as a function of gender and race-ethnicity while controlling for differences in chronologic age among a sample of participants with traumatic spinal cord injury (SCI). A field study of 597 people, including an oversampling of women and racial-ethnic minorities, was conducted. Multivariate analysis of covariance was used to compare SWB outcomes as a function of gender and race-ethnicity. SWB was measured by 2 global indexes and 7 factor scales of the revised Life Situation Questionnaire. Minority participants reported lower SWB than Caucasians on the Global Satisfaction index and on the Career Opportunities, Finances, and Living Circumstances scales. Men had lower scores than women on the Interpersonal Relations scale. Age was only modestly associated with SWB. The results suggest that rehabilitation professionals need to pay attention to gender, race-ethnicity, and age differences in response to SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Radiofrequency catheter ablation therapy in elderly patients with supraventricular tachycardia

In the present study, long-term and short-term rat preparations were used to develop a model for investigating external anal sphincter (EAS) reflexes in intact and spinal cord-injured (SCI) rats. In this model, EAS distension with an external probe elicits reflex contractions of the EAS in intact, unanesthetized animals. At 2 h after spinal cord transection, none of the lesioned animals displayed EAS EMG activity. In fact, once distended, the EAS was incapable of maintaining closure of the anal orifice. Over a period of 4 days, spinalized animals developed a hyperreflexia of the EAS response. By 48 h, the rectified, integrated EAS EMG was significantly elevated in comparison with nonlesioned controls (EAS hyperreflexia). In addition, the duration of the EAS EMG bursts in response to sphincter distension had significantly increased. At 6 weeks after injury, the EAS was significantly hyperreflexic as measured by EMG burst duration and burst area. As with intact animals, posttransection EAS reflexes were highly anesthesia sensitive. These studies indicate that (1) brief distension of the anal orifice is sufficient to evoke a physiologically relevant reflexive activation of the EAS in the rat, (2) the 2- to 24-h postinjury areflexia observed in these experiments may be a suitable model for the study of spinal shock, and (3) the observed EAS hyperreflexia after chronic SCI may represent the permanent effects of removing descending inhibitory circuits and segmental plasticity, making this reflex an appropriate measure of defecatory dysfunction after spinal cord injury.     

Comparability of two administration formats of the Keane Posttraumatic Stress Disorder Scale.

Evaluated the utility of administering the 49 items of the Keane MMPI posttraumatic stress disorder (PTSD) scale (T. M. Keane et al; see record 1985-02913-001) as an instrument separate from the full MMPI. Scores obtained through a separate administration of the PTSD scale were significantly positively correlated with scores obtained through a standard administration of the MMPI. This finding held for both White (n?=?114) and African-American (n?=?61) Ss. Within each ethnic group, mean scores were virtually identical across administration formats. Overall, 94.3% of the veterans were similarly classified on both administrations of the PTSD scale when the recommended cutoff score of 30 was applied. The clinical and research uses of the PTSD scale as a separate instrument are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients

The aim of this paper is to review the incidence and characteristics found in traumatic spinal cord injury (SCI) occurring in patients with long-standing ankylosing spondylitis (AS). The incidence of patients with traumatic SCI admitted to our unit from January 1984 to February 1996 was 2% (15 out of 893). They were all men with a mean age of 56 years. Most frequently the etiology of the lesion was a motor vehicle accident and the injury was mainly due to a hyperextension mechanism. Acute spinal fracture occurred in 13 patients, all involving the cervical region. No fracture was observed in two patients with thoracic neurological level. Three patients presented with an interval free period of neurological symptoms in whom a spinal epidural hematoma was visualized with magnetic resonance imaging. On admission eight patients were diagnosed as having complete SCI and the other seven an incomplete SCI. In the acute phase, respiratory complications were most frequent, causing six patients to die. Treatment was conservative in 14 patients. Multidisciplinary management of these patients should be implemented in an institution equipped with both a Spinal Injury Unit and an Intensive Care Unit.     

Distribution and latency of muscle responses to transcranial magnetic stimulation of motor cortex after spinal cord injury in humans

Noninvasive transcranial magnetic stimulation (TMS) of the motor cortex was used to evoke electromyographic (EMG) responses in persons with spinal cord injury (n = 97) and able-bodied subjects (n = 20, for comparative data). Our goal was to evaluate, for different levels and severity of spinal cord injury, potential differences in the distribution and latency of motor responses in a large sample of muscles affected by the injury. The spinal cord injury (SCI) population was divided into subgroups based upon injury location (cervical, thoracic, and thoracolumbar) and clinical status (motor-complete versus motor-incomplete). Cortical stimuli were delivered while subjects attempted to contract individual muscles, in order to both maximize the probability of a response to TMS and minimize the response latency. Subjects with motor-incomplete injuries to the cervical or thoracic spinal cord were more likely to demonstrate volitional and TMS-evoked contractions in muscles controlling their foot and ankle (i.e., distal lower limb muscles) compared to muscles of the thigh (i.e., proximal lower limb muscles). When TMS did evoke responses in muscles innervated at levels caudal to the spinal cord lesion, response latencies of muscles in the lower limbs were delayed equally for persons with injury to the cervical or thoracic spinal cord, suggesting normal central motor conduction velocity in motor axons caudal to the lesion. In fact, motor response distribution and latencies were essentially indistinguishable for injuries to the cervical or thoracic (at or rostral to T10) levels of the spine. In contrast, motor-incomplete SCI subjects with injuries at the thoracolumbar level showed a higher probability of preserved volitional movements and TMS-evoked contractions in proximal muscles of the lower limb, and absent responses in distal muscles. When responses to TMS were seen in this group, the latencies were not significantly longer than those of able-bodied (AB) subjects, strongly suggestive of "root sparing" as a basis for motor function in subjects with injury at or caudal to the T11 vertebral body. Both the distribution and latency of TMS-evoked responses are consistent with highly focal lesions to the spinal cord in the subjects examined. The pattern of preserved responsiveness predominating in the distal leg muscles is consistent with a greater role of corticospinal tract innervation of these muscles compared to more proximal muscles of the thigh and hip.     

Graded histological and locomotor outcomes after spinal cord contusion using the NYU weight-drop device versus transection

Injury reproducibility is an important characteristic of experimental models of spinal cord injuries (SCI) because it limits the variability in locomotor and anatomical outcome measures. Recently, a more sensitive locomotor rating scale, the Basso, Beattie, and Bresnahan scale (BBB), was developed but had not been tested on rats with severe SCI complete transection. Rats had a 10-g rod dropped from heights of 6.25, 12.5, 25, and 50 mm onto the exposed cord at Tl 0 using the NYU device. A subset of rats with 25 and 50 mm SCI had subsequent spinal cord transection (SCI + TX) and were compared to rats with transection only (TX) in order to ascertain the dependence of recovery on descending systems. After 7-9 weeks of locomotor testing, the percentage of white matter measured from myelin-stained cross sections through the lesion center was significantly different between all the groups with the exception of 12.5 vs 25 mm and 25 vs 50 mm groups. Locomotor recovery was greatest for the 6.25-mm group and least for the 50-mm group and was correlated positively to the amount of tissue sparing at the lesion center (p < 0.0001). BBB scale sensitivity was sufficient to discriminate significant locomotor differences between the most severe SCI (50 mm) and complete TX (p < 0.01). Transection following SCI resulted in a drop in locomotor scores and rats were unable to step or support weight with their hindlimbs (p < 0.01), suggesting that locomotor recovery depends on spared descending systems. The SCI + TX group had a significantly greater frequency of HL movements during open field testing than the TX group (p < 0.005). There was also a trend for the SCI + TX group to have higher locomotor scores than the TX group (p > 0.05). Thus, spared descending systems appear to modify segmental systems which produce greater behavioral improvements than isolated cord systems.     

Brief screening for psychological and substance abuse disorders in veterans with long-term spinal cord injury.

Objective: To determine rates of positive screens for psychological and substance use disorders in persons with long-term spinal cord injury (SCI). Study Design: A naturalistic cohort design wherein consecutive admissions during an 8-month period completed the screening battery. Setting: Veterans Affairs SCI Center. Participants: One hundred fifteen men, 2 women, mean age 57.4 years, injured an average of 20 years, readmitted for various reasons. Main Outcome Measures: The Alcohol Use Disorders Identification Test (AUDIT) and screening items for depression and anxiety disorders. Results: Rates of positive screens ranged from 6.2% for alcohol problems to over 40% for anxiety disorders. Positive screens for depression and anxiety correlated positively with the number of recent hospital admissions. Conclusions: Systematic brief screening for psychological and substance abuse disorders in this population revealed rates of positive screens at least equal to those in other medical patient populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of complete spinal cord injury on skeletal muscle within 6 mo of injury

This study examined the influence of spinal cord injury (SCI) on affected skeletal muscle. The right vastus lateralis muscle was biopsied in 12 patients as soon as they were clinically stable (average 6 wk after SCI), and 11 and 24 wk after injury. Samples were also taken from nine able-bodied controls at two time points 18 wk apart. Surface electrical stimulation (ES) was applied to the left quadriceps femoris muscle to assess fatigue at these same time intervals. Biopsies were analyzed for fiber type percent and cross-sectional area (CSA), fiber type-specific succinic dehydrogenase (SDH) and alpha-glycerophosphate dehydrogenase (GPDH) activities, and myosin heavy chain percent. Controls showed no change in any variable over time. Patients showed 27-56% atrophy (P = 0.000) of type I, IIa, and IIax+IIx fibers from 6 to 24 wk after injury, resulting in fiber CSA approximately one-third that of controls. Their fiber type specific SDH and GPDH activities increased (P 相似文献   

Depression among acute spinal cord injury patients: A study utilizing the Zung Self-Rating Depression Scale.

Administered the Self-Rating Depression Scale (SRDS) an average of 63 days post-injury to 58 acute spinal cord injury (SCI) patients (aged 18–55 yrs) and 51 age-matched healthy controls (CTLs). Mean SRDS scores were 37.1 for CTLs and 49.0 for SCI Ss. Several factors, including age, yrs of education, level of injury (paraplegic vs quadriplegic), etiology of injury (violent vs nonviolent), presence of acute closed head injury, or recent history of alcohol or substance abuse, had no association with SRDS scores. Since undiagnosed and untreated depression may compromise an SCI patient's adaptation to injury and motivation during rehabilitation, abnormally elevated SRDS scores may help to determine which patients might require more focused psychological assessment and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of intrathecal nimodipine on spinal cord blood flow and evoked potentials in the normal or injured cord

A method was developed for administering intrathecal pharmacotherapy in a rat model of spinal cord injury. The effects of intrathecal administration of nimodipine on spinal cord blood flow (SCBF) and evoked potentials (EPs) were measured in the normal and injured spinal cord. It had previously been shown that systemic nimodipine caused severe hypotension after spinal cord injury. After baseline SCBF and EPs, 15 uninjured rats were blindly allocated to one of three groups: one placebo group (n = 5); and two groups with intrathecal nimodipine, 0.05 mg/kg (n = 5), or 0.2 mg/kg (n = 5). Ten other rats received a 35 g acute clip compression injury of the spinal cord for 1 minute and, were allocated to one of two groups: placebo (n = 5); and intrathecal nimodipine 0.05 mg/kg (n = 5) given 60 min after injury. In the uninjured groups, neither 0.05 nor 0.2 mg/kg of nimodipine increased SCBF during, or 30 min after, intrathecal infusion. However, the mean arterial blood pressure (MABP) decreased significantly to 69.73.1% after the infusion of 0.2 mg/kg nimodipine and did not recover by 98 min. In all three groups of uninjured rats, the amplitude of the cerebellar EP was decreased 30 min after infusion. After spinal cord injury, there were significant decreases in MABP, SCBF and EP amplitude in both placebo and treatment groups, but there was no therapeutic benefit from nimodipine. Thus, intrathecal infusion of nimodipine did not prevent the hypotension encountered with systemic administration and exerted no beneficial effect on SCBF or EPs after acute spinal cord injury.