Preliminary Evidence for the Clinical Utility of Tactile Somatosensory Assessments of Sport-Related mTBI

Abstract Objectives To evaluate the clinical utility of tactile somatosensory assessments to assist clinicians in diagnosing sport-related mild traumatic brain injury (SR-mTBI), classifying recovery trajectory based on performance at initial clinical assessment, and determining if neurophysiological recovery coincided with clinical recovery. Research Design Prospective cohort study with normative controls. Methods At admission (n = 79) and discharge (n = 45/79), SR-mTBI patients completed the SCAT-5 symptom scale, along with the following three components from the Cortical Metrics Brain Gauge somatosensory assessment (BG-SA): temporal order judgement (TOJ), TOJ with confounding condition (TOJc), and duration discrimination (DUR). To assist SR-mTBI diagnosis on admission, BG-SA performance was used in logistic regression to discriminate cases belonging to the SR-mTBI sample or a healthy reference sample (pooled BG-SA data for healthy participants in previous studies). Decision trees evaluated how accurately BG-SA performance classified SR-mTBI recovery trajectories. Results BG-SA TOJ, TOJc, and DUR poorly discriminated between cases belonging to the SR-mTBI sample or a healthy reference sample (0.54–0.70 AUC, 47.46–64.71 PPV, 48.48–61.11 NPV). The BG-SA evaluated did not accurately classify SR-mTBI recovery trajectories (> 14-day resolution 48%, ≤14–day resolution 54%, lost to referral/follow-up 45%). Mann-Whitney U tests revealed differences in BG-SA TOJc performance between SR-mTBI participants and the healthy reference sample at initial clinical assessment and at clinical recovery (p < 0.05). Conclusions BG-SA TOJ, TOJc, and DUR appear to have limited clinical utility to assist clinicians with diagnosing SR-mTBI or predicting recovery trajectories under ecologically valid conditions. Neurophysiological abnormalities persisted beyond clinical recovery given abnormal BG-SA TOJc performance observed when SR-mTBI patients achieved clinical recovery.

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Sensory testing as a predictor of short vs. long term trajectory of recovery from concussion

The Journal of Science and Medicine ◽

10.37714/josam.v2i4.71 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Eric Francisco ◽

Oleg Favorov ◽

Anna Tommerdahl ◽

Jameson Holden ◽

Mark Tommerdahl

Keyword(s):

Animal Model ◽

Reaction Time ◽

Somatosensory System ◽

Duration Discrimination ◽

Neural Mechanisms ◽

Time Variability ◽

Post Injury ◽

Reaction Time Variability ◽

Temporal Order Judgement ◽

Recovery Trajectory

There have been numerous reports of neurological assessments of post-concussed athletes. However, the majority of the methods commonly deployed are either qualitative assessments that are simply symptom based or are psycho-social questionnaires. The information provided from those studies does not provide insight into the neural mechanisms impacted by concussion, and more importantly, does not contribute to a prognostic view of overall brain health that would facilitate or predict the recovery of the concussed individual. Cortical metrics are measures that were designed to probe brain function via the somatosensory system (i.e., with high fidelity tactile inputs) and have been demonstrated to be both objective, quantifiable and physiologically based. The methods have also been recently reported to parallel findings in a neurophysiological animal model of brain injury (Challener et al, 2020) that support the concept that these metrics parallel alterations in specific neural mechanisms post-injury. In this report, the battery of tactile based measures are reaction time (RT), reaction time variability (RTvar), sequential and simultaneous amplitude discrimination, temporal order judgement (TOJ) and duration discrimination (DD). These methods are administered with a computer mouse sized tactile stimulator (the Brain Gauge) that delivers sinusoidal stimuli to digits 2 and 3 with precision control of both amplitude and frequency. The results obtained during the first week of observation post-injury predict the recovery trajectory of the concussed individual. Interestingly, some of the metrics of the individuals who take longer to recover from injury obtained during the first week outperform the metrics of individuals that recover quickly, and these findings parallel the findings from the animal model.

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P5672Diagnostic accuracy and clinical utility of point-of-care ultrasound among syncope patients in the emergency department

European Heart Journal ◽

10.1093/eurheartj/ehz746.0614 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E Pivetta ◽

F Moretto ◽

G Bianchi ◽

S Masellis ◽

F Bovaro ◽

...

Keyword(s):

Emergency Department ◽

High Risk ◽

Diagnostic Accuracy ◽

Clinical Evaluation ◽

Clinical Assessment ◽

Clinical Utility ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Short Term

Abstract Background/Introduction Syncope is still a challenge for risk stratification in the Emergency Department (ED), and the indication to discharge is not well established for all patients. Purpose To evaluate diagnostic accuracy and clinical utility of integration of clinical assessment and point-of-care ultrasound (POCUS) in evaluating non high-risk syncopes in the ED. Methods This observational prospective cohort study enrolled patients between February 2016 and January 2019. All adult patients presenting in the ED for a non-high risk syncope were eligible (defined according to the 2015 ESC consensus on management of syncope in the ED). Subject for whom event etiology was identified right after the clinical assessment (i.e. history, physical exam, and EKG) or showing a clinical high risk for short term serious outcomes or refuse to participate in the study were excluded. After the initial clinical assessment, the physician responsible for patient care was asked to categorize the syncope as low or neither high nor low risk. Immediately after, the same physician performed POCUS, and a new risk assessment, based on the results of both clinical and sonographic findings, was recorded. Thirty days after the ED evaluation, all participants were telephonically followed up by the investigators in order to assess the risk of short-term outcomes as defined in the San Francisco Syncope Rule cohorts. Both diagnostic accuracy, defined as sensitivity (SE) and specificity (SPE), and clinical utility, evaluated as net reclassification index (NRI) and net benefit were evaluated for clinical and POCUS-integrated assessment. Results A total of 415 patients with a syncope were eligible. Of these, 194 were enrolled (107 women - 55.2%). Median age was 63 years (interquartile range, IQR, 30 years). During the follow up, 21 patients experienced 28 events. SE and SPE of the clinical evaluation were 33.3% (95% confidence interval, CI, 14.6–57%) and 79.5% (95% CI 72.7–85.3%), and they were 42.9% (95% CI 21.8–66%), and 92.4% (95% CI 87.4–95.9) for the POCUS-integrated evaluation (p<0.01 for SE and 0.05 for SPE). NRI for events and non-events during follow up was 9.5% and 12.7%, respectively. Using the prevalence of events in our cohort (10.8%) as the threshold probability, the use of the POCUS-integrated approach would reduce the diagnostic error of the clinical evaluation by 4.6 cases/100 patients. The median time between clinical and POCUS-integrated evaluation was 15 minutes (iqr 20 minutes). Conclusion The results of our study suggest that the integration of the clinical evaluation with POCUS for patients presenting to the ED for non high-risk syncope might be able to increase the diagnostic accuracy and the utility of the clinical assessment alone.

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fNCI-directed treatment of sports related post-concussion syndrome ion syndrome

Neurology ◽

10.1212/01.wnl.0000550611.90268.73 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S21.1-S21

Author(s):

Christiane Paney ◽

Marci Johnson ◽

Alina Fong ◽

Mark Allen

Keyword(s):

Reference Sample ◽

Treatment Protocol ◽

Severity Index ◽

Post Treatment ◽

Treatment Modalities ◽

Percent Reduction ◽

Symptom Scale ◽

Subjective Measurements ◽

Pre Treatment

PurposeWe propose that our individualized Enhanced Performance in Cognition (EPIC) Treatment can effectively address PCS in sports-related concussions by employing functional NeuroCognitive imaging (fNCI) in conjunction with post-concussion symptom scale measurements to inform and direct treatment modalities. fNCI is a specialized application of fMRI that utilizes a normative reference sample and biomarkers for concussion to provide sensitive and specific predictive diagnostic values. The fNCI addresses neurovascular coupling (NVC) dysregulation that commonly arises in PCS. These results inform individualized EPIC Treatment to restore normal NVC function with a treatment protocol that strategically integrates cardiovascular therapies with cognitive training.MethodsTwo hundred four sports concussion patients were assessed pre- and post-treatment using both objective (fNCI) and subjective Post-Concussion Symptom Scale (PCSS) measures, establishing pre-treatment benchmarks to measure therapeutic effectiveness. Patients underwent EPIC Treatment, which is a week-long, multiple treatments per day period consisting of cognitive, occupational, and neuromuscular therapy informed by fNCI and standardized PCSS findings.ResultsfNCI Severity Index Score (SIS) reported an average 80 percent reduction in objective measurements from the pre-treatment scan. Subjective measurements from the Post-Concussion Symptoms Scale (PCSS) reveal 59 percent reduction of symptoms as described by patient report. The SIS measurements are stable in follow-up scans 1-year post-treatment.ConclusionWe provide evidence that fNCI can be used in assessment and treatment of chronic PCS resulting from SRC. Furthermore, the results provide evidence that our fNCI-guided treatment has positive outcomes in both objective and subjective measurements. This supports the hypothesis that our treatment effectively addresses PCS symptoms resulting from SRC. Follow-up fNCI scans indicate that improvements are stable following treatment.SignificanceSRC patients suffering from chronic PCS who were assessed by fNCI and underwent EPIC treatment report immediate, sustainable, and longitudinal reduction in symptoms resulting in significant improvements to quality of life and functionality.

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A comparison between complete immobilisation and protected active mobilisation in sensory nerve recovery following isolated digital nerve injury

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411431208 ◽

2011 ◽

Vol 37 (5) ◽

pp. 422-426 ◽

Cited By ~ 4

Author(s):

F. P. Henry ◽

R. I. Farkhad ◽

F. S. Butt ◽

M. O’Shaughnessy ◽

S. T. O’Sullivan

Keyword(s):

Return To Work ◽

Clinical Assessment ◽

Nerve Repair ◽

Sensory Nerve ◽

Digital Nerve ◽

Cold Intolerance ◽

Clinical Recovery ◽

Significant Difference ◽

Nerve Recovery

Post-operative immobilisation following isolated digital nerve repair remains a controversial issue amongst the microsurgical community. Protocols differ from unit to unit and even, as evidenced in our unit, may differ from consultant to consultant. We undertook a retrospective review of 46 patients who underwent isolated digital nerve repair over a 6-month period. Follow-up ranged from 6 to 18 months. Twenty-four were managed with protected active mobilisation over a 4-week period while 22 were immobilised over the same period. Outcomes such as return to work, cold intolerance, two-point discrimination and temperature differentiation were used as indicators of clinical recovery. Our results showed that there was no significant difference noted in either clinical assessment of recovery or return to work following either post-operative protocol, suggesting that either regime may be adopted, tailored to the patient’s needs and resources of the unit.

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A form of Autoimmune Diabetes in Adults Named LADA – An Update on Essential Features and Controversies

Current Diabetes Reviews ◽

10.2174/1573399814666180716152342 ◽

2019 ◽

Vol 15 (3) ◽

pp. 172-173 ◽

Cited By ~ 1

Author(s):

Valdemar Grill ◽

Bjørn O. Åsvold

Keyword(s):

Genetic Background ◽

Clinical Utility ◽

Autoimmune Diabetes ◽

Classical Type ◽

Phenotypic Characteristics ◽

Latent Autoimmune Diabetes ◽

The Impact

Latent Autoimmune Diabetes in the Adult, LADA has been investigated less than “classical” type 1 and type 2 diabetes and the criteria for and the relevance of a LADA diagnosis has been challenged. Despite the absence of a genetic background that is exclusive to LADA, this form of diabetes displays phenotypic characteristics that distinguish it from other forms of diabetes. LADA is heterogeneous in terms of the impact of autoimmunity and lifestyle factors, something that poses problems as to therapy and follow-up perhaps particularly in those with marginal positivity. Yet, there appears to be clear clinical utility in classifying individuals as LADA.

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Primary Extra-Nodal DLBCL of Glands: Our Experiences outside Guidelines of Treatment

Healthcare ◽

10.3390/healthcare9030286 ◽

2021 ◽

Vol 9 (3) ◽

pp. 286

Author(s):

Antonello Sica ◽

Mario Santagata ◽

Caterina Sagnelli ◽

Piero Rambaldi ◽

Renato Franco ◽

...

Keyword(s):

Lymph Node ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Lymphoid Tissues ◽

Clinical Recovery ◽

Large B Cell Lymphoma ◽

Thyroid Glands ◽

Chemotherapy Protocol ◽

Large B Cell

Lymphomas usually involve lymph nodes and other lymphoid tissues, but sometimes occur in non-lymphoid organs, called extra-nodal sites. Primary diffuse extra-lymph node large B-cell lymphoma (DLBCL) of the thyroid and parotid gland have been observed rarely. According to the most accredited guidelines, primary extra-nodal DLBCL of the parotid and thyroid glands should be treated with three cycles of R-CHOP followed by radiotherapy of the involved site (ISRT). Surgery alone is not enough to treat DLBCL. We describe two unusual cases of primary extra-nodal DLBCL in elderly patients treated exclusively with surgical resection, given the inability to apply chemotherapy. Both patients achieved clinical recovery, which was maintained after a follow-up of more than 18 months, despite not having performed the indicated chemotherapy protocol. The two cases presented here, and a few others reported in the literature, should be considered exceptions to the rule, and do not allow the conclusion that surgery alone might be sufficient for complete remission.

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Proximal Row Carpectomy with Total Scapoidectomy vs. Conventional Carpal Resection for ReMotion Total Wrist Arthroplasty

Journal of Clinical Medicine ◽

10.3390/jcm10091865 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1865

Author(s):

Stefan M. Froschauer ◽

Matthias Holzbauer ◽

Dietmar Hager ◽

Oskar Kwasny ◽

Dominik Duscher

Keyword(s):

Grip Strength ◽

Clinical Assessment ◽

Complication Rates ◽

Proximal Row Carpectomy ◽

Prosthesis Implantation ◽

Total Wrist Arthroplasty ◽

Significant Difference ◽

Flexion Extension ◽

Wrist Arthroplasty

High complication rates in total wrist arthroplasty (TWA) still lead to controversy in the medical literature, and novel methods for complication reduction are warranted. In the present retrospective cohort study, we compare the outcomes of the proximal row carpectomy (PRC) method including total scaphoidectomy (n = 22) to the manufacturer’s conventional carpal resection (CCR) technique, which retains the distal pole of the scaphoid (n = 25), for ReMotion prosthesis implantation in non-rheumatoid patients. Mean follow-up was 65.8 ± 19.8 and 80.0 ± 28.7 months, respectively. Pre- and postoperative clinical assessment included wrist flexion-extension and radial-ulnar deviation; Disability of Arm, Shoulder, and Hand scores; and pain via visual analogue scale. At final follow-up, grip strength and satisfaction were evaluated. All complications, re-operations, and revision surgeries were noted. Clinical complications were significantly lower in the PRC group (p = 0.010). Radial impaction was detected as the most frequent complication in the CCR group (n = 10), while no PRC patients suffered from this complication (p = 0.0008). Clinical assessment, grip strength measurements, and the log rank test evaluating the re-operation as well as revision function showed no significant difference. All functional parameters significantly improved compared to preoperative values in both cohorts. In conclusion, we strongly recommend PRC for ReMotion prosthesis implantation.

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Evaluation of ‘the R-Model’ crisis intervention de-escalation training for law enforcement

The Police Journal Theory Practice and Principles ◽

10.1177/0032258x19864997 ◽

2019 ◽

Vol 93 (4) ◽

pp. 271-289 ◽

Cited By ~ 1

Author(s):

Jillian Peterson ◽

James Densley ◽

Gina Erickson

Keyword(s):

Law Enforcement ◽

Crisis Intervention ◽

Health Resources ◽

Police Department ◽

Preliminary Evidence ◽

Outcome Evaluation ◽

Calls For Service ◽

Model Research ◽

One Year

This study presents findings from a process and outcome evaluation of a custom crisis intervention and de-escalation training for law enforcement, delivered in-house to a suburban Minnesota police department (the R-Model: Research, Respond, Refer). Individual officer survey data showed the R-Model significantly decreased stigma and increased self-reported knowledge of mental health resources over baseline. Knowledge of resources held at the 4-month follow-up. One-year follow-up data at the agency level, showed decreases in the number of crisis calls for service and the number of repeat calls to the same addresses, even when compared to crisis call rates at similar police departments. Findings provide preliminary evidence that the R-Model may be an effective model that warrants additional study.

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Prospective Evaluation of Serum β-Glucan Testing in Patients With Probable or Proven Fungal Diseases

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw128 ◽

2016 ◽

Vol 3 (3) ◽

Cited By ~ 26

Author(s):

Cécile Angebault ◽

Fanny Lanternier ◽

Frédéric Dalle ◽

Cécile Schrimpf ◽

Anne-Laure Roupie ◽

...

Keyword(s):

Clinical Utility ◽

Clinical Suspicion ◽

Fungal Diseases ◽

Prospective Evaluation ◽

Invasive Fungal Diseases ◽

Undetectable Serum ◽

Antifungal Use ◽

Kinetics Of ◽

Rule Out

Abstract Background. Early diagnosis and treatment are crucial in invasive fungal diseases (IFD). Serum (1-3)-β-d-glucan (BG) is believed to be an early IFD marker, but its diagnostic performance has been ambiguous, with insufficient data regarding sensitivity at the time of IFD diagnosis (TOD) and according to outcome. Whether its clinical utility is equivalent for all types of IFD remains unknown. Methods. We included 143 patients with proven or probable IFD (49 invasive candidiasis, 45 invasive aspergillosis [IA], and 49 rare IFD) and analyzed serum BG (Fungitell) at TOD and during treatment. Results. (1-3)-β-d-glucan was undetectable at TOD in 36% and 48% of patients with candidemia and IA, respectively; there was no correlation between negative BG results at TOD and patients' characteristics, localization of infection, or prior antifungal use. Nevertheless, patients with candidemia due to Candida albicans were more likely to test positive for BG at TOD (odds ratio = 25.4, P = .01) than patients infected with other Candida species. In 70% of the patients with a follow-up, BG negativation occurred in >1 month for candidemia and >3 months for IA. A slower BG decrease in patients with candidemia was associated with deep-seated localizations (P = .04). Thirty-nine percent of patients with rare IFD had undetectable BG at TOD; nonetheless, all patients with chronic subcutaneous IFD tested positive at TOD. Conclusions. Undetectable serum BG does not rule out an early IFD, when the clinical suspicion is high. After IFD diagnostic, kinetics of serum BG are difficult to relate to clinical outcome.

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