The effect of voluntary trunk rotation and half-field eye-patching for patients with unilateral neglect in stroke: a randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of voluntary trunk rotation and half-field eye-patching to treat patients with unilateral neglect in stroke. DESIGN: Pre-post, day 60 follow-up, single-blinded randomized controlled trial. SETTING: Single-centre inpatient rehabilitation hospital. SUBJECTS: Sixty subacute patients with right hemisphere stroke having unilateral neglect within eight weeks post stroke consented to participate between November 2003 and July 2005. They were randomly assigned to three comparison groups. INTERVENTIONS: Nineteen patients received daily experimental training in voluntary trunk rotation (TR) for 1 hour five times a week for 30 days. Twenty patients received the same kind of treatment together with half-field eye-patching (TR + EP). Fifteen patients in the control group received conventional training with the same contact time. MAIN OUTCOME MEASURES: Patients were assessed on days 0, 30 and 60 using the Behavioural Inattention Test, the Clock Drawing Test, and the Functional Independence Measure. RESULTS: No significant differences between voluntary trunk rotation (TR), voluntary trunk rotation and half-field eye-patching (TR + EP) and controls were found in functional performance and neglect measures at day 30 (P = 0.042-0.994) and follow-up (P = 0.052-0.911) at P = 0.005 using Bonferroni correction. CONCLUSIONS: The results of this study do not support the use of voluntary trunk rotation alone or with half-field eye-patching to improve functional performance or reduce unilateral neglect in subacute patients with stroke.

Tea drinking and bone mineral density in older women.

BACKGROUND: High caffeine intake is reportedly a risk factor for reduced bone mineral density (BMD) in women. Most studies, however, are from populations in which coffee drinking predominates and is the major caffeine source. Tea contains caffeine but also has other nutrients, such as flavonoids, that may influence bone mass in different ways. OBJECTIVE: We examined the relation between tea drinking and BMD in older women in Britain, where tea drinking is common. METHODS: We measured BMD at the lumbar spine, femoral neck, greater trochanter, and Ward's triangle in 1256 free-living women aged 65-76 y in Cambridge, United Kingdom. Tea drinking was assessed by self-completed questionnaire and women were categorized as tea drinkers or non-tea drinkers. RESULTS: There were 1134 tea drinkers (90.3%) and 122 non-tea drinkers (9.7%). Compared with non-tea drinkers, tea drinkers had significantly greater ( approximately 5%) mean BMD measurements, adjusted for age and body mass index, at the lumbar spine (0.033 g/cm(2); P = 0.03), greater trochanter (0.028 g/cm(2); P = 0.004), and Ward's triangle (0.025 g/cm(2); P = 0.02). Differences at the femoral neck (0.013 g/cm(2)) were not significant. These findings were independent of smoking status, use of hormone replacement therapy, coffee drinking, and whether milk was added to tea. CONCLUSIONS: Older women who drank tea had higher BMD measurements than did those who did not drink tea. Nutrients found in tea, such as flavonoids, may influence BMD. Tea drinking may protect against osteoporosis in older women.

The prenatal exclusion test for Huntington's disease: experience in the west of Scotland, 1986-1993.

Information about the prenatal exclusion test for Huntington's disease (HD) has been given to an unselected series of couples who attended the genetic counselling clinic from 1986 onwards. Ten couples underwent 13 prenatal tests during this period with expressed intention of stopping a pregnancy if the result indicated a high risk (almost 50%) that the fetus carried the HD gene. Nine fetuses at nearly 50% risk of carrying the HD gene were identified but only six such pregnancies were terminated. In each of three high risk pregnancies which continued, the mother made a "final hour" decision not to undergo the scheduled, first trimester termination. In our experience, late reversal of a previous decision to undergo first trimester pregnancy termination for a genetic indication is uniquely frequent among couples who have undergone the prenatal exclusion test for HD.

A criterion based audit of community-acquired pneumonia.

UNLABELLED: We undertook a prospective audit of patients admitted to a specialist respiratory unit in order to assess: (a) the completeness of the objective assessment of severity of community-acquired pneumonia in patients on admission to hospital, and whether such indices were useful in predicting outcome; (b) the completeness of microbiological testing and whether maximizing the number of specimens sent to the laboratory would increase the frequency of positive microbiological diagnoses and; (c) the influence of the above on clinical management. Forty-eight patients with consolidation on chest X-ray were studied in two audit periods: 1 February 1991 to 1 May 1991 and 2 May 1991 to 16 March 1992. After the first audit period, a rubber stamp with a check list of microbiological investigations was used in the patients' notes. Seven 'markers of severity' of pneumonia, were recorded consistently throughout the study and these were useful in predicting outcome (P < 0.01). In the first audit period sputum culture, blood culture and acute serology were recorded in approximately 50% of patients. Following the introduction of the rubber stamp, the requesting of sputum, blood and urine antigen rose from none in the first audit period to 40-60%. The increase in the number of specimens obtained was not associated with an increase in the proportion of positive microbiological diagnoses. Clinical management was altered in 10 patients because of the microbiological reports and in four patients with negative microbiology (chi2 = 8.19; P < 0.01). CONCLUSION: The standard of initial assessment was high in this specialist unit, and the presence of two or more 'markers of severity' did help predict outcome. A simple change in work practice resulted in a significant improvement in the thoroughness of microbiological investigations.(ABSTRACT TRUNCATED AT 250 WORDS)

Do familial neural tube defects breed true?

The tendency for sibs affected by non-syndromal neural tube defect (NTD) to have the same type of lesion was assessed retrospectively in a series of 66 affected sibships from the west of Scotland. Different schemes were used to classify the lesions: in the simplest classification into either anencephaly (including anencephaly-spina bifida) or spina bifida there was a tendency for spina bifida to breed true. More detailed description of the NTD in 48 sibships permitted classification according to location on the neuraxis; in this scheme sibs had dissimilar lesions. In 48 sets of affected sibs the lesions were separable into high NTD, which had involvement above vertebral level T12, and low NTD, which did not extend above T12. Low lesions comprised a minority of the total and each one occurred in a sibship with a high lesion. These results do not support the idea that NTDs occurring above and below vertebral level T12 have a different genetic basis.

Maternal serum alpha-fetoprotein screening for open neural tube defects in twin pregnancies.

Data on maternal serum alpha-fetoprotein (AFP) levels at 13-24 weeks' gestation in 46 twin pregnancies with open neural tube defects (22 with anencephaly, 24 with open spina bifida) and 169 unaffected twins were used to estimate the detection and false-positive rates associated with different cut-off levels. Using the conventional cut-off level of 2.5 multiples of the median (MoM) for unaffected singleton pregnancies of the same gestation and laboratory, the detection rate in twins was 99 per cent for anencephaly and 89 per cent for open spina bifida, with a false-positive rate of 30 per cent. Using a 5.0 MoM cut-off level to maintain a similar false-positive rate to that found among singleton pregnancies at 16-18 weeks' gestation (about 3 per cent), the detection rate was 83 per cent for anencephaly and 39 per cent for open spina bifida. Estimates are provided of the odds of having an affected twin pregnancy given a positive AFP result as well as the odds for individual women with a raised AFP level.

Amniotic band disruption syndrome associated with elevated amniotic AFP and normal acetylcholinesterase gel test.

Ultrasonography in an 18 week pregnancy selected for detailed scanning because of a single elevated maternal serum AFP result suggested the presence of anencephaly. Amniocentesis at 19 weeks yielded a clear AF with an elevated AFP result (5.4 MOM) and no evidence of an acetylcholinesterase band of neural origin on PAG electrophoresis. At termination, the fetus had cephalo-amniotic fusion and multiple abnormalities including bilateral cleft lip and palate and digital amputations characteristic of the amniotic band syndrome. The cranial defect was completely sealed by attachment of the amniotic surface of the placenta to the skull.

A collaborative study of the aetiology of Turner syndrome.

Data on Turner Syndrome from four sources were analysed for possible associations with several aetiological factors. Two classes of liveborn propositae were included, those with a non-mosaic 45, X karyotype (XO) and those with an isochromosome of the long arm of the X (iso-X). The numbers were 288 and 84 respectively and constitute the largest series of such cases to be analysed to date. For the XO's, an analysis using the liveborn full sibs of propositae as controls (method of Carothers et al. 1978) confirmed earlier studies in finding no positive association with parental age or birth order, and even suggested a small negative association. There were no significant differences between the mean parental ages of those cases shown by Xg grouping to have received a maternal X chromosome and those of the remainder. Among the iso-X's there was an exceptionally high proportion (17.5%) of parents with an age difference (paternal-maternal) of 10 or more years, raising the possibility of a paternal age effect. This agrees with earlier studies but conflicts with the finding of a negligible tendency for affected individuals to be born later within their sibships. The apparent discrepancy may be due to the relative insensitivity of the latter method to small parental age effects in samples of this size. For the XO's there were no detectable seasonal variations in the month of birth, but for the iso-X's there was a significant excess of births in the first 6 months of the year. Reviewing the conflicting evidence from the literature on seasonal variations in chromosomal aberrations, we urge caution in interpreting these results. In agreement with earlier studies, the incidence of twins among both XO's and iso-X's was higher than the population average, but the numbers were too small for statistical significance. There was no evidence for any alteration in the sex ratio among the liveborn sibs of either class.

Avoidance of anencephalic and spina bifida births by maternal serum-alphafetoprotein screening.

Screening of 11 585 pregnant women between 16 and 20 completed weeks' gestation for raised serum-alphafetoprotein (A.F.P.) levels showed that the birth of 81.4% of babies with open neural-tube defects could be avoided. The screening test was sensitive enough to detect 93% of those affected and serum-A.F.P. levels above the point at which intervention shouldbe considered were found in 1.7% of pregnancies. After 75.2% of false-positives had been excluded by ultrasonography or by a repeat of the serum test, only 0.63% of pregnancies proceeded to amniocentesis, 46.6% of amniocenteses showed raised amniotic A.F.P. levels due to fetal abnormality. Fetal loss by abortion or perinatal death after amniocentesis occurred in 0.034% of pregnancies screeded, 75% being associated with threatened abortion before amniocentesis. There were no terminations of normal pregnancies due to false-positive amniotic A.F.P. results. It is concluded that voluntary maternal serum-A.F.P. screening has a valuable role in antenatal care.