Video and CD-ROM as a training tool for performing neurologic examinations of 1-year-old children in a multicenter epidemiologic study.

In lieu of traditional training of examiners to identify cerebral palsy on a neurologic examination at age 1 year, we proposed an alternative approach using a multimedia training video and CD-ROM we developed after a two-step validation process. We hypothesized that use of CD-ROM interactive training will lead to reliable and valid performance of the neurologic examination by both pediatric neurologists and nonpediatric neurologists. All examiners were asked to take one of six interobserver variability tests found on the CD-ROM on two occasions. In the first interobserver variability evaluation, 89% (531 of 594) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the two items that had a 60% correct rate, the correct response rate rose to 93% (114 of 123). In the second interobserver variability evaluation, 88% (493 of 560) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the four items that had a 70% correct rate, the correct response rate rose to 96% (104 of 108). Interactive CD-ROM examination training is an efficient and cost-effective means of training both neurologists and non-neurologists to perform structured neurologic examinations in 1-year-old children. It provides an effective means to evaluate interobserver variability, offers a route for feedback, and creates an opportunity to reevaluate variability, both immediately and at periodic intervals.

Memory loss in a patient treated with fluoxetine.

OBJECTIVE: To report a case of severe memory loss in an elderly patient after initiation of fluoxetine. CASE SUMMARY: An 87-year-old white woman was started on fluoxetine for depression, and the dose was titrated to 20 mg/d. She developed progressive memory loss over the next 6 weeks for which she ultimately was hospitalized. Other potential causes for her memory loss were ruled out. After fluoxetine was discontinued, the patient's memory improved significantly over the next 2 months. An objective causality assessment indicated a possible relationship between the memory loss and fluoxetine in this patient. DISCUSSION: Our report documents a case of severe reversible memory deterioration after initiating fluoxetine. Fluoxetine has a favorable adverse effect profile when compared with older classes of antidepressants. Postmarketing studies and isolated case reports, however, suggest that fluoxetine may harm memory in some patients. Some selective serotonin-reuptake inhibitors (SSRIs) appear to cause memory loss more frequently than others. CONCLUSIONS: Clinicians should be aware of the possible effects of fluoxetine (and possibly other SSRIs) on memory.