A pilot study to investigate the effects of electrical stimulation on recovery of hand function and sensation in subacute stroke patients.

Objectives. 1) To compare the effect of cyclic neuromuscular electrical stimulation (NMES) of the forearm and elbow extensor muscles with passive stretching exercises on hand function and sensation following stroke. 2) To inform sample size for a larger randomized controlled trial (RCT). Materials and Methods. Twenty-two subjects with hemiplegia resulting from a stroke during the previous 12 months were randomly allocated into stimulation (treatment) and exercise (control) groups. Stimulation was applied to the elbow, and forearm extensor muscle groups of the hemiplegic arm for 12 weeks. Subjects in the control group were taught passive stretching exercises for the same period. The primary outcome measure was the Action Research Arm test (ARAT). Sensation was tested using two-point discrimination. Statistical analysis applied nonparametric analysis of covariance (ancova). Results. Statistically significant between-group differences in change in ARAT scores were shown between the two groups after 12 weeks of treatment (p = 0.003) and following 12 further weeks without intervention (p = 0.012). There were no significant differences in sensation. Conclusions. 1) A significant treatment effect of electrical stimulation over passive exercise has been demonstrated in a group of 22 subacute stroke patients, randomized into two equal groups and further work identified which may help to improve recovery of hand function and sensation following stroke. 2) A sample size of 24 subjects in each group has been estimated assuming a two-sided test significance level of 5% with 80% power, primary outcome variability SD = 6.75, a minimum difference of ten ARAT score units, and a 10% dropout rate.

See one, do one, teach one--is this still how it works? A comparison of the medical and nursing professions in the teaching of practical procedures.

A survey of 80 junior doctors and nurses was performed to compare the methods of teaching medical and nursing students in eight common practical procedures. Nurses were more likely to have received formal teaching and to be supervised when first performing a procedure. Some 42% percent of doctors felt inadequately trained to carry out a practical procedure safely when performing it alone for the first time compared with 7% of nurses. This study confirms that much of the training of doctors in practical procedures is still received on an informal basis, compared with that of nurses. It also reveals that many doctors view this training as insufficient.

Development and validation of the computerized clinician administered post-traumatic stress disorder scale-1-revised.

A computer administered version of the clinician administered post-traumatic stress disorder (PTSD) scale-1 was developed to assess PTSD in subjects presenting with psychological symptoms following exposure to a traumatic event. Both forms were administered to 40 subjects who met the Diagnostic and Statistical Manual, third edition, revised (DSM-III-R) criteria for exposure to a significantly traumatic stressor. Inter-observer reliability was demonstrated with a kappa statistic of 0.90. The computer version had a sensitivity of 0.95 and a specificity 0.95. A correlation of 0.95 was found between the two versions and the mean score difference was non-significant. The computer form demonstrated adequate internal reliability and test-retest reliability. Overall results suggest the computer version is a valid and reliable measure of PTSD.

Sexually transmitted diseases in transient British forces in the tropics.

OBJECTIVE: To compare the incidence of sexually transmitted diseases (STD) in British troops in the tropics with that in a standard population. DESIGN: Retrospective analysis of STD clinic records over one calendar year. SETTING: A British Military Hospital in the Tropics serving 1441 resident personnel. SUBJECTS: All patients attending a STD clinic. MAIN FINDINGS: 815 cases of STD were recorded during the study period, giving incidence rate of 56,558 per 100,000 population per year. When compared with a matched population from England and Wales, the age standardised relative risk for STD amongst tropical troops was 25.0 (95% confidence interval 24.9 to 25.1). Thirty nine percent of cases reported prostitute contact as a source of their disease. Of patients questioned about condom usage, 70% reported that they did not normally use a condom. CONCLUSIONS: British troops spending short periods of time in a tropical environment are significantly more likely to acquire a STD than men in the same age groups in England and Wales. The proportions of cases who reported that they did not use condoms and the number who cited prostitute contact as a source of infection indicate that even greater sexual education of troops on deployment overseas may be required.

Hepatitis A immunity and travel history.

Travel histories were taken from 1111 British travellers. Serological testing showed that increasing age and a past history of jaundice were associated with a greater likelihood of travellers being immune to hepatitis A. Neither travel to nor the duration of stay in areas of increased hepatitis A endemicity influenced the level of hepatitis A immunity. It is concluded that travel histories from British citizens normally resident in the U.K. cannot be used to identify those travellers in whom serological prescreening would be of value prior to immunoglobulin prophylaxis.

Perineal cleansing and midstream urine specimens in ambulatory women.

A prospective trial is reported of an assessment of perineal cleansing as a means of reducing bacterial contamination of midstream urine samples. One hundred and ninety-two asymptomatic antenatal ambulatory patients were randomly allocated into cleansing and non-cleansing cohorts. Quantitative urine microscopy and culture showed no significant differences between the groups. It is concluded that perineal cleansing has no role to play in the collection of midstream urine specimens from ambulatory women.

Probability of pathology.

The literature on population screening tests provides us with a well-developed statistical framework for identifying groups at risk of specific disease, taking account of the limitations of the test as a disease marker, the prevalence of the disease in the population being screened, and the relative costs of misclassification. This predictive value model has a relatively simple interpretation in the context of binary test variables (Test+/Test-). Its interpretation in the context of continuous test variables is less straightforward because we now have to draw a distinction between group risk associated with the test cut-off value, and the individual risk for a specific subject associated with his/her particular test value. Failure to appreciate this distinction can lead to a gross misinterpretation of the risk of disease for the individual test subject.

Proteinuria--what value is the dipstick?

The value of the urinary dipstick in the assessment of proteinuria was investigated in a study correlating laboratory measurements of protein and albumin against the dipstick protein in the same samples of urine; 94 patients (100 admissions) were studied at the Royal Air Force Renal Unit, each patient collecting two 24-h urine samples. Along with each 24-h sample, 10-ml aliquots of urine were obtained at 3 designated times during the day for both ward dipstick testing and laboratory assay; + or more on the dipstick correlated with abnormal proteinuria (greater than or equal to 150 mg/24 h) in 88% of cases, whilst trace values straddled the level of significant proteinuria. Further differentiation of trace was possible by repeat testing during the day. The subsequent presence of a dipstick negative during that day correlated with normality in all but 5% of cases. In order to ensure detection of renal disease presenting as isolated orthostatic proteinuria, assay of the mid-morning sample is recommended.

Sexually transmitted diseases in a British military force in peacetime Europe, 1970-83.

A retrospective analysis was performed to identify the incidence and pattern of sexually transmitted diseases (STD) affecting a modern British peacetime military force in 1970-83. Relative risk factors for a comparable UK civilian population were assessed and showed a slightly greater risk or the military only in 1974-81. The development of incidence and pattern of STD affecting the military force was shown to be broadly similar to trends in the UK.

Hepatitis A immunity in British adults--an assessment of the need for pre-immunisation screening.

A total of 858 British adults were screened for immunity to hepatitis A. Immune rates ranged from 13% in the 16-20 years age group to 61% in the 51-55 years age group. Factors affecting these rates are discussed and the implications for pre-immunisation screening are considered.

Significance of dipstick haematuria. 1. Correlation with microscopy of the urine.

The reliability of a chemical test for haematuria has been evaluated in patients referred for investigation of suspected renal or urological disease. Red blood cells in concentrations of 10/microliter or greater were found in 24% of urines giving a negative dipstick result, 82% of urines giving a trace positive result and nearly 100% of urines giving dipstick results greater than this. The accuracy of the reagent strip in predicting the presence or absence of significant haematuria was improved by testing several urines from each patient. On the basis of this study, if significant haematuria is present, reagent strip urine testing is an efficient method for its detection.

Regional analgesia with bupivacaine in dental anaesthesia.

Sixty (ASA 1) patients were studied to determine the effect of bilateral local infiltration with 0.25% bupivacaine plain during third molar extraction under general anaesthesia. Bupivacaine infiltration significantly reduced the incidence of wide complex extrasystoles (P less than 0.05) during surgery and the severity of dental pain (P less than 0.05), when assessed at 6 h after operation.

Standardizing clinical laboratory data for the development of transferable computer-based diagnostic programs.

The existence of systematic differences between test results obtained at different laboratories can compromise the development of generally accessible reference databases for interpretive pathology. We review approaches to the elimination of inter-laboratory bias from pathology test results through the use of standard unit transformations. A general transform procedure is described that will permit laboratories serving a common population to make use of reference data, decision rules, and computer-based interpretive programs developed around a larger clinical database than each of these test centers could amass for themselves.

Single-dose amoxycillin in the treatment of bacteriuria in pregnancy and the puerperium--a controlled clinical trial.

Ninety obstetric patients with significant bacteriuria were treated randomly with either a single dose of 3 g amoxycillin or with a conventional course of ampicillin over 7 days. Treatment groups were comparable in terms of age, gravidity and socioeconomic status, and the outcome of pregnancy in the two groups did not differ significantly. Cure rates, assessed at 1 week and 6 weeks after treatment, were not significantly different: 88% for single-dose treatment and 84% for conventional treatment. It is concluded that a single dose of 3 g amoxycillin is a safe, effective and acceptable treatment for bacteriuria in pregnancy and the puerperium.

An evaluation of gentamicin EMIT--its performance on the Kem-O-Mat and its role in the small laboratory.

An investigation was made into the use of gentamicin EMIT on the Coulter Kem-O-Mat in a small microbiology laboratory. EMIT was found to correlate well with plate assay and to be a more rapid, more precise and technically less time-consuming method. EMIT was more expensive in clinical use. This single disadvantage was considered to be outweighed by a saving in capital equipment expenditure and by the benefits to the laboratory and clinician.

Neural-tube defect risk assessment for individual pregnancies using alphafetoprotein and acetylcholinesterase test results.

Pregnancies at risk of being associated with (open) neural tube defects can be identified by maternal serum and amniotic-fluid alphafetoprotein (AFP) concentrations in excess of established screening cut-off valves in conjunction with the results of an amniotic fluid electrophoretic acetylcholinesterase screening test. The risk associated with the AFP cut-off values are formulated in terms of a population screening programme. These "population risks" are of little value in the assessment of test results from individual "at-risk" pregnancies, especially when the observed AFP concentrations are in proximity to the "cut-off" values. A complete risk assessment procedure for individual pregnancies is described and presented in graphical form to permit immediate access by clinical staff.

Observations on the validation of immunochemical assays of monoclonal immunoglobulins.

Assays of specific immunoglobulins by immunochemical methods are subject to a well-documented discrepancy when the test sample contains a monoclonal immunoglobulin of the class under assay. Demonstration of parallelism of the polyclonal standard and test sample log dose-response curves if proposed as an essential step in the validation of such assays, but theoretical considerations suggest that the mechanism underlying the observed discrepancy is unlikely to be associated with non-parallelism. The examination of 50 samples containing monoclonal immunoglobulins provides no evidence for rejecting the theoretical conclusions. It is shown here that demonstration of parallelism is of no value in establishing the validity of monoclonal immunoglobulin assays by immunochemical methods. The observation of relative changes in paraprotein concentration using an initial myeloma serum from the same subject as an arbitrary reference point is criticised.