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Abramson JS, Bengston EM, Redd R, Barnes JA, Takvorian T, Sokol L, Lansigan F, Armand P, Shah B, Jacobsen E, Martignetti R, Turba E, Metzler SR, Patterson V, LaCasce AS, Bello CM. MATURE RESULTS FROM A PHASE II TRIAL OF BRENTUXIMAB VEDOTIN PLUS ADRIAMYCIN AND DACARBAZINE WITHOUT RADIATION IN NON‐BULKY LIMITED STAGE CLASSICAL HODGKIN LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.110_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J. S. Abramson
- Massachusetts General Hospital Center for Lymphoma Boston Massachusetts USA
| | - E. M. Bengston
- Dartmouth‐Hitchcock Medical Center Hematology/Oncology Lebanon New Hampshire USA
| | - R. Redd
- Dana‐Farber Cancer Institute Biostatistics Boston Massachusetts USA
| | - J. A. Barnes
- Massachusetts General Hospital Center for Lymphoma Boston Massachusetts USA
| | - T. Takvorian
- Massachusetts General Hospital Center for Lymphoma Boston Massachusetts USA
| | - L. Sokol
- Moffitt Cancer Center Hematology/Oncology Tampa USA
| | - F. Lansigan
- Dartmouth‐Hitchcock Medical Center Hematology/Oncology Lebanon New Hampshire USA
| | - P. Armand
- Dana‐Farber Cancer Institute Medical Oncology Boston USA
| | - B. Shah
- Moffitt Cancer Center Hematology/Oncology Tampa USA
| | - E. Jacobsen
- Dana‐Farber Cancer Institute Medical Oncology Boston USA
| | - R. Martignetti
- Massachusetts General Hospital Center for Lymphoma Boston Massachusetts USA
| | - E. Turba
- Moffitt Cancer Center Hematology/Oncology Tampa USA
| | - S. R. Metzler
- Dartmouth‐Hitchcock Medical Center Hematology/Oncology Lebanon New Hampshire USA
| | - V. Patterson
- Dana‐Farber Cancer Institute Medical Oncology Boston USA
| | - A. S. LaCasce
- Dana‐Farber Cancer Institute Medical Oncology Boston USA
| | - C. M. Bello
- Moffitt Cancer Center Hematology/Oncology Tampa USA
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Patterson V. Audit of total adequacy of prescribed parenteral nutrition and identification of related confounding factors. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hakim-Rad K, Patterson V, Paudyal A, Murdoch J. Identifying the molecular function of Tulp3 in neural tube closure and patterning. Cilia 2012. [PMCID: PMC3555955 DOI: 10.1186/2046-2530-1-s1-p69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
BACKGROUND AND METHODS We conducted an all-Ireland population-based prospective epidemiological survey of motor neurone disease (MND) using the Northern Ireland and Republic of Ireland MND registers to examine the incidence and prevalence of the disease over the period 2004-2005. RESULTS AND CONCLUSIONS Incidence of MND was 1.9 per 100 000 person-years and rates were comparable in both the north and south of Ireland. Prevalence of MND was 5.0 per 100 000 population. When compared with previous published surveys of MND performed in the Republic of Ireland over the last 10 years, rates of disease have remained relatively constant. When standardized to the 1990 US population, the incidence of MND in Ireland was found to be consistent with other European prospective surveys of MND.
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Affiliation(s)
- C Donaghy
- Department of Neurology, Royal Victoria Hospital, Belfast, UK.
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Abstract
Background and Aims Patients often wait many months to see a neurologist for the first time. With the introduction of targets for maximum waiting times there is a need for novel approaches. Real time telemedicine by videolink (VL) is one such method and we aimed to replicate this in Aberdeen. Methods Patients were seen by VL by two Irish-based neurologists, one experienced in telemedicine, the other not. A senior trainee neurologist present with some of the patients validated the telemedicine diagnosis and management with his own face-to-face (FF) assessment. Satisfaction was assessed by questionnaires. Numbers requiring investigations and review were recorded as were representations to neurology over six months. Results Forty-four patients were seen. Satisfaction was higher and review rates were similar to previous cohorts seen by FF and VL. There was no difference between the two neurologists. There was complete diagnostic agreement between the VL and FF neurologists. There was a diagnostic change in a single patient after six months follow-up. Conclusion Neurology consultation using VL is safe and effective as well as acceptable, and the necessary skills were acquired rapidly by a telemedicine-naive neurologist. Telemedicine using VL can contribute to waiting list reduction, and is likely to be most useful in rural areas.
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Affiliation(s)
- C Duncan
- Department Of Neurology, Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - C Dorrian
- Department Of Neurology, Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - P Crowley
- Neurologist in Private Practice, Kilkenny, Ireland
| | - R Coleman
- Department Of Neurology, Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - V Patterson
- Department of Neurology, Royal Victoria Hospital, Belfast, N. Ireland
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Patterson V. Northern Ireland. Pract Neurol 2009; 9:114-6. [DOI: 10.1136/jnnp.2008.171173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Patterson V. Telemedicine and the clinical neurosciences. Ir Med J 2008; 101:233-234. [PMID: 18990950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Gough J, Patterson V, Brewer K. The Use of Cortisol as an Early Marker for Acute Myocardial Infarction in an Emergency Department Setting. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Craig J, Chua R, Russell C, Wootton R, Chant D, Patterson V. A cohort study of early neurological consultation by telemedicine on the care of neurological inpatients. J Neurol Neurosurg Psychiatry 2004; 75:1031-5. [PMID: 15201365 PMCID: PMC1739134 DOI: 10.1136/jnnp.2002.001651] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To find out the effect of early neurological consultation using a real time video link on the care of patients with neurological symptoms admitted to hospitals without neurologists on site. METHODS A cohort study was performed in two small rural hospitals: Tyrone County Hospital (TCH), Omagh, and Erne Hospital, Enniskillen. All patients over 12 years of age who had been admitted because of neurological symptoms, over a 24 week period, to either hospital were studied. Patients admitted to TCH, in addition to receiving usual care, were offered a neurological consultation with a neurologist 120 km away at the Neurology Department of the Royal Victoria Hospital, Belfast, using a real time video link. The main outcome measure was length of hospital stay; change of diagnosis, mortality at 3 months, inpatient investigation, and transfer rate and use of healthcare resources within 3 months of admission were also studied. RESULTS Hospital stay was significantly shorter for those admitted to TCH (hazard ratio 1.13; approximate 95% CI 1.003 to 1.282; p = 0.045). No patients diagnosed by the neurologist using the video link subsequently had their diagnosis changed at follow up. There was no difference in overall mortality between the groups. There were no differences in the use of inpatient hospital resources and medical services in the follow up period between TCH and Erne patients. CONCLUSIONS Early neurological assessment reduces hospital stay for patients with neurological conditions outside of neurological centres. This can be achieved safely at a distance using a real time video link.
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Affiliation(s)
- J Craig
- Institute of Telemedicine and Telecare, Queen's University of Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland.
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Abstract
OBJECTIVES To determine whether an email triage system between general practitioners and a neurologist for new outpatient referrals is feasible, acceptable, efficient, safe, and effective. METHODS This was a prospective single cohort study on the interface between primary care practitioners and the neurology clinic of a district general hospital. Seventy six consecutive patients with neurological symptoms from nine GPs, for whom a specialist opinion was deemed necessary, were entered in the study. The number of participants managed without clinic attendance and the reduction in neurologist's time compared with conventional consultation was measured, as was death, other specialist referral, and change in diagnosis in the 6 months after episode completion. The acceptability for GPs was ascertained by questionnaire. RESULTS Forty three per cent of participants required a clinic appointment, 45% were managed by email advice alone, and 12% by email plus investigations. GP satisfaction was high. Forty four per cent of the neurologist's time was saved compared with conventional consultation. No deaths or significant changes in diagnosis were recorded during the 6 month follow up period. CONCLUSIONS Email triage is feasible, acceptable to GPs, and safe. It has the potential for making the practice of neurologists more efficient, and this needs to be tested in a larger randomised study.
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Affiliation(s)
- V Patterson
- Department of Neurology, Neurology Ward 4E, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, N. Ireland, UK.
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Patterson V. Telemedicine Information Exchange: http://tie.telemed.org. J Neurol Psychiatry 2003. [DOI: 10.1136/jnnp.74.7.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- L E Graham
- Department of Medicine, Patan Hospital, Kathmandu, Nepal.
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Abstract
An e-mail link with the facility to send high-resolution digital images is a cheap and uncomplicated telemedicine method. The Swinfen Charitable Trust helped establish such a link in Patan Hospital Kathmandu, Nepal in March 2000. Over 12 months using this link 42 telemedicine referrals were sent to specialists throughout the world. Referrals were: 36% respiratory medicine; 21% neurology, 21% dermatology; 14% cardiology; 5% nephrology; and 3% radiology--28 had digital pictures attached, of which 96% were of high enough quality on which specialists were able to comment. Thirty-nine replies were received. The average time for a specialist reply was 2 days, and 45% were answered within 24 hours. All replies were judged by independent assessors to be helpful or very helpful for diagnosis, management and education. The assessors decided that in 50% of cases the advice if acted upon would have shortened hospital stay. This pilot study has shown that a low-cost telemedicine link is technically feasible and can be of significant benefit for diagnosis, management and education in a developing world setting.
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Affiliation(s)
- L E Graham
- Department of Medicine, Patan Hospital, PO Box 252, Kathmandu, Nepal.
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Abstract
A randomized controlled trial was conducted to compare the costs of realtime teleneurology with the cost of conventional neurological care. Two district hospitals in Northern Ireland were equipped with videoconferencing units and were connected to the regional neurological centre by ISDN at 384 kbit/s. Of 168 patients randomized to the study, 141 kept their appointments (76 male, 65 female). Sixty-five patients were randomized to a conventional consultation while 76 were randomized to a teleconsultation. The average age was 44 years of those seen conventionally and 42 years of those seen by telemedicine. The groups had similar diagnoses. The telemedicine group required more investigations and reviews than the conventional group. The average cost of the conventional consultation was 49 pounds sterling compared with 72 pounds sterling for the teleconsultation. Realtime teleneurology was not as cost-effective as conventional care.
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Affiliation(s)
- R Chua
- Royal Group of Hospitals Trust, Belfast, UK
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Abstract
We assessed the feasibility of a store-and-forward email teleneurology service between a UK neurologist and a rehabilitation hospital in Bangladesh. Over 12 months, email advice was requested for 12 patients (mean age 43 years, range 15-57 years). Each patient generated an average of 5.2 email messages. Eight cases were considered complicated by the neurologist, who would have preferred a video-link consultation for these. The referring doctor found the neurologist's advice beneficial in 75% of the complex cases and in all of the more straightforward cases. Patient care was changed in 50% of the cases as a result of the specialist advice and one patient transfer out of the country was avoided. Store-and-forward teleneurology is effective for delivering expert neurological advice.
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Affiliation(s)
- V Patterson
- Department of Neurology, Royal Victoria Hospital, Belfast, UK.
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Vassallo DJ, Hoque F, Roberts MF, Patterson V, Swinfen P, Swinfen R. An evaluation of the first year's experience with a low-cost telemedicine link in Bangladesh. J Telemed Telecare 2002; 7:125-38. [PMID: 11346472 DOI: 10.1258/1357633011936273] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In July 1999, the Swinfen Charitable Trust in the UK established a telemedicine link in Bangladesh, between the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka and medical consultants abroad. This low-cost telemedicine system used a digital camera to capture still images, which were then transmitted by email. During the first 12 months, 27 telemedicine referrals were made. The following specialties were consulted: neurology (44%), orthopaedics (40%), rheumatology (8%), nephrology (4%) and paediatrics (4%). Initial email replies were received at the CRP within a day of referral in 70% of cases and within thee days in 100%, which shows that store-and-forward telemedicine can be both fast and reliable. Telemedicine consultation was complete within three days in 14 cases (52%) and within three weeks in 24 cases (89%). Referral was judged to be beneficial in 24 cases (89%), the benefits including establishment of the diagnosis, the provision of reassurance to the patient and referring doctor, and a change of management. Four patients (15% of the total) and their families were spared the considerable expense and unnecessary stress of travelling abroad for a second opinion, and the savings from this alone outweighed the set-up and running costs in Bangladesh. The latter are limited to an email account with an Internet service provider and the local-rate telephone call charges from the CRP. This successful telemedicine system is a model for further telemedicine projects in the developing world.
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Affiliation(s)
- D J Vassallo
- Royal Hospital Haslar and 33 Field Hospital, Gosport, UK.
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Graham LE, Flynn P, Cooke S, Patterson V. The interdisciplinary management of cerebral haemorrhage using telemedicine--a case report from Nepal. J Telemed Telecare 2002; 7:304-6. [PMID: 11571086 DOI: 10.1258/1357633011936570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- L E Graham
- Department of Medicine, Patan Hospital, GPO Box 252, Kathmandu, Nepal.
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Patterson V. How best to organise acute hospital services? Realtime teleneurology can help small hospitals. BMJ 2001; 323:1306. [PMID: 11764755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Patterson V. Training in general (internal) medicine alone. Clin Med (Lond) 2001; 1:419. [PMID: 11706893 PMCID: PMC4952265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Abstract
OBJECTIVE To test the hypothesis that telemedicine for new patient referrals to neurological outpatients is as efficient and acceptable as conventional face to face consultation. METHODS A randomised controlled trial between two groups: face to face (FF) and telemedicine (TM). This study was carried out between a neurological centre and outlying clinics at two distant hospitals linked by identical medium cost commercial interactive video conferencing equipment with ISDN lines transmitting information at 384 kbits/s. The same two neurologists carried out both arms of the study. Of the 168 patients who were suitable for the study, 86 were randomised into the telemedicine group and 82 into the face to face group. Outcome measures were (1) consultation process: (a) number of investigations; (b) number of drugs prescribed; (c) number of patient reviews and (2) patient satisfaction: (a) confidence in consultation; (b) technical aspects of consultation; (c) aspects surrounding confidentiality. Diagnostic categories were also measured to check equivalence between the groups: these were structural neurological, structural non-neurological, non-structural, and uncertain. RESULTS Diagnostic categories were similar (p>0.5) between the two groups. Patients in the telemedicine group had significantly more investigations (p=0.001). There was no difference in the number of drugs prescribed (p>0.5). Patients were generally satisfied with both types of consultation process except for concerns about confidentiality and embarrassment in the telemedicine group (p=0.017 and p=0.005 respectively). CONCLUSION Telemedicine for new neurological outpatients is possible and feasible but generates more investigations and is less well accepted than face to face examination.
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Affiliation(s)
- R Chua
- Institute of Telemedicine and Telecare, Royal Victoria Hospital, Belfast, UK.
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Hughes CA, Byrne PC, Webb S, McMonagle P, Patterson V, Hutchinson M, Parfrey NA. SPG15, a new locus for autosomal recessive complicated HSP on chromosome 14q. Neurology 2001; 56:1230-3. [PMID: 11342696 DOI: 10.1212/wnl.56.9.1230] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors studied two families with autosomal recessive hereditary spastic paraplegia (HSP) complicated by the presence of additional symptoms of pigmented maculopathy, distal amyotrophy, dysarthria, mental retardation, and further intellectual deterioration. Evidence was obtained for linkage to a locus on chromosome 14q that is distinct from the SPG3 locus for autosomal dominant HSP (D14S77: lod score of 4.20 at zero recombination). Haplotype construction of nearby markers confirms the existence of this novel HSP locus (SPG15) and narrows it to a 19-cM interval flanked by D14S1038 and D14S61.
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Affiliation(s)
- C A Hughes
- Department of Pathology, University College Dublin and St. Vincent's University Hospital, Dublin, Ireland
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Abstract
To evaluate the feasibility of interactive videoconsultation (IATV) as a means by which neurologists might assess patients admitted with neurological symptoms to hospitals distant from a neurological centre, we studied 25 unselected patients using interactive videoconsultation (IATV) and then validated the IATV diagnoses and management plans at a later face-to-face consultation. IATV consultation led to an eventual diagnosis in 23 out of 25 patients, with one diagnosis being changed and one remaining uncertain. The IATV management plans were felt to be appropriate for all patients in study. Twelve patients were able to be discharged from hospital on the same day as IATV on the advice of the neurologist. It is therefore practical to assess patients admitted with neurological symptoms to distant hospitals using IATV and this may result in more efficient use of in-patient resources.
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Affiliation(s)
- J Craig
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
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Abstract
We investigated whether new patients attending a neurological outpatient clinic could be safely managed by neurologists at a distance, using a video-link. In Northern Ireland, a video-link, transmitting at 384 kbit/s, was set up between a neurological centre and a small rural hospital 140 km away. Twenty-five unselected patients who had been referred by their family doctor were assessed by a neurologist using the telemedicine link and then immediately by another neurologist face to face. Examiners were blinded to the results of each other's assessment. In 24 cases the diagnoses made after the telemedicine and face-to-face examinations were identical. There were minor differences between the type and number of investigations requested, and the requirements for treatment and follow-up between the two groups. Disposal method was the same in 21 of the cases. No major organizational difficulties were encountered during the study. The study showed that neurologists can deliver outpatient neurological care to distant patients using telemedicine. This has the potential to allow access to assessment for the large number of neurological outpatients who might otherwise be denied it.
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Affiliation(s)
- J Craig
- Institute of Telemedicine and Telecare, Royal Victoria Hospital, Belfast, UK
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Abstract
User satisfaction (i.e. that of patients, medical staff at a remote hospital and medical staff at a neurological centre) with realtime teleneurology consultations was studied prospectively. Twenty-five patients with neurological problems admitted to a hospital without permanent neurological cover were assessed from a neurological centre by specialist neurologists using realtime video-links transmitting at 384 kbit/s. All users reported high levels of satisfaction with the technical aspects of the consultations. Patients, almost universally, reported confidence in teleneurology as a means of dealing with their presenting complaints. Similarly, medical staff at either site felt confident in managing patients using teleneurology and almost always felt that a telephone consultation would not have achieved as good an outcome. No major organizational problems were identified. These findings suggest overall user satisfaction with realtime teleneurology for managing patients with neurological problems admitted to hospitals that do not have resident neurologists.
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Affiliation(s)
- J Craig
- Institute of Telemedicine and Telecare, Royal Group of Hospitals, Belfast, UK
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Craig J, Chua R, Russell C, Patterson V, Wootton R. The cost-effectiveness of teleneurology consultations for patients admitted to hospitals without neurologists on site. 1: A retrospective comparison of the case-mix and management at two rural hospitals. J Telemed Telecare 2000; 6 Suppl 1:S46-9. [PMID: 10793970 DOI: 10.1258/1357633001934122] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We are currently evaluating the use of telemedicine for improving the care of patients admitted with neurological symptoms to hospitals that do not have specialist neurologists on site. To do this we have been comparing the outcome of patients admitted to two small hospitals. In one hospital all patients with neurological symptoms are seen by a neurologist at a distance using an interactive video-link transmitting at 384 kbit/s; in the other patients with neurological problems are managed as per usual practices. For the results of this study to be valid, it is essential that the case-mix and process of management for neurological patients are similar at the two hospitals. We therefore compared the case-mix, process of management, and outcome for all patients admitted over a four-month period to either hospital who had been coded using ICD-10 as having a final diagnosis of a neurological condition. No appreciable differences were noted between the two hospitals for measures of case-mix or outcome. Likewise, most measures of process were similar, although there was a significant difference for the overall length of hospital episode between the two hospitals. When patients with prolonged hospital episodes were excluded, or only patients with a diagnosis of headache, epilepsy or transient ischaemic attack were considered (who as a group made up the bulk of neurological admissions), the difference in the length of hospital episode was not significant. It should therefore be possible for us to estimate the effect of telemedicine on the management of patients with neurological problems.
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Affiliation(s)
- J Craig
- Institute of Telemedicine and Telecare, Royal Victoria Hospital, Belfast, UK
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Affiliation(s)
- V Patterson
- Department of Neurology, Royal Victoria Hospital, Belfast, UK.
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Pulkes T, Eunson L, Patterson V, Siddiqui A, Wood NW, Nelson IP, Morgan-Hughes JA, Hanna MG. The mitochondrial DNA G13513A transition in ND5 is associated with a LHON/MELAS overlap syndrome and may be a frequent cause of MELAS. Ann Neurol 1999; 46:916-9. [PMID: 10589546 DOI: 10.1002/1531-8249(199912)46:6<916::aid-ana16>3.0.co;2-r] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report on 4 male patients with clinical, radiological, and muscle biopsy findings typical of the mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) phenotype. Skeletal muscle mitochondrial DNA (mtDNA) analysis showed that all patients harbored a heteroplasmic G13513A mutation in the ND5 subunit gene. One of these cases (Patient 1) presented with symptoms characteristic of Leber's hereditary optic neuropathy (LHON) 2 years before the first stroke-like episode. Quantitative analysis in several postmortem tissue sections showed that the relative proportions of mutant mtDNA were generally lower than those reported with other pathogenic mtDNA mutations. Single-fiber polymerase chain reaction studies demonstrated significantly higher amounts of mutant mtDNA in ragged red fibers (RRFs) compared with non-RRFs. This study indicates that the G13513A transition is likely to be pathogenic, that it can cause an LHON/MELAS overlap syndrome, and that it may be a more frequent cause of MELAS than previously recognized.
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Affiliation(s)
- T Pulkes
- Department of Clinical Neurology, Institute of Neurology, Queen Square, London, England, UK
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Abstract
OBJECTIVE To describe surgical treatment of tricuspid valve stenosis using the Fontan procedure in a young dog. STUDY DESIGN Case report. SAMPLE POPULATION One client-owned dog RESULTS A six month old female Labrador retriever was diagnosed with tricuspid obstruction. The dog had a displaced tricuspid valve and small right ventricle and had progressed to right-sided (backward) cardiac failure. A Fontan procedure (connection of the right atrium to the pulmonary artery with a prosthetic conduit) was performed. Within three days the right atrial pressure had dropped from a preoperative value of 33 mm Hg to 8 mm Hg and the ascites was significantly reduced. The dog died suddenly two months after surgery. Postmortem examination of the heart showed a greatly enlarged right atrium and hypoplastic right ventricle. The tricuspid valve leaflets were fused and displaced ventrally leaving an opening measuring 3x5 mm between the chambers. The conduit was intact with no evidence of leakage or thrombosis. CONCLUSIONS Palliation of tricuspid stenosis using the Fontan procedure can be performed in dogs. Sudden death may occur and is most likely because of cardiac arrythmias.
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Affiliation(s)
- S A Robertson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing 48824-1314, USA
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Craig J, Morrison P, Morrow J, Patterson V. Failure of periconceptual folic acid to prevent a neural tube defect in the offspring of a mother taking sodium valproate. Seizure 1999; 8:253-4. [PMID: 10452927 DOI: 10.1053/seiz.1999.0283] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- J Craig
- Department of Neurology, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK
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Settle C, Wilcox MH, Rashid A, Cooke RS, Patterson V, Abernethy L. Acute obstructive hydrocephalus complicating bacterial meningitis. BMJ 1999. [DOI: 10.1136/bmj.318.7176.123b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cooke RS, Patterson V. Acute obstructive hydrocephalus complicating bacterial meningitis. Hydrocephalus was probably non-obstructive. BMJ 1999; 318:124. [PMID: 10068235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Robertson L, Sawhney B, Patterson V. Spinal accessory nerve palsy: a difficult but treatable diagnosis. Hosp Med 1998; 59:329-30. [PMID: 9722377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- L Robertson
- Department of Neurology and Neurophysiology, Royal Victoria Hospital, Belfast
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Kidd D, Nelson J, Jones F, Dusoir H, Wallace I, McKinstry S, Patterson V. Long-term stabilization after bone marrow transplantation in juvenile metachromatic leukodystrophy. Arch Neurol 1998; 55:98-9. [PMID: 9443716 DOI: 10.1001/archneur.55.1.98] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- D Kidd
- Department of Neurology, Royal Victoria Hospital, Belfast, Northern Ireland
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Abstract
This analysis examines the use of marijuana by 458 adolescents in Dade County, Florida public schools in 1992. Statistically significant factors which tended to increase the probability of marijuana use by adolescents include: the fact that their peers were using marijuana, the fact that they were white, male, and their ready access to the substance. Although not statistically significant, adolescents were less likely to use marijuana if they knew of the risks associated with marijuana use. The only statistically significant variables which inhibited marijuana use by Miami adolescents was the fact that religion was an important part of their lives, that their fathers resided with them, and that they were "good" students (receiving mostly "A's" and "B's"). Not significantly related to marijuana use were a number of other variables, including family-related variables (whether adolescents lived with their mothers or alone); and whether someone in the family had a problem with drugs or alcohol. Similarly, early cigarette smoking and alcohol consumption did not serve as gateways to later marijuana use. Extracurricular school activities (athletics, music, school clubs, and other activities) were all unrelated to the use of marijuana by adolescents. Marijuana users tended to be in higher grades (9 through 12), though this was not significant.
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Affiliation(s)
- B M Yarnold
- Florida International University, North Miami 33181, USA
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Abstract
OBJECTIVE Two families with autosomal recessive hereditary spastic paraplegia and pigmented maculopathy are described. METHODS All family members were examined by two neurologists. An assessment of cognitive function in affected members was made using the mini mental state examination (MMSE) or Cambridge cognitive examination (CAMCOG). RESULTS Six patients from two families presented with a slowly progressive, autosomal recessive, spastic tetraplegia. Although they were always considered to be intellectually slower than their peers, further intellectual deterioration was noted during the second decade. Five had a pigmented maculopathy with mild decrease in visual acuity and all had distal amyotrophy, mild cerebellar signs, and developed faecal and urinary incontinence late in the course of the disease. CONCLUSION The association of hereditary spastic paraplegia and pigmented maculopathy has rarely been described; only 11 families with 32 affected members have been reported, showing considerable heterogeneity in presentation. These described conditions may be allelic or more probably reflect mutations at different genetic loci.
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Affiliation(s)
- S Webb
- Department of Neurology, St Vincent's Hospital, Dublin, Ireland
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Affiliation(s)
- J Head
- Physical Medicine and Rehabilitation Service, VA Medical Center, Birmingham, AL 35233, USA
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Esmonde T, Gamble W, Patterson V. Neuralgic amyotrophy and infectious mononucleosis: a case report. Eur J Neurol 1995; 2:223-4. [DOI: 10.1111/j.1468-1331.1995.tb00122.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
This study was undertaken to evaluate factors correlated with crack use by 479 adolescents in 1992 in Dade County, Florida public schools. Based upon self-reports, after application of the Bonferroni correction, only two variables were related to crack use, i.e., having friends who use crack and living alone.
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Affiliation(s)
- B M Yarnold
- Department of Public Administration, Florida International University, North Miami 33181, USA
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Avaria M, Patterson V. Myotonic dystrophy: relative sensitivity of symptoms signs and abnormal investigations. Ulster Med J 1994; 63:151-4. [PMID: 8650827 PMCID: PMC2448763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Twenty-five symptoms, signs, and abnormal investigations were looked for in 20 patients with clinically-definite myotonic dystrophy. Weakness of facial muscles, neck flexors, and arm external rotators was found in all patients (sensitivity = 100%). Arm external rotation has not been reported as a frequently involved muscle in previous clinical studies on myotonic dystrophy. Careful examination of muscle strength may therefore predict which patients may or may not carry the abnormal gene for myotonic dystrophy.
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Affiliation(s)
- M Avaria
- Department of Neuropathology, Royal Victoria Hospital, Belfast
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Abstract
Intrathecal baclofen abolishes spasticity in many patients with neurological diseases but there are few studies on its long-term effectiveness. Since 1986 a manually operated subcutaneous pump has been used to deliver baclofen intrathecally in 21 patients with a follow up of at least one year. Most patients had multiple sclerosis and all were wheelchair-bound. Sixteen patients had a complete and sustained benefit. In four other patients the treatment was effective in the short term but not in the long term. In the remaining patient the pump never worked. Complications included meningitis, pump failure, erosion through the skin, and baclofen overdose. Nevertheless, only three patients have asked to discontinue the treatment. We conclude that intrathecal baclofen, delivered by a manually operated implanted pump, is an effective treatment for severe spasticity in most patients.
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Affiliation(s)
- V Patterson
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
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Abstract
We conducted a double-blind, placebo-controlled, crossover study of oral L-threonine at 6 g/day in patients with spinal spasticity. Muscle tone from selected leg muscles, measured by the Ashworth Scale, was the principal measure of spasticity and was evaluated before and at the end of each treatment period. A 10% reduction in Ashworth score was regarded as a positive response to a treatment. The results were analyzed sequentially, patients being classified as threonine-responders, placebo-responders or non-responders (those who responded to both treatments by either less or greater than 10%) and a level of significance of p = 0.05 was chosen. The trial concluded in favour of L-threonine after 33 patients. Side-effects were minimal. L-threonine has a modest but definite antispastic effect, and its possible role in modifying spinal glycinergic transmission is discussed.
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Affiliation(s)
- A Lee
- Department of Neurology Royal Victoria Hospital Belfast, Northern Ireland
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Abstract
We report an unusual familial myopathy characterized morphologically by the presence of large tubular aggregates in all fibre types. Two patients, a father and daughter, presented with slowly progressive proximal weakness, limitation of eye movement, and Achilles tendon contractures. Serum creatine kinase was 5-10 times normal. Light microscopy revealed type I fibre predominance. Basophilic accumulations, which stained intensely with the NADH-TR reaction, were present in both fibre types. Electron microscopy revealed that these consisted of tightly packed parallel tubular arrays. These varied somewhat in their ultrastructural appearance and were classified accordingly as type I, II, and III tubular structures. The tubular aggregates appear to be derived from the sarcoplasmic reticulum. This report further supports the evidence of a distinct clinico-pathological entity of genetic origin.
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Affiliation(s)
- C H Cameron
- Neuropathology Laboratory, School of Clinical Medicine, Queens University, Belfast, Northern Ireland, U.K
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Cook S, Gray WJ, Byrnes DP, McKinstry CS, O’Sullivan MGJ, Connolly EA, Buckley TF, Reid V, McCullagh PJ, Wallace WFM, McClelland RJ, Hutchinson M, Kirker S, Connolly S, Hawkins SA, Douglas J, McMillan SA, McNeill TA, Lyttle JA, O’Donovan C, Murphy S, Farrell MA, Phillips J, Devlin J, McLaughlin B, McCormack D, Stefani L, Bymes D, Mirakhur M, Coleman C, Eustace P, Fitzgerald J, Bouchier-Hayes D, Kui-Chung L, Patterson V, Roberts G, Trimble E, O’Donohoe NV, Forsythe I, Khan T, McKinstry CS, Bell KE, Young S, O’Neill P, Phillips J, Farrell MA, Keohane C, Galvin RJ, Buckley TF, McMenamin J, Norse C, Bolger C, Coakley D, Malone J, Martin E, Hutchinson M, Sheridan M, Sheehan N, Avaria MA, Patterson VH, Robinson F, Haller A, Patterson V, Kirker S, Browne P, Martin EA, Cotell E, Hutchinson M, Harrington MG. Irish Neurological association. Ir J Med Sci 1990. [DOI: 10.1007/bf02937243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patterson V, Dickey W, Hicks E. What's up with the enzymes? Lancet 1990; 335:601-2. [PMID: 1968589 DOI: 10.1016/0140-6736(90)90381-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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O’Dwyer JA, Toland JA, Geraghty M, Hardiman O, Keogan M, O’Moore B, King M, Farrell MA, O’Neill D, Rowan M, Abrahamson D, P. Walsh J, Coakley D, Feeley J, Fahy J, Glynn D, Hutchinson M, McMenamin J, Monaghan G, Khan Y, Diamond T, Gray WJ, Chee CP, Fannin TF, Murphy SF, Phillips JP, Connolly S, Byrnes DP, Patterson V, Hicks E, Taylor T, Brown RH, Farrell MA, Halperin JJ, Shapiro BE, Wray IS, McMackin D, Murphy S, Staunton H, Phillips J, Farrell M, Radford I, Trew KJ, Hawkins SA, Burke TE, Keelin T, Lord D, O’Farrell AG, Connolly MJ, Stack J, Martin EA, Bergin A, Keoghane C, Callaghan N, O’Riordan T, Daly PA, Shattock A, Gardner S, Davies MG, Rowan MJ, MacMathuna P, Keeling PWN, Weir DG, Feely J, McLoughlin P, Keelan T, Tormey W, Donohoe J, O’Donovan C, Browne O, Dinn JJ, Fry GC, Pidgeon CN, Regan M, Moran J, Moran L, O’Kennedy R, Kaar G. Proceedings of the Irish Neurological Association 24th Annual Scientific Meeting, Beaumont Hospital, May 1988. Ir J Med Sci 1989. [DOI: 10.1007/bf02943061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- K Boyd
- Department of Neurology, Royal Victoria Hospital, Belfast
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