Impact of Shared Leadership Quality on Agile Team Productivity and Project Results

Drawing on leadership theory, this research verified what makes shared leadership an effective form of leadership for agile project teams, and whether using it influences the outcomes achieved by such teams as well as the more distal outcomes. Survey data were collected from 251 members of agile project teams implementing projects of an iterative and incremental character. Structural equation modeling (PLS-SEM) was adopted to test the hypotheses. Our research confirms that shared leadership is an effective form of leadership for agile project teams whose members are empowered to engage in leadership functions or processes. The findings confirm a positive direct impact of shared leadership on the performance of agile project teams and indirect impact on project efficiency and effectiveness. The research results also confirm the influence of project team–related contextual moderators on shared leadership inputs and outputs. The study contributes to leadership theory in the plural leadership research stream and confirms the shift from individual leadership to collective leadership as a result of the growing popularity of the agility paradigm.

Does insourcing of processes pay off?

Purpose

This study aims to examine whether insourcing of processes pays off and verifies key hypotheses regarding the financial ratios of organisations.

Design/methodology/approach

This paper randomly selects and then surveys 1996 organisations, of which 9.5% (190) stated that they used insourcing, 1.9% (37) made a decision to implement insourcing in the near future and 88.6% did not use insourcing. Then, for available firm data (100 insourcing firms and 100 firms without it), the financial statements of the surveyed companies were obtained to compare the most important financial ratios. The financial situation was compared at four-time points. The mean and median values of individual indicators were compared with the significance of relevant statistical tests.

Findings

A U-shaped curve of financial results in the time of enterprises that implemented insourcing and reverse U-shaped curve for enterprises that did not have insourcing are seen. Thus, the insourcing of processes pays off in the long run.

Research limitations/implications

Limitations exist in the generalisation of the results obtained, due to the limited number of samples qualified for analyses (limited reliable financial data).

Practical implications

The research highlights the importance of effective insourcing projects in the long term.

Originality/value

This study is the first to quantify the financial performance of companies that have used insourcing in comparison with a reference group. This paper defines insourcing and contributes to the growing number of studies on insourcing by bringing attention to the financial outcomes in the long run.

A Questionnaire Survey of Management of Patients with Aneurysmal Subarachnoid Haemorrhage in Poland

BACKGROUND

Aneurysmal subarachnoid haemorrhage (aSAH) remains a potentially devastating threat to the brain with a serious impact on mortality and morbidity. We attempted to investigate correspondence between the current guidelines for aSAH management and real clinical practice in Poland.

METHODS

A web-based questionnaire was performed between 03.2019 and 06.2019. Centres performing neuro-interventional radiology procedures and neuro-critical care were included (n = 29). One response from each hospital was recorded.

RESULTS

In three (10.4%) centres, there was no clear protocol for an interventional treatment plan. Endovascular embolisation was predominantly used in 11 (37.9%) hospitals, and microsurgical clipping, in 10 (34.5%). A written protocol for standard anaesthetic management was established only in six (20.7%) centres for coiling and in five (17.2%) for microsurgical clipping. The diagnosis of cerebral vasospasm was based on transcranial Doppler as the first-choice method in seven (24.1%) units. "3-H therapy" was applied by 15 (51.8%) respondents, and "2-H therapy", by four (13.8%) respondents. In only eight (27.6%) centres were all patients with aSAH being admitted to the ICU.

CONCLUSION

Many discrepancies exist between the available guidelines and clinical practice in aSAH treatment in Poland. Peri-procedural management is poorly standardised. Means must be undertaken to improve patient-oriented treatment and care.

Endovascular Approach to Glomus Jugulare Tumors

Background

Paragangliomas are benign neuroendocrine tumors derived from the glomus cells of the vegetative nervous system. Typically, they are located in the region of the jugular bulb and middle ear. The optimal management is controversial and can include surgical excision, stereotactic radiosurgery and embolization.

Case Report

We report the endovascular approach to three patients harboring glomus jugulare paragangliomas. In all cases incomplete occlusion of the lesions was achieved and recanalization in the follow-up period was revealed. Two patients presented no clinical improvement and the remaining one experienced a transient withdrawal of tinnitus.

Conclusions

It is technically difficult to achieve complete obliteration of glomus jugulare tumors with the use of embolization and the subtotal occlusion poses a high risk of revascularization and is not beneficial in terms of alleviating clinical symptoms.

Comparative study on the treatment of Rockwood type III acute acromioclavicular dislocation: Clinical results from the TightRope® technique vs. K-wire fixation

BACKGROUND AND HYPOTHESIS

The aim of this study was to address the inconsistency regarding the operative treatment of Rockwood type III acromioclavicular joint separation. We compared results after single- and double TightRope^® reduction with results after acromioclavicular transfixation via K-wires only and additional ligament augmentation in acute acromioclavicular (AC) joint separations graded Rockwood type III, and hypothesized that the TightRope^® technique leads to better clinical and radiological results.

MATERIALS AND METHODS

We conducted a retrospective clinical cohort study and included 42 consecutive patients (mean age 43 years [24-66]) diagnosed and operatively treated between 2004 and 2012 (mean follow-up was 54.6 months [15-118]). Specific shoulder scores as well as scores reflecting the patients' overall mental and physical health status were used. Radiological evaluation was also performed.

RESULTS

The SF12 test revealed comparability between all subgroups. Specific shoulder tests and a visual analogue scale demonstrated comparable results. Radiographic measurements showed a significant reduction in the AC distance and CC distance after surgery in all subgroups. The early complication rate was 9.5% for all patients, while late complications occurred in 14.3% of all cases.

CONCLUSIONS

Compared to the established methods, the operative TightRope^® procedures represent a safe alternative in Rockwood III injuries. All investigated techniques predominantly led to good and excellent clinical results in acute Rockwood type III AC joint instabilities. Avoidance of material removal and shorter hospital stays appear to speak in favour for the TightRope^® technique.

LEVEL OF EVIDENCE

IV.

Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: Review of consecutive 34 cases

OBJECTIVE

We report our experience with stent-assisted coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes, retreatment rate and periprocedural complications.

MATERIALS AND METHODS

The analysis included 34 consecutive ruptured and unruptured wide-neck aneurysms. The aneurysm size ranged from 2 to 18mm (mean 5.47). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of 6 months.

RESULTS

Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 32 (94%) and 2 (6%) cases, respectively. Imaging follow-up, performed in 28 (82%) patients, showed no change in the degree of occlusion in 25 (89%) cases and coil compaction in 3 (11%) patients. Of these, one (3.6%) patient underwent a second coil embolization. The periprocedural severe complication rate was 2.9% (1/35) and was associated with prolonged attempt of retrieval of migrated coil resulting in anterior cerebral artery infarct with serious clinical consequences. In another 3 patients periprocedural adverse events without delayed clinical consequences were noticed. The clinical follow-up evaluation achieved in 33 (97%) patients showed no change in 30 (91%) cases, one patient (3%) with clinical improvement and two (6%) cases of neurological deterioration.

CONCLUSIONS

The use of stent is feasible and effective for coil embolization of wide-necked anterior communicating artery aneurysms. Although periprocedural complications resulting in severe morbidity are rare, they should be noted, since in terms of thromboembolic events some of them presumably have a potential to be avoidable.

Stand-alone coil embolization of anterior communicating artery aneurysms: Efficacy and technical issues

OBJECTIVE

We report our experience with endovascular coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes and periprocedural complications.

MATERIALS AND METHODS

The analysis included treatment results of 28 patients with ruptured and unruptured aneurysms. The aneurysm size ranged from 1.8 to 9.8 mm (mean 5.2, SD 1.7). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of six months.

RESULTS

Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 27 (96%) cases and incomplete occlusion in one (4%) case. Imaging follow-up, performed in 15 (53.6%) patients, showed no change in the degree of occlusion in 11 (73%), coil compaction in one (7%) and progressive occlusion in three (20%) patients. Three (20%) patients underwent a second coil embolization. The procedure-related severe morbidity and mortality rate was 6.4% (2/31). Coil prolapse was present in one (3.2%) case and intraprocedural aneurysm rupture in three (9.6%) cases. The clinical follow-up evaluation achieved in 19 (67.9%) patients showed no change in 17 (89.5%) patients and improvement in two (10.5%) patients.

CONCLUSIONS

Although the efficacy of coil embolization of anterior communicating artery aneurysms is unquestionable and the procedure-related complications are acceptable, they should not be neglected. Further investigations are needed to better understand protective factors, as well as to establish unequivocally appropriate management strategy of these complications.

Reconstruction of a quadriceps tendon tear using Polyvinylidene fluoride sutures and patellar screw fixation: A biomechanical study

BACKGROUND

Acute quadriceps tendon tears are infrequent injuries requiring surgical treatment. Improved stability after surgical repair may allow for earlier weight-bearing and range of motion. Therefore, a new implant was tested and compared with the "gold standard", using transosseous sutures.

METHODS

Quadriceps tendon tears were constructed using a cadaveric model of 12 fresh matched-pair specimens (aged 61-97; mean age: 82 years). The biomechanical testing compared non-absorbable suture anchors (Polyvinylidene fluoride) versus transosseous absorbable sutures (Polydioxanon). Following anatomic reconstruction, the repaired specimens were loaded until they failed (testing machine: Hounsfield H10KM, Redhill, United Kingdom; maximum force: 1000 N; load speed: 25 mm/min; maximum test length: 150 mm; pre-load: 5 N). Values for load until tear displacement, maximum load until complete failure of the construct (pullout or breakage of the sutures or anchors) and stiffness of the reconstruction were recorded.

RESULTS

The stiffness found in the Polyvinylidene fluoride reconstruction (mean 9.83 N/mm) (standard deviation (SD) 7.75) showed a significant increase compared to the Polydioxanon reconstruction (mean 6.66 N/mm (SD 3.32); P=0.045). Transosseous fixation showed comparable results to the suture anchor system. There was no significant difference found in the maximum load to tear displacement (PVDF: 290.88 N (SD 106.01) vs. PDS: 266.75 N (SD 82.61); P=0.358).

CONCLUSIONS

Using the Polyvinylidene fluoride thread showed comparable results to the established method in reconstruction of ruptured quadriceps tendon. Stiffness of the Polyvinylidene fluoride thread reconstruction was even greater than Polydioxanon thread.

CLINICAL RELEVANCE

Improved stiffness may facilitate healing and is suggested as clinical relevance in reconstruction.

[Long-term results after polytrauma]

Rehabilitation treatment, which is necessary in the majority of polytrauma patients, is long-lasting and even after several years the final result is frequently not reached yet. Our study is the first in which a population of 510 patients were followed up for 10 years and more and in which many clinical and social parameters were determined. Our study showed that even after a period of 10 years and more the quality of life in several patients is still obviously impaired, according to the parametes "financial losses", "decreased net income", "loss of social services", "credit loan" and "loss of friends". In our study, differences according to financial and professional perspectives between injuries of the lower and upper extremities or combination injuries of the extremities were statistically significant. For the everyday clinic it is important to reintegrate children and young patients into a strong social network because there is a higher percentage of young patients who are socially impaired, even many years after trauma. Adult patients should get strong support to return to their original profession and financial status.

[Corrective growth after vertebral body fracture in the adolescence]

We present the case of a 13-year-old female patient who sustained an incomplete burst fracture of the 1st lumbar vertebral body and an impression fracture of the 3rd vertebral body. Using a dorsal instrumentation the kyphosis of the thoracolumbar junction was treated. The radiographical follow-up indicated a correction of the involved vertebral bodies. However, complete restoration of the height of the vertebral bodies was not achieved. In view of this long-term follow-up the potential for correction of the adolescent thoracolumbar junction spine is discussed.

The interaction of multiple environmental stressors affects adaptation to a novel habitat in the natterjack toad Bufo calamita

The potential to adapt to novel environmental conditions is a key area of interest for evolutionary biology. However, the role of multiple selection pressures on adaptive responses has rarely been investigated in natural populations. In Sweden, the natterjack toad Bufo calamita inhabits two separate distribution areas, one in southernmost Sweden and one on the west coast. We characterized the larval habitat in terms of pond size and salinity in the two areas, and found that the western populations are more affected by both desiccation risk and pond salinity than the southern populations. In a common garden experiment manipulating salinity and temperature, we found that toads from the west coast populations were locally adapted to shorter pond duration as indicated by their higher development and growth rates. However, despite being subjected to higher salinity stress in nature, west coast toads had a poorer performance in saline treatments. We found that survival in the saline treatments in the west coast populations was positively affected by larger body mass and longer larval period. Furthermore, we found negative genetic correlations between body mass and growth rate and their plastic responses to salinity. These results implicate that the occurrence of multiple environmental stressors needs to be accounted for when assessing the adaptive potential of organisms and suggest that genetic correlations may play a role in constraining adaptation of natural populations.

Observer variation in FDG PET-CT for staging of lymphoma

8557

Background: Evaluation of observer agreement is fundamental in the assessment of any new imaging modality. While many studies demonstrate high accuracy of positron emission tomography (PET) for lymphoma staging, few assess observer variation. This study aims to quantify intra- and inter- observer agreement amongst experienced readers for staging lymphoma with PET-CT. Methods: One hundred consecutive patients with biopsy proven lymphoma deemed appropriate for staging with PET-CT were reported independently by three experienced readers, with two readers reviewing each series a second time. Primary outcome variables were agreement of Ann Arbor stage, number of nodal regions and presence of extra-nodal involvement. Secondary outcome variables were agreement of specific nodal and extra-nodal sites. Weighted kappa (κw) was used to compare ratings from two readers, and interpreted according to the Landis-Koch benchmarks. Interclass-correlation coefficient (ICC) was used to assess total of nodal regions involved. Results: Both intra- and inter-reporter agreement for Ann-Arbor stage (κw=0.79–0.91), total number of nodal regions involved (ICC=0.83–0.93) and presence of extra-nodal disease (κ=0.74–0.86) was substantial or almost perfect. High agreement was also observed for specific nodal regions (κw>0.60) except hilar (κw=0.56–0.63) and infra-clavicular regions (κw=0.14–0.37). Conclusions: Amongst experienced readers there was a high level of agreement utilising PET-CT for lymphoma staging. This complements other studies demonstrating high accuracy and supports use of PET-CT as a robust non-invasive staging tool. Further research is needed to evaluate reporter variability for restaging during and after completion of chemotherapy.

[Table: see text]

No significant financial relationships to disclose.

Routine PET and PET-CT scans in melanoma patients with positive sentinel node biopsy is of limited benefit

8582

Background: Positron emission tomography (PET) scanning is increasingly used for the staging and management of malignant melanoma. The role of PET as a routine procedure in patients with positive sentinel node biopsy (SNB) is not yet established. We report in the series with longest follow up outcomes of PET scans performed in patients with subclinical lymph node disease. Methods: Case notes of 29 sequential patients with melanoma of Breslow thickness greater than 1mm who had PET scans within 130 days after a positive SNB were reviewed. Four patients had a PET after the lymph node dissection (LND). Results: 2 patients (6%) had a positive PET scan neither of which was melanoma related. The first patient had a thyroid tumour confirmed with fine needle aspiration biopsy and the second patient had increased uptake in the chest wall which on verification with bone scan proved to be old trauma. 28 patients (96%) had a LND and this was positive in 5 cases (17%). With a median follow up of 23 months 21 patients remained disease free. Out of the 8 patients (27%) who presented with recurrence 2 (25%) were successfully treated with further surgery and remained in remission, 4 (50%) died, 1 (12.5%) was lost from follow-up and 1 (12.5%) is followed up in another hospital. In none of the 29 cases did the early PET scan after a positive SNB alter subsequent melanoma management. Conclusions: The role of PET scanning soon after a positive sentinel node biopsy appears to be of uncertain benefit. It is questionable whether any imaging is beneficial at this stage. The results of this review suggest that PET scanning might not be indicated for this group of patients but larger prospective studies are required to confirm this. Patients Characteristics No % Male 15 (51) Female 14 (49) Melanoma Type: Nodular 8 (27) Superficial spreading 15 (51) Other 2 (6) Unknown 4 (13) Breslow thickness: 1.0–1.9 13 (44) 2.00–3.9 14 (49) ○= 4.0 2 (6) Ulceration: Yes 3 (10) No 25 (86) Unknown 1 (3) Age Median 56

No significant financial relationships to disclose.

Cancer patients’ reported illness and treatment related concerns, perception of availability and use of available information: The influence of socio-demographics

6077

Backgrounds: Studies that examine the roles of socio-demographics in illness perception and healthcare communication among cancer patients are relatively absent. Methods: This sample included 973 (904 whites, 69 non-whites) patients undergoing treatment for cancer at 20 geographically separate sites. Concerns over understanding the diagnosis and treatment plan were assessed on a 5-point-scale (“1=no concern” to “5=a great deal of concern”). Patients were also asked if: a) whether or not information was available to them, b) if yes, did they used it or not, and c) would more information have been helpful. χ2-analyses and ANCOVAs, were conducted to examine group differences in education, occupation, and concern over understanding the diagnosis and treatment plan. Logistic regressions were conducted to assess the independent association of race to patients’ beliefs that additional information would have been helpful. Results: χ2 analyses showed no significant difference between whites and non-whites in education and occupation (Ps > .05). Subsequent ANCOVAs showed significant group differences in concerns over understanding the diagnosis (F(1, 967) = 9.13, p = 0.003) and treatment plan (F(1, 967) = 7.95, p = 0.01), after adjusting for education, occupation, age, and gender. Additionally, χ2 showed significant group differences in beliefs that more information would have been helpful (p < .05). More non-whites (70.3%) than whites (53.1%) indicated that additional information would have been helpful to understanding the diagnosis. Similarly, more non-whites (69.4%) than whites (53.4%) indicated that additional information would have been helpful to understanding the treatment plan. Subsequent logistic regressions confirmed that race independently predicted patients’ indications that more information would have been helpful to understanding the diagnosis (OR = 1.96, 95%CI = 1.12, 3.42) and treatment plan (OR = 1.84, 95%CI = 1.05, 3.22). Conclusion: The findings underscore the need for oncology professionals to consider and integrate information about socio-demographics in their intervention and communication with racial/ethnic minority patients. Supported by NHI PHS-grant U10-CA37420

No significant financial relationships to disclose.

Chemotherapy-naïve cancer patients’ expectations of developing treatment-related side effects: A URCC CCOP study of 670 patients from community practices

8509

Background: Adequate management of cancer related side effects is important for patients yet challenging for clinical staff. Cancer treatment side effects have been characterized reasonably well in the literature; however, less is known about the relationships among response expectancies, personal characteristics, and side effects development of chemotherapy-naïve patients undergoing doxorubicin treatments. Methods: The present sample included 701 cancer patients from 14 CCOP institutions affiliated with the URCC CCOP research base. Of the total sample, 670 patients provided evaluable data to an item that assessed expectations that they will develop side effects such as nausea, vomiting, fatigue, and hair loss. Patients indicated their expectations on a 5-point scale (from 1 = “I am certain I will NOT have this” to 5 = “I am certain I WILL have this”). Results: The median number of symptoms expected (any value other than 1) was 4. Hair loss was most expected (98%) and vomiting the least (87%). Older patients (> 53-years, N = 316, ) were less confident they would get nausea (Mold = 2.96, SE = 0.064; Myoung = 3.23, SE = 0.057, p < 0.01) and hair loss (Mold = 4.22, SD = 0.063; Myoung = 4.39, SE = 0.051, p < 0.05). Females (n = 633) were more confident they would get hair loss than males (Mfemale = 4.34, SE = 0.041; Mmale = 3.89, SE = 0.172, p < 0.05). Patients who had some college (n = 397) thought it was more likely they would get hair loss than patients with less education (Mcollege = 4.38, SE = 0.048; Mnocollege = 4.21, SE = 0.069, p < 0.05). Conclusions: Chemotherapy-naïve patients scheduled to take doxorubicin clearly exhibit expectations about treatment side effects, which are influenced by age, gender and education. The findings show that knowledge of patients’ response expectancies and personal characteristics should be considered and integrated into interventions to control treatment side effects. Supported, in part, by a supplement from the Division of Cancer Control and Population Sciences, NCI, to Public Health Service grant U10 CA37420 and by grant RSG-01-071-PBP from the ACS

[Table: see text]

No significant financial relationships to disclose.

Can the Expanded Disability Status Scale be assessed by telephone?

Information from patients who are unable to continue their visits to a study centre may be of major importance for the interpretation of results in multiple sclerosis (MS) clinical trials. To validate a questionnaire based on the Expanded Disability Status Scale (EDSS), patients in five different European centres were assessed independently by pairs of trained EDSS raters, first by telephone interview and a few days later by standardized neurological examination. Seventy women and 40 men with an average age of 43.7 years (range 19-74 years) were included in the study. Mean EDSS score at the last visit was 4.5 (0-9). EDSS assessment by telephone was highly correlated with the EDSS determined by physical examination (Pearson's correlation coefficient = 0.95). An intraclass correlation coefficient (ICC) of 94.8% was found for the total sample; 77.6% and 86%, respectively, for patients with EDSS < 4.5 (n = 46) and > 4.5 (n = 64). Kappa values for full agreement were 0.48; for variation by +0.5 steps and +1.0 steps, 0.79 and 0.90, respectively. Best agreement could be found in higher EDSS scores, where assessment by telephone interview might be needed most. The telephone questionnaire is a valid tool to assess EDSS score in cases where the patient is unable to continue visiting a study centre or in long-term follow-up of trial participants.

Binaural weighting of pinna cues in human sound localization

Human sound localization relies on binaural difference cues for sound-source azimuth and pinna-related spectral shape cues for sound elevation. Although the interaural timing and level difference cues are weighted to produce a percept of sound azimuth, much less is known about binaural mechanisms underlying elevation perception. This problem is particularly interesting for the frontal hemifield, where binaural inputs are of comparable strength. In this paper, localization experiments are described in which hearing for each ear was either normal, or spectrally disrupted by a mold fitted to the external ear. Head-fixed saccadic eye movements were used as a rapid and accurate indicator of perceived sound direction in azimuth and elevation. In the control condition (both ears free) azimuth and elevation components of saccadic responses were well described by a linear regression line for the entire measured range. For unilateral mold conditions, the azimuth response components did not differ from controls. The influence of the mold on elevation responses was largest on the ipsilateral side, and declined systematically with azimuth towards the side of the free ear. Near the midsagittal plane the elevation responses were clearly affected by the mold, suggesting a systematic binaural interaction in the neural computation of perceived elevation that straddles the midline. A quantitative comparison of responses from the unilateral mold, the bilateral mold and control condition provided evidence that the fusion process can be described by binaural weighted averaging. Two different conceptual schemes are discussed that could underlie the observed responses.

Multicenter case series of pediatric metformin ingestion

OBJECTIVE

There are no large studies, case series, or case reports of metformin ingestion in children. This study summarizes the clinical course and outcomes of metformin ingestion in children reported to the American Association of Poison Control Centers-certified regional poison centers.

METHODS

This was a case series of all metformin ingestions in patients <18 years of age reported to eight regional poison centers. Data collection included age, gender, dose ingested, co-ingestants, symptoms, vital signs, laboratory values, length of hospital stay, and medical outcome. Entrance into the study required at least 24 hours of follow-up.

RESULTS

Fifty-five cases were collected. Ages ranged from 15 months to 17 years, with a mean (+/- SD) of 42+/-4.4 years. The dose ingested, by history, ranged from 250 mg to 16.5 g, with a mean and median of 1710+/-3391 and 500 mg, respectively. Forty-one children (76%) ingested a maximum of two tablets (< or =1700 mg). In the children younger than six years, dosage ranged from 9 to 196 mg/kg, with a mean and median of 60+/-41.1 and 40 mg/kg, respectively. Thirty-seven children were evaluated in a healthcare facility. Clinical effects were limited to nausea (2), diarrhea (2), and dizziness (1). None of the 38 children who had serial glucose measurements experienced hypoglycemia. Arterial blood gas and electrolyte measurements were performed in three and 19 children, respectively. No evidence of acidosis was demonstrated. Two children had lactate concentrations measured and were determined to be in the normal range. Twenty-nine patients received activated charcoal. Five patients received parenteral glucose and one adolescent with a history of diabetes received insulin for hyperglycemia.

CONCLUSIONS

Unintentional ingestion of < or =1700 mg of metformin in the healthy pediatric population does not appear to pose a significant health risk of hypoglycemia or detrimental outcome. In the 21 children who were tested for either blood glucose, electrolyte, or lactate concentrations, no evidence of lactic acidosis was seen.

Alzheimer's disease, depression and normal ageing: merit of simple psychomotor and visuospatial tasks

INTRODUCTION

A brief psychometric test battery was used to differentiate Alzheimer's disease (AD) patients from patients with depression and healthy age-matched control subjects. The purpose was to investigate the discriminative value of simple psychomotor and visuospatial tasks that were implemented in a computer-assisted test battery.

METHODS

Manumotoric coordination, discrimination reaction time and performance on a visuospatial pattern-matching task were assessed. Subjects were 30 patients with the diagnosis of probable AD (mild to moderate), 22 patients with a major depression and 15 healthy normal control subjects.

RESULTS

Discrimination reaction time separated the three groups most distinctly, but general level of cognitive functioning was a significantly confounding variable. There were no differences between the AD and the depressed patients when the MMSE was used as a covariate. Substantial deficiencies in manumotoric coordination were found in both demented and depressed patients. The visual pattern-matching task yielded longer reaction times in both patient groups than in the control group.

CONCLUSION

Translated into neuropsychological terms, these data suggest deficiencies in basic central operations, a slowing of central information processing and attentional deficits in AD and depressed patients. Psychomotor tasks were able to distinguish effectively healthy elderly persons from AD and depressed patients. This test battery, however, appears to be limited in differentiating AD from depression.

Topics in contemporary psychiatric practice: Consent and ethics

Ethical issues in psychiatry are currently in a state of flux. As a profession the field of psychiatry has to clarify the ethical basis of treatment and research, by outlining the conceptual issues and empirical findings related to the ethics of human experimentation. Psychiatrists must endeavour to anticipate the ethical problems of the future and to respond conscientiously to the next generation of ethical dilemmas, that will inevitably arise with advances in science. Indeed, such considerations are already an aspect of genetic research. The ethics embracing research in humans are broadly governed by a number of basic principles: respect for people, beneficence, justice, and the ideal of informed consent.

The role of magnetic resonance in the evaluation of functional results after CABG/PTCA

Magnetic resonance imaging (MRI) is a non-invasive modality which can be used for direct visualization of coronary artery bypass grafts. Spin-echo and gradient-echo (cine-MRI) techniques are now available on standard MR machines and provide information on graft morphology and graft patency with a 90% accuracy. By combining the standard techniques with MR phase velocity mapping, the flow rate in the graft can be measured, thereby offering a unique non-invasive assessment of the graft function. Newer techniques include MR coronary angiography, pharmacologically induced stress MRI, ultrafast MRI of the first-pass (perfusion) of a paramagnetic contrast agent through the myocardium, and 31P MR spectroscopy of high-energy phosphate metabolism of the myocardium. All of these may develop into valuable diagnostic tools for the assessment of functional results after CABG or PTCA, but still require clinical validation. At present, MRI is a useful screening procedure for assessment of graft patency and function in post-operative pain syndromes and in late graft occlusion or stenosis.

[The issue of lower limb amputations in vascular diseases]

A series of 363 amputations in 335 patients treated between 1979 and 1988 because of chronic peripheral vascular disease was reviewed. In years from 1979 to 1988 3500 vascular surgical procedures were carried out. In 217 cases (6,2%) subsequent amputation was necessary. Previously, from 1962 to 1978 it had occurred in 8,5%. The authors experience is indicative of limb vascularization as decisive factor in choosing the level of amputation. In high aortoiliac arterial occlusion a vascular procedure is carried out, resulting in good blood supply of the stump allowing lowering the level of amputation and shortening recovery period.