From early motor ability to global cognitive development seven years after neonatal arterial ischemic stroke

The developmental condition of children after neonatal arterial ischemic stroke (NAIS) is characterized by cognitive and motor impairments. We hypothesized that independent walking age would be a predictor of later global cognitive functioning in this population. Sixty-one children with an available independent walking age and full-scale IQ score seven years after NAIS were included in this study. Full-scale IQ was assessed using the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV). Independent walking age was negatively correlated with full-scale IQ score at seven years of age (Pearson correlation coefficient of -0.27; 95% confidence interval from 0.48 to -0.01; p <0.05). Early motor function is correlated with later global cognitive functioning in children after NAIS. Assessing and promoting early motor ability is essential in this population.

Perinatal inflammation exposure and developmental outcomes 7 years after neonatal arterial ischaemic stroke

AIM

To test the association between perinatal inflammation exposure and Full-Scale IQ (FSIQ) score 7 years after neonatal arterial ischaemic stroke (NAIS).

METHOD

We conducted a cross-sectional ancillary study nested in a multicentric longitudinal French cohort of infants born at term with NAIS between November 2003 and October 2006. Seventy-three children were included (45 males, 28 females). The a priori defined primary outcome measure was the FSIQ score assessed with the Wechsler Intelligence Scale for Children, Fourth Edition at 7 years of age.

RESULTS

Seventeen (23%) of the included children were exposed to perinatal inflammation. Exposure to perinatal inflammation was independently associated with an increase of FSIQ score (coefficient 13.4, 95% confidence interval 1.3-25.4; p = 0.03). Children exposed to perinatal inflammation had a higher median cerebral volume, a lower median lesion volume, and less extensive lesion distributions compared to non-exposed children.

INTERPRETATION

We propose the existence of two NAIS categories: arteritis-associated NAIS in children exposed to perinatal inflammation and embolism-associated NAIS in children non-exposed to perinatal inflammation. Identifying these two NAIS categories would open the possibility for specific curative strategies: anti-inflammatory strategy in arteritis-associated NAIS and recanalization strategy in embolism-associated NAIS.

Left Ventricular Outflow Tract Obstruction in Patients Treated With Milrinone for Cerebral Vasospasm: Case Report and Literature Review

Subarachnoid hemorrhage is associated with high morbidity and mortality, and cerebral arterial vasospasm is one of its main complications that determines neurological prognosis. The use of intravenous milrinone is becoming more common in the treatment of vasospasm. This molecule has positive inotropic and vasodilating properties by inhibiting phosphodiesterase-3. Its most described side effects are cardiac arrhythmias and arterial hypotension. In this paper, we raise a new issue concerning milrinone and discuss an undescribed side effect of this treatment, left ventricular outflow tract obstruction (LVOTO). Dynamic LVOTO is a clinical situation favored by hypovolemia, decreased left ventricular afterload, and excessive inotropism that can lead to severe hemodynamic failure and pulmonary edema. To our knowledge, this is the first study describing milrinone-induced LVOTO. This could compromise cerebral perfusion and therefore the neurological prognosis of patients. While it is known that catecholamines may induce LVOTO, milrinone-induced LVOTO appears to be a new pathophysiological entity of which neurosurgical intensivists should be aware.

CNTNAP1-encephalopathy: Six novel patients surviving the neonatal period

CNTNAP1 encodes CASPR1, involved in the paranodal junction. Thirty-three patients, with CNTNAP1 biallelic mutations have been described previously. Most of them had a very severe neurological impairment and passed away in the first months of life. We identified four patients, from two unrelated families, who survived over the neonatal period. Exome sequencing showed compound heterozygous or homozygous variants. Severe hypotonia was a constant feature. When compared to previous reports, the most important clinical differences observed in our patients were the absence of antenatal problems and, in two of them, the lack of respiratory distress. Less commonly reported characteristics such as epileptic seizures, dystonia, and impaired communication skills were also observed. MRIs revealed hypomyelination or abnormal white matter signal, cerebral or cerebellar atrophy. The present observations support a wider than initially reported clinical spectrum, including survival after the neonatal period and additional neurological features. They contribute to better delineate the phenotype-genotype correlations for CNTNAP1. In addition, we report one more family with two sibs who carry a missense variant of uncertain significance which we propose could be associated with a milder phenotype.

Key components of international and European governance for quality of care

The legal status and binding nature of various international governance and guidance instruments to foster and support quality strategies in European countries differs substantially. This presentation introduces and discusses the four main elements of an integrated international governance framework for quality in health care: i) raising political awareness of the relevance of health care quality and creating a common vision on how to improve it; ii) implementing this vision into actual policy frameworks by sharing experience and practice between countries; iii) developing and providing standards and models (voluntary or mandatory) that can be transposed into national policy; iv) measuring, assessing and comparing quality by developing better information, better indicators and methodologies as well as dissemination strategies.

The presentation will also focus on how quality in health care is addressed through EU policy, first through EU provisions and policies that are meant to ensure free movement of citizens and goods and establish an internal market, and by means of more horizontal and generic EU policies on quality and safety that stem from the mandate to support, coordinate or supplement national policies. It will further highlight how EU integration and policy touch upon quality in health care and how the approach has evolved over time.

Cognitive Vulnerability to Depression in Adolescents with Depression, their Healthy Siblings and a Control Group: A Cross-sectional Study

Introduction

At least half of first depressive episode appear before adulthood. A negative cognitive bias is present among individuals who suffer from major depression. This bias is also reported among individuals at high risk of major depression (e.g. child of depressed mother). When present, cognitive vulnerability may predispose to major depression. No study to date aimed to evaluate the cognitive vulnerability of siblings of depressed individuals.

Objectives and aims

To review the principles behind cognitive vulnerability. To assess cognitive vulnerability in depressed adolescents, in healthy siblings and in a control group.

Methods

Eighty adolescents (27 adolescents treated for depression, 24 healthy siblings and 29 controls), aged between 12 and 20 years old, were recruited and assessed using validated measures of bio-psycho-social vulnerabilities. All diagnoses were confirmed using a K-SADS interview. Cortisol level samples were obtained through morning saliva. Cognitive vulnerability was assessed using self-report questionnaires (CES-D, LEIDS-R, EPQ) as well as computer-based tasks (Ekman's tasks of facial recognition and the movie for assessment of social cognition [MASC]). We translated the MASC from German to French. The parents of the adolescents also filled the LEIDSR and the CESD.

Results

The LEIDS-R presented a significant increase in certain subscales (hopelessness, aggression and rumination) compared to the healthy siblings and the controls. Interestingly, there was also a correlation between the LEIDS R results of the parents and of the depressed adolescent (r = 0.43, P = 0.04).

Conclusions

The LEIDSR appears to be the most sensitive task to detect cognitive vulnerability. A relation between the parent response and the depressed adolescent response could be found.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Cross-border care and healthcare quality improvement in Europe: the MARQuIS research project

Citizens are increasingly crossing borders within the European Union (EU). Europeans have always been free to travel to receive care abroad, but if they wished to benefit from their statutory social protection scheme, they were subject to their local or national legislation on social protection. This changed in 1991 with the European Court of Justice defining healthcare as a service, starting a debate on the right balance between different principles in European treaties: movement of persons, goods and services, versus the responsibility of member states to organise their healthcare systems. Simultaneously, cross-border cooperation has developed between member states.

In this context, patient mobility has become a relevant issue on the EU’s agenda. The EU funded a number of Scientific Support to Policies (SSP) activities within the Sixth Framework Programme, to provide the evidence needed by EU policy makers to deal with issues that European citizens face due to enhanced mobility in Europe. One SSP project “Methods of Assessing Response to Quality Improvement Strategies” (MARQuIS), focused on cross-border care. It aimed to assess the value of different quality strategies, and to provide information needed when: (1) countries contract care for patients moving across borders; and (2) individual hospitals review the design of their quality strategies. This article describes the European context related to healthcare, and its implications for cross-border healthcare in Europe. The background information demonstrates a need for further research and development in this area.

Implementation of patient safety strategies in European hospitals

CONTEXT

This study is part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on cross-border care, investigating quality improvement strategies in healthcare systems across the European Union (EU).

AIM

To explore to what extent a sample of acute care European hospitals have implemented patient safety strategies and mechanisms and whether the implementation is related to the type of hospital.

METHODS

Data were collected on patient safety structures and mechanisms in 389 acute care hospitals in eight EU countries using a web-based questionnaire. Subsequently, an on-site audit was carried out by independent surveyors in 89 of these hospitals to assess patient safety outputs. This paper presents univariate and bivariate statistics on the implementation and explores the associations between implementation of patient safety strategies and hospital type using the chi(2) test and Fisher exact test.

RESULTS

Structures and plans for safety (including responsibilities regarding patient safety management) are well developed in most of the hospitals that participated in this study. The study found greater variation regarding the implementation of mechanisms or activities to promote patient safety, such as electronic drug prescription systems, guidelines for prevention of wrong patient, wrong site and wrong surgical procedure, and adverse events reporting systems. In the sample of hospitals that underwent audit, a considerable proportion do not comply with basic patient safety strategies--for example, using bracelets for adult patient identification and correct labelling of medication.