Suitability of memory aids and strategies for people with posterior cortical atrophy: protocol for a scoping review

Background

Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterised by progressive visuospatial and visuoperceptual impairment. Recent research shows that memory impairment can also occur as an early symptom of the condition and that the impairment can be ameliorated by providing support in the memory recall phase, for example, by presenting a related cue. In Alzheimer’s disease (AD), which is defined by an amnestic syndrome, memory aids and strategies have been used to help support everyday memory, which in turn can have a positive impact on patient and carer outcomes. Similar support for PCA could be achieved by using memory aids and strategies which help to encode and/or retrieve information, yet there are currently no guidelines for memory strategies that may be suitable in PCA. Due to the central visual disorder that defines PCA, careful consideration is needed when making recommendations.

Methods

A scoping review will be conducted of published studies that have assessed memory aids and strategies in people with AD and related dementias where memory is considered a core or supplementary feature, with the aim of distinguishing those that may be suitable or adaptable for PCA. The systematic search will include the electronic databases MEDLINE, PsycINFO and CINAHL, using search terms for dementia and memory aids and strategies identified in pilot searches. Findings will be mapped and described based on methods used, population, clinical data and memory aids and strategies identified.

Discussion

The scoping review will give an overview of the memory aids and strategies used in people with AD and related dementias and identify characteristics, modality and pragmatics to evaluate their suitability and adaptability for a PCA population. Tailored memory support strategies for people living with PCA could improve memory performance, with knock-on positive effects on patient and carer outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13643-023-02187-4.

Stereological analysis of bacterial load and lung lesions in nonhuman primates (rhesus macaques) experimentally infected with Mycobacterium tuberculosis

Infection with Mycobacterium tuberculosis primarily produces a multifocal distribution of pulmonary granulomas in which the pathogen resides. Accordingly, quantitative assessment of the bacterial load and pathology is a substantial challenge in tuberculosis. Such assessments are critical for studies of the pathogenesis and for the development of vaccines and drugs in animal models of experimental M. tuberculosis infection. Stereology enables unbiased quantitation of three-dimensional objects from two-dimensional sections and thus is suited to quantify histological lesions. We have developed a protocol for stereological analysis of the lung in rhesus macaques inoculated with a pathogenic clinical strain of M. tuberculosis (Erdman strain). These animals exhibit a pattern of infection and tuberculosis similar to that of naturally infected humans. Conditions were optimized for collecting lung samples in a nonbiased, random manner. Bacterial load in these samples was assessed by a standard plating assay, and granulomas were graded and enumerated microscopically. Stereological analysis provided quantitative data that supported a significant correlation between bacterial load and lung granulomas. Thus this stereological approach enables a quantitative, statistically valid analysis of the impact of M. tuberculosis infection in the lung and will serve as an essential tool for objectively comparing the efficacy of drugs and vaccines.

A novel adjuvant for mucosal immunity to HIV-1 gp120 in nonhuman primates

The development of a safe and effective mucosal adjuvant is a crucial step toward a mucosal HIV/AIDS vaccine. This study seeks to determine the promise of a nontoxic mutant of cholera toxin (mCT; E112K) as a mucosal adjuvant in nonhuman primates. HIV-1 gp120 was nasally administered together with mCT E112K or native CT (nCT) as adjuvant on five to six occasions over a 6- to 8-wk period to groups of four rhesus macaques and alone to two monkeys that acted as controls. Macaques given nasal gp120 with either mCT E112K or nCT showed elevated gp120-specific IgG and IgA Ab responses with virus-neutralizing activity in both their plasma and mucosal external secretions, as well as higher numbers of gp120-specific IgA Ab-forming cells in their mucosal and peripheral lymphoid tissues and of IL-4-producing Th2-type CD4-positive (CD4(+)) T cells than did controls. Even though significant mucosal adjuvanticity was seen with both mCT E112K and nCT, neuronal damage was observed only in the nCT-treated, but not in the control or mCT E112K-treated groups. These results clearly show that mCT E112K is an effective and safe mucosal adjuvant for the development of a nasal HIV/AIDS vaccine.

Review of treatment of pterygium in Queensland: 10 years after a primary survey

PURPOSE

To assess the practices in pterygium removal as a follow-up study to a similar project 10 years ago, in order to compare the current trends with those noted a decade ago.

METHODS

A survey was sent to all practising ophthalmologists in Queensland (100).

RESULTS

Eighty-seven of the 100 ophthalmologists undertook pterygium surgery with no change in indications for removal, grading or anaesthesia compared to 10 years ago. Nearly half of the ophthalmologists varied their surgical technique from eight commonly used methods according to the individual patient. More than half the respondents used a swinging conjunctival flap and 29% used simple excision leaving the area bare for primary pterygia, although nearly one-quarter of the ophthalmologists added adjunctive therapies such as beta irradiat on or mitomycin. For recurrent pterygia, one-third of ophthalmologists preferred adjunctve therapies, and 57% used an autoconjunctival transplant.

CONCLUSION

There has been no consistent trend in surgical removal of pterygia with a significant number of primary pterygia still removed using bare scleral closure.

GPs and eye skills. A brave new world?

OBJECTIVE

To evaluate the efficacy of a brief general practitioner eye upskilling intervention to enhance GP eye skills and increase their use in clinical practice.

METHOD

Seventeen GPs from a Brisbane Division of General Practice were recruited to participate in a 7 hour clinical upskilling intervention, delivered over an 8 week period.

RESULTS

The proportion of GPs able to accurately recognise glaucomatous fundal damage on clinical assessments rose from 24.0 to 54.2% (standard error [SE] 3.96). The proportion able to accurately recognise diabetic fundal disease on clinical assessment rose from 30.8 to 54.1% (SE 9.2). The ability to recognise fundal disease on slide presentations rose on average from 27.1 to 67.5% (SE 10.8). Although none of the practitioners were able to perform oculokinetic perimetry at the beginning of the intervention, all were able to accurately perform it at the conclusion of the intervention.

CONCLUSION

GPs are capable of rapidly upskilling in important areas of ocular assessment involving preventable blindness.

Leber hereditary optic neuropathy. Electron microscopy and molecular genetic analysis of a case

BACKGROUND

Leber hereditary optic neuropathy (LHON) is a mitochondrial genetic disorder characterized by bilateral central visual loss typically in early adulthood. Few histopathologic studies, including ultrastructural and molecular genetic analysis, have been reported.

METHODS

Ocular tissue was obtained postmortem from an 81-year-old woman with LHON from the Queensland 1 pedigree characterized by mutations at nucleotide positions 4160 and 14484. Routine histopathologic studies, electron microscopy, electron-probe analysis, and molecular genetic analysis were performed.

RESULTS

Marked atrophy of the nerve fiber and retinal ganglion cell layers and optic nerves was present. Results of electron microscopic examination demonstrated 1.2 microns electron-dense, double-membrane-bound inclusions, consisting of calcium by electron-probe analysis, in retinal ganglion cells. The optic nerve was homoplasmic for mutations 4160 and 14484.

CONCLUSION

Optic nerve and inner retinal atrophy in LHON may be a result of metabolic mitochondrial dysfunction leading to intramitochondrial calcification. Homoplasmy for mitochondrial mutations 4160 and 14484 in the leukocyte/platelet fraction of whole blood may correlate with homoplasmy in the optic nerve.

Brisbane GPs' perceptions of screening for primary open-angle glaucoma

BACKGROUND

Primary open-angle glaucoma (POAG) is one of the three leading causes of blindness in Australia, often causing considerable visual field loss before the patient becomes symptomatic. Recent years have seen a quickening of public health interest in primary open-angle glaucoma. Our study evaluates the attitudes and skills of Brisbane GPs with regard to screening for POAG.

OBJECTIVES

To evaluate general practitioners' current use of possible screening modalities for POAG. To evaluate general practitioners' attitudes to screening for POAG. To evaluate general practitioner's levels of satisfaction with their knowledge and skills in the diagnosis of common ophthalmological conditions.

METHOD

A questionnaire was distributed to 130 randomly selected GPs in the Brisbane metropolitan area. Response rate was 94%.

RESULTS

Tonometry and funduscopy were infrequently used in Brisbane general practice. Only 15% of the sample were satisfied with their current knowledge and skills concerning the detection of POAG. 88% felt that patients > 50 years should be screened for POAG and nominated a variety of sources -75% advocating ophthalmology screeners, 65% GP screeners, and 41% optometrist screeners. Ninety-nine per cent believed ophthalmologists should be treating glaucoma patients, and 57% believed GPs should have a role in management. Only 1% supported a therapeutic role for optometrists. Major perceived barriers to glaucoma screening in the elderly were the inaccuracy of current general practice screening tools (65%) and paucity of information concerning the desirability of screening (32%).

CONCLUSION

Brisbane general practitioners believe patients > 50 years old should be screened for POAG. They advocated a role for screening by ophthalmologists, GPs and optometrists. Major perceived barriers to current screening in general practice are the inaccuracy of current general practice tools (65%) and paucity of information on the subject (32%). The majority (85%) requested further information and provision of skills in this area.

Screening for glaucoma in a Brisbane general practice--the role of tonometry

OBJECTIVES

(1) To pilot, and evaluate, a tonometry training intervention for general practitioners; (2) to evaluate the efficacy of three types of tonometer (Perkins, Schiotz and Tonopen) in the hands of these general practitioners; (3) to evaluate the predictive value of tonometry in screening for glaucoma in a general practice population; and (4) to evaluate the acceptability of tonometry to general practice patients.

DESIGN

After being trained, three general practitioners recruited 73 of their patients over 50 years of age to attend for measurement of intraocular pressure by tonometry. Intraocular pressure was initially measured by an ophthalmologist using the Goldmann applanation tonometer, and then recorded in random order by GPs using three types of tonometer--the Perkins, Schiotz and Tonopen.

SETTING

A group general practice in a middle-class suburb in southern Brisbane.

OUTCOME MEASURES

(1) Comparison of measurements on the Perkins, Schiotz and Tonopen tonometers with that of the 'gold standard', the Goldmann Applanation tonometer; (2) prevalence of disc and perimetric abnormality suggestive of glaucoma among those patients with increased intraocular pressure; and (3) the acceptability of contact tonometry to general practice patients.

RESULTS

There was considerable variability between intraocular values obtained across doctors and across instruments (6% to 95% of values within 4 mm of the 'gold standard'). The Schiotz tonometer provided the most uniform assessment of intraocular pressure across the groups. Nineteen of the 73 patients (26%) had intraocular pressures > or = 21 mmHg using the 'gold standard'. Of these, 18 were followed up with funduscopy, gonioscopy, repeat measurement of intraocular pressure and visual field assessment. Five had persistent elevations of intraocular pressure > or = 21 mmHg on subsequent assessment, and two had mild abnormalities of cup-disc ratio with normal fields on testing with Humphrey computerised perimetry.

CONCLUSION

No one hand-held tonometer proved highly accurate in the hands of all three doctors. Even measured optimally, increased intraocular pressure alone was a poor predictor of glaucoma. Of the population screened, two patients (3%) showed evidence of mild cup-disc abnormality requiring follow-up.

The Nambour Skin Cancer and Actinic Eye Disease Prevention Trial: design and baseline characteristics of participants

The Nambour Skin Cancer and Actinic Eye Disease Prevention Trial (the Nambour Trial) is a field trial conducted in an unselected adult population in Australia. Using a randomized 2 x 2 factorial design, the principal aim is to evaluate whether regular use of high-protection sunscreen and/or dietary supplementation with beta-carotene (30 mg daily) can alter the incidence rates of basal cell carcinomas and squamous cell carcinomas of the skin over a minimum follow-up time of 4.5 years. Changes in the incidence of solar keratoses and actinic eye disease and the rate of photoaging after intervention will also be investigated. In 1992, 1626 participants between the ages of 25 and 75 years were enrolled, all of whom had been randomly selected from residents of the southeastern Queensland township of Nambour for an earlier skin cancer prevalence survey. This paper describes the background to the trial and its design, with respect to evaluation of effects on actinic skin disease, and documents the baseline characteristics of participants recruited into the Nambour Trial.

[Endoscopic-controlled laser lithotripsy of salivary calculi. In vitro studies and initial clinical use]

An in vitro study was performed to examine the application of a laser beam for the fragmentation of salivary stones. In accordance with the absorption and reflection spectra of sections of salivary stones, optimal fragmentation was achieved using a pulsed excimer laser with a pulse width of 60 ns and a wave-length of 308 or 351 nm. Further studies on particle size were conducted and a new "sialoendoscope" technique was developed. Twelve patients suffering from a sialolithiasis of the submandibular gland were treated. Under continuous endoscopic monitoring a laser-induced shock wave lithotripsy was performed. In 11 cases complete fragmentation and removal of the salivary stones was achieved. This approach to laser lithotripsy of salivary stones with endoscopic monitoring represents a novel method that permits treatment on an outpatient basis under local anaesthesia, with little inconvenience to the patient.

Awareness and knowledge of orthodontics

Lisa Hirst won the community dentistry section of the 1988 Desmond Greer Walker Award with her study of the level of awareness and knowledge of orthodontics and orthodontic treatment of patients and their parents, and her assessment of the health education material available about orthodontics. We now publish a summary of her paper.

The use of backscattered electrons to examine selectively stained nerve fibers in the scanning electron microscope

Selective staining of neuronal tissues using standard light microscopic techniques has been combined with backscattered electron scanning electron microscopy. This technique allows neurons to be readily distinguished from their surrounding tissues and examined at high resolution. The technique overcomes some of the problems involved in scanning electron microscopy of nervous tissue in situ.