• An interactional profile to assist the differential diagnosis of neurodegenerative and functional memory disorders

      Reuber, M.; Blackburn, D.; Elsey, C.; Wakefield, S.; Ardern, K.; Harkness, K.; Venneri, A.; Jones, Danielle K.; Shaw, C.; Drew, P. (2018-07-01)
      Specialist services for dementia are seeing an increasing number of patients. We investigated whether interactional and linguistic features in the communication behaviour of patients with memory problems could help distinguish between those with problems secondary to neurological disorders (ND) and those with Functional Memory Disorder (FMD). In Part 1 of this study, a Diagnostic Scoring Aid (DSA) was developed encouraging linguists to provide quantitative ratings for 14 interactional features. An optimal cut-off differentiating ND and FMD was established by applying the DSA to 30 initial patient-doctor memory clinic encounters. In Part 2, the DSA was tested prospectively in ten additional cases analysed independently by two Conversation Analysts blinded to medical information. In part one, the median score of the DSA was +5 in ND and -5 in FMD (p<0.001). The optimal numeric DSA cut off (+1) identified patients with ND with a sensitivity of 86.7% and a specificity of 100%. In part two, DSA scores of rater one correctly predicted 10/10 and those of rater two 9/10 diagnoses. This study indicates that interactional and linguistic features can help distinguish between patients developing dementia and those with FMD and could aid the stratification of patients with memory problems.
    • Is the 12-item General Health Questionnaire (GHQ-12) confounded by scoring method in individuals with facial disfigurement?

      Martin, C.R.; Newell, Robert J. (2005)
      The GHQ-12 has been recommended as a reliable screening instrument for psychological distress in all clinical groups. The usefulness of the GHQ-12 was evaluated in individuals with significant facial disfigurement by examination of the impact of alternative scoring methods on case detection rates. The type of scoring method used had a significant impact on the relative prevalence of `cases'. However, examination of the receiver operating characteristics (ROC) of the alternative scoring methods revealed a good fit between methods. The use of the GHQ-12 as a screening instrument to determine psychological distress in individuals with facial disfigurement may be enhanced by inclusion of an appearance-specific measure in the screening schedule and by the adoption of one scoring method; the GHQ method.
    • Screening prior to gadolinium based contrast agent administration: A UK survey of guideline implementation and adherence

      Snaith, Beverly; Harris, Martine A.; Clarke, R. (2016-12)
      Contrast agents are used to enhance imaging examinations, however in magnetic resonance imaging (MRI) there is an association with nephrogenic systemic fibrosis (NSF). The risk is small, but elevated in patients with impaired renal function and screening of patients is advised prior to administration. This study examines adherence of UK hospitals to guidance on the use of gadolinium based contrast agents (GBCA) in MRI. This was a prospective study utilising an electronic survey. The sample comprised NHS Trusts in the UK (n = 174). An invitation was sent to all MRI lead radiographers including a link to the survey. 17.6% indicated they had no written protocol for the GBCA administration within radiology. 41.2% check blood test results for all patients undergoing a contrast MRI, whereas 45.6% only check those patients with known renal dysfunction or are high-risk. Comorbidities which categorised patients as high-risk included diabetes, cardiac or vascular disease and age, however the cut off varied from 65 to 75 years old. Six sites indicated point-of-care (POC) creatinine testing would be carried out where bloods were unavailable, a further 12 had considered POC testing and dismissed it as an adjunct to the patient pathway, the most commonly cited reason being the cost. Within the UK there is no consistent approach to renal function assessment prior to GBCA administration despite international guidance. POC testing may have a role to play, but a lack of evaluation in radiology has led to concerns that it may constrain capacity and increase costs.