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J E Starmark

Publications and source records attributed to J E Starmark.

28 records · Page 2Linked to original sources
PubMed1988

Current reporting of responsiveness in acute cerebral disorders. A survey of the neurosurgical literature.

One hundred sixty-six papers published in seven neurosurgical journals from 1983 through 1985 have been surveyed to determine the methods used for assessment of overall patient responsiveness in acute cerebral disorders (coma grading). Fifty-one different coma scales or modifications were found. The Glasgow Coma Scale (GCS) sum score (that is, the sum of the scores of the individual eye, verbal, and motor scales) dominated (54%), and was used in 73 (76%) of 96 of the head-injury studies; in 56 (77%) of these 73 studies it was the single method of grading neurological status. The GCS sum score was used in 16 (23%) of 70 studies in patients with other etiologies. The Hunt and Hess scale was used in 26 (57%) of 46 reports of patients with subarachnoid hemorrhage. In 31 (55%) of the 56 studies of head injuries using the GCS alone, it was not obvious if the 12- or 13-grade scale was used. In 13 studies (23%) no reference to methodological investigations was made. In 44 papers (79%) the handling of untestable features, such as intubation or swollen eyes, was not reported. In the 56 studies using the GCS alone, coma was defined in many different ways and in 22 studies the definition of coma was not specified. In 63% of reports, the GCS sum score scale was combined in one to five groups of scores and this was done in 32 different ways. No information was available to describe the procedure of data aggregation or the reliability of the 13-grade GCS sum score. The lack of standardization makes it unnecessarily difficult to perform valid comparisons between different series of patients. Since the GCS sum score is the most widely used scale, it is suggested that the reporting of the GCS sum score should be standardized regarding pseudoscoring, coma definition, and use of combined scores. Further studies on the reliability of the GCS sum score are needed.

Acute Disease↗
PubMed1988

A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85).

The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85) were compared for rating neurosurgical patients in regard to ranking order of deficit severity, interobserver variability, and coverage for relevant factors. Four physicians, four registered nurses, and four assistant nurses performed 72 pairwise ratings on 47 neurosurgical patients. The rank correlation between the GCS sum score and the RLS85 was -0.94, suggesting the same ranking order of severity and indicating that the underlying concepts of somnolence, delirium, and motor responses in coma are evaluated in the same way. By the sign test, the RLS85 was shown to have better interobserver agreement than the GCS sum score and the eye-motor-verbal (EMV) profile. The interobserver grading disagreements in both scales were distributed over the entire range of responsiveness, and for the GCS sum score they were slanted to combined segments 9 to 15. The RLS85 showed full coverage of relevant factors, while 43 (60%) of the 72 test occasions in the GCS sum score and the EMV profiles showed untestable features, most often because of patient intubation. The pseudoscore (that is, the choice of value given to untestable features) affects interobserver agreement as well as the estimated overall patient responsiveness in the GCS sum score. Assessment by the order of applying the scales showed a significant effect on the GCS eye-opening scale (p = 0.01) and the GCS sum score (p = 0.03), indicating a sensitivity to environmental stimuli unrelated to the patient's status. This study demonstrates that basically the same information as that found in the separate eye, motor, and verbal scales of the GCS can be combined directly into the RLS85, which has better interobserver agreement and better coverage than the GCS sum score.

Coma↗
PubMed1987

Alprazolam compared to amitriptyline in the treatment of major depression.

In a double-blind randomized study the therapeutic effect and safety of alprazolam was compared with amitriptyline in 81 outpatients suffering from major depression. Variable dosages of both drugs were used, the mean final dose of alprazolam being 3.05 and that of amitriptyline 130 mg. Both treatment groups improved steadily, assessed weekly with the use of the Hamilton Rating Scale for Depression, and no significant differences were found between the groups, either on comparison between single items or total scores. On several of the criteria used for assessment of treatment response, however, more patients responded to amitriptyline than to alprazolam. In an analysis of specific subgroups, patients whose depression was accompanied by retardation, those in whom there were no precipitating factors and those with low levels of anxiety, responded better to amitriptyline. Considerably fewer side effects were reported by patients receiving alprazolam. In particular, there was a significantly lower incidence of dry mouth, light-headedness, tremor and tachycardia in patients receiving alprazolam compared with amitriptyline.

Adolescent↗
PubMed1986

Is it possible to define a general "conscious level"?

The difficulties in defining a general conscious level are discussed as exemplified by Glasgow Coma Scale and Reaction Level Scale, a new scale recommended by Swedish neurosurgeons. Precise definitions of stimuli and of responses are needed since several studies have shown ambiguity of assessment within the same patient. Some of the difficulties arising from summing up and grouping levels of the Glasgow Coma Scores are discussed and as a consequence a new level for defining coma with a better reliability is proposed. We also briefly discuss the difficulty when to stop assessing conscious level.

Coma↗
PubMed1986

Possible mechanisms of "vegetative state".

A scaling of severity degrees of the vegetative state must perhaps consider the remaining as well as the deficient integrating functions from the arousal and cortical systems to an automatically working but partly disconnected part of the "central brain" with no awareness but some wakefulness.

Arousal↗
PubMed1986

Assessment of responsiveness in head injury patients. The Glasgow Coma Scale and some comments on alternative methods.

The last twelve years history of coma scaling, i.e. reaction level scaling is reviewed. Examples are given of different Glasgow Coma Scale sum scores. The common use of these "sum scores", aggregations of various features, may give an impression of corresponding conscious levels with different functions tested. A more direct approach with mention of varied responses in a reaction level scale may be more reliable and this is also possible to use in a neurological observation chart at bedside.

Coma↗
PubMed1980

Abscesses following prolonged intramuscular administration of perphenazine enantate.

In an investigation of 109 patients on neuroleptics in a vegetable oil base, four of the patients developed abscesses at the site of deposits of perphenazine enantate given intramuscularly in large doses every 1-4 weeks. Observations suggested that the risk of such a complication could be minimized by limiting the frequency of administration to once a fortnight, by limiting the dose injected, by frequent variation of the site of injection, and by regular use of a disinfectant.

Abscess↗