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Fetal Diagnosis and Therapy 2024These guidelines follow the mission of the World Association of Perinatal Medicine, in collaboration with the Perinatal Medicine Foundation, which brings together groups...
Clinical Practice Guidelines and Recommendations by the World Association of Perinatal Medicine and Perinatal Medicine Foundation: Reporting Suspected Findings from Fetal Central Nervous System Examination.
These guidelines follow the mission of the World Association of Perinatal Medicine, in collaboration with the Perinatal Medicine Foundation, which brings together groups and individuals worldwide, with the aim to improve prenatal detection of central nervous system anomalies and the appropriate referral of pregnancies with suspected fetal anomalies. In addition, this document provides further guidance for healthcare practitioners with the goal of standardizing the description of ultrasonographic abnormal findings.
Topics: Humans; Pregnancy; Female; Ultrasonography, Prenatal; Central Nervous System; Nervous System Malformations; Perinatology
PubMed: 38310852
DOI: 10.1159/000535917 -
Lancet (London, England) Feb 2024The cerebroplacental ratio is associated with perinatal mortality and morbidity, but it is unknown whether routine measurement improves pregnancy outcomes. We aimed to... (Randomized Controlled Trial)
Randomized Controlled Trial
Term planned delivery based on fetal growth assessment with or without the cerebroplacental ratio in low-risk pregnancies (RATIO37): an international, multicentre, open-label, randomised controlled trial.
BACKGROUND
The cerebroplacental ratio is associated with perinatal mortality and morbidity, but it is unknown whether routine measurement improves pregnancy outcomes. We aimed to evaluate whether the addition of cerebroplacental ratio measurement to the standard ultrasound growth assessment near term reduces perinatal mortality and severe neonatal morbidity, compared with growth assessment alone.
METHODS
RATIO37 was a randomised, open-label, multicentre, pragmatic trial, conducted in low-risk pregnant women, recruited from nine hospitals over six countries. The eligibility criteria were designed to be broad; participants were required to be 18 years or older, with an ultrasound-dated confirmed singleton pregnancy in the first trimester, an alive fetus with no congenital malformations at the routine second-trimester ultrasound, an absence of adverse medical or obstetric history, and the capacity to give informed consent. Women were randomly assigned in a 1:1 ratio (block size 100) using a web-based system to either the concealed group or revealed group. In the revealed group, the cerebroplacental ratio value was known by clinicians, and if below the fifth centile, a planned delivery after 37 weeks was recommended. In the concealed group, women and clinicians were blinded to the cerebroplacental ratio value. All participants underwent ultrasound at 36 + 0 to 37 + 6 weeks of gestation with growth assessment and Doppler evaluation. In both groups, planned delivery was recommended when the estimated fetal weight was below the tenth centile. The primary outcome was perinatal mortality from 24 weeks' gestation to infant discharge. The study is registered at ClinicalTrials.gov (NCT02907242) and is now closed.
FINDINGS
Between July 29, 2016, and Aug 3, 2021, we enrolled 11 214 women, of whom 9492 (84·6%) completed the trial and were eligible for analysis (4774 in the concealed group and 4718 in the revealed group). Perinatal mortality occurred in 13 (0·3%) of 4774 pregnancies in the concealed group and 13 (0·3%) of 4718 in the revealed group (OR 1·45 [95% CI 0·76-2·76]; p=0·262). Overall, severe neonatal morbidity occurred in 35 (0·73%) newborns in the concealed group and 18 (0·38%) in the revealed group (OR 0·58 [95% CI 0·40-0·83]; p=0·003). Severe neurological morbidity occurred in 13 (0·27%) newborns in the concealed group and nine (0·19%) in the revealed group (OR 0·56 [95% CI 0·25-1·24]; p=0·153). Severe non-neurological morbidity occurred in 23 (0·48%) newborns in the concealed group and nine (0·19%) in the revealed group (0·58 [95% CI 0·39-0·87]; p=0·009). Maternal adverse events were not collected.
INTERPRETATION
Planned delivery at term based on ultrasound fetal growth assessment and cerebroplacental ratio at term was not followed by a reduction of perinatal mortality although significantly reduced severe neonatal morbidity compared with fetal growth assessment alone.
FUNDING
La Caixa foundation, Cerebra Foundation for the Brain Injured Child, Agència per la Gestió d'Ajuts Universitaris i de Recerca, and Instituto de Salud Carlos III.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Fetal Development; Fetus; Perinatal Death; Pregnancy Outcome; Prenatal Care; Ultrasonography, Prenatal
PubMed: 38219773
DOI: 10.1016/S0140-6736(23)02228-6 -
Prenatal Diagnosis Mar 2024Sotos syndrome is a rare genetic disorder that occurs in less than 1 in 10,000 births. It is characterized by rapid growth during childhood (tall stature and unusually...
Sotos syndrome is a rare genetic disorder that occurs in less than 1 in 10,000 births. It is characterized by rapid growth during childhood (tall stature and unusually large head), typical facial dysmorphic features, neurodevelopmental delays of both mental and movement abilities, and learning disabilities. Prenatal diagnosis of Sotos syndrome is infrequent and sonographic findings are not well characterized as the condition is generally detected during childhood. We present a case in which routine third trimester ultrasound detected intracranial findings including ventriculomegaly, periventricular pseudocysts, and increased periventricular echogenicity. Although initially suspected to be the result of fetal infection with CMV, amniocentesis excluded fetal infection and microarray analysis detected a de novo 2.13 MB interstitial deletion of 5q35.2-35.3 involving several genes including the NSD1 gene, thus confirming the diagnosis of Sotos syndrome. This case provides novel characterization of the sonographic phenotype in a fetus with Sotos syndrome and discusses the differential diagnosis.
Topics: Pregnancy; Female; Humans; Sotos Syndrome; Histone-Lysine N-Methyltransferase; Histone Methyltransferases; Phenotype; Fetus
PubMed: 38152001
DOI: 10.1002/pd.6504 -
Behavioral Sciences & the Law 2024Civil litigation involving the forensic neuropsychiatric evaluation of a personal injury case requires an assessment of damages and causation. The expert witness is...
Civil litigation involving the forensic neuropsychiatric evaluation of a personal injury case requires an assessment of damages and causation. The expert witness is obliged to integrate data from three critical sources of information: the review of records; the results of neuropsychological testing; and the findings from the clinical examination. In civil litigation involving a personal injury claim, the expert witness can be expected to address causation and prognosis of any neuropsychiatric damages. We discuss the undertaking of a forensic neuropsychiatric evaluation, psychiatric disorders often encountered in personal injury litigation, provide case vignettes and describe a number of special types of forensic neuropsychiatric evaluations, for example, Workers' Compensation, VA Disability and Social Security Disability.
Topics: Humans; Expert Testimony; Mental Disorders; Disability Evaluation
PubMed: 38145476
DOI: 10.1002/bsl.2642 -
Archives of Clinical Neuropsychology :... May 2024To examine the normal frequency of obtaining one or more scores considered potentially problematic based on normative comparisons when completing the NIH Toolbox Emotion...
OBJECTIVE
To examine the normal frequency of obtaining one or more scores considered potentially problematic based on normative comparisons when completing the NIH Toolbox Emotion Battery (NIHTB-EB).
METHOD
Participants (N = 753; ages 18-85, 62.4% women, 66.4% non-Hispanic White) from the NIHTB norming study completed 17 scales of emotional functioning fitting into three subdomains (i.e., Negative Affect, Psychological Well-being, Social Satisfaction). Scores were considered potentially problematic if they were 1 SD above/below the mean, depending on the orientation of the scale, and cutoffs for 1.5 and 2 SD were also included for reference. Multivariate base rates quantified the rate at which participants obtained one or more potentially problematic scale or subdomain scores.
RESULTS
The portion of participants obtaining one or more potentially problematic scores on the NIHTB-EB scales and subdomains was 61.2 and 23.2%, respectively. Participants who were younger (i.e., 18-49) or had less education had higher rates of potentially problematic scores within specific subdomains. There were no significant differences by sex or race/ethnicity.
CONCLUSIONS
Elevated scores on the NIHTB-EB were common in the normative sample and related to education/age. The multivariate base rates provided indicate obtaining one or more potentially problematic scores on the NIHTB-EB is broadly normal among adults, which may guard against overinterpreting a single score as clinically significant. These base rates should be considered in the context of other assessment findings, such as interviews, medical history or informant reports, to ensure that true emotional problems are not dismissed, and normal variation in emotional functioning is not pathologized.
Topics: Humans; Female; Male; Middle Aged; Aged; Adult; Adolescent; National Institutes of Health (U.S.); United States; Young Adult; Aged, 80 and over; Emotions; Neuropsychological Tests; Reference Values; Multivariate Analysis
PubMed: 38102764
DOI: 10.1093/arclin/acad094 -
General Hospital Psychiatry 2024
Topics: Humans; Malingering; Anemia, Sickle Cell
PubMed: 38102021
DOI: 10.1016/j.genhosppsych.2023.12.001 -
Applied Neuropsychology. Adult Dec 2023Performance validity tests (PVTs) aim to detect noncredible performance during neuropsychological testing. Despite their established utility, their cognitively...
Performance validity tests (PVTs) aim to detect noncredible performance during neuropsychological testing. Despite their established utility, their cognitively undemanding nature and format may unintentionally reveal their purpose, leading to ongoing efforts to develop novel PVTs. In this study, we examined the ability of the embedded validity indices of the Poreh Nonverbal Memory Test (PNMT) to detect simulation. An initial sample of 61 participants was randomly assigned to either a simulation or control condition. Participants then completed the PNMT, the Test of Memory Malingering (TOMM), and the Digit Span subtest. A second validation study using 49 participants was conducted in Israel utilizing the same paradigm. In both studies, simulators were less accurate, exhibited shallow and- at times- reversed PNMT learning curves, and obtained lower scores on the delayed and recognition trials. Additionally, PNMT indices showed similar sensitivity and specificity and were highly correlated with more established validity measures. These findings, however, should be considered preliminary and await further validation in clinical settings.
PubMed: 38086391
DOI: 10.1080/23279095.2023.2267154 -
Archives of Clinical Neuropsychology :... May 2024The objective of this study was to determine base rates of response bias in veterans and service members (SM) referred specifically for attention-deficit/hyperactivity... (Observational Study)
Observational Study
OBJECTIVE
The objective of this study was to determine base rates of response bias in veterans and service members (SM) referred specifically for attention-deficit/hyperactivity disorder (ADHD) evaluation.
METHOD
Observational study of various performance validity tests (PVTs) and symptom validity tests (SVTs) in a sample of SMs (n = 94) and veterans (n = 504) referred for clinical evaluation of ADHD.
RESULTS
SVT and PVT failure rates were similar between the samples, but they were lower than previous Veterans Affairs (VA) and SM studies that were not exclusive to ADHD evaluations. Invalid reporting across all SVT scales on the Minnesota Multiphasic Personality Inventory and Personality Assessment Inventory was relatively uncommon, with rates of invalid scores falling at less than 7%. In both samples, free-standing PVTs were failed at about 22%.
CONCLUSIONS
Although the base rates of PVT and SVT failures in ADHD-specific evaluations were lower than previously published data on non-ADHD-specific evaluations in veterans and SMs, the current study continues to support the inclusion of these measures.
Topics: Humans; Attention Deficit Disorder with Hyperactivity; Veterans; Male; Female; Adult; Military Personnel; Middle Aged; Malingering; Neuropsychological Tests; Reproducibility of Results; MMPI
PubMed: 38073319
DOI: 10.1093/arclin/acad092 -
Applied Neuropsychology. Adult Dec 2023There appears to be a lack of consensus regarding how best to interpret cognitive test findings when there is a failure on only one Performance Validity Test (PVT). The...
There appears to be a lack of consensus regarding how best to interpret cognitive test findings when there is a failure on only one Performance Validity Test (PVT). The current study examined the impact of failing one freestanding, forced-choice, memory-based (Fr-FC-MB) PVT across two memory measures in a large sample of veterans ( = 1,353). The impact of failing zero, one, or two Fr-FC-MB PVTs (Test of Memory Malingering Trial 1 or the Medical Symptom Validity Test) on subsequent memory measures was examined (California Verbal Learning Test-II [CVLT-II], Brief Visuospatial Memory Test-R [BVMT-R]). Compared to those failing zero PVTs, those failing one PVT showed significant declines across all memory indices with large average effect sizes (BVMT-R, = -0.9, CVLT-II, = -1.0). Those failing one PVT had memory scores more similar to those failing two PVTs. There is a need for greater nuance and flexibility when determining invalid test performance. The current findings, along with a brief review of the literature, find that failing even one Fr-FC-MB PVT dramatically (negatively) impacts memory performance. Results suggest that including individuals failing one Fr-FC-MB PVT into a credible group should be more closely scrutinized.
PubMed: 38065580
DOI: 10.1080/23279095.2023.2285503