How Effective is a Multidisciplinary Approach in Normal Pressure Hydrocephalus (NPH)? (P4.037)
Bibliographic record
Abstract
Objective: To retrospectively review and determine the outcome of patients evaluated in a Multidisciplinary Normal Pressure Hydrocephalus Clinic (MNPHC) for Ventriculo-Peritoneal (VP) shunt from October 2012- October 2015. Background: Today, over 46 million people live with dementia worldwide, resulting in a huge economic impact. NPH, a type of dementia, commonly presents with gait difficulty, cognitive impairment and urinary incontinence. NPH, left untreated, results in significant disabilities. Design: MNPHC is a bimonthly clinic with a team consisting of dedicated neurosurgeon, neurologist and a physician assistant. During the initial evaluation, the team evaluates the patient together. Our NPH assessment protocol includes neurological exam, Montreal Cognitive Assessment Testing (MOCA), Tinetti-Gait and Balance (T-G&B) analysis, MRI brain with Fast Imaging Employing Steady-State Acquisition (FIESTA) sagittal cuts and Cerebrospinal Fluid (CSF) flow studies. Based on the clinical evaluation and MRI brain findings, patients were selected for large volume (40cc) CSF removal. This was performed by admitting the patients in the hospital for 24hours. T-G&B and MOCA was performed by the same person 2 hours and 24hours after the lumbar puncture (LP). If LP result was unequivocal, then a lumbar drain was placed. Results: To this date 125 patients were evaluated and 19/125 (15.2[percnt]) had VP Shunt placed for NPH. The patients who were selected for shunt, post CSF removal, improved T-G&B (scored out of 28) on an average by 6 points from prior to CSF removal. Six-month and one-year followup of the shunted patients has shown satisfactory improvement in clinical symptoms in 19/19 (100[percnt]) of the patients. Conclusion: Multidisciplinary approach with a standardized patient selection criteria to offer VP shunt in a systematic manner has enabled the diagnosis and management of NPH patients effectively and has improved the quality of life of our shunted patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".