The need for an institution-specific normal pressure hydrocephalus management protocol
Bibliographic record
Abstract
Background: Despite the publication of international guidelines, the management of normal pressure hydrocephalus (NPH) varies due to clinician preference and varying clinical evidence. An audit was performed to review the current pathways used in clinical practice with the aim of formulating an institution-specific protocol to optimize and standardize care. Methods: An internal audit was performed on the management of patients with NPH who presented to the Princess Alexandra Hospital, Brisbane between January 2016 and February 2019. Results: Forty-one patients were included in the study. Lumbar puncture (LP) was the main diagnostic test used (63.4%). About 14.6% underwent lumbar drain (LD) insertion instead. About 12.2% did not undergo either LP or LD before definitive treatment. Only 60% of all patients underwent ventriculoperitoneal shunt insertion. Overall, five treatment pathways were noted. LP + VP shunt showed the greatest average improvement in Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE) (+3.8 ± 3.18), followed by LD + VP shunt (+3.25 ± 3.52) and sole treatment with LP (+1.83 ± 1.18). Both pre and post intervention assessment of gait and cognition were only performed in 31% and 48.8% of patients, respectively. Four types of cognitive assessment were used (MOCA 46.4%, MMSE 46.4%, Rowland Universal Dementia Assessment Scale 3.6%, and Addenbrooke's Cognitive Examination-III 3.6%). MoCA showed greater cognition improvement (2.07) compared to MMSE (1.3) post intervention. There was no consistent objective gait assessment test used. Conclusion: The multiple NPH treatment pathways, low rate of pre and post objective symptom assessment, and lack of standardized gait and cognitive assessment tests demonstrate a clear need for an institution-specific NPH management protocol to standardize diagnostic workup, definitive management, and allied health assessment.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 teacher head, 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".