SUMMARY The nature of the neurological and mental disabilities resulting from severe head injuries are analysed in 150 patients. Mental handicap contributed more significantly to overall social disability than did neurological deficits. This social handicap is readily described by the Glasgow Outcome Scale, an extended version of which is described and compared with alternatives. Comments are made about the quality oflife in disabled survivors.

A series of 42 children is described who, following a seemingly minor or trivial head injury, developed neurological signs after a lucid or symptom-free period. This group constitutes 4.34 per cent of 967 consecutive patients aged 2 months to 17 years who were seen by members of the neurological staff during the years 1978-1981. Only one patient had an intracranial haematoma. The majority of patients showed a benign transient syndrome consisting of either convulsive or nonconvulsive signs with a spontaneous and full recovery. There were, however, 3 deaths in this series, apparently due to severe and uncontrollable unilateral or diffuse brain swelling, demonstrating the malignant counterpart of this benign syndrome. The theories seeking to explain these phenomena are reviewed. Special reference is made to the hypotheses of Bruce and his associates regarding brain swelling as a causative factor. It is considered that an adequate theory to explain the pathogenesis is still lacking. It is concluded that the juvenile brain responds to cranial trauma in a manner different from the adult brain. This implies a different approach in policy to hospital admission.

BTA is significantly more effective in the treatment of ICD, with less adverse effects.

The second Caucasian xeroderma pigmentosum patient (XP42RO) belonging to complementation group F (XP-F) is described. Mild ocular photophobia was present from childhood, and acute skin reactions occurred upon exposure to sunlight. Basal and squamous cell carcinomas developed after his twenty-seventh year. In his late forties progressive neurologic symptoms emerged, which included intellectual decline, mild chorea and ataxia, and marked cerebral and cerebellar atrophy. Such neurologic abnormalities are very unusual in XP-F. Similar symptoms have been described in only one of 17 other XP-F individuals. His approximately 5-fold reduced activity of nucleotide excision repair in cultured cells, combined with moderately affected cell survival and DNA replication after UV exposure, are typical of XP-F. The recent cloning of the XPF gene allowed a molecular genetic analysis of this unusual patient. XP42RO, representing the second case studied in this respect, turned out to be homozygous for a point mutation in the XPF gene, causing an R788-->W substitution in the encoded protein. Surprisingly, this mutation had also been found in one allele of the other unrelated Caucasian XP-F case. The amount of mutated XPF protein is strongly reduced in cells from XP42RO, presumably due to a conformational change. Biochemical, genetic, and clinical data all indicate the presence of considerable residual repair activity, strongly suggesting that the R788W mutation is leaky.

BackgroundTeacher feedback on student reflective writing is recommended to improve learners’ reflective competence. To be able to improve teacher feedback on reflective writing, it is essential to gain insight into which characteristics of written feedback stimulate students’ reflection processes. Therefore, we investigated (1) which characteristics can be distinguished in written feedback comments on reflective writing and (2) which of these characteristics are perceived to stimulate students’ reflection processes.MethodsWe investigated written feedback comments from forty-three teachers on their students’ reflective essays. In Study 1, twenty-three medical educators grouped the comments into distinct categories. We used Multiple Correspondence Analysis to determine dimensions in the set of comments. In Study 2, another group of twenty-one medical educators individually judged whether the comments stimulated reflection by rating them on a five-point scale. We used t-tests to investigate whether comments classified as stimulating and not stimulating reflection differed in their scores on the dimensions.ResultsOur results showed that characteristics of written feedback comments can be described in three dimensions: format of the feedback (phrased as statement versus question), focus of the feedback (related to the levels of students’ reflections) and tone of the feedback (positive versus negative). Furthermore, comments phrased as a question and in a positive tone were judged as stimulating reflection more than comments at the opposite side of those dimensions (t = (14.5) = 6.48; p = < .001 and t = (15) = −1.80; p < .10 respectively). The effect sizes were large for format of the feedback comment (r = .86) and medium for tone of the feedback comment (r = .42).ConclusionsThis study suggests that written feedback comments on students’ reflective essays should be formulated as a question, positive in tone and tailored to the individual student’s reflective level in order to stimulate students to reflect on a slightly higher level. Further research is needed to examine whether incorporating these characteristics into teacher training helps to improve the quality of written feedback comments on reflective writing.