Standardization of a reference dosimeter system for radiotherapy in Switzerland

The Swiss ordinance on radioprotection prescribes the periodic verification of the reference dosimeter systems for radiotherapy. The corresponding modalities were elaborated by an interdisciplinary collaboration of representatives of all concerned institutions. The modalities require in particular that the verifications are performed with the radiation qualities used in the hospitals. The verification concept is already realized for high energy photon radiation and for low and medium energy X-rays. The measurement capabilities for the verification with high energy electron beams are in preparation. The tasks to verify the reference dosimeter systems are divided between the Swiss Office of Metrology and Accreditation, METAS, and the Institut Universitaire de Radiophysique Appliquée, IRA. The corresponding metrological infrastructure and measurement capabilities of both institutes are presented. In particular, the traceability of the standards used for the verification to national and international primary standards and thus to the SI system of units is explained. The primary standards established and operated by METAS are briefly described.     

Feasibility and validity of the RADAI, a self-administered rheumatoid arthritis disease activity index

OBJECTIVE: The goal of the Rheumatoid Arthritis Disease Activity Index (RADAI) is to provide an easy to use assessment of disease activity. It is a self-administered questionnaire that combines five items into a single index: current and past global disease activity, pain, morning stiffness and a joint count. METHODS: A sample of 484 rheumatoid arthritis (RA) patients was used to assess the internal consistency and the convergent validity of the RADAI. This was achieved by calculating Cronbach's alpha and RADAI item and total score correlations with core set measures and DAS28. RESULTS: Cronbach's alpha was 0.87, supporting the summation of the items into a single index. The index correlated best with physicians' global assessment (r = 0.59; P < 0.0001), the Health Assessment Questionnaire (r = 0.55; P < 0.0001) and the number of tender joints (r = 0.55; P < 0.0001). Correlation with the erythrocyte sedimentation rate was low (r = 0.27; P < 0.0001). The RADAI and the DAS28 were correlated (r = 0.53; P < 0.0001), but there was low agreement. CONCLUSIONS: The RADAI is valid to assess disease activity in RA patients. However, the RADAI may not automatically replace other measures of disease activity, such as the DAS28.     

Transoral Tracheal Intubation for Gastroscopy in Rats

Abstract: A new method of orotracheal intubation in rats which was developed to prevent apnea during upper gastrointestinal endoscopiy is described. After the anesthetized animals are relaxed with an I. V. injection of Vecuronium, orotracheal intubation was performed with a thin endoscope under complete visual control. After relaxation is achieved the glottis is wide open and intubation can be performed carefully without any medianical irritation of the larynx. After placement of the tube in the trachea, the fiberoptic was removed and pressure–controlled ventilation occurred. This technique can be widely applied in any kind of rat experiment, where controlled ventilation is required.     

Mitochondrial function in carbon tetrachloride-induced cirrhosis in the rat. Qualitative and quantitative defects

Mitochondrial function is impaired in patients and experimental animals with liver cirrhosis. The relationship between mitochondrial impairment and severity of cirrhosis is unknown, however. We therefore characterized the severity of cirrhosis in rats with phenobarbital/CCl4-induced cirrhosis by the aminopyrine breath test, a microsomal function test reflecting hepatocellular mass. Mitochondrial function was evaluated by measuring oxygen consumption, enzyme activities and ATP production in mitochondria isolated from cirrhotic (N = 8) and control livers (N = 4). Oxygen consumption and mitochondrial enzyme activities calculated per liver were significantly reduced in the presence of cirrhosis. This decrease corresponded to the loss of hepatocytes calculated from the reduction in aminopyrine breath test. The effect of atractylate, oligomycin and dinitrophenol on state 3 respiration was equal between the two groups. The respiratory control ratio was significantly reduced in mitochondria from cirrhotic livers with beta-hydroxybutyrate (4.01 +/- 0.94 vs 5.45 +/- 0.40), but not with succinate as substrate. The rate of ATP production was significantly decreased in mitochondria from cirrhotic rats for both substrates. In contrast, the static head (state 4) phosphate potential was fully developed after 10 min and was equal between the two groups. We conclude that cirrhosis of the liver leads to a loss of hepatocytes which is paralleled by reduced oxygen uptake and reduced mitochondrial enzyme activities.     

Physiotherapy in spinal stenosis

Spinal stenosis mainly is a disease of the elderly patient. Mostly the lumbar spine is affected. The assessment is based on the typical constellation of symptoms (neurogenic claudication, subjective weakness) and physical findings (abnormal reflex status, loss of strength, sensory deficits). It further is supported by the radiographic proof of stenosis of the spinal canal, the lateral recess and the intervertebral foramina. The targets of physical therapy are the relief of pain and an improvement concerning the activities of daily living, which are especially impaired by reduced walking distance and difficulties in climbing stairs as well. That can be achieved by physiotherapy treatment of myofascial disorders oral medication/local injection.     

Early-stage impairments and limitations of functioning from the geriatric ICF core set as determinants of independent living in older patients after discharge from post-acute rehabilitation.

OBJECTIVE: To identify the impairments and limitations that indicate loss of independence in older patients after discharge from post-acute rehabilitation. DESIGN: Prospective cohort study. SUBJECTS/PATIENTS: A total of 128 patients in the development cohort and 137 patients in the validation cohort. METHODS: Data on functioning and previous living situation were collected at admission; data on prospective living situation were collected at discharge. Multivariable logistic and non-parametric (CART) analyses were carried out with the development cohort. The resulting models were validated in a validation cohort. RESULTS: Development cohort: mean age was 80.3 years (95% confidence interval (CI) 79.1-81.6), 52% of patients experienced loss of independence. The International Classification of Functioning, Disability and Health (ICF) category d465 "moving around using equipment"(odds ratio (OR) = 2.7, 95% CI 1.2-5.8) and a dichotomous indicator variable for fractures or joint replacement (OR = 2.3, 95% CI 1.1-4.9) remained in the logistic model. CART yielded the ICF categories d465 "moving around using equipment", and b765 "involuntary movement functions" conditional on d465. Validation cohort: mean age was 72.6 years (95% CI 70.3-74.9). 40% experienced loss of independence. d465 (OR = 7.6, 95% CI 1.6-35.5) and b765 (OR = 5.9, 95% CI 2.6-13.4) were also significant predictors in the logistic model. CONCLUSION: Older patients who are not able to move around with the help of equipment at the beginning of post-acute rehabilitation are 3 times as likely to lose independence when discharged. It may be important for patients' independent living to encourage the use of wheelchairs and walking aids at very early stages of rehabilitation.     

Developing "Human Functioning and Rehabilitation Research" from the comprehensive perspective.

With the International Classification of Functioning, Disability and Health (ICF) the World Health Organization (WHO) has prepared the ground for a comprehensive understanding of Human Functioning and Rehabilitation Research, integrating the biomedical perspective on impairment with the social model of disability. This poses a number of old and new challenges regarding the enhancement of adequate research capacity. Here we will summarize approaches to address these challenges with respect to 3 areas: the organization of Human Functioning and Rehabilitation Research into distinct scientific fields, the development of suitable academic training programmes and the building of university centres and collaboration networks.