Determination of β4-galactosyltransferase-7 activity using high-performance liquid chromatography-electrospray ionization tandem mass spectrometry

Objectives

Patients with Ehlers-Danlos syndrome were described to contain reduced activities of β4-galactosyltransferase-7 (β4Gal-T7). Therefore, measurement of β4Gal-T7 activity can help to characterize defects in proteoglycan biosynthesis in patients with connective tissue diseases.

Design and methods

We developed a sensitive and specific method to assay β4Gal-T7 which is based on the transfer of galactose from UDP-galactose to the synthetic peptide Bio-BIK-F-Xyl.

Results

Calibration curves exhibited consistent linearity in the range of 10-2000 μg/L Bio-BIK-F-Xyl-Gal, corresponding to a β4Gal-T7 activity of 3.5-659 μU/L. The limit of detection and the lower limit of quantification were 3.70 μg/L (1.22 μU/L) and 4.50 μg/L Bio-BIK-F-Xyl-Gal (1.48 μU/L β4Gal-T7 activity), respectively. Interassay imprecision (CV) was 8.1-13.1% in the range from 15.9 to 659 μU/L, and mean recovery was 85.3% (range 61.7-106.3%).

Conclusions

This sensitive, robust and interference-free LC-MS/MS assay allows an accurate determination of β4Gal-T7 activity in human body fluids.     

Implementation of newborn screening for Krabbe disease: Population study and cutoff determination

Objective

The aim of this study was to develop a newborn screening algorithm for Krabbe disease.

Design and methods

We measured the galactocerebrosidase activity of 139,074 anonymous newborns, 56 known carriers, and 16 Krabbe patients using a tandem mass spectrometry method. The activities were converted to percentages of daily mean activity (%DMA), and the results from diseased and normal populations were used to establish cutoffs.

Results

The absolute activities for the newborns ranged from 0.17 to 355 μmol/L h (N = 139,074) and activities for Krabbe-positive controls ranged from 0.08 to 0.48 μmol/L h (N = 16, n = 91 measurements) while activities for carriers ranged from 0.28 to 2.71 μmol/L h (N = 56, n = 72 measurements). Cutoffs were set based on results from Krabbe-positive and carrier controls and the newborn population distribution.

Conclusions

The algorithm and cutoffs we propose provided 100% detection of all positive controls with 60/100,000 screen positive results predicted. In the course of this study, one anonymous newborn was predicted to have Krabbe disease based on enzyme activity and subsequent DNA analysis.     

Protein carbonyls as a biomarker of foetal-neonatal hypoxic stress

Objectives:

Investigation of the effect of hypoxic conditions during labour on the protein oxidative modifications and changes in plasma antioxidative capacity of newborns.

Design and methods:

Oxidative damage to proteins was determined by high-performance liquid chromatography. Antioxidative status was monitored by Trolox equivalent antioxidant capacity method. In our study, 11 hypoxic and 19 normoxic newborns were involved.

Results:

In hypoxic newborns, we have found a significant increase in protein carbonyl levels (3.55 ± 0.86 versus 3.24 ± 0.69 mol carbonyls/mol proteins, p = 0.045) and plasma antioxidant capacity (1.76 ± 0.056 versus 1.68 ± 0.097 mmol Trolox/L, p = 0.004) when compared to normoxic children. Bilirubin levels were unchanged (p = 0.87).

Conclusion:

Our results show elevated levels of carbonyls in hypoxic neonates compared to normoxic children. The oxidative damage to proteins is not sufficiently prevented by increased antioxidant capacity detected in plasma of hypoxic newborns.     

A Study of Bone Mineral Density in Adults With Disability

Smith ÉM, Comiskey CM, Carroll ÁM. A study of bone mineral density in adults with disability.

Objectives

To examine prevalence of low bone mineral density (BMD) among adults with disability, using World Health Organization diagnostic categories.

Design

Cross-sectional study.

Setting

National Rehabilitation Hospital, Dublin, Ireland.

Participants

Patients (N=255; 178 men, 77 women) who were disabled for at least 3 months because of acquired brain injury, spinal cord injury, other neurologic condition, or lower-limb amputation.

Interventions

None.

Main Outcome Measures

Laboratory investigations including intact parathyroid hormone, 25-hydroxyvitamin D (25-OHD), and sex hormones; and BMD of lumbar spine and at least 1 hip, measured by dual-energy x-ray absorptiometry and expressed as T scores and z scores.

Results

Mean age ± SD of participants was 48.7±15.6 years. Vitamin D deficiency, 25-OHD level 50nmol/L or less, occurred in 154 (62.9%); insufficiency, a level between 51 and 72nmol/L, occurred in 36 (14.7%). Based on T scores, 108 participants (42.4%) had osteopenia, and 60 (23.5%) had osteoporosis. A z score of −1 or less but more than −2 occurred in 76 (29.8%); a further 52 (20.4%) had a z score of −2 or less. On multiple linear regression analysis, ambulatory status and duration of disability were independent predictors of BMD at neck of femur (β=.152, P=.007; β=−.191, P=.001, respectively) and total proximal femur (β=.170, P=.001; β=−.216, P<.001, respectively).

Conclusions

Osteopenia and osteoporosis are very common in adults with disability participating in rehabilitation, compared with the general young adult population. Duration since onset of disability and mobility status are independent predictors of BMD at the hip. Bone health monitoring should form part of the long-term follow-up in adults with newly acquired disabilities.     

Reference values for serum levels of cholesteryl ester transfer protein and its distribution characteristics in healthy Chinese children and newborns

Objective

To investigate the distribution characteristics of serum CETP levels in childhood.

Design and methods

CETP was measured in 912 healthy children and 40 cord blood with an ELISA.

Results

CETP was skewed in children with a median of 2.48 (2.5-97.5 percentiles: 0.56-6.96) mg/L. CETP in cords was much lower than in children, and was lower in younger children (< 1 year) than in elder children.

Conclusions

CETP is lowest at birth and sharply rises to maximum levels in infancy.     

The value and limitations of a wound inspection clinic after cardiac device implantation

Background

Due to the growing number of cardiac device implantations it is important to develop methods to reduce device-implantation related complications.

Aims

To determine whether a wound inspection clinic can play a role in the detection of device-implantation related complications.

Methods

Single-center observational study evaluating patients who received a pacemaker or implantable cardioverter-defibrillator (ICD).

Results

Of 159 patients who received an appointment for the wound inspection clinic, 52 (33%) received a pacemaker and 107 (67%) received an ICD. The majority had no signs of infection. Pain (n = 13, 8%) and swelling (n = 11, 7%) were the most frequent signs observed, but they never necessitated intervention and recovered spontaneously in all patients. During follow-up (mean 20 ± 9 weeks), complications occurred in 10 patients (6%). Most complications occurred early, within 4 days after implantation. The two late complications (at 19 and 41 days) could not be recognized at the wound inspection clinic.

Conclusion

We found no useful role for a wound inspection clinic two weeks post-implant to detect device-related complications. Open rapid access to the pacemaker/ICD center for patients with signs and symptoms of (threatening) complications seems to be more appropriate to manage post-implant patients.     

The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

Objectives

To examine effects of sedative music on cancer pain.

Design

A randomized controlled trial.

Settings

Two large medical centers in Kaoshiung City, in southern Taiwan.

Participants

126 hospitalized persons with cancer pain.

Methods

Participants were randomly assigned to an experimental (n = 62) or a control group (n = 64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test.

Results

Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p < .001. Effect sizes were large, Cohen's d = .64, sensation, d = .70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective.

Conclusions

Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.     

Analytical investigation: assay of D-lactate in diabetic plasma and urine

Objective

In this study we developed a 96-micro plate enzymatic assay for d-lactate in plasma and urine.

Methods

d-lactate was assayed enzymatically with a UV-spectrophotometer in plasma from 38 and in urine from 37 diabetics and from 42 non-diabetic controls.

Results

The within-run coefficients of variations (CV) were 2.6% for plasma and 5.7% for urine. The between run CVs were 6.8% for plasma and 6.7% for urine. The mean recovery with standard deviation (S.D.) was 107.4 ± 7.3% for plasma and 100.1% ± 6.7% for urine. The plasma d-lactate in diabetics were (mean ± S.D.) 39.6 ± 23.7 μM. We found significant difference between the urinary d-lactate in controls and diabetics (18.2 ± 12.0 vs. 35.9 ± 24.2 μM/mM creatinine, p < 0.0001).

Conclusions

The assay proved reliable with acceptable precision and recovery. Results suggest that diabetics have elevated urinary and plasma d-lactate as compared to controls.     

Association between mobility mode and C-reactive protein levels in men with chronic spinal cord injury

Morse LR, Stolzmann K, Nguyen HP, Jain NB, Zayac C, Gagnon D, Tun CG, Garshick E. Association between mobility mode and C-reactive protein levels in men with chronic spinal cord injury.

Objective

To assess clinical determinants of systemic inflammation in persons with chronic spinal cord injury (SCI).

Design

Cross-sectional survey.

Setting

Veterans Affairs medical center.

Participants

As part of an epidemiologic study assessing SCI-related health conditions, 63 men with chronic SCI provided a blood sample and information regarding locomotive mode and personal habits.

Interventions

Not applicable.

Main Outcome Measure

Plasma high-sensitivity C-reactive protein (CRP).

Results

The mean ± standard deviation age was 56±14y, and participants were assessed 21±13y after injury. Adjusting for heart disease, hypertension, and body mass index (BMI), the mean CRP in 12 motorized wheelchair users (5.11mg/L) was not significantly greater than 23 participants who used a manual wheelchair (2.19mg/L) (P=.085) but was significantly greater than the 17 who walked with an assistive device (1.41mg/L) (P=.005) and the 12 who walked independently (1.63mg/L) (P=.027). CRP was significantly greater in participants with obesity but was not related to age, smoking, or SCI level and severity. CRP was elevated in participants reporting a urinary tract infection (UTI) or pressure ulcer within a year, but adjustment for this did not account for the elevated CRP in motorized wheelchair users.

Conclusions

These results suggest that CRP in chronic SCI is independently related to locomotive mode, BMI, and a history of pressure ulcers and UTI. It is suggested that future studies in SCI investigate whether modifying these factors influence systemic inflammation and cardiovascular health.     

Repeatability of physiotherapy chest wall vibrations applied to spontaneously breathing adults

Objective

Chest wall vibrations are commonly used techniques that remain largely unquantified. In order to understand their effects, it is essential to measure the forces applied and their repeatability over time. This study investigated the repeatability of vibrations within and between test occasions.

Design

Test-retest repeatability study.

Participants

Eight physiotherapists applied vibrations to two healthy female adults.

Intervention

Physiotherapists performed seven vibrations on each subject, and measurements were repeated after 24 hours and 6 months.

Outcome measures

A force-sensing mat placed over the subject’s chest measured the amplitude, duration and force profile of each physiotherapist’s vibrations.

Results

There were no significant differences in maximum force, duration, frequency of oscillation or amplitude of oscillation within each set of seven chest wall vibrations, confirmed by repeated measures analysis of variance (P = 0.42). However, there were wide variations in vibrations between different physiotherapists. Maximum forces ranged from 71 to 258 N, with frequency and amplitude of oscillation ranging from 3 to 11 Hz and 2 to 66 N, respectively. Duration of vibration ranged from 2 to 5 seconds. While there was no systematic bias in forces applied between test occasions, limits of agreement were wide following an interval of 24 hours (−34 to 58 N) and wider still after 6 months (−84 to 76 N).

Conclusion

Physiotherapists exhibit fine control of techniques, delivering vibrations uniformly within single test occasions. However, the variation between therapists and test occasions precludes accurate prediction of applied forces when treating stable patients on consecutive occasions. Furthermore, this study raises important questions about factors influencing the pattern and magnitude of forces applied, and the clinical and physiological effects of such variations.     

Apolipoprotein B versus LDL-cholesterol: Association with other risk factors for atherosclerosis

Objective

To characterize the differences in various risk factors for atherosclerosis between individuals with apoB higher (H) and lower (L) than predicted from regression equation apoB vs LDL-C.

Methods

We evaluated 391 dyslipidemic subjects not treated with hypolipidemic drugs. The measured parameters included lipid profile, apolipoproteins A-1 and B, markers of insulin resistance and inflammation/hemostasis.

Results

Correlation coefficient between apoB and LDL-C was 0.9 (p < 0.0001). Individuals with H apoB compared to L apoB had significantly higher sex and age adjusted BMI, waist circumference, insulin, HOMA (fasting insulin ? glucose/22.5), C-peptide, proinsulin, PAI-1, sICAM-1, sVCAM-1, t-PA, vWF, frequency of metabolic syndrome and lower values of TC, LDL-C and HDL-C (p < 0.05 to < 0.001 for all parameters).

Conclusion

Individuals with apoB higher than predicted by their LDL-C levels are more insulin resistant and have more atherogenic risk profile. Thus, at least for dyslipidemic patients with high cardiometabolic risk, apoB is a more appropriate marker of risk than LDL-C.     

Apolipoprotein B levels in adults with type 1 diabetes not receiving lipid-lowering therapy

Objectives

To investigate apolipoprotein B (apoB) levels in adult patients with type 1 diabetes with no history of cardiovascular disease and not receiving lipid-lowering therapy.

Design and methods

Subjects (n = 169) were divided into two groups based on gender. Primary analysis examined lipid parameters and glycosylated hemoglobin. Secondary analysis involved classifying patients according to the Canadian Diabetes Association's (CDA) LDL cholesterol and apoB targets.

Results

Mean apoB levels were 0.81 ± 0.17 g/L in males and 0.78 ± 0.18 g/L in females. We also found that among patients who failed to achieve the CDA LDL cholesterol target, 46% of males and 54% of females met the apoB target.

Conclusions

There is low prevalence of elevated apoB among patients with type 1 diabetes. In addition, there is discordance between the proportions of patients meeting either LDL cholesterol or apoB targets, thus a significant number of patients may be prescribed lipid-lowering medications unnecessarily.     

Soluble CD40 ligand and soluble P-selectin levels in Gilbert's syndrome: A link to protection against atherosclerosis?

Objective

To investigate the role of CD40 ligand and P-selectin in the mechanism of decreased incidence of cardiovascular disease in Gilbert's syndrome (GS).

Design and methods

The soluble forms of CD40 ligand (sCD40L) and P-selectin (sP-selectin), and high sensitive C reactive protein (hs-CRP) levels were investigated in subjects with GS (n = 25) and compared to healthy controls (n = 53).

Results

sCD40L and hs-CRP levels were significantly lower in GS compared to the controls (0.33 ± 0.27 vs 0.71 ± 0.37 ng/mL, p < 0.001 and 0.51 ± 0.45 vs 1.16 ± 1.31 mg/L, p = 0.046, respectively). Both sCD40L and hs-CRP were negatively correlated with total bilirubin (r = − 0.5, p < 0.001 and r = − 0.34, p = 0.002, respectively). sP-selectin levels were lower in GS when compared to the controls but the difference did not reach statistical significance (p = 0.052). No correlation was found between the plasma levels of sCD40L, sP-selectin and hs-CRP.

Conclusion

These novel findings suggest that reduced sCD40L and hs-CRP concentrations may have a role in the mechanism of protection against atherosclerosis in GS.     

Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: A randomised controlled trial

Background

In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans.

Objective

The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences.

Design

A randomised, single-blind controlled trial study design was used.

Settings

This study involved seven hospitals and 10 obstetricians in Taiwan.

Participants

Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n = 155) or control (n = 141) groups.

Methods

The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations.

Results

The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t = 2.48, p = 0.01). The experimental group also showed a higher degree of childbirth control (t = 9.60, p < 0.001). There were no noticeable differences in mean values between the experimental and control groups in prenatal birth expectations, but a significant difference (t = 2.63, p = 0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t = 3.74, p < 0.001) in the experimental group than in the control group.

Conclusions

The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling pregnant women's childbirth expectations, of affording them a larger degree of control over the birth process, and for their overall positive experiences. Birth plans are acceptable and feasible in maternity care.     

Can urinary excretion rate of malondialdehyde, uric acid and protein predict the severity and impending death in perinatal asphyxia?

Background

Perinatal asphyxia (PA) associated with multi-organ damage is a leading cause of neonatal mortality and morbidity. We evaluated if urinary malondialdehyde:creatinine (UMDA:Cr), uric acid:creatinine (UUA:Cr) and protein:creatinine (UP:Cr) vary with the severity of PA and if these parameters can predict the impending death in PA.

Methods

Study included 20 asphyxiated and 20 healthy newborn males. Hypoxic-ischemic encephalopathy (HIE) staging, APGAR (activity, pulse, grimace, appearance and respiration) score and urinary protein, uric acid, creatinine and MDA were evaluated.

Results

UMDA:Cr, UUA:Cr and UP:Cr were significantly higher and correlated with APGAR and HIE in PA. By regression analysis also, urinary parameters were found to have significant association with HIE stage and APGAR in PA. Receiver operating characteristics (ROC) curve of UP:Cr, UUA:Cr and UMDA:Cr showed area under curve of 0.896 (p = 0.003), 0.859 (p = 0.008) and 0.849 (p = 0.010) with cut-off value of 9.04 mg, 2.34 mg and 3.49 µg/mg of creatinine respectively that can optimally predict the impending death in PA. SDS-PAGE of unconcentrated urine detected both high (73 kDa and 68 kDa) and low molecular weight proteins (52 kDa, 47 kDa, 25 kDa and 20 kDa) in PA but not in controls.

Conclusion

Urinary excretion rate of uric acid, MDA and proteins is higher and has potential to act as biochemical markers for severity evaluation and death prediction in PA.     

Treatment with beta-hydroxybutyrate and melatonin is associated with improved survival in a porcine model of hemorrhagic shock

Introduction

The neuroprotective ketone β-hydroxybutyrate (BHB) and the antioxidant melatonin have been found at elevated levels in hibernating mammals. Previous studies in rat models of hemorrhagic shock have suggested a benefit. We compared infusion of 4 M BHB and 43 mM melatonin (BHB/M) to 4 M sodium chloride and 20% DMSO (control solution) to evaluate for potential benefits in porcine hemorrhagic shock.

Methods

Hemorrhagic shock was induced to obtain systolic blood pressures <50 mmHg for 60 min. Pigs were treated with a bolus of either BHB/M (n = 9) or control solution (n = 8) followed by 4-h infusion of the either BHB/M or control solution. All animals were then resuscitated for 20 h after shock. Physiological data were continually recorded, and blood samples were taken at intervals throughout the experiment. Serum samples were analyzed via high resolution NMR for metabolomic response.

Results

BHB/M treatment significantly increased 24-h survival time when compared to treatment with control solution (100% versus 62%; p = 0.050), with a trend toward decreased volume of resuscitative fluid administered to animals receiving BHB/M. BHB/M-treated animals had lower base deficit and higher oxygen consumption when compared to animals receiving control solution. Serum metabolite profiles revealed increases in β-hydroxybutyrate (BHB), succinate, 2-oxovalerate and adipate with BHB/M treatment as compared with animals treated with control infusion.

Conclusion

Infusion of BHB/M conferred a survival benefit over infusion of control solution in hemorrhagic shock. BHB and its products of metabolism are identified in serum of animals subjected to shock and treated with BHB/M. Further preclinical studies are needed to clarify the mechanisms of action of this promising treatment strategy.     

An investigation into the immediate impact of breathlessness management on the breathless patient: randomised controlled trial

Objective

Physiotherapy breathlessness management is considered to be a major component in the treatment of breathlessness; however, evidence of the efficacy of this practice is lacking. This clinical study aimed to identify the immediate impact of breathlessness intervention on perceived breathlessness.

Design

A pragmatic randomised controlled study.

Setting

Collection of data took place over a 4-month period within an in-patient setting in a National Health Service acute teaching hospital.

Participants

Thirty-one subjects participating in the study were recruited over 3 consecutive days and were randomly allocated to the intervention or control groups.

Intervention

Physiotherapy breathlessness management including pursed lip and diaphragmatic breathing, ‘blow-as-you-go’, positioning and pacing techniques were taught to the individuals in the intervention group on an individual basis during a 45-minute training session.

Main outcome measure

The Borg scale was the primary outcome measure. Measurements were taken before, during and after a stair climbing exercise.

Results

Data were collected from 30 subjects (mean age 75.2 years) with a variety of cardiopulmonary conditions. The results suggested that the intervention group reported a reduction in breathlessness during stair climbing (P = 0.02) and after descending the stairs (P = 0.02) following a session of breathlessness management. No change was observed in the control group.

Conclusion

The findings of the current investigation suggest that individuals with dyspnoea are able to incorporate techniques taught as part of a breathlessness management package of care, and that in the short term, these techniques have a positive effect on the perception of breathlessness. Future studies should look at the long-term benefit of these procedures.     

The effect of sample storage on the reliability of thyroglobulin and thyroglobulin-antibody measurements

Objectives

To investigate how sample-storage alters thyroglobulin (Tg) and thyroglobulin-antibody (TgAb) immunoreactivity.

Design and methods

Tg and TgAb measurements at different storage-times and -temperatures.

Results

48-h-storage at 4-10 °C (but not 8 h at room temperature) increased Tg and decreased TgAb immunoreactivity by maximum + 23% and − 16%. 4-weeks-storage at − 17 to − 20 °C decreased both Tg and TgAb by max. 21-31%.

Conclusions

Storage of samples at 4-10 °C for > 24-48 h, or at − 17 to − 20 °C for > 2-3 weeks significantly alters Tg and TgAb immunoreactivity.     

Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis

Khan F, Pallant JF, Turner-Stokes L. Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis.

Objectives

To use goal attainment scaling (GAS) to measure clinically important functional change in persons with multiple sclerosis (MS) and to assess its responsiveness compared with standard measures used to evaluate progress in rehabilitation.

Design

Prospective, observational cohort study.

Setting

Tertiary inpatient rehabilitation unit in Victoria, Australia.

Participants

Consecutive sample of 24 persons with MS admitted for comprehensive rehabilitation program. The male-to-female ratio was 10:14, and the mean age ± standard deviation was 52.0±8.3 years (range, 37−62y). Over half (n=14 [58.3%]) had secondary progressive MS.

Interventions

Not applicable.

Main Outcome Measures

GAS scores were calculated for 5 to 10 priority goals set prospectively by each patient in agreement with the multidisciplinary treating team and compared with standard outcome measures—the FIM instrument and Barthel Index—rated on admission and discharge from the program. Patients were categorized into responders and nonresponders based on an overall clinical global impression.

Results

Of 203 selected goals, 167 were achieved at the predicted level. GAS recorded outcomes for 105 individualized goals not measured by the FIM and Barthel Index. Although all 3 measures showed statistically significant change from admission to discharge (P<.001), only GAS scores strongly correlated with the Clinical Global Impression scale (ρ=−.86, P<.001). GAS discharge scores differed significantly between the responder and nonresponder groups (Mann-Whitney, z=−3.78, P<.001). Different measures of effect size gave different results, but GAS was consistently more responsive than either the FIM or Barthel Index.

Conclusions

This preliminary study suggests that GAS is a responsive and useful outcome measure for the rehabilitation of persons with MS, providing added value to standardized outcome measurement.     

The SAFE or SORRY? programme. part II: effect on preventive care

Background

Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously.

Objective

The SAFE or SORRY? programme targeted three adverse events (pressure ulcers, urinary tract infections and falls) and was successful in reducing the incidence of these events. This article explores the process of change and describes the effect on the preventive care given.

Design

Separate data on preventive care were collected along the cluster randomised trial, which was conducted between September 2006 and November 2008.

Settings

Ten hospital wards and ten nursing home wards.

Participants

We monitored nursing care given to adult patients with an expected length of stay of at least five days.

Methods

The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for pressure ulcers, urinary tract infections and falls. A multifaceted implementation strategy was used to implement this multiple guidelines programme. Data on preventive care given to patients were collected in line with these guidelines and the difference between the intervention and the usual care group at follow-up was analysed.

Results

The study showed no overall difference in preventive pressure ulcer measures between the intervention and the usual care group in hospitals (estimate = 6%, CI: −7-19) and nursing homes (estimate = 4%, CI: −5-13). For urinary tract infections, even statistically significantly fewer hospital patients at risk received preventive care (estimate = 19%, CI: 17-21). For falls in hospitals and nursing homes, no more patients at risk received preventive care.

Conclusion

Though the SAFE OR SORRY? programme effectively reduced the number of adverse events, an increase in preventive care given to patients at risk was not demonstrated. These results seem to emphasise the difficulties in measuring the compliance to guidelines. More research is needed to explore the possibilities for measuring the implementation of multiple guidelines using process indicators.