Handicap questionnaires: what do they assess?

Background and purpose: There is an increasing need to get insight into the social and societal impact of chronic conditions on a person's life, i.e. person-perceived handicap. The purpose of this study is to report how current handicap questionnaires assess handicap. Method: A literature search using both Medline and the database of the Dutch Institute of Allied Health Professions (NPi) was conducted for handicap questionnaires. Questionnaires were included if addressing handicaps or life roles, environmental influences and social consequences of a disease. Excluded were questionnaires focusing on only impairments, disabilities or quality of life. Results and conclusion: 20 questionnaires were identified. Handicap is not uniformly defined in these questionnaires. Based on different concepts, the various questionnaires encompass different domains and different aspects are emphasized in similar domains. Fourteen questionnaires assess societyperceived handicaps, and do not address the life roles, care needs or individual problem-experience. Six questionnaires are to some extent person-perceived, but a generic person-perceived handicap questionnaire could not be identified. It is concluded that development of a generic person-perceived handicap questionnaire is essential for adequate assessment of needs, outcome, and relevance of rehabilitation interventions from the individual's point of view.     

Blood cell microRNAs: what are they and what future do they hold?

The advent of blood component storage revolutionized health care by allowing for a managed supply of transfusion quality blood products. During storage, blood components undergo a series of physiological changes that affect the product quality, which ultimately can interfere with the safety and efficacy of such products after transfusion. Despite continuous improvements in blood component quality and safety, it is still desirable to have in vitro standard markers of measurable characteristics that predict blood component safety and efficacy in vivo following their transfusion. Over the last decade, research on the feasibility of using microRNAs as biomarkers for various clinical manifestations and cellular pathologies has exploded. Here, we review the literature on blood cell microRNAs and discuss the potential of these molecules to act as measurable characteristics (product biomarkers) for stored blood component quality and safety.     

Teenagers in hospital: what do they want?

A questionnaire based survey undertaken in north London secondary schools supported the need for designated hospital facilities for teenagers: 53 per cent of young people who had been admitted to a paediatric ward, and 81 per cent of those admitted to an adult ward, had felt out of place there; 77 per cent of the total (347 adolescents) surveyed, thought a specific teenagers' room would be an improvement in service. In this article, the authors present the research.     

Advanced life support drugs: do they really work?

Basic life support and rapid defibrillation for ventricular fibrillation or pulseless ventricular tachycardia are the only two interventions that have been shown unequivocally to improve survival after cardiac arrest. Several drugs are advocated to treat cardiac arrest, but despite very encouraging animal data, no drug has been reliably proven to increase survival to hospital discharge after cardiac arrest. This review focuses on recent experimental and clinical data concerning the use of vasopressin, amiodarone, magnesium, and fibrinolytics during advanced life support (ALS). Animal data indicate that, in comparison with epinephrine (adrenaline), vasopressin produces better vital organ blood flow during cardiopulmonary resuscitation (CPR). These apparent advantages have yet to be converted into improved survival in large-scale trials of cardiac arrest in humans. Data from two prospective, randomized trials suggest that amiodarone may improve short-term survival after out-of-hospital ventricular fibrillation cardiac arrest. On the basis of anecdotal data, magnesium is recommended therapy for torsades de pointes and for shock-resistant ventricular fibrillation associated with hypomagnesemia. In the past, CPR has been a contraindication to giving fibrinolytics, but several studies have demonstrated the relative safety of fibrinolysis during and after CPR. Fibrinolytics are likely to be beneficial when cardiac arrest is associated with plaque rupture and fresh coronary thrombus or massive pulmonary embolism. Fibrinolysis may also improve cerebral microcirculatory perfusion once a spontaneous circulation has been restored. A planned, prospective, randomized trial may help to define the role of fibrinolysis during out-of-hospital CPR.     

HMO Web sites: what do they tell consumers?

Despite the growth of managed care, little is known about health plans' web sites. This paper reports on a review of the web sites of the 25 largest HMOs in the United States to identify whether their content included information deemed important by consumers: quality, price, provider network, personal health information, and customer service features. Findings show variation in the content of HMO web sites, with sites emphasizing customer service features, the provider network, and personal health information. Two-thirds of HMOs offer information on quality; however, pricing information is offered by only four plans. Implications for future differentiation of HMO web sites are discussed.     

Clinical prediction rules: What are they and what do they tell us?

QUESTION: Clinical prediction rules are research-based tools that quantify the contributions of relevant patient characteristics to provide numeric indices that assist clinicians in making predictions. Clinical prediction rules have been used to describe the likelihood of the presence or absence of a condition, assist in determining patient prognosis, and help the classification of patients for treatment. The recent rapid rise in the use of clinical prediction rules raises questions about the conditions under which they may be used most appropriately. What is the potential role of clinical prediction rules in physiotherapy practice and what are the strategies by which clinicians can determine their appropriate use for a given clinical setting? CONCLUSION: Clinical prediction rules use quantitative methods to build upon the body of literature and expert opinion and can provide quick and inexpensive estimates of probability. Clinical prediction rules can be of great value to assist clinical decision making but should not be used indiscriminately. They are not a replacement for clinical judgment and should complement rather than supplant clinical opinion and intuition. The development of valid clinical prediction rules should be a goal of physiotherapy research. Specific areas in need of attention include deriving and validating clinical prediction rules to screen patients for potentially serious conditions for which current tests lack adequate diagnostic accuracy or have unacceptable cost and risk, and to assist in classification of patients for treatments that are likely to result in substantially different outcomes in heterogeneous groups of patients.     

Children and adolescents with headache: what do they need?

Headache is the most frequent neurological symptom and common manifestation of pain in children. The needs of this group are poorly understood. The aim of this study is to quantify the extent of unmet need in a primary care paediatric population. A patient questionnaire survey of 2,425 children between the ages of 8 and 17 and an uncontrolled intervention study was undertaken in a large general practice in England. Headache impact was measured before and 4 months after a headache clinic intervention using the paediatric migraine disability assessment score. A total number of 74 (3%) children accepted an invitation for a headache assessment. However, only 49 (2%) attended for consultation of whom 84% were judged to have migraine. A total number of 43 (58%) had been seen before for a headache by their general practitioner. The median impact score was 17 days headache impact in a 3-month period. An intervention by a general practitioner with an interest in headache significantly reduced the headache impact score. There is a significant need amongst children with headache that can be addressed by interventions well within the capacity of general practitioners. Further studies are needed to explore why so few children with headache present to primary care and when they do, why their needs are not adequately addressed.     

Treating individuals according to evidence: why do primary care practitioners do what they do?

Research evidence does not necessarily translate into changed management for individual patients, but that may not mean that the evidence has been ignored. Drawing on accounts from general practitioners, we use a study of non-rheumatic atrial fibrillation (NRAF) to illuminate the processes by which practitioners became aware of and assimilated research evidence. We follow that with an account of how the evidence was incorporated into practice protocols for anticoagulation and then applied to a review of individual patients' records. Practitioners used a range of sources of evidence. They reported difficulties arising from their own skills and circumstances and from the perceived quality of the evidence. Creating a protocol involved overcoming problems of scheduling, resources and managing judgements about the value of the review process. In applying the protocol practitioners drew on their knowledge of the patients' preferences, circumstances and previous specialist consultations. As a result, practitioners made judgements that evidence, combined with prior experience, did not support the initiation of anticoagulation in 52% of an unselected primary care population with NRAF. Our findings have implications for evidence-based practice and for practitioner education.     

Measurements in the intensive care unit: what do they mean?

Intensivists depend upon a large number of measurements to make daily decisions in the ICU. However, the reliability of these measures may be jeopardized by the effects of therapy. Moreover, in critical illness, what is normal is not necessarily optimal. Procalcitonin, a putative marker of occult infection, is emerging as a valuable diagnostic marker in the ICU. Although questions remain regarding its specificity, an increasing body of work suggests that it is reliably elevated in the setting of infection. As demonstrated by Level and colleagues in this issue of Critical Care, its utility as a diagnostic marker is not affected by concomitant hemodialysis.     

IR ear thermometers: what do they measure and how do they comply with the EU technical regulation?

Medical diagnostics and clinical practice rely extensively on test and measurement instrumentation. It is therefore of paramount importance that test and measurement instrumentation provides reliable data of sufficient stability, within appropriate limits of accuracy. At the same time the intended purpose of a particular measuring instrument has to be taken into account. The essential problem of every measuring instrument is that it measures and indicates basically what appears at the input of the measuring instrument, which might be significantly different from the real condition of a measurand. Namely, it is assumed that a measurand is stable, repeatable, and relatively unsusceptible to environmental influences. All these requirements are difficult to assure in a biological system and especially difficult in medical practice. Technology could easily provide high-resolution measurements, but due to natural instability of a measurand and various influential parameters the measurement uncertainty is inevitable. Sometimes even gross measurement errors are introduced. To achieve the expected accuracy for intended purpose is therefore much more demanding than merely relying on manufacturers' specifications. This paper describes and analyses the mentioned dilemmas in the case of widely used infrared ear thermometers, with their benefits and limitations, as well as with regard to the European technical regulation in the field of medical devices.     

At what cost care?

This paper looks at the concept of care in nursing and considers the ever-changing focus relative to the meaning of the term care and how this care is delivered by nursing staff. In the process of looking at these issues it examines the theoretical and practical issues and how these factors have changed considerably over the last twenty-five years. This examination touches upon some of the intermingled and not mutually exclusive issues which surround care and caring such as technology, stress and burnout, bureaucracy, fiscal policy, the humanness of the nurse and the ever changing nature of care delivery. Many readers will be able to relate to the issues discussed and understand how some of these factors tend to get in the way of one another and affect good patient care and outcomes.