Evidence-based measurement: which disability scale for neurologic rehabilitation?

OBJECTIVE: To compare the 10-item Barthel Index (BI), 18-item Functional Independence Measure (FIM), and 30-item Functional Independence Measure + Functional Assessment Measure (FIM+FAM) as measures of disability outcomes for neurologic rehabilitation. METHODS: A total of 149 inpatients from two rehabilitation units in South England specializing in neurologic disorders were studied. Traditional psychometric methods were used to evaluate and compare acceptability (score distributions), reliability (internal consistency, intrarater reproducibility), validity (concurrent, convergent and discriminant construct), and responsiveness (standardized response mean). RESULTS: All three rating scales satisfied recommended criteria for reliable and valid measurement of disability, and are acceptable and responsive in this study sample. The FIM and FIM+FAM total scales are psychometrically similar measures of global disability. The BI, FIM, and FIM+FAM motor scales are psychometrically similar measures of physical disability. The FIM and FIM+FAM cognitive scales are psychometrically similar measures of physical disability. CONCLUSIONS: In the sample studied, the BI, FIM, FIM+FAM have similar measurement properties, when examined using traditional psychometric analyses. Although instruments with more items and item response categories generate more qualitative information about an outcome, they may not improve its measurement. Results highlight the importance of using recognized techniques of scale construction to develop health outcome measures.     

The potential value of mammographically guided fine-needle aspiration biopsy of nonpalpable breast lesions

Nonpalpable breast lesions in 20 female patients were prospectively evaluated with a new technique of fine-needle aspiration biopsy (FNAB) under mammographic guidance. The patient age range was 37-82 years (mean: 60 years), and the mammographic indications for biopsy were microcalcifications (30%), mass (30%), mass with calcifications (25%), and asymmetric density (15%). Seven (35%) patients had significant risk factors for breast cancer. Prototype coaxial 19-gauge/22-gauge and 18-gauge/20-gauge needle systems (Cook, Inc., Bloomington, IN) were used for localization and biopsy. The technique involved needle localization of the target lesion with FNAB performed through the localizing needle after radiologic confirmation of position. A localizing wire then was inserted to allow each patient to proceed directly to the operating room for a standard needle localization open biopsy. Successful localization and aspiration was possible in 18 (90%) patients. Surgical excision was performed in all 20 patients and confirmed by specimen radiography in 17 (85%). A significant concordance of 94 per cent was found between the histologic results of the open biopsy specimens and the cytologic findings of aspirated specimens. These findings suggest that mammographically guided FNAB may offer a safe, reliable, and cost-effective alternative to open biopsy of nonpalpable breast lesions. Further study of this procedure is warranted to confirm its potential in this area.     

Epidemiological features and control of an outbreak of scarlet fever in a Perth primary school

Scarlet fever was associated with feared outbreaks and mortality in the 19th Century. It occurs sporadically in modern society and infection is readily treated with antibiotics. We report on a scarlet fever outbreak in children attending a primary school in Perth, Western Australia, in late 2003. A total of 13 cases were identified over a five week period. Six of the cases were pre-primary children (ages 4 to 5) from the same class of 26 children (attack rate 23.1%). Three of the remaining seven cases were older siblings of pre-primary cases who developed scarlet fever after their younger siblings. Screening of the children and teachers from the two pre-primary classes at the school yielded 12 positive pharyngeal swabs for group A Streptococcus. Emm-typing of the screening isolates indicated that a common strain was circulating within the outbreak pre-primary class, with four of six isolates identified as emm-type 3. The overall group A Streptococcus carriage rate in screened students in this class was 31.6 per cent and the carriage rate for emm-type 3 was 21.1 per cent. Carriers were treated with oral penicillin V to eradicate carriage and control the outbreak. No further cases of scarlet fever were reported after the treatment of pharyngeal carriers. Outbreaks of scarlet fever still occur in young children and identification and treatment of carriers may still be valuable.     

Choice menus will serve up more private sector options

The independent sector's contribution to NHS patient choice is to be significantly extended through an invitation to bid for inclusion on PCT choice menus. In an exclusive interview, NHS chief executive Sir Nigel Crisp reveals that 'the BUPAs of this world' will be encouraged to supply care in all areas of elective care where choice is to be offered.     

Hormonal effects of high dose naloxone in humans

Utilizing a double-blind crossover design, the hormonal effects of high dose, 2 mg/kg, were compared to low dose, 0.4 mg (approx. 5 micrograms/kg), naloxone administration in physically healthy humans. A significant naloxone dose effect on plasma cortisol levels was found (p less than 0.001), but no significant effect on plasma or serum levels of prolactin, follicle stimulating hormone, luteinizing hormone, norepinephrine or epinephrine. These results confirm involvement of the endogenous opioid system (EOS) in the tonic regulation of the hypothalamicpituitary-adrenal axis, but fail to find evidence of EOS involvement in the regulation of adrenal medullary function or the gonadotrophic axis in man. The results are however consistent with a continuing action of naloxone as an EOS antagonist even at high doses in man.     

Caffeine maintains vigilance and improves run times during night operations for Special Forces

PURPOSE: This study examined the effects of caffeine (CAF) on vigilance, marksmanship, and run performance during 27 h of sustained wakefulness in Special Forces personnel. METHODS: There were 31 soldiers (29.8 +/- 5.4 yr, 86.4 +/- 8.6 kg) who were divided into placebo (PLAC, n = 15) and CAF (n = 16) groups. A 6.3-km control run was completed on the morning of Day 1. In the evening of Day 2, soldiers performed a control observation and reconnaissance vigilance task (ORVT) in the field. This 90-min task was repeated twice more between 02:00 and 06:00 on Day 3 during an overnight period of sleep deprivation. Marksmanship was assessed before and after the ORVT. PLAC or 200 mg of CAF gum was administered at 01:45, 03:45, and approximately 06:30 on Day 3. A final 6.3-km run commenced within 30 min of receiving the final dose. RESULTS: ORVT was maintained in CAF at control levels of 77 +/- 13% during the overnight testing. However, values decreased significantly for PLAC from 77 +/- 15% to 54 +/- 29% and 51 +/- 31% during the first and second overnight testing periods, respectively. CAF had no effect on marksmanship but improved 6.3-km run times by 1.2 +/- 1.8 min. Run times slowed for PLAC by 0.9 +/- 0.8 min from approximately 35 min during the control run; the changes in performance were significant between groups. CONCLUSIONS: It was concluded that CAF maintained vigilance and improved running performance during an overnight field operation for Special Forces personnel.