Development of a client-generated health outcome measure for community nursing

OBJECTIVE: To develop a client-generated outcome measure for use in community nursing. METHOD: Participants for the study were identified from the case load of community health nurses, from a nursing home service and from residents of a retirement village. All participants had a diagnosis of venous leg ulcer (VLU) and/or type 2 diabetes. Preliminary development of the measure involved focus groups of community clients and health professionals, and pilot testing of an existing quality of life (QoL) measure, the Patient-Generated Index. The resulting Client-Generated Index was tested for reliability and validity. RESULTS: The Pearson's correlation coefficient between administration of the CGI at T1 and T2 was 0.526 (n = 51; p = 0.0001). The CGI correlated significantly with four of eight dimensions of the SF-36, and with pain as a clinical marker for VLU r = 0.54 (p = 0.001). Overall, participants with VLU reported a lower QoL (mean CGI score 2.8) compared to those with diabetes (mean CGI score 4.1). CONCLUSIONS: The CGI was developed to measure outcomes in community health settings. Some measures of its reliability and validity are demonstrated and further research is needed to validate the instrument using other client groups. IMPLICATIONS: If routine assessment and evaluation is to contribute to measures of outcome, the instruments need to be concise and acceptable to health care providers. The CGI has all these properties.     

Fatigue and psychological disorders in chronic hepatitis C

BACKGROUND AND AIM: Most patients with chronic hepatitis C report that they suffer from fatigue. The aim of this study was to determine if the symptom of fatigue can be a guide to indicate disease activity in chronic hepatitis C, or if it is related to psychological factors. METHODS: 115 chronic hepatitis C patients attending a liver clinic at Wollongong Hospital, Wollongong, Australia, were asked to fill out a questionnaire on the functional impact of their fatigue, and a questionnaire on psychological parameters. These were correlated with a history of intravenous drug use, alcohol history, transaminase levels and liver biopsy findings. RESULTS: Fatigue weakly correlated with the level of fibrosis on the liver biopsy, but strongly correlated with all the psychological domains of depression, anxiety, somatization, interpersonal sensitivity and hostility. CONCLUSION: The level of fatigue strongly correlated with all the psychological domains, particularly depression, and not with our measures of disease activity.     

Seizures in children with low-grade tumors： outcome after tumor resection and risk factors for uncontrolled seizures

OBJECT： The goals of this study were to define the incidence of seizures in children with low-grade tumors, study seizure outcome after lesionectomy in these children, and identify risk factors for poor seizure outcome, METHODS： The authors performed a retrospective chart review of children who harbored low-grade brain tumors, experienced seizures, and were treated in a single institution, Statistical analyses included step-wise as well as single-variable binary logistic regression analyses.     

Perinatal stimulation and adaptation of the neonate

The present report describes psychobiological studies of behavior around the time of birth. An adaptive, ecological perspective is presented in which stimulation of the fetus and newborn is purported to instigate adaptive postpartum behavior. Studies describing the perinatal sensory environment are reviewed, with a consideration of emergent sensory function of the fetus. It is asserted that afferent input associated with parturition perturbs the fetus and neonate, producing a general arousal state that facilitates breathing, suckling, and early learning. The view developed herein is that perinatal sensory input induces and canalizes the newborn's behavior, thereby regulating adaptive postpartum function. Deviations in afferent input may alter ontogenetic trajectories and compromise developmental outcome by reducing availability of conditions necessary for adequate postpartum adaptation.