A new questionnaire for constipation and faecal incontinence

BACKGROUND: The prevalence, severity and risk factors of faecal incontinence in women in the community are incompletely characterized. AIM: To develop and validate a self-report questionnaire (faecal incontinence and constipation assessment) to address these issues. METHOD: Eighty-three women completed the instrument; 20 randomly selected patients answered the faecal incontinence and constipation assessment again 6 weeks later. A gastroenterologist also completed the faecal incontinence and constipation assessment in all 83 subjects after a detailed clinical assessment. Concurrent validity was evaluated by comparing the patient's self-report to a doctor interview for every question. Reproducibility was evaluated by a test-retest approach for every question. The severity of faecal incontinence was rated by incorporating the frequency and type of faecal incontinence, rectal urgency and use of sanitary devices. RESULTS: The questionnaire was well-understood. Reproducibility [median kappa statistic, 0.80 (interquartile range: 0.66-0.90)]; and concurrent validity [0.59 (0.47-0.67)] were acceptable. For the index question on faecal incontinence, the kappa for reproducibility and concurrent validity was 0.90 and 0.95, respectively. The faecal incontinence severity score was also valid (kappa = 0.5). CONCLUSION: The faecal incontinence and constipation assessment has excellent reproducibility and reasonable validity for assessing the presence, risk factors and severity of faecal incontinence and associated bowel disorders in women when compared against clinical assessment.     

Copper tolerance in fathead minnows: II. Maternal transfer

Female fathead minnows (Pimephales promelas) exposed to copper (Cu) maternally transfer Cu tolerance to their larval offspring. Larvae produced after female parents received a sublethal 5-d, 100 microg/L Cu exposure had significantly greater survivorship in potentially lethal Cu solutions than larvae produced before those females were exposed to Cu.     

Profiling penciclovir susceptibility and prevalence of resistance of herpes simplex virus isolates across eleven clinical trials

Summary. A susceptibility testing program was established to determine the prevalence of resistance to penciclovir among herpes simplex virus isolates collected from patients participating in 11 world-wide clinical trials involving penciclovir (topical or intravenous formulations) or famciclovir, the oral prodrug of penciclovir. These trials represented nine randomised double blind, placebo or aciclovir-controlled studies and two open-label studies. Groups surveyed included immunocompetent or immunocompromised patients receiving 2 to 12 months chronic suppressive therapy for genital herpes, immunocompetent patients with recurrent herpes labialis treated for four days, and immunocompromised patients with mucocutaneous herpes simplex virus (HSV). Another subset of patients had been identified as non-responders to aciclovir or to valaciclovir. This program assessed the susceptibility profile for a total of 2145 herpes simplex virus isolates from 913 immunocompetent and 288 immunocompromised patients treated with penciclovir, famciclovir, aciclovir or placebo (depending on trial design). HSV isolates were tested for susceptibility to penciclovir using the plaque reduction assay (PRA) in MRC-5 cells. Resistance was defined as an IC₅₀2.0µg/ml or an IC₅₀>10-fold above the wild type control virus IC₅₀ within that particular assay. Penciclovir-resistant HSV was isolated from 0.22% immunocompetent patients, and 2.1% of immunocompromised patients overall and therefore the frequency of penciclovir-resistant herpes simplex virus in the immunocompetent population approximates that of aciclovir-resistant herpesvirus reported previously. Penciclovir-resistant HSV isolates were more common in isolates from immunocompromised patients, consistent with aciclovir clinical experience. Treatment with penciclovir (intravenous formulation) was associated with the development of resistant HSV in only one severely immunocompromised patient (day 7 isolate IC₅₀=2.01µg/ml), although treatment was effective and resulted in the complete clearance of the lesion by day 8. No patients receiving topical penciclovir developed treatment-associated penciclovir-resistant HSV, and a single immunocompromised patient developed resistant HSV upon treatment with oral famiciclovir.Received October 28, 2002; accepted March 26, 2003 Published online June 5, 2003     

Measurement of parental discipline and nurturance

This paper reviews the measurement of parental discipline and nurturance over the past 20 years. Discipline and nurturance are two of the most heavily referenced constructs in the parenting research literature, but there are varying ways to operationalize them with respect to both method and content. The review considered 76 questionnaires that purported to assess discipline, nurturance, or both. The evaluation included examination of a total of 27 interview schedules that used either in-person or telephone structured questions or a vignette format and focused on discipline and nurturance or discipline only. A total of 33 observational systems were reviewed, the majority of which addressed both discipline and nurturance. All measures were profiled, and several noteworthy instruments were discussed. Recommendations were offered regarding how to strengthen measurement and scientific understanding of discipline and nurturance, including the need for greater attention to cultural variation and measurement equivalence issues.     

Clinical trials in neuroprotection. 23-25 January 2003, Key Biscayne, Florida, USA

Many common neurological and psychiatric disorders are accompanied by extensive neuronal loss, either acutely or chronically. These include stroke, head trauma, spinal cord injury, epilepsy, perinatal and perioperative hypoxia-ischaemia, Alzheimer's and Parkinson's diseases, amyotrophic lateral sclerosis (ALS) and even some aspects of schizophrenia and depression. Despite considerable research effort, no agent has been found that can protect the brain from any of these neurodegenerative conditions. 'Clinical Trials in Neuroprotection,' sponsored by the University of Pennsylvania, was held to address this situation in a unique way. Rather than focus on one neurodegenerative condition, the conference brought together researchers from a variety of neuroprotection areas. They reviewed basic mechanisms of neuronal injury, the animal models used in a variety of paradigms and the design and results of clinical trials in many neuroprotection areas. The presentations and extensive discussions focused on common issues encountered and lessons learned, and on developing innovative strategies for clinical evaluation of potential neuroprotective agents. Conference participants came to a general consensus that some mechanisms were the same for all conditions, models need to be improved, new clinical trial paradigms should consider drug combinations and/or sequential administration of neuroprotective agents, new biomarkers should be developed and a 'proof-of-principle' trial would be widely valuable and should be developed.     

Is irritable bowel syndrome more likely to be persistent in those with relatives who suffer from gastrointestinal symptoms? A population‐based study at three time points

BACKGROUND: We tested the hypothesis that subjects with relatives who suffered from abdominal pain or bowel dysfunction would be at an increased risk of more persistent irritable bowel syndrome. METHODS: A valid, self-report questionnaire was mailed to an age- and gender-stratified random sample of residents, aged 30-64 years, in Olmsted County, MN, USA, on three occasions over a 4-year period. Persistent irritable bowel syndrome was defined as the presence of irritable bowel syndrome on at least two of the three surveys, and fluctuating irritable bowel syndrome was defined as the presence of irritable bowel syndrome on only one of the surveys. RESULTS: Subjects were less likely to have persistent irritable bowel syndrome over the age of 50 years [odds ratio (OR), 0.20; 95% confidence interval (CI), 0.09, 0.47]. A positive family history was reported by 23%. A family history of gastrointestinal symptoms was independently associated with persistent irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.5; 95% CI, 1.3, 4.9) and fluctuating irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.4; 95% CI, 1.3, 4.4). However, subjects reporting a positive family history were not more likely to report persistent vs. fluctuating irritable bowel syndrome (OR, 1.2; 95% CI, 0.5, 2.9). The use of non-steroidal anti-inflammatory drugs (OR, 2.3; 95% CI, 1.2, 4.3) and a history of food sensitivity (OR, 3.6; 95% CI, 1.9, 6.9) were the only other predictors of persistent irritable bowel syndrome. CONCLUSIONS: A history of abdominal pain or bowel troubles in first-degree relatives appears to be independently associated with both persistent and fluctuating irritable bowel syndrome.     

Can symptoms predict endoscopic findings in GERD?

BACKGROUND: It is difficult to decide which patients with reflux symptoms require endoscopy. The aim of this study was to develop a scoring system to predict esophageal findings at endoscopy. METHODS: A consecutive sample of 1011 adult patients scheduled for upper endoscopy were asked to complete a validated symptom questionnaire. The endoscopy reports were abstracted. Individual logistic regression models were developed to predict esophagitis, Barrett's esophagus (long and short segment) and esophageal stricture, including Schatzki's ring. RESULTS: Reflux esophagitis was independently associated with heartburn frequency (p<0.0001) but not severity or duration (p>0.05). Barrett's esophagus was associated with the duration of acid regurgitation (p<0.005) but not with frequency or severity (p>0.05). Strictures were associated with dysphagia severity (p<0.0001) and duration (p<0.0001) but not frequency (p>0.05). At a sensitivity of 80%, the models had a specificity of 49% for esophagitis, 57% for Barrett's esophagus, and 68% for strictures. At a specificity of 80%, the sensitivities were 51% for esophagitis, 62% for Barrett's esophagus and 71% for strictures. CONCLUSIONS: Endoscopic findings were associated with distinct attributes of reflux symptoms. Symptoms are only modestly predictive of findings at endoscopy.     

Pathways for continence care: an audit to assess how they are used

This is a follow-up article to three articles that were published between 2000 and 2001 in the British Journal of Nursing about the development of template pathways for continence care (Bayliss et al, 2000a,b, 2001). It reports on what has happened since the development of these templates. One hundred and forty-four healthcare professionals working in the field of continence care were asked to complete a questionnaire about whether the pathways are being used and what changes have been made to them. The audit found nearly half of the respondents are currently using the pathways and find them an effective method of assessing incontinence and providing equitable quality of care for patients. Many respondents have made changes to the pathways, making them easier to use and adapting them to local practice and the availability of local resources. This was what was anticipated, although the authors noted that variance tracking, which should be the driver for change, had not significantly influenced local pathways. Of those healthcare professionals not using pathways, all said they were still interested in using them, which is particularly encouraging as pathways are promoted in 'Guidelines for Continence Care' (Department of Health, 2000). To provide support to these individuals and encourage the efforts of those already using the pathways, a support group is to be established following a further conference on pathways for continence care later this year. It will be the role of this group to facilitate information sharing on pathway development. As a first step in the dissemination of information, a pack is being produced comprising consolidated versions of the changes to the pathways used in practice all over the country.     

The patient's perspective of irritable bowel syndrome

OBJECTIVE: The researchers wanted to understand how irritable bowel syndrome (IBS) affects patients' lives and their interactions with physicians and the health care system. STUDY DESIGN: A qualitative study was performed using focus groups of people with physician-diagnosed IBS. Immersion/crystallization was used to identify overriding themes. POPULATION: Adult volunteers with a previous physician diagnosis of IBS were included. OUTCOMES MEASURED: The outcomes were patient-reported symptoms, episode triggers, treatments, lifestyle changes, and interactions with their physicians that were related to IBS, and overriding themes identified from the focus groups. RESULTS: The subjects described IBS as a chronic episodic illness that affects their daily lives. Interaction with the medical community seldom clarified understanding of the condition or improved its management. Three overriding themes emerged from the groups: a sense of frustration, a sense of isolation, and a search for a niche in the health/sick role continuum. Frustration was evident in the perceived inability to control symptoms, prevent episodes, identify episode triggers, and obtain medical validation of the condition. The constant anticipation of the next IBS episode, the need for immediate access to toilet facilities, and the nature of the bowel symptoms often required withdrawal from social activities and resultant isolation. CONCLUSIONS: IBS is perceived as a chronic condition resulting in frustration and social isolation, and physicians are perceived to be providing inadequate medical information or support to patients with IBS.     

Meniscal injuries: detection using MR imaging

Both retrospective and blinded analyses of thin-section, high-resolution magnetic resonance (MR) images of the knee joint, produced using a solenoid surface coil, indicate that MR imaging is an effective technique for evaluating meniscal injuries. Images of 49 patients were evaluated, and the results were correlated with those of subsequent arthroscopy. A grading scale was developed to rate the index of suspicion of a meniscal tear based on the MR images. Overall, approximately 80% of menisci rated grade 4 (definite tear) or 3 (probable tear) were found to have corresponding tears at arthroscopy. In many other patients with a grade 4 or 3 meniscus in whom a corresponding tear was not found arthroscopically, meniscal tears at other sites or other abnormalities were correctly diagnosed using MR. A majority of the false-positive MR images involved the posterior horns of the menisci, the sites of most false-negative arthroscopic diagnoses. The predictive value of a negative MR image was almost 100%. Even in patients with moderate-to-large effusions, the menisci were accurately evaluated. The results imply that MR imaging is useful in the preoperative evaluation of suspected meniscal tears.