Evaluation of quality of life for diverse patient populations

Summary Quality of life is used increasingly as a primary and secondary endpoint of clinical investigations of new therapies. Quality of life information may be especially useful for the assessment of cancer treatments, where increases in survival may be accompanied by detrimental side effects. The recognition of the importance of quality of life has led to the recent proliferation of cancer specific quality of life instruments. As more is understood about the heterogeneity of patient populations, however, we must assess how culturally defined factors may impact patient quality of life and its assessment. Quality of life instruments are diverse, ranging from those focusing on objective measures of functionality to those assessing subjective measures of patient preferences for their current health state. These instruments have been developed for use in the general population and for disease-specific populations. Assessment of the appropriateness of potential quality of life instruments in specific clinical settings, in addition to understanding the cultural diversity of the clinical population being studied, will guide the researcher in the choice of an appropriate quality of life instrument for cancer clinical trials.     

Fluid collections in the intraperitoneal and extraperitoneal spaces: comparison of MR and CT

Fourteen patients with abnormal subdiaphragmatic fluid collections (eight intraperitoneal, two extraperitoneal, and four intra- and extraperitoneal) were examined with computed tomography (CT) and magnetic resonance (MR) imaging. MR and CT provided equivalent information concerning the presence and extent of fluid collections in 13 of the 14 cases. Image acquisitions with two different repetition times (TRs) and two echo times (TEs) were necessary, in most cases, to detect and discriminate between different types of pathologic fluids. Transudative ascites demonstrated long T1 and T2 relaxation times, whereas abscesses, phlegmon, pancreatic pseudocyst, exudative pancreatitis, and chronic hematoma demonstrated an intermediate or short T1 and a long T2.     

Evaluating community health worker performance in India

In 1977 the Government of India launched a health care experimentin which volunteers were used to provide a basic health careservice. Community health workers have also been used in manysmall, non-governmental programmes. Although much has been saidabout the selection and training of such workers, there havebeen very few attempts to evaluate their actual work performance.This paper makes the plea for more, regular evaluations of theiractivities by those involved in the programmes: communities,supervisors and health workers themselves. Such evaluationsare useful even if they are only done on a small scale. Whatis described here is a small study of the performance of part-timecommunity health workers (PTCHWs) in a programmme initiatedin 1977 by the Community Health Department of the ChristianMedical College in Vellore, South India. It concludes that thePTCHWs with the highest performance scores have, on the whole,less education, more experience, less population to cover andmore intense supervision.     

Developmental biology of the dendritic cell system

Aim : To determine whether an imbalance of dendritic cell subsets might contribute to diminished adaptive host responses observed in newborn infants. It was hypothesized that the proportion of lymphoid dendritic cells would be greater than that of myeloid dendritic cells in cord blood. Methods : To investigate this, dendritic cell subsets were evaluated in whole cord blood by flow cytometry. Circulating dendritic cells were also isolated from cord blood based on CD1c and BDCA-2 expression. Myeloid dendritic cells were also obtained by culturing cord and adult blood monocytes. Surface phenotypes of these cells were determined by flow cytometry using monoclonal antibodies directed against lineage, major histocompatibility, adhesion, co-stimulation and cytokine receptor molecules. Antigen-presenting functions of dendritic cell subsets were determined by mixed leukocyte reactions. Results : Circulating myeloid dendritic cells were higher in cord blood than previously reported in adult blood, whereas lymphoid dendritic cell numbers were similar between cord and adult blood. Expression of CD11c, CD45RA and CD45RO did not accurately differentiate between dendritic cell subsets circulating in cord blood. Fresh and culture-derived cord blood myeloid dendritic cells stimulated adult allogeneic leukocyte proliferation, while lymphoid dendritic cells were less effective inducers of an adult allogeneic leukocyte response. Culture-derived dendritic cells induced modest autologous cord blood leukocyte proliferation, but freshly isolated myeloid and lymphoid dendritic cells did not stimulated autologous leukocytes.
Conclusion : Contrary to the hypothesis, an imbalance in the ratio of circulating myeloid to lymphoid dendritic cell subsets does not exist and, therefore, does not contribute to diminished adaptive immune responses in newborn infants.