Bleeding Time from Incisions Standardized by Protruding Skin Fold Method

S ummary . A modification of the Ivy bleeding time is described. The incision is made through a protruding skin fold, and constant depth of the incision is ensured by standardizing the amount of protrusion. The method gives reproducible results, within a narrow normal range. Acetylsalicylic acid (ASA) medication approximately doubles the bleeding time with this method. The incisions are only about 3 mm long. The method combines the advantages of the free blood flow of the linear incision methods with the small scar of the punctate methods.     

ECG changes in patients with acute ethanol intoxication

Objectives. To assess how ethanol in potential lethal serum concentrations affects features of the ECG that may be associated with cardiac arrhythmias. Design. We included 84 patients, who were hospitalised with assumed acute ethanol intoxication. In the emergency room resting ECG was recorded and blood was collected for serum osmolality measurement used as a proxy for ethanol level. Thirty-two also had ECG recorded at discharge. Twenty-seven hospitalised patients without known alcohol ingestion served as controls. ECG segment durations were compared with controls and related to intoxication level. Results. In subjects with moderately elevated to high serum osmolality, the P wave and QTc intervals were prolonged compared with sober subjects. P wave, PR, QRS and QTc intervals were longer when the subjects had high blood ethanol levels (at admission) than at discharge (p-values: 0.0001, 0.0002, 0.010 and < 0.0001 for P wave, PR, QRS and QTc intervals. n = 32). Conclusions. Ethanol at high to very high blood concentration causes several changes in the ECG that might be associated with increased risk of arrhythmias.     

Association of willingness to pay with severity of chronic obstructive pulmonary disease, health status and other preference measures.

SETTING: Willingness to pay (WTP) is a method frequently used to measure the benefits of health interventions in monetary terms. OBJECTIVE: To assess the construct validity of the WTP method in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Fifty-nine COPD patients (34 men, mean age 57 years) were asked about their maximum WTP for a theoretical cure for COPD. In addition, they reported utility scores using standard gamble, time trade-off, a multi-attribute utility instrument, and a rating scale. They also responded to the Short Form 36 (SF-36) questionnaire, dyspnea measures and had comprehensive pulmonary function tests. RESULTS: The participants reported a median WTP of Norwegian kroner 200 000 (US $24 096) for a theoretical cure for COPD without side-effects. The associations of WTP with utility scores, dimensions of health status, dyspnea measures and lung function tests were low. CONCLUSION: The findings of this study question the validity of the WTP method in patients with chronic obstructive pulmonary disease.     

Service quality in hospital wards with different nursing organization: nurses' ratings

Title. Service quality in hospital wards with different nursing organization: nurses’ ratings. Aim. This paper is a report of a study to assess: (1) the relations between nursing organization models in hospital wards and nurses’ perception of the quality of patient care and dimensions of the practice environment, and (2) if these relations were modified by variations in local conditions at the ward level. Background. Previous literature is inconclusive concerning what model of nursing organization maximizes the quality of nursing services. Method. A cross‐sectional survey was carried out in a representative sample of Norwegian hospital wards in 2005. Intra‐ward organization models were classified as: (1) Team leader (n = 30), characterized by extensive responsibilities for team leaders, (2) Primary nurse (n = 18), with extensive responsibilities for named nurses, and (3) Hybrid (n = 37), (1) and (2) combined. We prepared multilevel regression models using scales describing quality of patient care, learning climate, job satisfaction, and relationships with physicians as dependent variables. As independent variables, we used variables representing local ward conditions. Results. Eighty‐seven wards and 1137 nurses (55% response rate) provided complete data. The ward level proportion of variance ranged from 0·10 (job satisfaction) to 0·22 (relationships with physicians). The univariate effect of organization models on quality ratings was not statistically significant. Introducing local ward conditions led to a statistically significant effect of primary nurse organization on relationships with physicians, and to a substantial proportional reduction in ward level variance, ranging from 32% (quality of patient care) to 24% (learning climate). Conclusion. Caution is needed about using service quality arguments when considering the possible benefits and drawbacks of different organizational models.     

The benefit of an acute stroke unit in patients with intracranial haemorrhage: a controlled trial

OBJECTIVES: Patients with stroke receiving organised inpatient (stroke unit) care after stroke are more likely to be alive and independent compared with patients offered conventional care. The objective was to determine the effect of an acute stroke unit on patients with primary intracranial haemorrhage. METHODS: In a prospective controlled study, the effect of an acute stroke unit was examined on 30 day and 1 year mortality in patients with primary intracranial haemorrhage. Patients treated in general medical wards served as controls. RESULTS: Of 121 patients included, 56 were allocated to an acute stroke unit and 65 to a general medical ward. The 30 day mortality rate was 39% in the acute stroke unit compared with 63% in the general medical wards, and the 1 year mortality rates were 52% and 69%, respectively. There was a difference between the 30 day and 1 year survival curves between the groups (p=0.007 and 0.013, respectively); however, there was no difference in survival between 30 and 365 days. There was no difference in risks of being discharged home or to long term care between the groups. CONCLUSIONS: In this study admission to an acute stroke unit reduced mortality 30 days and 1 year after primary intracranial haemorrhage, which could be attributed to a large difference in survival during the first 30 days.     

Confirmation of the Existence of Human Serum Leukaemia-Associated Antigens (LAA)

We have obtained antisera from rabbits which react with serum from several leukaemia patients after absorption with normal human serum. The specificities of these rabbit antisera have been shown to be closely related to those of the original anti-LAA antisera of Viza et al (1970) and Harris et al (1971). Thus, the existence of leukaemia associated (but probably not leukaemia specific) serum antigen in man has been confirmed. One of the animals was immunized with normal amniotic fluid obtained at 15–16 weeks of gestation. Thus, LAA seems to be a normal constituent of amniotic fluid. This suggests that LAA is another onco-fetal component.     

The Same Type of Crystalline Inclusions in T-Lymphocytes as in Plasma Cells and B-Lymphocytes in Multiple Myeloma A Pathological Clone Originating from a Common Lymphocyte Stem Cell?

2 patients with multiple myeloma had the same type of crystals in plasma cells, B-lympho-cytes, and T-lymphocytes. It is hypothesized that these crystals are formed in cells belonging to the same clone of pathological cells. The clone would then have to be derived from a common lymphocyte stem cell.     

Predictors of headache 22 years after hospitalization for head injury

OBJECTIVES: To assess predictors of headache in patients who had sustained a head injury 22 years earlier. MATERIALS AND METHODS: A questionnaire about headache was sent to 361 subjects hospitalized for head injury in 1974-1975. RESULTS: A total of 249 patients (69%) responded to the questionnaire. The prevalence of headache >14 days a month last year was 11%. In multivariate logistic regression analysis female sex (OR = 3.4, 95% CI 1.2-9.6), severe headache 3 months after the head injury (OR = 10.6, 95% CI 2.6-43.5) and psychiatric disease (OR = 2.9, 95% CI 1.1-7.7) predicted chronic headache. There was no significant association between chronic headache and post-traumatic amnesia or other trauma-related variables. CONCLUSION: Female sex and headache 3 months after the head injury were the strongest predictors of long-term headache, while there was little association between long-term headache and trauma variables.     

Properties of the 15D and EQ-5D utility measures in a community sample of people with epilepsy

To perform economic evaluation studies in epilepsy using utilities, such as cost-utility analyses, it is necessary to have reliable and valid instruments for eliciting people's preferences. The objective of this study was to assess the reliability and validity of two multiattribute utility measures in a community sample of 397 people with epilepsy. We assessed the test-retest reliability of individual questionnaire items and aggregate scores. Additionally, construct validity was assessed by correlating items of the EQ-5D with items of the 15D health status questionnaire, and discriminant validity was assessed by comparing scores for known groups. The test-retest reliabilities for the individual items of the 15D (weighted kappa 0.59-0.90, except mobility with only 0.28) and the EQ-5D (weighted kappa 0.49-0.86) were acceptable. For the composite utility scores the test-retest reliability was better (intraclass correlation coefficient 0.93 for both 15D and the EQ-5D). Spearman's rank correlations between EQ-5D single item scores and corresponding 15D single item scores were high (rho 0.34-0.79) and generally higher than the associations between non-corresponding items. Some EQ-5D and 15D items discriminated well between patients according to seizure status, psychiatric comorbidity and working status; less well after antiepileptic drug use and neurologic comorbidity. Both the EQ-5D and 15D were reliable instruments and showed properties supporting the construct validity of both measures.