An examination of the psychometric structure of the Multidimensional Pain Inventory

Factor analyses to create the Multidimensional Pain Inventory (MPI) warrant further examination due to small sample size, the use of separate factor analyses for each MPI section, and lack of evidence for the replicability of the factor model. The present study randomly assigned 972 respondents to one of three samples. Study 1 used data from Sample 1 (n = 452) to examine the replicability of the MPI factor structure reported by Kerns, Turk, and Rudy (1985), and to measure the internal consistencies of MPI scales. In Study 2, confirmatory factor analyses using Sample 2 data (n = 267) verified a revised MPI factor structure that was generated in Study 1; cross-validation was achieved using data from Sample 3 (n = 253). The revised MPI model differed from the original model in its number of scales and pattern of scale loadings. Recommendations for the refinement of the MPI are proposed.     

Evaluating health-related quality of life: cost comparison of computerized touch-screen technology and traditional paper systems

We estimated and compared the costs for three different methods of administering and evaluating the Short Form-36 as a routine part of clinical practice from the provider perspective. In an outpatient pain management practice, we assessed a computer touch-screen system with facsimile and scanning scoring methods. Equipment, supply, and labor costs needed to construct, maintain, and generate reports for each system were measured. The annual fixed, variable, and total costs/survey were calculated. Sensitivity analyses were performed varying the number of surveys administered/year. The facsimile method was the least costly, $9.62 and $5.88/survey, at annual questionnaire volumes of 250 and 1000, respectively. When the annual survey volume increased to 1250 (5 surveys/day), the costs of the facsimile ($5.63/survey) and computer touch-screen ($5.65/survey) methods were nearly equivalent per survey administration. At volumes of 1500 and above, the least costly method was the computer touch screen at $5.47/survey. The system implemented in a clinical practice is dependent not only on questionnaire volume but also on personnel availability, equipment access, required speed of results, and the acceptable level of data error.     

Spider monkeys (Ateles sp.) as animal models for atherosclerosis research

Spider monkeys (Ateles sp.) were evaluated for their usefulness in research on atherosclerosis. These animals became only slightly hypercholesterolemic (increase from control serum cholesterol concentrations of about 200 mg/100 ml to about 290 mg/100 ml) when fed diets containing 1 mg of cholesterol/kcal (diets shown previously to produce marked hypercholesterolemia in most species of nonhuman primates).Both control and experimental monkeys had aortic fatty streaks and occasional lesions of the major branches of the coronary arteries. Cholesterol feeding for up to 48 months exacrebated the lesions only slightly.Biochemically, the atherosclerotic lesions of spider monkeys, as compared with other primates, have relatively less cholesterol ester and markedly more phospholipid.     

Macrocyclic inhibitors for peptide deformylase: a structure-activity relationship study of the ring size

Peptide deformylase (PDF) catalyzes the removal of the N-terminal formyl group from newly synthesized polypeptides in eubacteria. Its essential role in bacterial cells but not in mammalian cells makes it an attractive target for antibacterial drug design. We have previously reported an N-formylhydroxylamine-based, metal-chelating macrocyclic PDF inhibitor, in which the P(1)' and P(3)' side chains are covalently joined. In this work, we have carried out a structure-activity relationship study on the size of the macrocycle and found that 15-17-membered macrocycles are optimal for binding to the PDF active site. Unlike the acyclic compounds, which are simple competitive inhibitors, the cyclic compounds all act as slow-binding inhibitors. As compared to their acyclic counterparts, the cyclic inhibitors displayed 20-50-fold higher potency against the PDF active site (K(I) as low as 70 pM), improved selectivity toward PDF, and improved the metabolic stability in rat plasma. Some of the macrocyclic inhibitors had potent, broad spectrum antibacterial activity against clinically significant Gram-positive and Gram-negative pathogens. These results suggest that the macrocyclic scaffold provides an excellent lead for the development of a new class of antibiotics.     

A review of health-related workplace productivity loss instruments

The objective of this review was to identify health-related workplace productivity loss survey instruments, with particular emphasis on those that capture a metric suitable for direct translation into a monetary figure. A literature search using Medline, HealthSTAR, PsycINFO and Econlit databases between 1966 and 2002, and a telephone-administered survey of business leaders and researchers, were conducted to identify health-related workplace productivity measurement survey instruments. This review was conducted from the societal perspective. Each identified instrument was reviewed for the following: (i). reliability; (ii). content validity; (iii). construct validity; (iv). criterion validity; (v). productivity metric(s); (vi). instrument scoring technique; (vii). suitability for direct translation into a monetary figure; (viii). number of items; (ix). mode(s) of administration; and (x). disease state(s) in which it had been tested. Reliability and validity testing have been performed for 8 of the 11 identified surveys. Of the 11 instruments identified, six captured metrics that are suitable for direct translation into a monetary figure. Of those six, one instrument measured absenteeism, while the other five measured both absenteeism and presenteeism. All of the identified instruments except for one were available as paper, self-administered questionnaires and many were available in languages other than English. This review provides a comprehensive overview of the published, peer-reviewed survey instruments available to measure health-related workplace productivity loss. As the field of productivity measurement matures, tools may be developed that will allow researchers to accurately calculate lost productivity costs when performing cost-effectiveness and cost-benefit analyses. Using data captured by these instruments, society and healthcare decision makers will be able to make better informed decisions concerning the value of the medications, disease management and health promotion programmes that individuals receive.     

Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis

Changes in maladaptive cognitions may constitute therapeutic processes of multidisciplinary pain programs. A cross-lagged panel design was used to determine whether (a) early-treatment cognitive change predicted late-treatment outcome index change, but not vice versa; and (b) these effects remained significant with depression change controlled. Ninety chronic pain patients, in a 4-week multidisciplinary program, completed measures of catastrophizing, pain helplessness, depression, pain, interference, and activity level at pre-, mid-, and posttreatment. With depression changes controlled, early-treatment catastrophizing and pain helplessness changes predicted late-treatment outcome index changes, but not vice versa; early-treatment depression changes predicted late-treatment activity changes, but not vice versa. Findings advance understanding of pain treatment process and suggest that negative cognition changes may indeed affect improvements in treatment outcome.     

Endocarditis caused by Staphylococcus lugdunensis

We describe a case of native valve endocarditis caused by Staphylococcus lugdunensis, a perineal skin commensal, and review 28 other cases from the medical literature. Correctly identifying this coagulase-negative organism is critical because endocarditis is usually associated with left sided valvular disruption and life-threatening embolic complications, reminiscent of disease caused by Staphylococcus aureus. Urgent surgical intervention is necessary in most cases.