The consumer quality index (CQ-index) in an accident and emergency department: development and first evaluation

ABSTRACT: BACKGROUND: Assessment of patients' views are essential to provide a patient-centred health service and to evaluating quality of care. As no standardized and validated system for measuring patients' experiences in accident and emergency departments existed, we have developed the Consumer Quality index for the accident and emergency department (CQI A&E). METHODS: Qualitative research has been undertaken to determine the content validity of the CQI A&E. In order to assess psychometric characteristics an 84-item questionnaire was sent to 653 patients who had attended a large A&E in the Netherlands. Also, fifty importance questions were added to determine relevance of the questions and for future calculations of improvement scores. Exploratory factor analysis was applied to detect the domains of the questionnaire. RESULTS: Survey data of 304 (47%) patients were used for the analysis. The first exploratory factor analysis resulted in three domains based on 13 items: 'Attitude of the healthcare professionals', 'Environment and impression of the A&E' and 'Respect for and explanation to the patient'. The first two had an acceptable internal consistency. The second analysis, included 24 items grouped into 5 domains: 'Attitude of the healthcare professionals', 'Information and explanation', 'Environment of the A&E','Leaving the A&E' and 'General information and rapidity of care'. All factors were internal consistent. According to the patients, the three most important aspects in healthcare performance in the A&E were: trust in the competence of the healthcare professionals, hygiene in the A&E and patients' health care expectations. In general, the highest improvement scores concerned patient information. CONCLUSIONS: The Consumer Quality index for the accident and emergency department measures patients' experiences of A&E healthcare performance. Preliminary psychometric characteristics are sufficient to justify further research into reliability and validity.     

A psychometric evaluation of the Chinese version of the Cardiovascular Limitations and Symptoms Profile in patients with coronary heart disease

Aims and objectives. The aim of this study was to translate from English and evaluate the validity, reliability and cultural relevance of the Cardiovascular Limitations and Symptoms Profile (CLASP) as a health‐related quality‐of‐life (HRQL) measure in Chinese patients with coronary heart disease. Background. Improvement in HRQL is increasingly used as a primary outcome in determining the treatment benefit using a generic instrument. However, disease‐specific instruments are being cited as more responsive and sensitive in detecting even the smallest changes in health status. Therefore, valid and reliable disease‐specific measures for patients with coronary heart disease are now being developed and evaluated. Design. Questionnaire design. Methods. The translation equivalence and content validity of the Chinese version of CLASP were evaluated by an expert panel. Measurement performance was tested on a convenience sample of 369 Chinese coronary heart disease patients. Results. The instrument demonstrated good content validity (content validity index 0·94), acceptable internal consistency (>0·70), except for two subscales of angina and tiredness and significant positive correlations among the subscales of CLASP, Hospital Anxiety Depression Scale and the Short Form 36 Health Survey. Principal components analysis revealed nine factors that together explained 69% of the variance. Conclusions. The results of this study support that CLASP is a valid and reliable disease‐specific health status measure for Chinese patients with coronary heart disease. However, further item modifications and testings are needed when considering the cross‐cultural context. Relevance to clinical practice. The use of disease‐specific HRQL measures could effectively evaluate nursing interventions in clinical practice. Further validations of CLASP among different diagnostic groups, such as patients with heart failure and those who have survived an acute myocardial infarction, would provide further empirical support for its use with all patients with heart disorders.     

东亚和北美产红豆杉属七种植物中紫杉醇及短叶醇的含量

应用高效液相色谱分析了东亚产四种红豆杉和北美产三种红豆杉的紫杉醇和短叶醇含量。结果表明，短叶红豆杉树皮中紫杉醇含量最高，其次为中间红豆杉树皮；东亚产四种红豆杉枝叶中，云南红豆杉枝叶中紫杉醇含量较高，东北红豆杉和美丽红豆杉次之；短叶醇含量则以短叶红豆杉针叶最高，东北红豆杉及云南红豆杉次之。     

Validation of a short questionnaire in English and French for use in patients with persistent upper gastrointestinal symptoms despite proton pump inhibitor therapy: the PASS (Proton pump inhibitor Acid Suppression Symptom) test.

BACKGROUND: The management of persistent symptoms during acid suppression therapy in patients with gastroesophageal reflux disease or dyspepsia might be improved if patient-physician communication regarding the presence and character of these persistent symptoms were facilitated. AIM: To validate a short, simple questionnaire (the Proton pump inhibitor [PPI] Acid Suppression Symptom [PASS] test), in English and French, to identify patients with persistent acid-related symptoms during PPI therapy and document their response to a change in therapy. METHODS: Patients with persistent acid-related symptoms on PPI therapy were interviewed to produce a draft, five-item questionnaire; content validity was evaluated by focus groups comprising English- and French-speaking patients. Psychometric validity was subsequently evaluated in a multicentre, family practice-based study of English- and French-speaking patients with persistent acid-related upper gastrointestinal symptoms despite PPI therapy. The PASS test, Global Overall Symptom scale, Gastrointestinal Symptom Rating Scale (GSRS), Quality of Life in Reflux and Dyspepsia questionnaire and Reflux Disease Questionnaire were completed at baseline and repeated after one week while patients continued their original PPI therapy. All patients then received esomeprazole 40 mg once daily for four weeks, after which all questionnaires and an evaluation of overall treatment effect were completed. RESULTS: Content validity was established in 20 English- and 16 French-speaking patients. Psychometric validation in 158 English- and 113 French-speaking patients revealed good-to-excellent test-retest reliability coefficients: 0.76 for English; 0.68 for French. For construct validity, the PASS test showed moderate-to-high correlation with the GSRS scale (0.51 for English; 0.43 for French). After four weeks of therapy, the PASS test score fell to zero in 30% of English- and 33% of French-speaking patients, while the Global Overall Symptom score fell to one (no symptoms) in 32% of patients (English- and French-speaking); the PASS test demonstrated good responsiveness in comparison with the GSRS, Reflux Disease Questionnaire and Quality of Life in Reflux and Dyspepsia questionnaire. CONCLUSION: The five-item PASS test is a valid tool for the evaluation of persistent acid-related symptoms in patients receiving PPI therapy. It demonstrates good content validity, test-retest reliability, responsiveness and construct validity in both English and French forms. The PASS test is a simple, clinically applicable tool for the identification of patients with persistent acid-related symptoms during therapy and the assessment of their responses to a change in therapy.     

Accumulation of physical activity: blood pressure reduction between 10-min walking sessions

The accumulation of intermittent bouts of physical activity (PA) has been found to reduce blood pressure (BP) in prehypertension and hypertension. Yet, the BP response among several short sessions within the accumulation of PA in a single day has not been examined. The purpose of the study was (1) to investigate the BP reduction during the rest periods following three successive 10-min walking sessions accumulated over a 3-h period in prehypertensive adults and (2) to observe the role of autonomic modulation during the rest periods following each short PA session. Adults with prehypertension (131.9+/-4.7/82.5+/-6.4 mm Hg) participated in the study. BP using ambulatory monitoring and autonomic modulation through heart rate variability (HRV) using Holter monitoring were measured at baseline and during the rest periods following three short sessions (three 10-min treadmill walks at 50% of peak oxygen uptake (VO2peak); at least 50 min apart) over a 3-h period. Variables of BP and autonomic modulation were averaged for the baseline and for the rest periods following each 10-min walk. One-way analysis of variance with repeated measures was used to test the differences over time in BP and HRV (P<0.05). A significant main effect was found in systolic BP (P=0.039), whereas none was found in diastolic BP (P=0.630). Systolic BP was decreased following the third short session (-4.0+/-7.4 mm Hg) compared to baseline. No significance was found in any of the autonomic modulation variables. In conclusion, accumulating intermittent bouts of PA, as short as 10 min, total 30-min walk sessions may reduce systolic BP in prehypertension.     

Differential effects of clinically used derivatives and metabolites of artemisinin in the activation of constitutive androstane receptor isoforms

BACKGROUND AND PURPOSE Widespread resistance to antimalarial drugs requires combination therapies with increasing risk of pharmacokinetic drug-drug interactions. Here, we explore the capacity of antimalarial drugs to induce drug metabolism via activation of constitutive androstane receptors (CAR) by ligand binding. EXPERIMENTAL APPROACH A total of 21 selected antimalarials and 11 major metabolites were screened for binding to CAR isoforms using cellular and in vitro CAR-coactivator interaction assays, combined with in silico molecular docking. Identified ligands were further characterized by cell-based assays and primary human hepatocytes were used to elucidate induction of gene expression. KEY RESULTS Only two artemisinin derivatives arteether and artemether, the metabolite deoxyartemisinin and artemisinin itself demonstrated agonist binding to the major isoforms CAR1 and CAR3, while arteether and artemether were also inverse agonists of CAR2. Dihydroartemisinin and artesunate acted as weak inverse agonists of CAR1. While arteether showed the highest activities in vitro, it was less active than artemisinin in inducing hepatic CYP3A4 gene expression in hepatocytes. CONCLUSIONS AND IMPLICATIONS Artemisinin derivatives and metabolites differentially affect the activities of CAR isoforms and of the pregnane X receptor (PXR). This negates a common effect of these drugs on CAR/PXR-dependent induction of drug metabolism and further provides an explanation for artemisinin consistently inducing cytochrome P450 genes in vivo, whereas arteether and artemether do not. All these drugs are metabolized very rapidly, but only artemisinin is converted to an enzyme-inducing metabolite. For better understanding of pharmacokinetic drug-drug interaction possibilities, the inducing properties of artemisinin metabolites should be considered.     

ALTERED TONIC CONDUCTANCES IN AXONS OF TRANSGENIC MOUSE EXPRESSING THE HUMAN NEUROFILAMENT HEAVY GENE: A MOUSE MODEL OF AMYOTROPHIC LATERAL SCLEROSIS

Neurofilaments (NFs; made by copolymerization of three intermediate filament proteins NF‐L, NF‐M, and NF‐H, for light, medium, and heavy) constitute the most abundant cytoskeletal structure in large myelinated axons. The presence of aberrant NF accumulation has been associated with neurodegenerative diseases (such as ALS). The possible causal role of NF in neurodegeneration has been supported by studies on recently available transgenic mice in which expression of human NF‐H (hNF‐H +/+) leads to overt neuropathy. We have examined electrophysiological properties of myelinated axons in hNF‐H +/+ mice using intraaxonal microelectrode recording from isolated sciatic and tibial nerves. Transgenic mice showed several deficits in physiological properties of low threshold myelinated fibers: conduction velocity and resting membrane potential were significantly decreased (20 +/? 1.6 vs 40 +/? 2 m/s; ?71.3 +/? 0.9 vs ?75.5 +/? 0.5 m/s; mean +/? SE; n = 25; 22 degrees C). While the amplitude of action potentials was of comparable size (82 +/? 5 vs 86 +/? 3 mV) duration of action potential (at half‐amplitude, AP/2) in hNF‐H +/+ was significantly prolonged (0.82 +/? 0.02 vs 0.65 +/? 0.02 ms). Voltage‐current properties of axonal membrane indicate a significant decrease in inward and outward rectification. Occasionally, impaled axons of hNF‐H +/+ showed membrane oscillations and repetitive activity (reminiscent of fasciculations) never observed in normal animals. These results are compatible with an imbalance between ion conductances in axons from transgenic animals (an increase in Na+ and a decrease in K+ conductances), in agreement with recent suggestion based on clinical studies on ALS patients (H. Bostock et al., 1995, Brain 118, 217–225). One may hypothesize that these changes could contribute to neurodegenerative processes (i.e., via an increase in [Na+](i)), as well as clinical symptoms (fasciculations) observed in patients with degenerative motor neuron diseases.     

Complicated diverticulitis during pregnancy

The authors report a case of perforated diverticulitis with presence of a fistulous tract between a peridiverticular abscess and the uterus during pregnancy with favorable outcome under medical treatment. The purpose of this case report is to illustrate specific imaging findings and clinical management of diverticulitis during pregnancy.