All talk, no action?: the global diffusion and clinical implementation of the international classification of functioning, disability, and health.

OBJECTIVE: We aimed to review the global diffusion and clinical implementation of the International Classification of Functioning, Disability, and Health (ICF) endorsed by the World Health Assembly in 2001. DESIGN: First, we analyzed the diffusion process of the ICF, with a special focus on clinical rehabilitation. This was done by researching the spread of ICF-related terms in Pubmed and Google from 2001 to 2010. Second, we examined the clinical implementation of the ICF in rehabilitation settings by a systematic review of the literature in the databases Pubmed and Embase. Eligible were studies evaluating the current application and impact of the ICF in the daily practice of clinical rehabilitation. RESULTS: We found that the diffusion of the ICF as a mere term and concept in the area of rehabilitation is successful. However, the implementation in clinical rehabilitation practice is highly idiosyncratic and rarely evaluated appropriately. The question arises whether this idiosyncratic implementation can be regarded as a process toward standardization at all. Evidence of concrete benefits of a clinical ICF implementation for team members or even patients is at best weak. CONCLUSIONS: We suggest more comprehensive and comparable multicenter studies to solve the urgent need for best practice recommendations on ICF implementation in clinical rehabilitation.

Analysis of albumin fatty acid binding capacity in patients with benign and malignant colorectal diseases using electron spin resonance (ESR) spectroscopy.

INTRODUCTION: In colorectal cancer (CRC), no biological marker is known that could serve both as a marker for detection and prognosis. Electron spin resonance (ESR) spectroscopy of spin-labeled fatty acid (FA) molecules binding to human serum albumin is a suitable method for the detection of conformational changes and alterations of transport function of albumin through changes in its FA binding capabilities. OBJECTIVE: The aim of this study was to examine whether the FA binding to albumin is detectably and significantly altered in CRC patients when compared with patients having benign colorectal diseases. MATERIALS AND METHODS: One hundred four patients operatively or endoscopically treated for CRC, sigmoid diverticulitis, or a colorectal adenoma were examined before procedure. Albumin was analyzed by ESR with spin-labeled FA. A determination ratio (DR) was calculated from the measured ESR spectra as ratios of the fraction of FA that is tightly bound vs. the fractions that are loosely interacting with albumin or are unbound. RESULTS AND DISCUSSIONS: Patients with CRC showed significantly lower DR values (DR, -0.09 +/- 0.98 vs. 0.61 +/- 1.43) than patients with benign colorectal diseases, consistent with a change of conformation and transport function of albumin in CRC. Within the CRC group, with advanced tumor stage, the difference in DR values increased. ESR of FA binding to albumin thus seems to be suitable for detection of patients with CRC. Furthermore, a correlation with advanced tumor stage can be established. CONCLUSIONS: These results suggest that a further evaluation of the role of ESR in patients with all stages of CRC should take place. It should also be examined whether ESR might play a role in detecting CRC in a larger panel of patients.