Consuming the evidence: consumers and evidence-based medicine.

Consumers have varying expectations and knowledge about evidence-based medicine (EBM), but expect the healthcare system to offer best practice based on the latest evidence. With the increasing power of the consumer movement, EBM has the potential to promote informed participation in health decision making by individual consumers and carers. To more effectively incorporate consumer experiences, views and concerns into the evidence base, there needs to be greater value put on qualitative research and acknowledgement of its importance. Consumers would like the research agenda to reflect population health needs, and for there to be more consultation about evidence-based decisions on access to care and rationing, and greater understanding of consumers' attitudes in decisions about treatment. Consumers want patient-centred healthcare and therefore must be involved collaboratively in the way EBM is used by health services and health practitioners.

Assessment of cardiac function by M-mode echocardiography in selenium-deficient phenylketonuric children.

Selenium (Se) deficiency is associated with cardiac and skeletal muscle dysfunction. Twenty well children aged 2-16 years (10 male) attending the Phenylketonuria (PKU) Clinic at the Royal Children's Hospital, Brisbane, had low Se levels (mean 0.29 +/- 0.02 s.e.m. mumol/L; normal range 0.56-1.16 mumol/L). Their myocardial function was assessed at rest and after exercise provocation by M-mode echocardiography in order to exclude occult left ventricular dysfunction. At rest, fractional shortening (FS) was normal (mean 38.1 +/- 1.1 s.e.m. %, n = 20). After exercise, FS increased significantly (P less than 0.001) from 37.6 +/- 1.4% to 44.3 +/- 1.2%, n = 12). This was associated with a significant rise (P less than 0.001) in heart rate (HR) from 77.3 +/- 3.1 beats/min to 125.8 +/- 5.2 beats/min (n = 12). The normal resting FS and normal increase in FS and HR with exercise is evidence against significant cardiac impairment in this group of Se-deficient children.