The use, feasibility and psychometric properties of an individualised quality-of-life instrument: a systematic review of the SEIQoL-DW.

PURPOSE: To review published studies regarding the use, feasibility and psychometric performance of the schedule for the evaluation of individual quality of life-direct weighting (SEIQoL-DW) in clinical research. METHODS: Systematic literature review. Studies using the SEIQoL-DW were included if they were published in English and employed a quantitative design. A pre-defined checklist was used to analyse the reported results. RESULTS: Thirty-nine relevant articles were identified. The SEIQoL-DW has been included in studies relating to a variety of populations, including those who are severely ill. The results of convergent and discriminant validity support our hypotheses in which SEIQoL-DW was expected to correlate moderately to high with measures of global QoL, life satisfaction and mental health and weakly with measures of functional status and health. CONCLUSION: The SEIQoL-DW appears to be a feasible and valid instrument. The lack of association between the Index score and health, functional status, demographic and clinical parameters may be explained by the instrument's focus on global QoL and by that of the idiographic measurement approach reflecting the capacity of a patient to value domains other than health in life, despite having health problems. Nevertheless, continued psychometric evaluation in large populations with a longitudinal design is recommended.

Gene expression patterns within cell lines are predictive of chemosensitivity.

BACKGROUND: The NCI has undertaken a twenty-year project to characterize compound sensitivity patterns in a selected set of sixty tumor derived cell lines. Previous studies have explored the relationship between compound sensitivity patterns to gene expression, protein expression, and DNA copy number for these same cell lines. A strong correlation between the pattern of expression of a biomarker and sensitivity to a compound could suggest a clinically interesting biological relationship between the two. RESULTS: We isolated RNA's and measured expression of 40000 genes using cDNA microarrays from the fifty-nine publicly available cell lines. Analysis of this data set in comparison with published gene expression data sets demonstrates a high degree of reproducibility in expression level measurements even using completely independent RNA preparations and array technologies. Using the fifty-nine cell lines for discovery and an additional seven cell lines for which extensive compound sensitivity data were available as a test set, we determined that gene-compound pairs with a correlation coefficient above 0.6 had a false discovery rate of approximately 5%. Large scale features of the gene expression and chemosensitivity data, such as tissue of origin and other physiological factors, did not seem to explain the majority of correlations between gene and compound patterns. CONCLUSION: A comparison of gene expression and compound sensitivity in panels of cell lines was demonstrated to have a relatively high validation and low false discovery rate supporting the use of this approach and datasets for identifying candidate biomarkers and targeted biologically active compounds.

A meta-analysis for echocardiographic assessment of right ventricular structure and function in ARVC.

INTRODUCTION: Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is an inherited pathology that can increase the risk of sudden death. Current Task Force Criteria for echocardiographic diagnosis do not include new, regional assessment tools which may be relevant in a phenotypically diverse disease. We adopted a systematic review and meta-analysis approach to highlight echocardiographic indices that differentiated ARVC patients and healthy controls. METHODS: Data was extracted and analysed from prospective trials that employed a case-control design meeting strict inclusion and exclusion as well as a-priori quality criteria. Structural indices included proximal RV outflow tract(RVOT1) and RV diastolic area(RVDarea). Functional indices included RV fractional area change (RVFAC), Tricuspid Annular Systolic Excursion(TAPSE), peak systolic and early diastolic myocardial velocities (S' and E' respectively) and myocardial strain. RESULTS: Patients with ARVC had larger RVOT1 (mean  SD; 34 vs. 28 mm P<0.001) and RVDarea (23 vs. 18 cm2 P<0.001) compared to healthy controls. ARVC patients also had lower RVFAC (38 vs. 46 % P<0.001), TAPSE(17 vs. 23 mm P<0.001), S' (9 vs. 12 cm.s-1 P<0.001), E' (9 vs. 13 cm.s-1 P<0.001) and myocardial strain (-17 vs. -30% P<0.001). CONCLUSION: The data from this meta-analysis support current Task Force criteria for the diagnosis of ARVC. In addition, other RV measures that reflect the complex geometry and function in ARVC clearly differentiated between ARVC and healthy controls and may provide additional diagnostic and management value. We recommend that future working groups consider this data when proposing new / revised criteria for the echocardiographic diagnosis of ARVC.

[Mutation of hepatitis B virus DNA pre-C region in patients with primary hepatocellular carcinoma in Guangxi].

OBJECTIVE: To study the association between mutation of hepatitis B virus (HBV) pre-C gene and HBV infection in patients with primary hepatocellular carcinoma (PHC) but negative hepatitis B e antigen (HBeAg) in Guangxi Province, China. METHODS: Nested polymerase chain reaction (nPCR) was used for amplification of HBV DNA Pre C region in sera collected from 16 patients with PHC in Guangxi, and then their HBV DNA nPCR products were sequenced by Sanger method. RESULTS: Sera in fourteen of 16 patients showed positive HBV DNA, with a positive proportion of 87.5% (14/16). One (C23) of them was positive for HBeAg; one (C24) was negative HBeAg, but with normal sequence in his Pre C region; two (C7, C14) were co-infected with HBV wild and mutant strains; and the remainder eight cases (C3, C4, C5, C8, C10, C11, C12, C13) were infected with mutant virus strains, but stop codon at codon 28 was only found in C4, C5 and C12. One case (C8) was co-infected with both HBV stop codon mutant and non-stop codon strains. CONCLUSION: It is uncommon for patients with PHC in Guangxi infected with HBV mutant strain with classical mutation at nt 1 896, which suggests that maybe there exist other types of mutation other than that in pre-C region causing HBV infection without HBeAg.

Refill adherence by the elderly for asthma/chronic obstructive pulmonary disease drugs dispensed over a 10-year period.

OBJECTIVE: The objective was to survey prescription refill adherence for preventive asthma/chronic obstructive pulmonary disease (COPD) medication dispensed to patients 60 years and older over a 10-year period. METHODS: A retrospective analysis was conducted based on a Swedish pharmacy record database in the county of Jämtland for the years 1994-2003. Satisfactory refill adherence was set as dispensed refills covering 80-120% of the prescribed treatment time for inhaled corticosteroids, combination products of adrenergics and steroids and anticholinergics. RESULTS AND DISCUSSION: Only 28% (n=160) of the repeat prescriptions for inhaled corticosteroids had been dispensed with a satisfactory refill adherence, 59% showed an undersupply and 12% showed an oversupply. There was no difference in refill adherence in relation to age and gender. However, during the 10-year study period repeat prescriptions being dispensed for 2-4 years showed higher satisfactory refill adherence than those being dispensed for <2 years. CONCLUSIONS: Our study shows that over half of the repeat prescriptions for inhaled corticosteroids dispensed to patients over 60 years showed an undersupply. Therefore, it is likely that elderly patients on long-term therapy have a non-optimal drug use of their preventive asthma/COPD medication.

Single application of a fluorescent test cream by healthy volunteers: assessment of treated and neglected body sites.

BACKGROUND: Management of dermatological self-treatment is demanding. Imperfect application of creams and ointments and poor adherence to topical treatment are common, resulting in unsatisfactory treatment outcome. OBJECTIVES: To assess the technique and precision of test subjects' self-application of a test cream. Treated and neglected skin sites were measured after intended widespread single application of a fluorescent test cream. METHODS: Twenty healthy volunteers (10 women, 10 men) were included. They were asked to treat their whole skin surface with the fluorescent test cream, except the head and neck and skin covered by underwear. Treated and untreated sites were subsequently measured under Wood's ultraviolet radiation. RESULTS: Thirty-one per cent of the skin surface that was a target for application did not show any fluorescence and thus was assumed to have been untreated. Typical neglected sites included the central back, the upper breast, the axilla with surrounding skin, the legs and the feet, particularly the sole. The posterior aspect of both trunk and extremities, not easily inspected, was more often neglected. In the treated sites the fluorescence was typically uneven. CONCLUSIONS: Qualified and motivated persons with no obvious physical limitations practised imperfect self-application of a test cream mimicking a therapeutic cream product. As much as 31% of the skin surface was neglected. Sites especially prone to nonapplication were identified. This might imply that dermatological patients on long-term self-treatment may practise local application very poorly, a problem of major therapeutic and economic importance. A fluorescent test cream can be used for research, and as an educational tool in the training of dermatological patients on how to apply local treatment.

Feasibility and validity of a computer administered version of SEIQoL-DW.

Computer administrered QoL instruments are increasingly used to assess outcomes. Our aim was to assess the feasibility and validity of an electronic version of the SEIQoL-DW. Pharmacy students (n = 40; mean age 25; 92% women) were administrated both the touch screen and the paper-and-pen versions in a cross-over study. The majority of the students (65 %) preferred the computer version, while almost a third (27%) preferred the paper and pen version. There was no overall order effect and the SEOQoL-DW index mean scores differed with 1.2 between the two versions. Those respondents completing the computer version first had higher scores than those completing the computer version second. The ICC comparing the formats was 0.77 (CI: 0.57-0.88) and the limits of agreement method showed that 85% of the observations were within +/- 1-10 units. Most students (82%) judged their QoL as being equivalent to their SEIQoL-DW score. The computer version of the SEIQoL-DW seems to be feasible and acceptable and seems to be valid alternative to the paper and pen version. However, further validation studies in larger patient populations are needed.

Patients' experiences of long-term oxygen therapy.

The aim of this study, which was undertaken in patients' homes in Sweden, was to describe patients' experiences in the self-management of continuous oxygen therapy and their view of managing their chronic disease. A phenomenological approach was used. Data were collected in interviews and analysis produced four categories. The findings show that the patients need help with relief for different physiological and psychological difficulties and from social isolation. The patients had insufficient resources for daily life. They were restricted to their homes, had mobility problems and were dependent upon a continuous life rhythm. Dependence upon another family member is therefore an important factor. But even with the presence of a significant other, social isolation is prevalent.

Continuous fiberoptic arterial oxygen tension measurements in dogs.

An experimental study using a new fiberoptic sensor for the continuous intraarterial measurement of oxygen tension is described. This "optode" sensor uses the phenomenon of fluorescence quenching to determine the oxygen tension of the surrounding medium. To assess the accuracy of this device, we anesthetized 4 dogs and monitored them continuously with arterial catheters and an intraarterial optode probe, and intermittently with arterial blood gas analysis. The inspired oxygen fraction was varied from 1.0 to 0.1, and arterial blood gases were measured for comparison with the optode reading. Two hundred ninety data sets yielded a correlation coefficient of 0.96, with a linear regression slope of 0.98 and intercept of 5.1 mm Hg. In the 72 data sets from the last dog, the bias and precision of the optode arterial oxygen tension values were -10.3 mm Hg and 20.0 mm Hg, respectively. The optode probe was easily inserted through a 20-gauge catheter and did not interfere with continuous arterial pressure measurement or blood sampling. This study suggests that the optode has great potential as a continuous, real-time monitor of arterial oxygen tension.