Measurement of quality of recovery using the QoR-40: a quantitative systematic review.

BACKGROUND: Several rating scales have been developed to measure quality of recovery after surgery and anaesthesia, but the most extensively used is the QoR-40, a 40-item questionnaire that provides a global score and subscores across five dimensions: patient support, comfort, emotions, physical independence, and pain. It has been evaluated in a variety of settings, but its overall psychometric properties (validity, reliability, ease of use, and interpretation) and clinical utility are uncertain. METHODS: We undertook a quantitative systematic review of studies evaluating psychometric properties of the QoR-40. Data were combined in meta-analyses using random effects models. This resulted in a total sample of 3459 patients from 17 studies originating in nine countries. RESULTS: We confirmed content, construct, and convergent [pooled r=0.58, 95% confidence interval (CI): 0.51-0.65] validity. Reliability was confirmed by excellent intraclass correlation (pooled α=0.91, 95% CI: 0.88-0.93), test-retest reliability (pooled r=0.90, 95% CI: 0.86-0.92), and inter-rater reliability (intraclass correlation=0.86). The clinical utility of the QoR-40 instrument was supported by high patient recruitment into evaluation studies (97%), and an excellent completion and return rate (97%). The mean time to complete the QoR-40 was 5.1 (95% CI: 4.4-5.7) min. CONCLUSIONS: The QoR-40 is a widely used and extensively validated measure of quality of recovery. The QoR-40 is a suitable measure of postoperative quality of recovery in a range of clinical and research situations.

Micellar electrokinetic chromatography of tri aza aromatic ligand compounds of iron (II): influence of bile salt type on enantiomeric separation.

Micellar electrokinetic chromatography is used with a variety of bile salt micelles to separate the enantiomers of bis(8-((pyridine-2-methylene)amino)quinoline)iron(II) hexafluorophosphate, Fe(PMAQ)2(PF6)2; bis(8-((pyridine-2-methylene)amino)lepidine iron(II) hexafluorophosphate, Fe(PMAL)2(PF6)2; and bis(1-(2-pyridinyl)ethylidine)-8-aminoquinoline iron(II) hexafluorophosphate, Fe(PEAQ)2(PF6)2. The influence of ten different bile salts on the resolution of each pair of enantiomers is investigated. Significant changes in resolution are seen depending upon the bile salt used. The dihydroxy bile salts are superior to the trihydroxy bile salts in terms of resolution, and the taurine or glycine conjugated bile salts yield better results than the unconjugated bile salts. Resolution for most enantiomers is maximized in a buffer solution containing 10-15% acetone and employing either taurochenodeoxycholic or glycochenodeoxycholic acid as the bile salt. Evidence for the separation of the corresponding Fe(III) complexes is presented.

Molecular characterization and ocular hypotensive properties of the prostanoid EP2 receptor.

The cloning of the genes that encode for prostaglandin (PG) receptors has resolved much of the complexity and controversy in this area by confirming the classification proposed by Coleman, et al. Two issues that remained unresolved were (1) the inability of the EP2 agonist butaprost to interact with the cloned putative EP2 receptor and (2) molecular biological confirmation of a fourth PGE2-sensitive receptor, which was pharmacologically designated EP4. In order to provide clarification, we attempted to clone further PGE2-sensitive receptors. By using a cDNA probe that encodes for the human EP3A receptor, a cDNA clone that encoded for a novel PGE2-sensitive receptor was obtained by screening a human placenta library. This cDNA clone was transfected into COS-7 cells for pharmacological studies. The cDNA clone obtained from human placenta had only about 30% amino acid identity with cDNAs for other PG receptors, including those that encode for the previously proposed murine and human EP2 receptors. Radioligand binding studies on the novel EP receptor expressed in COS-7 cells revealed that selective EP2 agonists such as butaprost, AH 13205, AY 23626 and 19(R)-OH PGE2 all competed with 3H-PGE2 for its binding sites, whereas selective agonists for other PG receptor subtypes had minimal or no effect. This receptor was coupled to adenylate cyclase and EP2 agonists caused dose-related increases in cAMP. It appears that the cDNA described herein encodes for the pharmacologically defined EP2 receptor. Ocular studies revealed that AH 13205 decreased intraocular pressure in normal and ocular hypertensive monkeys by a mechanism that does not appear to involve inhibition of aqueous humor secretion.

Community programs to enhance in-school anti-tobacco efforts.

This article presents theoretical bases for the development of community-wide anti-tobacco programs to reinforce school-based programs, discusses the problems involved in translating these theoretical bases into practice, and suggests means for minimizing those problems. Spiral of silence theory, diffusion theory, and expectancy value theory are covered. Special attention is given to the importance of a community program based in and "belonging" to the community, the need for high visibility, maximum participation by community individuals and organizations, mechanisms for program self-perpetuation, and explicit and visible ties to school-based anti-tobacco programs.

Prevalence and predictors of smokeless tobacco use: Iowa's program against smoking.

Data from surveys of adolescents were analyzed so that we could determine the prevalence of smokeless tobacco use and identify and compare the concurrent correlates of its use and cigarette smoking. Panel data from seventh through eleventh and eighth through twelfth graders between 1980 and 1984 and cross-sectional data from seventh graders in 1980 and 1985 suggest that boys are more likely to use SLT than are girls and that the boys' use has increased with age and over time. Concurrent correlates of seventh-grade boys' and girls' SLT use and cigarette smoking were identified with discriminant analyses. Predictors of smokeless tobacco use were compared with those of weekly smoking for boys and girls separately. Predictors of use by boys were also compared with those by girls. Trying alcohol and the other form of tobacco were the only predictors that related to the use of either form by boys and girls. Differences among other predictors were noted and their implications for prevention are discussed.

The FDA pesticides monitoring program.

The U.S. Food and Drug Administration (FDA) carries out an extensive program to monitor foods for pesticide residues. The 2 main objectives of the program are to enforce tolerances established by the Environmental Protection Agency for pesticide residues on foods and feeds and to determine the incidence and level of pesticide residues in the food supply. Because of the wide diversity of pesticide/commodity combinations encountered, FDA uses a number of different approaches to achieve effective consumer protection. The components of the FDA Pesticides Monitoring Program and the strategy used in its development are described.

Secretion from corticotropes after avidin-fluorescein stains for biotinylated ligands (CRF or AVP).

Viable pituitary target cells were identified with biotin-labeled corticotropin-releasing factor (1-Bio-CRF) or arginine vasopressin (Bio-AVP) and avidin-fluorescein (cell sorter grade). Stain was reduced from 8-10% of pituitary cells to less than 3% if nonbiotinylated ligands were added to compete with their respective biotinylated ligand for specific binding sites. However, AVP did not decrease the stain for 1-Bio-CRF nor did CRF decrease the Bio-AVP stain. Media adrenocorticotropin (ACTH) levels increased 4-18 times when 1-Bio-CRF or Bio-AVP were added during the staining process. One hour after staining, the cells secreted ACTH at levels identical to prestain basal levels. When challenged with CRF or AVP after this hour, the cells responded again with increases not different from those seen during staining. Tests of stained cell populations also showed that the cells were fully responsive 24 h after staining. The reverse hemolytic plaque assay for ACTH, which was used to study secretion from individual stained cells, showed that approximately 80% of plaques contained a stained cell and that plaque numbers and areas were like those of unstained populations. These data show that corticotropes are not chronically desensitized during exposure to low doses of biotinylated ligands (50-500 pM).

Use of the reverse hemolytic plaque assay to study the regulation of anterior lobe adrenocorticotropin (ACTH) secretion by ACTH-releasing factor, arginine vasopressin, angiotensin II, and glucocorticoids.

A reverse hemolytic plaque assay (RHPA) for ACTH was developed to study the responses of anterior lobe corticotropes to secretagogues-CRF, arginine vasopressin (AVP), angiotensin II (A-II), or to a 6- to 24-h pretreatment with corticosterone. Tests showed that optimal plaque formation was obtained after 3-4 h with 1:100-1:200 anti ACTH-(25-39) and 1:20-1:50 complement. Under optimal basal conditions, 6.6% of pituitary cells from normal male rats formed plaques. The addition of 50-90 micrograms/ml ACTH to the anti-ACTH for 48 h before its use in the RHPA resulted in a decrease in percentage of ACTH plaques to levels not different from those obtained with preimmune serum, or when complement was omitted from the assay (0.9-1.3%). There was a gradual increase in percentage of ACTH plaques to 9.8% of the population after exposure to increasing doses of CRF (0.1-10 nM). These same high percentages of ACTH plaques could also be obtained by the addition of 1 nM AVP or A-II with the lowest doses of CRF (100-500 pM). Exposure to 1 nM AVP alone resulted in no significant increases in percentages above basal values. Average plaque areas were increased to maximal levels of three to four X basal with increasing doses of CRF. Finally, when cells were pretreated with 100 nM corticosterone for up to 24 h, the percentage of plaques formed under basal conditions was reduced by 60% (2.6%) and it did not increase after exposure to 1 nM CRF. The data from the RHPA correlate well with previous studies of corticotropes. Since ACTH cells normally represent 10% of the anterior lobe cell population, the RHPA shows that a subset of corticotropes (6.6%) is actively secreting under basal conditions tested in this study. The remaining 3% can be stimulated to form plaques by high doses of CRF (greater than 1 nM) or low doses of CRF (100 pM) and 1 nM AVP or A-II. Glucocorticoids reduce the percentage of ACTH plaques formed under basal or stimulated conditions and allow no CRF-stimulated increase in plaque area. This correlates with recent reports that show glucocorticoids inhibit proopiomelanocortin messenger RNA synthesis and lower the number of pituitary CRF receptors.

The short-term effects of competition and rewards in an adolescent smoking prevention program.

This study evaluated whether interventions involving competition and rewards would enhance a school-based educational curriculum on tobacco use. Written pre- and post-tests were used to assess the relevant knowledge of 1068 seventh grade students in three comparable communities. The students' smoking beliefs, intentions, and behavior were assessed by questionnaires before and after the educational unit. Students in two communities participated in interventions designed to enhance knowledge acquisition, social activism, and non-use of tobacco; students in one community served as controls. Students in competitive and control communities did not differ prior to intervention. The interventions influenced respondents' concern about their health and the health of their family and friends and increased the likelihood that they would associate smoking with maturity and short-term bad effects, regardless of their pre-intervention smoking behavior. Experimenters' and regular smokers' knowledge about smoking and its consequences, and concern about the amount of substance use in their town were increased by the competitions. The competitions were also more likely to reduce their intentions to smoke. The interventions did not affect smoking behavior. Fortunately, competition losers and winners were not differentially affected by the interventions.

Acetyl glyceryl ether phosphorylcholine (AGEPC). A putative mediator of cardiac anaphylaxis in the guinea pig.

Platelet-activating factor is a novel phospholipid that has been implicated as an important mediator of acute allergic reactions. The intravenous administration of acetyl glyceryl ether phosphorylcholine, a pure, synthetic platelet-activating factor, causes electrocardiographic changes in the rabbit similar to those which are characteristic manifestations of systemic anaphylaxis. To determine whether platelet-activating factor contributes to anaphylactic cardiac dysfunction, we measured platelet-activating factor release from the sensitized guinea pig heart challenged in vitro with specific antigen and compared the resulting cardiac dysfunction with that induced by the injection of acetyl glyceryl ether phosphorylcholine into nonsensitized hearts. The results of these studies document that, during anaphylaxis in the isolated guinea pig heart, a platelet-activating factor is released into the coronary effluent that has physicochemical and functional properties similar to those of acetyl glyceryl ether phosphorylcholine. The intracardiac administration of acetyl glyceryl ether phosphorylcholine (10(-14) to 3 X 10(-9) mol) induced dose-related decreases in left ventricular contractile force (-5 to -85%) and coronary flow (-5 to -85%), as well as impaired atrioventricular conduction. The negative inotropic effect of acetyl glyceryl ether phosphorylcholine also was present in hearts perfused at constant flow. Although, in these hearts, acetyl glyceryl ether phosphorylcholine increased coronary resistance, which may have caused regional shunting and ischemia, it is unlikely that the negative inotropic effect of acetyl glyceryl ether phosphorylcholine was secondary to changes in coronary flow, since acetyl glyceryl ether phosphorylcholine also caused a dose-dependent negative inotropic effect in the electrically paced, noncoronary-perfused left atrium and right ventricular papillary muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac and pulmonary anaphylaxis in guinea pigs and rabbits induced by glycoprotein isolated from tobacco leaves and cigarette smoke condensate.

Cigarette smoking is a major risk factor for heart attack. The pathologic mechanisms responsible for this association are obscure. It has been reported that approximately one-third of human volunteers, smokers and nonsmokers, exhibit immediate cutaneous hypersensitivity to a glycoprotein antigen (TGP) purified from cured tobacco leaves and present in cigarette smoke. It is also known that the heart is a primary target organ for anaphylactic reaction in many animals, including primates. In experiments described herein anaphylaxis was induced in the isolated hearts and lungs of rabbits and guinea pigs previously sensitized by immunization with TGP and challenged with TGP isolated from either tobacco leaf or cigarette smoke condensate. Cardiac anaphylaxis was characterized by sinus tachycardia, decreased contractility, decreased coronary perfusion accompanied by hypoxic electrocardiographic changes, and a variety of rhythm disturbances, including idioventricular tachyarrhythmias. These observations suggest that allergic reactions to tobacco constituents may initiate cardiac arrhythmia and sudden death in some smokers and may, in part, underly the association between cigarette smoking and heart attack.

Plaquing procedure for infectious hematopoietic necrosis virus.

A single overlay plaque assay was designed and evaluated for infectious hematopoietic necrosis virus. Epithelioma papillosum carpio cells were grown in normal atmosphere with tris(hydroxymethyl)aminomethane- or HEPES (N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid)-buffered media. Plaques were larger and formed more quickly on 1- to 3-day-old cell monolayers than on older monolayers. Cell culture medium with a 10% addition of fetal calf serum (MEM 10) or without serum (MEM 0) were the most efficient virus diluents. Dilution with phosphate-buffered saline, saline, normal broth, or deionized water reduced plaque numbers. Variations in the pH (7.0 to 8.0) of a MEM 0 diluent did not affect plaque numbers. Increasing the volume of viral inoculum above 0.15 ml (15- by 60-mm plate) decreased plaquing efficiency. Significantly more plaques occurred under gum tragacanth and methylcellulose than under agar or agarose overlays. Varying the pH (6.8 to 7.4) of methylcellulose overlays did not significantly change plaque numbers. More plaques formed under the thicker overlays of both methylcellulose and gum tragacanth. Tris(hydroxymethyl)aminomethane and HEPES performed equally well, buffering either medium or overlay. Plaque numbers were reduced when cells were rinsed after virus adsorption or less than 1 h was allowed for adsorption. Variation in adsorption time between 60 and 180 min did not change plaque numbers. The mean plaque formation time was 7 days at 16 degrees C. The viral dose response was linear when the standardized assay was used.

Lymphoid hyperplasia of the bowel and its surgical significance in children.

Twelve children with abdominal complaints had lymphoid hyperplasia of the bowel presenting in an acute or chronic form. The etiology is obscure. An infectious process is thought to precipitate the acute form of the disease. Parasites were identified in two patients with the chronic disease. The acute form, with involvement of the appendix or terminal ileum, presents commonly as acute appendicitis. Because of its self-limiting nature, appendectomy with perservation of the terminal ileum is appropriate. When intussusception is present, resection of the ileum is advisable. The chronic form, which is also common in the terminal ileum, produces disabling symptoms, recurrent intussusception, chronic anemia, and weight loss and is, therefore, amenable to surgical resection.

Eosinophilic infiltration of the gastrointestinal tract in children.

Three children had eosinophilic infiltration of the gastrointestinal tract. This entity has two forms--diffuse and circumscribed. The diffuse lesion is confined mainly to the gastric antrum. Surgical resection of this form is seldom necessary. Involvement of the appendix with this form has not been previously described. The polypoid lesion, which may arise in any segment of the gastrointestinal tract, commonly produces secondary gastrointestinal symptoms and is amenable to local surgical excision.

Scanning electron microscopy of the urinary tract.

Scanning electron microscopy of the urinary tract. A scanning electron microscopic investigation of the luminal surface of the entire urinary tract of the Wistar rat was performed. This report defines criteria for identifying different segments of normal urinary tract on the basis of scanning electron microscopic observations of the epithelial surface. The study was undertaken to provide a reference for future studies of changes in urinary tract morphology resulting from injury or disease.

The epithelial surface of the monkey gastrointestinal tract. A scanning electron-microscopic study.

A scanning electron-microscopic investigation of the luminal surface of the primate gastrointestinal tract has been performed using tissue prepared by critical point drying. This report defines criteria for identifying different segments of the normal primate gastrointestinal tract on the pasis of scanning electron-microscopic observations of the epithelial surface.

Giardiasis in childhood.

Giardiasis is still regularly encountered in the United States, both as endemic cases from the local community as well as in patients returning from travel abroad. Giardiasis should be suspected in any child with steatorrhea, unexplained chronic diarrhea (especially if associated with growth failure), weight loss, or abdominal pain and bloating. Duodenal aspiration or small intestinal biopsy may be necessary to make a diagnosis because Giardia lamblia are not found by stool examination in 50% of symptomatic individuals. A diagnosis of giardiasis is important because the disease is curable.