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A randomized trial of electronic versus paper pain diaries in children: impact on compliance, accuracy, and acceptability.

Electronic diary assessment of pain and disability has become increasingly popular in adult chronic pain research but use of this methodology with children has received limited attention. The aim of this study was to compare two formats of a prospective daily diary (handheld computer=e-diary; paper diary=p-diary) on children's compliance, accuracy, and acceptability ratings. Sixty children, ages 8-16 (M=12.3) with headaches or juvenile idiopathic arthritis, were randomized to receive either e-diaries administered via home visits (n=30) or p-diaries (n=30) handed out during clinic visits for return by mail. Results demonstrated significant mean differences in diary entries completed between groups, with children with e-diaries completing more days (M=6.6) compared to children with p-diaries (M=3.8), P<0.001. Diaries returned by children in the p-diary group contained significantly more errors and omissions compared to diaries returned by children in the e-diary group (which contained none), P<0.001. Children rated both diary formats as highly acceptable and easy to use. A significant gender x diary format interaction (P<0.01) was found for compliance where boys demonstrated greater compliance with the e-diary format. Findings demonstrated that the e-diary was feasible to use with children and showed significantly greater compliance and accuracy in diary recording compared to traditional paper diaries in a population of children with recurrent pain.

Adolescent↗

Validating a pencil-and-paper measure of perimenopausal menstrual blood loss.

In the study presented here, we describe our efforts to develop and validate a new measurement tool for perimenopausal menstrual blood loss. We validate this simple-to-use, subjective pencil-and-paper scale, the Mansfield-Voda-Jorgensen Menstrual Bleeding Scale (MVJ), against an objective measure, the weight of used menstrual products. Thirty-one women from the Minneapolis-St. Paul, MN region saved all their used products over three menstrual cycles, storing them in airtight zip bags, and rated their menstrual fluid volume loss using the MVJ. The overall correlation between MVJ scores and log discharge rate was quite high (r = 0.683); all MVJ categories were statistically unique with the exception of categories "1" and "2." The overall fit, then, was particularly good at the heavy bleeding end of the scale. When five women with poor performance were removed, the correlations ranged from 0.480-0.894. The MVJ is a promising tool for identifying women with excessive menstrual bleeding. It is a simple-to-use, pencil-and-paper scale that offers an inexpensive and practical method to clinicians who work with perimenopausal women, the group most vulnerable to unnecessary worry and/or interventions when menorrhagia is incorrectly diagnosed.

Adult↗

Screening for tetrahydrobiopterin deficiencies using dried blood spots on filter paper.

Tetrahydrobiopterin (BH4) deficiency among newborns with hyperphenylalaninemia must be rapidly diagnosed and distinguished from classical phenylketonuria (PKU) to initiate immediately specific treatment and to prevent irreversible neurological damage. The characteristic pattern of urinary pterins makes it possible to differentiate between PKU and BH4 deficiencies, and to identify different variants of BH4 deficiency. However, collection, storage, and shipment of urine samples for pterin analysis is cumbersome. A method for the measurement of different pterins (neopterin, biopterin, and pterin) in blood collected on filter paper was developed as a potential alternative to the screening for BH4 deficiencies in urine and for the monitoring of BH4 pharmacokinetics. Pterins pattern in blood spots was comparable with those in plasma and urine. We thus established reference values for pterins in blood spots in patients with hyperphenylalaninemia and identified new patients with GTP cyclohydrolase I deficiency, 6-pyruvoyl-tetrahydropterin synthase deficiency, and dihydropteridine reductase deficiency using dried blood spots on filter paper.

Biopterins↗

Evaluation of whole fresh blood and dried blood on filter paper discs in serological tests for Trypanosoma evansi in experimentally infected water buffaloes.

In this study we investigated if whole blood could substitute for serum in the direct card agglutination test (CATT/Trypansosoma evansi) and the indirect card agglutination test (LATEX/T. evansi) for the sero-diagnosis of T. evansi in buffaloes. Likewise blood spots on filter paper were compared with sera for use in the indirect enzyme-linked immunosorbent assay/T. evansi (ELISA) and immunotrypanolysis test (T.L./T. evansi). Samples were collected weekly from experimentally T. evansi infected- and non-infected water buffaloes. To estimate test agreement between serum and respectively whole fresh blood and dried blood spots on filterpaper of the tests, kappa values with 95% confidence intervals were calculated, 0.75+/-0.11 for the CATT/T. evansi; 0.80+/-0.11 for the ELISA/T. evansi; 0.84+/-0.11 for the LATEX/T. evansi and 0.93+/-0.11 for the T.L./T. evansi. In addition kappa values with 95% confidence intervals were computed to assess agreement between results obtained in the reference T.L./T. evansi test and those obtained in the other assays; 0.70+/-0.10 for the CATT-Serum; 0.75+/-0.11 for the LATEX-Blood; 0.77+/-0.11 for the LATEX-Serum; 0.81+/-0.10 for the CATT-Blood; 0.81+/-0.11 for the ELISA-Serum and 0.84+/-0.11 for the ELISA-Confetti. Based on the high kappa values as calculated, we conclude that serum can be replaced by fresh whole blood for the agglutination assays or blood on filter paper for the ELISA/T. evansi and T.L./T. evansi.

Animals↗

Testing usability with 3D paper prototypes--Case Halton system.

In our study, we set out to see how low-fidelity three-dimensional paper prototypes could be used to test the usability of two alternative concepts for a drink can refund machine. The tests were carried out in the real environment with the actual users of the product. The tests took place before any software or hardware had been implemented. Using paper prototypes is a quantitative evaluation method which is easy to apply and suitable for product development processes with a tight schedule. We found the 3DPP modeling and testing method turned out to be useful and the results obtained had an influence on the product.

Beverages↗

Quo vadis collateral blood flow? A commentary on a highly cited paper.

This text is a commentary on the highly cited paper by Maxwell-Hearse-Yellon describing the amount of collateral blood flow in several species of mammals after coronary artery occlusion. The measurement of collateral blood flow, an academic exercise in previous times because of its invariance and the futility of changing the degree of adaptation under chronic conditions, has reached new importance because collateral vessel growth (presently called arteriogenesis) can now be manipulated with growth factors, their genes or peptides. The early successes and failures are discussed and a plea is made for the rigorous application of goldstandard methods (like in the Maxwell-Hearse-Yellon paper) to avoid disappointments in the new science of 'therapeutic angiogenesis'.

Animals↗

Determination of urinary homovanillic and vanillylmandelic acids from dried filter paper samples: assessment of potential methods for neuroblastoma screening.

Urinary homovanillic (HVA) and vanillylmandelic (VMA) acids were analyzed on 200 random urine samples from patients with neuroblastoma and controls, after the samples had been dried onto absorbent filter paper. The acids were determined quantitatively by gas chromatography (GC) and qualitatively by thin layer chromatography (TLC). The results were analyzed for correlation between liquid urine samples and urine dried on filter paper and between TLC and GC methods. A high overall correlation for HVA and VMA (99%) was found between liquid and dried filter samples analyzed by GC. The correlations were more significant for samples with elevated levels of these acids than for those with normal levels. Normalization of the results to the urinary creatinine concentration (UCr) is indicated due to variations in urine concentration. Results from TLC analysis showed a false positive rate of 3.5% and a false negative rate of 0.5% compared to GC analysis. This work suggests that a combination of a sensitive TLC method with a rapid quantitative GC method would be suitable for mass neuroblastoma screening in infants.

Adolescent↗

Should we have confidence in radiology papers?

This study aims to assess whether Confidence Intervals are used appropriately in papers published in Clinical Radiology, and compares 50 consecutive papers in this journal with similar samples in Radiology and the British Medical Journal (BMJ). The utilization or omission of Confidence Intervals and statistical hypothesis testing is analysed. The results are discussed using chi 2 tests and 95% Confidence Intervals for the difference between proportions. This illustrates the important additional quantitative information that Confidence Intervals can convey, particularly when evaluating the degree of uncertainty related to a result from a small sample or subgroup in a study.

Confidence Intervals↗

Lysosomal enzymes in human tear fluid collected by filter paper strips.

Protein concentrations and lysosomal enzyme activities in tear fluid collected by filter paper strips were studied. The magnitude of the wetted area on the filter paper did not affect the apparent protein concentration in the tear fluid. Lysosomal enzyme activities in tear fluid were higher than those in serum. The pH and enzyme activity curves in tear fluid were similar to those in serum. The optimal pH of acid phosphatase, beta-D-glucuronidase, N-acetyl-beta-D-glucosaminidase, alpha-L-fucosidase and alpha-D-mannosidase in tear fluid were determined.

Acetylglucosaminidase↗

Comparison of plasma hormone changes using a "conventional" and a "paper" pill formulation of a low-dose oral contraceptive.

Two formulations of a low-dose oral contraceptive (Microgynon: 150 microgram of levonorgestrel [NG] +30 micrograms of ethynylestradiol [EE2]) were studied. The first was the "conventional" pill; the second was a "paper" pill prepared by evaporation of aliquots of a solution of the component steroids onto squares of edible cellulose separated by perforations, similar to a sheet of postage stamps. The effects of the two formulations on plasma levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17beta-estradiol (E2), and progesterone were compared. Samples of blood were obtained from five women during a treatment period on the "conventional" pill and from five on the "paper" pill. When possible, blood samples were also obtained from a "control" cycle of each of these female subjects. Plasma LH, FSH, E2, and progesterone levels were determined by specific radioimmunoassay methods during control and treatment periods and NG and EE2 levels during treatment periods. Eight-hour plasma profiles for NG and EE2 at the beginning and in the later stage of the treatment periods were obtained and these samples were also analyzed for LH, FSH, E2, and progesterone. Results showed that with one exceptcrogynon were equally effective in suppressing ovulation. As in a previous study, FSH levels appeared to be one of the most sensitive indices of suppression.

Adult↗

Rock-paper-scissors.

A study of 20 doctors in their first or second postgraduate year highlighted deficiencies in their knowledge of the nerve supply of the hand and forearm. The children's game rock-paper-scissors (Figs. 1-3) can be used as a simple aide-memoir for the nerve supply to the hand and forearm. The median nerve creates the "rock position" of the pronated fist (Fig. 1). The radial nerve extends the wrist and hand forming the "paper position" (Fig. 2a and b) and the ulnar nerve creates the "scissor position" (Fig. 3), by clawing the ring and little fingers and spreading the index and middle and adducting the thumb and flexing the interphalangeal joint.

Clinical Competence↗

Genetic heterogeneity of ribosomal internal transcribed spacer in clinical samples of Leishmania donovani spotted on filter paper as revealed by single-strand conformation polymorphisms and sequencing.

A polymerase chain reaction and single-strand conformation polymorphism determination (PCR-SSCP) was used to detect deoxyribonucleic acid sequence polymorphisms in the transcribed non-coding regions between the small and large sub-unit ribosomal ribonucleic acid (rRNA) genes in Leishmania donovani from 63 clinical samples collected in eastern Sudan, between April 1997 and October 1998. Specific Leishmania primers were used to amplify the internal transcribed spacer (ITS) regions of L. donovani isolates directly from clinical samples spotted on filter papers. Amplification products were subsequently analysed by SSCP. Eleven polymorphic patterns were detected in the first part of the spacer, the ITS1 region, and were sequenced. Most of the changes were due to deletions of adenine bases and AT pairs within the first 192 nucleotides of the ITS region. This is the first application of PCR-linked SSCP analysis for the detection of population variation with direct display of sequence variation in parasitologically positive clinical samples spotted on filter paper. Culturing the parasite is thus not required, which is beneficial particularly in epidemiological studies based on field work where obtaining cultures can be extremely difficult.

Animals↗

Measurement of the effect of high-power ultrasound on wetting of paper.

High-power ultrasound has been known to promote penetration of liquids into porous materials. This work presents results of experimental investigations of the influence of 40 kHz high-power ultrasound on wetting processes of papers. Wetting was monitored by the measurement of the attenuation of 0.5-9 MHz ultrasound transmitted through the immersed sample. The samples were sized papers with contact angles 40 degrees, 70 degrees and 110 degrees, and the immersion liquids were isopropanol-water mixtures of 0-100% isopropanol concentration. The investigation showed that application of high-power ultrasound resulted in faster sorption processes. However, the absolute reduction in time to reach the stationary state was not very great.

Journal Article↗

Storage of bovine viral diarrhoea virus samples on filter paper and detection of viral RNA by a RT-PCR method.

Of four solid carriers tested, Whatman paper No 1 was the best for storing blood and serum samples for the diagnosis of bovine viral diarrhoea (BVD) by means of viral RNA detection. The filter papers were impregnated with 10 microl of blood or serum, followed by air drying. Samples collected in this way from persistently infected animals had lost infectivity within a few days, but viral RNA could still be detected by RT-PCR for up to 6 months. When investigated by RT-PCR, 12 blood and 10 serum samples selected at random from animals persistently infected with BVD virus showed the same results whether samples had been spotted onto filters or examined directly from the liquid state. The filters spotted with blood or serum are convenient for storage and transport of samples to a diagnostic laboratory without the need for cooling. Sequencing of amplified RNA can be used subsequently for genetic typing.

Animals↗

Summary of papers and research recommendations presented at the International Symposium on Lifestyle Factors and Human Lung Cancer, Guangzhou, China.

This paper summarizes the themes and recommendations that emerged from the papers presented at the "International Symposium on Lifestyle Factors and Human Lung Cancer". In terms of our current knowledge, the following are considered important: (1) recognition and confirmation of lung cancer as a multifactorial disease; (2) the strong association known to exist between cigarette smoking and lung cancer does not explain the observation that the lung cancer death rate is lower than the smoking rate in certain groups of individuals, e.g. Chinese farmers; (3) the high incidence of adenocarcinoma in non-smoking women, e.g. Chinese housewives, suggests that factors other than cigarette smoking are involved for the development of lung cancer; (4) indoor air pollution is a significant risk factor for lung cancer in China; (5) there is incomplete information on the chemical nature and exposure assessment of indoor air pollutants; and (6) the need to better define the role of diet and nutrients as confounding factors for lung cancer. Based on the above, several recommendations were offered for continuing research to further our understanding of the etiology and pathogenesis of lung cancer.

Adenocarcinoma↗

Commemoration of the publication 100 years ago of the papers by Dr. Th. Escherich in which are described for the first time the organisms that bear his name.

The centenary of the publication by Dr. Th. Escherich of his papers on the colonization of the intestines of neonates by bacteria is commemorated. His papers are reviewed and discussed from the point of view of current knowledge. The organisms described by him as Bacterium coli commune and now known as Escherichia coli are particularly discussed and their role as enteropathogens assessed. Current work on these organisms is contrasted with studies on them over the last 100 years.

Austria↗

Emergency Medical Services for Children managed care white paper series: introduction.

The introduction of managed care principles profoundly changed the delivery of health care in the United States. The Emergency Medical Services for Children (EMSC) program has developed a series of white papers to address the impact of managed care on the emergency care system for children and adolescents. We hope that these white papers will focus discussions among managed care organizations, health care providers, and the public in ways that will lead to improvement in the system of care available to children and adolescents.

Adolescent↗

Political principles in action: a critical analysis of Education and Training: Working Paper 10 and its implications for nurse education.

Education and Training: Working Paper Ten (WP10) (Department of Health 1989a) was published in October 1989. It was an integral part of Working for Patients (Department of Health 1989b) and as such was alleged to embrace the same fundamental principles. WP10 may result in the most significant change to nurse education in the UK since the 1949 Nurses Act, with variations in its funding, structure and organisation. Surprisingly, there has been relatively little discussion about this important development within the nursing press. The aim, therefore, of this paper is to evaluate WP10 within the context of the ideology which has underpinned social policy in the last 14 years. Firstly, Conservative Party policy will be explored, the WP10 itself will then be examined in order to assess how far such principles have been applied to nurse education through its implementation. It is intended that by this process of analysis further understanding will be gained about this policy and its potential consequences for the future of nursing.

Education, Nursing↗