The Northwick Park Dependency Score (NPDS): a measure of nursing dependency in rehabilitation.

BACKGROUND: Disability scores, such as the Functional Independence Measure (FIM) and Barthel Index, have been shown to correlate with care needs but cannot be used to assess them directly, as they do not indicate the number of people required to help with a task, nor the time taken. The Northwick Park Dependency Score (NPDS) is an ordinal scale that can be used to assess impact on nursing time. It takes 3-5 minutes to complete. Together with a short set of additional questions, it may be used directly to assess care needs in the community and to facilitate discharge planning. AIMS: To develop and evaluate the NPDS for use in a rehabilitation setting. METHODS: (1) DEVELOPMENT: Following a survey of existing instruments, tasks were selected on the basis of their impact on nursing time and divided into Basic Care Needs (BCN) and Special Nursing Needs (SNN). Cut-off points were devised to reflect the number of helpers needed and time taken. Following evaluation of the NPDS version 5, minor changes were made to produce version 6 which was re-evaluated on a smaller scale. (2) EVALUATION: Inter-rater and intra-rater reliability were tested in a cohort of 23 inpatients using five senior nurses. Analysis included assessment of degree of association, significant differences, absolute agreement, and agreement +1 level. Although there is no gold standard, the BCN section should correlate inversely with independently assessed Barthel scores. Re-evaluation of version 6 was undertaken using the same method of analysis in a cohort of 21 patients using three senior nurses. RESULTS: On initial evaluation inter-rater reliability testing showed an excellent level of association in total composite score between each pair of nurses (rho = 0.73-0.92, p <0.01) and agreement +1 level for individual items ranged from 73 to 100%. Significant disagreements were in six items. On re-evaluation following minor modification, high levels of association were still seen for total BCN, SNN and composite scores both between and within raters, with very satisfactory levels of agreement for individual items. The BCN section of the NPDS showed good inverse correlation with Barthel scores (rho = 0.91, p <0.01). CONCLUSION: The NPDS is simple and practical to use in a busy setting. It is shown to be reliable and valid in its assessment of nursing dependency on the ward. Its translation into a directly costable measure of continuing care needs in the community now requires evaluation.

Bender-Gestalt developmental scores: predicting reading and mathematics achievement.

This study examined the relative importance of perceptual-motor processes and intelligence in predicting reading and mathematics achievement of children of low birthweight. Subjects were two groups of 153 children, ages 6 to 12 years, of either low (3 lb. or below, n = 72) or normal birthweight (n = 81) who participated in a comparative study on sequelae of children of low birthweight. To examine the utility of the Bender-Gestalt test in predicting academic achievement, Bender developmental scores, WRAT reading and mathematics scores, and WISC-R Full Scale IQs from both groups were compared and then intercorrelated separately. The mean comparisons indicated that children of low birthweight scored significantly lower on both Bender scores and reading achievement and had lower IQs than those of normal birthweight. Bender scores also appeared to have more utility for predicting reading and mathematics achievement for children of low birthweight than for those of normal birthweight.

Reverse transformation of vole cells transformed by avian sarcoma virus containing the src gene.

Vole cells transformed by avian sarcoma virus carrying the src gene lose their fibroblastic morphology, the organized cytoskeletal system of the normal fibroblastic cell, the typical fibronectin deposit around the cell membrane, and the ability to shut off multiplication when suspended in liquid medium. All of these transformation characteristics are reversed by treatment with cAMP derivatives. Moreover, the cAMP treatment does not cause loss of activity of the src gene product. These data imply that cAMP exerts its effect at or after the point in the metabolic pathway affected by the src gene product, pp60src. Presumably, the decision to adopt the transformed or the normal state is determined by the degree to which the src gene or cAMP-mediated kinase activities respectively predominante in the cell. The development of all four transformation characteristics as a result of introduction of the src gene, and their coordinate reversal by cAMP derivatives, supports the previous thesis that in the normal vole or CHO fibroblast all four properties are part of a common regulatory system.

Deposition of fibronectin in the course of reverse transformation of Chinese hamster ovary cells by cyclic AMP.

The Chinese hamster ovary (CHO) cell, like other transformed cells, has lost the fibronectin deposit around its membrane. Treatment with cyclic AMP derivatives restores the typical fibroblastic deposit of fibronectin. Thus, the reverse transformation process induced by cyclic AMP (cAMP) in the CHO cell restores this important property as well as other morphological, biochemical, and growth behavioral characteristics of the normal fibroblastic state. The fibronectin deposit occurs significantly later in time than do other characteristics of the reverse transformation reaction and may therefore reflect a metabolic action that requires other cAMP effect to precede it. The restoration of fibronectin deposition in response to cAMP derivatives is also exhibited by vole cells transformed by avian sarcoma virus, but it is not by HeLa cell. Addition of Colcemid, which disrupts microtubules, to CHO cells containing a fibronectin deposit induced by cAMP derivatives causes little or no erosion of the deposit, but cytochalasin B, which disrupts 5-nm microfilaments, eliminates it completely. Thus, various features of the action of cAMP derivatives on CHO and related cells require integrity of the cellular microfibrils--in some cases microtubules only, in some cases 5-nm microfilaments only, and in some cases both classes of fibrils.