An equivalence study: Are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey?

BACKGROUND: To determine if the EuroQol Health Related Quality of Life survey produces equivalent results when administered by phone interview or patient-completed forms. METHODS: People awaiting hip or knee arthroplasty at a major metropolitan hospital participated. They were randomly assigned to receive the EuroQol Health Related Quality of Life survey via telephone, followed by a patient completed form 1 week later, or vice versa. Equivalence was determined using two one-sided tests (TOST) based on minimal clinically-important differences for the visual analogue scale (VAS) and the summary Utility Index. Cohen's Kappa scores were computed to determine agreement for the individual EuroQoL Likert scale items. RESULTS: Seventy-six from 90 (84%) participants completed the survey twice. Based on limits set at ±7 and ±0.11 for the VAS and Utility Index, respectively, equivalence was established between the two methods of administration for both the VAS (mean difference 0.05 [90% CI -3.76-3.67]) and the Utility Index (mean difference 0.06 [90% CI 0.02-0.11]). Varying levels of agreement, ranging from slight to substantial (κ = 0.17-0.67), were demonstrated for the individual health domains. The order of telephone and patient-completed survey administration had no significant effect on results. CONCLUSIONS: Equivalent results are obtained between telephone and patient-completed administration for the VAS and Utility Index of the EuroQol Survey in people with advanced hip or knee osteoarthritis. The limits of agreement for the individual health domains vary which prevents the accurate interpretation of real change in these items across modes.

Scrub typhus infection presenting as acute heart failure: A case report and systematic review of literature of cardiopulmonary involvement in scrub typhus infection.

We describe a middle aged previoulsy healthy female patient who presented with clinical features suggestive of acute heart failure. Investigations revealed very high NT pro-BNP, right heart enlargement, bilateral pulmonary alveolar edema and bilateral pleural effusion. In view of falling platelet counts and exudative pleural effusion inflammatory/infective causes were considered. Her Weil Felix test was strongly positive and IgM for scrub typhus also returned positive. She was started on doxycycline to which there was dramatic improvement. Thus in this case scrub typhus infection presented as acute right heart failure and the cause seemed elusive at the outset. We also systematically reviewed the existing literature on cardio-pulmonary manifestations of scrub typhus infection.

Partner Counselling and Referral Services (PCRS) for HIV in Armed Forces - Visiting a Blind Spot.

The Indian armed forces have over 5000 cases of human immunodeficiency virus (HIV) infection since 1990. The spouses of the affected soldiers are at a constant risk of contracting infection if not informed of their husband's HIV status. The onus of counselling the spouse has been delegated to the commanding officer (CO) of the soldier as per policy. The spouses usually reside at their hometown away from the soldier's unit and bridging this "geographical discordance" and offering effective counselling becomes a tricky issue for the commanding officer (CO). This article examines the effectiveness of this strategy as practised in Indian armed forces.

Tracheobronchopathia osteochondroplastica.

Tracheobronchopathia osteochondroplastica (TO) is a rare and benign disorder characterized by cartilagenous and/or osseous submucosal deposits projecting into the laryngotracheobronchial lumen. The disorder is usually asymptomatic and most of the cases have been diagnosed incidentally at autopsy or during bronchoscopy. A case of TO in association with bronchogenic carcinoma is being reported for its rarity.

Lung function in mitral stenosis.

OBJECTIVES: The aim of this study was to look to for a relationship between pulmonary artery pressure (PAP), left atrial pressure (LAP), mitral valve area (MVA) and transmitral gradient (Gr) on the one hand and the spirometric data on the other, in cases of mitral stenosis. METHODS: The spirometry values measured were forced vital capacity (FVC), forced expiratory volume in one second and as percent of FVC (FEV1, FEV1/FVC%), forced expiratory flow between 25% to 75% of FVC (FEF 25-75%), at 50% of FVC (FEF 50%) 75% of FVC (FEF 75%) and peak expiratory flow rate (PEFR). The PAP, LAP, MVA and Gr were measured at echocardiography and cardiac catheterisation. RESULTS: Analysis of results was done of 60 patients in four groups divided on basis of mean PAP: Group 1 with least and group 4 with highest mean PAP. FVC values were reduced in direct proportion to PAP, LAP, MVA and Gr in three out of four groups. FEV1% as a percent of predicted value showed uniform reduction in all the groups, PEFR was moderately affected in group 1 and most severely in group 4. Values of FEV1/FVC% were within normal range in all the groups. FEF 25-75%, and FEF 50% showed serial reduction in values in keeping with the elevation of the PAP. FEF 75% was also moderately affected in group 1 and most severely in group 4. CONCLUSION: We found that a moderate restrictive defect and a small airway defect which is found in cases of mitral stenosis, directly correlates to the PAP, LAP, MVA and Gr. There was no significant involvement of the larger airways.

Clinical profile of pulmonary nocardiosis.

Pulmonary nocardiosis mimics pulmonary tuberculosis in both clinical symptoms, being chronic in nature and radiological characteristics, and it is often wrongly treated with anti-tuberculosis drugs. The present study was undertaken to determine the prevalence of pulmonary nocardial infection in patients having chronic chest symptoms and to study their clinical response to specific chemotherapeutic agents. All the patients, who had a negative sputum for AFB on direct smear examination consecutively, were investigated for nocardiosis by examining the sputum with KOH preparation and modified Ziehl-Neelsen method. This was later confirmed by fungal culture of the sputum and inoculation on McClung's broth for paraffin baiting technique. Fibreoptic bronchoscopy was performed on all the suspected cases and the bronchial aspirate was examined similarly. The confirmed cases of nocardiosis were treated with cotrimaxazole and doxycycline for a total duration of six months. The prevalence of pulmonary nocardiosis in the present study was 1.9 percent. All the patients were immunocompetent. All the patients showed a good clinical response to chemotherapy at the end of six months of treatment. No relapse has been observed on follow up.

An ethnography of dementia.

The experiences of dementia sufferers have rarely been examined in sociological literature. This article seeks to describe the experiences of one Alzheimer's Disease patient at the point of institutionalization in order to address a series of questions. Can Alzheimer's Disease patients be thought of as experiencing subjects? Is experience tied to modes of expression? An answer to this set of questions is sought by problematizing the concept of 'voice,' freeing it from a restricted location in natural language to embed it in other forms of embodiment.

EXPERIENCE WITH VIPERINE ENVENOMATION.

Two hundred and twenty one cases of viperine envenomation, who presented to hospital without specific treatment, seen over an twenty five years period, have been presented. Mild, moderate and severe envenomation was encountered in 33 per cent, 47 per cent and 20 per cent respectively. Bites on feet and ankles were seen in 85.5 per cent of cases. The average time interval between bite and hospitalisation was 4.8 hours, range being 15 minutes to 7 days. Local swelling was observed in 97.7 per cent, hematuria in 62 per cent, mucosal haemorrhages in 24.8 per cent and haematemesis in 19 per cent of patients. Average Antisnake Venom (ASV) required in mild, moderate and severe envenomation was 50 ml, 147.5 ml and 324 ml respectively. Major complications observed were renal failure in 10, intracompartmental syndrome in 3, intracerebral bleed and septicaemia in 2 each. One patient each developed finger gangrene, osteomyelitis, perirenal haematoma, sinus bradycardia and uncontrolled bleeding. Blood transfusion was required in 32 patients. Reactions to ASV were seen in 12 patients and overall there were 5 deaths.

Spontaneous lung hernia.

A case of spontaneous thoracic type of acquired lung hernia in a diabetic obese patient is presented in this report. The patient has been on conservative medical therapy for the last six months.

Pulmonary alveolar microlithiasis: diagnosed by sputum examination and transbronchial biopsy.

A case of pulmonary alveolar microlithiasis presenting with uncharacteristic radiological features who was diagnosed on the basis of sputum examination and confirmed by transbronchial biopsy, is being reported. Azoospermia resulting in primary infertility and increased lung volumes by helium dilution test were other noteworthy features of the case.

MULTIDRUG RESISTANT TUBERCULOSIS - BIOMECHANISM, EPIDEMIOLOGY AND MANAGEMENT STRATEGIES.

Muitidrug resistant tuberculosis has shown an alarming increase and this assumes added importance in view of the increasing number of HIV infected patients. This article reviews the biomechanism of resistance and discusses the present stategies that are available and recommended to tackle the rising incidence of tuberculosis due to resistant mycobacteria.