Pain, quality of life, and coping in sickle cell disease.

This study examined the frequency and severity of sickle related pain, its impact on quality of life, and methods of coping for 25 children with sickle cell disease, aged 6-16 years. Subjects were matched with non-affected peers and asked to complete the Central Middlesex Hospital Children's Health Diary for four weeks. Results indicated that sickle pain occurred on average one in 14 days, and total summary pain scores indicated significantly greater pain than for controls. Children with sickle cell disease could discriminate sickle pain and did not adopt sick role responses to ordinary childhood ailments. Nearly all sickle pain was dealt with at home. Sickle pain resulted in over seven times increased risk of not attending school and was highly disruptive of social and recreational activities. Careful assessment of sickle pain in the home environment is an essential part of a community focused pain management service, which effectively supports children's resilience and improves their quality of life.

Procedures for measuring accuracy and sensitivity of immunochemical pregnancy test kits.

Analytical procedures were used to measure the accuracy and sensitivity of immunochemical pregnancy test kits. Performances of all currently marketed hemagglutination inhibition, latex agglutination inhibition, and direct latex agglutination pregnancy kits were evaluated.

PIP: 7 immunochemical methods are currently available for measuring human chorionic gonadotropin (HCG) which is secreted during pregnancy, reaching its highest level during the 1st trimester: 1) latex agglutination inhibition (LAI), 2) hemagglutination inhibition (HAI), 3) direct latex agglutination (DLA), and 4) radioimmunoassay (RIA). In a study of 5 commercial immunochemical pregnancy kits, it was concluded that the HAI kits were more accurate and sensitive than the LAI or DLA kits. The need for a standardized, transferrable analytical method for evaluating kit performance was expressed by the Food and Drug Administration and by increased over-the-counter sales of these products. This paper presents protocols developed for testing the performance of these kits including the following aspects: accuracy and sensitivity determination, test procedures for HAI, LAI, and DLA, apparatus, and reagents. A test was performed on 206 assorted lots of kits with the following results: 1) none of the 98 HAI kits gave false positive or false negative results, 2) the LAI kits gave 24 false and 3 inconclusive results, 3) the mean level of HCG detected by HAI kits was below that obtained with LAI and DLA kits; thus the HAI detects pregnancy at an earlier stage, 4) average sensitivity of all kits tested was greater than or equal to that claimed by the manufacturer, 5) denaturation of the antisera may enhance the sensitivity and given an increase of false positive reactions, 6) low concentrations or HCG standard in dilute solutions were unstable due to absorption of HCG on glass surfaces, 7) erroneous results can be caused by HCG secreted in hydatidiform moles, choriocarcinoma and certain tumors, ectopic pregnancy, and protein in the urine, 8) data from repeat analyses could be misleading, and 9) reagents should be visually inspected before use to detect bad reagents.