Patterns of outcome measurement in Parkinson's disease clinical trials.

The study examines the pattern of use and clinimetric properties of clinical endpoints used in randomized trials for Parkinson's disease (PD). Randomized drug trials for PD were identified through a Medline search conducted from January 1966 until August 1998. The endpoints used in these trials were abstracted. Reports examining the clinimetric properties of the disease-specific scales used in these trials were also abstracted. Data regarding the consistency, accuracy, discrimination and feasibility of scales used in at least 10% of trials were determined. One hundred and thirty-seven articles met the inclusion criteria; 70.8% of trials used some clinical scale for PD as an endpoint. The Unified Parkinson's Disease Rating Scale (UPDRS) was the most commonly used scale (32.8%). Factors independently associated with the use of the UPDRS included: the study location in the US, mean age of subjects over 62.7 years and publication after 1994. The UPDRS was more thoroughly studied and superior in most clinimetric domains compared to scales developed earlier. Few studies included generic health status (2.9%) or cognitive measures (16.8%) as secondary endpoints. There have been definite improvements in the area of disease-specific measurement in PD trials since the introduction of the UPDRS. The results of studies that used instruments with poor or unreported clinimetric properties should be critically interpreted.

Does the functional assessment measure (FAM) extend the functional independence measure (FIM) instrument? A rasch analysis of stroke inpatients.

Adding the items of the Functional Assessment Measure (FAM) to the Functional Independence Measure (FIM instrument) has been proposed as a method to extend the range of the FIM, particularly when assessing functional status in rehabilitation patients with brain injury, including stroke. It has been proposed that this approach is especially helpful in ameliorating ceiling effects when brain-injured patients have reached the end of their inpatient rehabilitation stay or are being seen in outpatient settings. In the present study, 376 consecutive stroke patients on a Canadian inpatient rehabilitation unit were concurrently administered the FIM and the FAM. Rasch analysis was used to evaluate how well the FAM items extended the difficulty range of the FIM for both the Motor and Cognitive domains. Within the Motor domain, only the FAM item assessing Community Access was found to be more difficult than extant FIM items, and this item showed some tendency to misfit with the other motor items. In the Cognitive domain, the only FAM item with a higher difficulty level than the FIM items was that assessing Employability. Notably, strict adherence to scoring guidelines for these two FAM items requires taking patients out into the community to evaluate their actual performances, a practice unlikely in the typical inpatient stroke rehabilitation unit. Results indicate that use of the entire FAM as an adjunct to the FIM reduces test efficiency while providing only minimal additional protection against ceiling effects.

Taste, temperature, and presentation predict satisfaction with foodservices in a Canadian continuing-care hospital.

OBJECTIVE: To identify food, service, and patient variables associated with high satisfaction with foodservices in a continuing-care hospital that serves, primarily, geriatric patients and patients undergoing physical rehabilitation. DESIGN: Survey questionnaire concerning eight aspects of food and foodservice as well as type of diet and major patient descriptors. SUBJECTS: All patients from geriatric continuing-care units, geriatric rehabilitation units, and physical rehabilitation units at Saint-Vincent Pavilion were considered potential respondents. A convenience sample of 65 clients met the established inclusion criteria and were willing to participate. Patients had to be able to communicate their views, and the clinical nursing staff judged all respondents to be cognitively able to provide opinions concerning food and foodservice. The mean age of subjects was 67 years, the mean length of stay in the hospital was 2 years, and 60% of the subjects were women (n = 39). STATISTICAL ANALYSES: Spearman rank correlations, univariate analyses (t tests for continuously distributed data, chi 2 tests for categorical data), and multivariate analyses (regular and logistic regression). RESULTS: In general, patients questioned were extremely positive about the quality and quantity of food and foodservices at this continuing-care/rehabilitation hospital. Type of diet and patient characteristics were not differentially associated with high levels of overall satisfaction with foodservices (as assessed by a general satisfaction question). Univariate analyses revealed that all aspects of foodservices (except quantity of food) were significantly correlated with overall satisfaction. Multivariate analyses showed that satisfaction with presentation of meal was the best predictor of overall satisfaction and that clients who were very satisfied with the taste of food and were very satisfied that cold food was cold enough were the most satisfied overall. Knowledge of key variables as assessed by multivariate analyses (ie, taste and coldness) predicted whether clients were very satisfied overall 80% of the time. APPLICATIONS: Surveys are usefull tools for assessing the ways in which clients view the food and services provided by dietitians. Dietitians in continuing-care settings need to focus on a few specific characteristics related to what is eaten and how food is presented, rather than on patient-specific variables, when trying to maximize satisfaction with hospital food. The information in this study can be used as a baseline against which future data can be compared. The survey contributes to a continuing quality assurance process that allows dietitians to track the effect of changes that are made to food and foodservices and to monitor areas that require modification.

Changing bowel hygiene practice successfully: a program to reduce laxative use in a chronic care hospital.

Laxative use was significantly reduced in our long-term care facility when an interdisciplinary program based on a philosophy of prevention and health promotion was implemented. Specifically, increased fluid and fiber intake, timely toileting habits, and regular activity/exercise led to a halving of the number of patients receiving laxatives as required, relative to pre-program levels and relative to a control unit not receiving the program.

Patient death in a long-term care hospital. A study of the effect on nursing staff.

1. The most common ways in which staff were affected by patient death were "low morale" and "loss of efficacy at work." 2. Staff most commonly reported coping with death by "sharing feelings," knowing that their "work contributed to a good death" and by "placing death in a good light," although one in five nurses reported no strategy for dealing with patient death. 3. Nurses who are most affected by patient death have a more difficult time caring for younger patients, tend to "take their stress home" and are more likely to base their nursing care on a personal relationship with the patient, than nurses who are less affected.

Purposes and structures of Canadian hospital-based research: results of a national survey.

Little is known about the current extent, purpose and organization of research within Canadian hospitals. As hospitals face the challenge of reorganization, such information would seem essential. To explore this issue, the authors surveyed Canadian hospitals with more than 100 beds. The results, reported here, reveal that almost all of responding hospitals had engaged in some form of research in the previous 12 months, although the type and number of research projects tended to vary with size of hospital and the status of university affiliation. The study also found that most hospitals have resources specifically dedicated to research, conduct ethical reviews and engage in interdisciplinary research. The vast majority of respondents felt that hospital-based research would assume more importance in the future.

When is ethical review of research protocols necessary? A proposed classification system for evaluating Canadian hospital-based research.

Although research is an activity commonly undertaken in Canadian hospitals, no mandatory or even standardized mechanism exists for the ethical clearance of hospital-based research in Canada. This paper describes the current procedures used by Canadian hospitals to evaluate research protocols. A research classification system is proposed by SCO Hospital, Saint-Vincent Pavilion. The proposed classification system offers criteria for screening hospital-based research for risk to human subjects and detecting potential ethical problems in a proposed research study. SCO Hospital, Saint-Vincent Pavilion, has also found the proposed research classification system helpful in identifying research activities that have an impact on hospital resources.

Puréed diet: prevalence and reported reasons for use in a long-term care hospital.

Although puréed diets are thought to be widely used for patients in long-term care facilities, there is little specific information concerning prevalence and reasons for the actual use of this diet texture. At Saint-Vincent Hospital, a 516 bed, long-term care and rehabilitation facility, 25.9% of the chronic-care population (n = 424) were on a puréed diet. Those who received puréed diets tended to be older (83.5 years versus 75.4 years, P < 0.001) and were more likely to be female (82.7% versus 70.8% P < 0.006), than the total population of long-term care patients. A greater percentage of patients receiving a puréed diet had dementia (43.0% versus 30.6%, P < 0.02), and fewer had cerebrovascular accident as a primary diagnosis (22.6% versus 33.9%, P < 0.05), than the total population of long-term care patients at this hospital. Following data collection, reasons for patients being on a puréed diet were grouped into five categories. The most popular categories were "Physiological/Mechanical" and "Cognitive" problems.

Sex-role ideology among self-identified psychotherapists.

Analysis of the sex-role ideology of 1,258 self-identified psychotherapists from nine occupations indicated that: the sample was representative; as a group, self-identified psychotherapists were moderately feminist; there were significant differences among occupations; and results were not due solely to the effects of age or sex distributions among occupations.

Penetrating orbital foreign body with intracranial involvement.

A 19-year-old man presented with a penetrating orbital foreign body. Preoperative evaluation established involvement of the middle cranial fossa and right internal carotid artery. An extensive preoperative evaluation of penetrating orbital trauma and a combined ophthalmic neurosurgical approach is recommended to ensure complete removal of the foreign material and to minimize the morbidity of the surgical extraction.

Filling the need for emergency psychiatrists: is better education the answer?

Although the need for specialists in emergency psychiatry is increasing, little attention is given to this field by American psychiatric residency programs, and few psychiatrists choose emergency psychiatry as a career. Like their American counterparts, few Canadian psychiatric residents also choose this specialty. To determine Canadian patterns of emergency education and Canadian residents' opinions of their emergency psychiatry experience, the authors distributed a 41-item questionnaire to 190 psychiatric residents across Canada. The results showed that most residents worked long hours alone, with little complementary education or evaluation. Residents in programs with formal education and evaluation components and on-call assignments no more than once a week found the emergency psychiatry experience most rewarding. The authors make a series of recommendations to strengthen the educational aspects of the emergency psychiatry experience.

A comparison of AMA and non-AMA patients on a short-term crisis unit.

Nineteen patients who left a short-term psychiatric crisis unit against medical advice were compared with 109 patients who received a regular discharge during a six-month period. Demographic, historic, assessment, and diagnostic variables of both groups were examined. Results indicated that patients diagnosed as having personality or substance use disorders and patients judges abnormal on a mental status examination were more likely to be AMA patients. However, AMA patients indicated fewer social problems as rated on Linn's Social Dysfunction Scale. It was concluded that diagnostic variables best differentiated patients leaving the treatment unit against medical advice from those who completed treatment.

Medical detoxification admissions during the Manitoba beer and liquor strikes of 1978.

Admission rates to a medical detoxification ward of a general hospital were examined for periods during a beer and a liquor strike and equivalent length periods before and after each strike. They were also compared to analogous periods during a non-strike year. Results indicated that admissions were lowered during the liquor but not the beer strike, a finding which is consistent with an earlier report that overall alcohol consumption was lowered during the liquor but not the beer strike. This finding indicates that there is a positive association between amount of alcohol consumed by the general public and an index of severe alcohol abuse. No subgroup of the detoxification population was identified as being responsible for the reduced admissions.

Alcoholism and the forensic-psychiatric patient: a comparative study.

A group of male forensic psychiatric patients was compared to groups of non-forensic psychiatric patients, hospitalized alcoholics and general hospital admissions on a modified version of the self-administered Michigan Alcoholism Screening Test. Results indicated more alcoholic related problems in both psychiatric groups than the general hospital group, but less than for the hospitalized alcoholics. The scores of the two psychiatric groups, however, did not differ significantly. It was concluded that alcoholism was non-additively associated with both criminality and psychiatric disturbance. It was suggested that the degree of alcohol related problems in psychiatric populations warrants careful screening and treatment even when alcoholism is not reflected in the psychiatric diagnosis.