United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III).

STUDY DESIGN: Multi-center, prospective, cohort study. OBJECTIVES: To assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in persons with spinal cord injury (SCI). SETTING: Inpatient rehabilitation hospitals in the United States (US). METHODS: Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM), the default functional measure currently used in most US hospitals, was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III. RESULTS: Total agreement between raters was above 70% on most SCIM III tasks and all κ-coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach's-α was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8 (P<0.001). For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM (P<0.0001). CONCLUSION: Overall, the SCIM III is a reliable and valid measure of functional change in SCI. However, improved scoring instructions and a few modifications to the scoring categories may reduce variability between raters and enhance clinical utility.

Rubidium-86 uptake and energy metabolism in suspended human erythrocytes monitored by microdialysis.

We aimed to develop a model for studying membrane leakiness. A microdialysis technique was used to investigate rubidium-86 (86Rb) uptake in suspended human erythrocytes in vitro, with the aim of later applying the technique to in vivo studies. Suspensions were prepared from washed erythrocytes and 86Rb administered directly or via the microdialysis probe. The effects on 86Rb uptake of varying the haematocrit were measured. Erythrocytes were also treated with the K+ ionophore valinomycin or the Na+/K+-ATPase inhibitor ouabain. The effects on 86Rb uptake, microdialysate content of lactate and pyruvate, and erythrocyte content of 2,3-bisphosphoglycerate (2,3-BPG) were measured. Valinomycin dissipates the potassium gradient and activates Na+/K+-ATPase, demonstrated by decreased erythrocyte 86Rb uptake with increasing concentrations of valinomycin. This increased ion pump activity enhanced glycolysis, which was demonstrated by accumulation of pyruvate and lactate due to enhanced consumption of 2,3-BPG. The microdialysis technique is appropriate for in vitro studies of ion fluxes across cellular membranes.

The influence of repeated health examinations on mortality in a prospective cohort study, with a comment on the autopsy frequency. The study of men born in 1913.

In the Study of Men Born in 1913 it was possible to investigate the influence of repeated health examinations on mortality in a prospective cohort study. On January 1, 1963, 1010 men in the experimental group and 1956 in the control group were alive. The experimental group took part in repeated examinations in 1963, 1967, 1973 and 1980. Overt diseases were treated accordingly. Newly detected hypertension was also treated. By the end of a 15-year-long observation period, the cumulative mortality in the experimental group (14.5%) was not significantly lower than that in the control group (15.7%). In the experimental group, 855 took part. The mortality was significantly higher in the non-participating group. The autopsy frequency decreased for in-hospital deaths but increased for deaths outside hospital during the study period.