Electronic von Frey as an objective assessment tool for oxaliplatin-induced peripheral neuropathy: A prospective longitudinal study.

OBJECTIVE: There is wide discrepancy on how to perform clinical assessment of oxaliplatin-induced peripheral neuropathy. In this scenario, the Electronic von Frey (EVF), which evaluates pain objectively based upon mechanical pain thresholds (MPTs), may be a valuable tool. The present study aims to quantify hyperalgesia in the hands and feet of patients treated with oxaliplatin and to propose a novel method to classify the degree of neurotoxicity using EVF-derived measures as cut-off points. METHODS: This is a prospective cohort study including 46 patients treated for colorectal cancer with the FLOX regimen. Before each oxaliplatin administration, patients were evaluated with the Acute and Chronic Neuropathy Questionnaire, Oxaliplatin-Specific Neurotoxicity Scale and National Cancer Institute Common Terminology Criteria for Adverse Events scale. Also, objective pain assessment with the EVF was performed. RESULTS: For both upper and lower extremities, EVF was shown to correlate well with patients' symptoms and functional impairment, as assessed by subjective scales. Also, when cut-off MPT variations were determined for diagnosis of neurotoxicity grade 2 or 3, the method showed good sensitivity and specificity. CONCLUSION: Electronic von Frey is a noninvasive and easy-to-perform objective method with potential to supplement the current assessment tools for oxaliplatin-induced peripheral neuropathy, which are mostly subjective.

The ethics of placebo prescribing.

The prescribing of placebos brings into focus the practice of being truthful to patients. The term "placebo" has a generally pejorative connotation in medicine, although the Latin is "I shall please." More recently, the definition of "placebo" has expanded to include "medication without proven pharmacological activity." Yet it is known that the use of placebos often leads to substantial improvement. The effectiveness of placebos is a challenging and troubling issue for physicians.

PROQSY: a computerised technique for psychiatric case identification in general practice.

Two-stage screening for minor psychiatric morbidity was carried out with a consecutive sample of 256 patients aged 15-69 consulting an experienced GP in a semirural setting over a seven-week period. Patients completed a short GHQ, and the GP made a standardised assessment of the reason for consultation and the degree of psychological disorder. A 40% random subsample were evaluated using PROQSY, a newly developed computerised psychiatric assessment based on the CIS. PROQSY is acceptable to patients in general practice, and yields an estimate of the prevalence of minor psychiatric morbidity (33%), and validity indices for the 12-item, 28-item, and 30-item GHQs, comparable with those found in similar studies, when the CIS has been administered by an interviewer. PROQSY may be recommended as a research tool, providing a criterion measure of minor psychiatric morbidity in general practice, where it may reduce time and manpower, and eliminate interviewer bias.

Validation of a computerized assessment (PROQSY) of minor psychological morbidity by Relative Operating Characteristic analysis using a single GP's assessments as criterion measures.

This is a study of the criterion validity of a newly developed computerized assessment (PROQSY) of minor psychological morbidity based on the Clinical Interview Schedule, employing a single GP's assessments as criterion measures of such morbidity and Relative Operating Characteristic (ROC) analysis. Two-stage screening was carried out with a consecutive sample of 256 patients aged 15-69 consulting an experienced GP in a semi-rural setting over a six-week period. The GP made a standardized assessment of the reason for consultation and the degree of psychological disorder present. A 40% random sub-sample was then assessed using PROQSY. The area under the ROC curve using a GP criterion of minor psychological disorder ('degree of psychological problem - mild or greater') was 0.81 (S.D. = 0.06). However, the kappa coefficient obtained between this criterion assessment and the PROQSY assessment of minor psychological problem at the observed optimal cut-off score was only 0.28 (S.E. = 0.1; Z = 2.83). It is concluded that PROQSY may be recommended for further development as a research tool providing a valid measure of minor psychological morbidity as assessed by GPs in primary care settings.