In search of evidence for occupational therapy: A new tool

Where is the evidence that occupational therapy intervention can make a difference? In short, it may be found somewhere among thousands of articles, spread over hundreds of journals. It is not surprising that surveys show that a major difficulty facing occupational therapists implementing evidence-based practice is the limited time they have to locate relevant research (Humphris et al, 2000; Bennett et al, 2003).

Differences in carcass grading schemes used in the USA, Japan and Australia

Over the past 30 years there has been increasing pressure for the establishment of a beef, quality grading system in Australia. During this time, many and varied options have been proposed and comparisons have often been made with the United States Department of Agriculture (USDA) and the Japanese Meat Grading Association (JMGA) systems. Australia has now developed a grading system that is driven by the consumer — Meat Standards Australia (MSA). Although some years (70+) behind the USDA, the Australian model has been scientifically proven to identify product that can achieve a guaranteed level of satisfaction to the consumer. While this paper evaluates the 3 systems and their specific operations, both the USDA and JMGA systems are compared with the potential performance of the MSA system applied on a cut by grade by cooking method basis.

Homeostatic competition among T cells revealed by conditional inactivation of the mouse Cd4 gene

Absence of CD4 impairs the efficiency of T cell receptor (TCR) signaling in response to major histocompatibility complex (MHC) class II-presented peptides. Here we use mice carrying a conditional Cd4 allele to study the consequences of impaired TCR signaling after the completion of thymocyte development. We show that loss of CD4 decreases the steady-state proliferation of T cells as monitored by in vivo labeling with bromo-deoxyuridine. Moreover, T cells lacking CD4 compete poorly with CD4-expressing T cells during proliferative expansion after transfer into lymphopenic recipients. The data suggest that T cells compete with one another during homeostatic proliferation, and indicate that the basis of this competition is TCR signaling.

A double-blind, randomized, prospective evaluation of the efficacy and safety of risperidone versus haloperidol in the treatment of schizoaffective disorder

The relative efficacy and safety of risperidone versus haloperidol in the treatment of schizoaffective disorder was studied. Sixty-two patients (29 depressed type; 33 bipolar type) entered a three-site, randomized, double-blind, 6-week trial of risperidone (up to 10 mg/day) or haloperidol (up to 20 mg/day). Trained raters assessed baseline, weekly, and end-of-study levels of psychopathology with the Positive and Negative Syndrome Scale (PANSS), the 24-item Hamilton Rating Scale for Depression (HAM-D-24) and the Clinician-Administered Rating Scale for Mania (CARS-M). The authors were unable to statistically distinguish between risperidone and haloperidol in the amelioration of psychotic and manic symptoms. In addition, there was no difference in worsening of mania between the two agents in either subgroup (i.e., depressed or bipolar subgroups). For the total PANSS, risperidone produced a mean decrease of 16 points from baseline compared with a 14-point decrease with haloperidol. For the total CARS-M scale, risperidone and haloperidol produced mean change scores of 5 and 8 points, respectively, and for the CARS-M Mania subscale, 3 and 7 points, respectively. Additionally, risperidone produced a mean decrease of 13 points from the baseline 24-item HAM-D, compared with an 8-point decrease with haloperidol. In those patients who had more severe depressive symptoms (i.e., HAM-D baseline score >20), risperidone produced at least a 50% mean improvement in 12 (75%) of 16 patients in comparison to 8 (38%) of 21 patients receiving haloperidol. Haloperidol produced significantly more extrapyramidal side effects and resulted in more dropouts caused by any side effect. There was no difference between risperidone and haloperidol in reducing both psychotic and manic symptoms in this group of patients with schizoaffective disorder. Risperidone did not demonstrate a propensity to precipitate mania and was better tolerated than haloperidol. In those subjects with higher baseline HAM-D scores (i.e., >20), risperidone produced a greater improvement in depressive symptoms than haloperidol.

Rehabilitation outcomes for brain injured patients in Australia: functional status, length of stay and discharge destination

This study describes the rehabilitation length of stay (LOS), discharge destination and discharge functional status of 149 patients admitted with traumatic brain injury (TBI) to an Australian hospital over a 5-year period. Hospital charts of patients admitted between 1993-1998 were reviewed. Average LOS over the 5-year time period was 61.8 days and only decreased nominally over this time. Longer LOS was predicted by lower admission motor FIM scores and presence of comorbidities. Mean admission and discharge motor FIM scores were 58 and 79, which represented a gain of 21 points. Higher discharge motor FIM scores were predicted by higher admission motor FIM scores and younger age. FIM gain was predicted by cognitive status and age. Most patients, 88%, were discharged back to the community, with 30% changing their living setting or situation. Changing living status was predicted by living alone and having poorer functional status on admission.

Improving patient recruitment to multicentre clinical trials: the case for employing a data manager in a district general hospital-based oncology centre

One of the most frequently cited reasons for poor recruitment to multicentre randomized clinical trials is the additional workload placed on clinical staff. We report the effect on patient recruitment of employing a data manager to support clinical staff in an English district general hospital (DGH). In addition, we explore the effect data managers have on the quality of data collected, proxied by the number of queries arising with the trial organizers. We estimate that the cost of employing a data manager on a full-time basis is 502 per patient recruited but may amount to 326 if the appointment is part-time. Data quality is high when full responsibility lies with a data manager but falls when responsibility is shared. Whether the costs of employing a data manager to recruit patients from a DGH are worth incurring depends on the value placed on the speed at which multicentre trials can be completed, how important it is to broaden the research base beyond the traditional setting of teaching hospitals, and the amount of evaluative data required.

Effects of calorie and fluid intake on adverse events during hemodialysis

PURPOSE

To investigate the incidence of adverse events during hemodialysis treatments as a function of calories and fluid intake.

METHODS

The study period was August 3-26, 1999. Hemodialysis visits were studied. Twenty-three patients receiving hemodialysis during the 2nd shift on Tuesday, Thursday, and Saturday were studied. A total of 166 hemodialysis patient visits were studied. Data collected included: amount of fluid and food consumed, blood pressure levels, and mannitol use during each hemodialysis treatment; and any symptoms that occurred either during or after the dialysis treatment (hypotension, nausea, vomiting, diarrhea, cramping, and access problems).

RESULTS

Using regression analysis, calories and fluids were strong predictors of both hypotension (P =.003) and mannitol use (P =.000), but not of cramping or access problems. Patients were 3 times more likely to have hypotension if taking any fluids (P =.011). Patients consuming >200 calories were 2 times as likely to have hypotension (P =.058). Patients were 5 times more likely to use mannitol if taking any fluids (P =.005). Mannitol use increased significantly (P =.001) with those patients consuming >200 calories.

CONCLUSION

Patients who ate more than 200 calories and consumed more than 200 mL of fluid during hemodialysis had an increased incident of hypotensive events and increased use of mannitol.

Development, reliability, and concurrent validity of the modified inventory of potential reconstructive needs

Documentation of burn sequelae can be a difficult and time-consuming task. To date a reliable and systematic format for recording postburn trauma is lacking. The purpose of this research was two-fold: first, to develop a Modified Inventory of Potential Reconstructive Needs from the original Inventory of Potential Reconstructive Needs to allow methodical documentation of functional and cosmetic burn sequelae in all body surface areas of children with burns and, second, to establish interrater reliability and concurrent validity of the instrument, thus allowing its clinical application. Two raters scored the Modified Inventory of Potential Reconstructive Needs on 41 children with a range of burns types and severity. Excellent interrater reliability was demonstrated for both total (intraclass correlation coefficient = 0.996) and subsection inventory scores. Concurrent validity was also established with total scores showing strong positive correlations (0.73-0.76) with three indicators of burn severity. These findings provide initial support for the tool's clinical applicability, particularly in relation to rehabilitative planning and documentation.

Impaired survival of T helper cells in the absence of CD4

Signal transduction in response to ligand recognition by T cell receptors regulates T cell fate within and beyond the thymus. Herein we examine the involvement of the CD4 molecule in the regulation of T helper cell survival. T helper cells that lack CD4 expression are prone to apoptosis and show diminished survival after adoptive transfer to irradiated recipients. The helper lineage in CD4(-/-) animals shows a higher than normal apparent rate of cell division and is also enriched for cells exhibiting a memory cell phenotype. Thus the data point to a necessary role for CD4 in the regulation of T helper cell survival and homeostasis.

A longitudinal subspecialty experience for internal medicine residents

OBJECTIVE

Market and technology innovations have greatly changed the teaching and practice of medicine in the past 10 years. This report describes an innovation in the ambulatory education of internal medicine residents: a subspecialty continuity clinic.

METHODS

A subspecialty continuity clinic was developed to improve the training of internal medicine residents in caring for complex ambulatory patients. The clinic structure is discussed from the perspective of patients, residents, and subspecialists. Logistical challenges and solutions are described.

RESULTS

Two and one-half years into the program, feedback from residents and subspecialists has been positive. In-training examination scores are relatively higher in the involved specialties, and residents are managing illnesses they rarely saw in an outpatient setting before this program.

CONCLUSION

This experience suggests that a subspecialty continuity clinic is worthwhile and practical in educating primary care residents.

Negative regulation of CD4 lineage development and responses by CD5

CD5 deficiency results in a hyper-responsive phenotype to Ag receptor stimulation. Here we show that the development and responses of CD4 lineage T cells are regulated by the function of CD5. Thymocytes expressing the I-Ad-restricted DO11.10 TCR undergo abnormal selection without CD5. In H-2d mice, the absence of CD5 causes deletion of double-positive thymocytes, but allows for efficient selection of cells expressing high levels of the DO11.10 clonotype. By contrast, there is enhanced negative selection against the DO11.10 clonotype in the presence of I-Ab. T cell hybridomas and DO11.10 T cells are more responsive to TCR stimulation in the absence of CD5. Such hypersensitivity can be eliminated by expression of wild-type CD5, but not by a form of CD5 that lacks the cytoplasmic tail. Finally, CD5 deficiency partially suppresses the block of CD4 lineage development in CD4-deficient mice. Taken together, the data support a general role for CD5 as a negative regulator of Ag receptor signaling in the development and immune responses of CD4 lineage T cells.

Knowledge about pain among newly graduated occupational therapists: relevance for curriculum development

In recent years there has been a growing awareness amongst health professionals of the need to prepare undergraduate students more adequately for practice with clients who have pain. Occupational therapists have a central role in enabling such clients to have productive lives despite pain. In this study, an examination was made of the adequacy of preparation for pain practice in graduates from one Australian occupational therapy curriculum. Recent occupational therapy graduates from the University of Queensland, Australia, who responded to a postal survey, obtained an overall 53% correct response rate to a 69-item pain knowledge and attitudes questionnaire. Results indicated the need for further education in this area, especially in the areas of pharmacological management, and pain assessment and measurement. These results were comparable to those obtained from final year occupational therapy students at Dalhousie University in Halifax, Nova Scotia prior to undertaking an elective course about pain. Follow-up interviews with a number of new graduates supported the inclusion of an elective pain course in the undergraduate occupational therapy curriculum at the University of Queensland in Australia.

Assessment of pain perception in clinical practice

With pain a frequent precipitant in individuals seeking manual therapy, it is important for therapists to adequately assess pain. At one level, pain forms an important part of the diagnostic assessment. It is suggested that a simple, reliable and quantitative pain measure be used in patients who present with routine problems. At another level, when the therapist is presented with clients in whom pain does not make sense in terms of its pattern, distribution, history or features, it is advisable to go beyond a simple pain intensity measure.

Thioguanine administered as a continuous intravenous infusion to pediatric patients is metabolized to the novel metabolite 8-hydroxy-thioguanine

Thiopurine antimetabolites have been in clinical use for more than 40 years, yet the metabolism of thiopurines remains only partially understood. Data from our previous pediatric phase 1 trial of continuous i.v. infusion of thioguanine (CIVI-TG) suggested that TG was eliminated by saturable mechanism, with conversion of the drug to an unknown metabolite. In this study we have identified this metabolite as 8-hydroxy-thioguanine (8-OH-TG). The metabolite coeluted with the 8-OH-TG standard on HPLC and had an identical UV spectrum, with a lambda(max) of 350 nm. On mass spectroscopy, the positive ion, single quad scan of 8-OH-TG yielded a protonated molecular ion at 184 Da and contained diagnostic ions at m/z 167, 156, 142, and 125 Da. Incubation of TG in vitro with partially purified aldehyde oxidase resulted in 8-OH-TG formation. 8-OH-TG is the predominant circulating metabolite found in patients receiving CIVI-TG and is likely generated by the action of aldehyde oxidase.