The minimally important difference for the fatigue visual analog scale in patients with rheumatoid arthritis followed in an academic clinical practice

OBJECTIVE

To estimate the minimally important difference (MID) for a fatigue visual analog scale (VAS) using patient-reported anchors (fatigue, pain, and overall health).

METHODS

Patients with rheumatoid arthritis (RA; n = 307) had 2 clinic visits at a median of 5.9 months apart. They completed a fatigue VAS (0-10 scale) and the retrospective anchor items, "How would you describe your overall fatigue/pain/overall health since the last visit?" with response options: Much worsened, Somewhat worsened, Same, Somewhat better, or Much better. The fatigue anchor was used for primary analysis and the pain/overall health anchors for sensitivity analyses. The minimally changed group was defined by those reporting they were somewhat better or somewhat worsened.

RESULTS

The mean [standard deviation (SD)] age was 59.4 (13.2) years, disease duration was 14.1 (11.5) years, and 83% of patients were women. The baseline mean (SD) Health Assessment Questionnaire-Disability Index score was 0.84 (0.75). The baseline fatigue VAS score was 4.2 (2.9) and at followup was 4.3 (2.8) [mean change of -0.07 (2.5); p = not significant]. The fatigue change score (0-10 scale) for Somewhat better and Somewhat worsened for the fatigue anchor averaged -1.12 and 1.26, respectively. Using the pain anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.87 and 1.13; and using the global anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.82 and 1.17, respectively. Effect size estimates using 3 anchors were small for the Somewhat better (range 0.27-0.39) and Somewhat worsened (0.40-0.44) groups, but larger than for the no-change group (0.03-0.08).

CONCLUSION

The MID for fatigue VAS is between -0.82 for -1.12 for improvement and is 1.13 to 1.26 for worsening on a 0-10 scale in a large RA clinical practice, and is similar to that seen in RA clinical trials. This information can aid in interpreting fatigue VAS in day-to-day care in clinical practice.

[Study of the relation between transformational leadership of the head nurse and supplementary efforts of nursing personnel]

The present study proposes to show that the ethos of the Head Nursing staff is related to the practice of transformational leadership, and to additional efforts displayed by the treatment staff. Using a sampling of 57 nurses, it was established that transformational leadership presented a positive influence on additional efforts which were superior to that produced by transactional leadership. Contrary to transactional leadership, transformational leadership was shown to exert a positive effect on the ethos of the leader who in turn, had a positive influence on the extra care supplied by the nursing staff.

[Family system and delinquant behavior in adolescence in Montréal in 1985.]

This article raises three questions : Has the family unit changed between the mid-70s and the mid-80s? Which characteristics of the family system are the most appropriate indicators of felonious activity? Does the explanation of felonious activity vary according to the sex of an adolescent? Two surveys conducted with Montreal adolescents in 1974 and in 1985 provide the answers. The authors show that the family structure has changed in view of single parenthood, its living conditions have deteriorated, control has been tightened, but emotional relationships have remained the same. The authors have found that the components of a family structure can be related to a precise model ; rebellion precedes delinquency ; didactic methods filter the influence of other family factors ; the psy-chosocial functionning of the family as well as conjugality follow as precipitative factors; finally, structural factors appear to have a remote influence. Also, the authors have noticed a great resemblance between boys and girls with respect to the primordial factors of delinquent behavior. In conclusion, the authors suggest practical involvement, particularly in terms of a diagnostic strategy for family problems, along with intervention strategies according to the type of problem.

Nonallergic bronchial hyperexcitability in chronic bronchitis

The aim of this study was to assess responsiveness to inhaled histamine and methacholine using PC20, the concentration causing a 20% fall in forced expiratory volume in one second (FEV1) in 28 subjects with chronic bronchitis excluding asthma. Eighteen subjects had airway hyperexcitability, as demonstrated by a PC20 less than 16 mg/ml. The response to histamine and methacholine was not significantly different and the correlation coefficient was 0.75. Baseline airway caliber was related to the level of hyperexcitability, as 14 of 14 subjects with a FEV1 to forced vital capacity ratio less than 95% pred and/or a forced expiratory flow during the middle half of the FVC less than 80% pred, and only 4 of 10 subjects with normal spirometry, had a PC20 less than 16 mg/ml (x2 = 15.6, p less than 0.001). There was no correlation between blood or sputum eosinophilia, total IgE levels, or atopy and the level of airway hyperexcitability. Spontaneous daily variations of peak expiratory flow rates were significantly (t = 2.43, p less than 0.05) more pronounced in subjects with PC20 less than 16 mg/ml. We conclude that airway hyperexcitability assessed with PC20 is often present in chronic bronchitis and more often so in the presence of airway obstruction.

Combined alveolitis and asthma due to hexamethylene diisocyanate (HDI), with demonstration of crossed respiratory and immunologic reactivities to diphenylmethane diisocyanate (MDI)

A worker exposed intermittently to hexamethylene diisocyanate (HDI) developed episodes of dyspnea, wheezing, and fever on working days. Complete lung function tests performed when the subject was asymptomatic were normal except for increased airway responsiveness to histamine, which significantly improved after a 3 wk period off work. At that time, specific inhalation challenges with HDI were carried out. After being exposed for 5 min, the subject developed general malaise, cough, fever, and leukocytosis, together with a mixed restrictive and obstructive breathing defect. We demonstrated a subsequent increase in airway hyperexcitability, which lasted for 2 mo. The subject was also challenged with diphenylmethane diisocyanate (MDI) for 15 min. A late obstructive reaction was documented. Increased levels of specific IgG antibodies against HDI-human serum albumin (HSA) and MDI-HSA were demonstrated.

Tinea faciale

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