Use In Clinical Assessment Research Articles

Acute Myeloid Leukemia: Low Peripheral Blast Count May Predict Better Outcome with Best Supportive Care Than with Intensive Chemotherapy in Older Patients

AbstractAbstract 3550 Introduction:Older patients diagnosed with acute myeloid leukemia (AML) present the clinician with particularly difficult treatment decisions. A number of attempts have been made to develop algorithms to assist clinician decision making but these are not widely used. The United Kingdom Medical Research Council AML14 Trial failed to recruit to a randomization between intensive and non-intensive treatment approaches, suggesting that clinicians preferred to use clinical judgement when selecting patients for intensive chemotherapy despite the lack of evidence on how this should be done. Methods:Several published scoring systems were evaluated and two applied retrospectively to 54 consecutive patients older than 60 years old presenting with AML between January 2009 and December 2010 to three collaborating Hematology departments. In addition, the role of the peripheral blast count (less than versus equal to or more than 0.1×109/L), as a marker of degree of proliferation, in predicting outcome was assessed. Treatment decisions for all patients had been based on clinical assessment by a senior physician and discussion by a multidisciplinary team rather than on application of a scoring system. Patients received palliative care only (2), best supportive care (16), non-intensive (9) and intensive (27) chemotherapy. Results:Median overall survival was 5.5 months. A significant difference in survival (12.0 versus 3.2 months, p<0.005 log-rank test) was seen, irrespective of treatment received, between those with low (<6.9, equivalent to predicted treatment related mortality (TRM) of 3%) versus high (>6.9, equivalent to predicted TRM of 20%) scores using the AML Treatment-Related Mortality (AML-TRM) score (Walter RB et al, 2011, J.Clin Oncol. 29:4417), which was developed to predict risk of early death following induction chemotherapy in older patients. Despite the use of clinical assessment only, 65% of low risk patients by AML-TRM had received intensive chemotherapy; 70% of high risk patients had not received intensive chemotherapy. By contrast, the Hematopoetic cell transplantation - specific comorbidity index (HCT-CI) (Sorror ML et al, 2005, Blood 106:2912), developed to assess fitness for transplantation in younger patients, did not predict outcome in this patient group.A peripheral blast count of less than versus equal to or more than 0.1×109/L was found to predict outcome for patients who received best supportive care (Table 1).Table 1Intensive Chemotherapy: Median Survival (months)Best Supportive Care: Median Survival (months)P value (log-rank test)Peripheral blast count <0.1×109/L6.215.90.684Peripheral blast count >0.1×109/L13.21.30.0015Four patients with peripheral blast counts equal to or more than 0.1×109/L who received non-intensive chemotherapy also showed poor survival (median 2.0 months). Conclusions:The previously validated AML-TRM score is a strong predictor of outcome in older patients with AML irrespective of treatment received. However, it is not clearly better than a treatment decision based on clinical assessment by an experienced physician. The peripheral blast count was a single parameter which could be used to influence treatment decisions. In this series, patients with peripheral blast counts less than 0.1×109/L, correlating with less proliferative disease, did at least as well with best supportive care as with intensive chemotherapy. These patients should be offered best supportive care unless a clear curative plan, including for example an allogeneic stem cell transplant after intensive chemotherapy, can be made. However, patients with a peripheral blast count equal to or more than 0.1×109/L did very badly with best supportive care only or with non-intensive chemotherapy and should be offered intensive chemotherapy where possible. Disclosures:No relevant conflicts of interest to declare.

Assessments of sensory processing in infants: a systematic review

The aim of the study was to evaluate the psychometric properties and clinical use of assessments of sensory processing function, within the first 2 years of life, and to identify which assessment is the most appropriate and precise in measuring the construct of sensory processing. The literature was comprehensively searched, and assessments used to measure sensory processing in infancy were systematically selected and reviewed for clinical use, reliability, validity, and responsiveness. Thirty-four assessments were identified; three met the predefined inclusion criteria. All discriminative assessments, the Sensory Rating Scale, and Infant/Toddler Sensory Profile are parent-reported questionnaires and can be administered from birth up to 3 years of age. The Test of Sensory Function in Infants is a performance-based assessment and is suitable for infants aged 4 to 18 months. Studies evaluating the psychometric properties of these three assessments differed in the properties addressed and reported poor to adequate reliability. Selecting the most appropriate and precise assessment to measure sensory processing function in infancy will depend on the specific components of sensory processing that need to be evaluated, infant age, and what other sources of information are available about the infant's development.

Anxiety and depression in oncology patients; a longitudinal study of a screening, assessment and psychosocial support intervention

Background. Anxiety and depression in cancer patients are associated with poor health-related quality of life (HRQOL). Clinical interventions to detect and support patients with these symptoms need to be developed and evaluated. We investigated the feasibility of screening with the Hospital Anxiety and Depression Scale (HADS) in a clinical oncology setting. In patients with anxiety or depression symptoms (HADS >7) we explored the use of clinical assessment and psychosocial support and described the development of anxiety, depression and HRQOL during a six-month period. Material and methods. Four hundred and ninety-five consecutive patients were screened for anxiety and depression at the time of their first visit at an oncology department (baseline). Half of the patients with HADS >7 on any of the two HADS subscales were referred to clinical assessment and psychosocial support (intervention group, IG) and half received standard care (SCG) using a historical control group design. HADS and EORTC QLQ-C30 were completed at baseline and after one, three and six months. Results. One hundred and seventy-six (36%) of 495 patients had anxiety or depression symptoms at screening, HRQOL at baseline was clearly impaired for them. Thirty-six (43%) of 84 IG patients attended clinical assessment, resulting in subsequent psychosocial support for 20 (24%) of them. In the SCG, only five (5%) patients attended clinical assessment after self referral, two received subsequent psychosocial support. Anxiety and depression decreased and HRQOL increased statistically significantly over time although anxiety was frequent and HRQOL impaired during the entire six month period. There were no differences between the SCG and IG regarding anxiety, depression or HRQOL at any time point. Conclusion. Systematic screening with HADS is feasible for oncology patients in clinical settings; it identifies patients with persistent symptoms and increases referral to clinical assessment and utilisation of psychosocial support.

Managing projected midwifery workforce deficits through collaborative partnerships

To address workforce shortages, the Australian Government funded additional nursing and midwifery places in 2009 pre-registration courses. An existing deficit in midwifery clinical placements, combined with the need to secure additional clinical placements, contributed to a serious shortfall. In response, a unique collaboration between Midwifery Academics of Victoria (MIDAC), rural and metropolitan maternity managers (RMM and MMM) groups and Department of Health (DOH) Victoria was generated, in order to overcome difficulties experienced by maternity services in meeting the increased need. This group identified the large number of different clinical assessment tools required to be being completed by midwives supervising students as problematic. It was agreed that the development of a Common Assessment Tool (CAT) for use in clinical assessment across all pre-registration midwifery courses in Victoria had the potential to reduce workload associated with student assessments and, in doing so, release additional placements within each service. The CAT was developed in 2009 and implemented in 2010. The unique collaboration involved in the development of the CAT is a blueprint for future projects. The collaboration on this project provided a range of benefits and challenges, as well as unique opportunities for further collaborations involving industry, government, regulators and the tertiary sector.

Clinical impairment in premanifest and early Huntington's disease is associated with regionally specific atrophy

TRACK-HD is a multicentre longitudinal observational study investigating the use of clinical assessments and 3-Tesla magnetic resonance imaging as potential biomarkers for future therapeutic trials in Huntington's disease (HD). The cross-sectional data from this large well-characterized dataset provide the opportunity to improve our knowledge of how the underlying neuropathology of HD may contribute to the clinical manifestations of the disease across the spectrum of premanifest (PreHD) and early HD. Two hundred and thirty nine gene-positive subjects (120 PreHD and 119 early HD) from the TRACK-HD study were included. Using voxel-based morphometry (VBM), grey and white matter volumes were correlated with performance in four domains: quantitative motor (tongue force, metronome tapping, and gait); oculomotor [anti-saccade error rate (ASE)]; cognition (negative emotion recognition, spot the change and the University of Pennsylvania smell identification test) and neuropsychiatric measures (apathy, affect and irritability). After adjusting for estimated disease severity, regionally specific associations between structural loss and task performance were found (familywise error corrected, P < 0.05); impairment in tongue force, metronome tapping and ASE were all associated with striatal loss. Additionally, tongue force deficits and ASE were associated with volume reduction in the occipital lobe. Impaired recognition of negative emotions was associated with volumetric reductions in the precuneus and cuneus. Our study reveals specific associations between atrophy and decline in a range of clinical modalities, demonstrating the utility of VBM correlation analysis for investigating these relationships in HD.

Detection of fetal malnutrition using “CAN score”

Use of clinical assessment of nutrition status (CAN) score to assess the prevalence of fetal malnutrition among term newborns and to compare other anthropometric criteria used to assess fetal growth. Prospective study of 529 term healthy newborns assessed using CAN score. Complete anthropometric assessment and determination of weight for gestation was done. Using CAN score as a standard, the usefulness of birth weight, weight for gestation, length, head circumference (HC), mid arm circumference (MAC), MAC/HC ratio and Ponderal index to assess fetal nutrition was determined. With a cut off value of 25, CAN score identified 148 (27.97%) malnourished neonates. 4% of appropriate for gestational age neonate were malnourished and 42.9 % of small for gestational age neonates were well nourished. When CAN score was taken as a standard, weight for gestation and MAC/HC had the highest sensitivity to identify malnourished neonates (92.5% & 90.5%). CAN score identifies malnourished neonates which can be missed by other methods and identifies well nourished neonates classified as growth retarded by other methods.

Nitrous oxide can be made more effective and predictable using a closed breathing circuit

We read with interest the study by Babl et al 1 published in the EMJ in November 2008. Central to the protocol and management is the use of clinical assessment...

Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint

The sacroiliac joint (SIJ) has been implicated as a potential source of low back and buttock pain. Several types of motion palpation and provocation tests are used to examine the SIJ. It has been suggested that use of a cluster of motion palpation or provocation tests is a more acceptable method than single test to assess SIJ. This study examined the inter- and intra-examiner reliability of single and composites of the motion palpation and provocation tests together. Twenty-five patients between the ages of 20 and 65 years participated. Four motion palpation and three provocation tests were examined three times on both sides (left, right) by two examiners. Kappa coefficient and prevalence-adjusted and bias-adjusted kappa (PABAK) were calculated to evaluate the reliability. PABAK for intra- and inter-examiner reliability of individual tests ranged from 0.36 to 0.84 (95% CI: −0.22 to 1.12) and 0.52 to 0.84 (95% CI: −0.18 to 1.08) which is considered fair to substantial. PABAK for intra- and inter-examiner reliability for clusters of motion palpation or provocation tests ranged from 0.44 to 0.92 (95% CI: −0.36 to 1.2) which is considered moderate to excellent reliability. PABAK for intra- and inter-examiner reliability of composites of motion palpation and provocation tests ranged from 0.44 to 1.00 (95% CI: −0.22 to 1.12) and 0.52 to 0.92 (95% CI: −0.02 to 1.32) which is considered substantial to excellent. It seems that composites of motion palpation and provocation tests together have reliability sufficiently high for use in clinical assessment of the SIJ.

Screening cancer patients' families with the distress thermometer (DT): a validation study

Although family members of cancer patients are at great risk of experiencing psychological distress, clinical tools to assist with recognizing and intervening with appropriate psychosocial care are sparse. This study reports on the first validation of the distress thermometer (DT) as a screening instrument for symptoms of depression and anxiety in family members of cancer patients. The DT was administered with the Hospital Anxiety and Depression Scale (HADS) in a sample of 321 family members. Receiver operating characteristics (ROC) demonstrated that the DT has good diagnostic utility relative to the HADS (area under the curve= 0.88 relative to the HADS anxiety scale; 0.84 relative to the HADS depression scale, respectively). The ROC curves indicate that using a cut-off of 4/5 maximizes sensitivity (86.2% HADS anxiety scale; 88.2% HADS depression scale) and specificity (71.2% HADS anxiety scale; 67.6% HADS depression scale); however, the alternative lower cut-off of 3/4 increases sensitivity (94.1% for both scales) and hence reduces the risk of missing distressed family members (specificity is 62.9% for HADS anxiety scale; 59.1% for HADS depression scale). The results offer validation of the DT for screening family members of cancer patients and support its use for clinical assessment. Distress screening with DT for family members of cancer patients is a promising and efficient approach to integrating family members in the program of care and provides the first step toward meeting their unmet needs with referral for supportive services.

Quantitative ultrasound predicts bone mineral density and failure load in human lumbar vertebrae

Quantitative ultrasound is in widespread clinical use for assessment of bone quality at peripheral skeletal sites, but has not yet been applied to those sites in the axial skeleton, such as the spine and hip, where osteoporotic fractures are common. Ultrasound measurements were made in 11 cadaveric vertebrae and relationships with bone mineral density and failure load were investigated. An ultrasonic imaging system was used to measure speed of sound, broadband ultrasonic attenuation, and attenuation at a single frequency, through the vertebral body in the sagittal plane. Ultrasonic measurements were averaged over a region of interest centrally within the vertebral body, and were calculated with and without normalization for bone size. Vertebral bone mineral density was measured in antero-posterior and lateral projections using dual energy X-ray absorptiometry. Compressive mechanical testing was performed to determine vertebral failure load. Bone mineral density correlated with failure load (r=0.74-0.78, all P<0.01), and with quantitative ultrasound (r=0.63-0.82, P=0.038-0.004), in line with previous studies. Of the ultrasonic measurements, those parameters not normalized for bone size gave the highest correlations with failure load, ranging from r=0.71 (P=0.021) for speed of sound to r=0.93 (P<0.001) for attenuation. When ultrasonic measurements were normalized for bone size, the correlations with both failure load and bone mineral density were lower. These results confirm the feasibility of vertebral quantitative ultrasound in vitro, and indicate that ultrasound does provide information on both bone mineral density and failure load. The predictive performance of ultrasonic measurements for failure load was comparable to or greater than that of bone mineral density, suggesting that ultrasound has the potential to be at least as useful as mineral density in the assessment of vertebral bone. Normalizing ultrasonic measurements for bone size reduced the strength of correlations because both bone mineral density and bone strength reflect bone size to a certain extent.

Assessment of dynamic walking balance in children with acquired brain injury

Children with brain injuries typically present with walking and balance difficulties, and successful rehabilitation depends on the therapist's ability to measure and understand the different components of gait accurately. Professional guidelines stress the need for adequate outcome measurement. Despite this, there is no standardised assessment of walking balance in children for use in clinical assessment. Measurement tools range from observational to three-dimensional gait analysis. Observational analysis lacks reliability and accuracy whilst clinical gait analysis is time-consuming and costly, requires complex nterpretation and is not routinely available to clinicians. Portable sensors and pressure sensitive devices have recently emerged as alternatives. In situations where it is preferable to avoid attachments to the child, the measurement of the forces or pressures generated by the body to control its movement and balance offers a practical solution. This review will discuss the advantages and limitations of these tools.

The use of outcome scores in surgery of the shoulder

The pursuit of ‘best practice’, health economic planning, the increasing awareness and expectations of patients, pressure from politicians and the media, and the emergence of league tables for surgeons are some of the reasons why orthopaedic surgeons are encouraged to adopt evidence-based

A Brief Overview of the Principles of Psychotherapy with Asperger’s Syndrome

People with Apserger’s syndrome understand and respond to the world in a very different way from other people. Individual psychotherapy can be an important approach, in addition to other therapies and case management, for children with Asperger’s syndrome. A frame of reference for the therapeutic relationship with Asperger individuals is described. This addresses the perspective of those with Asperger’s as well as the perspective of others in their lives. The cognitive concepts theory of mind, central coherence, and executive functioning are briefly reviewed with an emphasis on how they help us to understand the Asperger mind, and with examples of their presentation and use in clinical assessment and psychotherapy. Perspective, intention, and awareness, as they relate to the therapeutic interventions, are illustrated with brief vignettes.

An evaluation of methods for the assessment of healing of open wounds in the dog

Assessment of re‐epithelialization is commonly used to evaluate rates of cutaneous wound healing in experimental studies with treated and control wounds; results may be expressed as percentage of re‐epithelialization over the wound surface. This is difficult with crusted lesions where wound margins are obscured. However, even when measured histologically, this approach does not allow accurate assessment of dermal repair. This study aimed to evaluate and compare the use of clinical assessment, high‐resolution ultrasound (HRU) and histological morphometry in assessment of mode and rate of healing in open wounds of canine skin. The dorsal thoracolumbar area of 10 beagle dogs was clipped and two rows of six full‐thickness cylinders of skin removed (5‐mm punch biopsies) on either side of the midline under general anaesthesia. Wounds were allocated randomly on left and right sides to treatment or control groups and wound gel (active formulation or base) applied twice daily; wounds were allowed to form a scab and heal by second intention. Concentric 8‐mm punch biopsy samples of the healing wounds were taken on days 1, 2, 4, 8 and 14 for histopathological assessment, leaving two wounds per dog to be followed by HRU throughout the study. Wounds were imaged longitudinally and transversely with 20 MHz HRU daily for 28 days using the wound gel as the transmission medium. Wound morphometry was performed on the digital HRU images (diameter at top, middle and bottom, and depth of wound) and on sections from paraffin‐embedded biopsy specimens. The 8‐mm biopsies were not uniformly concentric in relation to the original wounds, owing to concealment of wound margins by crust formation. This confirmed the inaccuracy of visual assessment of healing in the crusted lesions. To allow for asymmetrical positioning of the 8‐mm biopsies, trigonometric extrapolation was used to calculate the real extent of the ulcer and re‐epithelialization; only specimens including both left and right wound margins were used. Measurements at days 4, 8 and 14 were log transformed and analysed using a split‐plot model and the LSD Tukey test. Tongues of new epithelium were 0.20 ± 0.07 mm (SE) at day 4 (11.1%), 0.37 ± 0.08 mm at day 8 (19.3%), and 0.73 ± 0.07 mm at day 14 (35.7%) (P &lt; 0.05). High‐resolution ultrasound provided images throughout the skin allowing differentiation of the wound and surrounding collagen. Longitudinal and transverse measurements of wound depth and width were analysed using a mixed model with post hoc Bonferroni adjustment. Depth reduction was linear whereas width was not. Depth reduced most consistently and rapidly, followed by width at the bottom and then at the middle and top (P &lt; 0.001); wounds narrowed more rapidly transversely (P &lt; 0.001). Dermal healing was still incomplete at 28 days. Scanning with HRU enables frequent, noninvasive, quantitative assessment of structural changes deep within wounds in canine skin. The method shows great promise. Histopathological assessment allows more precision, but does not allow serial examination of wound sites. Funding: The Royal Veterinary College, Innovet.

Strategies and approaches towards evidence-based practice in the management of chronic leg ulcers by nurses working in the community in Kronoberg County, Sweden and the East Riding & Hull, UK

Aim: This paper reports one aspect of a study concerning management of chronic leg ulcers by nurses working in the community in Kronoberg County, Sweden (KC) and the East Riding & Hull, UK (ER). Our study focus was to describe reported evidence-based practice in leg ulcer care in two samples of nurses from two countries. The paper describes the overall utilisation of clinical guidelines and their use in clinical assessment, documentation and resource utilisation. Method: A semi-structured self-administered questionnaire was used. The questionnaire was sent to practising community nurses, nurses working in primary health care and nurses working in nursing homes. A total of 222 nurses working in KC, Sweden and 124 nurses in ER, UK (response rate 55% vs 50%) returned the questionnaire. Results: The results provide a rather mixed picture in relation to evidence-based practice. Whilst 60.3% of nurses in KC and 87.1% in ER use guidelines, the reported use of guidance on diagnostic investigations is much more variable both in terms of frequency and indication ( P=0.000). The widest difference was found in the use of cleansing agents: in KC 83.7% of nurses used tap water against 92.8% of nurses in ER who used a sodium chloride preparation ( P=0.000). Conclusion: This study provides information on the reported use of guidelines by the nurses in two different countries. It raises questions about the relationship between evidence and practice. Comparison between the two countries helps to expose the taken for granted expectations of practice.

Combined use of clinical assessment and d-dimer to improve the management of patients presenting to the emergency department with suspected deep vein thrombosis (the EDITED Study)

Suspected deep vein thrombosis (DVT) is a common problem facing emergency physicians. Timely diagnostic testing must be performed to accurately identify patients with DVT. The purpose of this study was to evaluate the safety and effectiveness of a management strategy that combined consideration of clinical pretest probability and a d-dimer test to evaluate patients presenting to the emergency department with suspected deep vein thrombosis (DVT). A prospective cohort study was performed in the emergency departments of four tertiary care institutions involving 1075 patients with suspected DVT. An emergency physician determined the pretest probability for DVT to be low, moderate, or high using an explicit clinical model. A blood sample was taken for d-dimer testing. Subsequent investigations (compression ultrasound, venography) were performed based upon the pretest probability and the d-dimer result. Patients considered at low pretest probability with negative d-dimer had no further diagnostic testing performed. All patients in whom the diagnosis of DVT was excluded by the algorithm did not receive anticoagulant therapy and were followed up for 90 days for the development of proximal DVT or pulmonary embolism. Overall, 195 (18.1%; 95% CI 15.9% to 20.6%) of 1075 patients were confirmed to have proximal DVT. Of the 882 patients who had proximal DVT excluded during the initial evaluation period using the algorithms, four (0.5%; 95% CI 0.1% to 1.2%) were subsequently diagnosed with proximal DVT in the follow-up period, including three patients in the low pretest probability group (1.0%; 95% CI 0.2% to 2.1%) who had normal d-dimer and no additional diagnostic testing performed. None of the 882 patients (0%: 95% CI 0% to 0.5%) developed pulmonary embolism in the follow-up period. A diagnostic strategy for the evaluation of patients with suspected DVT based on pretest probability and d-dimer is safe and feasible in the emergency department setting.

Ultrasonography and computed tomography in suspected acute appendicitis

Patients with typical signs and symptoms of acute appendicitis should have a prompt surgical consultation for timely appendectomy. The use of diagnostic imaging tests such as CT scan or ultrasonography should be selective in those with atypical presentation or findings. The high accuracy of imaging tests can be achieved when they are utilized according to well thought out clinical pathways. The use of imaging modalities in suspected acute appendicitis should be complement to, but not replacing, clinical assessment and judgement. The skillful use of clinical assessment and imaging modalities will reduce the negative appendectomy rate yet assure low perforation and mortality rates.

MH3: CLINICAL ASSESSMENT OF QUALITY OF LIFE AMONG SCHIZOPHRENIA PATIENTS WITH DEFICIT SYNDROME

OBJECTIVE: To determine whether persons with deficit syndrome exhibit lower quality of life than do their counterparts. METHODS: Participants were drawn from the U.S. Schizophrenia Care and Assessment Program (SCAP). Trained assessors collected baseline data. Baseline QLS was used (n = 781; mean = 56) and was modeled as a linear function of covariates, including demographic, clinical, medication adherence, and site variables. Presence of deficit syndrome was assigned based on proxy methods using clinical data collected at the baseline assessment (Kirkpatrick B., et al., 1993). RESULTS: Modeling revealed that deficit syndrome had a negative impact of 4.7 points (p < .001) on quality of life score (range 0–120), suggesting that persons with deficit syndrome may experience a significantly lower quality of life than their non-deficit counterparts, all else equal. Those having higher hallucinations/delusions scores (p < .001) exhibited lower QLS scores and those with higher functioning scores (GAF; p < .001) exhibited higher QLS scores. The presence of insurance other than Medicare or Medicaid (as compared to no insurance) revealed a positive relationship to QLS score. Significance was achieved on one site variable and indicated a negative relationship. Weak evidence was obtained (p = .0587) indicating a positive association between higher education level and QLS score. CONCLUSIONS: Findings suggest that persons with deficit syndrome experience lower quality of life than those who are non-deficit. The result is expected given the use of clinical assessment of quality of life and is contrary to the expectation of higher self-reported quality of life for persons with deficit. Although the clinical and functional scores are significant, the impact of deficit syndrome is at least five times greater than that of hallucinations/delusions. The interpretation of significance on the insurance and site variables is less clear and may suggest that the observed variation is a result of an unobserved mediating process, such as selection or differential access.

Validation of a fatigue impact score in primary biliary cirrhosis: towards a standard for clinical and trial use

Background/Aims: Fatigue is the commonest symptom of the chronic liver disease primary biliary cirrhosis (PBC). PBC is increasingly being diagnosed earlier in its natural history at a stage when concerns about progression to liver failure may be less prominent than current symptoms. The importance of symptomatic treatment is therefore increasingly being recognised. Research into the aetiology and treatment of fatigue in PBC has been hampered by the lack of relevant, reproducible measures of fatigue severity. The aim of this study was to validate the Fisk Fatigue Severity Score (FFSS), a measure of the impact of fatigue on daily living, for use in PBC and to use the FFSS to study the severity and correlates of fatigue in this condition.Methods: Fifty-eight patients with PBC and 31 matched control patients attending hospital for non-hepatic disease were studied. The reproducibility of FFSS was assessed over periods from 1 hour to 1 month. Fatigue, as measured by FFSS, was compared in PBC patients and controls. The severity of fatigue in the patients with PBC was correlated with other symptoms and with established biochemical and histological markers of severity.Results: The FFSS questionnaire was acceptable to patients and had reasonable intra-observer variation (coefficient of reproducibility 13% of mean value at 1 hour). The FFSS was more reproducible than a visual analogue scale. FFSSs varied over 4 weeks by up to 36%. Median FFSS's were 2.3 times higher in PBC patients than controls (p<0.005). There were no associations between FFSS and patient age, disease duration, or histological or biochemical markers of severity.Conclusions: The FFSS is a highly acceptable, internally consistent and reproducible measure of fatigue severity in PBC. We advocate its use in clinical assessment of patients, in studies of the aetiology of fatigue in PBC and, most importantly, in therapeutic trials of symptomatic treatment.

A preliminary version of a computerized naming test for preschool children with language impairment

The most prevailing hypothesis regarding mechanisms behind specific language impairment today is the hypothesis of general limitations of processing capacity. Such an hypothesis can hardly be tested by available language assessment tools, especially not by instruments in use for clinical assessment of the lexical-semantic domain in children. Reduced naming speed is by some researchers considered as a core deficit in dyslexia and a better predictor of some aspects of reading proficiency than phonological processing. The overall purpose of the present study was therefore to develop a processing dependent tool, that could capture dynamic aspects of naming; response latencies, hesitation phenomena and contextual influence. We also present data from 30 children (4-6 years old) with normal language development. We believe that, with some modifications, the naming test has a potential of becoming a processing dependent measure of naming and a necessary complement to the assessment of vocabulary skills in children with language impairment.