Quality of life measurement in neurodegenerative and related conditions

Blog post by Crispin Jenkinson, Professor of Health Services Research, Department of Public Health, University of Oxford, and Senior Research Fellow, Harris Manchester College, Oxford, and Michele Peters, Research Officer,  Health Services Research Unit, Department of Public Health, University of Oxford

Patient reported outcome measures (PROMs) are questionnaires that ask people questions about their current health. PROMs assess or measure patients’ quality of life, or what is sometimes referred to as health-related quality of life. Two types of PROMs exists: generic and disease-specific. Generic PROMs can be used across a broad range of diseases as well as the general population; whereas disease-specific PROMs are designed to be used in a specific patient group. Disease-specific instruments are generally regarded as potentially both more precise and sensitive to changes than more generic measures because they are intended to reflect the particular demands of specific conditions. However, generic measures allow comparing health status of (disease) groups to population norms and between disease groups.

Letter from a Pragmatic Idealist

Blog Post by James J. Amos MD, University of Iowa, USA

I read with interest an article from The Hospitalist, August 2008 discussing the Center for Medicare and Medicaid Services (CMS) requirement for hospitals to submit information on Medicare claims regarding whether a list of specific diagnoses were present on admission (POA)[1]. The topic of the article was whether or not delirium would eventually make the list of diagnoses that CMS will pay hospitals as though that complication did not occur, i.e., not pay for the additional costs associated with managing these complications. At the time this article was published, CMS was seeking public comments on the degree to which the conditions would be reasonably preventable through application of evidence-based guidelines. I have no idea whether delirium due to any general medical condition made the list or not. But I have a suggestion for a delirium subtype that probably should make the list, and that would be intoxication delirium associated with using beverage alcohol in an effort to treat presumed alcohol withdrawal.

The role of self-management in the treatment of depression

Blog Post by Albert Yeung, M.D., ScD; Greg Feldman, Ph.D., Maurizio Fava, M.D.

While the exact etiology of unipolar depression continues to be unclear, most clinicians and researchers consider that it is caused by a mixture of genetic predisposition, psychological factors like negative thoughts and unrealistic expectations, and sociological factors like marital problems, tension at work, or difficulties with interpersonal relationships.  Intuitively, treatment of depression should involve a multi-dimensional approach to help patients achieve an improved quality of life. 

The Trouble with the Sensory Examination

Blog Post by J. D. Bartleson MD, Associate Professor and Consultant in the Department of Neurology, Mayo Clinic, Rochester, MN

The sensory examination is problematic for clinicians because all sensory loss – whether it is partial or complete – is subjective.  If the patient gives a good effort, one can usually be confident about the presence or absence of motor weakness including eye movements.  One can be fairly confident about the presence of muscle atrophy and the presence and type of abnormal muscle tone.  One can also be confident about the state of reflexes – deep tendon, pupillary, and corneal, for example.  Even mental status testing can be relied upon so long as the patient gives a good effort, and even then, one can often determine if the patient is purposefully providing wrong answers.

Helping students unlock the mysteries of Bayes

Blog Post by George Bergus, Department of Family Medicine, University of Iowa

I am continually impressed by the link between seeing and understanding. This should not be surprising. How often have we had the experience of being told by a student (or colleague) that “I just don’t see it” after our failed attempts to explain a complex concept. If there is a relationship between seeing and understanding can we facilitate understanding by presenting the concept visually? This is not a novel idea but it is still one which often slips by me particularly in areas where I am facile (such as medical decision making).