Subjective scoring of cough in children: parent-completed vs child-completed diary cards vs an objective method

Cough is often used as an outcome measure, although the reporting of cough is unreliable. Using a 24 h ambulatory cough meter to measure cough frequency, the aim of this study was to compare: 1) the correlation of child-completed diary cards to the objective measurement, with that of parent-completed diary cards; and 2) the visual analogue scale (VAS) to the verbal category descriptive (VCD) score. The cough meter consisted of a previously validated Holter monitor and a cough processor. Eighty four children (39 with recurrent cough and 45 controls, aged 6-17 yrs) used a cough meter at least once. Thirty three subjects used the cough meter twice. Parents and children completed separate diary cards using the VAS and VCD scores. The strength of the relationship between the subjective scores and the objective recordings was analysed by spearman's rank correlation coefficient. For daytime cough, child-completed diary cards and the VCD correlated better to the objective measurement than parent-completed diary cards and the VAS, respectively. In subjects that used the cough meter twice, the difference between the cough frequency correlated to the difference in the subjective scores. The confidence intervals for the correlation coefficients were wide. The agreement between the objective and subjective presence of daytime cough was good but that for night-time cough was poor. We conclude that the severity of cough defined on diary cards may not represent cough frequency. Objective readings are first choice but currently not yet practical. The verbal category descriptive diary card completed by children and assisted by parents has the highest correlation to cough frequency measured objectively.

A new use for an old Holter monitor: an ambulatory cough meter

Cough is commonly used as an outcome measure in clinical studies, although the subjective reporting of cough is unreliable when compared to objective measures. We describe an inexpensive new ambulatory cough meter that is based on a disused Holter monitor. The cough meter consists of a Holter monitor and a cough processor, designed on a computer to select the most appropriate filters. The cough meter was then validated against the overnight tape recorder on 21 occasions in 18 children (aged 6-15 yrs). The agreement between the cough meter and the tape recorder was good (mean difference of -0.3 coughs x h(-1); limits of agreement -2.2 to 1.7 coughs x h(-1)). We conclude that our newly described ambulatory cough meter provides a valid and inexpensive method of objectively monitoring cough for up to 24 h.

Medical knowledge overload: a disturbing trend for physicians

The article examines responses of more than 500 physicians questioned about the time available for reading professional journals over the past 5 years as well as their utilization of information retrieval systems. It also examines physicians' perceptions of professional medical sales personnel as medical information sources.

Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs

One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs.

Another wall that crumbled--methadone maintenance treatment in Germany

During the past quarter-century there have been innumerable reports throughout the world documenting the effectiveness of methadone maintenance treatment. None have been as consistently positive as those from Germany, where just a few years ago methadone was effectively banned. The German accomplishments in the past 6 years in treating addicts with methadone confirm the experience elsewhere: Methadone treatment is a highly desired alternative to many who wish to escape the life of the street addict; it is very effective in benefiting the individual patient as well as the general community; and it can be expanded rapidly and on a large scale. What is needed today is not further discussion but a firm commitment to make treatment available on request to every addict willing to accept it. With methadone maintenance--one treatment approach among many--this goal is achievable. There is no justification for settling for less.

Retention of patients who entered methadone maintenance via an interim methadone clinic

Time in treatment is considered an important predictor of good outcomes for drug abuse treatment. Patient retention would be of particular concern for low-service types of treatment. Interim methadone maintenance was developed as an alternative to waiting lists and as a method of providing HIV risk-reduction services to heroin addicts waiting for treatment, and does not include the regular counseling required in comprehensive methadone treatment. This analysis compares the retention of patients first admitted to an interim methadone clinic versus that of patients admitted directly to a comprehensive methadone clinic. The two groups did not differ with regard to demographic characteristics and drug of abuse at the time of admission. The two groups did not differ with respect to demographics. The three-, six-, and 12-month retention rates of patients first admitted to the interim clinic were 78%, 69%, and 62%, respectively. The three-, six-, and 12-month retention rates for patients admitted directly to a traditional methadone clinic were 84%, 76%, and 68%, respectively. Life-table analysis revealed that the two groups did not differ significantly with regard to retention (p = 0.17). Interim treatment does not appear to adversely affect overall retention in treatment. Three- and six-month retention rates of interim clinic patients fall within the range of six-month nationwide retention rates reported by the GAO. Factors associated with discharge from treatment are examined for both groups.

Harm reduction--a common cause

In a field as complex as heroin addiction, controversy is useful in stimulating exchange of ideas. An appeal for action, however, based on what we already know to be enormously beneficial to addicts and to the general society, must be given higher priority than proselytizing for any given approach. We know that narcotic addiction takes a terrible toll and that, like alcoholism, we are currently unable to cure it. We also know that many addicts desperately seek methadone treatment, that many can be helped by it, and that many will die without it. The conclusion is clear: methadone treatment, one therapeutic approach among many, must be available upon request to all those who want it.

Methadone treatment: experiment and experience

The relationship between public policy and scientific investigation is explored by a review of the experience with methadone maintenance treatment for narcotic addiction. The implementation of a widespread treatment effort in Hong Kong in the 1970s is contrasted with recent policies in regard to methadone treatment expansion in the United States. In neither case did research findings form the basis for public policy. In Hong Kong, rapid expansion of methadone treatment was initiated before scientific evidence was available to support this course, and in the United States treatment expansion has been rejected despite extensive evidence of its utility and safety. Decisions by government officials and health care providers, as in the case of addiction treatment, may be influenced more by philosophy and intuition than by scientific evidence. Scientists must recognize and address this reality if they are to play a meaningful role in shaping public health policy.

The buyer-supplier interface under just-in-time relationships

In any contractural relationship, legally and ethically, all parties much benefit. Minor concessions to one party can be significant gains for the other. To establish the win/win environment, it is sometimes necessary to make reasonable concessions that preserve the overall objective of the JIT concept. It is good business sense to make those concessions that are inexpensive and guarantee greater control. The concessions discussed strengthen the buyer-seller relationship and aid in reaching the objectives of JIT.