Modification, validation and implementation of a protocol for post-thyroidectomy hypocalcaemia

Introduction The management of post-thyroidectomy hypocalcaemia should facilitate early discharge, and reduce risks of hypocalcaemia, readmission and treatment related hypercalcaemia. This paper describes the implementation, evaluation and revision a protocol for the optimal management of this condition. Methods Day 1 parathyroid hormone (PTH) measurements in addition to calcium measurements were commenced following review of the unit's outcomes and literature on post-thyroidectomy hypocalcaemia. Outcomes from a three-year cohort of patients undergoing thyroid surgery helped amend this protocol (revision 1) to reduce biochemical tests, stipulate the need, nature and dose of vitamin D/calcium supplements, and encourage early discharge. This was further validated over seven months to assess compliance, episodes of hyper and/or hypocalcaemia after discharge, readmissions and need for treatment changes. Further revisions were made (revision 2) and implemented. Results The temporary and long-term postoperative hypocalcaemia rates were 29.1% and 3.2% respectively. Repeat calcium measurements on the first day altered management in only 1.4% of cases. The revised protocol was adhered to in 90% of cases. One patient had hypocalcaemia (due to non-compliance) and one had hypercalcaemia. Revision 2 involved reducing the dose of calcium. Conclusions This is a good example of a unit protocol for post-thyroidectomy hypocalcaemia being developed and modified on the basis of the literature and local experience. Day 1 PTH and calcium levels determine the need for treatment and frequency of follow-up visits, facilitate early discharge, reduce risk of over and/or undertreatment, and are good indicators of permanent hypocalcaemia.

Thermoelectricity in polymer composites due to fluctuation-induced tunneling

Thermally induced fluctuations tunneling between localized conducting regions is an important mechanism for transport properties in highly doped polymers.

A gap approach to exploring quality of life in mental health

Improving quality of life (QoL) is an important treatment outcome for the serious mentally ill. There is, however, a need for an instrument which both captures consumers own assessments and gives direct information for intervention. A useful approach is to define QoL as the gap between actual and ideal life circumstances, which is weighted by importance. In this paper we detail how we developed and evaluated a QoL instrument which follows this model. This instrument, the 'QoL-GAP', is based on self-appraised items within various life domains. For each item respondents firstly identify what they have (actual) and then what they would like (ideal). They then rate the item for its importance and make any comments. A weighted gap score for each item is subsequently derived from the ideal actual gap being weighted by the importance rating. This weighted gap score is then related to domain satisfaction ratings, while their average from each domain is related to overall satisfaction and well-being. We surveyed 120 individuals with a serious and enduring mental illness living in different types of residences, such as psychiatric hospitals, hostels, or their own homes, in a largely urban part of Queensland. Sixty-eight percent were males, and 92% had schizophrenia or related disorders. We found that our approach demonstrated good psychometric properties, and that the model-based predictions were borne out: weighted gap measures were consistently more strongly related to domain satisfaction than were the actual circumstances alone. While further work is being undertaken--in such matters as short-forms and further evaluation of the QoL-GAP in a longitudinal study--our results suggest that this 'gap' approach helps consumers state their own goals and give their opinions and so is particularly relevant for consumer-focused mental health delivery and research.

The perceived utility of six selected measures of consumer outcomes proposed for routine use in Australian mental health services

OBJECTIVE

This paper aims to assess the utility of six measures of consumer outcomes: the Behaviour and Symptom Identification Scale, the Mental Health Inventory (MHI), the Medical Outcomes Study 36-Item Short-Form Survey, the Health of the Nation Outcome Scales, the Life Skills Profile (LSP) and the Role Functioning Scale previously recommended for the routine assessment in Australian mental health services.

METHOD

Consumers and service providers were invited through focus group discussions and surveys to describe the perceived utility of these selected measures.

RESULTS

All six measures were rated favourably. The qualitative and quantitative findings suggest that the MHI elicited the most positive results of the consumer measures. No observer-rated scale was clearly preferred.

CONCLUSION

The qualitative feedback obtained indicated that process and context issues may be as important to the successful use of routine instruments for the measurement of consumer outcomes in clinical practice as the choice of instrument.

Choosing negative symptom instruments: issues of representation and redundancy

Assuming that the negative syndrome in schizophrenia may be multidimensional, this study examines how conclusions about the structure of negative symptoms may be influenced by the particular rating scale used, the level of data reduction used (such as total, subscale and individual item scores), and also the type of data analyses used to compare scales. Forty-seven subjects with RDC schizophrenia were rated on three instruments: the negative symptom subscale of the BPRS (BPRS-WR); the negative symptom subscale of the PANSS (PANSS-NS); and the SANS. Comparisons were made of different levels of data reduction and different methods of analysis, which included bivariate correlation, bi-multivariate canonical correlation and redundancy analysis. We found that while the total scores from all three scales were highly correlated and therefore highly redundant, both the individual items and subscale scores from the SANS contained information independent of the BPRS-WR, and also, to a lesser extent, of the PANSS-NS. When the BPRS-WR was correlated with either the SANS or the PANSS-NS, one strong canonical variate (CV) emerged, on which all or most items loaded, particularly the affective items. When the SANS and PANSS-NS were correlated, this component again emerged along with three less strong but interpretable components. When examining the non-symmetrical redundancy, we found that the BPRS-WR variates explained 40% of the SANS variance, while conversely the SANS variates explained 80% of the BPRS-WR variance. The PANSS-NS variates were found to explain 58% of the SANS variance, while the SANS variates explained 85% of the PANSS-NS variance. Finally, the PANSS-NS variates explained 79% of the BPRS-WR variance, while conversely the BPRS-WR variates explained 54% of the PANSS-NS variance. AH three scales appear to measure a single general 'affective' component of the negative syndrome, while the PANSS-NS and the SANS also cover additional components which identify cognitive, anergic and social dimensions. This extra information is lost, however, if inappropriate data reduction and/or statistical analyses are used. The fact that the three instruments predicted the various dimensions of the negative syndrome to different degrees suggests that the best choice of a negative scale depends on the type of information required. Nevertheless, further examination of how negative symptom scales cover the multi-dimensional nature of the negative syndrome is required.

Approaches to measuring quality of life and their relevance to mental health

OBJECTIVES

This paper describes the 'sociological' and health-related approaches to the measurement of quality of life and aims to describe their major findings, shortcomings and potential uses with mental health problems.

METHOD

The literature is selectively reviewed to illustrate the major developments and conclusions.

RESULTS

Despite the lack of an accepted definition of quality of life, sociological approaches have repeatedly shown in general populations, the mentally ill and the elderly that subjective assessments are more influential in determining expressions of happiness, wellbeing and life satisfaction than are the objective circumstances of a person's life. This supports the use of subjective judgements as the basis for quality-of-life determinations..

CONCLUSIONS

The quality-of-life approaches can help to answer a broad range of questions of interest to psychiatry. Health-related quality-of-life approaches are potentially useful methods of demonstrating the impact of mental illness and the benefit of interventions. Further work is required to determine whether the commonly used measures are sensitive to change.

The distribution of adipose tissue in female in-patients receiving psychotropic drugs

Of 51 long-term female in-patients receiving psychotropic drugs, 62% were overweight or obese, and 73% were centrally obese to a degree which could be dangerous to their health. The patients also had waist: hip ratios which were significantly higher than expected for their age and obesity (P < 0.01).

Effects of tamoxifen and protein kinase C inhibitors on hyperthermic cell killing

The effects of the anti-estrogen, tamoxifen, and the protein kinase C inhibitor, 1-(5-isoquinolinylsulfonyl)2-methylpiperazine (H7), on hyperthermic cytotoxicity were studied. Three cell lines were used, a human colon cancer cell line (HT-29), a human mammary carcinoma cell line (MCF-7), and Chinese hamster V79 lung fibroblasts. With all three cell lines, tamoxifen at concentrations greater than 7.5 microM during heating or with a 3-hr exposure prior to heating significantly sensitized cells to heat. When cells were preincubated with 10-20 microM tamoxifen for 1-2 hr at 37 degrees C prior to heat treatment, washed free of extracellular tamoxifen, heated to generate thermoresistance, and examined 18 hr later for thermoresistance, tamoxifen treated HT-29 and MCF-7 cells were significantly more heat sensitive than thermotolerant controls not previously exposed to tamoxifen. In contrast, the degree of induced thermoresistance of V79 cells was unchanged after tamoxifen treatment. H7, but not its structural analogue and low affinity protein kinase C inhibitor, HA1004, also sensitized cells to heat. Neither H7 nor HA1004 had any apparent effect on the degree of heat-induced thermoresistance in the three cell lines tested.

Cytotoxic hyperthermia and Ca2+ homeostasis: the effect of heat on Ca2+ uptake by nonmitochondrial intracellular Ca2+ stores

The effect of cytotoxic hyperthermia on Ca2+ transport by intracellular, nonmitochondrial Ca2+ stores of the human colon cancer cell line, HT-29, was studied using cells permeabilized with saponin. Saponin treatment permitted equilibration of the cytosol with a defined extracellular medium consisting of an intracellular-like ionic composition, ATP and an ATP-regenerating system, and Ca2+/EGTA buffers to adjust the free [Ca2+]. Under the conditions employed, ATP-dependent Ca2+ uptake in saponin-permeabilized cells was demonstrated to be exclusively due to nonmitochondrial Ca2+ stores, e.g., endoplasmic reticulum or calciosomes. Heat treatment for 120 min at 44.5 degrees C sufficient to kill 80% of the cells inhibited ATP-dependent Ca2+ uptake by 50% in terms of rate and total Ca2+ accumulated. With cells made thermotolerant by either arsenite or heat treatment 24 h prior to challenge heating, ATP-dependent Ca2+ uptake was resistant to a second equivalent heat dose. Efflux of Ca2+ from saponin-permeabilized cells when measured at 37 degrees C was unaffected by a prior heat treatment (44.5 degrees C for 120 min).