Development and psychometric validation of a brief comprehensive health status assessment scale in older patients with hematological malignancies: The GAH Scale

OBJECTIVES

The purpose of this study was to develop a new brief, comprehensive geriatric assessment scale for older patients diagnosed with different hematological malignancies, the Geriatric Assessment in Hematology (GAH scale), and to determine its psychometric properties.

MATERIALS AND METHODS

The 30-item GAH scale was designed through a multi-step process to cover 8 relevant dimensions. This is an observational study conducted in 363 patients aged≥65years, newly diagnosed with different hematological malignancies (myelodysplasic syndrome/acute myeloblastic leukemia, multiple myeloma, or chronic lymphocytic leukemia), and treatment-naïve. The scale psychometric validation process included the analyses of feasibility, floor and ceiling effect, validity and reliability criteria.

RESULTS

Mean time taken to complete the GAH scale was 11.9±4.7min that improved through a learning-curve effect. Almost 90% of patients completed all items, and no floor or ceiling effects were identified. Criterion validity was supported by reasonable correlations between the GAH scale dimensions and three contrast variables (global health visual analogue scale, ECOG and Karnofsky), except for comorbidities. Factor analysis (supported by the scree plot) revealed nine factors that explained almost 60% of the total variance. Moderate internal consistency reliability was found (Cronbach's α: 0.610), and test-retest was excellent (ICC coefficients, 0.695-0.928).

CONCLUSION

Our study suggests that the GAH scale is a valid, internally reliable and a consistent tool to assess health status in older patients with different hematological malignancies. Future large studies should confirm whether the GAH scale may be a tool to improve clinical decision-making in older patients with hematological malignancies.

Sensitivity study of surface wind flow of a limited area model simulating the extratropical storm Delta affecting the Canary Islands

Abstract. In November 2005 an extratropical storm named Delta affected the Canary Islands (Spain). The high sustained wind and intense gusts experienced caused significant damage. A numerical sensitivity study of Delta was conducted using the Weather Research & Forecasting Model (WRF-ARW). A total of 27 simulations were performed. Non-hydrostatic and hydrostatic experiments were designed taking into account physical parameterizations and geometrical factors (size and position of the outer domain, definition or not of nested grids, horizontal resolution and number of vertical levels). The Factor Separation Method was applied in order to identify the major model sensitivity parameters under this unusual meteorological situation. Results associated to percentage changes relatives to a control run simulation demonstrated that boundary layer and surface layer schemes, horizontal resolutions, hydrostaticity option and nesting grid activation were the model configuration parameters with the greatest impact on the 48 h maximum 10 m horizontal wind speed solution.

High resolution modelling results of the wind flow over Canary Islands during the meteorological situation of the extratropical storm Delta (28–30 November 2005)

Abstract. On 28–29 November 2005 an extratropical storm affected the Canary Islands causing significant damage related to high average wind speeds and intense gusts over some islands of the archipelago. Delta was the twenty-sixth tropical or subtropical storm of the 2005 Atlantic hurricane season. It represents an unusual meteorological phenomenon for that region, and its impacts were underestimated by the different operational meteorological forecasts during the previous days of the arrival of the low near Canary Islands. The aim of this study is to reproduce the local effects of the flow that were observed over the Canary Islands during the travel of the Delta storm near the region using high-resolution mesoscale meteorological simulations. The Advanced Research Weather Research & Forecasting Model (WRF-ARW) is applied at 9, 3 and 1 km horizontal resolution using ECMWF forecasts as initial and boundary conditions. The high-resolution simulation will outline the main features that contributed to the high wind speeds observed in the archipelago. Variations in vertical static stability, vertical windshear and the intense synoptic winds of the southwestern part of Delta with a warm core at 850 hPa were the main characteristics that contributed to the development and amplification of intense gravity waves while the large-scale flow interacted with the complex topography of the islands.

Forecasting the air pollution episode potential in the Canary Islands

Abstract. In the frame of the WMO Global Atmosphere Watch Urban Research Meteorology and Environment programme (GURME), a system for forecasting air pollution episode potential in the Canary Islands has been developed. Meteorological parameters relevant to air quality (synoptic wind speed, wind direction, boundary layer height and temperature at 91 vertical levels) are obtained from the European Centre for Medium range Weather Forecasting (ECMWF) once a day for up to four days ahead. In addition, a model based on the analogue method utilising six years of historical meteorological and air quality data predicts the probability of SO2 concentration exceeding certain thresholds for a measurement station located in Santa Cruz de Tenerife. Meteorological forecasts are also provided from a high resolution (2 km) local area model (MM5) implemented for the Canary Islands domain. This simple system is able to forecast meteorological conditions which are favourable to the occurrence of pollution episodes for the forthcoming days.

Psychometric field study of the new haemophilia quality of life questionnaire for adults: The 'Hemofilia-QoL'

Although there is a worldwide interest in the assessment of health-related quality-of-life (HRQoL) in haemophilia patients, no non-disease specific instruments (for adults) are readily available. In this paper, a haemophilia-specific quality-of-life assessment measure for adults (the Hemofilia-QoL questionnaire) has been developed and tested for psychometric properties in 121 adults with haemophilia living in Spain. The Hemofilia-QoL questionnaire is a self-report modular instrument that assesses nine relevant HRQoL domains for patients with haemophilia (e.g. physical health, daily activities, joint damage, pain, treatment satisfaction, treatment difficulties, emotional functioning, mental health, relationships and social activity). Psychometric examination involved the assessment of data quality, scaling assumptions, reliability (internal consistency and test-retest) and validity (concurrent; external clinical criterion and sensitivity). The Hemofilia-QoL 36-item version questionnaire had acceptable internal consistency and retest reliability values. The questionnaire shows excellent concurrent validity (with the SF-36 Health Survey) and external clinical criterion validity (haemophilia clinical status) and sensitivity (health status changes) as well. The Hemofilia-QoL is now available for adult assessment and is ready for use in clinical research in Spain.

Development of a new disease-specific quality-of-life questionnaire to adults living with haemophilia

A haemophilia-specific health-related quality-of-life questionnaire (named 'Hemofilia-QoL') was developed to assess quality-of-life in adults with haemophilia, and was psychometrically tested. Seventy-three interviews with haemophilia patients and health care professionals were used to generate the items included in the questionnaire, and expert ratings on the items formulated were used to screen them for potential omission. This was followed by psychometric testing in a sample of 35 patients. Preliminary psychometric testing of the revised questionnaire version, which contains 10 domains (physical health, physical role, joint damage, pain, treatment satisfaction, emotional role, mental health, social support), showed acceptable reliability (alpha = 0.94 for the Hemofilia-QoL total score) and validity, and this will be examined in a subsequent study with a larger patient sample.

[Early and late epileptic crisis following cerebral hemisphere ischemia]

INTRODUCTION

There is no agreement as to the frequency and characteristics of epileptic seizures (ES) associated with cerebrovascular disease (CVD).

OBJECTIVE

To analyze the presence of early (Se) and late (SI) ES, factors related to these, prognosis and conversion to epilepsy.

PATIENTS AND METHODS

We made a retrospective study of 386 patients with cerebral hemisphere ischemia (100 TIA and 286 infarcts). Follow-up was 29.69 +/- 13.92 months. Two groups were defined: a) Patients without ES, and b) patients with ES. Those occurring within 15 days of the episode of ischemia were considered to be Se and the others Sl. We studied the prognosis (modified Rankin scale on discharge from hospital) and mortality.

RESULTS

Twenty three patients (6%) had crises (18 Se and 5 Sl). The commonest type was simple partial motor crises (13 or 56.5%) followed by generalized tonic-clonic crises (9 or 39.1%) which predominated in the Se group. There were 6 solitary crises (Se) and 17 (73.9%) recurrences (66.6% of the Se and 100% of the Sl) (p = 0.049). There was an association between the presence of a family history of epilepsy (p < 0.001) and increased risk factors for epilepsy and CVD, particularly previous ictus and cardiopathy respectively (p = 0.034). No patient with TIA or lacunar infarct had ES. Extensive infarcts showed and increased tendency to the associated with hemorrhagic transformation, involvement of the cortex (p < 0.001) and cardioembolic incidents (p = 0.025). They had a worse prognosis, led to more disability (p < 0.001) and earlier mortality (38.4%) (during the first three months) (p = 0.015). These factors were associated (p < 0.001).

CONCLUSIONS

Postischemic cerebral seizures are frequent and have a high recurrence rate, especially in patients with extensive infarcts involving the cortex and these of embolic origin. The prognosis is worse when crises occur early.

Multiple sclerosis in Móstoles, central Spain

OBJECTIVES

Until relatively recently southern Europe was regarded as having a medium to low multiple sclerosis prevalence, of about 20 or less per 100,000. However, recent studies in Sardinia, Sicily, continental Italy, Cyprus and Spain have yielded higher MS prevalence rates, between 32 and 102.6 per 100,000. We present the results of a prevalence study of MS in the municipality of M6stoles, central Spain.

MATERIAL AND METHODS

To ascertain the prevalence of multiple sclerosis in M6stoles (195,979 inhabitants), an intensive study was undertaken using several sources of information. We used the Poser criteria in diagnosis.

RESULTS

There were 85 patients (53 women and 32 men) classified as definite or probable, prevalence 43.4/100,000 (95% CI, 34.7 to 53.7). The incidence rate was 3.8/100,000/year (95% CI, 2.7 to 5.3) in the last 5 years. Mean age on prevalence day was 38.8+/-10.9 years. Mean age at onset was 31.7+/-9.3 years. Mean interval between initial symptoms and diagnosis was 1.7 years. Mean duration of disease was 7.6+/-6.1 years. Overall, 70.6% had a relapsing-remitting course, 18.8% had a primary progressive and 10.5% had a secondary progressive. Mean EDSS score was 2.7+/-1.9.

CONCLUSION

The M6stoles study confirms the conclusions of previous smaller population studies that Spain is a moderately high or medium MS risk zone.

[Association of plasmapheresis and high doses of intravenous immunoglobulins in the treatment of myasthenia gravis]

INTRODUCTION

In the past decade good therapeutic results have been reported with high dosage of intravenous immunoglobulins (Ig i.v.) in various autoimmune disorders, including myasthenia gravis (MG). Plasmapheresis has been used successfully in this disorder on indications similar to those described for the use of Ig i.v.. We have used sequential treatment of plasmapheresis followed by high doses of intravenous gammaglobulin in MG, seeking complementary benefits from the two kinds of treatment.

MATERIAL AND METHODS

The sample included 10 patients with MG (7 of Osserman's grade II-B, 1 of II-A and 2 of III). We began treatment with plasmapheresis, and then continued with an i.v. infusion of Ig at a dose of 400 mg/Kg/day for 5 days. To evaluate the response to treatment, we used the classification system for muscle weakness based on the Virginia University modification of Osserman's grades, on the clinical involvement grade scales and on functional activity.

RESULTS

All patients showed statistically significant improvement of the parameters studied. Improvement started between the first and sixth day, following administration of Ig i.v. and persisted for the following 16 weeks.

CONCLUSIONS

We consider that combined treatment with plasmapheresis and Ig i.v. may synergically potentiate the immunological effects since they have different mechanisms of action. The indication for this is limited to serious clinical conditions resistant to other treatment, to speed recovery.