Sharon Wood-Dauphinee

Critically ill children are at risk for psychological sequelae following pediatric intensive care unit hospitalization. This article reports on the psychometric testing of the first self-report measure of psychological distress for 6-12-yr-old children post-pediatric intensive care unit hospitalization: The Children's Critical Illness Impact Scale. This 23-item scale takes approximately 15 mins for children to complete. Psychometric testing based on Classic Test Theory and guidelines for health measurement scale development. The pediatric intensive care units of four Canadian pediatric hospitals and the ear, nose, and throat clinic of one participating hospital. A total of 172 children (pediatric intensive care unit group, n = 84; ear, nose, and throat group, n = 88) aged 6-12 yrs and their parents. None. We assessed the factor structure, internal consistency, and test-retest reliability of the Children's Critical Illness Impact Scale and conducted contrasted group comparisons and convergent and concurrent validation testing. Fit indices and internal consistency were best for a three-factor solution, suggesting three dimensions of psychological distress: 1) worries about getting sick again, 2) feeling things have changed, and 3) feeling anxious and fearful about hospitalization. As expected, Children's Critical Illness Impact Scale scores were positively correlated with child anxiety and medical fear scores. The ear, nose, and throat group scores were higher than expected. Higher Children's Critical Illness Impact Scale scores in older children may reflect a better understanding of the situation and its complexity and meaning, and younger children's tendency to provide more positive self-evaluation. The Children's Critical Illness Impact Scale is a promising new self-report measure of psychological distress with demonstrated reliability and validation testing in 6-12-yr-old children post-pediatric intensive care unit hospitalization. This new measure has potential to advance the evidence base for pediatric intensive care unit and post-pediatric intensive care unit health promotion interventions.

This trial compares the effects of task-oriented physical therapy (PT) provided with and without the use of rehabilitation technology on locomotor recovery in 63 persons with subacute stroke. Participants in the experimental (EXP) group used a treadmill, a Kinetron isokinetic exerciser, and a limb-load monitor, whereas those in the control (CTL) group did not while engaging in PT 1 h per day, 5 days per week for 2 months. Locomotor recovery was assessed by clinical (gait speed, Fugl Meyer motor leg and arm subscores, the Balance Scale, the Timed Up and Go, and the Barthel ambulation subscore) and laboratory outcomes (gait kinematics and kinetics) pre- and posttherapy and 3 months later. Within groups, gait speed (P < 0.01) and all secondary measures improved posttherapy (P < 0.01-0.05), and improvements in clinical measures were maintained at follow-up, but there was no difference between groups (P > 0.05). When the groups were pooled, the increase in gait speed was associated (r = 0.52, P = 0.003) with an increase in ankle power generation of the affected leg. The results demonstrate that the efficacy of the task-oriented approach is not dependent on rehabilitation technology.

Teaching awards are commonly regarded as an incentive to encourage pedagogic excellence. Inasmuch as their effectiveness depends on how they are perceived by faculty, the authors investigated the impact of a teaching award in the Faculty of Medicine (Faculty Honor List for Educational Excellence) on the attitudes of award recipients and departmental chairs. A questionnaire was designed to sample opinion on the extent to which the Honor List program was publicized, whether the award contributed to recognition and/or stature in the academic unit, and whether it was personally valued by recipients. The questionnaire was sent to all 23 departmental chairs and to all 43 faculty members who had received the award between 1998 and 2002; 78% of the chairs and 77% of the recipients responded. The results revealed marked discrepancies between the perceptions of chairs and recipients. Chairs, although uncertain of the effect on quality of teaching, largely regarded the award as prestigious and well publicized within their departments. A notably smaller percentage of award recipients shared these views. Nonetheless, 93% of recipients valued the award highly, and 45% of recipients indicated that the award inspired them to enhance the quality of their teaching.

The hypothesis that patients with chronic obstructive pulmonary disease (COPD) have chronic inspiratory muscle fatigue was tested in an effectiveness trial in which negative pressure ventilation (NPV) was used to produce inspiratory muscle rest. In a double-blind study 184 patients with severe COPD were randomly allocated active or sham NPV treatment for a 12-week period of home use. The distance walked in a 6 min walk test was the primary outcome variable. Secondary outcome measures were cycle exercise endurance time, severity of dyspnoea, quality of life, arterial blood gas tensions, and respiratory muscle strength. The percentage reduction in amplitude of the diaphragmatic electromyographic signal multiplied by hours of NPV was used to reflect the dose of NPV so we could examine dose-response relations. Analysis was based on intention to treat. We found no evidence of a clinically or statistically significant difference in any outcome measure between active and sham groups. No dose-response relation was observed. Moreover, the intervention was poorly accepted despite substantial clinical support. We conclude that NPV as used in this study is difficult to apply and ineffective when used with the aim of resting the respiratory muscles in patients with stable COPD.

This report documents the design and methods of a randomized clinical trial designed to test the effectiveness of home negative pressure ventilation in patients with severe chronic obstructive pulmonary disease. Active negative pressure ventilation was compared with a sham version of the treatment after a pre-trial assessment had indicated the feasibility of the latter. Over 1200 patients in the metropolitan Montreal area were screened. Of these, 348 patients were recruited to enter a 4-week stabilization period, and 184 were subsequently randomized to receive either active or sham negative pressure ventilation. A 5-day in-hospital period was used to train patients in ventilator use and obtain baseline measures of exercise capacity, lung function, respiratory symptoms, and quality of life. Home ventilation treatment took place during a following 12-week period. Respirator use was recorded both from patient logs and from concealed meters installed in the units. Patients received four home visits by physiotherapists during the 12-week period and returned for follow-up to the hospital 4 and 12 weeks post-discharge for reassessment.