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Patients treated with clozapine are required to have regular venous blood samples taken to measure white blood cell (WBC) and neutrophil counts to reduce the risk of agranulocytosis. The need for regular venous blood sampling can deter patients and clinicians from treatment with clozapine. Finger prick sampling offers patients a simpler and less invasive technique that is likely to be more acceptable. We undertook to evaluate a novel point of care testing (POCT) device which measures WBC and neutrophil counts using a small volume of capillary blood from a finger prick sample.

Case: A toddler underwent percutaneous pin fixation for a type III supracondylar humerus fracture (SHF). At home, her cast fell off and her k-wires pulled out. Subsequently, she presented to the emergency department for biting the tip of her index finger off and chewing on her thumb and middle fingers. She was diagnosed with a median nerve (MN) palsy with associated paresthesia., Conclusion: In very young children, it may be difficult to cope with the sensation of paresthesias after a MN palsy after a SHF. Self-mutilation of the fingers may be an unfortunate complication from these paresthesias.

Instrument content validity is often established through qualitative expert reviews, yet quantitative analysis of reviewer agreements is also advocated in the literature. Two quantitative approaches to content validity estimations were compared and contrasted using a newly developed instrument called the Osteoporosis Risk Assessment Tool (ORAT). Data obtained from a panel of eight expert judges were analyzed. A Content Validity Index (CVI) initially determined that only one item lacked interrater proportion agreement about its relevance to the instrument as a whole (CVI = 0.57). Concern that higher proportion agreement ratings might be due to random chance stimulated further analysis using a multirater kappa coefficient of agreement. An additional seven items had low kappas, ranging from 0.29 to 0.48 and indicating poor agreement among the experts. The findings supported the elimination or revision of eight items. Pros and cons to using both proportion agreement and kappa coefficient analysis are examined.

Twenty-three items were initially developed for the Atkins Osteoporosis Risk Assessment Tool (ORAT) after a thorough examination of the literature. These items were reviewed for relevance to the domain of content by a panel of eight experts using Lynn's (1986) two-stage process for content validation. The Content Validity Index and the kappa coefficient of agreement were analyzed from panelists' quantitative ratings and 15 items were retained. Qualitative suggestions from the experts were also used to improve the final items in the ORAT., (Copyright 2002, Elsevier Science (USA). All rights reserved.)

Purpose: High-dose adjuvant interferon alpha-2b (IFN alpha 2b) for high-risk melanoma is a 1-year regimen that improves relapse-free and overall survival but has significant toxicity. A quality-of-life--adjusted survival (QAS) analysis analysis of two cooperative group phase III trials, E1684 and E1690/S9111/C9190, was performed, incorporating patient values (utilities) for the toxicity of IFN alpha 2b treatment and melanoma recurrence., Patients and Methods: Quality-Adjusted Time Without Symptoms or Toxicity methodology was used with melanoma patient utilities and trial data to estimate the effect of IFN alpha 2b on QAS. The increase or decrease in QAS that patients could expect from treatment was estimated based on their utilities. Eleven utility predictor questions were tested to identify patients with utilities that result in decreased QAS., Results: Using E1684 data, IFN alpha 2b would result in an increase in QAS for all sets of patient utilities. This benefit was significant (P <.05) for 16% of patients. Using E1690/S9111/C9190 data, 77% of patients would experience a benefit in QAS from IFN alpha 2b and 23% would experience a decrease in QAS; neither of these effects was statistically significant. Using utility predictors and the E1690/S9111/C9190 analysis, a decision rule was formulated that helps identify patients in whom IFN alpha 2b may detract from QAS., Conclusion: Most patients experienced improvement in QAS in both trials, but this benefit was statistically significant in only 16% of patients in E1684. Change in QAS depends more on the utility for IFN alpha 2b toxicity than on the utility for melanoma recurrence. Cancer patients probably have higher utilities for IFN alpha 2b toxicity than members of the general population and will tend to favor IFN alpha 2b treatment as a result.