Assessing walking limitations in stroke survivors:are self-reports and proxy-reports interchangeable?

Objective: To examine the extent to which proxy-report measures adequately assess walking limitations and are interchangeable with self-report measures in stroke survivors. Design and Participants: Self-report, proxy-report, and observed performance measures of walking limitations were compared cross-sectionally on 3 occasions following the discharge from hospital of 101 stroke survivors. Correlations between measures, differences between mean scores, and agreement of self- and proxy reports were analyzed. Results and Conclusions: Self- and proxy-report measures correlated significantly with each other and with observed performance measures; differences between mean scores were not found. Agreement between individual self- and proxy-report pairs was poor, however, indicating that freely substituting proxy-report data for self-report data when self-report data are unavailable is inappropriate.

Patient experiences of serious adverse drug reactions and their attitudes to medicines:a qualitative study of survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK

Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality and account for around 6.5% of hospital admissions. Patient experiences of serious ADRs and their long-term impact on patients' lives, including their influence on current attitudes towards medicines, have not been previously explored. Objective: The aim of the study was to explore the experiences, beliefs, and attitudes of survivors of serious ADRs, using drug-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as a paradigm. Methods: A retrospective, qualitative study was undertaken using detailed semi-structured interviews. Fourteen adult survivors of SJS and TEN, admitted to two teaching hospitals in the UK, one the location of a tertiary burns centre, were interviewed. Interview transcripts were independently analysed by three different researchers and themes emerging from the text identified. Results: All 14 patients were aware that their condition was drug induced, and all but one knew the specific drug(s) implicated. Several expressed surprise at the perceived lack of awareness of the ADR amongst healthcare professionals, and described how the ADR was mistaken for another condition. Survivors believed that causes of the ADR included (i) being given too high a dose of the drug; (ii) medical staff ignoring existing allergies; and (iii) failure to monitor blood tests. Only two believed that the reaction was unavoidable. Those who believed that the condition could have been avoided had less trust in healthcare professionals. The ADR had a persisting impact on their current lives physically and psychologically. Many now avoided medicines altogether and were fearful of becoming ill enough to need them. © 2011 Adis Data Information BV. All rights reserved. Conclusions: Life-threatening ADRs continued to affect patients’ lives long after the event. Patients’ beliefs regarding the cause of the ADR differed, and may have influenced their trust in healthcare professionals and medicines. We propose that clear communication during the acute phase of a serious ADR may therefore be important.

Non-Western small states:activists or survivors?

In this introduction to the collection, we explain its focus on non-Western small states. While the terms ‘non-Western’ and ‘small states’ are problematic – we discuss these problems here – the smallness and non-Westerness of the states studied by the contributing authors set them apart in a way that has attracted little academic attention so far. They allow them to operate with fewer normative and practical constraints than their bigger, Western counterparts; offer them a wide range of (often historically forged) political ties; and force them to draw on a diversity of approaches and strategic thinking, and a creativity, that they are too rarely credited for. Non-Western small states, rather than being mere survivors constrained to the world’s periphery, are better understood as activist states intent on existing. The collection offers a range of analytical keys to make sense of these states and their role in the international scene.