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BACKGROUND: The EQ-5D is a generic preference-based health status measure that has been widely applied to measure the impact of Type 2 diabetes mellitus. This review summarizes evidence on the validity, reliability and responsiveness of the EQ-5D in studies of Type 2 diabetes and provides a catalogue of EQ-5D index scores for Type 2 diabetes and various complications and subgroups. METHODS: A structured search was conducted (1987-2009) using keywords relevant to Type 2 diabetes and the EQ-5D. Original research studies in Type 2 diabetes that reported EQ-5D results and/or measurement properties were included. RESULTS: Of the 59 included articles, 54 publications reported EQ-5D responses and 39 papers presented evidence on the measurement properties of the EQ-5D. Studies that reported measurement properties supported construct, convergent and discriminant validity, test-retest reliability and responsiveness of the EQ-5D in Type 2 diabetes. Several studies reported a ceiling effect for the EQ-5D and an inability to capture multiple complications was observed. EQ-5D index scores ranged from 0.20 (severe diabetic peripheral neuropathic pain) to 0.88 (general population: good HbA(1c) level). For six subgroups, sufficient studies were available to calculate pooled mean index scores (95% CI): general population 0.67 (0.59-0.75), no complications 0.76 (0.68-0.83), microvascular complications 0.73 (0.57-0.89), macrovascular complications 0.73 (0.57-0.88), diabetic peripheral neuropathic pain 0.45 (0.39-0.51) and retinopathy 0.57 (0.46-0.69). CONCLUSIONS: Evidence supported validity, reliability and responsiveness of the EQ-5D in Type 2 diabetes. EQ-5D index scores associated with Type 2 diabetes and various complications can be useful for modelling health outcomes in economic evaluations of health programmes for Type 2 diabetes.

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STUDY OBJECTIVES: To determine the validity of physical and mental unhealthy days as summary measures for county health status and to forward a method for examining county level health trends using a single year of data from the Behavioral Risk Factor Surveillance System (BRFSS). DESIGN: The study analysed geographical variation in physical and mental unhealthy days at the state and county level using the 2000 BRFSS. Whereas state level analyses used individual level data, this research conducted multilevel regression analysis using county level data as independent variables and individual level reports of physical and mental unhealthy days as dependent variables. SETTING: Population based samples of non-institutionalised civilian adult residents from each of the 50 states and the District of Columbia in the United States. MAIN RESULTS: Socioeconomic variables predicted similar mean numbers of physical and mental unhealthy days at both the state and county level, validating the county level analyses. County level disability rates were strongly associated with county mean unhealthy days. Using the regression method we forward, it is possible to analyse county level trends using a single year of BRFSS data. CONCLUSIONS: Physical and mental unhealthy days may be used as valid summary measures of county health status. Regression models may be used to assist local decision makers in assessing the needs of their communities and may be used to improve health resource allocation within states.

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PURPOSE: To examine the usefulness of questionnaires for assessing achievement of course goals in medical students' longitudinal community-based clinical experiences. METHOD: In 1997, the authors surveyed 114 first-year students and their preceptors in a longitudinal community-based program at The Joan and Sanford I. Weill Medical College of Cornell University. The questionnaire used a Likert scale to assess students' and preceptors' pre-course expectations for achieving specific course goals and their post-course perceptions of having met those goals. The students also rated global learning and satisfaction during each office preceptor session, and faculty assessed the students' physical examination skills at the end of the course. RESULTS: For all goals assessed, the preceptors scored their students' achievement of course goals significantly higher than did the students themselves (p < .01). The students invariably scored their post-course perceptions of having achieved the goals lower than they did their pre-course expectations (p < .001). Before the course, the preceptors were confident in their ability to teach the curricular material; this confidence remained after the course. Global learning and satisfaction scores were high and all students performed satisfactorily in the demonstration examination. CONCLUSIONS: Students and preceptors may not agree on students' achievement of course goals. Furthermore, despite students' high ratings of global satisfaction and learning, and despite their satisfactory performance of physical examination skills, their ratings of post-course performance may be affected by pre-course expectations. The authors suggest that questionnaires assessing students' and preceptors' perceptions of students' achievement of specific goals should be independently verified before making decisions to modify objectives and activities in these kinds of courses.

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OBJECTIVES: Recently, lung transplantation has been performed with increasing frequency and improved outcomes. GI complications have been observed and reported in patients undergoing cardiac and renal transplantations but only recently have been reported in patients after lung transplantation. No large cohort has been systematically analyzed for all GI complications after lung transplantation. The present study describes, categorizes, and assesses risk factors for the development of such GI complications. METHODS: Records of 45 patients who underwent 47 single or bilateral orthotopic lung transplants between November 1991 and January 1994 were reviewed. RESULTS: Twenty-three patients (51%) had 64 GI complications requiring 13 operations on eight patients. The incidence of major abdominal procedures in the entire transplant cohort was 18% (8/45). Their operative mortality rate was 63% (5/8). Eighteen different types of nonoperative complications occurred and were subclassified into major and minor complications. Complications were defined as major if they required medical or surgical intervention and altered patient management. Most GI complications (73%) occurred within 1 month after transplantation. No risk factors were identified to ascertain who will develop GI complications. CONCLUSIONS: GI complications occur in more than one-half of lung transplant recipients early after transplantation and in the absence of identifiable risk factors. Because there are no precedent risk factors to suggest who will develop GI complications, clinicians must be alert to any warning signs and symptoms. The majority of complications are nonoperative, responding to conservative therapy, but there is a higher overall mortality rate for patients requiring operative intervention, necessitating an aggressive search for major, life-threatening complications in these immunosuppressed patients.

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