Flavonoid and isoflavonoid glycosides are common dietary phenolics which may be absorbed from the small intestine of humans. The ability of cell-free extracts from human small intestine and liver to deglycosylate various (iso)flavonoid glycosides was investigated. Quercetin 4P-glucoside, naringenin 7-glucoside, apigenin 7-glucoside, genistein 7-glucoside and daidzein 7-glucoside were rapidly deglycosylated by both tissue extracts, whereas quercetin 3,4P-diglucoside, quercetin 3-glucoside, kaempferol 3-glucoside, quercetin 3-rhamnoglucoside and naringenin 7-rhamnoglucoside remained unchanged. The K m for hydrolysis of quercetin 4P-glucoside and genistein 7-glucoside was V32 þ 12 and V14 þ 3 W WM in both tissues respectively. The enzymatic activity of the cell-free extracts exhibits similar properties to the cytosolic broad-specificity L L-glucosidase previously described in mammals.z 1998 Federation of European Biochemical Societies.

SummaryThe aim of this study was to assess the acceptability, validity and reliability of the Short Form 36 quality of life questionnaire in 166 adult patients following discharge from a general intensive care unit. Reliability was quantified by measuring internal consistency using correlation among items and Cronbach's alpha coefficient. Reliability coefficients were calculated from two-way analysis of variance. Construct validity was tested by examining differences in scores between sex and age groups. Content validity was reflected by the spread of dimension scores. Acceptability to patients appeared reasonable, although considerable nursing time was required to administer the questionnaire. The measures of reliability exceeded recognised statistical standards in all but two instances. Construct validity was confirmed by lower scores being reported by women and older age groups. The scores of six of the eight dimensions were spread throughout the entire range of possible scores suggesting acceptable content validity. A. Ridley Accepted: 4 September 1996 Assessing the outcome of health care interventions is one of the key challenges of this decade. Mortality is a classic outcome indicator and has undoubtedly played a valuable role in the evaluation and comparison of intensive care units (ICUs). However, in the current climate, there is increasing pressure to consider other aspects of patient outcome, two of the most important being quality of life and functional ability. Mortality, although a vital measure, is too crude an indicator for this purpose. Patients who survive critical illness should be evaluated in terms of their ongoing health and the degree to which they are able to return to their previous lifestyle.Identifying standardised outcome measures is problematical in health care, but further complexities arise when dealing with patients obtunded by critical illness. Diseasespecific tools are available, such as alteration in quality of life following the onset of rheumatoid arthritis [1], but such tools can only be applied to a select group of patients.A general tool, reflecting the wide range of critical illness seen in ICU, may be more appropriate. An ideal general tool should be easy to administer and not present too great a burden for the patient; it should have wide application and yet be sensitive to modest changes in quality of life. Converting patient perceptions into a score, which can be analysed, makes assumptions about the nature and internal relationships of the scales or scores used. These assumptions may change if the tool is used on a different patient population. Therefore, it is most important that the tool is shown to be reliable and valid for use in its new setting before changes in quality of life as a result of illness are investigated. If a measure can provide reliable and accurate results, then comparisons between health care programmes, groups of patients and ICUs could be made.The Short Form 36 (SF-36), developed in the early 1990s and containing 36 questions, is a self-co...

SummaryThis study aimed to compare the very long-term survival of critically ill patients with that of the general population, and examine the association among age, sex, admission diagnosis, APACHE II score and mortality. In a retrospective observational cohort study of prospectively gathered data, 2104 adult patients admitted to the intensive care unit (ICU) of a teaching hospital in Glasgow from 1985 to 1992, were followed until 1997. Vital status at five years was compared with that of an age-and sex-matched Scottish population. Five-year mortality for the ICU patients was 47.1%, 3.4 times higher than that of the general population. For those surviving intensive care the fiveyear mortality was 33.4%. Mortality was greater than that of the general population for four years following intensive care unit admission (95% confidence interval included 1.0 at four years). Multivariate analysis showed that risk factors for mortality in those admitted to ICU were age, APACHE II score on admission and diagnostic category. Mortality was higher for those admitted with haematological (87.5%) and neurological diseases (61.7%) and septic shock (62.9%). A risk score was produced: Risk Score ¼ 10 (age hazard ratio + APACHE II hazard ratio + diagnosis hazard ratio). None of the patients with a risk score > 100 survived more than five years and for those who survived to five years the mean risk score was 57. Long-term survival following intensive care is not only related to age and severity of illness but also diagnostic category. The risk of mortality in survivors of critical illness matches that of the normal population after four years. Age, severity of illness and diagnosis can be combined to provide an estimate of five-year survival.

SummaryThe Short Form 36 was used to compare critically ill patients' premorbid quality of life with normal values and investigate any changes following 6 months convalescence. One hundred and sixty-six survivors completed the Short Form 36 at discharge from intensive care. The answers given by survivors were significantly lower than normal for all dimensions. However, 21 patients who suffered from acute life-threatening conditions were identified and their overall scores were similar to normal values. After 6 months, 95 questionnaires were returned. Patients who had suffered acute pathologies reported significant decreases in quality of life whilst other patients with pre-existing ill health reported significant improvement with reduced pain and better mental health, vitality and social function. This study suggests that quality of life of most patients admitted to intensive care is not as good as in the normal population but does not deteriorate except for those patients admitted after acute life-threatening events.

et al. Outcome measures for adult critical care: a systematic review. Health Technol Assess 2000;4(24). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see overleaf). NHS R&D HTA Programme T he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Acute Sector Panel and funded as project number 95/55/03. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work either prioritised by the Standing Group on Health Technology, or otherwise commissioned for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors.

Extracts of human small intestine epithelium, liver, plasma and colonic microýora (as a faecal sample) were prepared and esterase activity determined by incubation with chlorogenic acid and subsequent analysis by high-performance liquid chromatography. There was no evidence of enzymic hydrolysis by the intestine, liver or plasma extracts. However, esterase activity was observed in the faecal sample, and this activity was abolished if the extract was boiled prior to incubation. These results show that chlorogenic acid ingested by humans is most likely cleaved into caþ eic acid and quinic acid by an esterase enzyme(s) provided by the colonic microýora.1999 Society of Chemical Industry (

SummaryUsing average number of patients expected in a year, average length of stay and a target occupancy level to calculate the number of critical care beds needed is mathematically incorrect because of nonlinearity and variability in the factors that control length of stay. For a target occupancy in excess of 80%, this simple calculation will typically underestimate the number of beds required. More seriously, it provides no quantitative guidance information about other aspects of critical care demand such as the numbers of emergency patients transferred, deferral rates for elective patients and overall utilisation. The combination of appropriately analysing raw data and detailed mathematical modelling provides a much better method for estimating numbers of beds required. We describe this modelling approach together with evidence of its performance.

SummaryThe aim of this study was to determine the reliability and validity of relatives' assessment of patients' quality of life and to measure the agreement between patients' and relatives' responses to the Short Form 36 quality of life questionnaire, at discharge from and 6 months following intensive care treatment. Ninety-nine patient-relative pairs were studied. Reliability was quantified by using measures of internal consistency (Cronbach's alpha and correlation coefficients) and reliability coefficients. Relatives' responses met the required standards of reliability and validity, but reliability was consistently weaker in the mental health dimension. Relatives' and patients' scores differed significantly in six dimensions at discharge; however, agreement between patients' and relatives' responses, as measured by the Kappa statistic, was fair, improved over 6 months, and was greatest in aspects concerning physical health. We conclude that relatives are able to give a good proxy assessment of functional aspects of quality of life.