C. Roberts

Acute care costs of patients admitted for management of chronic obstructive pulmonary disease exacerbations: contribution of disease severity, infection and chronic heart failure.

Background: In 2003, chronic obstructive pulmonary disease (COPD) accounted for 46% of the burden of chronic respiratory disease in the Australian community. In the 65–74‐year‐old age group, COPD was the sixth leading cause of disability for men and the seventh for women.

The substantial personal burden experienced by younger people with hip or knee osteoarthritis

OBJECTIVE To compare Health-Related Quality of Life (HRQoL) and psychological distress in younger people with hip or knee osteoarthritis (OA) to age- and sex-matched population norms, and evaluate work limitations in this group. METHOD People aged 20-55 years with hip or knee OA were recruited from major hospitals (n = 126) and community advertisements (n = 21). HRQoL was assessed using the Assessment of Quality of Life (AQoL) instrument (minimal important difference 0.06 AQoL units) and compared to population norms. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10) and the prevalence of high/very high distress (K10 score ≥22) was compared to Australian population data. Work limitations were evaluated using the Workplace Activity Limitations Scale (WALS). RESULTS Considering most participants had a relatively recent OA diagnosis (<5 years), the extent of HRQoL impairment was unexpected. A very large reduction in HRQoL was evident for the overall sample, compared with population norms (mean difference -0.35 AQoL units, 95% CI -0.40 to -0.31). Females, people aged 40-49 years, and those with hip OA reported average HRQoL impairment of almost 40% (mean reductions -0.38 to -0.39 AQoL units). The overall prevalence of high/very high distress was 4 times higher than for the population (relative risk 4.19, 95% CI 3.53-4.98) and 67% reported moderate to considerable OA-related work disability, according to WALS scores. CONCLUSIONS These results clearly demonstrate the substantial personal burden experienced by younger people with hip or knee OA, and support the provision of targeted services to improve HRQoL and maximise work participation in this group.

Measuring performance to drive improvement: development of a clinical indicator set for general medicine

Background: There are delays in implementing evidence about effective therapy into clinical practice. Clinical indicators may support implementation of guideline recommendations.

Preferences for disease‐related education and support among younger people with hip or knee osteoarthritis

To explore the usefulness and accessibility of different delivery modes of disease‐related education and support, as perceived by younger people with osteoarthritis (OA).

Reply: Letters to the editor

The data for patients described by Dykes et al. show an excellent remission rate for these eight patients. However, rapid spontaneous remissions are common in this condition, and the numbers in their series are too small to make firm conclusions. As stated by Dykes et al. in their letter, ‘there are no large studies to indicate the most appropriate treatment regimen’. Hence their data, although encouraging, do not demonstrate whether the effect of prednisolone plus intravenous immunoglobulin is better than prednisolone alone.