Measuring educational needs among patients with rheumatoid arthritis using the Dutch version of the Educational Needs Assessment Tool (DENAT)

The Educational Needs Assessment Tool (ENAT) was developed in the United Kingdom (UK) to systematically assess the educational needs of patients with arthritis. The aim of the present study was to describe the educational needs of Dutch patients with rheumatoid arthritis (RA) by using the Dutch version of the ENAT (DENAT). The original UK version of the ENAT, comprising 39 items grouped into seven domains, was translated into Dutch according to international guidelines for cross-cultural translation and adaptation. The DENAT was then sent to a random sample of 319 RA patients registered at the outpatient clinic of a university hospital. For each domain (score range 1–5, equalling low–high educational needs), a median score with the inter-quartile range was computed. The Kruskal–Wallis test was used to determine possible associations between educational needs and age, disease duration, gender and educational background. The response rate was 165 out of 319 (52%). The median educational needs scores were 2.5 for “managing pain”, 3.0 for “movement”, 2.0 for “feelings”, 4.0 for “arthritis process”, 4.0 for “treatments from health professionals”, 3.5 for “self-help measures” and 2.5 for “support systems”. Lower age and shorter disease duration were associated with more educational needs in the domain “support systems”. In addition, younger patients had more educational needs regarding managing pain and feelings than older patients. There were no associations between gender or educational background and educational needs. The DENAT has demonstrated its ability to identify individual educational needs of Dutch patients with RA. The lower age and shorter disease duration were associated with more educational needs. The practical applicability of the DENAT needs further research

CD44: a multitude of isoforms with diverse functions.

The CD44 transmembrane glycoprotein of 90 kD has been known for more than ten years under such diverse designations as lymphocyte homing receptor gp90Hermes, phagocytic glycoprotein Pgp-1, extracellular matrix receptor III (ECMRIII) and hyaluronate receptor H-CAM (see reviews by Haynes et al., 1989 and 1991). Studies with monoclonal antibodies revealed similarity, and most likely identity among these molecules (Omary et al., 1988; Gallatin et al., 1989; Picker et al., 1989; Aruffo et al., 1990; Miyake et al., 1990; Culty et al., 1990). When the human, baboon and murine cDNA sequences were established identity was confirmed. However, the cDNA sequence codes only for about 360 amino acids, revealing a just 37 kD encompassing protein core (Stamenkovic et al., 1989; Goldstein et al., 1989; Idzerda et al., 1989; Nottenburg et al., 1989; Zhou et al., 1989; Wolffe et al., 1990). This protein core is highly glycosylated by N- and O-linked sugars to yield a 85 to 90 kD form and is sometimes additionally linked to chondroitin sulfate side chains to produce a 180 - 200 kD form (Jalkanen et al., 1988; Stamenkovic et al., 1989). Concomitant with the diverse names for CD44, the description of functions was as diverse: CD44 molecules were described to participate in cell-cell and cell-matrix interactions such as lymphocyte recirculation and prothymocyte homing, hematopoiesis, lymphocyte and monocyte activation, cell migration and metastasis (reviewed in Haynes et al., 1989 and 1991). It seemed rather unlikely that all these functions were associated with one and the same molecule, though differences in the posttranslational modification may as well modulate the adhesive properties (Brown et al., 1991). Thus, the description of new extracellular regions led to the assumption that the multitude of functions may be attributed to the various isoforms (Günthert et al., 1991; Brown et al., 1991; Hofmann et al., 1991; He et al., 1992; Matsumura and Tarin, 1992). The aim of this review article is to describe the ever growing family of isoforms and their organization and to discuss possible functional implications