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Hemilä H, Chalker E, Tukiainen J. Response: Commentary: Quantile treatment effect of zinc lozenges on common cold duration: a novel approach to analyze the effect of treatment on illness duration. Front Pharmacol 2024; 15:1335784. [PMID: 38655184 PMCID: PMC11035776 DOI: 10.3389/fphar.2024.1335784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Harri Hemilä
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Elizabeth Chalker
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Janne Tukiainen
- Department of Economics, University of Turku, Turku, Finland
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2
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Chapurin N, Schlosser RJ, Gutierrez J, Mace JC, Smith TL, Bodner TE, Khan S, Mulligan JK, Mattos JL, Alt JA, Ramakrishnan VR, Soler ZM. All chronic rhinosinusitis endotype clusters demonstrate improvement in patient-reported and clinical outcome measures after endoscopic sinus surgery. Int Forum Allergy Rhinol 2024; 14:765-774. [PMID: 37563836 PMCID: PMC10858289 DOI: 10.1002/alr.23255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND It is unclear whether chronic rhinosinusitis (CRS) endotypes show a differential response to endoscopic sinus surgery (ESS). We explored patient mucous inflammatory cytokine expression and associations with patient-reported and clinically measured post-operative outcome measures. METHODS Patients with CRS were prospectively recruited between 2016 and 2021 into a national multicenter, observational study. Mucus was collected from the olfactory cleft preoperatively and evaluated for 26 biomarkers using cluster analysis. Patient-reported outcome measures included the 22-item Sino-Nasal Outcome Test (SNOT-22) and Questionnaire of Olfactory Dysfunction (QOD). Additional clinical measures of disease severity included threshold, discrimination, and identification (TDI) scores using "Sniffin' Sticks" testing and Lund-Kennedy endoscopic score (LKES). RESULTS A total of 115 patients were clustered into type 2 inflammatory, non-type 2 inflammatory, noninflammatory, and two indeterminate clusters based on individual protein levels. Overall, the type 2 inflammatory cluster was found to have the highest mean improvement in both SNOT-22 (-28.3 [standard deviation, ±16.2]) and TDI (6.5 [standard deviation, ±7.9]) scores 6 months after ESS. However, on average, all endotype clusters demonstrated improvement in all outcome measures after ESS without statistically significant between-group differences in SNOT-22 (p = 0.738), QOD (p = 0.306), TDI (p = 0.358), or LKES (p = 0.514) measures. CONCLUSIONS All CRS endotype clusters responded favorably to surgery and showed improvements in patient-reported and objective outcome measures. Thus, ESS should be considered a more generalized CRS therapy, and benefits appear to not be limited to specific endotypes.
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Affiliation(s)
- Nikita Chapurin
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Rodney J. Schlosser
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jorge Gutierrez
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Timothy L. Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Sofia Khan
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer K. Mulligan
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Jose L. Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jeremiah A. Alt
- Department of Otolaryngology – Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Vijay R. Ramakrishnan
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zachary M. Soler
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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3
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Pipaliya RM, Duckett KA, Monaghan NP, Miller EM, Young G, Brennan EA, Nguyen SA, Soler ZM, Schlosser RJ. The placebo effect in randomized-controlled trials of medical treatments for chronic rhinosinusitis: A systematic review and meta-analysis. Int Forum Allergy Rhinol 2024; 14:695-710. [PMID: 37985206 DOI: 10.1002/alr.23302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The placebo effect observed in clinical trials evaluating medical treatments for chronic rhinosinusitis (CRS) is not well understood. This systematic review and meta-analysis sought to characterize the placebo effect present within CRS outcomes. METHODS A systematic review of PubMed, Scopus, and Cumulated Index in Nursing and Allied Health Nursing (CINAHL) was performed. Randomized controlled trials (RCTs) evaluating medical treatments for CRS versus placebo were included. We assessed patient-reported (sino-nasal outcome test 22 [SNOT-22], nasal obstruction, sense of smell, nasal obstruction visual analogue score [VAS], sense of smell VAS, anterior rhinorrhea, and postnasal drip) and objective (Lund-Mackay Computed tomography (CT) score, peak nasal inspiratory flow [PNIF], nasal polyp scores, 40-item Smell Identification Test, serum IgE, and blood eosinophil levels) outcomes. RESULTS Twenty-one RCTs were included, comprising 1437 patients (mean age 49.2 years). Biologics were the most common treatment investigated (n = 9). Eleven studies administered background steroids along with placebo. Following placebo administration, multiple patient-reported outcomes significantly decreased, including SNOT-22 (mean difference -9.49, 95% confidence interval [CI] [-11.26, -7.73]), nasal obstruction (-0.33 [-0.54, -0.13]), sense of smell (-0.22 [-0.33, -0.11]), nasal obstruction VAS (-2.47 [-2.87, -2.06]), and loss of smell VAS (-2.31 [-4.14, -0.47]) scores. For objective measures, significant changes occurred in Lund-Mackay CT score (-0.82, [-1.48, -0.16]) and PNIF (4.70, [4.76, 24.64]) with placebo. Placebo arms had the greatest impact when no background medications were used. CONCLUSIONS Placebo treatments have a statistically and potentially clinically significant effect on patient-reported and some objective CRS outcomes. Further investigation is required to fully understand placebo effect, which could improve assessment of RCTs and impact patient care.
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Affiliation(s)
- Royal M Pipaliya
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelsey A Duckett
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Neil P Monaghan
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emma Marin Miller
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gabrielle Young
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Andersson SA, Danielsson A, Ohlsson F, Wipenmyr J, Alt Murphy M. Arm impairment and walking speed explain real-life activity of the affected arm and leg after stroke. J Rehabil Med 2021; 53:jrm00210. [PMID: 33948673 PMCID: PMC8814842 DOI: 10.2340/16501977-2838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine to what extent accelerometer-based arm, leg and trunk activity is associated with sensorimotor impairments, walking capacity and other factors in subacute stroke. DESIGN Cross-sectional study. PATIENTS Twenty-six individuals with stroke (mean age 55.4 years, severe to mild motor impairment). METHODS Data on daytime activity were collected over a period of 4 days from accelerometers placed on the wrists, ankles and trunk. A forward stepwise linear regression was used to determine associations between free-living activity, clinical and demographic variables. RESULTS Arm motor impairment (Fugl-Meyer Assessment) and walking speed explained more than 60% of the variance in daytime activity of the more-affected arm, while walking speed alone explained 60% of the more-affected leg activity. Activity of the less-affected arm and leg was associated with arm motor impairment (R2 = 0.40) and independence in walking (R2 = 0.59). Arm activity ratio was associated with arm impairment (R2 = 0.63) and leg activity ratio with leg impairment (R2 = 0.38) and walking speed (R2 = 0.27). Walking-related variables explained approximately 30% of the variance in trunk activity. CONCLUSION Accelerometer-based free-living activity is dependent on motor impairment and walking capacity. The most relevant activity data were obtained from more-affected limbs. Motor impairment and walking speed can provide some information about real-life daytime activity levels.
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Affiliation(s)
- Sofi A Andersson
- Clinical Neuroscience, Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. E-mail:
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Dwyer M, Peterson G, Gall S, Kinsman L, Francis K, Ford K, Castley H, Kitsos A, Hilliard T, English J. Regional differences in access to acute ischaemic stroke care and patient outcomes. Intern Med J 2021; 50:965-971. [PMID: 31566867 DOI: 10.1111/imj.14638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Advances in stroke management such as acute stroke units and thrombolysis are not uniformly distributed throughout our population, with rural areas being relatively disadvantaged. It remains unclear, however, whether such disparities have led to corresponding differences in patient outcomes. AIMS To describe the regional differences in acute ischaemic stroke care and outcomes within the Australian state of Tasmania. METHODS A retrospective case note audit was used to assess the care and outcomes of 395 acute ischaemic stroke patients admitted to Tasmania's four major public hospitals. Sixteen care processes were recorded, which covered time-critical treatment, allied health interventions and secondary prevention. Outcome measures were assessed using 30-day mortality and discharge destination, both of which were analysed for differences between urban and rural hospitals using logistic regression. RESULTS No patients in rural hospitals were administered thrombolysis; these hospitals also did not have acute stroke units. With few exceptions, patients' access to the remaining care indicators was comparable between regions. After adjusting for confounders, there were no significant differences between regions in terms of 30-day mortality (odds ratio (OR) = 0.99, 95% confidence interval (CI) 0.46-2.18) or discharge destination (OR = 1.24, 95% CI 0.81-1.91). CONCLUSIONS With the exception of acute stroke unit care and thrombolysis, acute ischaemic stroke care within Tasmania's urban and rural hospitals was broadly similar. No significant differences were found between regions in terms of patient outcomes. Future studies are encouraged to employ larger data sets, which capture a broader range of urban and rural sites and record patient outcomes at extended interval.
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Affiliation(s)
- Mitchell Dwyer
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Greg Peterson
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Seana Gall
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Karen Francis
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Karen Ford
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Helen Castley
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Alex Kitsos
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Tamsin Hilliard
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Jennifer English
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
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6
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Maritz R, Tennant A, Fellinghauer C, Stucki G, Prodinger B. Creating a common metric based on existing activities of daily living tools to enable standardized reporting of functioning outcomes achieved during rehabilitation. J Rehabil Med 2020; 52:jrm00085. [PMID: 32719883 DOI: 10.2340/16501977-2711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Many different assessment tools are used to assess functioning in rehabilitation; this limits the comparability and aggregation of respective data. The aim of this study was to outline the development of an International Classification of Functioning, Disability and Health (ICF)-based interval-scaled common metric for 2 assessment tools assessing activities of daily living: the Functional Independence Measure (FIMTM) and the Extended Barthel Index (EBI), used in Swiss national rehabilitation quality reports. METHODS The conceptual equivalence of the 2 tools was assessed through their linking to the ICF. The Rasch measurement model was then applied to create a common metric including FIMTM and EBI. SUBJECTS Secondary analysis of a sample of 265 neurological patients from 5 Swiss clinics. RESULTS ICF linking found conceptual coherency of the tools. An interval-scaled common metric, including FIMTM and EBI, could be established, given fit to the Rasch model in the related analyses. CONCLUSION The ICF-based and interval-scaled common metric enables comparison of patients and clinics functioning outcomes when different activities of daily living tools are used. The common metric can be included in a Standardized Assessment and Reporting System for functioning information in order to enable data aggregation and comparability.
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7
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Tofani M, Castelli E, Sabbadini M, Berardi A, Murgia M, Servadio A, Galeoto G. Examining Reliability and Validity of the Jebsen-Taylor Hand Function Test Among Children With Cerebral Palsy. Percept Mot Skills 2020; 127:684-697. [PMID: 32321360 DOI: 10.1177/0031512520920087] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Manual dexterity has strongly predicted functional independence for daily life activities among children with cerebral palsy (CP). The Jebsen-Taylor Hand Function Test (JTHFT) is the most widely used assessment tool for exploring manual dexterity in the CP population, though no research has yet examined its psychometric properties for this use. This cross-sectional study explored the validity and internal consistency of the JTHFT in an Italian sample of inpatient and outpatient children with CP aged between 6-18 years (35 girls and 49 boys). We calculated internal consistency with Cronbach's alpha and tested validity against the Manual Ability Classification System (MACS) using Pearson's correlation coefficient. To better understand how the JTHFT compares with different levels of the MACS, we performed dominant hand timing variability for each test item. Results showed excellent internal consistency with a Cronbach's alpha of .944 and .911, respectively, for nondominant and dominant hands. There was also a statistically significant positive linear Pearson's correlation coefficient between the JTHFT and the MACS (p < .01). We observed high variability in writing performance (Item 1 of the JTHFT) within this sample for each level of the MACS. This study confirms that the JTHFT is a valid assessment tool when used in children with CP aged 6-18 years.
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Affiliation(s)
- M Tofani
- Neurorehabilitation Unit, Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - E Castelli
- Neurorehabilitation Unit, Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - M Sabbadini
- Neurorehabilitation Unit, Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - M Murgia
- Department of Anatomical Sciences, Histological, Legal Medicine and Locomotor Apparatus, Sapienza University of Rome
| | - A Servadio
- Department of Health Professions, Tor Vergata Hospital, Rome, Italy
| | - G Galeoto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome
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8
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Evans E, Cook NE, Iverson GL, Townsend EL, Duhaime AC. Monitoring Outcome after Hospital-Presenting Milder Spectrum Pediatric Traumatic Brain Injury Using the Glasgow Outcome Scale-Extended, Pediatric Revision. J Neurotrauma 2020; 37:1627-1636. [PMID: 32106753 DOI: 10.1089/neu.2019.6893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The Glasgow Outcome Scale, Pediatric Revision (GOSE-P) is an assessment of "global outcome" designed as a developmentally appropriate version of the Glasgow Outcome Scale-Extended for use in clinical trials of children with traumatic brain injury (TBI). Initial testing describes validity across a wide age and injury severity spectrum, yet the GOSE-P's utility for monitoring children with milder injuries is less clear. We examined the level of agreement between the GOSE-P and the Health and Behavior Inventory (HBI), a TBI-related symptom checklist used to assess children with mild TBI for clinical and research purposes. Participants included children and adolescents 3-16 years of age (n = 50) who presented to two level 1 trauma centers within 24 h of injury, with a GCS of 13-15, who underwent clinical neuroimaging. Outcome was assessed 2 weeks and 3 months following injury. We examined the severity of TBI-related symptoms across disability categories identified using the GOSE-P, and the level of agreement between the two measures in identifying deficits 2 weeks following injury and improvement from 2 weeks to 3 months. Using the GOSE-P, 62% had deficits at 2 weeks, and 42% improved from 2 weeks to 3 months. Agreement between the GOSE-P and HBI was fair 2 weeks after TBI (k = 0.24-0.33), and poor for identifying subsequent improvement (k = 0.10-0.16). Modest agreement between the GOSE-P and the HBI may reflect restricted participation from diverse causes, including TBI, other bodily injuries, and prescribed activity restrictions, and highlights the need for multi-dimensional outcome batteries.
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Affiliation(s)
- Emily Evans
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,MGH Institute of Health Professions, Boston, Massachusetts, USA.,The Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island, USA
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts, USA.,MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts, USA.,MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Elise L Townsend
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, Massachusetts, USA
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Canning J, Siebert S, Jani BD, Mair FS, Nicholl BI. Examining the relationship between rheumatoid arthritis, multimorbidity and adverse health-related outcomes: A systematic review protocol. J Comorb 2020; 10:2235042X20906657. [PMID: 32206633 PMCID: PMC7079302 DOI: 10.1177/2235042x20906657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/12/2020] [Indexed: 12/28/2022]
Abstract
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterised by articular inflammation and systemic complications. Multimorbidity (the presence of two or more long-term health conditions) is highly prevalent in people with RA but the effect of multimorbidity on mortality and other health-related outcomes is poorly understood. Objective: To determine what is known about the effect, if any, of multimorbidity on mortality and health-related outcomes in individuals with RA. Design: Systematic review of the literature. The following electronic medical databases will be searched: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, The Cochrane Library and Scopus. Included studies will be quality appraised using the Quality in Prognostic Studies tool developed by the Cochrane Prognosis Methods Group. A narrative synthesis of findings will be undertaken and meta-analyses considered, if appropriate. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 guidelines, ensuring the quality of the review. Conclusions: Understanding the influence of multimorbidity on mortality and other health-related outcomes in RA will provide an important basis of knowledge with the potential to improve future clinical management of RA. PROSPERO registration number: CRD42019137756.
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Affiliation(s)
- Jordan Canning
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Simkins M, Iqbal A, Gronemeyer A, Konzen L, White J, Koenig M, Palmer C, Kerby P, Buckman S, Despotovic V, Hoehner C, Boyle W. Inter-Rater Reliability and Impact of Disagreements on Acute Physiology and Chronic Health Evaluation IV Mortality Predictions. Crit Care Explor 2019; 1:e0059. [PMID: 32166239 DOI: 10.1097/CCE.0000000000000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acute Physiology and Chronic Health Evaluation is a well-validated method to risk-adjust ICU patient outcomes. However, predictions may be affected by inter-rater reliability for manually entered elements. We evaluated inter-rater reliability for Acute Physiology and Chronic Health Evaluation IV manually entered elements among clinician abstractors and assessed the impacts of disagreements on mortality predictions.
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Bembea MM, Felling RJ, Caprarola SD, Ng DK, Tekes A, Boyle K, Yiu A, Rizkalla N, Schwartz J, Everett AD, Salorio C. Neurologic Outcomes in a Two-Center Cohort of Neonatal and Pediatric Patients Supported on Extracorporeal Membrane Oxygenation. ASAIO J 2020; 66:79-88. [PMID: 30681441 PMCID: PMC7765760 DOI: 10.1097/mat.0000000000000933] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Contemporary studies of long-term outcomes in children supported on extracorporeal membrane oxygenation (ECMO) in the United States are limited. We enrolled 99 ECMO patients between July 2010 and June 2015 in a two-center prospective observational study that included neurologic and neuropsychologic evaluation at 6 and 12 months, using standardized outcome measures. Pre-ECMO, 20 (20%) had a pre-existing neurologic diagnosis, 40 (40%) had cardiac arrest, and 10 of 47 (21%) children with neuroimaging had acute abnormal findings. Of 50 children eligible for follow-up at 6 or 12 months, 40 (80%) returned for at least one visit. At the follow-up visit of longest interval from ECMO, the median Vineland Adaptive Behavior Scales-II (VABS-II) score was 91 (interquartile range [IQR], 81-98), the median Pediatric Stroke Outcome Measure (PSOM) score was 1 (IQR, 0-2), and the median Mullen Scales of Early Learning composite score was 85 (IQR, 72-96). Presence of new neuroimaging abnormalities during ECMO or within 6 weeks post-ECMO was associated with VABS-II score <85 or death within 12 months after ECMO. The Pediatric Cerebral Performance Category at hospital discharge showed a strong relationship with unfavorable VABS-II and PSOM scores at 6 or 12 months after ECMO. In this study, we report a higher prevalence of pre-ECMO neurologic conditions than previously described. In survivors to hospital discharge, median scores for adaptive behavior and cognitive, neurologic, and quality of life assessments were all below the general population means, but most deficits would be considered minor within each of the domains tested.
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Affiliation(s)
- Melania M Bembea
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aylin Tekes
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katharine Boyle
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alvin Yiu
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nicole Rizkalla
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jamie Schwartz
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Allen D Everett
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Cynthia Salorio
- Kennedy Krieger Institute, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Beswick DM, Ayoub NF, Mace JC, Mowery A, Hwang PH, Smith TL. Acute Exacerbations in Recurrent Acute Rhinosinusitis: Differences in Quality of Life and Endoscopy. Laryngoscope 2019; 130:E736-E741. [PMID: 31837149 DOI: 10.1002/lary.28460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Research surrounding outcome differences for patients with recurrent acute rhinosinusitis (RARS) is scarce. This investigation explored quality of life (QOL) and sinonasal attributes in patients during acute episodes (AEs) and in-between AEs of RARS. STUDY DESIGN Retrospective outcomes research. METHODS Data from patients with RARS were collected from two academic institutions between 2009 and 2017 using prospective and retrospective methodology. During clinical presentation, subjects were classified as with or without an AEs using guideline definitions of acute bacterial rhinosinusitis (ABRS). Between-group differences in 22-item Sino-Nasal Outcome Test (SNOT-22) survey and Lund-Kennedy (LK) endoscopy scores were assessed. RESULTS Four hundred twenty-three clinical visits from 202 patients were included. Visits during an AE (168/423, 40%) were associated with significantly worse SNOT-22 total scores compared to between AEs (255/423, 60%; median = 53.0 [interquartile range (IQR) = 24.0] vs. 34.0 [IQR = 29.5]) and all SNOT-22 subdomain scores (all P < .001). LK scores were available for 167 visits, with 56 (34%) completed during an AE. Compared to visits without an AE, endoscopy findings associated with an AE were less frequently normal (LK score = 0, 45% vs. 62%, P = .031) with worse median LK scores (2.0 [IQR = 4.0] vs. 0.0 [IQR = 2.0], P = .005). CONCLUSIONS AEs are associated with significantly worse QOL and mildly worse endoscopic findings. Almost half of visits during AEs had negative endoscopy, identifying a disparity between patient symptoms and objective findings and calling into question alternative or concomitant diagnoses. Diagnostic criteria for ABRS or AEs in RARS do not require objective confirmation of inflammation, presenting a conundrum for clinicians. The potential for overdiagnosis of ABRS and AEs should be considered when determining the risk/benefit ratio of treatments for RARS. LEVEL OF EVIDENCE 2c Laryngoscope, 2019.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology, University of Colorado, Aurora, Colorado
| | - Noel F Ayoub
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Alia Mowery
- School of Medicine, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
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Li CY, Arthur PB, Hong I, Velozo CA. Piloting an empirical approach to link the international classification of functioning, disability, and health to job demand classification. Work 2019; 64:721-729. [PMID: 31815712 DOI: 10.3233/wor-193034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Social Security Administration has a thorough disability claims process, though one goal is to process claims more efficiently. This pilot described the creation and trial of a web-based tool to assist this process. OBJECTIVE To empirically link the International Classification of Functioning, Disability and Health (ICF) model to the Occupational Information Network (O*NET) with a self-reported activity measure (physical domain). METHODS ICF Activity domains and item difficulty calibrations were obtained from a self-reported ICF-Activity Measure. Three work/disability experts matched measurement constructs, job names, and item difficulties with job demands. Item difficulties were linked for "Positioning and Transfer" with O*NET data values of "Stamina"; "Trunk Strength", and "Walking and Moving" with O*NET data values of "Stamina." The system was then pilot tested with 14 adults with more than one activity challenges. RESULTS An average total of 613 jobs were generated per participant and each job was categorized into one of 16 job clusters. Person ability measures and constructs were significant predictors for numbers of job (R2 = 0.92, p < 0.05). Participants demonstrated moderate satisfaction with program usability, and reported capability in performing jobs. CONCLUSIONS The system provides a feasible means to assist disability examiners and claimants in identifying relevant job abilities and options.
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Affiliation(s)
- Chih-Ying Li
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Paul B Arthur
- Department of Occupational Therapy, St. Catherine University, Minneapolis, MN, USA
| | - Ickpyo Hong
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Craig A Velozo
- Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Boia ES, David VL. The Financial Burden of Setting up a Pediatric Robotic Surgery Program. ACTA ACUST UNITED AC 2019; 55:medicina55110739. [PMID: 31739631 PMCID: PMC6915423 DOI: 10.3390/medicina55110739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Robotic surgery is currently at the forefront of both adult and pediatric treatment. The main limit in the wide adoption of this technology is the high cost of purchasing and running the robotic system. This report will focus on the costs assessment of running a robotic program in a pediatric surgery center in Romania. Materials and Methods: In 12 months we performed 40 robot-assisted procedures in children. We recorded and analyzed data regarding their age, gender, pathological condition and comorbidities, surgical procedure, time of surgery, complications, hospital stay and related costs, medication, robotic instruments and consumables, additional cost, and income per case received from the National Insurance Company (NIC). Results: Mean cost per case was €3260.63 (€1880.07 to €9851.78) and was influenced by type of the procedure, intraoperative incidents, postoperative complication, and non-scheduled reinterventions (p < 0.05). The direct costs for operating the surgical robot were relatively constant, regardless of the surgical procedure (mean €1579.81). The reimbursement from the NIC ranged from 5% to 56% (mean 16.9%) of the total cost per case. Conclusion: In Romania, a pediatric surgery robotic program is not cost-efficient and cannot operate relying solely onto the health insurance system.
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Maritz R, Tennant A, Fellinghauer C, Stucki G, Prodinger B. The Functional Independence Measure 18-item version can be reported as a unidimensional interval-scaled metric: Internal construct validity revisited. J Rehabil Med 2019; 51:193-200. [PMID: 30843597 DOI: 10.2340/16501977-2525] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Since the 1990s the Functional Independence Measure (FIM™) was believed to measure 2 different constructs, represented by its motor and cognitive subscales. The practice of reporting FIM™ total scores, together with recent developments in the understanding of the influence of locally dependent items on fit to the Rasch model, raises the question of whether the FIM™ 18-item version can be reported as a unidimensional interval-scaled metric. DESIGN Rasch analysis of the FIM™ using testlet approaches to accommodate local response dependency. PATIENTS A calibration sample containing 946 cases of data from 11,103 patients undergoing neurological or musculoskeletal rehabilitation in Switzerland in 2016. RESULTS Baseline analysis and the traditional testlet approach showed no fit with the Rasch model. When items were grouped into 2 testlets, fit to the Rasch model was achieved, indicating unidimensionality across all 18 items. A transformation table to convert FIM™ raw ordinal scores to the corresponding Rasch interval scaled values was created. CONCLUSION This study provides evidence that FIM™ total scores represent a unidimensional set of items, supporting their use in clinical practice and outcome reporting when applying the respective transformation table. This provides a basis for standardized reporting of functioning.
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Affiliation(s)
- Roxanne Maritz
- Rehabilitation Services and Care Unit, Swiss Paraplegic Research, , 6207 Nottwil, Switzerland.
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Affiliation(s)
- Peter Ludman
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Cardiovascular Sciences, Birmingham University, Birmingham, United Kingdom
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17
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Ramakrishnan VR, Mace JC, Soler ZM, Smith TL. Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS? Laryngoscope 2019; 129:558-566. [PMID: 30582166 PMCID: PMC6402589 DOI: 10.1002/lary.27651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Antibiotics have been a mainstay of chronic rhinosinusitis therapy; however, data suggest that antibiotics may also result in several adverse unintended consequences. We aimed to evaluate if greater antibiotic use prior to sinus surgery was associated with differences in surgical outcomes. METHODS Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were asked to recall systemic antibiotic use in the 90 days prior to endoscopic sinus surgery (ESS). Antibiotic use was examined in relation to demographics, disease characteristics, and outcomes. RESULTS Data were collected for 271 study participants followed for a mean of 14.9 [± 5.1] months across four institutions, with a mean preoperative antibiotic use of 27.8 [± 22.7] days out of the 90 preceding ESS. After ESS, significant improvement (P < 0.001) was reported for patient-reported outcome measures and endoscopy scores for the overall cohort. No bivariate correlation between preoperative antibiotic use and degree of benefit in objective clinical measures (endoscopy, Brief Smell Identification Test) was seen. Increased preoperative antibiotic use was associated with less improvement in 22-item SinoNasal Outcome Test (SNOT-22) and its rhinologic subdomain after ESS. Prevalence of achieving a minimal clinically important difference in overall SNOT-22 symptom scores was lower in those using more preoperative antibiotics, although statistical significance was not reached when adjusting for independent covariates in multivariate modeling. CONCLUSION Higher amounts of previous antibiotic use do not appear to be associated with better ESS outcomes. Specific recommendations for antibiotic use as part of CRS-appropriate medical therapy prior to ESS require further study, particularly given concerns for antibiotic overuse and implications for improving outcomes in the modern healthcare era. LEVEL OF EVIDENCE 2C Laryngoscope, 129:558-566, 2019.
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Affiliation(s)
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
| | - Zachary M. Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
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Torborg A, Cronje L, Thomas J, Meyer H, Bhettay A, Diedericks J, Cilliers C, Kluyts H, Mrara B, Kalipa M, Rodseth R, Biccard B. South African Paediatric Surgical Outcomes Study: a 14-day prospective, observational cohort study of paediatric surgical patients. Br J Anaesth 2018; 122:224-232. [PMID: 30686308 DOI: 10.1016/j.bja.2018.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/29/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4-11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2-8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6-1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION NCT03367832.
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Affiliation(s)
- A Torborg
- Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa.
| | - L Cronje
- Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa
| | - J Thomas
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa; Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - H Meyer
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa; Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - A Bhettay
- Department of Anaesthesia and Pain Medicine, Nelson Mandela Children's Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - J Diedericks
- Department of Anaesthesiology, University of the Free State, Bloemfontein, South Africa
| | - C Cilliers
- Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - H Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - B Mrara
- Department of Anaesthesia, Walter Sisulu University, Eastern Cape, South Africa
| | - M Kalipa
- Department of Anaesthesiology, University of Pretoria, Gauteng, South Africa
| | - R Rodseth
- Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa
| | - B Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa
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Sayyid RK, Simpson WG, Lu C, Terris MK, Klaassen Z, Madi R. Retzius-Sparing Robotic-Assisted Laparoscopic Radical Prostatectomy: A Safe Surgical Technique with Superior Continence Outcomes. J Endourol 2018; 31:1244-1250. [PMID: 28859492 DOI: 10.1089/end.2017.0490] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report early operative outcomes and assess continence in 100 consecutive patients who underwent Retzius-sparing robotic-assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS This was a prospective, single-center, consecutive case series of 100 and 100 patients undergoing a Retzius-sparing and a conventional RALP, respectively, by a single surgeon between March 2015 and April 2017. RESULTS Baseline patient characteristics were similar between the two groups. The Retzius-sparing approach required significantly less console time (120.0 minutes vs 144.0 minutes, p < 0.001). There were no differences between intra- and post-operative complication rates, and hospital length of stay was similar in the two groups. Incidence of positive surgical margins was nonsignificantly different between the two groups, with 17% and 13% of pT2 patients and 49% and 48% of pT3 patients in the Retzius-sparing and conventional groups, respectively. Patients in the Retzius-sparing group had significantly superior rates of achieving post-operative urinary continence (log-rank test: p < 0.001), with 20% of patients continent within the first month, compared with 8% of patients in the conventional group. The mean number of pads per day needed at 3, 6, 9, and 12 months post-operatively was also significantly lower in the Retzius-sparing group. CONCLUSIONS Retzius-sparing RALP requires shorter console time, is oncologically safe, and leads to significantly superior continence outcomes compared with conventional RALP.
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Affiliation(s)
- Rashid K Sayyid
- 1 Section of Urology, Department of Surgery, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - William G Simpson
- 1 Section of Urology, Department of Surgery, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Caroline Lu
- 1 Section of Urology, Department of Surgery, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Martha K Terris
- 1 Section of Urology, Department of Surgery, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Zachary Klaassen
- 1 Section of Urology, Department of Surgery, Medical College of Georgia, Augusta University , Augusta, Georgia .,2 Division of Urology, Department of Surgical Oncology, University Health Network , Toronto, Canada
| | - Rabii Madi
- 1 Section of Urology, Department of Surgery, Medical College of Georgia, Augusta University , Augusta, Georgia
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20
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Mayo NE, Kaur N, Barbic SP, Fiore J, Barclay R, Finch L, Kuspinar A, Asano M, Figueiredo S, Aburub AS, Alzoubi F, Arafah A, Askari S, Bakhshi B, Bouchard V, Higgins J, Hum S, Inceer M, Letellier ME, Lourenco C, Mate K, Salbach NM, Moriello C. How have research questions and methods used in clinical trials published in Clinical Rehabilitation changed over the last 30 years? Clin Rehabil 2017; 30:847-64. [PMID: 27496695 PMCID: PMC4976657 DOI: 10.1177/0269215516658939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
Research in rehabilitation has grown from a rare phenomenon to a mature science and clinical trials are now common. The purpose of this study is to estimate the extent to which questions posed and methods applied in clinical trials published in Clinical Rehabilitation have evolved over three decades with respect to accepted standards of scientific rigour. Studies were identified by journal, database, and hand searching for the years 1986 to 2016. A total of 390 articles whose titles suggested a clinical trial of an intervention, with or without randomization to form groups, were reviewed. Questions often still focused on methods to be used (57%) rather than what knowledge was to be gained. Less than half (43%) of the studies delineated between primary and secondary outcomes; multiple outcomes were common; and sample sizes were relatively small (mean 83, range 5 to 3312). Blinding of assessors was common (72%); blinding of study subjects was rare (19%). In less than one-third of studies was intention-to-treat analysis done correctly; power was reported in 43%. There is evidence of publication bias as 83% of studies reported either a between-group or a within-group effect. Over time, there was an increase in the use of parameter estimation rather than hypothesis testing and there was evidence that methodological rigour improved. Rehabilitation trialists are answering important questions about their interventions. Outcomes need to be more patient-centred and a measurement framework needs to be explicit. More advanced statistical methods are needed as interventions are complex. Suggestions for moving forward over the next decades are given.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Navaldeep Kaur
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Skye P Barbic
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio Fiore
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lois Finch
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ayse Kuspinar
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Miho Asano
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Sabrina Figueiredo
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Ala' Sami Aburub
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Fadi Alzoubi
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Alaa Arafah
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Sorayya Askari
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Behtash Bakhshi
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Vanessa Bouchard
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Johanne Higgins
- École de réadaptation, Université de Montréal, Montreal, Quebec, Canada
| | - Stanley Hum
- Montreal Neurological Institute and Hospital, Multiple Sclerosis Clinic, Montreal, Quebec, Canada
| | - Mehmet Inceer
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Marie Eve Letellier
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Christiane Lourenco
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo, Brazil Department of Physical Therapy, University of Toronto, Toronto, Ontario
| | - Kedar Mate
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Ontario
| | - Carolina Moriello
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Abstract
PURPOSE The 2-min walk test may be more appropriate functional exercise test for young children. This study aimed to examine the 2-min walk test's reliability; validity; and minimal clinically important difference; and to establish norms for children aged 6-12. METHODS Sixty-one healthy children were recruited to examine the 2-min walk test's reliability. Forty-six children with neuromuscular disorders (63% cerebral palsy) were recruited to test the validity. The normative study involved 716 healthy children without neuromuscular disorders (male = 51%, female = 49%). They walked at a self-selected speed for 2 min along a smooth, flat path 15 m in length. RESULTS The mean distance covered in the 2-min walk test was 152.8 m (SD =27.5). No significant difference was found in the children's test-retest results (p > 0.05). The intra- and inter-rater reliability were high (all intra-class correlation coefficients >0.8). All children, except one with neuromuscular disorders, completed the 2-min walk test, of which the minimal clinically important difference at 95% confidence interval was 23.2 m for the entire group, 15.7 m for children walking with aids, and 16.6 m for those walking independently. CONCLUSIONS The 2-min walk test is a feasible, reliable, and valid exercise test for children with and without neuromuscular disorders aged 6-12. The first normative references and minimal clinically important difference for children with neuromuscular disorders were established for children of this age group. Implications for rehabilitation The 2-min walk test is a feasible, safe, reliable, and valid time-based walk test for children aged 6-12 years. Normative references have been established for healthy children aged 6-12 years. Minimal clinically important difference at 95% confidence interval were calculated for children with neuromuscular disorders who walked without aids (i.e., independent and stand-by supervision) and those who walked with aids equal to 16.6 and 15.7 m, respectively. Distance covered by the healthy children in the 2 min did not correlate with age, gender, height, and weight of the children.
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Affiliation(s)
- Tamis W Pin
- a Department of Rehabilitation Sciences , Hong Kong Polytechnic University , Kowloon, Hong Kong
| | - H L Choi
- a Department of Rehabilitation Sciences , Hong Kong Polytechnic University , Kowloon, Hong Kong
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Mesquita R, Spina G, Pitta F, Donaire-Gonzalez D, Deering BM, Patel MS, Mitchell KE, Alison J, van Gestel AJ, Zogg S, Gagnon P, Abascal-Bolado B, Vagaggini B, Garcia-Aymerich J, Jenkins SC, Romme EA, Kon SS, Albert PS, Waschki B, Shrikrishna D, Singh SJ, Hopkinson NS, Miedinger D, Benzo RP, Maltais F, Paggiaro P, McKeough ZJ, Polkey MI, Hill K, Man WDC, Clarenbach CF, Hernandes NA, Savi D, Wootton S, Furlanetto KC, Cindy Ng LW, Vaes AW, Jenkins C, Eastwood PR, Jarreta D, Kirsten A, Brooks D, Hillman DR, Sant'Anna T, Meijer K, Dürr S, Rutten EP, Kohler M, Probst VS, Tal-Singer R, Gil EG, den Brinker AC, Leuppi JD, Calverley PM, Smeenk FW, Costello RW, Gramm M, Goldstein R, Groenen MT, Magnussen H, Wouters EF, ZuWallack RL, Amft O, Watz H, Spruit MA. Physical activity patterns and clusters in 1001 patients with COPD. Chron Respir Dis 2017; 14:256-269. [PMID: 28774199 PMCID: PMC5720232 DOI: 10.1177/1479972316687207] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expiratory volume in the first second [FEV1], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed. Daily physical activity measures and hourly patterns were analysed based on data from a multisensor armband. Principal component analysis (PCA) and cluster analysis were applied to physical activity measures to identify clusters. Age, body mass index (BMI), dyspnoea grade and ADO index (including age, dyspnoea and airflow obstruction) were associated with physical activity measures and hourly patterns. Five clusters were identified based on three PCA components, which accounted for 60% of variance of the data. Importantly, couch potatoes (i.e. the most inactive cluster) were characterised by higher BMI, lower FEV1, worse dyspnoea and higher ADO index compared to other clusters (p < 0.05 for all). Daily physical activity measures and hourly patterns are heterogeneous in COPD. Clusters of patients were identified solely based on physical activity data. These findings may be useful to develop interventions aiming to promote physical activity in COPD.
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Affiliation(s)
- Rafael Mesquita
- 1 Department of Research & Education, CIRO, Horn, The Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Gabriele Spina
- 3 Department of Signal Processing Systems, Technische Universiteit Eindhoven, Eindhoven, The Netherlands.,4 Smart Professional Spaces Group, Philips Research, Eindhoven, The Netherlands
| | - Fabio Pitta
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - David Donaire-Gonzalez
- 6 Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,7 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Brenda M Deering
- 8 Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Mehul S Patel
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Katy E Mitchell
- 10 NIHR EM CLAHRC - Centre for Exercise and Rehabilitation Science, University Hospitals, Leicester, UK
| | - Jennifer Alison
- 11 Clinical and Rehabilitation Sciences, The University of Sydney, Sydney, NSW, Australia.,12 Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Arnoldus Jr van Gestel
- 13 Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.,Deceased 3 June 2016
| | - Stefanie Zogg
- 14 Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland
| | - Philippe Gagnon
- 15 Centre de recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Ste-Foy Québec, Université Laval, Québec, Canada
| | - Beatriz Abascal-Bolado
- 16 Division of Pulmonary, Hospital U. Marqués de Valdecilla, IFIMAV, Santander, Spain.,17 Mindful Breathing Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Barbara Vagaggini
- 18 Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Judith Garcia-Aymerich
- 6 Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,7 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,19 Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Sue C Jenkins
- 20 School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Elisabeth Apm Romme
- 21 Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Samantha Sc Kon
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Paul S Albert
- 22 School of Ageing and Chronic Disease, University Hospital Aintree, Liverpool, UK
| | - Benjamin Waschki
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Dinesh Shrikrishna
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK.,24 Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Somerset, UK
| | - Sally J Singh
- 10 NIHR EM CLAHRC - Centre for Exercise and Rehabilitation Science, University Hospitals, Leicester, UK
| | - Nicholas S Hopkinson
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - David Miedinger
- 14 Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland
| | - Roberto P Benzo
- 17 Mindful Breathing Laboratory, Mayo Clinic, Rochester, MN, USA
| | - François Maltais
- 15 Centre de recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Ste-Foy Québec, Université Laval, Québec, Canada
| | - Pierluigi Paggiaro
- 18 Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Zoe J McKeough
- 11 Clinical and Rehabilitation Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Michael I Polkey
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Kylie Hill
- 20 School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - William D-C Man
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | | | - Nidia A Hernandes
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Daniela Savi
- 25 Department of Pediatrics and Pediatric Neurology, Cystic Fibrosis Center, Sapienza University of Rome, Rome, Italy
| | - Sally Wootton
- 11 Clinical and Rehabilitation Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Karina C Furlanetto
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Li W Cindy Ng
- 20 School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Anouk W Vaes
- 1 Department of Research & Education, CIRO, Horn, The Netherlands.,26 Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Christine Jenkins
- 27 Woolcock Institute of Medical Research, The University of Sydney, Camperdown, NSW, Australia
| | - Peter R Eastwood
- 28 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Anne Kirsten
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Dina Brooks
- 30 Respiratory Medicine, West Park Healthcare Centre and Faculty of Medicine, University of Toronto, Toronto, Canada
| | - David R Hillman
- 28 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Thaís Sant'Anna
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Kenneth Meijer
- 31 Department of Human Movement Science, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Selina Dürr
- 14 Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland
| | - Erica Pa Rutten
- 1 Department of Research & Education, CIRO, Horn, The Netherlands
| | - Malcolm Kohler
- 13 Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Vanessa S Probst
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,32 Center for Research in Health Sciences, University North of Paraná (UNOPAR), Londrina, Brazil
| | | | | | | | - Jörg D Leuppi
- 14 Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland
| | - Peter Ma Calverley
- 22 School of Ageing and Chronic Disease, University Hospital Aintree, Liverpool, UK
| | - Frank Wjm Smeenk
- 21 Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Richard W Costello
- 8 Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Marco Gramm
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Roger Goldstein
- 30 Respiratory Medicine, West Park Healthcare Centre and Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Helgo Magnussen
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Emiel Fm Wouters
- 1 Department of Research & Education, CIRO, Horn, The Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Richard L ZuWallack
- 34 Department of Pulmonary and Critical Care, Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - Oliver Amft
- 3 Department of Signal Processing Systems, Technische Universiteit Eindhoven, Eindhoven, The Netherlands.,35 ACTLab group, Chair of Sensor Technology, University Passau, Passau, Germany
| | - Henrik Watz
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Martijn A Spruit
- 1 Department of Research & Education, CIRO, Horn, The Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,36 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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23
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Ghaheri BA, Cole M, Fausel SC, Chuop M, Mace JC. Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study. Laryngoscope 2016; 127:1217-1223. [PMID: 27641715 PMCID: PMC5516187 DOI: 10.1002/lary.26306] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/18/2016] [Accepted: 08/04/2016] [Indexed: 01/07/2023]
Abstract
Objectives/Hypothesis Numerous symptoms may arise that prevent mother‐infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments that positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality. This investigation aimed to determine the impact of surgical tongue‐tie/lip‐tie release on breastfeeding impairment. Study Design Prospective, cohort study from June 2014 to April 2015 in a private practice setting. Methods Study participants consisted of breastfeeding mother–infant (0–12 weeks of age) dyads with untreated ankyloglossia and/or tethered maxillary labial frenula who completed preoperative, 1 week, and 1 month postoperative surveys consisting of the Breastfeeding Self‐Efficacy Scale‐Short Form (BSES‐SF), visual analog scale (VAS) for nipple pain severity, and the revised Infant Gastroesophageal Reflux Questionnaire (I‐GERQ‐R). Breastmilk intake was measured preoperatively and 1 week postoperatively. Results A total of 237 dyads were enrolled after self‐electing laser lingual frenotomy and/or maxillary labial frenectomy. Isolated posterior tongue‐tie was identified in 78% of infants. Significant postoperative improvements were reported between mean preoperative scores compared to 1 week and 1 month scores of the BSES‐SF (F(2) = 212.3; P < .001), the I‐GERQ‐R (F(2) = 85.3; P < .001), and VAS pain scale (F(2) = 259.8; P < .001). Average breastmilk intake improved 155% from 3.0 (2.9) to 4.9 (4.5) mL/min (P < .001). Conclusions Surgical release of tongue‐tie/lip‐tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1 week postoperatively) and continue to improve through 1 month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue‐tie and less obvious posterior tongue‐tie. This study identifies a previously under‐recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist. Level of Evidence 2c Laryngoscope, 127:1217–1223, 2017
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Affiliation(s)
- Bobak A Ghaheri
- Division of Otolaryngology-Head and Neck Surgery, The Oregon Clinic, Portland, Oregon, U.S.A
| | | | - Sarah C Fausel
- School of Medicine, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Maria Chuop
- School of Medicine, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
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24
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Mesquita R, Wilke S, Smid DE, Janssen DJ, Franssen FM, Probst VS, Wouters EF, Muris JW, Pitta F, Spruit MA. Measurement properties of the Timed Up & Go test in patients with COPD. Chron Respir Dis 2016; 13:344-352. [PMID: 27165963 DOI: 10.1177/1479972316647178] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We aimed to investigate the construct validity of the Timed Up & Go (TUG) test in chronic obstructive pulmonary disease (COPD), to identify characteristics related to an abnormal TUG time and to examine the responsiveness of the TUG to pulmonary rehabilitation (PR). TUG time was assessed before and after comprehensive PR in 500 COPD patients, and compared cross-sectionally in 100 non-COPD subjects. Physical health outcomes, mental health outcomes, symptom-related outcomes and multidimensional indices were assessed in COPD patients only. Good convergent and discriminant validity was demonstrated by fair-to-moderate correlation with physical health outcomes, symptom-related outcomes and multidimensional indices ( rs = 0.18-0.70) and by little correlation with mental health outcomes ( rs = 0.21-0.26). COPD patients had a worse TUG time than non-COPD subjects, demonstrating known-groups validity. A TUG time of 11.2 seconds had good sensitivity (0.75) and specificity (0.83) for identifying patients with a baseline 6-minute walk distance <350 m. TUG time improved after PR ( p < 0.0001) and a change of 0.9-1.4 seconds was identified as clinically important. The TUG is valid and responsive in COPD. An abnormal result is indicative of poor health outcomes. This simple test provides valuable information and can be adopted in clinical and research settings.
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Affiliation(s)
- Rafael Mesquita
- 1 Department of Research and Education, CIRO, Horn, The Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Sarah Wilke
- 1 Department of Research and Education, CIRO, Horn, The Netherlands
| | - Dionne E Smid
- 1 Department of Research and Education, CIRO, Horn, The Netherlands
| | - Daisy Ja Janssen
- 1 Department of Research and Education, CIRO, Horn, The Netherlands
| | | | - Vanessa S Probst
- 3 Center for Research in Health Sciences, University North of Paraná (UNOPAR), Londrina, Brazil.,4 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Emiel Fm Wouters
- 1 Department of Research and Education, CIRO, Horn, The Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Jean Wm Muris
- 5 Caphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Fabio Pitta
- 4 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Martijn A Spruit
- 1 Department of Research and Education, CIRO, Horn, The Netherlands
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25
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Evans L, Green S, Howe C, Sharma K, Marinho F, Bell D, Thomas P. Improving patient and project outcomes using interorganisational innovation, collaboration and co-design. London J Prim Care (Abingdon) 2015; 6:29-34. [PMID: 25949710 DOI: 10.1080/17571472.2014.11493410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background Common mental disorders (CMDs) are a leading cause of disability. The Department of Health has launched a large-scale initiative to improve access to evidence-based psychological treatments, such as cognitive behavioural therapy (CBT), through the Improving Access to Psychological Therapy (IAPT) programme. Access to IAPT services by black and minority ethnic (BME) communities is lower than for other groups. Setting The London Borough of Ealing in west London; a diverse borough with areas of high BME population and relatively high deprivation. Aim To compare the outcomes of two linked quality improvement (QI) projects undertaken by Ealing Mental Health and Wellbeing Service (MHWBS), both with the same aim of increasing access to talking therapies for BME communities. Methods Application of QI methodologies supported by the NIHR CLAHRC for northwest London in two different settings in Ealing. One, the 'Southall project', was set within a wider initiative for collaborative improvements and shared learning (the Southall Initiative for Integrated Care) in an ethnically diverse area of Ealing; it was undertaken between April 2010 and September 2011. The second, 'the Ealing project', operated in the two other Ealing localities that did not have the advantage of a broader initiative for collaborative improvements; it was undertaken between April 2011 and September 2012. Results Comparison of the monthly referral rates of BME patients (standardised per 10 000 general practitioner (GP)-registered patients) show that the Southall project was more effective in increasing referrals from BME communities than the Ealing project. Conclusion Broad local participation and ownership in the project design of the Southall project may explain why it was more effective in achieving its aims than the Ealing project which lacked these ownership-creating mechanisms.
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Affiliation(s)
- Liz Evans
- Quality Improvement Project Manager and CLAHRC for NW London Fellow
| | | | - Cathy Howe
- NIHR Knowledge Mobilisation Fellow and Programme Lead NIHR CLAHRC for Northwest London, Imperial College London, London, UK
| | | | - Fatima Marinho
- Mental Health and Wellbeing Service, NHS Ealing/West London Mental Health Trust, London, UK
| | - Derek Bell
- Director NIHR CLAHRC for Northwest London, Imperial College London, London, UK
| | - Paul Thomas
- Clinical Lead Editor, London Journal of Primary Care ; Ealing Clinical Commissioning Group, London, UK
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26
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Hill B, Kahn M, Pallant J, Williams G. Assessment of the internal construct validity of the revised High-Level Mobility Assessment Tool for traumatic orthopaedic injuries. Clin Rehabil 2013; 28:491-8. [PMID: 24113726 DOI: 10.1177/0269215513502798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether the revised High-Level Mobility Assessment Tool (HiMAT) was valid for measuring mobility for people with multi-trauma orthopaedic lower limb injuries. DESIGN Cross-sectional study. SUBJECTS Participants with lower limb multi-trauma orthopaedic injuries. METHODS One complete revised HiMAT was obtained for 106 people within 12 weeks of being allowed to fully weight bear. Rasch analysis was used to assess the overall fit of the model for individuals and items, differential item functioning, local dependency, targeting of items and dimensionality. RESULTS The mean revised HiMAT score was 10.5 (SD = 6.8) with a range of 5-30. Rasch analysis of revised HiMAT showed adequate overall fit to the model (P = 0.29) with no misfitting items (fit residual SD = 0.69) or persons (fit residual SD = 0.62). The scale showed good internal consistency (Person Separation Index = 0.91). One item (hopping) demonstrated disordered thresholds, however this item had good fit to the model in all other aspects. The revised HiMAT was unidimensional, and no differential item functioning was detected for gender or age. The revised HiMAT was well targeted for this group with a range of items across all ability levels. CONCLUSION The results of this study support the internal construct validity of the revised HiMAT as a well-targeted, unidimensional measure of high-level mobility with no ceiling or floor effect for males and females recovering from multi-trauma orthopaedic lower limb injuries.
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Affiliation(s)
- Bridget Hill
- 1Epworth Monash Rehabilitation Medicine Unit, Epworth HealthCare, Melbourne, Victoria, Australia
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27
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Davydow DS, Hough CL, Langa KM, Iwashyna TJ. Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans. Am J Geriatr Psychiatry 2013; 21:887-97. [PMID: 23567391 DOI: 10.1016/j.jagp.2013.01.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 01/30/2012] [Accepted: 02/23/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms. DESIGN Prospective longitudinal cohort study. SETTING Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006). PARTICIPANTS A total of 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview. MEASUREMENTS Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims. RESULTS The point prevalence of substantial depressive symptoms was 28% at a median of 1.2 years before sepsis, and remained 28% at a median of 0.9 years after sepsis. Neither incident severe sepsis (relative risk [RR]: 1.00; 95% confidence interval [CI]: 0.73, 1.34) nor severe sepsis-related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, presepsis substantial depressive symptoms (RR: 2.20; 95% CI: 1.66, 2.90) and worse postsepsis functional impairment (RR: 1.08 per new limitation; 95% CI: 1.03, 1.13) were independently associated with substantial depressive symptoms after sepsis. CONCLUSIONS The prevalence of substantial depressive symptoms in severe sepsis survivors is high but is not increased relative to their presepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions before hospital discharge, may improve outcomes.
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28
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Dumas H, Fragala-Pinkham M, Haley S, Coster W, Kramer J, Kao YC, Moed R. Item bank development for a revised pediatric evaluation of disability inventory (PEDI). Phys Occup Ther Pediatr 2010; 30:168-84. [PMID: 20608855 PMCID: PMC3627488 DOI: 10.3109/01942631003640493] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Pediatric Evaluation of Disability Inventory (PEDI) is a useful clinical and research assessment, but it has limitations in content, age range, and efficiency. The purpose of this article is to describe the development of the item bank for a new computer adaptive testing version of the PEDI (PEDI-CAT). An expanded item set and response options were reviewed by clinician experts and examined at parent and clinician focus groups. Eleven parents participated in 32 cognitive interviews to examine content, format, and comprehension of items and responses. A set of 76 self-care, 78 mobility, and 64 social function items with pictures and a four-point "Difficulty" scale were developed. The PEDI's Caregiver Assistance scale was replaced by a "Responsibility Scale" with 53 items. Content validity was established incorporating input from clinicians and parents. The new item bank covers a broad range of functional activities for children of all ages and abilities.
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Affiliation(s)
- Helene Dumas
- Franciscan Hospital for Children, Research Center, Boston, Massachusetts 02135, USA.
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29
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Abstract
BACKGROUND/OBJECTIVE Upper-extremity reconstruction for people with tetraplegia is underused, and we felt that physicians' beliefs could be contributing to this phenomenon. This research sought to determine whether (a) physicians underestimate the importance of upper-extremity function for people with tetraplegia, (b) physiatrists and hand surgeons disagree on the quality of life of those with tetraplegia, (c) surgeons believe that social issues make people with tetraplegia poor surgical candidates, and (d) the 2 specialties disagree on the benefits of upper-extremity reconstruction. METHODS A self-administered questionnaire was mailed to a national sample of 384 physiatrists and 379 hand surgeons. The data were analyzed with bivariate statistics. RESULTS The response rate was 62%. 65% of surgeons and 49% of physiatrists (P < 0.001) ranked upper-extremity function as the most important rehabilitative goal for people with tetraplegia. Both specialties believed the quality of life with tetraplegia was low (less than 60 on a scale of 0 to 100, with 100 representing perfect health). The 2 specialties have significantly different opinions regarding patient compliance, social support, and the effectiveness of surgery. CONCLUSIONS The majority of physicians believe that upper-extremity function is a rehabilitative priority for people with tetraplegia. However, physiatrists and hand surgeons have significantly different views about people with tetraplegia and the benefits of reconstructive surgery. Physician preconceptions and interdisciplinary divergence may be contributing to the underuse of these procedures, and these issues should be considered when designing programs to improve access to these procedures.
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Abstract
The majority of intensive care practitioners, until comparatively recently, was content to discharge surviving patients to the care of referring primary specialty colleagues who would undertake subsequent inpatient and outpatient care. With the exception of mortality statistics from clinical studies, the practitioners were thus denied the opportunity of understanding the full impact of critical illness on a patient and their family. The concept of the intensive care follow-up clinic has developed more recently, and is run commonly on multidisciplinary lines. These clinics serve a number of purposes, but importantly have drawn attention to broader patient-centred outcomes after intensive care. Investigators are just beginning to identify, and in some cases quantify, the postdischarge burden on patient and family; additional useful data have also come from follow-up of specific disease states. The purpose of the present review is to highlight some of the important issues that impact on recovery from critical illness towards an acceptable quality of postdischarge life. We have concentrated on the adult literature, and specifically on studies that inform us about the more general effects of critical illness. Head and spinal injury are thus largely ignored, as the effects of the primary injury overwhelm the effects of 'general' critical illness.
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Affiliation(s)
- L Robert Broomhead
- Department of Anaesthesia and Intensive Care, Hammersmith Hospital, London, UK
| | - Stephen J Brett
- Department of Anaesthesia and Intensive Care, Hammersmith Hospital, London, UK
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