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Anderson AM, McHugh GA, Comer C, Joseph J, Smith TO, Yardley L, Redmond AC. Supporting patients to prepare for total knee replacement: Evidence-, theory- and person-based development of a 'Virtual Knee School' digital intervention. Health Expect 2023; 26:2549-2570. [PMID: 37606150 PMCID: PMC10632615 DOI: 10.1111/hex.13855] [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: 06/02/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Digital delivery of pre-operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre- and post-operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks. OBJECTIVE To develop a pre-operative TKR education and prehabilitation digital intervention, the 'Virtual Knee School' (VKS). METHODS The VKS was developed using an evidence-, theory- and person-based approach. This involved a mixed methods design with four phases. The first three focused on planning the VKS. The final phase involved creating a VKS prototype and iteratively refining it through concurrent think-aloud interviews with nine patients who were awaiting/had undergone TKR. Meta-inferences were generated by integrating findings from all the phases. ISRCTN registration of the overall project was obtained on 24 April 2020 (ISRCTN11759773). RESULTS Most participants found the VKS prototype acceptable overall and considered it a valuable resource. Conversely, a minority of participants felt the prototype's digital format or content did not meet their individual needs. Participants' feedback was used to refine the prototype's information architecture, design and content. Two meta-inferences were generated and recommend: 1. Comprehensive pre-operative TKR education and prehabilitation support should be rapidly accessible in digital and non-digital formats. 2. Pre-operative TKR digital interventions should employ computer- and self-tailoring to account for patients' individual needs and preferences. CONCLUSIONS Integrating evidence, theory and stakeholders' perspectives enabled the development of a promising VKS digital intervention for patients awaiting TKR. The findings suggest future research evaluating the VKS is warranted and provide recommendations for optimising pre-operative TKR care. PATIENT OR PUBLIC CONTRIBUTION Patient and Public Involvement (PPI) was central throughout the project. For example, PPI representatives contributed to the project planning, were valued members of the Project Advisory Group, had key roles in developing the VKS prototype and helped disseminate the project findings.
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Affiliation(s)
- Anna M. Anderson
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
- Present address:
Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | | | - Christine Comer
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- Musculoskeletal and Rehabilitation ServicesLeeds Community Healthcare NHS TrustLeedsUK
| | - Judith Joseph
- Centre for Clinical and Community Applications of Health PsychologyUniversity of SouthamptonSouthamptonUK
| | - Toby O. Smith
- School of Health SciencesUniversity of East AngliaNorwichUK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
- Present address:
Warwick Medical SchoolUniversity of WarwickWarwickUK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health PsychologyUniversity of SouthamptonSouthamptonUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Anthony C. Redmond
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
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Siddle HJ, Bradley SH, Anderson AM, Mankia K, Emery P, Richards SH. Opportunities and challenges in early diagnosis of rheumatoid arthritis in general practice. Br J Gen Pract 2023; 73:152-154. [PMID: 36997210 PMCID: PMC10049595 DOI: 10.3399/bjgp23x732321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
- Heidi J Siddle
- Health Education England (HEE)/National Institute for Health and Care Research (NIHR) Senior Clinical Lecturer, Associate Professor, and Consultant Podiatrist, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | | | - Anna M Anderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Suzanne H Richards
- Professor of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds
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Anderson AM, Chapman LS, Siddle HJ, Watson S, Klugerman J, Antcliff D, Keenan AM, Brockett CL. "I could have a proper ankle" - a qualitative study of patients' perceptions of total ankle replacement and ankle fusion surgery. J Foot Ankle Res 2022; 15:88. [PMID: 36503504 PMCID: PMC9743489 DOI: 10.1186/s13047-022-00595-8] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND End-stage ankle osteoarthritis typically causes severe pain and impaired function. Surgical treatment involves total ankle replacement (TAR) or ankle fusion. Definitive evidence about which procedure is optimal is lacking. No previous studies have thoroughly explored patients' experiences across the entire TAR/ankle fusion pathway. This study aimed to address this gap by exploring perceptions of surgery, education, rehabilitation and outcomes among patients who had undergone TAR or ankle fusion. METHODS Seven participants were purposively selected from an orthopaedic centre in northern England (3 females, 4 males). Participants had undergone primary TAR without revision (n = 2), TAR requiring revision (n = 3) or ankle fusion (n = 2). Each participant completed a single semi-structured interview. Interviews were digitally recorded, transcribed verbatim and analysed thematically. RESULTS Three themes, each with two subthemes, were identified: decision-making (seeking help; surgical options), perceptions of support (information/education; clinical support) and impact on the individual (personal circumstances and beliefs; post-operative outcomes). Pain affecting participants' valued activities was key to their decision to seek help. Participants' decision between TAR and ankle fusion was influenced by multiple factors. Concerns regarding the lack of joint flexibility following fusion were highlighted, with some participants perceiving TAR as a "proper ankle" that would enable them to avoid limping. Participants obtained information from various sources, with most feeling that the education from their care team was inadequate. Participants' individual circumstances and beliefs influenced their decision-making and perceptions of their post-operative outcomes. Finally, whilst most participants were pleased with their outcomes, some experienced substantial ongoing problems such as difficulty walking and chronic pain. CONCLUSIONS This study demonstrates the importance of providing adequate education about TAR and ankle fusion to enable patients to make informed decisions. Most participants felt that the education and clinical support they received did not fully meet their needs. Participants' personal circumstances and beliefs had a strong influence on their decision-making and perceptions of their post-operative outcomes, highlighting the need to personally tailor education and clinical support. Future work with a larger sample of patients and other key stakeholders is required to develop consensus-based guidelines on pre- and post-operative support for patients undergoing TAR/ankle fusion.
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Affiliation(s)
- Anna M. Anderson
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK ,grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Lara S. Chapman
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Heidi J. Siddle
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sue Watson
- Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK
| | - Jane Klugerman
- Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK
| | - Deborah Antcliff
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,grid.451052.70000 0004 0581 2008Bury Integrated Pain Service, Bury Care Organisation, Northern Care Alliance NHS Foundation Trust, Bury, England, UK ,grid.9757.c0000 0004 0415 6205School of Medicine, Keele University, Keele, UK
| | - Anne-Maree Keenan
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK
| | - Claire L. Brockett
- grid.9909.90000 0004 1936 8403Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Anderson AM, Drew BT, Antcliff D, Redmond AC, Comer C, Smith TO, McHugh GA. Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review. Syst Rev 2022; 11:184. [PMID: 36050795 PMCID: PMC9436722 DOI: 10.1186/s13643-022-02019-x] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Total knee replacement (TKR) is a common operation typically performed for end-stage knee osteoarthritis. Patients awaiting TKR often have poor health-related quality of life. Approximately 20% of patients experience persistent pain post-TKR. Pre-operative TKR interventions could improve pre- and post-operative outcomes, but future research is required to inform their design. This review aimed to identify and synthesize recent literature on the content and delivery of pre-operative TKR interventions to help guide future research and clinical practice. METHODS This rapid review included randomized trials of pre-operative TKR interventions ("outcomes studies") and primary studies exploring patients' and/or health professionals' views of pre-operative TKR interventions ("views studies"). Medline, Embase, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials were searched for English language studies published between January 2009 and December 2020. Eligible studies' reference lists were screened. Studies were appraised using the Mixed Methods Appraisal Tool. The findings were narratively synthesized using a convergent segregated approach. RESULTS From 3263 records identified, 52 studies were included (29 outcomes studies, 21 views studies, two outcomes/views studies). The studies' methodological quality varied but was generally highest in qualitative studies. The outcomes studies investigated education (n=5), exercise (n=20), psychological (n=2), lifestyle (n=1), and/or other interventions (n=5). The views studies addressed education (n=20), exercise (n=3), psychological (n=1), lifestyle (n=4), and/or other interventions (n=1). Only three outcomes studies (two randomized controlled trials (RCTs) and a pilot study) compared the effectiveness of intervention components/delivery approaches. The two RCTs' results suggest that pre-operative TKR exercise interventions are equally effective regardless of whether they include strength or strength plus balance training and whether they are hospital- or home-based. Personal tailoring and using more than one delivery format were associated with improved outcomes and/or perceived as beneficial for multiple intervention types. CONCLUSIONS Definitive evidence on the optimal design of pre-operative TKR interventions is lacking. Personal tailoring and employing multiple delivery formats appear to be valuable design elements. Preliminary evidence suggests that including balance training and hospital versus home delivery may not be critical design elements for pre-operative TKR exercise interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019143248 FUNDER: National Institute for Health and Care Research (ICA-CDRF-2018-04-ST2-006).
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Affiliation(s)
- Anna M Anderson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. .,NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK.,Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, UK.,School of Medicine, Keele University, Keele, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Christine Comer
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Community Healthcare NHS Trust Musculoskeletal and Rehabilitation Services, Leeds, UK
| | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Lavender EC, Dusabe-Richards E, Anderson AM, Antcliff D, McGowan L, Conaghan PG, Kingsbury SR, McHugh GA. Exploring the feasibility, acceptability and value of volunteer peer mentors in supporting self-management of osteoarthritis: a qualitative evaluation. Disabil Rehabil 2021; 44:6314-6324. [PMID: 34498993 PMCID: PMC9590401 DOI: 10.1080/09638288.2021.1964625] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hip and knee osteoarthritis (OA) affect a large and growing proportion of the population. Treatment options are typically conservative making self-management a priority. Using trained peers to support individuals with OA has potential to improve self-management. PURPOSE To explore the process of engaging and training volunteers to become peer mentors; and to qualitatively evaluate the feasibility, acceptability and value of being a peer mentor to support others' self-management of OA. MATERIALS AND METHODS A qualitative evaluation of a peer mentorship support intervention reporting the processes of recruitment and training; and semi-structured interviews conducted with nine active peer mentors. Transcribed interviews were coded and analysed using framework analysis. RESULTS It was possible to recruit, train and retain volunteers with OA to become peer mentors. The peer mentors benefitted from their training and felt equipped to deliver the intervention. They enjoyed social elements of the mentorship intervention and gained satisfaction through delivering valued support to mentees. Peer mentors perceived the mentorship intervention to have a positive impact on self-management of OA for mentees. CONCLUSION Training volunteers with OA to become peer mentors was feasible and acceptable. Peer mentors perceived their support benefitted others with OA. They positively rated their experience of providing mentorship support.IMPLICATIONS FOR REHABILITATIONThis study demonstrates that it is possible to recruit, train and engage older volunteers to become peer mentors for people with osteoarthritis.Training should highlight the significance of employing key self-management techniques such as goal-setting.Peer mentors acknowledged that they benefitted from training and delivering the mentorship intervention, and this impacted positively on their own osteoarthritis self-management.Careful consideration of matching mentors and mentees appears to enhance the success of mentorship support.Recognising the impact of mentorship support on mentees' self-management is central to peer mentors' sustained engagement with the intervention.
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Affiliation(s)
| | | | - Anna M Anderson
- School of Healthcare, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK.,Physiotherapy Department, Bury & Rochdale Care Organisation, Northern Care Alliance NHS Group, Salford, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
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Lavender EC, Anderson AM, Dusabe-Richards E, Antcliff D, Kingsbury SR, Conaghan PG, McHugh GA. Understanding peer mentorship in supporting self-management of hip and knee osteoarthritis: A qualitative study of mentees' perspectives. Musculoskeletal Care 2021; 20:180-191. [PMID: 34314551 PMCID: PMC9290819 DOI: 10.1002/msc.1580] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022]
Abstract
Background Hip and knee osteoarthritis (OA) are common musculoskeletal conditions. Treatment is usually conservative, making self‐management a priority. We developed and trialled an OA peer mentorship intervention to support self‐management in older people. Our objectives were to gain understanding of the perceived challenges of living with OA and explore how a peer mentorship intervention can support tackling these challenges; and to explore mentees' experiences of receiving the intervention to understand how this affected their OA self‐management. Methods Qualitative semi‐structured interviews focussing on acceptability and feasibility of being in the study were conducted with mentees. Transcribed interviews were double coded and subject to framework analysis. To address the objectives of this paper, three main themes were subject to focused analysis: mentees' experiences of OA, experience of peer mentorship support and factors influencing self‐management. Results Seventeen mentees participated in an interview following completion of the peer support intervention. Themes emerging from focused analysis were the following: tackling the challenges of living with OA pre‐ and post‐intervention; and the interplay of the peer mentorship intervention and self‐management. Key elements of the latter theme are enabling factors provided by peer mentorship, and mentees' readiness to self‐manage. Conclusion To effectively support OA self‐management, peer mentorship interventions should include core educational components and focus on strategies that enhance key enablers of self‐management. Paying attention to the mentor–mentee relationship and timing of intervention engagement can maximise opportunities for older people to adjust and transition from supported to independent self‐management.
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Affiliation(s)
| | - Anna M Anderson
- School of Healthcare, University of Leeds, Leeds, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK.,Physiotherapy Department, Bury & Rochdale Care Organisation, Northern Care Alliance NHS Group, Bury, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
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Anderson AM, Lavender EC, Dusabe-Richards E, Mebrahtu TF, McGowan L, Conaghan PG, Kingsbury SR, Richardson G, Antcliff D, McHugh GA. Peer mentorship to improve self-management of hip and knee osteoarthritis: a randomised feasibility trial. BMJ Open 2021; 11:e045389. [PMID: 34290063 PMCID: PMC8296761 DOI: 10.1136/bmjopen-2020-045389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine the feasibility of conducting a randomised controlled trial (RCT) of a peer mentorship intervention to improve self-management of osteoarthritis (OA). DESIGN Six-month parallel group non-blinded randomised feasibility trial. SETTING One secondary care and one primary care UK National Health Service Trust. PARTICIPANTS Fifty adults aged ≥55 years old with hip and/or knee OA. INTERVENTIONS Participants were allocated 1:1 to the intervention or control group using an online randomisation service. Intervention group participants received usual care (information resources) and up to eight community-based self-management support sessions delivered by a peer mentor (trained volunteer with hip and/or knee OA). Control group participants received usual care only. OUTCOME MEASURES Key feasibility outcomes were participant and peer mentor recruitment and attrition, intervention completion and the sample size required for a definitive RCT. Based on these feasibility outcomes, four success criteria for proceeding to a definitive RCT were prespecified. Patient-reported outcomes were collected via questionnaires at baseline, 8 weeks and 6 months. RESULTS Ninety-six individuals were screened, 65 were eligible and 50 were randomised (25 per group). Of the 24 participants who commenced the intervention, 20 completed it. Four participants did not complete the 6-month questionnaire. Twenty-one individuals were eligible for the peer mentor role, 15 were trained and 5 withdrew prior to being matched with a participant. No intervention-related harms occurred. Allowing for 20% attrition, the sample size required for a definitive RCT was calculated as 170 participants. The intervention group showed improvements in self-management compared with the control group. CONCLUSIONS The feasibility outcomes achieved the prespecified criteria for proceeding to an RCT. The exploratory analyses suggest peer mentorship may improve OA self-management. An RCT of the OA peer mentorship intervention is therefore warranted with minor modifications to the intervention and trial procedures. TRIAL REGISTRATION NUMBER ISRCTN:50675542.
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Affiliation(s)
- Anna M Anderson
- School of Healthcare, University of Leeds, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, UK
| | | | | | | | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, UK
- NIHR Research Design Service for Yorkshire and the Humber, York, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK
- Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, UK
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Anderson AM, Comer C, Smith TO, Drew BT, Pandit H, Antcliff D, Redmond AC, McHugh GA. Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study. BMC Musculoskelet Disord 2021; 22:352. [PMID: 33853564 PMCID: PMC8044503 DOI: 10.1186/s12891-021-04160-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Over 90,000 total knee replacement (TKR) procedures are performed annually in the United Kingdom (UK). Patients awaiting TKR face long delays whilst enduring severe pain and functional limitations. Almost 20% of patients who undergo TKR are not satisfied post-operatively. Optimising pre-operative TKR education and prehabilitation could help improve patient outcomes pre- and post-operatively; however, current pre-operative TKR care varies widely. Definitive evidence on the optimal content and delivery of pre-operative TKR care is lacking. This study aimed to develop evidence- and consensus-based recommendations on pre-operative TKR education and prehabilitation. METHODS A UK-based, three-round, online modified Delphi study was conducted with a 60-member expert panel. All panellists had experience of TKR services as patients (n = 30) or professionals (n = 30). Round 1 included initial recommendations developed from a mixed methods rapid review. Panellists rated the importance of each item on a five-point Likert scale. Panellists could also suggest additional items in Round 1. Rounds 2 and 3 included all items from Round 1, new items suggested in Round 1 and charts summarising panellists' importance ratings from the preceding round. Free-text responses were analysed using content analysis. Quantitative data were analysed descriptively. All items rated as 'Important' or 'Very important' by at least 70% of all respondents in Round 3 were included in the final set of recommendations. RESULTS Fifty-five panellists (92%) (patients n = 26; professionals n = 29) completed Round 3. Eighty-six recommendation items were included in Round 1. Fifteen new items were added in Round 2. Rounds 2 and 3 therefore included 101 items. Seventy-seven of these reached consensus in Round 3. Six items reached consensus amongst patient or professional panellists only in Round 3. The final set of recommendations comprises 34 education topics, 18 education delivery approaches, 10 exercise types, 13 exercise delivery approaches and two other treatments. CONCLUSIONS This modified Delphi study developed a comprehensive set of recommendations that represent a useful resource for guiding decision-making on the content and delivery of pre-operative TKR education and prehabilitation. The recommendations will need to be interpreted and reviewed periodically in light of emerging evidence.
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Affiliation(s)
- Anna M Anderson
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - Christine Comer
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Community Healthcare NHS Trust Musculoskeletal and Rehabilitation Services, Leeds, UK
| | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Benjamin T Drew
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK
- Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, England, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
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Shwiff SA, Elser JL, Ernst KH, Shwiff SS, Anderson AM. Cost-benefit analysis of controlling rabies: placing economics at the heart of rabies control to focus political will. REV SCI TECH OIE 2019; 37:681-689. [PMID: 30747117 DOI: 10.20506/rst.37.2.2833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rabies is an economically important zoonosis. This paper describes the extent of the economic impacts of the disease and some of the types of economic analyses used to understand those impacts, as well as the trade-offs between efforts to manage rabies and efforts to eliminate it. In many cases, the elimination of rabies proves more cost-effective over time than the continual administration of postexposure prophylaxis, animal testing and animal vaccination. Economic analyses are used to inform and drive policy decisions and focus political will, placing economics at the heart of rabies control.
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Beavers KM, Beavers DP, Newman JJ, Anderson AM, Loeser RF, Nicklas BJ, Lyles MF, Miller GD, Mihalko SL, Messier SP. Effects of total and regional fat loss on plasma CRP and IL-6 in overweight and obese, older adults with knee osteoarthritis. Osteoarthritis Cartilage 2015; 23:249-56. [PMID: 25450847 PMCID: PMC4304884 DOI: 10.1016/j.joca.2014.11.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/13/2014] [Accepted: 11/01/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe associations between total and regional body fat mass loss and reduction of systemic levels of inflammation (C-reactive protein (CRP) and interleukin-6 (IL-6)) in obese, older adults with osteoarthritis (OA), undergoing intentional weight loss. DESIGN Data come from a single-blind, 18-month, randomized controlled trial in adults (age: 65.6 ± 6.2; Body mass index (BMI): 33.6 ± 3.7) with knee OA. Participants were randomized to diet-induced weight loss plus exercise (D + E; n = 150), diet-induced weight loss-only (D; n = 149), or exercise-only (E; n = 151). Total body and region-specific (abdomen and thigh) fat mass were measured at baseline and 18 months. High-sensitivity CRP and IL-6 were measured at baseline, six and 18 months. Intervention effects were assessed using mixed models and associations between inflammation and adiposity were compared using logistic and mixed linear regression models. RESULTS Intentional total body fat mass reduction was associated with significant reductions in log-adjusted CRP (β = 0.06 (95% CI = 0.04, 0.08) mg/L) and IL-6 (β = 0.02 (95% CI = 0.01, 0.04) pg/mL). Loss of abdominal fat volume was also associated with reduced inflammation, independent of total body fat mass; although models containing measures of total adiposity yielded the best fit. The odds of achieving clinically desirable levels of CRP (<3.0 mg/L) and IL-6 (<2.5 pg/mL) were 3.8 (95% CI = 1.6, 8.9) and 2.2 (95% CI = 1.1, 4.6), respectively, with 5% total weight and fat mass loss. CONCLUSIONS Achievement of clinically desirable levels of CRP and IL-6 more than double with intentional 5% loss of total body weight and fat mass. Global, rather than regional, measures of adiposity are better predictors of change in inflammatory burden. CLINICAL TRIAL REGISTRATION NUMBER NCT00381290.
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Affiliation(s)
- K M Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
| | - D P Beavers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - J J Newman
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
| | - A M Anderson
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - R F Loeser
- Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - B J Nicklas
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - M F Lyles
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - G D Miller
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
| | - S L Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
| | - S P Messier
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
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Anderson AM. Notes of a Peculiar Teat-Eruption in a Milch Cow, Coincident with an Outbreak of Typhoid Fever Amongst the Consumers of the Milk. Br Med J 2011; 2:465-71. [PMID: 20752796 DOI: 10.1136/bmj.2.1496.465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hanley AJG, Wagenknecht LE, Norris JM, Bryer-Ash M, Chen YI, Anderson AM, Bergman R, Haffner SM. Insulin resistance, beta cell dysfunction and visceral adiposity as predictors of incident diabetes: the Insulin Resistance Atherosclerosis Study (IRAS) Family study. Diabetologia 2009; 52:2079-86. [PMID: 19641896 PMCID: PMC3992852 DOI: 10.1007/s00125-009-1464-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 06/24/2009] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS Central obesity, insulin resistance and beta cell dysfunction are independent risk factors for incident type 2 diabetes, although few studies have used detailed measures of these disorders. Our objective was to study the association of directly measured visceral and subcutaneous adipose tissue (VAT, SAT), insulin sensitivity (S (I)) and the acute insulin response (AIR) with incident type 2 diabetes. METHODS Participants were 1,230 Hispanic-Americans and African-Americans in the Insulin Resistance Atherosclerosis Study (IRAS) Family Study who were free of type 2 diabetes at baseline (2000-2002). S (I) and AIR were determined from frequently sampled IVGTTs with minimal model analysis. VAT and SAT were determined by computed tomography. Impaired fasting glucose and type 2 diabetes were defined according to American Diabetes Association criteria. RESULTS Incident type 2 diabetes was diagnosed in 90 participants after 5 years. After adjustment for age, sex, ethnicity, centre, impaired fasting glucose, triacylglycerol, HDL-cholesterol and systolic BP, both S(I) and AIR were inversely associated with type 2 diabetes (S (I), OR 0.53, 95% CI 0.39-0.73; AIR, OR 0.22, 95% CI 0.14-0.34 per SD; both p < 0.001), while both VAT and SAT were positively associated with type 2 diabetes (VAT, OR 1.68, 95% CI 1.22-2.33; SAT, OR 1.49, 95% CI 1.13-1.99; both p < 0.01). In a model including all four factors, S (I) and AIR (S (I), OR 0.55, 95% CI 0.37-0.80; AIR, OR 0.21, 95% CI 0.13-0.33; both p < 0.01) were significant predictors of type 2 diabetes, although associations with VAT and SAT were no longer significant. A significant sex x VAT interaction indicated a stronger association of VAT with type 2 diabetes in women than in men. CONCLUSIONS/INTERPRETATION Insulin resistance, beta cell dysfunction and VAT predicted incident type 2 diabetes, with evidence of a stronger association of VAT with type 2 diabetes among women.
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Affiliation(s)
- A J G Hanley
- Department of Nutritional Sciences, University of Toronto, ON, Canada.
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Feuth M, Brandsma JW, Faber WR, Bhattarai B, Feuth T, Anderson AM. Erythema nodosum leprosum in Nepal: a retrospective study of clinical features and response to treatment with prednisolone or thalidomide. LEPROSY REV 2008; 79:254-269. [PMID: 19009975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Erythema nodosum leprosum (ENL) is an inflammatory reaction, which may occur in the course of leprosy and may result in nerve function impairment and subsequent disability. METHODS This retrospective study explores demographic and disease specific parameters. Severity of ENL was assessed using the Reaction Severity Scale (RSS). Records of 94 patients were reviewed. The study reports also on the treatment of 76 of these patients who were treated with prednisolone alone or thalidomide in addition to prednisolone. RESULTS Thirty percent of patients presented with ENL at time of diagnosis; 41% developed ENL-reaction in the first year of MDT. Forty-eight percent of patients were treated for ENL-reaction for less than 12 months; 13% for more than 5 years. High RSS-scores correlated with a longer duration of treatment. In group A (prednisolone) 51.7% and in group B (prednisolone and thalidomide) 76.6% of patients were male. Age, leprosy classification, delay of multidrug treatment (MDT) and interval between MDT and first ENL-symptoms did not differ significantly in both groups. Median duration of ENL-treatment was 15 months in group A versus 38 months in group B (P < 0.001). At the start of treatment, ENL-reaction was less severe in group A (RSS = 12) than in group B (RSS = 18; P = 0.003). DISCUSSION ENL-symptoms may be of help in the early diagnosis and adequate treatment of ENL. Characterisation of (sub) groups of patients with ENL based on presence and severity of symptoms is important for future prospective studies to better evaluate the efficacy of interventions.
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Affiliation(s)
- M Feuth
- Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
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14
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Abstract
Front load carriage is a common occupational task in some industries (e.g. agriculture, construction), but, as compared to lifting tasks, relatively little research has been conducted on the biomechanical loading during these activities. The focus of this study was to explore the low back biomechanics during these activities and, specifically, to examine the effects of load height and walking speed on trunk muscle activity and trunk posture. Eleven male participants participated in two separate front load-carriage experiments. The first experiment called for carrying a barbell (with weight corresponding to 20% of elbow flexion strength) at three heights (knuckle height, elbow height and shoulder height) at a constant horizontal distance from the spine. The second experiment called for participants to carry a bucket of potatoes weighing 14 kg at the same three heights, but with no further restrictions in technique. In both experiments, the participants performed this task while either standing still or walking at a self-selected speed. As they performed these tasks, the activity levels of the right-side muscle of the rectus abdominis, external oblique, biceps brachii, anterior deltoid and three levels (T9, T12 and L3) of the erector spinae were sampled. Mid-sagittal plane trunk posture was also quantified using three magnetic field-based motion sensors at T9, T12 and L3. The results showed a significant effect of both walking speed and load height on trunk posture and trunk muscle activity levels in both the barbell and bucket experiments. In the barbell experiment, the walking trials generated 43% more trunk muscle activity than the standing trials. Trials at shoulder height produced 11% more muscle activity than trials at elbow height in the T9 erector spinae muscles and 71% more muscle activity in the anterior deltoid. In the bucket experiment, trunk muscle activity responded in a similar fashion, but the key result here was the quantification of the natural hyperextension posture of the spine used to balance the bucket of potatoes. These results provide insight into muscle activation patterns in dynamic settings, especially (load) carrying biomechanics, and have implications in industrial settings that require workers to carry loads in front of their bodies.
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Affiliation(s)
- A M Anderson
- The Ergonomics Laboratory, Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina, NC 27695-7906, USA
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Brandsma JW, Schwarz RJ, Anderson AM, Herm FB. Transformation of a leprosy hospital in Nepal into a rehabilitation centre: the Green Pastures Hospital experience. LEPROSY REV 2005; 76:267-76. [PMID: 16411507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Green Pastures Hospital for leprosy patients in Pokhara Nepal, was established in 1957 by the International Nepal Fellowship (INF) in a decade which saw the establishment of many similar hospitals in other leprosy endemic countries. In recent years, mainly due to significant improvements in leprosy control services and the wide implementation of multiple drug therapy (MDT) for all patients, many of these specialist hospitals have encountered 1) a decline in prevalence rate, 2) a large decline in the percentage of patients presenting with WHO grade 2 disability, 3) a decline in the previous indications for hospital admission, e.g. immunologically mediated reactions, and 4) a need to develop financial independence making them less dependent on donor agencies. In addition, the decision to change from specialist to general services opened up the possibility of using facilities and expertise for the rehabilitation of non-leprosy affected persons, whilst also moving towards the reduction of stigma and prejudice against patients with leprosy. This paper describes the process of 'transformation' of an established and well known leprosy hospital in Western Nepal from 1997 onwards into a general rehabilitation hospital. Careful preparation, with full involvement of existing staff and co-operation with other agencies in the hospital catchment area were key factors in what has now become a successful venture. Surgical procedures and orthopaedic appliance services for non-leprosy affected persons have increased in recent years and the introduction of a dermatology service has resulted in out-patient attendance rising from about 1000 in 1999 to 4500 in 2003. No evidence of reluctance to attend and use the facilities offered by this hospital because of stigma against leprosy has been encountered. Many of the changes described have been made in order to reduce financial dependence on donor sources of support, but the underlying reason for transformation is still based on the vision of the INF mission to work for and improve the condition of the marginalized in society.
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Affiliation(s)
- J W Brandsma
- Green Pastures Hospital and Rehabilitation Centre, International Nepal Fellowship, Pokhara, Nepal.
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Affiliation(s)
- J W Turner
- Durham Veterans Affairs Medical Center and Duke University Medical Center, Durham, North Carolina, USA
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Abstract
Two new methods of thumb web space measurement, the intermetacarpal distance (IMD) and the derived intermetacarpal angle (DIMA), were proposed and compared with a conventional method for interrater reliability. Forty subjects (22 normal hands, 18 impaired hands) were measured. Reliability of the measurement was estimated using the intraclass correlation coefficient (ICC) and the Bland and Altman method of 95% limits of agreement. Overall, the IMD method showed an ICC of 0.88 with 95% limits of agreement of -6.9 to 5.6 mm (approximately +/-6.2 mm). Similarly, for the DIMA method, the ICC was 0.47 with 95% limits of agreement of -11.9 to 5.1 degrees (approximately +/-8.5 degrees ). The IMD method appears more reliable than the conventional method, which had an ICC of 0.26 and 95% limits of agreement of -17.5 to 9.2 degrees (approximately +/-13.3 degrees ). The IMD method is recommended as a reliable method of measuring the thumb web space.
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Affiliation(s)
- Prashant M Murugkar
- Physiotherapy Department, Green Pastures Hospital & Rehabilitation Centre, Pokhara, Nepal.
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Abstract
In most bryophytes, the thickness of boundary layers (i.e., unstirred layers) that surrounds plant surfaces governs rates of water loss. Architectural features of canopies that influence boundary layer thickness affect the water balance of bryophytes. Using field samples (9.3 cm diameter cushions) from 12 populations (11 species) of mosses and liverworts, we evaluated the relationship between canopy structure and boundary layer properties. Canopy structure was characterized using a contact surface probe to measure canopy depth along perpendicular transects at spatial scales ranging from 0.8 to 30 mm on 186 points per sample. Semivariance in depth measurements at different spatial scales was used to estimate three architectural properties: surface roughness (L(r)), the scale of roughness elements (S(r)), and fine-scale surface texture, the latter characterized by the fractal dimension (D) of the canopy profile. Boundary layer properties were assessed by evaporation of ethanol from samples in a wind-tunnel at wind speeds from 0.6 to 4.2 m/s and applied to characterize mass transfer using principles of dynamic similarity (i.e., using dimensionless representations of conductance and flow). In addition, particle image velocimetry (PIV) was used to visualize and quantify flow over two species. All cushions exhibited the characteristics of turbulent as opposed to laminar boundary layers, and conductance increased with surface roughness. Bryophyte canopies with higher L(r) had greater conductances at all wind speeds. Particle image velocimetry analysis verified that roughness elements interacted with flow and caused turbulent eddies to enter canopies, enhancing evaporation. All three morphological features were significantly associated with evaporation. When L(r), S(r), and D were incorporated with a flow parameter into a conductance model using multiple linear regression, the model accounted for 91% of the variation in mass transfer.
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Affiliation(s)
- S K Rice
- Department of Biological Sciences, Union College, Schenectady, New York 12308 USA
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Abstract
This case report describes a situation in which lack of milk production led the mother to seek help from a lactation consultant in private practice. Despite extensive breast stimulation with the baby at breast and mechanical breast expression, no milk was produced. Retained placenta was suspected by the lactation consultant. The mother was later diagnosed with placenta increta. Only when this condition was diagnosed and resolved did milk onset occur. It is important to evaluate for retained placental fragments when lactation appears to be delayed.
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Heynders ML, Meijs JJ, Anderson AM. Towards an understanding of non-compliance. An assessment of risk factors for defaulting from leprosy treatment. LEPROSY REV 2000; 71:369-76. [PMID: 11105497 DOI: 10.5935/0305-7518.20000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the Eastern Leprosy Control Project of Nepal, a retrospective case control study looked for simple factors that might be used operationally to predict non-compliant behaviour in patients. Patients with these factors would then become the targets of measures such as intensified health education messages and home visits in order to reduce the risk of defaulting. A study of 1442 patient cards (half defaulters, half treatment completed) revealed occasional small but significant demographic and clinical differences, but none was of a sufficient magnitude to be operationally useful. Review of the attendance of patients in the first few months of treatment suggested that eventual defaulting was strongly associated with irregularity from the commencement of treatment. It is possible that an early indicator based on attendance over the first months can be used to target patients who are in danger of non-completion of treatment.
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Winter TC, Anderson AM, Cheng EY, Komarniski CA, Souter VL, Uhrich SB, Nyberg DA. Echogenic intracardiac focus in 2nd-trimester fetuses with trisomy 21: usefulness as a US marker. Radiology 2000; 216:450-6. [PMID: 10924569 DOI: 10.1148/radiology.216.2.r00au32450] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether there is a relationship between the presence of an echogenic intracardiac focus in 2nd-trimester fetuses and trisomy 21 (Down syndrome). MATERIALS AND METHODS A complete genetic ultrasonographic (US) scan was obtained in 3,303 consecutive fetuses with an estimated gestational age of 14.0-24.0 weeks (mean +/- SD, 17.1 weeks +/- 1.75). US was performed in a prospective fashion without any knowledge of karyotype and included assessment of any potential echogenic intracardiac focus (ie, calcified papillary muscle). Karyotypes were obtained in all fetuses. Maternal ages ranged from 13.0 to 47.4 years (mean, 35.1 years +/- 5.1). The prevalence of Down syndrome in this population was 1.6% (53 of 3,303 fetuses). RESULTS An echogenic intracardiac focus was seen in 147 of the 3,192 karyotypically normal fetuses (4.6%) and 16 of the 53 fetuses with trisomy 21 (30%). The positive predictive value (PPV) of an echogenic intracardiac focus in this high-risk population was 9.8%; sensitivity, 30%; specificity, 95%; likelihood ratio, 6.6; and relative risk (RR), 8.2 (P <.001). For a sonographically isolated echogenic intracardiac focus, the PPV was 3.7%; sensitivity, 19%; specificity, 95%; likelihood ratio, 4.2; and RR, 4.8 (P =.002). CONCLUSION A sonographically isolated echogenic intracardiac focus (no other anomalies or markers noted on a complete genetic sonogram) was associated in our high-risk population with a 4.8-fold (95% CI: 1.8, 12.5) increase in RR for trisomy 21 (P =.002).
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Affiliation(s)
- T C Winter
- Department of Radiology, Division of Ultrasound, University of Washington Medical Center, Seattle, WA, USA
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Ezell DM, Geiselman PJ, Anderson AM, Dowdy ML, Womble LG, Greenway FL, Zachwieja JJ. Substrate oxidation and availability during acute exercise in non-obese, obese, and post-obese sedentary females. Int J Obes (Lond) 1999; 23:1047-56. [PMID: 10557025 DOI: 10.1038/sj.ijo.0801037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study compared fat oxidation rates during an acute bout of cycle ergometry exercise (E) typical of progressive fat oxidation in healthy, but sedentary, women of different obesity histories. DESIGN Five never-obese (NO) (mean age=25+/-3 (s.e.)y, mean body fat=25.0+/-2.8 (s.e.)%), five obese (O) (26+/-3 y, 44. 4+/-1.7%), and five post-obese (PO) (22+/-1 y, 32.2+/-3.0%) women cycled for 60 min at 60-65% peak VO2. To identify the specific effects of E, a control trial consisting of 60 min of seated rest (R) was also performed. E and R trials were counterbalanced one month apart in the follicular phase and conducted following a 3 d normalized, eucaloric diet. MEASUREMENTS Dual energy X-ray absorptiometry (DEXA) was used to determine body composition, and all were weight stable for at least eight weeks prior to experimentation. During both trials breath by breath measurements of VO2 and RER were used to determine substrate oxidation and energy expenditure. Blood samples were collected for hormone and metabolite analysis before, and every 15 min during exercise or rest. RESULTS All three groups showed a similar and progressive shift toward fat oxidation as exercise progressed. No group differences were observed for E energy expenditure or fat oxidation. Glycerol (P<0.0001) and free fatty acids (P<0.0001) increased similarly in all three groups, but PO maintained the highest free fatty acid level during exercise (group effect; P<0.01). E and R decreased (P<0.001 for both) insulin levels across groups, with lowest levels noted in PO and highest in O. Plasma epinephrine (P<0.0001) and norepinephrine (P<0.001) increased similarly during E in all three groups. Plasma growth hormone (GH) levels rose (P<0.05) during E, with a pronounced increase observed in PO. CONCLUSION We conclude that exercise of equal relative intensity elicited similar fat oxidation rates among NO, O, and PO women, despite group differences in free fatty acid availability. The PO women's persistently lower insulin and higher plasma GH levels may have enhanced free fatty acid availability.
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Affiliation(s)
- D M Ezell
- Exercise and Nutrition Program, Pennington Biomedical Research Center at Louisana State University, Baton Rouge, LA 70808, USA
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van Brakel WH, Anderson AM, Wörpel FC, Saiju R, Bk HB, Sherpa S, Sunwar SK, Gurung J, De Boer M, Scholten E. A scale to assess activities of daily living in persons affected by leprosy. LEPROSY REV 1999; 70:314-23. [PMID: 10603721 DOI: 10.5935/0305-7518.19990035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to develop a scale for identifying disability among people in the rural areas of developing countries. The studies were carried out in the Green Pastures Hospital and the leprosy field programme of the Western Region of Nepal. With the help of staff experienced in working with people with disability, a 68-question questionnaire was made, based on the International Classification of Impairments, Activities and Participation (ICIDH-2). A survey was carried out of 269 people affected by leprosy who had impairments, as well as a sample of those who were unimpaired. The survey results were used to develop the questionnaire into a scale, using standard scale development methods. This included checking of criterion validity, discrimination and reliability and stability using weighted kappa statistics. Of the 68 questions, 38 were included in the second draft of the instrument. Eight questions were added to identify difficulty in relationships, about the use of aids and about occupation and employment. The sum score of the scale against the expert score gave a Spearman correlation coefficient of 0.72. Intra- and inter-interviewer reliability coefficients were 0.77 (95% CI 0.73-0.81) and 0.61 (95% CI 0.56-0.67), respectively. The stability test gave an overall kappa of 0.76 (95% CI 0.70-0.82). Four questions with particularly poor results were omitted from the final draft of the instrument. An interview-based instrument was developed for identifying limitations in activities of daily living (disability) in people living in a rural setting in a developing country--the Green Pastures Activity Scale (GPAS). The scale performed well during validity and reliability testing. It consists of 34 activity questions, five relationship questions, and three questions on the use of aids, occupation and employment.
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Abstract
The reliability of methods of testing nerve function is important, since diagnostic decision making is a direct function of the quality of the test. Three methods of nerve function testing were investigated at the Danish Bangladesh Leprosy Mission (DBLM) in north Bangladesh, and assessed for inter-observer reliability. The three methods were 1) ballpoint pen test (BPT) for sensory function; 2) graded Semmes Weinstein monofilament test (SWM) for sensory function and 3) voluntary muscle testing (VMT) for motor function. The weighted kappa (kappa w) statistic was used to express inter-observer reliability. Using this statistic, 0 represents agreement no better than random, and 1.0 complete agreement. kappa w values of > or = 0.80 are reckoned to be adequate for monitoring and research. Fifty-three patients were tested, a Senior physiotechnician acting as 'gold standard' against whom four other staff physiotechnicians were assessed. All three testing methods were found to have minimal inter-observer variation, with the kappa w for inter-observer agreement using BPT being 0.86, the SWM 0.92, and VMT 0.94. It is concluded that in trained and experienced hands, all three methods are reliable and repeatable to a level allowing confident use of results obtained in monitoring and research.
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Ward-Lonergan JM, Liles BZ, Anderson AM. Verbal retelling abilities in adolescents with and without language-learning disabilities for social studies lectures. J Learn Disabil 1999; 32:213-223. [PMID: 15508241 DOI: 10.1177/002221949903200303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Verbal retelling abilities for social studies lectures were examined and compared in 20 adolescent boys, ages 12-5 to 14-7, with language-learning disabilities (LLD) and 29 with normal language abilities (NL). Participants viewed one videotaped social studies lecture with a comparison expository discourse structure and one with a causation discourse structure. Following each lecture presentation, participants verbally retold the lecture. Results of several repeated-measures analyses of variance indicated that the group with LLD produced a significantly smaller number of T-units, subordinate clauses, subordinate clauses per T-unit, T-units per second, lecture components per second, and percentage of lecture components in their retellings, compared with the group with NL, regardless of lecture type. Both groups produced a significantly greater number of T-units and subordinate clauses for the comparison lecture. By contrast, both groups recalled a significantly greater number of lecture components per T-unit and per second for the causation lecture. Results indicated that the comparison discourse structure facilitated more substantive and elaborate retellings, whereas the causation discourse structure facilitated more efficient, concise retellings in both groups. Research and instructional implications are discussed.
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Affiliation(s)
- J M Ward-Lonergan
- Department of Communication Disorders, Bowling Green State University, Ohio 43403, USA
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Croft RP, Nicholls P, Anderson AM, van Brakel WH, Smith WC, Richardus JH. Effect of prophylactic corticosteroids on the incidence of reactions in newly diagnosed multibacillary leprosy patients. Int J Lepr Other Mycobact Dis 1999; 67:75-7. [PMID: 10407634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Abstract
Ischemic necrosis of the femoral head occurring after the treatment of congenital dysplasia of the hip can negatively affect the long-term prognosis of the involved hip. Some investigators have suggested that the presence of the ossific nucleus of the femoral head at the time of closed or open reduction is associated with a lower rate of ischemic necrosis. This finding, if verified, could lead to a delay in the treatment of a dislocated hip until ossification of the femoral head has begun, which may be well after the age when the patient has started to walk. We conducted a computerized search of the medical records at our two tertiary-care children's hospitals to identify all patients with congenital dysplasia of the hip who had had a closed or open reduction between January 1, 1979, and December 31, 1993. One hundred and twenty-four patients (153 hips) who satisfied the criteria for inclusion were identified. The ossific nucleus was present in ninety hips and absent in sixty-three. Closed reduction was used in 112 hips and open reduction, in forty-one. Ischemic necrosis was identified in five hips (3 percent): four (6 percent) of the sixty-three hips that did not have an ossific nucleus and one (1 percent) of the ninety hips that had an ossific nucleus at the time of the reduction. With the numbers available for study, we could not detect a difference between these two groups. The age at reduction (p > 0.99), the method of reduction (p = 0.611), previous treatment with a Pavlik harness (p = 0.592), the use of preliminary traction (p = 0.602), concomitant procedures (p > 0.99), and a failure of the primary closed reduction (p = 0.579) were not associated with the development of ischemic necrosis after reduction. In our analysis of patients who were managed over a fifteen-year period, the data did not support the hypothesis that the presence of an ossific nucleus at the time of reduction of a congenitally dislocated hip is associated with a lower prevalence of ischemic necrosis of the femoral head. Sound operative principles dictate that operative reduction of a congenitally displaced hip should be performed when the child can be safely placed under anesthesia and without regard to the presence or absence of the ossific nucleus.
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Affiliation(s)
- S J Luhmann
- Shriners Hospital for Children, St. Louis Unit, Missouri 63131, USA
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Brandsma JW, Van Brakel WH, Anderson AM, Kortendijk AJ, Gurung KS, Sunwar SK. Intertester reliability of manual muscle strength testing in leprosy patients. LEPROSY REV 1998; 69:257-66. [PMID: 9805881 DOI: 10.5935/0305-7518.19980027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study reports the results of a study on the intertester reliability of manual muscle strength testing in leprosy patients with confirmed motor function loss of at least one nerve. Three testers graded the muscle strength of 72 patients in random order. Both hands and feet were graded. Strength was graded on a modified Medical Research Council Scale (9 points, 5, 4+, 4, 3+, 3, 2+, 2, 1, 0). The following movements were tested for strength: little finger and index finger abduction, intrinsic position of all four fingers, thumb abduction and opposition, foot dorsiflexion and eversion and extension of the big toe. The weighted kappa statistic was used to calculate the chance-corrected percentage of agreement between observers. Overall agreement for each of the 11 tests appeared to be good or very good (0.61-1.00). However, when data for hands or feet with normal strength or complete paralysis were excluded from the analysis, the reliability of the remaining mid-range scale was not acceptable (kappa 0.55-0.88, direct agreement range 11-41%). While the reliability of this scale could possibly be improved by special training, we feel that, for the evaluation of nerve function for leprosy patients with (suspected) nerve function loss, the extended 9-point VMT scale should only be used when direct intra- or intertester agreement is more than 80%.
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Affiliation(s)
- J W Brandsma
- Academic Medical Center, Amsterdam, The Netherlands
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Geiselman PJ, Anderson AM, Dowdy ML, West DB, Redmann SM, Smith SR. Reliability and validity of a macronutrient self-selection paradigm and a food preference questionnaire. Physiol Behav 1998; 63:919-28. [PMID: 9618017 DOI: 10.1016/s0031-9384(97)00542-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Our laboratory has developed a macronutrient self-selection paradigm (MSSP) designed to vary fat content significantly and systematically with sugar, complex carbohydrates, and protein content in a battery of foods in which fat is commonly consumed in the American diet. We have also developed a food preference questionnaire (FPQ) according to an identical design but using a list of foods mutually exclusive of those presented for selection and intake in the MSSP. Men were tested twice on both instruments, with a 4-week interval between tests. It was determined that the MSSP has strong test-retest reliability for overall fat (r = 0.91) and other macronutrient intake and total caloric intake. In addition, hunger and fullness ratings were reproducible, and fat preferences (r = 0.99) and hedonic responses to foods listed on the FPQ were highly consistent across trials. This study also demonstrated that the MSSP is a valid instrument with respect to the men's reports of habitual intake of fat (r = 0.80) and total carbohydrates on the Block food questionnaire (FQ). In addition, men's fat preferences on the FPQ were validated with respect to overall fat (r = 0.86) and total caloric intake in the MSSP and fat intake (r = 0.83) reported on the Block FQ. The MSSP also has the capability to detect a wide range of fat intake (3.06-50.35% among the present subjects), indicating that this instrument can identify individuals who differ markedly in fat intake or could detect changes in fat preference within subjects. In addition, this paradigm detected a large range of sugar and total caloric intake. It is anticipated that the use of these laboratory tools can enhance our understanding of the relationship between dietary fat intake and obesity.
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Affiliation(s)
- P J Geiselman
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge 70808-4124, USA.
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Abstract
The objective of this study was to develop a bait for delivering an oral rabies vaccine to free-ranging coyotes (Canis latrans) in southern Texas. Captive trials were conducted from January to April, 1994, to determine bait preferences and behavioral responses of coyotes (n = 42) to selected baits and attractants. Baits were hollow rectangular cubes made of polymer dog food or fish meal. Attractants had sweet (watermelon), fruity (raspberry), sulfurous (synthetic WU), and lard (beef lard) fragrances. Captive coyotes did not exhibit a preference for either bait bases or attractants; however, coyotes chewed dog food baits 1.6 times more than fish meal baits. Average proximity of coyotes eliciting a response to baits was 2.2 +/- 1.3 m (mean +/- SE). Captive coyotes readily accepted dog food baits containing 2 ml of liquid rhodamine B, a biological marker. Rhodamine B staining of the oropharyngeal region was evident in each captive coyote. Results from the field evaluation of baits and attractants were consistent with that of the captive trials. Of 2,070 bait station-nights conducted from February to April, 1994, coyotes comprised the greatest single species visitation and uptake rates with 31% and 28%, respectively. Bait uptake rates of free-ranging coyotes did not differ among bait-attractant combinations. Coyotes took baits 93% of the time they encountered a bait, regardless of bait type.
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Affiliation(s)
- S C Farry
- Caesar Kleberg Wildlife Research Institute, Texas A&M University-Kingsville 78363, USA
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Knuuttila JP, van Brakel WH, Anderson AM. Ocular impairments in an impairment survey of leprosy-affected persons in Nepal. Indian J Lepr 1998; 70:93-6. [PMID: 9598409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An impairment survey was carried out in Nepal. The study subjects (n = 318) were a mixture of out-patients and patients admitted less than one month before the survey. Of the subjects, 101 were attending the hospital out-patients clinic or were admitted and the rest were examined in the field. The patients studied included those on MDT and care-after-cure cases. Ocular impairments were found in 25% of these cases. The most common ocular impairment was poor vision followed by lagophthalmos and insensitive cornea.
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Ward-Lonergan JM, Liles BZ, Anderson AM. Listening comprehension and recall abilities in adolescents with language-learning disabilities and without disabilities for social studies lectures. J Commun Disord 1998; 31:1-32. [PMID: 9421765 DOI: 10.1016/s0021-9924(97)00048-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Listening comprehension and recall abilities for social studies lectures were examined and compared in 20 adolescent males with language-learning disabilities (LLD) and 29 without disabilities (WD). Subjects viewed two social studies lectures with comparison and causation expository discourse structures and verbally responded to literal and inferential comprehension questions. Regardless of lecture type or question type, the group with LLD performed significantly more poorly than did the group WD. Both groups responded accurately to significantly more inferential questions for the causation lecture over the comparison lecture. Neither group demonstrated a significant difference with respect to their response accuracy for the literal questions across lecture types.
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Affiliation(s)
- J M Ward-Lonergan
- Department of Communication Disorders, Bowling Green State University, OH 43403, USA.
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van Brakel WH, Anderson AM. Comment. Sensory testing of the hands in leprosy. LEPROSY REV 1997; 68:382-5. [PMID: 9503877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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van Brakel WH, Anderson AM. Impairment and disability in leprosy: in search of the missing link. Indian J Lepr 1997; 69:361-76. [PMID: 9474512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper describes the results of a survey aimed at studying the relationship between impairment and disability in leprosy. Persons affected by leprosy attending the Green Pastures Hospital, Pokhara, or one of the field clinics in the Western Region of Nepal visited during the study period were interviewed using a standardized questionnaire. Two hundred and sixty-nine subjects were included in the study. For the analysis, 'disability', was defined as activities being done with 'much difficulty', 'only with help' or being 'impossible'. The most commonly affected indoor activities were cutting nails (22%), washing clothes (16%), using scissors (17%) and tying a knot (18%). Among the outdoor activities, cutting grass, digging, harvesting, threshing and milking a cow or buffalo were the most commonly affected (22%-26%). Sensory impairment of the thumb and/or index finger at the 2 g level was a very significant risk factor for disability activities involving the hand(s). Muscle weakness of the thumb and mobile clawing of the fingers had a strong association with disability in several activities. Sensory impairment of the sole was the strongest determinant of disability in activities involving the lower limb. We recommend that efforts should be made to include disability as a standard activity for monitoring and evaluation of rehabilitation, both for individuals and on programme level.
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Morgan SL, Anderson AM, Hood SM, Matthews PA, Lee JY, Alarcón GS. Nutrient intake patterns, body mass index, and vitamin levels in patients with rheumatoid arthritis. Arthritis Care Res 1997; 10:9-17. [PMID: 9313385 DOI: 10.1002/art.1790100103] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess nutrient intakes and vitamin levels in 79 patients with rheumatoid arthritis participating in a trial and to determine whether changes in body mass index were associated with changes in disease activity. METHODS This study evaluated baseline vitamin levels, 1-day dietary intakes, and weight every 3 months for 1 year. Linear regression analysis was used to evaluate the relationship of time to body mass index. Analysis of covariance was used to determine if body mass index, time, or treatment had an effect on disease activity. RESULTS Deficient vitamin levels and poor nutrient intake patterns were prevalent in the study population. Changes in body mass index over time did not correlate with changes in disease activity. CONCLUSIONS Rheumatoid arthritis patients are at high risk of obesity, abnormal vitamin levels, and poor nutrient intakes. Changes in body mass index failed to correlate with changes in disease activity.
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Affiliation(s)
- S L Morgan
- Department of Nutrition Sciences School of Medicine, University of Alabama at Birmingham 35294-3360, USA
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Wichstrøm L, Anderson AM, Holte A, Wynne LC. Disqualifying family communication and childhood social competence as predictors of offspring's mental health and hospitalization. A 10- to 14-year longitudinal study of children at risk of psychopathology. J Nerv Ment Dis 1996; 184:581-8. [PMID: 8917154 DOI: 10.1097/00005053-199610000-00001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Forty-nine families from the University of Rochester Child and Family Study were followed up 10 to 14 years after initial assessment. Two inclusion criteria were applied: at least one of the parents had been hospitalized for a functional psychiatric disorder before initial assessment and, second, the male index offspring should be 18 years or older at follow-up. Initial measures included observationally based coding of the family's level of disqualifying communication toward the index offspring, index child's scores on the Child Manifest Anxiety Scale, and ratings of the index child's social competence carried out by peers, teachers, and parents. Offspring outcome was measured by the Mental Health Inventory, Global Assessment Scale (GAS), and hospitalization for psychiatric disorder. The results showed that every measure of offspring outcome was predicted by the amount of disqualification directed to the offspring from the other family members. In addition, GAS score and mental health were predicted by the offspring's competence as a child. Family disqualification, childhood competence, and socioeconomic status accounted for 63% of the variance in adult GAS scores.
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Affiliation(s)
- L Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology, Dragvoll, Norway
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Abstract
PURPOSE To explore fathers' experiences of developing a relationship with their infants during the infant's first 2 months of life DESIGN Grounded theory approach SETTING Fathers' homes or other mutually agreed-upon site PARTICIPANTS First-time fathers (N = 14), ages 28-44, Caucasian, middle class MAIN OUTCOME MEASURES Tape-recorded semistructured interviews to elicit fathers' perceptions of their fathering selves, their infants, and the father-infant relationship. RESULTS Using constant comparative method for analysis, three major categories were identified as operative in the initial development of the father-infant relationship: (a) making a commitment, (b) becoming connected, and (c) making room for the baby CONCLUSIONS With an increased understanding of the father-infant relationship, nurses can provide humanistic, thoughtful care to assist fathers in developing this significant relationship.
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Affiliation(s)
- A M Anderson
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
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Mowrey D, Albert RH, Anderson AM, Britton P, Cawley JL, Condon RJ, Reinberg M, Horwitz W, King DW, Malcolm S, McClure FD, Nelsen TC, Nemeth MA, Phillips JG, Rund RC. Statistics Committee. J AOAC Int 1996. [DOI: 10.1093/jaoac/79.1.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Daniel Mowrey
- Lilly Research Laboratories, PO Box 708, Greenfield, IN 46140, USA
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Wichstrom L, Anderson AM, Holte A, Husby R, Wynne LC. Confirmatory and disconfirmatory family communication as predictor of offspring socio-emotional functioning. A 10 to 14 year follow-up of children at risk. Acta Psychiatr Scand 1996; 93:49-56. [PMID: 8919329 DOI: 10.1111/j.1600-0447.1996.tb10618.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Forty-nine families from the University of Rochester Child and Family Study were followed up 10 to 14 years after initial assessment. Two inclusion criteria were applied: at least one of the parents should have been hospitalized for a functional psychiatric disorder before initial assessment and the male index offspring should be 18 years or older at follow-up. Family communication was observed by the Consensus Rorschach procedure and coded with the Confirmation-Disconfirmation Coding System. Offspring childhood social competence was rated by peers, teachers and parents. Outcome measures included the Denver Community Mental Health Questionnaire, the Global Assessment Scale and hospitalization for a psychiatric disorder. Results showed that the family's level of confirmation and disconfirmation communication during Consensus Rorschach at initial testing predicted offspring interpersonal functioning and hospitalization for psychiatric disorders. These findings were not due to the initial social competence or IQ of the child, the level of functional impairment in parents or their social class.
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Affiliation(s)
- L Wichstrom
- Department of Psychology, University of Trondheim
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Anderson AM. Enhancing hospital cash reserves management. Healthc Financ Manage 1993; 47:91, 93, 95. [PMID: 10145846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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O'Connor TP, Anderson AM, Lennox B, Muldoon C. A novel sustained-release formulation of ibuprofen provides effective once-daily therapy in the treatment of rheumatoid arthritis and osteoarthritis. Br J Clin Pract 1993; 47:10-3. [PMID: 8461240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The efficacy and safety of a novel sustained-release formulation of ibuprofen given once-daily was compared with conventional-release ibuprofen tablets 400 mg given four times daily, in a single-blind, parallel-group study. This study was conducted at 84 general practice centres throughout the UK among patients with osteoarthritis or rheumatoid arthritis. An unequal randomisation in the ratio of 4:1 was carried out, with 463 patients who received sustained-release and 115 who received conventional-release ibuprofen providing evaluable data. In this study sustained-release ibuprofen was shown to be a more effective alternative to conventional ibuprofen therapy for the treatment of arthritic diseases in general practice, offering the convenience of once-daily dosing and the associated potential benefit of improved patient compliance.
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Donnér M, Anderson AM, Kristofferson AC, Dahlbäck B, Holmberg L. Genetic polymorphism in a region of the vWF pseudogene corresponding to exon 28 of the vWF gene. Eur J Haematol 1992; 49:279. [PMID: 1473591 DOI: 10.1111/j.1600-0609.1992.tb00063.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Spontaneous mutants resistant to deoxycholic acid (DCA) have been selected from a CHO cell line AuxBl. One of the colonies or 'lines' selected was subsequently mutagenized by ethylmethanesulfonate (250 micrograms/ml) and a more resistant cell, named alpha 3, has been selected. When AuxBl and alpha 3 were exposed to graded concentrations of DCA for 1 h, the LD50 for the mutant strain alpha 3 was 0.66 mM compared to 0.26 mM for the parental line. AuxBl. alpha 3 showed a cross-resistance compared to AuxBl with respect to cholic acid and chenodeoxycholic acid and to other acidic lipids such as linoleic and oleic acids. As an initial step in characterization of the cell lines, the amounts of different phospholipids from whole cell extracts of the parental and mutant strains have been measured after thin-layer chromatography (TLC) separation. The results obtained demonstrated that the fraction of sphingomyelin and phosphatidylcholine over the total phospholipids was slightly increased in the resistant cell line, alpha 3, compared to the parental line, AuxBl (54.9% +/- 1.04 compared to 51.2% +/- 0.3, P = 0.01). Further characterization of cell lines resistant to bile acids could lead to the identification of the cellular target of bile acid action.
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Affiliation(s)
- G Caderni
- Ludwig Institute for Cancer Research, Toronto, Ontario, Canada
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Brolin RE, Wallis EM, Anderson AM, Avedian JD. A two-year analysis of DRG #288, procedures for obesity. Bull Am Coll Surg 1987; 72:11-6. [PMID: 10317974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
DRG #288 is composed of operative procedures performed for obesity, both gastric and plastic. A two-year cost analysis of 103 consecutive gastric reduction operations performed for morbid obesity was conducted at Robert Wood Johnson University Hospital. It showed a net loss to the hospital of $18,033 in 1984 and $24,126 in 1985. Although the mean length of stay was 1.43 days less in 1985 than in 1984, DRG #288 was still a money loser. A detailed cost breakdown of nine active cost-center categories showed large financial disincentives (losses) in surgical supplies, OR/recovery room time and X ray utilization during both years of the study. These losses were not offset by substantial profits in the room-and-board category, which is directly related to length of stay. It is intuitively obvious that plastic surgical procedures for obesity require less expensive surgical supplies, fewer X rays, and shorter OR/recovery room times than gastrointestinal operations performed for morbid obesity. We conclude that DRG #288 is improperly constructed because it contains a clinically incoherent, heterogeneous mixture of operations that cannot be expected to consume similar amounts of resources and incur similar costs. Hospitals in which the preponderance of operations performed for obesity are gastrointestinal as opposed to plastic are inherently penalized by the current aggregation of DRG #288.
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Abstract
To determine whether concentrations of potentially toxic lipids in the aqueous phase of human stool are responsive to changes in dietary fat, calcium, and fiber, 20 male volunteers were placed on a high-fat, low-calcium, low-fiber or a low-fat, high-calcium, high-fiber diet for 4 days. To assess toxicity of the fecal fractions, we examined the ability of fecal supernatants to lyse human erythrocytes. Bile acid concentrations in fecal water from the low-fat group were reduced significantly from 180 +/- 60 microM to 100 +/- 70 microM; in the high-fat group, increased from 190 +/- 60 microM to 250 +/- 100 microM. Erythrocyte lysis was 76% for the high-fat group, 37% for the low-fat group. There was a significant weak correlation between aqueous bile acid concentration and cell lysis. Results suggest that diet can influence concentrations of detergents in the aqueous phase of human stool and the potential toxicity of this fraction to cell membranes.
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Abstract
Collagen has been examined from normally and abnormally healing fractures. A higher proportion of type III collagen than was expected was found in abnormally healing fractures. Very little is known about collagen synthesis in healing fractures and how it is altered in abnormal healing states such as delayed and non-union.
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Anderson AM, Penny G, Potter FR, Taylor A. Three system built units for geriatric patients--a preliminary report. Health Bull (Edinb) 1979; 37:67-70. [PMID: 437967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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