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Edwards TC, Patel A, Szyszka B, Coombs AW, Kucheria R, Cobb JP, Logishetty K. 1393 The Impact of Using A Virtual Reality Surgical Curriculum to Train Scrub Practitioners in Complex Orthopaedic Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The training scrub practitioners receive varies considerably in comparison to their surgical counterpart, although their performance is key to a proficient surgical team. For infrequent procedures that require specific and often intricate equipment such as revision total knee arthroplasty (RTKA), their training may be limited to an initial guidance session by company representatives. This study aims to evaluate the impact of using a virtual reality (VR) curriculum to train scrub practitioners in the performance of a RTKA.
Method
Ten orthopaedic scrub practitioners were enrolled into VR training across four sessions. Each VR session consisted of training where participants were guided through the assembly of equipment and steps of the surgery. In the concluding three sessions, each training session was supplemented by an assessment session in VR without guidance. The outcomes measured in VR assessment were incorrect procedural sequence, duration of surgery and efficiency of movement. The transfer of skills outside VR were assessed pre-training and post-training by the participants performance in a sequence of tasks using real equipment.
Results
All participants enhanced their surgical performance in successive assessed VR sessions reducing their operative time by 47%, assistive prompts by 75% and dominant hand motion by 28%. Improvements in VR showed effective transfer when assessed using real equipment with participants achieving superior scores post-training (11.3% versus 83.5%).
Conclusions
VR enables safe learning and provides measurable feedback of procedural steps and technical skills of complex orthopaedic surgery. VR is an effective training tool for scrub practitioners, with transfer to the real world.
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Affiliation(s)
- T C Edwards
- Imperial College London, MSK Lab, London, United Kingdom
| | - A Patel
- Imperial College London, MSK Lab, London, United Kingdom
| | - B Szyszka
- Imperial College London, MSK Lab, London, United Kingdom
| | - A W Coombs
- Imperial College London, MSK Lab, London, United Kingdom
| | - R Kucheria
- Department of Trauma & Orthopaedics, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, United Kingdom
| | - J P Cobb
- Imperial College London, MSK Lab, London, United Kingdom
| | - K Logishetty
- Imperial College London, MSK Lab, London, United Kingdom
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Sephton BM, Edwards TC, Bakhshayesh P, Nathwani D. Should we routinely perform a post-operative hemoglobin check following unicompartmental knee arthroplasty? Knee 2020; 27:249-256. [PMID: 31911082 DOI: 10.1016/j.knee.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/07/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To study the significance of checking post-operative hemoglobin and hematocrit following unicompartmental knee arthroplasty (UKA). SETTING Single center. Multiple surgeons. DESIGN Retrospective case series. Level of evidence IV. MATERIALS AND METHODS Following institutional approval, a retrospective analysis of all patients undergoing UKA at our level one academic university hospital was conducted. Operative records of all patients undergoing primary UKA were reviewed between March 2016 and March 2019. Patients' pre-operative hemoglobin and hematocrit, BMI, co-morbidities, application of tourniquet, tourniquet time, administration of tranexamic acid, need for post-operative blood transfusion, hospital length of stay, complications, and re-admission were all recorded. Blood loss was estimated using the post-operative hematocrit. RESULTS A total number of 155 patients were included. There were 70 females (45%) and 85 males (55%). The mean age was 66 ± 10 years. Median pre-op blood volume was 4700 mLs (interquartile range (IQR); 4200-5100). Median blood loss was 600 mLs (IQR; 400-830). Mean pre-op hemoglobin was 135 ± 14 g/L and mean post-op hemoglobin was 122 ± 13 g/L. No patient had a post-op hemoglobin under 80 g/L (range 93-154). No patients in our study needed transfusion. CONCLUSION The results of our study indicated that post-operative hemoglobin and hematocrit check proved unnecessary in all of our patients and could have been omitted from post-operative routines. We conclude that routine post UKA check of hemoglobin and hematocrit can be avoided and be saved for special circumstances depending on patient's physiology.
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Affiliation(s)
- B M Sephton
- Department of Orthopaedics, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, United Kingdom.
| | - T C Edwards
- Department of Orthopaedics, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, United Kingdom.
| | - P Bakhshayesh
- Department of Orthopaedics, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, United Kingdom; Department of Orthopaedics, Karolinska Institutet, Sjukhusbacken, Stockholm 10 118 83, United Kingdom.
| | - D Nathwani
- Department of Orthopaedics, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, United Kingdom.
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Fredericksen RJ, Yang FM, Gibbons LE, Edwards TC, Brown S, Fitzsimmons E, Alperovitz-Bichell K, Godfrey M, Wang A, Church A, Gutierrez C, Paez E, Dant L, Loo S, Walcott M, Mugavero MJ, Mayer KH, Mathews WC, Patrick DL, Crane PK, Crane HM. Development and content validation of measures assessing adherence barriers and behaviors for use in clinical care. Res Social Adm Pharm 2018; 15:1168-1176. [PMID: 30327183 DOI: 10.1016/j.sapharm.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/26/2018] [Accepted: 10/04/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Providers are often unaware of poor adherence to prescribed medications for their patients with chronic diseases. OBJECTIVE To develop brief, computer-administered patient-reported measures in English and Spanish assessing adherence behaviors and barriers. Design, Participants, and Main Measures: Item pools were constructed from existing measures of medication adherence behaviors and barriers, which informed development of a patient concept elicitation interview guide to identify medication adherence behavior and barrier-related concepts. Two hundred six patients either living with HIV (PLWH) or without were interviewed. Interviews were coded, concepts matched to item pool content, and new items were developed for novel concepts. A provider/investigator team highlighted clinically relevant items. Cognitive interviews were conducted with patients on final candidate items (n = 37). The instruments were administered to 2081 PLWH. KEY RESULTS Behavioral themes from concept elicitation interviews included routines incorporating time of day, placement, visual cues, and intentionality to miss or skip doses. Barrier themes included health-related (e.g. depressed mood, feeling ill), attitudes/beliefs (e.g., need for medication), access (e.g., cost/insurance problems), and circumstantial barriers (e.g., lack of privacy, disruption of daily routine). The final instruments included 6 behavior items, and 1 barrier item with up to 23 response options. PLWH endorsed a mean (SD) of 3.5 (1.1) behaviors. The 201 PLWH who missed ≥2 doses in the previous week endorsed a mean (SD) of 3.1 (2.5) barriers. The intraclass correlation coefficient (ICC) for the numbers of behaviors endorsed in 61 PLWH after 4-16 days was 0.54 and for the number of barriers for the 20 PLWH with ≥2 missed doses the ICC was 0.89, representing fair and excellent test-retest reliability. CONCLUSION Measures of medication adherence behaviors and barriers were developed for use with patients living with chronic diseases focusing on clinical relevance, brevity, and content validity for use in clinical care.
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Affiliation(s)
- R J Fredericksen
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA.
| | - F M Yang
- Augusta University, 1120 15th Street Augusta, GA, 30912, USA
| | - L E Gibbons
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | - T C Edwards
- University of Washington, Quality of Life Group, Box 359455, Seattle, WA, 98195, USA
| | - S Brown
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | - E Fitzsimmons
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | | | - M Godfrey
- Beaufort Jasper Hampton Comprehensive Health Services, 1520 Grays Highway, Ridgeland, SC, 29936, USA
| | - A Wang
- Chase Brexton Health Care, 5500 Knoll N Dr #370, Columbia, MD, 21045, USA
| | - A Church
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | - C Gutierrez
- Fenway Community Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - E Paez
- University of California-San Diego, The Owen Clinic, 4168 Front Street, San Diego, CA, 92103, USA
| | - L Dant
- Fenway Community Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - S Loo
- Fenway Community Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - M Walcott
- University of Alabama-Birmingham, 1917 Clinic, Community Care Building, 908 South 20th Street, Birmingham, AL, 35294, USA
| | - M J Mugavero
- University of Alabama-Birmingham, 1917 Clinic, Community Care Building, 908 South 20th Street, Birmingham, AL, 35294, USA
| | - K H Mayer
- Fenway Community Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - W C Mathews
- University of California-San Diego, The Owen Clinic, 4168 Front Street, San Diego, CA, 92103, USA
| | - D L Patrick
- University of Washington, Quality of Life Group, Box 359455, Seattle, WA, 98195, USA
| | - P K Crane
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | - H M Crane
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
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Edwards TC, Emerson J, Genatossio A, McNamara S, Goss C, Patrick DL, Onchiri F, Rosenfeld M. Initial development and pilot testing of observer-reported outcomes (ObsROs) for children with cystic fibrosis ages 0-11years. J Cyst Fibros 2018; 17:680-686. [PMID: 29358075 DOI: 10.1016/j.jcf.2017.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 12/12/2017] [Accepted: 12/20/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Patient-reported outcomes are important clinical trial endpoints. Young children may not be able to reliably report on how they feel or function, so observer-reported outcomes (ObsROs) may be more appropriate for them. The purpose of this study was to develop and pilot field test electronic parent-reported observational instruments for children with cystic fibrosis (CF) 0-6 and 7-11years of age. METHODS We performed concept elicitation interviews with parents of children with CF ≤11years of age to elicit the respiratory signs they could observe at baseline and during an acute respiratory illness. The resulting instruments were refined based on interviews with parents and clinicians. We conducted a pilot field test to evaluate test-retest reliability and the ability of items to distinguish well and sick periods. RESULTS The instruments consist of 17 items assessing respiratory signs and observable CF-related impacts. Test-retest reliability was acceptable for both age groups but discrimination was low for ages 7-11, likely reflecting less direct observation of older children by their parents. CONCLUSIONS An ObsRO for children with CF ages 0-6 appears promising, while self-report may be more appropriate for children >6years of age. Next steps for the 0-6year old instrument will be utilizing it as an exploratory endpoint in clinical trials to enable item reduction, scale development, and further reliability and validity testing. Ultimately, this ObsRO could be a promising endpoint for early intervention trials in young children with CF.
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Affiliation(s)
- T C Edwards
- Department of Health Services, University of Washington, 1208 NE 43rd St. - Campus Box 359455, Seattle, WA 98195-9455, United States.
| | - J Emerson
- Division of Pulmonary Medicine, Seattle Children's Hospital, United States.
| | - A Genatossio
- Division of Pulmonary Medicine, Seattle Children's Hospital, United States.
| | - S McNamara
- Division of Pulmonary Medicine, Seattle Children's Hospital, United States.
| | - C Goss
- Department of Medicine and Pediatrics, University of Washington, Division of Pulmonary and Critical Care Medicine, United States.
| | - D L Patrick
- Department of Health Services, University of Washington, 1208 NE 43rd St. - Campus Box 359455, Seattle, WA 98195-9455, United States.
| | - F Onchiri
- Center for Biomedical Statistics, Seattle Children's Research Institute, Seattle, WA, United States; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States.
| | - M Rosenfeld
- Department of Pediatrics, University of Washington, Division of Pulmonary Medicine, Seattle Children's Hospital, United States.
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Fredericksen RJ, Gibbons L, Brown S, Edwards TC, Yang FM, Fitzsimmons E, Alperovitz-Bichell K, Godfrey M, Wang A, Church A, Gutierrez C, Paez E, Dant L, Loo S, Walcott M, Mugavero MJ, Mayer K, Mathews WC, Patrick DL, Crane PK, Crane HM. Medication understanding among patients living with multiple chronic conditions: Implications for patient-reported measures of adherence. Res Social Adm Pharm 2017; 14:540-544. [PMID: 28651924 DOI: 10.1016/j.sapharm.2017.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/10/2017] [Accepted: 06/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low health literacy is associated with poor medication adherence and poor health outcomes. Limited understanding of prescribed medications may decrease validity of patient-reported adherence measures. OBJECTIVES To assess knowledge of names and purposes of prescribed medications among patients with multiple chronic conditions. METHODS Individual interviews were conducted with a convenience sample of patients from six U.S. primary care clinics. Participants (n = 57) were English and/or Spanish-speaking patients prescribed 3+ medications for chronic conditions, for which non-adherence may lead to disability or death. In individual interviews, patients were asked to name their medications, explain the purpose of each, and to explain how they distinguish them from one another. Interviews were audio recorded, transcribed, and coded; coded content was quantified by 1) whether or not the patient could name medications; 2) method of categorizing medications; 3) whether or not the purpose of the medication was understood. Descriptive statistics were compiled using Fisher's exact test to determine the relationship between patient knowledge and medication characteristics. RESULTS Thirty percent of patients could not name at least one of their medications; 19% did not know their purpose; 30% held misconceptions about the purpose of one or more medications. There was no significant difference in ability to name medications or state their medication's purpose between patients using medi-sets, pre-packaged rolls, or blister packs, and patients who stored pills in their original containers (p = 0.56 and p = 0.73, respectively), or across demographic groups (p = 0.085 to 0.767). CONCLUSIONS Many patients demonstrated difficulty identifying the name and purpose of prescribed medications; this did not differ by demographic group or medication storage type. Patients may benefit from routine review of medications with their provider in order to improve health literacy, outcomes, and patient-reported adherence measurement.
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Affiliation(s)
| | - L Gibbons
- University of Washington, Center for AIDS Research, USA
| | - S Brown
- University of Washington, Center for AIDS Research, USA
| | - T C Edwards
- University of Washington, Seattle Quality of Life Group, USA
| | | | - E Fitzsimmons
- University of Washington, Center for AIDS Research, USA
| | | | - M Godfrey
- Beaufort Jasper Hampton Comprehensive Health Services, USA
| | - A Wang
- Chase Brexton Health Care, USA
| | - A Church
- University of Washington, Center for AIDS Research, USA
| | | | - E Paez
- University of California at San Diego, USA
| | - L Dant
- Fenway Community Health, USA
| | - S Loo
- Fenway Community Health, USA
| | - M Walcott
- University of Alabama at Birmingham, USA
| | | | - K Mayer
- Fenway Community Health, USA
| | | | - D L Patrick
- University of Washington, Seattle Quality of Life Group, USA
| | - P K Crane
- University of Washington, Center for AIDS Research, USA
| | - H M Crane
- University of Washington, Center for AIDS Research, USA
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Gibbons LE, Fredericksen R, Batey DS, Dant L, Edwards TC, Mayer KH, Mathews WC, Morales LS, Mugavero MJ, Yang FM, Paez E, Kitahata MM, Patrick DL, Crane HM, Crane PK. Validity assessment of the PROMIS fatigue domain among people living with HIV. AIDS Res Ther 2017; 14:21. [PMID: 28400850 PMCID: PMC5387298 DOI: 10.1186/s12981-017-0146-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/19/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate psychometric characteristics and cross-sectional and longitudinal validity of the 7-item PROMIS® Fatigue Short Form and additional fatigue items among people living with HIV (PLWH) in a nationally distributed network of clinics collecting patient reported data at the time of routine clinical care. Methods Cross-sectional and longitudinal fatigue data were collected from September 2012 through April 2013 across clinics participating in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We analyzed data regarding psychometric characteristics including simulated computerized adaptive testing and differential item functioning, and regarding associations with clinical characteristics. Results We analyzed data from 1597 PLWH. Fatigue was common in this cohort. Scores from the PROMIS® Fatigue Short Form and from the item bank had acceptable psychometric characteristics and strong evidence for validity, but neither performed better than shorter instruments already integrated in CNICS. Conclusions The PROMIS® Fatigue Item Bank is a valid approach to measuring fatigue in clinical care settings among PLWH, but in our analyses did not perform better than instruments associated with less respondent burden. Electronic supplementary material The online version of this article (doi:10.1186/s12981-017-0146-y) contains supplementary material, which is available to authorized users.
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Canestaro WJ, Edwards TC, Patrick DL. Systematic review: patient-reported outcome measures in coeliac disease for regulatory submissions. Aliment Pharmacol Ther 2016; 44:313-31. [PMID: 27349458 DOI: 10.1111/apt.13703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/20/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND New therapeutics are moving into phase 3 clinical trials for the treatment of coeliac disease, a condition with no established therapies other than gluten-free diet. These trials will require a meaningful, validated and fit for purpose patient-reported outcome measure (PROM) to quantify the symptomatic improvement of patients. AIM To evaluate existing PROMs for suitability in a Food and Drug Administration (FDA) approval trial for a coeliac disease therapeutic. METHOD We performed a systematic search in five online databases (MedLine, EmBase, Web of Science, CENTRAL, CINAHL) for studies that enrolled patients with coeliac disease and used PROMs. Studies included in this review had to measure some PROM concept, be patient administered and based upon a previously validated instrument with published measurement properties. RESULTS Our literature search identified 2706 unique records of which 199 ultimately qualified for abstraction. The majority of PROMs used in studies of coeliac disease was generic and did not measure numerous symptoms or concerns of interest to patients. Four PROMs were found to contain appropriate content for use in an FDA trial: the coeliac disease-specific modification of the Gastrointestinal Symptoms Rating Scale (CeD-GSRS), Psychological General Well-Being Index (PGWB), the Celiac Disease Symptom Diary (CDSD) and the Celiac Disease Patient Reported Outcome (CeD-PRO). The GSRS and PGWB are most often used together and are two of the most extensively used measures in coeliac disease. The CDSD and CeD-PRO were developed exclusively for trials in coeliac disease but have much less published information on their measurement properties. CONCLUSIONS While we did not find PROMs that currently meet the stated expectations of the FDA for regulatory purposes, four PROMs (CeD-GSRS, PGWB, CDSD and CeD-PRO) appear to contain appropriate content and with modest additional validation work could meet scientific standards for valid and sensitive measures of disease and treatment outcome. Specifically, what is needed for these instruments is an understanding of how sensitive they are to real changes in-patient condition, how stable they are over a period of time when health status should not have changed (test-retest reliability) as well as how they correlate with other measures of patient functioning such as intestinal biopsy. All of these objectives could feasibly be accomplished over a short cohort study of patients with biopsy-defined coeliac disease undergoing gluten challenge.
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Affiliation(s)
- W J Canestaro
- Pharmaceutical Outcomes Research and Policy Program, University of Washington School of Pharmacy, Seattle, WA, USA
| | - T C Edwards
- Department of Health Services, Seattle Quality of Life Group, University of Washington School of Public Health, Seattle, WA, USA
| | - D L Patrick
- Department of Health Services, Seattle Quality of Life Group, University of Washington School of Public Health, Seattle, WA, USA
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Kushalnagar P, Topolski TD, Schick B, Edwards TC, Skalicky AM, Patrick DL. Mode of communication, perceived level of understanding, and perceived quality of life in youth who are deaf or hard of hearing. J Deaf Stud Deaf Educ 2011; 16:512-23. [PMID: 21536686 PMCID: PMC3202327 DOI: 10.1093/deafed/enr015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Given the important role of parent-youth communication in adolescent well-being and quality of life, we sought to examine the relationship between specific communication variables and youth perceived quality of life in general and as a deaf or hard-of-hearing (DHH) individual. A convenience sample of 230 youth (mean age = 14.1, standard deviation = 2.2; 24% used sign only, 40% speech only, and 36% sign + speech) was surveyed on communication-related issues, generic and DHH-specific quality of life, and depression symptoms. Higher youth perception of their ability to understand parents' communication was significantly correlated with perceived quality of life as well as lower reported depressive symptoms and lower perceived stigma. Youth who use speech as their single mode of communication were more likely to report greater stigma associated with being DHH than youth who used both speech and sign. These findings demonstrate the importance of youths' perceptions of communication with their parents on generic and DHH-specific youth quality of life.
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Affiliation(s)
- P Kushalnagar
- University of Rochester Medical Center, Rochester, NY 14627-8990, USA.
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9
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Patrick DL, Skalicky AM, Edwards TC, Kuniyuki A, Morales LS, Leng M, Kirschenbaum DS. Weight loss and changes in generic and weight-specific quality of life in obese adolescents. Qual Life Res 2010; 20:961-8. [PMID: 21188537 DOI: 10.1007/s11136-010-9824-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate how weight loss correlates with changes in generic and weight-specific quality of life (QoL). METHODS Youth generic (YQOL-S) and weight-specific instruments (YQOL-W) from 133 youth age 11-19 were analyzed at the beginning and end of 4-week immersion camp sessions known to produce weight loss. Paired samples t tests were used to test mean difference between baseline and final Body Mass Index (BMI) and YQOL-S and YQOL-W scores. YQOL-S and YQOL-W scores were transformed to values between 0 and 100, with higher values indicating better QOL. Cohen's d effect sizes were calculated to assess magnitude of effects. Percent weight loss (as % of baseline weight), change in BMI (baseline kg/m²-follow-up kg/m²), and change in % overweight ((BMI-50th% BMI for age and sex)/50th% BMI for age and sex × 100) were calculated. Multiple regressions were used to model final YQOL scores in the 11-14 and 15-19 age groups as functions of each measure of weight change, sex, age, and baseline YQOL score. RESULTS Youth experienced significant reductions in BMI (Mean change = 3.7, SD = 1.4, t = 34.1, P < 0.001) and in the other measures of weight change. YQOL-S and YQOL-W scores improved significantly (P < 0.001), and effect sizes were 0.61 and 0.66, respectively. CONCLUSION Changes in generic and weight-specific quality of life scores are associated with weight loss. The weight-specific measure is slightly more sensitive to weight changes; however, when controlling for modifiers, the YQOL-W remained significantly associated with weight loss, while the generic QoL measure did not.
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Affiliation(s)
- D L Patrick
- Department of Health Services, School of Public Health, University of Washington, Box 394555, Seattle, WA 98195-9455, USA.
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10
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Goss CH, Edwards TC, Ramsey BW, Aitken ML, Patrick DL. Patient-reported respiratory symptoms in cystic fibrosis. J Cyst Fibros 2009; 8:245-52. [PMID: 19481983 DOI: 10.1016/j.jcf.2009.04.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 04/08/2009] [Accepted: 04/12/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) specific patient-derived and reported symptom tools are critical steps toward evaluating the outcomes of new therapies for CF. METHODS We conducted 25 in-depth qualitative interviews using the Day Reconstruction Method and 9 cognitive interviews at two CF programs, the University of Washington and Seattle Children's Hospital and Regional Medical Center. The interviews were audio-recorded and transcribed, and then coded and analyzed for themes relating to pulmonary symptoms and related psychosocial impacts. RESULTS Six pulmonary symptoms were identified as central to CF: cough, sputum production, wheeze, chest tightness, difficulty breathing/shortness of breath, and fever. Emotional impacts included frustration, sadness/depression, irritability, worry, difficulty sleeping; while activity impacts included time spent sitting or lying down, reduction of usual activities, and missing school or work. In all, 8 symptom items, 4 emotional impacts items, and 4 activity impacts were selected for inclusion on a new daily diary. We also assessed triggers for seeking care. CONCLUSIONS Using a qualitative inductive methodology, we have obtained patient centered data regarding pulmonary symptoms and burdens and have created a novel patient reported outcome measure for CF. Future studies will assess the validity of the instruments.
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Affiliation(s)
- C H Goss
- Department of Medicine, University of Washington, Seattle, WA, USA.
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11
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Zimmermann NE, Edwards TC, Moisen GG, Frescino TS, Blackard JA. Remote sensing-based predictors improve distribution models of rare, early successional and broadleaf tree species in Utah. J Appl Ecol 2007; 44:1057-1067. [PMID: 18642470 PMCID: PMC2368764 DOI: 10.1111/j.1365-2664.2007.01348.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2006] [Revised: 04/25/2007] [Indexed: 12/01/2022]
Abstract
Compared to bioclimatic variables, remote sensing predictors are rarely used for predictive species modelling. When used, the predictors represent typically habitat classifications or filters rather than gradual spectral, surface or biophysical properties. Consequently, the full potential of remotely sensed predictors for modelling the spatial distribution of species remains unexplored. Here we analysed the partial contributions of remotely sensed and climatic predictor sets to explain and predict the distribution of 19 tree species in Utah. We also tested how these partial contributions were related to characteristics such as successional types or species traits.We developed two spatial predictor sets of remotely sensed and topo-climatic variables to explain the distribution of tree species. We used variation partitioning techniques applied to generalized linear models to explore the combined and partial predictive powers of the two predictor sets. Non-parametric tests were used to explore the relationships between the partial model contributions of both predictor sets and species characteristics.More than 60% of the variation explained by the models represented contributions by one of the two partial predictor sets alone, with topo-climatic variables outperforming the remotely sensed predictors. However, the partial models derived from only remotely sensed predictors still provided high model accuracies, indicating a significant correlation between climate and remote sensing variables. The overall accuracy of the models was high, but small sample sizes had a strong effect on cross-validated accuracies for rare species.Models of early successional and broadleaf species benefited significantly more from adding remotely sensed predictors than did late seral and needleleaf species. The core-satellite species types differed significantly with respect to overall model accuracies. Models of satellite and urban species, both with low prevalence, benefited more from use of remotely sensed predictors than did the more frequent core species.Synthesis and applications. If carefully prepared, remotely sensed variables are useful additional predictors for the spatial distribution of trees. Major improvements resulted for deciduous, early successional, satellite and rare species. The ability to improve model accuracy for species having markedly different life history strategies is a crucial step for assessing effects of global change.
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Abstract
PURPOSE To assess the association between health-risk behaviors and self-perceived quality of life among adolescents METHODS A sample of 2801 students (957 seventh and eighth graders and 1844 ninth through twelfth graders) completed the Teen Assessment Survey (TAP) and the surveillance module of the Youth Quality of Life Instrument (YQOL-S). TAP responses were used to determine health-risks related to tobacco use, alcohol use, illicit drug use, and high risk sexual behavior. Separate multivariate analyses of variance showed mean differences in contextual and perceptual items of the YQOL-S for each health-risk behavior. Differences among engagers (adolescents who often engage), experimenters (occasionally engage), and abstainers (never engage) in the health-risk behavior were evaluated by gender and junior/senior high school groups. RESULTS In general, adolescent abstainers reported higher quality of life (QoL) than engagers and experimenters on YQOL-S items. Adolescents who engaged in multiple risk behaviors scored even lower than those who engaged in only one health-risk behavior. Experimenters tended to rate their QoL more similar to that of abstainers than to that of engagers. CONCLUSIONS The framework of QoL proved useful in the evaluation of adolescents' engagement in health-risk behaviors. Additionally, assessing the areas of QoL that differ between the groups may provide information for planning interventions aimed at risk reduction among engagers and experimenters.
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Affiliation(s)
- T D Topolski
- Department of Health Services, University of Washington, Seattle, Washington 98195-7660, USA.
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Abstract
This study examined the control of cardiovascular dynamics in response to exercise during the development of obesity in dogs. Left atrial pressure (LAP), mean arterial pressure, and cardiac output (CO) were determined both at rest and in response to treadmill exercise (5.6 km/h, 10% grade) first during a control, lean state and then, once a week while the dogs were maintained on a high fat diet (HFD) for 4 weeks. Body weight increased from 22.8 +/- 1.1 to 33.1 +/- 2.0 kg after 4 weeks of HFD. The dogs developed mild hypertension with increases in resting CO, heart rate, and LAP. The response to exercise was characterized by a decrease in LAP when the dogs were lean and, in contrast, by a dramatic increase in LAP during the development of obesity. In addition, after the third week, the dogs could no longer maintain exercise at the original level. These results suggest that abnormal left ventricular function may occur very early during the development of canine obesity.
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Affiliation(s)
- H L Mizelle
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson 39216-4505
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Abstract
PURPOSE This review of findings in children undergoing transcatheter shunt occlusion was carried out to describe and compare the results of four different embolization techniques. PATIENTS AND METHODS A retrospective review of clinical, radiologic, and cardiac catheterization records was carried out for 18 consecutive pediatric patients referred for Blalock-Taussig shunt occlusion at one institution. Technical aspects included the use of three devices--steel wire/fiber coils, detachable latex balloons, and ductal occlusion devices--and four techniques--direct transarterial placement, transarterial placement with proximal or with distal flow control, and transvenous delivery. RESULTS Occlusion of the shunt was attempted in 17 patients (mean age, 6.2 years). Shunt occlusion was successful in 14 patients. Embolization of a device into the pulmonary circulation occurred in five patients, and was most frequent with transarterial delivery without flow control or with proximal flow control (in four of six). Transarterial occlusion with distal flow control and transvenous delivery of ductal occluder devices were the most reliable methods of occluding shunts without distal stenosis, with success in eight of nine cases with the former technique and all of three with the latter technique. CONCLUSIONS Transarterial embolization of Blalock-Taussig shunts carries a risk of device embolization to the pulmonary circulation; this is best avoided by the use of distal flow control or transvenous placement of a ductal occlusion device.
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Affiliation(s)
- P E Burrows
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada
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Abstract
Sweet's syndrome is a rare condition characterized by fever, leukocytosis, dense dermal infiltration of leukocytes, and painful indurated cutaneous plaques. We describe a 23-month-old male infant with the typical cutaneous manifestations of Sweet's syndrome and painful extremities that limited ambulation. Evaluation revealed multifocal sterile osteomyelitis of both tibia. After the institution of systemic corticosteroid therapy, the patient's symptoms resolved, and bone scans normalized. After one year of follow-up, the patient has intermittent recrudescences that resolve during corticosteroid therapy. Sterile multifocal osteomyelitis represents another clinical manifestation of Sweet's syndrome.
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Edwards TC, Candido EP, Chovnick A. Xanthine dehydrogenase from Drosophila melanogaster: a comparison of the kinetic parameters of the pure enzyme from two wild-type isoalleles differing at a putative regulatory site. Mol Gen Genet 1977; 154:1-6. [PMID: 197387 DOI: 10.1007/bf00265570] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Xanthine dehydrogenase (XDH) from Drosophila melanogaster has been purified to homogeneity by immunoaffinity chromatography, and its kinetic parameters determined. Drosophila XDH exhibits ordered binding for substrate and NAD+, analogous to the corresponding enzymes from vertebrate sources. The wild-type enzyme exhibits a Km for xanthine of 2.4 X 10(-5) M, and for NAD+ of 4.0 X 10(-5) M. XDH purified from a genetic variant exhibiting elevated levels of enzyme activity has similar kinetic constants. The results provide further evidence that the site of variation in the latter strain results in higher steady state numbers of XDH molecules per fly.
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Edwards TC. HISTORY OF THE MONTEREY COUNTY MEDICAL SOCIETY. Cal West Med 1925; 23:620. [PMID: 18739653 PMCID: PMC1654705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Edwards TC. THE DOCTOR, AS HE WAS, IS AND SHOULD BE. Cal West Med 1924; 22:249-251. [PMID: 18739327 PMCID: PMC1654445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Edwards TC. SOME RESPONSIBILITIES AND DUTIES OF MEDICAL ORGANIZATIONS: President's Address, California Medical Association. Cal State J Med 1923; 21:319-321. [PMID: 18739058 PMCID: PMC1517695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Edwards TC. Death Following an Ant Bite. Cal State J Med 1914; 12:290-291. [PMID: 18736308 PMCID: PMC1641165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Edwards TC. A Phase of Unequal Inspiratory Murmur. Cal State J Med 1909; 7:319-320. [PMID: 18734760 PMCID: PMC1653071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Edwards TC. Local Anesthesia. Cal State J Med 1906; 4:217. [PMID: 18733903 PMCID: PMC1651546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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