Background. Nontuberculous mycobacterial (NTM) lymphadenitis in children is most often caused by Mycobacterium avium. In a prospective, multicenter trial of the optimal treatment, 23.7% of the NTM ...cervicofacial lymphadenitis cases in children were caused by Mycobacterium haemophilum. In this article, we describe the epidemiological and clinical features of M. haemophilum cervicofacial lymphadenitis. Methods. The diagnosis of Mycobacterium avium or M. haemophilum infection was established by culture or polymerase chain reaction. Demographic characteristics and data regarding clinical presentation and possible environmental exposure were compared for patients infected with M. avium and those infected with M. haemophilum. Results. Ninety-four (69.9%) of 135 infections were caused by M. avium, 32 (23.7%) by M. haemophilum, and 9 (6.4%) by other NTM species. The median age of the M. haemophilum-infected children was 72 months, compared with 41 months for the M. avium-infected children (P < .001), with an equal distribution for both sexes. Involvement of multiple lymph nodes was frequently observed among the M. haemophilum-infected patients (56% of patients). Extranodal localizations were only observed in M. haemophilum-infected patients. Children with M. haemophilum infection were more likely to have a non-Dutch background (P = .001), and in most cases, they had a history of contact with swimming water (P = .03), whereas M. avium-infected patients were more likely to have a history of playing in sandpits (P = .01). In a multivariate analysis, only older age and a non-Dutch background were predisposing risk factors for M. haemophilum infection, compared with M. avium infection. Conclusion. Higher age, non-Dutch background, and involvement of multiple cervicofacial lymph nodes with extranodal localizations distinguished M. haemophilum infection from M. avium infection.
Little is known about the effects on the performance of activities of daily living (ADL) and quality of life (QoL) of transient ischemic attack (TIA) or a nondisabling stroke (NDS) with a full ...recovery in 72 hours. The present study evaluated ADL performance and QoL, as well as symptoms of anxiety and depression, in patients at 1 and 6 months after a TIA or an NDS. Consecutive hospitalized TIA/NDS patients not requiring rehabilitation were assessed at 1 and 6 months after discharge from a hospital or emergency department. ADL performance was evaluated using the Assessment of Motor and Process Skills (AMPS), QoL was assessed with the Short Form 36 (SF-36), and depression and anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). A total of 45 patients completed the follow-up. At 1 month after TIA/NDS, all patients were independent in ADL performance but had AMPS and SF-36 scores below the norm. In addition, 12 patients (27%) had anxiety symptoms, and 9 patients (20%) had symptoms of depression. Although initially considered fully recovered, 23 patients (51%) required rehabilitation after the first follow-up. After 6 months, their AMPS, SF-36, and HADS scores were lower than those of the patients who did not require rehabilitation after the first screening. Half of the patients with a TIA or an NDS who were initially considered fully recovered exhibited ADL limitations, decreased QoL, and symptoms of anxiety or depression after 6 months.
Background
Cancer survivors’ perspectives on a successful return to work (RTW) may not be captured in the common measure of RTW, namely time until RTW.
Objective
The purpose of this study was ...therefore to develop an RTW outcome measure that reflects employed cancer survivors’ perspectives, with items that could be influenced by an employer, i.e. the Successful Return-To-Work questionnaire for Cancer Survivors (I-RTW_CS), and to assess its construct validity and reproducibility.
Methods
First, three focus groups with cancer survivors (
n
= 14) were organized to generate issues that may constitute successful RTW. Second, a two-round Delphi study among 108 cancer survivors was conducted to select the most important issues. Construct validity of the I-RTW_CS was assessed using correlations with a single-item measure of successful RTW and the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS;
n
= 57). Reproducibility (test–retest reliability) was assessed using the intraclass correlation coefficient (ICC;
n
= 50).
Results
Forty-eight issues were generated, of which seven were included: ‘enjoyment in work’; ‘work without affecting health’; ‘confidence of employer without assumptions about work ability’; ‘open communication with employer’; ‘feeling welcome at work’; ‘good work–life balance’; and ‘joint satisfaction with the situation (employer and cancer survivor)’. Correlations with single-item successful RTW and QWLQ-CS were 0.58 and 0.85, respectively. The reproducibility showed an ICC of 0.72.
Conclusions
The I-RTW_CS provides an RTW outcome measure that includes cancer survivors’ perspectives and weights its items on an individual basis, allowing a more meaningful evaluation of cancer survivors’ RTW. This study provides preliminary evidence for its construct validity and reproducibility.
Background and Objective. The assessment of locus of control forms an important part of headache treatment, and there is need to adapting them to the Dutch population. Methods. Forward-backward ...translation was used to obtain the Headache-Specific Locus of Control Scale–Dutch Version (HSLC-DV). The response of 87 participants with migraine, tension-type headache, and cervicogenic headache, aged between 18 and 55 years (75% female), is used. Test-retest reliability was measured by intraclass correlations. Construct validity was assessed by correlations with corresponding domains of the Pain Coping and Cognition List (PCCL) and by confirmation of known groups hypotheses. Structural validity was evaluated by factor analysis (principal axis factoring). Results. The intraclass correlations for the External, Internal, and Chance domains were 0.79, 0.89, and 0.73, respectively. Internal consistencies for domains exceeded 0.73 and were similar to those observed in the original study. Convergent correlations were as expected and three of the seven known groups hypotheses were confirmed. Structural validity was supported by results of the factor analysis that matched the proposed structure of the original instrument. Conclusions. The HSLC-DV is a valid and reliable questionnaire for measuring the locus of control.
Currently over 50% of drugs prescribed to children have not been evaluated properly for use in their age group. One key reason why children have been excluded from clinical trials is that they are ...not considered able to exercise meaningful autonomy over the decision to participate. Dutch law states that competence to consent can be presumed present at the age of 12 and above; however, in pediatric practice children's competence is not that clearly presented and the transition from assent to active consent is gradual. A gold standard for competence assessment in children does not exist. In this article we describe a study protocol on the development of a standardized tool for assessing competence to consent in research in children and adolescents.
In this study we modified the MacCAT-CR, the best evaluated competence assessment tool for adults, for use in children and adolescents. We will administer the tool prospectively to a cohort of pediatric patients from 6 to18 years during the selection stages of ongoing clinical trials. The outcomes of the MacCAT-CR interviews will be compared to a reference standard, established by the judgments of clinical investigators, and an expert panel consisting of child psychiatrists, child psychologists and medical ethicists. The reliability, criterion-related validity and reproducibility of the tool will be determined. As MacCAT-CR is a multi-item scale consisting of 13 items, power was justified at 130-190 subjects, providing a minimum of 10-15 observations per item. MacCAT-CR outcomes will be correlated with age, life experience, IQ, ethnicity, socio-economic status and competence judgment of the parent(s). It is anticipated that 160 participants will be recruited over 2 years to complete enrollment.
A validity study on an assessment tool of competence to consent is strongly needed in research practice, particularly in the child and adolescent population. In this study we will establish a reference standard of children's competence to consent, combined with validation of an assessment instrument. Results can facilitate responsible involvement of children in clinical trials by further development of guidelines, health-care policies and legal policies.
The CAMCOG, ADAS-cog, and MMSE, designed to grade global cognitive ability in dementia have inadequate precision and accuracy in distinguishing mild dementia from normal ageing. Adding ...neuropsychological tests to their scale might improve precision and accuracy in mild dementia. We, therefore, pooled neuropsychological test-batteries from two memory clinics (ns = 135 and 186) with CAMCOG data from a population study and 2 memory clinics (n = 829) and ADAS-cog data from 3 randomized controlled trials (n = 713) to estimate a common dimension of global cognitive ability using Rasch analysis. Item difficulties and individuals' global cognitive ability levels were estimated. Difficulties of 57 items (of 64) could be validly estimated. Neuropsychological tests were more difficult than the CAMCOG, ADAS-cog, and MMSE items. Most neuropsychological tests had difficulties in the ability range of normal ageing to mild dementia. Higher than average ability levels were more precisely measured when neuropsychological tests were added to the MMSE than when these were measured with the MMSE alone. Diagnostic accuracy in mild dementia was consistently better after adding neuropsychological tests to the MMSE. We conclude that extending dementia specific instruments with neuropsychological tests improves measurement precision and accuracy of cognitive impairment in mild dementia.
Background
The purpose of the study was to evaluate differences between prescribed and recommended protein intake in moderate‐preterm (MP) and late‐preterm (LP) infants and examine the contribution ...of the first week's prescribed protein intake to growth until term age.
Methods
Data on intake and anthropometrics were collected retrospectively in 235 preterm infants admitted to our general hospital's neonatal ward: 60 MP (320/7–336/7 weeks’ gestational age) and 175 LP (340/7–366/7 weeks’ gestational age). Differences between prescribed and recommended protein intake during the first postnatal week and z‐score change for weight and head circumference (HC) between birth and term age were calculated. Multiple regression was used to evaluate the independent contribution of first week's prescribed protein intake to growth until term age.
Results
At day 7, 58% of MP and 19% of LP infants reached recommended protein intake. At term age, mean z‐score change was −0.4 for weight and +0.1 for HC. Mean protein intake (g/kg/d) was associated with z‐score change of +0.34 (95% CI, 0.14–0.53; P < .001) for weight and +0.25 (95% CI, 0–0.5; P = .03) for HC. Reaching recommended protein intake at day 7 was only independently associated with weight z‐score change (+0.22 95% CI, 0.04–0.41; P = .002).
Conclusion
First week's prescribed protein intake does not meet recommended intake. Higher protein intakes in the first postnatal week result in increased weight gain and head growth until term age. Desirability and feasibility of increasing the protein intake need careful consideration and further discussion.
To examine whether it is appropriate to sum the cognitive part of the Alzheimer Disease Assessment Scale (ADAS-cog) items to assess cognitive impairment. This assumes items to have (1) equal ...measurement precision and (2) hierarchically ordered categories.
Rasch analysis on the basis of pooled data from 3 Randomized Controlled Trials was used to examine these assumptions and to estimate each patient's level of impairment. Analyses were replicated in an independent sample.
The original ADAS-cog scoring did not fit the Rasch Model and did not reliably distinguish between impairment levels. Patients with equal test scores had different impairment levels. Similarly, patients with different test scores could have the same impairment level. Revising the ADAS-cog by (1) weighting the items by their measurement precision and (2) collapsing nonhierarchical item categories resulted in good fit and a valid one to one correspondence between sum scores and estimated impairment levels. This revealed that equal differences in ADAS-cog scores did not reflect equal differences in impairment level along the test's score range.
It is appropriate to summate the ADAS-cog items provided that the items are weighted and have their categories hierarchically ordered.
Adaptive cognitive testing in dementia Wouters, Hans; Zwinderman, Aeilko H.; van Gool, Willem A. ...
International journal of methods in psychiatric research,
June 2009, Letnik:
18, Številka:
2
Journal Article
Currently, there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes. However, there are few item banks, which have been developed to quantify ...functional status, as expressed by the ability to perform activities of daily life. This paper examines the measurement properties of the Academic Medical Center linear disability score item bank in a mixed population.
This paper uses item response theory to analyse data on 115 of 170 items from a total of 1002 respondents. These were: 551 (55%) residents of supported housing, residential care or nursing homes; 235 (23%) patients with chronic pain; 127 (13%) inpatients on a neurology ward following a stroke; and 89 (9%) patients suffering from Parkinson's disease.
Of the 170 items, 115 were judged to be clinically relevant. Of these 115 items, 77 were retained in the item bank following the item response theory analysis. Of the 38 items that were excluded from the item bank, 24 had either been presented to fewer than 200 respondents or had fewer than 10% or more than 90% of responses in the category 'can carry out'. A further 11 items had different measurement properties for younger and older or for male and female respondents. Finally, 3 items were excluded because the item response theory model did not fit the data.
The Academic Medical Center linear disability score item bank has promising measurement characteristics for the mixed patient population described in this paper. Further studies will be needed to examine the measurement properties of the item bank in other populations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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