Summary Background & aims Oral nutritional supplements (ONS) are often considered for hospitalized patients with acute severe malnutrition, however the compliance to the supplements is known to be ...variable. The aim of our study was to investigate whether providing a lower volume of ONS at a higher frequency during medication rounds would improve the intake of the supplements. Methods In this randomized controlled trial, 234 malnourished inpatients (mean age 71.2 years, 55% male, median LOS 10 days) were randomized to receive ONS (300 kcal and 12 g Protein per 125 ml serving) in one of three different schemes. The usual care group ( n = 88) was offered ONS 125 ml twice per day in between meals. This was compared to two intervention groups that were offered ONS during medication rounds: intervention group 1 ( n = 66) received 125 ml of ONS twice per day, at 12 and 17 o'clock, and intervention group 2 ( n = 80) received 62 ml of ONS four times a day, at 8, 12, 17 and 20 o'clock. Follow-up was performed until discharge or until ONS was no longer needed, with a maximum follow-up period of 30 days. The primary outcome measure was the percentage of patients who consumed at least 75% of the prescribed volume of ONS. Results No significant differences were observed between the control groups and intervention group 1 (risk difference of −16.0% (95% CI −33.2–1.2). However, the percentage of patients consuming at least 75% of the prescribed ONS was higher in intervention group 2, with a risk difference 23.4% (95% CI 7.8–39.0%) and a mean increased intake of 35 ml (84 kcal) per day, p < 0.001). Median time ONS were taken was 5 days (range 1–17). Conclusion A higher frequency of a lower volume of ONS during medication rounds increased the compliance of patients needing ONS. Clinical trial registration number NTR2535 ; www.trialregister.nl.
Whenever questionnaires are used to collect data on constructs, such as functional status or health related quality of life, it is unlikely that all respondents will respond to all items. This paper ...examines ways of dealing with responses in a 'not applicable' category to items included in the AMC Linear Disability Score (ALDS) project item bank.
The data examined in this paper come from the responses of 392 respondents to 32 items and form part of the calibration sample for the ALDS item bank. The data are analysed using the one-parameter logistic item response theory model. The four practical strategies for dealing with this type of response are: cold deck imputation; hot deck imputation; treating the missing responses as if these items had never been offered to those individual patients; and using a model which takes account of the 'tendency to respond to items'.
The item and respondent population parameter estimates were very similar for the strategies involving hot deck imputation; treating the missing responses as if these items had never been offered to those individual patients; and using a model which takes account of the 'tendency to respond to items'. The estimates obtained using the cold deck imputation method were substantially different.
The cold deck imputation method was not considered suitable for use in the ALDS item bank. The other three methods described can be usefully implemented in the ALDS item bank, depending on the purpose of the data analysis to be carried out. These three methods may be useful for other data sets examining similar constructs, when item response theory based methods are used.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Sealing esophageal leaks by stent placement allows healing in 44 % - 94 % of patients. We aimed to develop a prediction rule to predict the chance of successful stent therapy.
In this multicenter ...retrospective cohort study, patients with benign upper gastrointestinal leakage treated with stent placement were included. We used logistic regression analysis including four known clinical predictors of stent therapy outcome. The model performance to predict successful stent therapy was evaluated in an independent validation sample.
We included etiology, location, C-reactive protein, and size of the leak as clinical predictors. The model was estimated from 145 patients (derivation sample), and 59 patients were included in the validation sample. Stent therapy was successful in 55.9 % and 67.8 % of cases, respectively. The predicted probability of successful stent therapy was significantly higher in success patients compared with failure patients in both the derivation (
< 0.001) and validation (
< 0.001) samples. The area under the receiver operating characteristic curve was 74.1 % in the derivation sample and 84.7 % in the validation sample. When the model predicted ≥ 70 % chance of success, the positive predictive value was 79 % in the derivation sample and 87 % in the validation sample. When the model predicted ≤ 50 % chance of success, the negative predictive value was 64 % and 86 %, respectively.
This prediction rule, consisting of four clinical predictors, could identify patients with esophageal leaks who were likely to benefit from or fail on stent therapy. The prediction rule can support clinical decision-making when the predicted probability of success is ≥ 70 % or ≤ 50 %.
The Nociception Coma Scale (NCS) is a pain observation tool, developed for patients with disorders of consciousness (DOC) due to acquired brain injury (ABI). The aim of this study was to assess the ...interrater reliability of the NCS and NCS-R among nurses for the assessment of pain in ABI patients with DOC. A secondary aim was further validation of both scales by assessing its discriminating abilities for the presence or absence of pain. Hospitalized patients with ABI (n = 10) were recorded on film during three conditions: baseline, after tactile stimulation, and after noxious stimulation. All stimulations were part of daily treatment for these patients. The 30 recordings were assessed with the NCS and NCS-R by 27 nurses from three university hospitals in the Netherlands. Each nurse viewed 9 to 12 recordings, totaling 270 assessments. Interrater reliability of the NCS/NCS-R items and total scores were estimated by intraclass correlations (ICC), which showed excellent and equal average measures reliability for the NCS and NCR-R total scores (ICC 0.95), and item scores (range 0.87-0.95). Secondary analysis was performed to assess differences in ICCs among nurses’ education and experience and to assess the scales discriminating properties for the presence of pain. The NCS and NCS-R are valid and reproducible scales that can be used by nurses with an associate (of science) in nursing degree or baccalaureate (of science) in nursing degree. It seems that more experience with ABI patients is not a predictor for good agreement in the assessment of the NCS(-R).
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) has thus far only been tested for diminishing behavior problems in the US. This study tested relative efficacy of MTFC-P on multiple ...outcomes against treatment as usual in the Netherlands (TAU; Study I), and regular foster care (Study II). The sample included 55 children that received MTFC-P, 23 children received TAU and 30 children from regular foster care (RFC). Changes in behavioral and relationship functioning, trauma symptoms, hypothalamic-adrenal-pituitary (HPA-) axis functioning, and caregiving stress were assessed via questionnaires, interviews, and salivary cortisol. Outcomes of Study I were evaluated using a randomized controlled design and quasi-experimental design, outcomes of Study II according to non-equivalent group comparison. No evidence was found for relative efficacy of MTFC-P over TAU. A treatment effect was found on trauma symptoms, in favor of TAU. Outcomes of Study II revealed that whereas caregiving stress and secure base distortions were significantly more severe at baseline in MTFC-P compared to RFC, post treatment differences were no longer significant. However, percentages of symptoms of disinhibited attachment and attachment disorder were nearly equal between groups at baseline, while post treatment percentages indicated significantly more symptoms in MTFC. In addition, results revealed a significant difference in the severity of externalizing problems post treatment, in favor of RFC. The results obtained within this study indicate that children in MTFC-P and usual treatment foster care in the Dutch context improved similarly, thus not showing the same advantages that MTFC-P has demonstrated in the US. Results should be interpreted with caution due to lower than planned power. Findings underscore the challenges of testing novel treatments across contexts with highly different child welfare provisions.
PURPOSE:Although rehabilitation after treatment for non-small cell lung cancer (NSCLC) was found to have a beneficial effect on exercise capacity in a number of studies, insight into its effect on ...quality of life (QoL) and fatigue is limited. The aim of this study was to examine the outcome of pulmonary rehabilitation (PR) regarding fatigue, QoL, and exercise capacity in adult patients curatively treated for NSCLC stages I to IIIa.
METHODS:Study data were prospectively and routinely gathered in daily practice in patients taking part in an outpatient PR program after treatment for NSCLC stages I to IIIa. PR consisted of 12 weeks of supervised exercises 3 times a week, supplemented with scheduled visits with members of a multidisciplinary team. Data were gathered at initial assessment and discharge. Outcomes included fatigue (the Functional Assessment of Cancer Therapy-Fatigue and the fatigue domain of the Chronic Respiratory Disease Questionnaire); QoL (total CRQ score), Functional Assessment of Cancer Therapy-Lung, and the Short Form 36; and exercise capacity (cardiopulmonary exercise testing).
RESULTS:Fifty patients started the program out of the 70 patients referred to PR and 43 (86%) completed the program. Significant (P ≤ .01) and clinically relevant improvements were observed for all outcome measures.
CONCLUSIONS:Rehabilitation after treatment for NSCLC stages I to IIIa showed promising improvements regarding patient fatigue, QoL, and exercise capacity. PR should be considered for patients after treatment for NSCLC stages I to IIIa.
Aims: To investigate post‐operative capillary density regeneration in healing mucoperiosteal flaps at guided bone regeneration‐treated implant sites.
Material and Methods: A non‐invasive ...post‐operative investigation was performed in 10 patients using orthogonal polarization spectral (OPS) imaging for assessment of capillary density during the course of mucoperiosteal flap wound healing for 6 weeks in patients receiving dental implants.
Results: The greatest increase in capillary regeneration occurred in the early wound‐healing phase, during weeks 1 and 2, and recovery to baseline was achieved between weeks 4 and 5. A comparison of adjacent OPS measurements indicated that differences between the time point immediately following administration of local anaesthesia and directly post‐operatively ( p=0.002), between a directly post‐operative time point and after 1 week (p=0.009), and between post‐operative weeks 1 and 2 (p=0.036) were statistically significant.
Conclusions: The early healing phase of mucoperiosteal flaps is characterized by rapid capillary regeneration. OPS imaging enabled the possibility to monitor and quantify the temporal development of mucoperiosteal flap revascularization following periodontal surgery.
In primary care, meniscal tears are difficult to detect. A quick and easy clinical prediction rule based on patient history and a single meniscal test may help physicians to identify high-risk ...patients for referral for magnetic resonance imaging (MRI).
The study objective was to develop and internally validate a clinical prediction rule (CPR) for the detection of meniscal tears in primary care.
In a cross-sectional multicentre study, 121 participants from primary care were included if they were aged 18-65 years with knee complaints that existed for <6 months, and who were suspected to suffer from a meniscal tear.
One diagnostic physical meniscal test and 14 clinical variables were considered to be predictors of MRI outcome. Using known predictors for the presence of meniscal tears, a 'quick and easy' CPR was derived.
The final CPR included the variables sex, age, weight-bearing during trauma, performing sports, effusion, warmth, discolouration, and Deep Squat test. The final model had an AUC of 0.76 (95% CI = 0.72 to 0.80). A cut-point of 150 points yielded an overall sensitivity of 86.1% and a specificity of 45.5%. For this cut-point, the positive predictive value was 55.0%, and the negative predictive value was 81.1%. A scoring system was provided including the corresponding predicted probabilities for a meniscal tear.
The CPR improved the detection of meniscal tears in primary care. Further evaluation of the CPR in new primary care patients is needed, however, to assess its usefulness.
Purpose
The aim of the present study was to determine the long-term outcome after the arthroscopic Bankart procedure, in terms of recurrent instability, shoulder function, glenohumeral arthropathy ...and patient satisfaction.
Methods
Patients who underwent the arthroscopic Bankart procedure between January 1999 and the end of December 2005 were invited to complete a set of Patient Reported Outcome Measures (PROMs) and visit the hospital for clinical and radiological assessment. PROMs included the Western Ontario Shoulder Instability Index (WOSI), the Oxford Shoulder Instability Score (OSIS) and additional questions on shoulder instability and patient satisfaction. Clinical assessment included the apprehension test and the Constant–Murley score. The Samilson–Prieto classification was used to assess arthropathy on standard radiographs. The primary outcome was a re-dislocation that needed reduction. Secondary outcomes in terms of recurrent instability included patient-reported subluxation and a positive apprehension test.
Results
Of 104 consecutive patients, 71 patients with a mean follow-up of 13.1 years completed the PROMs, of which 53 patients (55 shoulders) were also available for clinical and radiological assessment. Re-dislocations had occurred in 7 shoulders (9.6%). Subluxations occurred in 23 patients (31.5%) and the apprehension test was positive in 30 (54.5%) of the 55 shoulders examined. Median functional outcomes were 236 for WOSI, 45 for OSIS, and 103 for the normalized Constant–Murley score. Of all 71 patients (73 shoulders), 29 (39.7%) reported being completely satisfied, 33 (45.2%) reported being mostly satisfied and 8 (11%) reported being somewhat satisfied. Glenohumeral arthropathy was observed in 33 (60%) of the shoulders.
Conclusion
Despite 10% re-dislocations and frequent other signs of recurrent instability, shoulder function and patient satisfaction at 13 years after arthroscopic Bankart repair were good.
Level of evidence
Level IV.
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