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991.
M. Simons R. Kimble S. McPhail Z. Tyack 《Burns : journal of the International Society for Burn Injuries》2019,45(8):1792-1809
BackgroundThe measurement of health-related quality of life (HRQoL) provides information about the perceived burden of the health condition and treatments from a lived experience. The Brisbane Burn Scar Impact Profile (caregiver report for young children, BBSIP0–8), developed in 2013, is a proxy-report measure of burn scar-specific HRQoL. The aim of this study was to report its psychometric properties in line with an evaluative purpose.MethodsCaregivers of children up to 8 years of age at risk of burn scarring were recruited into a prospective, longitudinal cohort study. Caregivers completed the BBSIP0–8, Pediatric Quality of Life Inventory and Patient Observer Scar Assessment Scale at baseline (approximately ≥85% of the total body surface area re-epithelialised), 1–2 weeks after baseline and 1-month after baseline. Psychometric properties measured included internal consistency, test–retest reliability, validity and responsiveness.ResultsEighty-six caregivers of mostly male children (55%), of a median age (IQR) of 1 year, 10 months (2 years, 1 month) and total body surface area burn of 1.5% (3.0%) were recruited. Over one third of participants were grafted and 15% had contractures or skin tightness at baseline. Internal consistency of ten item groups ranged from 0.73 to 0.96. Hypothesised correlations of changes in the BBSIP0–8 items with changes in criterion measures supported longitudinal validity (ρ ranging from ?0.73 to 0.68). The majority of item groups had acceptable reproducibility (ICC = 0.65–0.83). The responsiveness of five item groups was supported (AUC = 0.71–0.90).ConclusionThe psychometric properties tested support the use of the BBSIP0–8 as an evaluative measure of burn scar-related health-related quality of life for children aged below eight years in the early post-acute period of rehabilitation. Further investigation at longer time period after burn injury is indicated. 相似文献
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Objectives
To identify temporal trends in muscular fitness of English children using allometric scaling for height and weight to adjust for the influence of body size.Design
Repeated cross-sectional study.Methods
We measured; height, weight, standing broad-jump, handgrip, sit-ups and bent-arm hang in 10-year-old boys and girls from Chelmsford, England in: 2014 (n = 306), 2008 (n = 304) and 1998 (n = 310). Physical activity was (PAQ-C) was assessed in 2008 and 2014. Muscular fitness was allometrically scaled for height and weight. We assessed temporal trends using General Linear Models (fixed factors: wave and sex) and reported effect sizes using partial eta squared (ηP2). We compared percentage change per year 1998–2008 with 2008–2014.Results
Ten-year-olds in 2014 were taller and heavier than in 2008 and 1998 but there were no differences in BMI. Compared with 2008, physical activity was lower in boys (ηP2 = 0.012) and girls (ηP2 = 0.27) assessed in 2014. There were significant main effects of wave for handgrip (ηP2 = 0.060), sit-ups (ηP2 = 0.120) and bent-arm hang (ηP2 = 0.204). Pairwise comparisons showed muscular fitness of both sexes was significantly lower in 2014 than in 1998. From 2008 to 2014 percent change per year in handgrip (1.6%) and sit-ups (3.9%) were greater than for the preceding decade (handgrip 0.6%, sit-ups 2.6%).Conclusions
Downward temporal trends in muscular fitness appear independent of secular changes in body size. We found a decrease in self-reported physical activity concurrent with the accelerated declines in fitness from 2008 to 2014. These findings suggest the declines in children are not engaging in physical activities which support development of muscular fitness. 相似文献993.
We report four years of observational data from a large UK hospital and tertiary referral unit, following the introduction of a rotational thromboelastometry-guided algorithm for treatment of coagulopathy in major obstetric haemorrhage. Fibrinogen concentrate was used to treat acquired hypofibrinogenaemia as defined by a FibTEM A5 value of < 7 mm, or 7–12 mm with ongoing or high risk of haemorrhage. Of 32,647 deliveries over 4 years, 893 (2.7%) women had an estimated blood loss ≥ 1500 ml. Two-hundred and three (23%) of these had a FibTEM A5 ≤ 12 mm and 110 received fibrinogen concentrate. We compared clinical outcomes and blood product use with 52 patients who met the same criteria, over a 12-month pre-intervention period during which shock packs were used. In the algorithm group, there was a significant reduction in the number of units (p < 0.0001) and total volume (p = 0.0007) of blood products transfused, with a reduction in transfusion-associated circulatory overload (p = 0.002). Women with placental abruption exhibited more severe coagulopathy and required higher doses of fibrinogen concentrate than women who bled due to other causes. Analysis of rotational thromboelastometry results demonstrated that coagulopathy is not observed in all women who suffer obstetric haemorrhage and cannot be predicted solely by blood loss. Therefore, formulaic treatment with blood products is not justified. When coagulopathy does occur, it appears to be multifactorial and can be severe. Point-of-care testing allows early identification and individualised treatment of coagulopathy. This is supported by the improved outcomes reported. 相似文献
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