Diagnosing daytime bladder symptoms in children with nocturnal enuresis: A comparison of brief parental questionnaire with in‐depth,physician‐elicited,assessment

Aims: To assess the accuracy of brief parental questionnaire reporting of daytime bladder symptoms in children with nocturnal enuresis and compare with in‐depth reporting elicited by physician assessment, for diagnosing monosymptomatic and non‐monosymptomatic nocturnal enuresis. Methods: A cross‐sectional study of consecutive children attending an outpatient nocturnal enuresis clinic at a tertiary paediatric hospital participated in the study. Parents were asked to complete a questionnaire as part of routine assessment at their first visit which was compared with a detailed clinical assessment by the physician involving eliciting a thorough history from the parent and child. Results: Parents of 585 children participated in the study (mean age 9.2 years, range 5.0–17.5 years). Sixty percent of children were males. There was poor agreement between initial parental reporting and physician diagnosis of monosymptomatic and non‐monosymptomatic nocturnal enuresis (Kappa = 0.3, 95% confidence interval 0.21–0.37), mainly because parents underreport daytime incontinence and urgency compared with physician‐elicited information (43% vs. 69% and 66% vs. 87%, respectively). Conclusions: Parents underreport daytime symptoms by 20–25%. Reliance on a brief parental history without prompting by physicians for daytime symptoms for diagnosing type of nocturnal enuresis may be misleading and result in suboptimal management.     

Validity and reproducibility of a semi‐quantitative food frequency questionnaire for use among Portuguese pregnant women

This study aimed to evaluate the validity and reproducibility of a semi‐quantitative food frequency questionnaire (FFQ) to estimate nutrient intake among Portuguese pregnant women. A sample of 101 pregnant women completed a 3‐day food diary (FD) in each pregnancy trimester (reference method) and an interviewer‐administered FFQ in the immediate post‐partum period. Ranking women according to their usual intake showed that, on average, 65% were classified into the same ±1 quintile and 2.4% into opposite quintiles by the two methods. Energy‐adjusted and de‐attenuated correlation coefficients ranged from 0.20 (protein) to 0.58 (riboflavin). Similar results were obtained when the FFQ was compared to each trimester‐specific FD. To assess the FFQ reproducibility, 70 women in their third pregnancy trimester were interviewed twice within a 2‐week interval. The level of agreement was high, with ≥75% of the participants being classified into the same ±1 quintile by the two administrations for 13 of the 15 nutrients examined. A review of the published literature revealed that this is the first FFQ to take the whole pregnancy as its reference time window. Our findings showed that a single administration of this FFQ in the immediate post‐partum period is a valid tool to rank Portuguese pregnant women according to their intakes.     

基于德尔菲法构建老年人功能受损评估初始量表

目的构建适合我国老年人的功能受损评估初始量表。方法通过检索和复习文献,选取与老年功能评估相关的量表,通过专家小组讨论形成条目池。采用德尔菲专家咨询法筛选条目,使用电子邮箱将功能受损评估量表专家咨询问卷发放给25名专家,专家对条目的重要性及可行性评分,并填写判断依据和熟悉程度。根据专家意见筛选条目,计算各指标得分平均值和变异系数,形成老年人功能受损评估初始量表。结果经文献检索和专家小组讨论,共筛选25个二级指标的条目池。两轮咨询专家积极系数为80%和100%,权威系数为0.94和0.90。第一轮条目的重要性Kendall协调系数为0.26(P<0.001),可行性Kendall协调系数0.28(P<0.001)。第二轮条目重要性Kendall协调系数为0.39(P<0.001),可行性Kendall协调系数0.37(P<0.001)。根据得分情况及专家修改意见,最终形成3个一级指标和18个二级指标。结论通过德尔菲专家咨询法构建了包含3个一级指标和18个二级指标的老年人功能受损评估初始量表。     

老年人功能受损评估正式量表的建立

目的由于国内外尚无功能受损的评估量表,本研究拟在前期通过德尔菲专家咨询法建立的老年人功能受损评估(FIST)初始量表的基础上,进一步构建适合我国老年人的FIST正式量表。方法使用FIST初始量表对305例老年人进行调查,通过相关系数法、克朗巴赫系数法和因子分析法,分别计算各条目得分与总分的相关系数、校正条目的总相关系数(CITC)和删除某条目后的克朗巴赫系数、公因子方差和因子负荷进行条目筛选,得到正式量表。结果共收到300份有效问卷,克朗巴赫系数法中CITC、删除该条目后的克朗巴赫系数和因子分析法中公因子方差、因子负荷均提示删除"社会活动",予以删除该条目。相关系数法计算结果提示"进食""洗漱梳头""穿脱衣服""控制大小便"需删除;克朗巴赫系数法计算结果提示"体育锻炼"需删除;经课题组专家讨论,删除"控制大小便",其余条目予以保留。最终形成了包含3个一级指标和16个二级指标的FIST正式量表。结论使用FIST初始量表进行预试验调查,通过经典统计学方法计算预试验结果,进行条目筛选,建立了老年人功能受损评估正式量表。     

Efficacy of patient questionnaire in predicting renal dysfunction in outpatients older than 60 years of age prior to contrast-enhanced computed tomography

Introduction: Contrast‐induced nephropathy (CIN), a common iatrogenic cause of acute renal failure, is preventable. Identification of impaired renal function prior to intravenous contrast is important. Questionnaire screening has been useful to negate the need for cumbersome and costly renal function testing on all patients prior to contrast‐enhanced CT (CECT). The Royal Australian and New Zealand College of Radiologists guidelines include age older than 60 as a risk marker requiring renal function testing. The aim of this retrospective study is to assess the efficacy of the pre‐CT questionnaire in identifying patients with pre‐existing renal impairment even in this older than 60 age group. Methods: All outpatients were given questionnaires containing 11 CIN risk markers prior to CECT. Radiographers documented age, gender, serum creatinine and/or estimated glomerulofiltration rate (eGFR mL/min/1.72 m²) within 3 months of CT. Questionnaires of all patients older than 60 years were collated. The data was tabulated and analyzed. Incomplete questionnaires were excluded. Results: 134/171 (78.4%) patients had eGFR ≥ 60 and 37/171 (21.6%) had eGFR < 60, with 31/171 (18.1%) having eGFR between 30 and 60 and 3/171 (1.8%) having eGFR < 30. 47/171 (27.5%) circled ‘no’ to all risk markers. Percentage for sensitivity is 81.1% (95% confidence interval (CI) 64.8–92%), for specificity 29.9% (95% CI 22.3–38.4%), for positive predictive value 24.2% (95% CI 17–32.7%) and for negative predictive value 85.1% (95%CI 71.7–93.8%). Kidney disease, anaemia, myeloma and vasculitis seem to be statistically significant risk factors (P < 0.05). All three true‐positive patients with eGFR < 30 indicated known kidney disease. Seven false‐negative patients had eGFR 30–60, with 4/7 (57.1%) having CIN risk markers in their medical records. Conclusion: Questionnaire screening for CIN risk has a high negative predictive value (85.1%) even in patients older than 60 years.     

Identifying Unmet Rehabilitation Needs in Patients After Stroke With a Graphic Rehab-CompassTM

Background

Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic “Rehab-Compass,” a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients' rehabilitation needs in clinical practice.