Clinimetric properties of the knee extension prone test (KEPT): A new method to assess knee hyperextension deficit

IntroductionThe knee extension prone test (KEPT) can be a low-cost and affordable alternative for this assess knee hyperextension deficit.ObjectiveTo analyze concurrent validity and reliability of a new method for assessing knee extension prone (knee extension prone test; KEPT).MethodsParticipants were divided into two groups: Group 1 comprised healthy participants (HG) and Group 2 comprised participants with a history of knee injury (IG). Two examiners performed the following evaluations: (1) lateral knee goniometry, (2) anterior tibial inclinometry, (3) lateral photogrammetry in supine, (4) lateral photogrammetry in prone, and (5) KEPT. Concurrent validity was analyzed by Pearson's linear correlation coefficient (r), and intra- and inter-examiner reliability were analyzed by intraclass correlation coefficient (ICC).ResultsKEPT demonstrated good intra-examiner (ICC = 0.85, 95% CI = 0.75–0.89) and excellent inter-examiner (ICC = 0.92, 95% CI = 0.88–0.94) reliability. The standard error of measurement was 0.47° and 1.30° and the minimum detectable change was 2.35° and 6.5° for intra- and inter-examiner agreement, respectively. Concurrent validity of KEPT ranged from moderate to good (r = 0.54–0.78, p < 0.01).ConclusionKEPT is a valid and reliable method for assessing knee hyperextension deficit in both healthy individuals and patients with knee injuries.     

Burnout and the Sexual Assault Nurse Examiner: Who Is Experiencing Burnout and Why?

IntroductionA sexual assault nurse examiner role exemplifies the high-stress and highly emotional patient interactions that are often associated with burnout. The purpose of this study was to examine the frequency of burnout among sexual assault nurse examiners in North Carolina.MethodsThis cross-sectional study was an anonymous survey of practicing sexual assault nurse examiners within North Carolina using the Maslach Burnout Inventory and additional demographics. Results were analyzed with odds ratios, confidence intervals, Fisher exact, chi-square, and Kruskal Wallis tests as appropriate.ResultsAmong 95 respondents, burnout was more frequent in sexual assault nurse examiners who stopped both emergency and nurse examiner work (55.6%, odds ratio 4.41, 95% confidence interval 1.07-18.06) and in dual function nurses (both emergency and nurse examiner work, 35.7%, odds ratio 2.71, 95% confidence interval 1.04-7.06). Sexual assault nurse examiners who had a high percentage of pediatric cases (above the median of 40%) were more likely to meet burnout thresholds for emotional exhaustion scores > 26 (48.78% vs 25.93%, χ² = 5.30, P = .02) and more likely to meet burnout thresholds for depersonalization scores > 9 (48.78% vs 24.07%, χ² = 6.28, P = .01).DiscussionHigher frequency of burnout threshold criteria was found in those people who worked concurrently as a sexual assault nurse examiner and an emergency nurse and in those who had retired from both specialties. We also found that sexual assault nurse examiners with a higher case mix of pediatric cases had higher emotional exhaustion scores and higher depersonalization scores.     

Smartphone goniometer has excellent reliability between novice and experienced physical therapists in assessing knee range of motion

IntroductionSmartphone app-based goniometer (SG) are emerging as an alternative to Universal Goniometers (UG) in assessing joint range of motion (ROM). This study examined whether the experience level of examiner affected the reliability of assessing knee flexion (KF) and knee extension (KE) ROM using UG and SG.MethodsParticipants with osteoarthritis of the knee or following total knee replacement were recruited. KF and KE ROM using UG and SG were assessed twice by an experienced physical therapist (PT) and a student PT (SPT). Intraclass correlation coefficients (ICC) examined the interrater (experienced PT vs SPT) and intrarater reliabilities (for experienced PT and SPT) in assessing KF and KE ROM for UG and SG. Concurrent relationships were examined between the knee ROM with pain and physical function using Pearson Correlation Coefficient (r).ResultsThe interrater reliability in assessing KF and KE ROM was excellent (ICC>0.90) between novice and experienced examiners. The standard error of measurement (SEM) for novice examiner in assessing KF was 1° and 2° while using UG and SG respectively; whereas the SEM for experienced examiner in assessing KF was 1° irrespective of which device was used. The concurrent relationships between KF and KE ROM with measures of pain and function were divergent (moderate to low correlations; r <0.7; p > 0.05).ConclusionBoth UG and SG have smaller measurement error in assessing KF and KE ROM irrespective of experience level of examiner and therefore no one tool is superior than the other for assessing knee ROM in clinical practice.     

The inter- and intra-rater reliability of Modified Tardieu Scale in assessing spasticity of knee extensors in patients with multiple sclerosis

IntroductionSpasticity is one of the most common and disabling symptoms in Multiple sclerosis (MS). The is a clinical tool for assessing spasticity. This study aimed to investigate the inter- and intra-rater reliability of the modified Tardieu scale for assessing knee extensors spasticity in MS patients.MethodsTwenty-six patients with MS (12 females and 14 males) with a mean age of 40 ± 11.39 years participated in this study. The extensor muscles of both knees were evaluated using the MTS in two sessions. At first session, two examiners randomly assessed the knee extensor spasticity to study the inter-rater reliability and 3–4 days later the first examiner assessed the patients again, to determine intra-rater reliability. Intra-class Correlation Coefficient (ICC) analysis, two-way random effect model was used to determine the reliability of various components of the modified Tardieu scale.ResultsThe inter-rater reliability for quality of muscle reaction of knee extensor muscles was very good (ICC = 0.89) and for the difference between the angle of muscle response (R1) and full range(R2) of movement (R2- R1), as spasticity intensity criterion, was good (ICC = 0.73). ICC values for R2-R1 and muscle response quality assessments by one rater were 0.73 and 0.82, respectively.ConclusionThe findings of the current study showed that the MTS has good to very good inter- and intra-rater reliability for assessing knee extensors spasticity in MS patients.     

The interrater reliability of a pain mechanisms-based classification for patients with nonspecific neck pain

ObjectiveTo examine the interrater reliability and agreement of a pain mechanisms-based classification for patients with nonspecific neck pain (NSNP).MethodsDesign – Observational, cross-sectional reliability study with a simultaneous examiner design. Setting: University hospital-based outpatient physical therapy clinic. Participants: A random sample of 48 patients, aged between 18 and 75 years old, with a primary complaint of neck pain was included. Interventions: Subjects underwent a standardized subjective and clinical examination, performed by 1 experienced physical therapist. Two assessors independently classified the participants’ NSNP on 3 main outcome measures. Main outcome measures: The Cohen kappa, percent agreement, and 95% confidence intervals (CIs) were calculated to determine the interrater reliability for (1) the predominant pain mechanism; (2) the predominant pain pattern; and (3) the predominant dysfunction pattern (DP).ResultsThere was almost perfect agreement between the 2 physical therapists’ judgements on the predominant pain mechanism, kappa = .84 (95% CI, .65–1.00), p < .001. There was substantial agreement between the raters’ judgements on the predominant pain pattern and predominant DP with respectively kappa = .61 (95% CI, .42–.80); and kappa = .62 (95% CI, .44–.79), p < .001.Conclusion(s)The proposed classification exhibits substantial to almost perfect interrater reliability. Further validity testing in larger neck pain populations is required before the information is used in clinical settings.Clinical trial registration numberNCT03147508 (https://clinicaltrials.gov/ct2/show/NCT03147508).     

Reliability and validity of the One Arm Hop Test and Seated Medicine Ball Throw Test in young adults: A cross-sectional study

BackgroundFunctional performance tests are inexpensive, accessible, and easy to apply tools that can be used to help practitioners in daily decision making process. The purpose of this study was to evaluate the reliability and validity of the One Arm Hop Test (OAHT) and Seated Medicine Ball Throw Test (SBMT) in young adults.MethodsCross-sectional study with a sample consisted of 59 young adults. The subjects performed the OAHT and SMBT in two moments separated by seven days and by two examiners. The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) was performed at the second moment. The time in OAHT, distance in SMBT, mean number of touches, normalized score, and power of the CKCUEST were measured. Reliability was determined using Intraclass Correlation Coeficient (ICC) and Bland-Altman Plots. Validity was assessed via Pearson's Correlation Coefficient (r) between these tests and CKCUEST.ResultsWe found good reliability of the OAHT between different raters (dominant limb – ICC = 0.83; non-dominant limb – ICC = 0.80) and moderate reliability between the same rater (dominant limb – ICC = 0.63; non-dominant limb – ICC = 0.62). In the SMBT we found good reliability inter-examiner (ICC = 0.84) and intra-examiner (ICC = 0.77). Low to moderate correlations with the CKCUEST were found (r < 0.70; p < 0.05).ConclusionsThe OAHT and the SMBT show moderate/good reliability intra and inter-examiner, however these tests are poorly correlated with CKCUEST. The SMBT presented higher values of ICC than OAHT. A combination of the SMBT and CKCUEST is recommended in clinical practice.     

Validity and reliability of a smartphone application for knee posture quantification and the effects of external markers on the precision of this measure

BackgroundTechnological resources, such as smartphones can contribute to the quantitative assessment of posture.PurposesTest the validity and reliability of using a postural assessment application to quantify the frontal plane knee posture in orthostatism and to test the influence of the use of external markers on the precision of this measure.DesignMethodological study.MethodsThe knee frontal plane posture of 30 volunteers were analyzed by two independent examiners. The photographs were taken with different external marker arrangements. The photographs were analyzed at two moments using the Kinovea software and PhysioCode Posture (PCP) application. Reliability was analyzed using the intraclass correlation coefficient (ICC) between measures with each instrument conducted at two moments with a 7-day interval. Concurrent validity of PCP with Kinovea measure was analyzed using Pearson's correlation coefficient. Standard error measurement (SEM), minimum detectable change (MDC) and Bland Altman plots were analyzed.ResultsPCP demonstrated excellent intra-rater [ICC = 0.92 (95% confidence interval [CI] 0.90–0.93)] and inter-rater [ICC = 0.88 (95%CI 0.85–0.90)] reliability. Concurrent validity analysis showed excellent agreement between PCP and Kinovea software (r = 0.88). The use of markers, independent of positioning, did not influence the measurement properties of measures with both softwares. The SEM was inferior to 1.2°, and the MDC was below 2.85°. No systematic errors were observed in the Bland Altman graphs.ConclusionsThe use of PCP application to measure knee posture was valid and demonstrated excellent intra- and inter-rater reliability levels. The use of external markers did not influence the measurement.     

Development and Validation of the ACP-CAT for Assessing the Quality of Advance Care Planning Communication

ContextHigh-quality advance care planning (ACP) discussions are important to ensure patient receipt of goal-concordant care; however, there is no existing tool for assessing ACP communication quality.ObjectivesThe objective of this study was to develop and validate a novel instrument that can be used to assess ACP communication skills of clinicians and trainees.MethodsWe developed a 20-item ACP Communication Assessment Tool (ACP-CAT) plus two summative items. Randomized rater pairs assessed residents' performances in video-recorded standardized patient encounters before and after an ACP training program using the ACP-CAT. We tested the tool for its 1) discriminating ability, 2) interrater reliability, 3) concurrent validity, 4) feasibility, and 5) raters' satisfaction.ResultsFifty-eight pre/post-training video recordings from 29 first-year internal medicine residents at Mount Sinai Hospital were evaluated. ACP-CAT reliably discriminated performance before and after training (median score 6 vs. 11, P < 0.001). For both pre/post-training encounters, interrater reliability was high for ACP-CAT total scores (intraclass correlation coefficient or ICC = 0.83 and 0.82) and the summative items Overall impression of ACP communication skills (ICC = 0.73 and 0.80) and Overall ability to respond to emotion (ICC = 0.83 and 0.82). Concurrent validity was shown by the strong correlation between ACP-CAT total score and both summative items. Raters spent an average of 4.8 minutes to complete the ACP-CAT, found it feasible, and were satisfied with its use.ConclusionACP-CAT provides a validated measure of ACP communication quality for assessing video-recorded encounters and can be further studied for its applicability with clinicians in different clinical contexts.     

Reliability of the Thai version of the International Physical Activity Questionnaire Short Form in chronic obstructive pulmonary disease

ObjectiveTo determine the reliability of the Thai version of International Physical Activity Questionnaire Short Form (IPAQ-SF) in Chronic Obstructive Pulmonary Disease (COPD) patients.MethodsA cross sectional study was carried out in COPD subjects at Chiang Dao hospital, Chiang Mai, Thailand in June and July 2019. COPD subjects were asked to complete the Thai version of the IPAQ-SF. Calculations for each level of activity were carried out separately (vigorous activity, moderate activity, walking, and sitting). This was carried out twice with an interval of four weeks between visits. The test–retest reliability of the IPAQ was assessed using the intraclass correlation (ICC) with a 95% confidence interval (CI). Cohen's kappa coefficient and percentage agreement were used to test the repeatability of the physical activity classification between the two visits.ResultsSixty COPD subjects (50% male), with a mean age of 71.2 ± 7.7 years were included. The least reliability was established for sitting time (ICC = 0.439; 95%CI; 0.212, 0.621, p-value < 0.001) and the greatest for the total physical activity (ICC = 0.837; 95%CI; 0.741, 0.899, p-value < 0.001). The Kappa statistic was 0.433 with a 95%CI; 0.237, 0.639, p-value < 0.001 and the percentage agreement of the physical activity classification between the two visits was 66.7%.ConclusionThe test–retest reliability was adequate for vigorous activity and total physical activity. Although there are concerns about the agreement for classification of physical activity, the IPAQ-SF may be a useful if not definitive tool for assessing physical activity in COPD.     

Measuring shoulder internal rotation range of motion: a comparison of 3 techniques

OBJECTIVE: To compare the reliability of shoulder internal rotation (IR) range of motion (ROM) measured using 3 different methods: standard technique, manual scapular stabilization technique, and visual inspection technique. DESIGN: Prospective study. SETTING: Clinic-based sports medicine center. PARTICIPANTS: Convenience sample of 56 unimpaired high-school athlete volunteers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Shoulder IR ROM was measured by using a digital inclinometer with each of the 3 techniques. All measurements were performed independently by 2 groups of examiners and repeated to determine intra- and interrater reliabilities. RESULTS: IR ROM measurements obtained with the scapula stabilized or by visual inspection were significantly less than when measured with the standard technique (P=.001). Intrarater reliability was good or excellent for all 3 methods (intraclass correlation coefficients=.63-.71), was similar for the scapular stabilization and visual inspection techniques, and was superior to that previously reported for similar measurements. In general, interrater reliability was lower than intrarater reliability for all measurements. CONCLUSION: Because the visual inspection and scapular stabilized techniques control for accessory scapulothoracic motion, these techniques may represent more valid measures of glenohumeral motion than the standard technique. Both the visual inspection and scapular stabilized techniques exhibited equally acceptable reliability for clinical use. However, because the visual inspection technique may be applied by a single examiner, we recommend its use to measure shoulder IR ROM in the clinical setting.     

Application of ultrasound-guided radial artery cannulation in paediatric patients: A systematic review and meta-analysis

BackgroundNumerous studies have demonstrated the benefits and safety of ultrasound guidance in comparison with conventional palpation for radial artery cannulation in adult patients. However, the current evidence for paediatric patients is not fully understood.ObjectiveThe objective of this study was to compare the efficiency and safety of ultrasound guidance with those of traditional palpation for radial artery cannulation in paediatric patients and provide convincing evidence for clinical practice.MethodsPubMed, Cochrane Library, ClinicalTrials.gov (Min et al-2019, NCT02795468, Anantasit et al-2017, NCT02668471), China National Knowledge Infrastructure, and Wanfang Data were systematically searched from their inception until December 31, 2019, to identify relevant randomised controlled trials. Data were extracted from the included studies independently by two investigators. The primary outcome of interest was the first-attempt success rate. Review Manager Version 5.3 and trial sequential analysis (beta = 0.9) were applied to analyse the collected data.ResultsA total of eight randomised controlled trials involving 680 paediatric patients were included in this study. The pooled findings showed that ultrasound-guided radial artery cannulation, in comparison with traditional palpation, can significantly improve the first-attempt success rate (relative risk [RR] = 1.65, 95% confidence interval [CI] = 1.36–2.01, P < 0.00001). Trial sequential analysis indicated that this available evidence was conclusive. Moreover, ultrasound guidance was associated with an increased total success rate (RR = 1.38, 95% CI = 1.15–1.66, P = 0.0004), a decreased mean procedural time (standardised mean difference = ?0.89, 95% CI = ?1.52 to ?0.25, P = 0.006), and incidence of haematoma (RR = 0.19, 95% CI = 0.10–0.35, P < 0.00001).ConclusionUltrasound-guided radial arterial cannulation in paediatric patients is associated with improved first-attempt success rates, total success rates, and mean procedural time and decreased incidence of haematoma. The current evidence suggests that ultrasound guidance should be the standard of care for radial artery cannulation in clinical practice.     

Hemiplegic shoulder pain syndrome: interrater reliability of physical diagnosis signs

OBJECTIVE: To determine the interrater reliability of shoulder physical diagnosis signs in the acute stroke rehabilitation setting. DESIGN: Prospective inception cohort. SETTING: Academic inpatient stroke rehabilitation service. PARTICIPANTS: People admitted to stroke rehabilitation service. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Neer impingement test, Speed test, acromioclavicular shear test, Rowe shoulder score, and palpation. RESULTS: Two examiners evaluated 46 consecutively admitted participants at 18.9+/-14.1 days after stroke. Percentage agreement was 78% or higher on all tests. The kappa statistic was in the fair to excellent interrater reliability range on all tests except those involving the acromioclavicular joint, for which findings were infrequent. CONCLUSIONS: Most of the shoulder physical diagnosis signs used in this study have sufficient interrater reliability for use in future clinical studies of hemiplegic shoulder pain.     

Ultrasonographic assessment of patellar tendon thickness at 16 clinically relevant measurement sites – A study of intra- and interrater reliability

ObjectivesTo determine intra- and interrater reliability of ultrasonographic imaging (USI) measurements of patellar tendon (PT) thickness using 16 measurement sites covering the entire tendon.DesignReliability study.SettingPhysiotherapy outpatient clinic.ParticipantsTwenty healthy and physically active volunteers (9 women). Mean age: 24 years (SD ± 2.73). Mean body mass: 75.8 kg (SD ± 11.8).Main outcome measuresIntraclass correlation coefficient (ICC) and 95% limits of agreement (LOA) in cm and in percentage relative to the mean PT thickness.ResultsIntrarater reliability ranged from 0.59 to 0.87 and 0.59 to 0.93 for examiners I and II, respectively. Interrater reliability ranged from 0.37 to 0.89. Measurement precision for examiner I ranged from 0.05 to 0.09 cm (17.5%–26.7%) while ranging from 0.04 to 0.13 cm (13.3%–38.7%) for examiner II. Interrater measurement precision ranged from 0.07 to 0.15 cm (19.1%–42.5%).ConclusionIn an attempt to replicate daily clinical USI practice, this was the first study extensively assessing reliability throughout the full range of the patellar tendon - revealing a considerable variation in intra- and interrater reliability as well as measurement precision throughout the 16 individual PT sites. In a clinical context, the low interrater reliability and precision found at the proximal tendon insertion site may have implications for USI of the symptomatic PT, as this is the site mainly associated with underlying pathologic changes. Further reliability studies are needed to clarify the region-specific reliability of the full length PT.     

Trends in Place of Death for Individuals With Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States

ContextAn important aspect of end-of-life care, place of death is understudied in advanced chronic (CKD) and end-stage kidney disease (ESKD).ObjectiveWe sought to examine trends and factors associated with where advanced CKD/ESKD patients die.MethodsWe conducted a retrospective cross-sectional study using mortality data from 2003 to 2017 for deaths attributed primarily to advanced CKD/ESKD in the United States.ResultsBetween 2003 and 2017, 222,247 deaths were attributed to advanced CKD/ESKD. From 2003 to 2017, deaths occurring in hospitals declined from 56.0% (n = 5356) to 35.6% (n = 7764), whereas increases occurred in deaths at home (13.5% [n = 1292] to 24.3% [n = 5306]), nursing facilities (18.6% [n = 1776] to 19.3% [n = 4221]), and hospice facilities (0.3% [n = 29] to 13.4% [n = 2917]). Nonwhite race was associated with increased odds of hospital death (Black [OR = 1.59; 95% CI = 1.55, 1.62]; Native American [OR = 1.47; 95% CI = 1.32, 1.63]; Asian [OR = 1.43; 95% CI = 1.32, 1.55] and reduced odds of nursing facility (Black [OR = 0.622; 95% CI = 0.600, 0.645]; Native American [OR = 0.638; 95% CI = 0.572, 0.712]; Asian [OR = 0.574; 95% CI = 0.533, 0.619], or hospice facility death (Black [OR = 0.843; 95% CI = 0.773, 0.918]; Native American [OR = 0.380; 95% CI = 0.289, 0.500]; Asian [OR = 0.609; 95% CI = 0.502, 0.739]). Older age was associated with reduced odds of hospital death (≥85 [OR = 0.334; 95% CI = 0.312, 0.358]) and increased odds of home (≥85 [OR = 1.55; 95% CI = 1.43, 1.68]), nursing facility (≥85 [OR = 3.09; 95% CI = 2.76, 3.45]) or hospice facility death (≥85 [OR = 1.60; 95% CI = 1.49, 1.72]).ConclusionsHospitals remain the most common place of death from advanced CKD/ESKD; however, the proportion of home, nursing facility, and hospice facility deaths have increased.     

Repeatability and reproducibility of the pressure biofeedback unit

IntroductionAlthough the pressure biofeedback unit (PBU) is used for muscular assessment and training, there is little evidence of its reproducibility and repeatability.ObjectiveThis study aims to assess intra- and inter-rater reproducibility and repeatability of the PBU in the assessment of the transverse abdominal (TrA), internal oblique (IO), low back multifidi, and deep neck flexors (DNF).MethodsFifty individuals had three muscular groups tested: TrA/IO, lower back multifidi, and DNF. For repeatability, one rater did three consecutive measures; for intra-rater reproducibility the same rater did two measures with seven-day intervals, and for inter-rater reproducibility, three raters, on the same day, did the measures. Data were analyzed with: Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC). (α = 0,05).ResultsRepeatability: TrA/IO (ICC = 0.847), Multifidi (ICC = 0.860), DNF (ICC = 0.831). Inter-rater reproducibility: TrA/IO (ICC = 0.876), Multifidi (ICC = 0.508), DNF (ICC = 0.442). Intra-rater reproducibility: TrA/IO (ICC = 0.747), Multifidi (ICC = 0.293), DNF (ICC = 0.685). Except for Multifidi, all the SEM values were less than 10 mmHg and the MDC values were less than 15 mmHg.ConclusionsThe PBU can be used with reliability by different evaluators, although the evaluation of multifidi is not indicated.     

The influence of Nigella sativa for asthma control: A meta-analysis

IntroductionThe efficacy of Nigella sativa supplementation for asthma control remains controversial. We conduct a systematic review and meta-analysis to explore the influence of Nigella sativa supplementation on asthma control.MethodsWe search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through June 2019 for randomized controlled trials (RCTs) assessing the efficacy of Nigella sativa supplementation for asthma control. This meta-analysis is performed using the random-effect model.ResultsFour RCTs are included in the meta-analysis. Overall, compared with control group for asthma, Nigella sativa supplementation is associated with increased ACT scores (Std. MD = 0.50; 95% CI = 0.11 to 0.88; P = 0.01), FEV1 (Std. MD = 1.84; 95% CI = 0.07 to 3.60; P = 0.04), but demonstrates no obvious impact on PEF (Std. MD = 3.11; 95% CI = −1.30 to 7.52; P = 0.17), IL-4 (Std. MD = −0.31; 95% CI = −1.21 to 0.59; P = 0.50), or IFN-γ (Std. MD = 1.11; 95% CI = -0.44 to 2.67; P = 0.16).ConclusionsNigella sativa supplementation may provide additional benefits for the treatment of asthma.     

National Trends in Hospice Facility Deaths in the United States, 2003–2017

ContextHospice facilities are increasingly preferred as a location of death, but little is known about the characteristics of patients who die in these facilities in the U.S.ObjectivesWe sought to examine the trends and factors associated with death in a hospice facility.MethodsRetrospective cross-sectional study using mortality data for years 2003–2017 for deaths attributed to natural causes in the U.S.ResultsThe proportion of natural deaths occurring in hospice facilities increased from 0.2% in 2003 to 8.3% in 2017, resulting in nearly 1.7 million deaths during this time frame. Females had increased odds of hospice facility deaths (odds ratio [OR] = 1.04; 95% CI = 1.04, 1.05). Nonwhite race was associated with lower odds of hospice facility death (black [OR = 0.915; 95% CI = 0.890, 0.940]; Native American [OR = 0.559; 95% CI = 0.515, 0.607]; and Asian [OR = 0.655; 95% CI = 0.601, 0.713]). Being married was associated with hospice facility death (OR = 1.06; 95% CI = 1.04, 1.07). Older age was associated with increased odds of hospice facility death (85 and older [OR = 1.40; 95% CI = 1.39, 1.41]). Having at least some college education was associated with increased odds of hospice facility death (OR = 1.13; 95% CI = 1.11, 1.15). Decedents from cardiovascular disease had the lowest odds of hospice facility death (OR = 0.278; 95% CI = 0.274, 0.282).ConclusionHospice facility deaths increased among all patient groups; however, striking differences exist by age, sex, race, marital status, education level, cause of death, and geography. Factors underlying these disparities should be examined.     

Interrater reliability in pupillary assessment among intensive care nurses

BackgroundPupillary abnormalities are a common and reliable finding of brain herniation, ischaemia, and acute brain injury in critically ill patients. Reliable pupil assessment is a vital evaluation in diagnostic and therapeutic procedures for neurocritical patients.AimTo evaluate inter-rater reliability of pupillary assessment among intensive care.MethodsIn this prospective, blind observational study, intensive care nurses and two researchers evaluated the pupil size, reactivity and symmetry of 200 patients with neurosurgery or neurological diseases. A total of 200 pupillary measurement sets were completed independently and blindly.ResultsThree observers –two researchers and the nurse– found fair-to-good and excellent agreements in initial pupil size evaluations of right and left pupils, respectively (ICC = 0.70, 95%; ICC = 0.75, 95%). In patients with pupil size ≥4 mm, the observers found fair-to-good agreements in both right and left pupil initial size measurements (ICC = 0.52; ICC = 0.65). Agreement in pupil symmetry was moderated (K = 0.58), and reactivity was near perfect (K = 0.89) between the three observers.ConclusionAlthough the two researchers found near perfect agreement in pupil size, symmetry and reactivity assessment, two researchers and the nurse found moderate agreement in pupil symmetry and fair-to-good agreement in pre- and post-light stimulation pupil size.     

The efficacy of telemedical care for heart failure: A meta-analysis of randomized controlled trials

IntroductionThe efficacy of telemedical care for the treatment of heart failure remains controversial. We conduct a systematic review and meta-analysis to explore the impact of telemedical care on heart failure.MethodsWe search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2020 for randomized controlled trials (RCTs) assessing the effect of telemedical care on heart failure. This meta-analysis is performed using the random-effect model.ResultsFour RCTs involving 2516 patients are included in the meta-analysis. Overall, compared with control group for heart failure, telemedical care demonstrates no significant influence on cardiovascular death (OR = 0.74; 95% CI = 0.54 to 1.00; P = 0.05), mortality (OR = 0.86; 95% CI = 0.61 to 1.20; P = 0.38), hospital stay for heart failure (SMD = -1.57; 95% CI = -6.31 to 3.16; P = 0.52) or hospital stay for any readmission (SMD = -0.65; 95% CI = -8.98 to 7.68; P = 0.88), but can reduce the days lost due to death or heart failure readmissions (SMD = -6.50; 95% CI = -8.44 to −4.56; P < 0.00001).ConclusionsTelemedical care may provide no additional benefits for heart failure.