Development and validation of a short form of the valued life activities disability questionnaire for rheumatoid arthritis

Objective

To develop and validate a shortened version of the Valued Life Activities disability and accommodations scale (VLA) for individuals with rheumatoid arthritis (RA).

Methods

To shorten the existing VLA measure, item response theory analyses were conducted using data from 449 patients with RA. Next, the resulting 14‐item shortened version of the VLA scale (S‐VLA) was evaluated by structured interviews among 20 RA patients. Lastly, the S‐VLA was administered to 150 RA patients along with other measures, including the Health Assessment Questionnaire (HAQ) and Short Form 36 (SF‐36). A random sample of 50 patients completed the S‐VLA 2 weeks later to assess reliability. Item statistics were calculated to evaluate correlations between individual items and the S‐VLA total score. Correlations between the S‐VLA and other measures were used to evaluate validity.

Results

Test–retest reliability was 0.91, while Cronbach's alpha for the S‐VLA was 0.95. None of the 14 items was associated with improved alpha coefficients when omitted. All of the items were strongly correlated with the S‐VLA total score. S‐VLA scores were highly positively correlated with the HAQ (r = 0.81, P ≤ 0.001), patient‐reported disease activity (r = 0.71, P ≤ 0.001), satisfaction with abilities (r = 0.82, P ≤ 0.001), and number of days with activity limitations (r = 0.65, P ≤ 0.001). In addition, as hypothesized, the S‐VLA was inversely correlated with the SF‐36 physical component summary score (r = ?0.78, P ≤ 0.001) and the physical functioning (r = ?0.80, P ≤ 0.001), role physical (r = ?0.67, P ≤ 0.001), and social functioning (r = ?0.72, P ≤ 0.001) subscales.

Conclusion

The S‐VLA is a short, valid, and reliable instrument that may prove useful for monitoring disability among individuals with RA.

     

Reliability of a questionnaire for pharmacological treatment appropriateness in patients with multiple chronic conditions

BackgroundThe original Medication Appropriateness Index was validated for elderly and polymedicated patients, both in hospital and outpatient contexts. However, no studies have applied this questionnaire in patients with multiple chronic conditions. The objective of this study is to assess the reliability of a modified Medication Appropriateness Index questionnaire in a population of patients with multiple chronic conditions.MethodsWe selected patients with multiple chronic conditions who were included in an integrated care project conducted at the Hospital Universitario Virgen del Rocío. To determine inter-observer reliability, each professional (internist or hospital pharmacy specialist) applied the questionnaire under the same conditions and with the same resources. To determine intra-observer reliability, each physician applied the tool at baseline and two months later. We measured inter- and intra-observer reliability using the kappa coefficient. The proportion of overall agreement was also determined.ResultsWe obtained a weak overall kappa (k = 0.38) for inter-observer reliability and moderate (k = 0.52) and very good (k = 0.84) values for intra-observer reliability of the internist and specialist in hospital pharmacy, respectively. The proportion of overall agreement is very high in all three situations: 96%, 98%, and 99%, respectively.ConclusionsDespite its limitations, the Medication Appropriateness Index questionnaire modified by our group can be used, as a reliable method, to assess the appropriateness of pharmacotherapy in patients with multiple chronic conditions.     

简短炎症性肠病生活质量问卷的信效度评价

背景简短炎症性肠病问卷(the short inflammatory bowel disease questionnaire,SIBDQ)广泛用于评估炎症性肠病(inflammatory bowel disease,IBD)患者的健康相关生活质量.目的引进SIBDQ量表并评估其信效度.方法根据Brislin模型的翻译-回译流程得到中文版SIBDQ(SIBDQ-C).对2020-06/2021-06就诊于广州中医药大学第一附属医院、中山大学第一附属医院IBD患者进行测评;使用克朗巴赫系数、分半信度和重测信度检验量表的信度,使用验证性因子分析评价其结构效度.结果共发放问卷113份,最终回收112份.SIBDQ-C的Cronbach’sα为0.90,折半系数为0.86;量表四个维度间的Spearman相关系数在0.61到0.77之间;验证性因子分析的近似误差方根、非范拟合指数、比较拟合指数、拟合优度指数分别为0.08、0.93、0.97、0.92;不同粪便形态患者的SIBDQ-C总分及各维度得分均有统计学差异(P<0.05).结论SIBDQ-C具有良好的信度及效度,可以用于临床测量我国IBD患者的生活质量.     

Development of a new predictive model for polypathological patients. The PROFUND index

Background

There is a concern about the accuracy of the available prognostic indexes when applying them to the emergent population of polypathological patients (PP).

Methods

To develop a 1-year mortality predictive index on PP, we developed a multicenter prospective cohort-study recruiting 1.632 PP after hospital discharge, outpatient clinics, or home hospitalization, from 33 hospitals. Potential risk factors were obtained in the 1.525 PP who completed follow-up. Each factor independently associated with mortality in the derivation cohort (757 PP from western hospitals) was assigned a weight, and risk scores were calculated by adding the points of each factor. Accuracy was assessed in the validation cohort (768 PP from eastern hospitals) by risk quartiles calibration, and discrimination power, by ROC curves. Finally, accuracy of the index was compared with that of the Charlson index.

Results

Mortality in the derivation/validation cohorts was 35%/39.5%, respectively. Nine independent mortality predictors were identified to create the index (age ≥ 85 years, 3points; No caregiver or caregiver other than spouse, 2points; active neoplasia, 6points; dementia, 3points; III-IV functional class on NYHA and/or MRC, 3points; delirium during last hospital admission, 3points; hemoglobinemia < 10 g/dl, 3points; Barthel index < 60 points, 4points; ≥ 4 hospital admissions in last 12 months, 3points). Mortality in the derivation/validation cohorts was 12.1%/14.6% for patients with 0-2points; 21.5%/31.5% for those with 3-6 points; 45%/50% for those with 7-10 points; and 68%/61.3% for those with ≥ 11points, respectively. Calibration was good in derivation/validation cohorts, and discrimination power by area under the curve was 0.77/0.7. Calibration of the Charlson index was good, but discrimination power was suboptimal (area under the curve, 0.59).

Conclusions

This prognostic index provides an accurate and transportable method of stratifying 1-year death risk in PP.     

Perceived quality of healthcare in a multicenter, community-based population of polypathological patients

The objective was to determine perceived quality of care (PQC) in patients with multiple chronic conditions, whose care is structured in Andalusia (Spain) under polypathological patients (PP) care process, and identifying aspects for its improvement. The study was a community-based cross-sectional survey carried out in 4 primary care centers (which attended a total of 62,702 adults, of them, 662 were actively identified as PP). Finally, 461 PP and their caregivers were interviewed (69% of eligible population) including assessment of PQC following SERVQUAL model, clinical and demographical data. On a five-point Likert scale (from 1, ‘much worse than expected’; to 5, ‘much better’), PQC rated 3.68 ± 0.59 (±S.D.). Independent PQC predictors were: empathy for family physician, identifying nurses, presence of peripheral artery disease or diabetes mellitus with vascular complications, and not having functional limitations. In this population-based survey, PP attended at primary care have an acceptable PQC. Measures aimed to lessening functional deterioration, supporting dependent patients, and improving relationship between PP and their healthcare professionals could increase PQC.     

Outcomes of critically ill cancer patients in a university hospital setting

Critically ill cancer patients constitute a large percentage of admissions to tertiary care medical intensive care units (ICUs). We sought to describe outcomes of such patients, and to evaluate how conditions commonly seen in these patients impact mortality. A total of 348 consecutive medical ICU cancer patients were evaluated. Subgroup comparisons included the three most common cancer types (leukemia, lymphoma, lung cancer), as well as three different treatments/conditions (bone marrow transplant [BMT] versus non-BMT, mechanical ventilation [MV] versus non-MV, neutropenic versus non-neutropenic). There were no mortality differences between patients with leukemia, lymphoma, or lung cancer. By logistic regression, mortality predictors were: MV, hepatic failure, and cardiovascular failure for the group as a whole (41% overall mortality); MV and allogeneic (as compared with autologous) BMT for the BMT group (39% overall mortality); hepatic failure, cardiovascular failure, and persistent acute respiratory distress syndrome (ARDS) for the MV group (67% overall mortality); and MV for the neutropenic group (53% overall mortality). Neutropenia showed no independent association with mortality in the group as a whole or any subgroup analyzed. We conclude that respiratory, hepatic, and cardiovascular failure predict mortality, whereas neutropenia does not. Additionally, we have noted an encouraging improvement in survival in many groups of critically ill cancer patients.     

Identifying a short functional disability screen for older persons

BACKGROUND: Disability in instrumental activities of daily living (IADLs) or activities of daily living (ADLs) is an indicator of health risk. The inclusion of these items in population screens may be limited by variation in item performance across gender and age groups. Further, identification of shortened lists may encourage inclusion of these items in screens. METHODS: We applied item response theory (IRT) methods to assess the responses of 9865 community-dwelling elders in the 1993 Medicare Current Beneficiary Survey to 11 IADL/ADL items. Items were classified as "receive help/not receive help" for the overall population and stratified by age and gender. We assessed the same IADL/ADL items using responses classified as "difficulty/no difficulty." After eliminating items that performed poorly, we performed all-subsets analyses to identify abbreviated sets of items that would select the highest proportion of persons with IADL/ADL disability. RESULTS: Responses classified in receive help format showed consistency by gender and age group. Changing the response classification to difficulty/no difficulty influenced the reported order and relationship of IADL/ADL items. Receipt of help for any one of five items--shopping, doing light housework, walking, bathing, or managing finances--identified 93% of individuals receiving help with any IADL/ADL. A slightly different set of five items--walking, shopping, transferring, doing light housework, or bathing--identified 91% of persons reporting difficulty with any IADL or ADL. CONCLUSIONS: The relationship of IADL and ADL items to the underlying construct of disability was similar for men and women. The relationship was also similar for oldest-old and younger-old individuals. This study also identified abbreviated lists of disability items that can be used to efficiently screen community-dwelling elders for the presence of IADL/ADL disability.     

Validation of a short food frequency questionnaire to evaluate nutritional lifestyles in hypercholesterolemic patients

ObjectivesThe purpose of our study was to develop and validate a short food frequency questionnaire which could assess the nutritional lifestyles of hypercholesterolemic patients consulting in daily practice.Material and methodsThe questionnaire explores 11 nutrient categories. Hundred and thirty-one patients were recruited for the construct validity and 58 patients for the external validity in La Pitié Hospital, Paris. The reference method used was the diet history. To measure the internal consistency and to test the sensibility to change on a large scale, the questionnaire was used in an observational study conducted in Spain in 1048 moderate hypercholesterolemic patients. Psychometric analyses included construct validity, internal consistency, test-retest reliability, external validity and sensibility to change.ResultsValidation of the questionnaire indicated a good internal consistency (Cronbach Coefficient Alpha at 0.69) and test-retest reliability (intraclass correlation coefficient = 0.89). The correlation between the scores of the FFQ and those of the diet history was significant with a Pearson correlation coefficient at 0.3 (P = 0.029). The comparison between the ranking of the patients showed an agreement of 72% with a kappa of 0.48 [0.10; 0.69]. The sensibility to change was good with a score evolution improving one and four months after nutrition advices: 28.2% of patients ranked in group 1 at inclusion versus 61.3% (P < 0.0001) at one month and 75.2% (P < 0.0001) at four months.ConclusionIn conclusion, we developed and validated a food questionnaire for hypercholesterolemic patients, which can be used as a therapeutic education tool in daily practice or in clinical research.     

Impact of spiral computed tomography on the diagnosis of pulmonary embolism in a community hospital setting

BACKGROUND: While the optimal role of spiral CT angiography (CTA) in the diagnosis of pulmonary embolism (PE) remains controversial, this technology is already being widely utilized in the community setting. OBJECTIVES: To assess the impact CTA has had on angiography utilization rates and the overall diagnostic rate of PE. METHODS: All patients evaluated for PE during a 4-year period were studied. PE was defined as either a high-probability V/Q scan, a positive conventional angiogram, or a CTA with emboli in the segmental or larger pulmonary vessels. Diagnostic rates of PE per 1,000 hospital admissions were determined and analyzed for time periods before and after the introduction of CTA. CT reports were compared with their concurrent chest radiograph (CXR) reports and additional findings that were not apparent on CXR were abstracted. RESULTS: The diagnostic rate of PE per 1,000 hospital admissions was 1.8 prior to the introduction of CTA and increased to 2.8 per 1,000 admissions after the introduction of CTA (p < 0.0001). Total costs for diagnostic testing per PE diagnosis made went from US 2,518 dollars to US 2,572 dollars. While the number of PE diagnosed by V/Q scan remained constant, the number of PE diagnosed by conventional angiography decreased while the number diagnosed by CTA increased. In patients with intermediate probability V/Q scan results, the percentage of patients receiving subsequent angiography (conventional or CTA) increased from 17 to 26% (p = 0.043). When conventional angiography was performed, CT imaging of the chest still had to be ordered for other reasons 38% of the time. Additional information was obtained in 78% of cases when CTA was performed. CONCLUSIONS: Increased utilization of CTA was associated with an increase in angiography utilization rates and diagnostic rates of PE, was cost effective, and often provided additional, useful, and unanticipated diagnostic information.     

Rasch analysis of the Dutch health assessment questionnaire disability index and the health assessment questionnaire II in patients with rheumatoid arthritis

Objective

The Health Assessment Questionnaire (HAQ) disability index (DI) is the most common self‐reported measure of physical disability in rheumatoid arthritis (RA). Recently, the HAQ‐II was developed in the US as a short, valid, and reliable alternative using Rasch analysis. Our objective was to compare the scaling properties of the HAQ DI and HAQ‐II in Dutch patients with RA.

Methods

We used data from 472 patients with confirmed RA. Internal construct validity of the HAQ versions was assessed using Rasch analysis. Additionally, external construct validity was assessed by examining correlates with other outcome measures.

Results

The HAQ DI had a large floor effect, with 9.5% of the patients indicating no disability compared with 4.3% for the HAQ‐II. Both versions were unidimensional and adequately fit the Rasch model, containing only 1 nonfitting item. Additionally, 2 HAQ‐II items demonstrated overfit and a high residual correlation, suggesting overlap or redundancy in item content. The HAQ‐II demonstrated better item separation, indicating that it covered a wider range of physical function. Item difficulty estimates were reasonably well spread for the HAQ‐II, whereas the HAQ DI items tended to cluster around similar difficulty levels. Both scales contained several items with differential item functioning by sex, age, or disease duration. Both scales demonstrated the expected pattern of correlations with other outcome measures.

Conclusion

The results indicate that both the HAQ DI and HAQ‐II are psychometrically robust measures of physical function. The Rasch‐developed HAQ‐II, however, has several favorable scaling properties, including a better scale length and a reduced floor effect.     

Risk factors for delirium tremens in patients with alcohol withdrawal syndrome in a hospital setting

BackgroundThe clinical expressions of alcohol withdrawal syndrome (AWS) may vary and the factors determining these variations are not well-known. It would be useful to have a set of clinical tools capable of predicting which patients are likely to develop the more severe forms of the syndrome.AimTo analyse the clinical variables associated with the development of delirium tremens (DTs) in patients who were admitted to a general hospital with AWS.MethodsCohort study of AWS patients admitted to the Xeral Hospital in Lugo, Spain, between 1987 and 2003. The characteristics of patients with the syndrome who did not develop delirium tremens were contrasted with those who did. Cases presenting with DTs at diagnosis were excluded. The different clinical, epidemiological and biochemical variables reflective of alcohol consumption habits, basal health status and presentation features of syndrome were all recorded.ResultsData from 156 episodes of AWS that coursed without DTs were compared with 147 cases that coursed with it. Three independent variables for development of DTs were identified in a multivariate logistic regression model: number of seizures [1 or 2: OR 2.2 (CI 95% 1.2–3.8), p = 0.005; 3 or more: OR 2.6 (CI 95% 1.04–6.8), p = 0.04]; systolic blood pressure > 150 mm Hg [OR 1.9 (CI 95% 1.1–3.8), p = 0.03] and axillary temperature > 38 °C [OR 1.9 (CI 95% 1.05–3.5), p = 0.01]. ROC analysis revealed an area under the curve of 0.679.ConclusionThree clinical findings (seizures, blood pressure and temperature) can aid in identifying patients with AWS who are likely to develop DTs. The model's predictive capacity is not high.     

A new instrument for patients’ ratings of physician performance in the hospital setting

A new instrument to elicit patients' appraisals of physician performance has been developed from a previously-derived taxonomy of desired physician attitudes and behavior. The instrument allows patients to give ratings for their physicians' discrete, observable items of behavior, and also for complex, multidimensional attributes. When the instrument was administered to 131 randomly chosen medical inpatients, the results showed that technical competence and interpersonal (or humanistic) qualities were equally valued, and that physicians received high ratings for most features of performance. Except for less satisfaction in younger patients, clinical and demographic characteristics had little impact on the ratings. The performance characteristics of the instrument appear satisfactory, and its potential applications and proposals for further research are discussed.     

Evaluation of functional disability using the health assessment questionnaire in Japanese patients with systemic sclerosis

OBJECTIVE: To assess whether the functional disability in Japanese patients with systemic sclerosis (SSc) can be adequately evaluated by the Health Assessment Questionnaire (HAQ) developed in the United States. METHODS: The HAQ was completed by 121 Japanese patients with SSc, in whom SSc-specific physical examinations and laboratory tests were performed at the same time. Clinical findings associated with the disability index (DI) and individual components of the HAQ were examined using Student's t tests and Pearson's correlation tests. Logistic regression analysis was used to identify clinical findings that independently contributed to the increase in the HAQ-DI score. RESULTS: Japanese patients with SSc had significant functional disability, especially in the categories of eating and gripping, but the degree of disability was much less than was reported in previous studies carried out in the US. The increase in the HAQ-DI score was strongly correlated with increased total skin score, reduced oral aperture, reduced hand extension, increased finger flexion, subcutaneous calcinosis, flexion contractures, increased erythrocyte sedimentation rates, decreased percent vital capacity, and vascular involvement (p < 0.001 for all correlations). Multivariate logistic regression analysis showed that hand extension was the most important and an independent correlate of the HAQ-DI. CONCLUSION: Our multicenter, cross-sectional study has demonstrated that the self-administered HAQ is a valuable assessment tool of functional disability in Japanese SSc patients, who have social customs different from Americans, but functional disability measured by the HAQ is potentially influenced by ethnic variability.     

Comparing the Berlin and the ARES questionnaire to identify patients with obstructive sleep apnea in a dental setting

Purpose  

The aim of this study was to compare the sensitivity and specificity of two questionnaires to identify patients with obstructive sleep apnea (OSA).     

A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.

Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.