Development of a Valid Simplified Chinese Version of the Oxford Hip Score in Patients With Hip Osteoarthritis

Background

Although the Oxford Hip Score has been translated and validated in several languages, there is currently no Chinese version of the outcomes measurement. Our study aims to crossculturally adapt and validate the Oxford Hip Score into a simplified Chinese version.

Questions/purposes

We tested the (1) reliability; (2) validity; and (3) responsiveness of the Chinese version of the Oxford Hip Score.

Methods

First we translated the Oxford Hip Score into simplified Chinese, then back into English, then held a consensus meeting to achieve the final simplified Chinese version. Then we evaluated the psychometric properties of Chinese version of the Oxford Hip Score in patients undergoing total hip arthroplasty (THA). All patients undergoing THA between July and December 2012 were invited to participate in this study; a total of 108 (79% of 136 invited) did so. To assess the test-retest validity, all participants completed the Chinese version of the Oxford Hip Score again with a 2-week interval. Pearson correlation coefficient was used to evaluate the construct validity between the Chinese version of the Oxford Hip Score and visual analog scale (VAS), Harris hip score, and eight individual domains of the SF-36. Responsiveness was demonstrated by comparing the pre- and postoperative scores of the Chinese version of the Oxford Hip Score.

Results

The test-retest reliability with intraclass correlation coefficient (0.937) and internal consistency with Cronbach’s alpha (0.91) were excellent. The Chinese version of the Oxford Hip Score correlated with the Harris hip score (0.89, p < 0.01), VAS (−0.79, p < 0.01), and Physical Functioning (0.79, p < 0.01) and Bodily Pain (0.70, p < 0.01) domains of SF-36, which suggested construct validity. No floor or ceiling effects were found. The effect size and standardized response mean values were 3.52 and 3.31, respectively, indicating good responsiveness.

Conclusions

The Chinese version of the Oxford Hip Score showed good reliability, validity, and responsiveness in evaluating standard Chinese-speaking patients with hip osteoarthritis undergoing THA. It can be used by clinical surgeons as a complement to the traditional outcome measures.     

Internists’ Attitudes About Assessing and Maintaining Clinical Competence

BACKGROUND

Important changes are occurring in how the medical profession approaches assessing and maintaining competence. Physician support for such changes will be essential for their success.

OBJECTIVE

To describe physician attitudes towards assessing and maintaining competence.

DESIGN

Cross-sectional internet survey.

PARTICIPANTS

Random sample of 1,000 American College of Physicians members who were eligible to participate in the American Board of Internal Medicine Maintenance of Certification program.

MAIN MEASURES

Questions assessed physicians’ attitudes and experiences regarding: 1) self-regulation, 2) feedback on knowledge and clinical care, 3) demonstrating knowledge and clinical competence, 4) frequency of use and effectiveness of methods to assess or improve clinical care, and 5) transparency.

KEY RESULTS

Surveys were completed by 446 of 943 eligible respondents (47 %). Eighty percent reported it was important (somewhat/very) to receive feedback on their knowledge, and 94 % considered it important (somewhat/very) to get feedback on their quality of care. However, only 24 % reported that they receive useful feedback on their knowledge most/all of the time, and 27 % reported receiving useful feedback on their clinical care most/all of the time. Seventy-five percent agreed that participating in programs to assess their knowledge is important to staying up-to-date, yet only 52 % reported participating in such programs within the last 3 years. The majority (58 %) believed physicians should be required to demonstrate their knowledge via a secure examination every 9–10 years. Support was low for Specialty Certification Boards making information about physician competence publically available, with respondents expressing concern about patients misinterpreting information about their Board Certification activities.

CONCLUSIONS

A gap exists between physicians’ interest in feedback on their competence and existing programs’ ability to provide such feedback. Educating physicians about the importance of regularly assessing their knowledge and quality of care, coupled with enhanced systems to provide such feedback, is needed to close this gap.     

Outcomes of emergency surgery for acute abdomen in dialysis patients: experience of a single community hospital

Purpose

Long-term dialysis often causes physiological and metabolic problems that may affect the outcomes of surgery. The aim of this study was to elucidate whether emergency surgery for acute abdomen yields similar outcomes in dialysis patients versus non-dialysis patients.

Methods

The subjects were 126 patients who underwent emergency surgery for acute abdomen between January, 2007 and November, 2011 in our hospital. They were divided into a dialysis group (HD group; n = 9) and a non-dialysis group (non-HD group; n = 117) and their postoperative morbidity and mortality were compared.

Results

Postoperative morbidity and mortality were significantly worse in the HD group. All 9 of these patients succumbed to postoperative complications versus only 5 of the 117 patients in the non-HD group.

Conclusion

The outcomes of emergency surgery for acute abdomen were significantly worse for dialysis patients than for non-dialysis patients. Prompt diagnosis, initiation of the most suitable surgical procedure, and meticulous postoperative cares are imperative to improving the surgical outcomes of dialysis patients.