Development of a generic fidelity measure for rehabilitation intervention research for children with physical disabilities

Aim

To increase research rigour and create a plausible way to assess clinical effectiveness, it is necessary to measure the degree to which interventions are delivered as intended (fidelity). Generic fidelity measures enable evaluation of more than one intervention through observation of unique and general characteristics relevant across interventions. This study describes the first generic fidelity measure in paediatrics.

Method

Items were constructed from multiple sources to create a general attributes domain and two paediatric cerebral palsy (CP) intervention‐specific domains. After a pre‐testing procedure, raters were trained and videos of clinical interventions were rated to test the measure's psychometric properties.

Results

The Paediatric Rehabilitation Observational measure of Fidelity (PROF) consisted of 30 items. Six raters were trained on the PROF and rated 25 videos. Internal consistency (α) and interrater reliability (IRR) for the frequency scale showed the following results: context therapy: α=0.71, IRR=0.75; child therapy: α=0.85, IRR=0.87; and general attributes; α=0.78, IRR=0.82. Quality scale scores across domains demonstrated internal consistency greater than 0.80 and interrater reliability of less than 0.40. Pearson's correlations (r=?0.71, p<0.001) and analyses of variance (p=0.01) validated that each intervention domain was an independent construct.

Interpretation

The PROF is reliable and valid for evaluating interventions used for children with CP. Future studies may use the measure's framework, general attributes domain, and procedures to test the psychometric properties of other interventions.

     

A study of semantic treatment of three Chinese anomic patients

A treatment combining semantic feature analysis and semantic priming was carried out on three Cantonese-speaking brain-injured individuals with word-finding difficulties. Two of the participants with mild to moderate semantic impairment demonstrated significant progress on naming performance. Treatment effects also generalised to semantically related and unrelated untrained items. However, only one of these two participants was able to maintain the treatment gain for at least one month after the therapy was completed. The third patient with severe semantic deficits did not benefit from the intervention. The different outcomes of these participants to the same intervention were explained in terms of the nature of the treatment approach, the patients' underlying language deficits, and their level of cognitive abilities.     

Rapid carrier screening for beta-thalassemia by single-step allele-specific PCR and detection

OBJECTIVES: This study aimed to evaluate a rapid molecular carrier screening strategy for beta-thalassemia. DESIGN AND METHODS: Allele-specific PCR was combined with amplicon detection by dissociation curve analysis of SYBR Green I fluorescence in a single step. RESULTS: The presence of a particular mutation results in the amplification of a mutation-specific product and the dissociation temperature of each amplicon was highly reproducible. CONCLUSIONS: Homogeneous allele-specific PCR amplification and detection of multiple beta-globin mutations can serve as a rapid and inexpensive carrier screening tool.     

Patient- and Provider-Reported Information about Transplantation and Subsequent Waitlisting

Because informed consent requires discussion of alternative treatments, proper consent for dialysis should incorporate discussion about other renal replacement options including kidney transplantation (KT). Accordingly, dialysis providers are required to indicate KT provision of information (KTPI) on CMS Form-2728; however, provider-reported KTPI does not necessarily imply adequate provision of information. Furthermore, the effect of KTPI on pursuit of KT remains unclear. We compared provider-reported KTPI (Form-2728) with patient-reported KTPI (in-person survey of whether a nephrologist or dialysis staff had discussed KT) in a prospective ancillary study of 388 hemodialysis initiates. KTPI was reported by both patient and provider for 56.2% of participants, by provider only for 27.8%, by patient only for 8.3%, and by neither for 7.7%. Among participants with provider-reported KTPI, older age was associated with lack of patient-reported KTPI. Linkage with the Scientific Registry for Transplant Recipients showed that 20.9% of participants were subsequently listed for KT. Patient-reported KTPI was independently associated with a 2.95-fold (95% confidence interval [95% CI], 1.54 to 5.66; P=0.001) higher likelihood of KT listing, whereas provider-reported KTPI was not associated with listing (hazard ratio, 1.18; 95% CI, 0.60 to 2.32; P=0.62). Our findings suggest that patient perception of KTPI is more important for KT listing than provider-reported KTPI. Patient-reported and provider-reported KTPI should be collected for quality assessment in dialysis centers because factors associated with discordance between these metrics might inform interventions to improve this process.     

Male Breast Cancer: A Population-Based Comparison with Female Breast Cancer in Hong Kong,Southern China: 1997–2006

Background

Male breast cancer (MBC) is uncommon. As a result, there is limited availability of studies and reviews and even fewer reports from Asia. This is the largest population-based study to compare Chinese MBC patients with female patients during a 10-year period in Hong Kong, Southern China.

Methods

A retrospective review of medical records of 132 male and 8,118 female breast cancer patients between year 1997 and 2006 in Hong Kong was performed. Each MBC patient was matched with three female breast cancer patients for further analysis. Different characteristics, overall, breast-cancer specific, and disease-free survivals (DFS) were compared.

Results

Mean age at diagnosis of male and female patients was 64.5 and 52.7 years respectively. Male patients showed lower histological grade, overall stage, smaller tumor size, and more positive sensitivity in hormone receptors. They were more likely to die of causes other than breast cancer. Matched analysis found that the 5-year overall survival (OS), breast-cancer–specific mortality, and DFS for male and female patients were 78.7, 90.5, 90.5, and 77.9, 86.4, and 81.4 % respectively. Male patients had poorer OS at early overall stage but better breast-cancer—specific mortality rates at any age (p < 0.01). Male patients had a significant risk of dying due to any cause in the presence of distant relapse and had less risk of dying when tumor was ER-positive and HER2-positive.

Conclusions

Chinese male breast cancer patients tend to have poorer OS but better breast-cancer—specific survival compared with their female counterparts.     

Development and validation of an imaging and clinical scoring system to predict early mortality in spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization

Abdominal Radiology - To develop and validate a scoring system using a combination of imaging and clinical parameters to predict 30-day mortality in ruptured HCC (rHCC) patients after transarterial...