Psychometric evaluation of the Perceived Barriers to Health Care-seeking Decision in Chinese patients with acute coronary syndromes

Objectives

This study aimed to develop the Chinese version of the Perceived Barriers to Health Care-seeking Decision (PBHSD-C) and evaluate its psychometric properties in Chinese patients with acute coronary syndromes (ACS).

Background

The assessment of the level of perceived barriers in the care-seeking trajectory of ACS patients is important for the understanding of its impact on pre-hospital delay in seeking care.

Methods

The psychometric properties of PBHSD-C were evaluated among 114 ACS patients in the cardiac unit of two major hospitals in Hong Kong.

Results

The Content Validity Indexes were ranged from .88 to 1. The Cronbach's alpha of the PBHSD-C was .74. The intraclass correlation coefficients of all items were above .80. The convergent validity of the PBHSD-C was also supported.

Conclusion

The PBHSD-C is reliable and valid to be used to assess the level of perceived barriers in the care-seeking of Chinese patients with ACS.     

The vulnerable plaque: Current concepts and future perspectives on coronary morphology,composition and wall stress imaging

Cardiovascular imaging plays an important role in the identification and characterization of the vulnerable plaque. A major goal is the ability to identify individuals at risk of plaque rupture and developing an acute coronary syndrome. Early recognition of rupture‐prone atherosclerotic plaques may lead to the development of pharmacologic and interventional strategies to reduce acute coronary events.We review state‐of‐the‐art cardiovascular imaging for identification of the vulnerable plaque. There is ample evidence of a close relationship between plaque morphology and patient outcome, but molecular imaging can add significant information on tissue characterization, inflammation and subclinical thrombosis. Additionally, identifying arterial wall exposed to high shear stress may further identify rupture‐prone arterial segments. These new modalities may help reduce the individual, social and economic burden of cardiovascular disease.     

The panoply of field-dependent behavior in 1436 stroke patients. The mirror neuron system uncoupled and the consequences of loss of personal autonomy

Evaluation of the multifaceted nature of frontal network syndromes is uniquely challenging and rarely tested in the acute/sub-acute stroke period. Field-dependent behavior such as imitation behavior, utilization behavior, and environmental dependency syndrome, as a component of altered environmental autonomy, may be a reliable bedside test. This research focused on the frequency of field-dependent behavior in stroke, the subtypes and relation to frontal lobe lesion location and stroke etiology. A validated frontal network score incorporating a 10-point imitation behavior scale was applied to alert patients without significant aphasia, encephalopathy, dementia, or substance abuse. Discriminative validity assessment with magnetic resonance imaging, diffusion weight imaging (MRI-DWI brain) was performed and correlational validity was established using standard neuropsychological tests. Of the stroke patients (n = 1436), those with frontal network symptoms (335/1203; 28%) were analyzed further. In the 73 patients with lesions restricted to the frontal lobes or the frontal subcortical circuits, 56 complied with the 10-point imitation behavior scale testing. Forty-five of 56 (80%) demonstrated imitation behavior (sensitivity 73% and specificity 94%). Correlational validity testing with four commonly used frontal lobe neuropsychological tests was good. The stroke etiology included 26 (59%) “other” causes, 9 (20%) intracerebral hemorrhages, 3 (7%) cardioembolic causes, 3 (7%) large vessel disease, 2 (4%) small vessel disease, and 2 (4%) unknown etiology. Field-dependent behaviour subtypes included imitation behavior (n = 45), utilization behavior (n = 9), environmental dependency syndrome (n = 4), and complex other forms of environmental dependence syndrome (n = 5). It was concluded that imitation behavior is a relatively common occurrence with lesions in the frontal lobes in the acute/sub-acute stroke period and is associated predominantly with non-mainstream (other) stroke causes and intracerebral hemorrhage.     

Different therapeutic mechanisms of rigid and semi-rigid mandibular repositioning devices in obstructive sleep apnea syndrome

To clarify the mechanisms of rigid and semi-rigid mandibular repositioning devices (MRDs) in obstructive sleep apnea syndrome (OSAS), seven and 13 patients received rigid and semi-rigid MRDs, respectively. Each patient underwent polysomnographic and computed tomographic examinations at the initial consultation and after symptom improvement. Three-dimensional models of the upper airway (hard palate level to epiglottic base) were reconstructed by image processing software (Mimics version 14.2) to measure airway morphology. The mean age and body mass index were 58.1 years and 24.8 kg/m², respectively, in the rigid MRD group and 57.9 years and 23.2 kg/m², respectively, in the semi-rigid MRD group. The apnea-hypopnea index significantly improved (P < 0.05, Wilcoxon signed-rank test) from 22.0 to 8.9 and 20.5 to 11.5 events per hour of sleep in the respective groups. The cross-sectional areas measured at the epiglottic tip (from 2.0 to 2.6 cm²) and hard palate (from 2.6 to 3.3 cm²) levels also increased in the respective groups (P < 0.05). However, airway volume, cross-sectional area measured at the uvular tip level, and anteroposterior and transverse diameters of the airway were not significantly different. In conclusion, both types of MRDs improve respiratory status, but they affect different parts of the airway.     

Scoring system for poor limb perfusion after limb fracture in children

BACKGROUNDAssessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome, which is an emergency condition.AIMTo establish a simple and efficient grading scale of limb perfusion in children undergoing surgery for limb fracture.METHODSThis retrospective study included pediatric patients with a limb fracture and postoperative plaster fixation who were admitted at The Department of Pediatric Orthopedics of Xinhua Hospital between February 2017 and August 2017. The outcome was poor limb perfusion, which is defined as the postoperative use of mannitol. The children were divided into two groups: The normal perfusion group and the poor perfusion group. Key risk factors have been selected by univariable analyses to establish the Grading Scale for Vascular Status.RESULTSA total of 161 patients were included in the study: 85 in the normal perfusion group and 76 in the poor perfusion group. There were no significant differences in age, sex, body mass index, ethnicity, cause of fracture, fixation, or site of fracture between the two groups. After surgery, the skin temperature (P = 0.048) and skin color (P < 0.001) of the affected limb were significantly different between the two groups. The relative risk and 95% confidence interval for skin temperature of the affected limb, skin color, and range of motion of the affected limb are 2.18 (1.84-2.59), 2.89 (2.28-3.66), and 2.16 (1.83-2.56), respectively. The grading scale was established based on those three factors (score range: 0-3 points). Forty-one patients (32.5%) with score 0 had poor limb perfusion; all patients with scores 1 (n = 32) and 2 (n = 3) had poor limb perfusion (both 100%).CONCLUSIONIn children undergoing surgery for limb fracture, a higher Grading Scale for Vascular Status score is associated with a higher occurrence of poor limb perfusion. A prospective study is required for validation.     

Lymphoproliferative disorders in Sotos syndrome: Observation of two cases

Sotos syndrome is included among the overgrowth disorders, most of which have an increased risk of neoplasms. Sotos syndrome does not appear to be related to a specific tumor type, but rather to the development of solid tumors of ectodermal or mesodermal origin in general. We report on two Sotos syndrome patients who developed a non-Hodgkin lymphoma and an acute lymphoblastic leukaemia, respectively. Our experience suggests that there may exist a high frequency of lymphoproliferative disorders in Sotos syndrome, and points out the importance of a long-term follow-up of Sotos syndrome patients, to detect a possible neoplastic evolution. © 1996 Wiley-Liss, Inc.     

Immunodeficiency as a component of recognizable syndromes

Immunodeficiency occurs in numerous genetic syndromes. While it is the dominant manifestation in primary immunodeficiencies, immune deficits may also be seen in a variety of other recognizable syndromes. Immunodeficiency has been reported in 64 such conditions, adding to the 45 recognized primary immunodeficiencies. These uncommon syndromes with immune defects can present with: (a) growth deficiency (11 syndromes with disproportionate or proportionate short stature), (b) specific organ system dysfunction (18 with gastrointestinal, dermatologic, or neurologic abnormalities), (c) inborn errors of metabolism (13), (d) miscellaneous anomalies (10), or (e) chromosome anomalies (12). In most of the disorders, only some of the affected patients have immune defects. However, in 27 syndromes, immunodeficiency is a constant finding. We briefly review the clinical manifestations of each syndrome and delineate the specific associated immune defects. In most syndromes, the connection between the immune and other defects is unknown. Recognition of these conditions involving both the immune and other organ systems may facilitate accurate diagnosis and management as well as yield information regarding genes critical for the development of the involved systems. © 1996 Wiley-Liss, Inc.