The value of remembered pre-operative quick disabilities of the arm,shoulder and hand (QuickDASH) scores

Abstract

It would be useful if it were possible for the patients to recreate their pre-operative QuickDASH scores in audits where this score had not been recorded before surgery. We assessed the accuracy of remembered pre-operative QuickDASH scores among 229 consecutive patients and the value of a previously developed algorithm for correcting these scores. Real pre-operative scores and remembered pre-operative scores were compared after a mean of 21?months. Furthermore, the scores of a subgroup of 79 patients with carpal tunnel syndrome, subacromial impingement, thumb basal joint arthrosis or Dupuytren’s contracture were corrected using an algorithm. The mean difference between remembered and real pre-operative scores for all patients showed heteroscedacity in the Bland–Altman plot. The scores of the 79 sub-analysis patients were homoscedastic. The mean difference between remembered and real pre-operative scores was 9 (SD 16, SEM 1.85). Correcting the scores of the sub-group patients using our algorithm decreased the variation only moderately. The remembered pre-operative score is too inaccurate to be useful in individual patients, also when using our algorithm. However, subtracting nine from the mean remembered pre-operative score in a group of patients with any of the above diagnoses gives the real pre-operative score within the 95% confidence interval of four above and four below the real score.     

Comparison of dietary fat and fatty acid intake estimated by the duplicate diet collection technique and estimated dietary records

Introduction A high saturated fatty acid intake is a well recognized risk factor for coronary heart disease development. More recently a high intake of n‐6 polyunsaturated fatty acids (PUFA) in combination with a low intake of the long chain n‐3 PUFA, eicosapentaenoic acid and docosahexaenoic acid has also been implicated as an important risk factor. Aim To compare total dietary fat and fatty acid intake measured by chemical analysis of duplicate diets with nutritional database analysis of estimated dietary records, collected over the same 3‐day study period. Methods Total fat was analysed using soxhlet extraction and subsequently the individual fatty acid content of the diet was determined by gas chromatography. Estimated dietary records were analysed using a nutrient database which was supplemented with a selection of dishes commonly consumed by study participants. Results Bland & Altman statistical analysis demonstrated a lack of agreement between the two dietary assessment techniques for determining dietary fat and fatty acid intake. Conclusion The lack of agreement observed between dietary evaluation techniques may be attributed to inadequacies in either or both assessment techniques. This study highlights the difficulties that may be encountered when attempting to accurately evaluate dietary fat intake among the population.     

Breast carcinoma in the elderly patient: an assessment of operative risk, morbidity and mortality

Of 711 patients with histologically proven carcinoma of the breast, 94 patients aged 65 years or older were treated primarily by operation. The long-term survival was comparable to that in the general population with breast cancer despite a high percentage of noncancer death from intercurrent disease. Surgical therapy appropriate for the stage of disease can be performed with acceptable morbidity and mortality. Elderly patients often present with advanced disease but should not be denied the benefits of surgical palliation strictly on the basis of age.     

Comparison of Measurements by Multiple Methods or Instruments

Much work has been done on comparison of one device with another, but the problem of comparing three or more devices is less well known. Most existing work has concentrated on the possibilities of a constant relative bias between the devices, or of different linear relationships with the underlying true value. These two possibilities are placed within a hierarchy of models extending them to settings with multiplicative interaction terms. These additional terms can capture departures such as outliers, variance changing with the analyte concentration, and different measurement variances between the devices.     

Components of variance

Components of variance have a long history and find application in all areas of scientific investigation. This review introduces components of variance and their importance firstly by examples on blood pressure, proteomic data, breath analysers and esophageal pH monitoring devices. We then present an intuitive geometric representation of analysis of variance and explain how the components of variance can be estimated from the analysis of variance table. We conclude by suggesting practice points for studies which incorporate components of variance, and recommend commonly used statistical software to undertake such analysis.     

Comparison of congenital pulmonary airway malformation volume ratios calculated by ultrasound and magnetic resonance imaging

Objective: To compare congenital pulmonary airway malformation (CPAM) volume to head circumference ratios (CVRs) determined by different imaging modalities and calculation techniques.

Methods: Fetal thoracic lesion images by ultrasound (US) and magnetic resonance imaging (MRI) were retrospectively reviewed and the CVRs were calculated. The CVR^US was determined by the standard method. The CVR^MRI was calculated from T2-weighted sequences (HASTE/SSH-TSE) in two ways, dimensional measurements analogous to US technique (MRI-D) and by using a MRI-software calculated volume (MRI-V). CVR values between methods were compared using Wilcoxon matched-pairs signed-rank testing, Bland–Altman analyses, and Spearman correlations.

Results: Appropriate images were available to compare CVR^US to CVR^MRI-D for 20 patients and CVR^US to CVR^MRI-V for 18 patients. There were no significant differences in CVR values between modalities. By Bland–Altman analyses, the CVR measurements were largely within the limits of agreement: 18 of 20 for CVR^MRI-D and 17 of 18 for CVR^MRI-V, with a slight bias towards larger measurements by MRI.

Conclusions: Though values varied between modalities for individual patients, there was no systematic difference in CVRs determined by US or MRI. Fetal prognostic category for CPAMs did not change based on MRI in any patient in this series.     

肾癌伴下腔静脉瘤栓合并血栓的多种影像学比较

目的:研究肾癌伴下腔静脉瘤栓合并血栓患者的临床及影像资料,分析下腔静脉超声、泌尿系增强CT及增强磁共振3种影像学检查方法对下腔静脉瘤栓伴血栓的诊断效能。方法:选择北京大学第三医院泌尿外科2014年1月至2018年7月的肾癌伴瘤栓病例56例进行回顾性分析,所有患者术前均同时行下腔静脉超声、泌尿系增强CT及增强磁共振检查并完成手术治疗,且术后病理诊断证实为肾癌伴下腔静脉瘤栓。结果:根据术中观察及术后病理诊断证实下腔静脉瘤栓是否合并血栓为标准,将56例患者分为合并血栓组(n=18)及不合并血栓组(n=38)。比较发现,瘤栓合并血栓的患者,瘤栓长度更长[(10.50 ± 5.55) cm vs.(6.66 ± 3.73) cm,P = 0.014];瘤栓直径/下腔静脉(inferior vena cava, IVC)冠状最大径比值更接近1[1.0(0.7,1.0) vs. 0.9 (0.2,1.0), P= 0.004];出现下肢水肿的比例更高[66.7%(12/18) vs.5.3%(2/36),P = 0.005];行下腔静脉节段性切除或下腔静脉横断术的比例更高[66.7%(12/18) vs.15.8%(6/38), P<0.001]。对比下腔静脉超声、泌尿系增强CT及增强磁共振3种影像检查方法,鉴别瘤栓合并血栓,灵敏度最高的是增强磁共振(77.8%),特异性最高的是下腔静脉超声和增强CT(97.4%), 准确性最高的是增强CT及增强磁共振(83.9%),阳性预测值最高的是增强CT(90.9%),阴性预测值最高的是增强磁共振(89.2%)。结论:肾癌伴下腔静脉瘤栓合并血栓的患者,下腔静脉瘤栓长度更长,瘤栓直径/IVC冠状最大径比值更接近1,更易出现下肢水肿。术前需综合多种影像方法,提高诊断的准确率。