Clinical Items Research Articles

Development and construct validation of a parent-proxy quality of life instrument in children with bronchopulmonary dysplasia aged 4\u20138\xa0years old

PurposeChildren with bronchopulmonary dysplasia often develop complications that affect them well into adult life. Very little is known about how this affects their quality of life, since no sensitive instrument is available to measure health-related quality of life in this population. In this study, a Dutch parent-proxy instrument was developed for this purpose.MethodsA list of items was generated after literature search and interviews with both parents of patients and clinical experts. Clinically relevant items were selected with the clinical impact method and item analysis. Results of clinical tests to measure complications in children with bronchopulmonary dysplasia were correlated with these items to select the items that show construct validity. Cronbach’s alpha was calculated to estimate internal consistency of the items in the final questionnaire.ResultsIn total, 92 children and their parents and 7 clinicians participated. Of 130 identified items, 47 showed clinical relevance. Spirometry, the Child Behavior Checklist, mean arterial pressure, and body mass index were used to determine construct validity of 33 items. These items were structured within five domains: pulmonary complaints, school functioning, growth and nutrition, exercise and locomotion, emotional functioning and health care concerns. The questionnaire showed excellent internal consistency with Cronbach’s alpha of 0.919.ConclusionThis study developed a disease-specific parent-proxy instrument to measure health-related quality of life in children with bronchopulmonary dysplasia aged 4–8 years old, the BPD-QoL. All included items show construct validity and internal consistency reliability. Future research should focus on further validation and analysis of responsiveness and reliability.

How does physician gender influence primary care quality? evidence from a standardised patient audit study in China

BackgroundStudies in high-income countries have found that female physicians exhibit better performance than their male counterparts. However, it is largely unclear whether these findings are influenced by case and patient mix bias. We aimed to objectively assess differences in clinical practice and treatment between female and male primary care providers in rural China. MethodsIn this cross-sectional study, we used standardised patients to assess provider performance in clinical practice, yielding objective performance measures free from case and patient mix bias. We included 309 primary providers who received 412 visits from standardised patients in township health centres in rural areas of three provinces in western, central, and eastern China. All providers were visited by standardised patients who were trained to consistently present three disease cases. Clinical process was graded against checklists based on national and international guidelines of recommended questions and exams to be performed. Assessment of treatment considered the appropriateness of medicine dispensed and referrals made, as well as the types and quantity of medicines dispensed. Unadjusted comparisons of the performance of male and female providers used Ordinary Least Squares (OLS) regressions controlling for disease cases. Adjusted comparisons additionally controlled for facility fixed effects and provider characteristics. We obtained ethics approval from the institutional review boards of Stanford University, USA, and Sichuan University, China. Informed consent was obtained verbally from all providers participating in the study. Consent from village and township providers was obtained as part of the facility survey approximately 5 weeks before visits. All individuals who participated as standardised patients were trained to protect themselves from any invasive tests or procedures. FindingsIn unadjusted comparisons, female providers completed 0·76 (95% CI 0·05–1·47) more clinical checklist items on average than male providers, representing an increase of 15% over the mean number of checklist items completed by male providers (5·04 items). Female providers were also 15 percentage points (95% CI 0–30) more likely to give appropriate treatment than male providers (38%). Although, there was no significant difference in unadjusted comparisons (43% for female providers and 41% male providers), female providers prescribed significantly fewer unnecessary or harmful medicines such as antibiotics than male providers after controlling for facility fixed effects and other provider characteristics (–21 percentage points, 95% CI −41 to −2). InterpretationThis study finds that female providers prescribe fewer unnecessary or harmful treatments in primary care than male providers in rural China after controlling for potential sources of bias. No difference between female and male providers was found for other measures of clinical process quality after adjusting for observable characteristics. Funding111 Project (Grant B16031), the Laboratory of Modern Teaching Technology of the Ministry of Education, Shaanxi Normal University, National Natural Science Foundation of China (Grant 71703083), the National Social Science Fund Youth Project (Grant 15CJL005), the National Natural Science Foundation of China (Grant 71703084), and the Knowledge for Change program at The World Bank (Grant 7172469).

Expert recommendations for diagnosing cervical, oromandibular, and limb dystonia.

Diagnosis of focal dystonia is based on clinical grounds and is therefore open to bias. To date, diagnostic guidelines have been only proposed for blepharospasm and laryngeal dystonia. To provide practical guidance for clinicians with less expertise in dystonia, a group of Italian Movement Disorder experts formulated clinical diagnostic recommendations for cervical, oromandibular, and limb dystonia. A panel of four neurologists generated a list of clinical items related to the motor phenomenology of the examined focal dystonias and a list of clinical features characterizing neurological/non-neurological conditions mimicking dystonia. Thereafter, ten additional expert neurologists assessed the diagnostic relevance of the selected features and the content validity ratio was calculated. The clinical features reaching a content validity ratio > 0.5 contributed to the final recommendations. The recommendations retained patterned and repetitive movements/postures as the core feature of dystonia in different body parts. If present, a sensory trick confirmed diagnosis of dystonia. In the patients who did not manifest sensory trick, active exclusion of clinical features related to conditions mimicking dystonia (features that would be expected to be absent in dystonia) would be necessary for dystonia to be diagnosed. Although reliability, sensitivity, and specificity of the recommendations are yet to be demonstrated, information from the present study would hopefully facilitate diagnostic approach to focal dystonias in the clinical practice and would be the basis for future validated diagnostic guidelines.

Variation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex

BackgroundThe identification of contextual factors that modify associations between client frailty and their health and service use outcomes is essential for informed home health care and policy planning. Our objective was to examine variation in the associations between frailty and select 1-year health outcomes by caregiver distress and client sex among community-residing older care recipients.MethodsWe conducted a retrospective cohort study using linked population-based clinical and health administrative databases for all long-stay home care clients (n = 234,552) aged 66+ years assessed during April 2010–2013 in Ontario, Canada. Frailty was assessed using a previously validated 72-item frailty index (FI). Presence of caregiver distress was derived from clinical assessment items administered by trained home care assessors. Multivariable log-binomial regression models were used to examine variations in the associations between frailty and outcomes of interest (mortality, nursing home [NH] placement, all-cause and prolonged hospitalization) by caregiver distress, with further model stratification by client sex.ResultsFrailty prevalence varied little by sex (19.3% women, 19.9% men) despite significant sex-differences in clients’ sociodemographic and health characteristics. In both sexes, frailty was significantly associated with all outcomes, particularly NH placement (RR = 3.84, 95%CI 3.75–3.93) and death (RR = 2.32, 95%CI 2.27–2.37), though risk ratios were greater for women. Caregiver distress was more common with increasing frailty and for male clients, and a significant independent predictor of NH placement and prolonged hospitalization in both sexes. The association between frailty and NH placement (but not other outcomes) varied by caregiver distress for both men and women (p < 0.001 interaction terms), showing a greater magnitude of association among clients without (vs. with) a distressed caregiver.ConclusionsAs caregiver distress varies by client sex, represents a key driver of NH placement (even among relatively robust clients), and modifies the impact of other risk factors such as frailty, it should be routinely assessed. Further, sex-differences should be considered when developing and evaluating community-based services for older adults and their caregivers.

Ruling out pulmonary embolism across different subgroups of patients and healthcare settings: protocol for a systematic review and individual patient data meta-analysis (IPDMA)

BackgroundDiagnosing pulmonary embolism in suspected patients is notoriously difficult as signs and symptoms are non-specific. Different diagnostic strategies have been developed, usually combining clinical probability assessment with D-dimer testing. However, their predictive performance differs across different healthcare settings, patient subgroups, and clinical presentation, which are currently not accounted for in the available diagnostic approaches.MethodsThis is a protocol for a large diagnostic individual patient data meta-analysis (IPDMA) of currently available diagnostic studies in the field of pulmonary embolism. We searched MEDLINE (search date January 1, 1995, till August 25, 2016) to retrieve all primary diagnostic studies that had evaluated diagnostic strategies for pulmonary embolism. Two authors independently screened titles, abstracts, and subsequently full-text articles for eligibility from 3145 individual studies. A total of 40 studies were deemed eligible for inclusion into our IPDMA set, and principal investigators from these studies were invited to participate in a meeting at the 2017 conference from the International Society on Thrombosis and Haemostasis. All authors agreed on data sharing and participation into this project. The process of data collection of available datasets as well as potential identification of additional new datasets based upon personal contacts and an updated search will be finalized early 2018. The aim is to evaluate diagnostic strategies across three research domains: (i) the optimal diagnostic approach for different healthcare settings, (ii) influence of comorbidity on the predictive performance of each diagnostic strategy, and (iii) optimize and tailor the efficiency and safety of ruling out PE across a broad spectrum of patients with a new, patient-tailored clinical decision model that combines clinical items with quantitative D-dimer testing.DiscussionThis pre-planned individual patient data meta-analysis aims to contribute in resolving remaining diagnostic challenges of time-efficient diagnosis of pulmonary embolism by tailoring available diagnostic strategies for different healthcare settings and comorbidity.Systematic review registrationProspero trial registration: ID 89366.

Study on the standardization of the evaluation method for rehabilitation robots

These days, many rehabilitation robots are used in clinical practice In order to prove the effectiveness and safety of rehabilitation robots, it is necessary to standardize the method used to evaluate rehabilitation using robots. The purpose of this research is to create evaluation standards for rehabilitation using robots and to standardize them. In preparing evaluation criteria for rehabilitation that uses robots, the candidate evaluation items were objectively collected from past articles and academic abstracts These items were classified into clinical evaluation items, economic evaluation items, safety evaluation items, and evaluation items related to engineering development. For the first questionnaire survey, we divided the evaluation items into “upper limbs”, “trunk + lower limbs”, and asked about “measurement experience”, “usefulness”, “difficulty of measurement” and so on This questionnaire was carried out at 63 facilities in Japan which are using rehabilitation robots Based on the results of the first questionnaire, we carried out a second questionnaire survey and selected what seemed to be useful from among the collected evaluation items Furthermore, we used the selected evaluation items in clinical practice and verified their practicality. As a result of the questionnaire survey, 27 items of “upper limbs” and 34 items of “trunk + lower limbs” were selected The validity of the selected evaluation items was also verified However, there were some problems such as: expensive evaluation tools are required, a large amount of time and labor for evaluation is required, and the sensitivity to rehabilitation using robots is low. We conducted a questionnaire survey to standardize the evaluation of rehabilitation using robots and selected evaluation items that seemed useful. We would like to increase the number of cases, narrow down useful evaluation items, and aim for standardization of the evaluation items for rehabilitation robots.

Successful implementation of diabetes audits in Australia: the Australian National Diabetes Information Audit and Benchmarking (ANDIAB) initiative.

We developed and implemented a national audit and benchmarking programme to describe the clinical status of people with diabetes attending specialist diabetes services in Australia. The Australian National Diabetes Information Audit and Benchmarking (ANDIAB) initiative was established as a quality audit activity. De-identified data on demographic, clinical, biochemical and outcome items were collected from specialist diabetes services across Australia to provide cross-sectional data on people with diabetes attending specialist centres at least biennially during the years 1998 to 2011. In total, 38 155 sets of data were collected over the eight ANDIAB audits. Each ANDIAB audit achieved its primary objective to collect, collate, analyse, audit and report clinical diabetes data in Australia. Each audit resulted in the production of a pooled data report, as well as individual site reports allowing comparison and benchmarking against other participating sites. The ANDIAB initiative resulted in the largest cross-sectional national de-identified dataset describing the clinical status of people with diabetes attending specialist diabetes services in Australia. ANDIAB showed that people treated by specialist services had a high burden of diabetes complications. This quality audit activity provided a framework to guide planning of healthcare services.

Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain

BackgroundIdentification of sciatica may assist timely management but can be challenging in clinical practice. Diagnostic models to identify sciatica have mainly been developed in secondary care settings with conflicting reference standard selection. This study explores the challenges of reference standard selection and aims to ascertain which combination of clinical assessment items best identify sciatica in people seeking primary healthcare.MethodsData on 394 low back-related leg pain consulters were analysed. Potential sciatica indicators were seven clinical assessment items. Two reference standards were used: (i) high confidence sciatica clinical diagnosis; (ii) high confidence sciatica clinical diagnosis with confirmatory magnetic resonance imaging findings. Multivariable logistic regression models were produced for both reference standards. A tool predicting sciatica diagnosis in low back-related leg pain was derived. Latent class modelling explored the validity of the reference standard.ResultsModel (i) retained five items; model (ii) retained six items. Four items remained in both models: below knee pain, leg pain worse than back pain, positive neural tension tests and neurological deficit. Model (i) was well calibrated (p = 0.18), discrimination was area under the receiver operating characteristic curve (AUC) 0.95 (95% CI 0.93, 0.98). Model (ii) showed good discrimination (AUC 0.82; 0.78, 0.86) but poor calibration (p = 0.004). Bootstrapping revealed minimal overfitting in both models. Agreement between the two latent classes and clinical diagnosis groups defined by model (i) was substantial, and fair for model (ii).ConclusionFour clinical assessment items were common in both reference standard definitions of sciatica. A simple scoring tool for identifying sciatica was developed. These criteria could be used clinically and in research to improve accuracy of identification of this subgroup of back pain patients.

Development and Validation of the Nursing Home Minimum Data Set 3.0 Mortality Risk Score (MRS3).

To develop a score to predict mortality using the Minimum Data Set 3.0 (MDS 3.0) that can be readily calculated from items collected during nursing home (NH) residents' admission assessments. We developed a training cohort of Medicare beneficiaries newly admitted to United States NHs during 2012 (N = 1,426,815) and a testing cohort from 2013 (N = 1,160,964). Data came from the MDS 3.0 assessments linked to the Medicare Beneficiary Summary File. Using the training dataset, we developed a composite MDS 3.0 Mortality Risk Score (MRS3) consisting of 17 clinical items and patients' age groups based on their relation to 30-day mortality. We assessed the calibration and discrimination of the MRS3 in predicting 30- and 60-day mortality and compared its performance to the Charlson Comorbidity Index and the clinician's assessment of 6-month prognosis measured at admission. The 30- and 60-day mortality rates for the testing population were 2.8% and 5.6%, respectively. Results from logistic regression models suggest that the MRS3 performed well in predicting death within 30 and 60 days (C-Statistics of 0.744 [95% confidence limit (CL) = 0.741, 0.747] and 0.709 [95% CL = 0.706, 0.711], respectively). The MRS3 was a superior predictor of mortality compared to the Charlson Comorbidity Index (C-statistics of 0.611 [95% CL = 0.607, 0.615] and 0.608 [95% CL = 0.605, 0.610]) and the clinicians' assessments of patients' 6-month prognoses (C-statistics of 0.543 [95% CL = 0.542, 0.545] and 0.528 [95% CL = 0.527, 0.529]). The MRS3 is a good predictor of mortality and can be useful in guiding decision-making, informing plans of care, and adjusting for patients' risk of mortality.

The utility of pharmacogenetic testing to support the treatment of bipolar disorder.

BackgroundBipolar disorder (BD) is a frequent cause of disability, health care costs, and risk of suicide. Pharmacogenetic tests (PGTs) could help clinicians to identify those patients predisposed to the occurrence of adverse events (AEs) improving the understanding of the correlation between genetic variants and drug response.Materials and methodsThe study evaluated 30 patients affected by BD type I or II (according to Diagnostic and Statistical Manual of Mental Disorders, version 5) who underwent the PGT Neurofarmagen® (AB-BIOTICS SA, Barcelona, Spain) between March 2016 and March 2017. The primary aim of this study was to identify if the treatment prescribed by the psychiatrists was consistent with the treatment suggested by the PGT at T0 (corresponding to the test report communication). As a secondary aim, we wanted to assess if clinicians had changed the treatment (in case of discordance) at T1 (3-month follow-up visit) according to the results of the PGT.ResultsAt T0, only 4 patients (13%) had an optimal therapy in line with the PGT suggestions. At 3-month follow-up, 13 patients (40%) had received a change of therapy consistent to the test, showing a significant statistical improvement in the Clinical Global Impression item Severity (CGI-S) score over time compared to those not having changes consistent with the test. Regarding AEs, at baseline 9 out of 10 (90%) of the patients who received a therapy modification according to the test presented AEs, and a significant within-group reduction was observed after 3 months (p = 0.031).ConclusionDespite the small sample size, the study shows promising data about the usefulness of PGT to support clinicians in reaching a more effective and tolerated treatment in the routine approach of BD.

37IN - Is “hyper-progression” a relevant clinical item for patient with solid tumours candidate to check-point inhibitor treatment?

37IN - Is “hyper-progression” a relevant clinical item for patient with solid tumours candidate to check-point inhibitor treatment?

Olanzapine and haloperidol for the treatment of acute symptoms of mental disorders induced by amphetamine-type stimulants: A randomized controlled trial.

Background:This study aimed to compare olanzapine and haloperidol efficacies in the treatment of acute psychiatric symptoms due to amphetamine-type stimulants (ATSs).Methods:The Zelen II design method was used; 124 patients with acute mental disorders due to amphetamine were randomly divided into olanzapine group (n = 63) and haloperidol group (n = 61). Then, a 4-week open-label medical therapy was performed. Clinical Global Impression Scale Item 2 was employed to evaluate the onset time; meanwhile, Brief Psychiatric Rating Scale (BPRS) was used at baseline and at posttreatment weeks 1, 2, and 4. Moreover, adverse reactions during the treatment were recorded.Results:Onset time in the olanzapine group was significantly earlier than in the haloperidol group; BPRS scores in the olanzapine group were significantly lower than haloperidol group values at 1 and 2 weeks of treatment. The overall effective rates had no statistically significant difference.Conclusion:Short-term olanzapine and haloperidol treatments had equivalent efficacies in the treatment of acute symptoms of mental disorders due to ATSs; however, olanzapine administration resulted in relatively earlier disease onset, with less adverse reactions.

Impact of question order on prioritisation of outcomes in the development of a core outcome set: a randomised controlled trial

BackgroundCore outcome set (COS) developers increasingly employ Delphi surveys to elicit stakeholders’ opinions of which outcomes to measure and report in trials of a particular condition or intervention. Research outside of Delphi surveys and COS development demonstrates that question order can affect response rates and lead to ‘context effects’, where prior questions determine an item’s meaning and influence responses. This study examined the impact of question order within a Delphi survey for a COS for oesophageal cancer surgery.MethodsA randomised controlled trial was nested within the Delphi survey. Patients and health professionals were randomised to receive a survey including clinical and patient-reported outcomes (PROs), where the PRO section appeared first or last. Participants rated (1–9) the importance of 68 items for inclusion in a COS (ratings 7–9 considered ‘essential’). Analyses considered the impact of question order on: (1) survey response rates; (2) participants’ responses; and (3) items retained at end of the survey.ResultsIn total, 116 patients and 71 professionals returned completed surveys. Question order did not affect response rates among patients, but fewer professionals responded when clinical items appeared first (difference = 31.3%, 95% confidence interval [CI] = 13.6–48.9%, P = 0.001). Question order led to different context effects within patients and professionals. While patients rated clinical items highly, irrespective of question order, more PROs were rated essential when appearing last rather than first (difference = 23.7%, 95% CI = 10.5–40.8%). Among professionals, the greatest impact was on clinical items; a higher percentage rated essential when appearing last (difference = 11.6%, 95% CI = 0.0–23.3%). An interaction between question order and the percentage of PRO/clinical items rated essential was observed for patients (P = 0.025) but not professionals (P = 0.357). Items retained for further consideration at the end of the survey were dependent on question order, with discordant items (retained by one question order group only) observed in patients (18/68 [26%]) and professionals (20/68 [29%]).ConclusionsIn the development of a COS, participants’ ratings of potential outcomes within a Delphi survey depend on the context (order) in which the outcomes are asked, consequently impacting on the final COS. Initial piloting is recommended with consideration of the randomisation of items in the survey to reduce potential bias.Trial registrationThe randomised controlled trial reported within this paper was nested within the development of a core outcome set to investigate processes in core outcome set development. Outcomes were not health-related and trial registration was not therefore applicable.

Novel approach to characterising individuals with low back-related leg pain: cluster identification with latent class analysis and 12-month follow-up.

Traditionally, low back-related leg pain (LBLP) is diagnosed clinically as referred leg pain or sciatica (nerve root involvement). However, within the spectrum of LBLP we hypothesised that there may be other, unrecognised patient subgroups. This study aimed to identify clusters of LBLP patients using latent class analysis (LCA) and describe their clinical course.The study population were 609 LBLP primary care consulters. Variables from clinical assessment were included in the LCA. Characteristics of the statistically identified clusters were compared and their clinical course over one year was described.A five cluster solution was optimal. Cluster 1 (n=104) had mild leg pain severity and was considered to represent a referred leg pain group with no clinical signs suggesting nerve root involvement (sciatica). Cluster 2 (n=122), cluster 3 (n=188) and cluster 4 (n=69) had mild, moderate and severe pain and disability respectively and response to clinical assessment items suggested categories of mild, moderate and severe sciatica. Cluster 5 (n=126) had high pain and disability, longer pain duration, more comorbidities and was difficult to map to a clinical diagnosis.Most improvement for pain and disability was seen in the first four months for all clusters. At 12 months the proportion of patients reporting recovery ranged from 27% for cluster 5 to 45% for cluster 2 (mild sciatica).This is the first study that empirically shows the variability in profile and clinical course of patients with LBLP including sciatica. More homogenous groups were identified which could be considered in future clinical and research settings.

Diagnosis of Acute Appendicitis in Sub-Saharan Africa

Objective: The aim of our study was to propose a solution for rationalizing requests for ultrasound examination and CT scan in suspected acute appendicitis, based on use of the Alvarado score. Patients and Methods: We included in our study all patients consulting for pain of the right iliac fossa, whatever their age and sex, who had been diagnosed with acute appendicitis and who had undergone appendectomy. We used the Alvarado scoring system, based on clinical items and laboratory measurements, to diagnose appendicitis. Results: One hundred eleven patients, of whom 77 were men (69.4%) and 34 were women (30.6%), with a sex ratio of 2:2.6, were included. Mean age was 31.29 ± 1.31 years, with a range of 1 to 81 years. The diagnosis of definite appendicitis was established in 54 patients (48.6%). Abdominal ultrasound examination had been performed in 80 patients (72.1%). It established a diagnosis of appendicitis in 69 patients (86.2%), while in 11 patients (13.8%) the appendix was described as normal or was not visualized. Conclusion: Our study demonstrated good agreement between peroperative diagnosis and the result of the Alvarado score applied a posteriori. Ultrasound was not always contributory to the diagnosis of acute appendicitis. It could be reserved for patients whose clinical and laboratory score indicated that appendicitis was unlikely.

Social Functioning in Schizophrenia Clinical Correlations.

Schizophrenia remains one of the major psychiatric disorder with huge social and economic costs for the individual and community. The role of psycho-social factors is important both on the etiopathogenesis of the illness and its evolution, lack of social functioning and associated stress have impact on everyday life of people with this diagnosis. Our study of 100 subjects with schizophrenia has showed significant correlations between clinical and social items: bigger number of admissions, longest duration of the evolution, cognitive deficits, smoking, suicidal behavior, age, marital status, smoking, level of perceived stress. The social functioning was influenced by these factors, and the therapeutically management during the hospitalization does not showed an improvement of the social function.

Factors influencing clinical learning environment among nursing students: A cross sectional study

Clinical learning is the essence of nursing education. Many factors have been demonstrated to influence students’ development of clinical competence. A non-experimental descriptive study was conducted aiming to assess the factors influencing clinical learning environment, to prioritize those factors and to compare with degree and diploma nursing. The study was conducted among student nurses in a selected nursing college in Thiruvananthapuram district of Kerala. 100 student nurses including fifty B. Sc. nursing and fifty General nursing students were recruited using stratified and simple random sampling technique after obtaining institutional ethical committee clearance. data was collected from samples after getting informed consent; the tools used were: Section A-Performa to collect demographic characteristics of subjects and Section B-Assessment of factors influencing CLE which was a three point likert scale and it included factors like; Supervision-10 items, Clinical facilities-5 items, Organization-5 items, Inter personal relationship-5 items and Student related factors-5 items. descriptive statistical measures such as frequency, percentage and mean were used for analyze data. The collected data was analyzed using statistical package for social sciences version 20. The mean score of distribution of factors affecting CLE was found as supervision (24.59), clinical facilities (10.74), organization (10.60), IPR (11.68) and student related factors (11.33). On prioritizing the factors highest mean percentage was obtained for supervision (81.97) and the lowest for organization (70.67).

Comparison of the outcomes of different human spermatozoa selection methods in assisted reproduction

Selecting sperm by density-gradients in assisted reproductive technologies has a great improvement in keeping DNA integrity and sperm quality. However, study showed that histone retention and DNA methylation were changed in the method of selecting human spermatozoa by density-gradients in assisted reproductive technologies. In the present study, a total of 1874 cycles (1411cycles of using density-gradients method or the combination of density-gradients and swim-up (group A) and 463 cycles of using swim-up only (group B)) of in vitro fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) that were performed in our hospital from January 2010 to December 2015 were retrospectively analyzed. Implantation rate, clinical pregnancy rate, miscarriage rate, ectopic pregnancy rate, twin pregnancy rate, still birth rate, prematurity rate, low birth weight rate, live birth rate, macrosomia rate and fetal or baby abnormality rate were compared. There were no significant differences in the clinical items shown above between two groups except for the live birth rate of per transferred cycle. Live birth rate was higher in the group A than group B. We conclude that both using density-gradients (or combination with swim-up) and swim-up method alone to separate sperm are safe to prepare the sperm for IVF and ICSI.

Development and Testing of the interRAI Acute Care: A Standardized Assessment Administered by Nurses for Patients Admitted to Acute Care.

Background:Underpinning standards for developing comprehensive care in hospital is the need to identify, early in the admission process, functional and psychosocial issues which affect patient outcomes. Despite the value of comprehensive assessment of patients on admission, the process is often sub-optimal due to a lack of standardized assessment practices. This project aimed to develop a concise, integrated assessment for patients admitted to acute care and test its psychometric properties.Methods:Two international expert panels of clinicians and health scientists collaborated to establish design parameters. Using clinical observations and a variety of derivative applications sourced from the interRAI research collaborative repository, the panels constructed a draft instrument to examine feasibility, resource requirements, and inter-rater reliability. Field testing was conducted in Australia and Canada. Next, the system was revised to its final form, the interRAI Acute Care, after feedback and review from international interRAI members.Results:Constructed using 56 items, the interRAI Acute Care required a median of 15 minutes to complete. Inter-rater reliability tested on 130 paired assessments was substantial to almost perfect for 78% of the clinical items and moderate for the remaining 22% of items. A subset of 30 items from the admission assessment comprised the discharge assessment.Discussion:The interRAI Acute Care has been shown to be an efficient nursing assessment instrument with good psychometric properties. Implementation in a digital environment will enable documentation and care planning to comply with standards for quality of care in the general adult hospital population.

CLINICAL INDICATORS OF FEEDING SELF-CARE DEFICIT BASED ON BARTHEL INDEX MEASUREMENT IN PATIENTS SUFFERING FROM STROKE

Objective: This aim of this research is to describe clinical indicators of feeding self-care deficit based on Barthel Index measurement in patients with stroke.&#x0D; Methods: The research used a quantitative description study with cross-sectional design. This research was conducted in one hospital in Yogyakarta, Indonesia on March – April 2017 with total sampling technique. Instrument was developed based on clinical indicators of NANDA-I nursing diagnosis of feeding self-care deficit.&#x0D; Results: There were 28 respondents involved in this study, with males (60.7%) and females (39.3%) with an average age of 57 years. Respondents who suffered from non-hemorrhagic stroke were 60.7% and hemorrhagic stroke were 39.3%. Clinical indicator items for impaired ability to swallow sufficient amount of food (9.1%) was found in respondents with independency criteria on Barthel Index. Impaired ability to swallow sufficient amount of food item (25%) and impaired ability to prepare food (25%) were found in respondents with partial dependency criteria. The most items identified on respondents with severe dependency criteria were impaired ability to self-feed a complete meal item (53.8%) and impaired ability to prepare food item (53.8%).&#x0D; Conclusion: There were different pattern of clinical indicators items found in different level of Barthel index level criteria.