Effectiveness Of Different Treatment Strategies Research Articles

Exploration of verbal repetition in people with dementia using an online symptom-tracking tool.

Online tools can be used by people with dementia and their caregivers to self-identify and track troubling symptoms, such as verbal repetition. We aimed to explore verbal repetition behaviors in people with dementia. Participants were recruited via an online resource for people with dementia and their caregivers. Respondents were instructed to complete information about symptoms that are most important to them for tracking over time. In this cross-sectional study, we analyzed data pertaining to individuals with dementia who had at least three symptoms selected for tracking. Of the 3,573 participants who began a user profile, 1,707 fulfilled criteria for analysis. Verbal repetition was identified as a treatment target in 807 respondents (47.3%). Verbal repetition was more frequent in individuals with mild dementia compared to those with moderate and severe dementia (57.2% vs. 36.0% and 39.9%, p < 0.01) and in those with Alzheimer's disease versus other dementias (65.2% vs. 29.7%, p < 0.001). Repetitive questioning was the most frequent type of verbal repetition (90.5% of individuals with verbal repetition). Verbal repetition was most strongly associated with difficulties operating gadgets/appliances (OR 3.65, 95%CI: 2.82-4.72), lack of interest and/or initiative (3.52: 2.84-4.36), misplacing or losing objects (3.25: 2.64-4.01), and lack of attention and/or concentration (2.62: 2.12-3.26). Verbal repetition is a common symptom in people at all stages of dementia but is most commonly targeted for monitoring and treatment effects in its mild stage. Much research is required to further elucidate the underlying mechanisms and the effect of different treatment strategies.

The Effectiveness of Different Health Education Strategies in People with Pre-diabetes: A Randomized Controlled Trial

Background. People with pre-diabetes often lack knowledge of their risks of developing diabetes. In one of our previous study, Multi-Approach Health Education was shown evidence to be effective on health behavior of reducing risks of developing diabetes. However, which one approach is really effective and efficient need further investigation. Purpose. To examine the effects of different intervention strategies on diabetes prevention knowledge, exercise, dietary behavior, and physiological indicators for people with pre-diabetes. Methods. This was a randomly controlled trial. People who received health examination and were found fasting blood glucose higher than normal, between 100 - 125 mg/dl in 2011 were recruited. Three types of intervention were randomly assigned to 3 groups respectively. The control group (n=51) received a health education lecture. One experimental group (n=48) received the identical lecture plus telephone encouragement. The second experimental group (n=41) received the identical lecture plus a health reminder poster in their daily life. The outcomes were evaluated for the change in knowledge of diabetes prevention, exercise behavior, dietary behavior, and physiological outcomes at 6 and 12 weeks after the lecture of three groups, respectively. Results. Three intervention strategies were equally efficacious at inducing positive behavioral changes but overall the magnitudes of physiological changes were the same. In general, the maximum change in parameters was achieved after 6 weeks and maintained in the second 6 weeks of the study. Conclusions. Educating people with pre-diabetes about their condition can have a positive effect upon their health behaviors. However, education lecture coupled with a telephone follow up or plus educational posters were found no more effective than lecture alone. The lecture alone of health education may be enough for people with pre-diabetes, but the long term effect needs further investigation.

Erratum to: Subsequent risk of ipsilateral and contralateral invasive breast cancer after treatment for ductal carcinoma in situ: incidence and the effect of radiotherapy in a population-based cohort of 10,090 women.

Purpose To assess the effect of different treatment strategies on the risk of subsequent invasive breast cancer (IBC) in women diagnosed with ductal carcinoma in situ (DCIS).

Subsequent risk of ipsilateral and contralateral invasive breast cancer after treatment for ductal carcinoma in situ: incidence and the effect of radiotherapy in a population-based cohort of 10,090 women.

PurposeTo assess the effect of different treatment strategies on the risk of subsequent invasive breast cancer (IBC) in women diagnosed with ductal carcinoma in situ (DCIS).MethodsUp to 15-year cumulative incidences of ipsilateral IBC (iIBC) and contralateral IBC (cIBC) were assessed among a population-based cohort of 10,090 women treated for DCIS in the Netherlands between 1989 and 2004. Multivariable Cox regression analyses were used to evaluate associations of treatment with iIBC risk.ResultsFifteen years after DCIS diagnosis, cumulative incidence of iIBC was 1.9 % after mastectomy, 8.8 % after BCS+RT, and 15.4 % after BCS alone. Patients treated with BCS alone had a higher iIBC risk than those treated with BCS+RT during the first 5 years after treatment. This difference was less pronounced for patients <50 years [hazard ratio (HR) 2.11, 95 % confidence interval (CI) 1.35–3.29 for women <50, and HR 4.44, 95 % CI 3.11–6.36 for women ≥50, P interaction < 0.0001]. Beyond 5 years of follow-up, iIBC risk did not differ between patients treated with BCS+RT or BCS alone for women <50. Cumulative incidence of cIBC at 15 years was 6.4 %, compared to 3.4 % in the general population.ConclusionsWe report an interaction of treatment with age and follow-up period on iIBC risk, indicating that the benefit of RT seems to be smaller among younger women, and stressing the importance of clinical studies with long follow-up. Finally, the low cIBC risk does not justify contralateral prophylactic mastectomies for many women with unilateral DCIS.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-016-3973-y) contains supplementary material, which is available to authorized users.

Role of transarterial chemoembolization in relation with sorafenib for patients with advanced hepatocellular carcinoma.

BackgroundAlthough sorafenib is considered standard therapy for advanced hepatocellular carcinoma (HCC), actual treatments vary. We evaluated the effects of different treatment strategies on overall survival.MethodsA retrospective study of sorafenib-treated patients with advanced HCC was conducted. The primary outcome was overall survival. Prognostic factors were analyzed using multivariate Cox-proportional hazards model.ResultsA total of 658 patients (mean age, 54.5 years; 83.3% male) were analyzed; 293, 129, and 236 patients were treated with sorafenib, a combination therapy of sorafenib and transarterial chemoembolization (TACE), and TACE followed by sorafenib, respectively. Overall, 51.2% of patients treated under the combination strategy had portal vein invasion, whereas 89.9% of patients receiving sorafenib monotherapy had distant metastasis. Median overall survival durations were comparable (11.8 months for sorafenib, 16.2 months for the combination therapy, and 13.5 months for TACE followed by sorafenib; P = 0.13). However, among portal vein invasion cases, combination (25.7 months, P = 0.002) and TACE followed by sorafenib (14.0 months, P = 0.030) treatments were associated with longer overall survival duration compared with than sorafenib monotherapy (5.5 months). In a multivariate model, sorafenib duration (hazard ratio [HR], 0.96, P < 0.001) and TACE (HR, 0.24, P < 0.001) along with Child-Pugh stage (HR, 1.83, P = 0.005) were associated with better survival.ConclusionsIn patients with portal vein invasion, TACE performed concurrently with or before sorafenib administration is associated with better survival.

Stabilization of high-risk plaques.

The prevalence of atherosclerotic cardiovascular diseases (ASCVDs) is increasing globally and they have become the leading cause of death in most countries. Numerous experimental and clinical studies have been conducted to identify major risk factors and effective control strategies for ASCVDs. The development of imaging modalities with the ability to determine the plaque composition enables us to further identify high-risk plaque and evaluate the effectiveness of different treatment strategies. While intensive lipid-lowering by statins can stabilize or even regress plaque by various mechanisms, such as the reduction of lipid accumulation in a necrotic lipid core, the reduction of inflammation, and improvement of endothelial function, there are still considerable residual risks that need to be understood. We reviewed important findings regarding plaque vulnerability and some encouraging emerging approaches for plaque stabilization.

Effect of coronary-caval shunt combined with partial pericardial devascularisation on oesophageal and gastric variceal bleeding caused by portal hypertension.

To investigate the effect of coronary-caval shunt combined with partial pericardial devascularisation on oesophageal and gastric variceal bleeding caused by portal hypertension. Between January 2005 and January 2015, coronary-caval shunt operations combined with partial pericardial devascularisation were performed electively on 15 cirrhotic patients with portal hypertension. All of these patients had a history of oesophageal and gastric variceal bleeding. The clinical and follow-up data of these patients were reviewed retrospectively. Another 15 patients receiving non-surgical treatments in a similar follow-up period were used as controls to compare the preventive effects of different treatment strategies on rebleeding. All of the 15 surgical procedures were performed successfully, and no severe complications occurred. Among these, autogenous splenic veins were used as bridge vessels in 6 cases, whereas the coronary vein and inferior vena cava were anastomosed directly in 9 cases. All surgical patients were followed up from 5 months to 10 years with an average of 63 months; 2 patients died due to liver failure induced by reactivation of hepatitis B virus and oesophageal/gastric variceal rebleeding, respectively. The rebleeding rates for surgical and non-surgical patients were 6.7% and 66.7% (p < 0.05), respectively, whereas the 5-year survival rates for the two groups were 85.7% and 33.3% (p < 0.05), respectively. Patients with oesophageal and gastric variceal bleeding caused by portal hypertension may benefit from a coronary-caval shunt combined with partial pericardial devascularisation due to decreased coronary vein pressure, unaffected hepatic blood inflow, and reduced incidence of rebleeding.

Would the use of dimensional measures improve the utility of psychiatric diagnoses?

Would the use of dimensional measures improve the utility of psychiatric diagnoses?

Current Treatments for Breast Cancer-Related Lymphoedema: A Systematic Review

Background and objective:Breast cancer-related lymphoedema (BCRL) is a disabling complication with long term impact on quality on life after breast cancer treatment. Its management remains a major challenge for patients and health care professionals; the goal of this overview was to summarize effects of different treatment strategies for patients with BCRL.Methods:A thorough search was undertaken to allow a systematic review or meta-analysis of treatments for BCRL. Two investigators independently selected studies and abstracted the data.Results:Combined physical therapy (CPT) with different combinations of surgery, oral pharmaceuticals, low-level laser therapy, weight reduction, mesenchymal stem cell therapy, kinesio tex taping, and acupuncture might be effective in reducing lymphoedema, but exercise demonstrated no obvious benefit. The results of direct comparisons showed CPT might be more effective than standard physiotherapy (ST). Manual lymphatic drainage (MLD) may not offer additional benefits to ST for swelling reduction, but could facilitate compression bandaging. MLD seemed to have similar effects with self-administered simple lymphatic drainage (SLD) or using an intermittent pneumatic compression pump (IPC). IPC might also not be associated with additional effectiveness for CPT. Efficacy of stem cell therapy vs. compression sleeve or CPT, as well as the effects of daflon and coumarin could not be established.Conclusion:Although many treatments for BCRL might reduce lymphoedema volume, their effects were not well established. The quality of many of the original studies in the included reviews was not optimal, so that in future randomized control trials are a high priority.

Non-obstructive prosthetic heart valve thrombosis (NOPVT): Really a benign entity?

AimsTo assess the effectiveness of different treatment strategies in patients with non-obstructive prosthetic valve thrombosis (NOPVT) during hospitalization and long-term follow-up. MethodsNOPVT was diagnosed by transesophageal echocardiography. Resolution was defined as the disappearance or reduction of the thrombus under anticoagulation. All cases were first managed with optimization of anticoagulation. At discharge, patients received oral anticoagulation (OAC) alone or OAC and antiplatelet therapy (double treatment). Adverse events were defined as cardiovascular death, recurrence, thromboembolic events or major bleeding. ResultsFrom 1997 to 2012, 47 patients (mean age: 65years; women: 60%) were diagnosed with NOPVT (mitral valve: 97%). Previous poor anticoagulation control was documented in 66% of patients. Twenty-one patients (45%) were treated with unfractionated heparin (UFH), especially those with thrombus size >10mm (19/21). Optimization of OAC was performed in the remaining patients. Treatment failed in 13 (27.6%) patients, mostly in those who received UFH (10/13), requiring surgery (53.8%) or fibrinolysis (30.7%). Forty-two patients survived and, at discharge, 44% of patients received OAC alone and 56% the double treatment. At follow-up (median 23months; range 0.03–116months), 59.5% of patients presented cardiovascular events, however no differences in outcome were observed with double treatment or OAC alone (p=0.385). ConclusionsNOPVT is a high-risk complication, not only during hospitalization but also during follow-up. Optimization of anticoagulation is efficient in most patients except in thrombi ≥10mm treated with UFH. The double treatment does not prevent adverse events or complications during follow-up.

Development of the Plutonium-DTPA Biokinetic Model.

Estimating radionuclide intakes from bioassays following chelation treatment presents a challenge to the dosimetrist due to the observed excretion enhancement of the particular radionuclide of concern where no standard biokinetic model exists. This document provides a Pu-DTPA biokinetic model that may be used for making such determination for plutonium intakes. The Pu-DTPA biokinetic model is intended to supplement the standard recommended biokinetic models. The model was used to evaluate several chelation strategies that resulted in providing recommendations for effective treatment. These recommendations supported early treatment for soluble particle inhalations and an initial 3-day series of DTPA treatments for wounds. Several late chelation strategies were also compared where reduced treatment frequencies proved to be as effective as multiple treatments. The Pu-DTPA biokinetic model can be used to assist in estimating initial intakes of transuranic radionuclides and for studying the effects of different treatment strategies.

Assessment of serum asymmetric dimethylarginine levels and left ventricular diastolic function in patients with ankylosing spondylitis.

To assess left ventricular diastolic functions and serum dimethylarginine (ADMA) concentrations, as well as the effect of different treatment strategies on ADMA concentrations and diastolic function parameters, in patients with ankylosing spondylitis (AS). Sixty AS patients and 40 control subjects without classical cardiovascular (CV) risk factors were included in the study. Baseline clinical and echocardiographic variables were obtained. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA levels were measured. Spinal mobility, disease activity and functional status were assessed using Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. CRP, ESR and ADMA levels were significantly higher in the AS group as compared to the control group. Two (5%) control subjects and six (10%) AS patients met the criteria for left ventricular diastolic dysfunction (DD) on conventional Doppler echocardiography, but the difference was not statistically significant (P=0.36). However, using tissue Doppler imaging, 12 (20%) patients in the AS group and three (8%) subjects in the control group were diagnosed with left ventricular DD (P=0.08). The anti-tumor necrosis factor (TNF)-α group, conventional therapy group and control group were compared in terms of ADMA, CRP, ESR levels and echocardiographic parameters. ADMA levels were significantly lower in anti-TNF-α group as compared to the conventional therapy group (P<0.001). In the control group, ADMA levels were significantly lower than both treatment groups (P<0.001). Increased ADMA levels reveal impaired nitric oxide metabolism in a relatively young group of patients with AS, who have no classical CV risk factors. Anti-TNF-α may have beneficial effect on endothelial function in AS patients by reducing ADMA levels.

Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy.

Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy.

Efficacy of third-line pemetrexed monotherapy versus pemetrexed combination with bevacizumab in patients with advanced EGFR mutation-positive lung adenocarcinoma.

The purposes of this study were to observe the effects of different treatment strategies, including third-line pemetrexed alone versus its combination with bevacizumab, in patients with advanced epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma, and to analyze the effects of the different medication orders of first- and second-line drugs on third-line efficacy. One hundred and sixteen cases of patients with EGFR-positive lung adenocarcinoma who had received third-line pemetrexed alone or in combination with bevacizumab between March 2010 and March 2014 at Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University were analyzed retrospectively. Additionally, all the patients were treated with first-line gemcitabine and cisplatin (GP) chemotherapy and second-line EGFR tyrosine kinase inhibitor (TKI) or with first-line EGFR-TKI and second-line GP chemotherapy. The median survival of 61 cases with third-line pemetrexed monotherapy was 36.22 months, the median survival time of 55 cases with third-line pemetrexed plus bevacizumab was 38.76 months, and there was a significant difference in survival time between the two groups (P=0.04). Subgroup analysis revealed that among the 55 cases with third-line bevacizumab plus pemetrexed treatment, the median survival of 29 patients with first-line GP and second-line EGFR-TKI was 42.80 months, while the median survival of 26 patients with first-line EGFR-TKI and second-line GP was only 34.46 months; additionally, there was a significant difference in the survival time between the two subgroups (P=0.001). Among 61 cases with third-line pemetrexed treatment, the median survival of 34 patients with first-line GP and second-line EGFR-TKI was 38.72 months, while the median survival of 27 patients with first-line EGFR-TKI and second-line GP was only 32.94 months; the survival time of the two subgroups was significantly different (P=0.001). Regardless of the order of the first- and second-line chemotherapy and TKI therapy, the pemetrexed plus bevacizumab regimen was superior to the pemetrexed monotherapy as the third-line therapy in patients with advanced EGFR-positive lung adenocarcinoma. However, this strategy is worth further investigation in prospective studies.

Abstract 4393: miR-138 overexpression most effectively enhanced efficacy of apigenin to impair cell cycle progression and induce apoptosis in human malignant neuroblastoma SK-N-DZ and SK-N-BE2 cells in vivo

Abstract Malignant neuroblastoma, which mostly occurs in children, remains incurable with conventional chemotherapeutic agents. Innovative therapeutic strategies must be developed to control the growth of this childhood malignancy. Inhibition of cyclin D3 may induce cell cycle arrest and apoptosis in human malignant neuroblastoma. Also, inhibition of the catalytic component of human telomerase reverse transcriptase (hTERT) may induce apoptosis in many human cancers including malignant neuroblastoma. Decrease in expression of the tumor suppressor microRNA-138 (miR-138) is often associated with increases in expression of hTERT and cyclin D3. We hypothesized that miR-138 overexpression could be a better therapeutic strategy than hTERT knockdown to potentiate pro-apoptotic effect of apigenin (APG), a plant-derived flavonoid, in human malignant neuroblastoma. We found that transfection of miR-138 mimics was more powerful than transfection of hTERT shRNA plasmid in potentiating efficacy of APG for decreasing cell viability in human neuroblastoma SK-N-DZ and SK-N-BE2 cells. We then examined comparative effectiveness of different treatment strategies in reducing tumor growth and inducing apoptosis in SK-N-DZ and SK-N-BE2 xenografts in athymic nude mice. Combination of miR-138 overexpression and APG treatment showed better efficacy than combination of hTERT knockdown and APG treatment in reducing tumor growth and inducing cell death in both neuroblastoma xenograft models. According to the microRNA database (miRDB), miR-138 may target and inhibit expression of cyclin D3 so as to impair cell cylce progression. Combination of miR-138 overexpression and APG treatment caused the highest inhibition of expression of cyclin D3, CDK4, and CDK6, which were required for G1/S transition in cell cycle. Down regulation of cyclin D3 could inhibit phosphorylation of the tumor suppressor Rb and impair cell cycle progression. We delineated that apoptosis occurred with induction of molecular components of extrinsic and intrinsic pathways in the xenografts. Combination of miR-138 overexpression and APG treatment most effectively activated caspase-8 and cleaved Bid to tBid to induce extrinsic pathway of apoptosis and also raised Bax:Bcl-2 ratio to trigger intrinsic pathway of apoptosis with mitochondrial release of Smac into the cytosol to neutralize a set of endogenous inhibitor-of-apoptosis proteins such as Survivin so as to facilitate activation of caspase-3. Activation of both calpain and caspase-3 caused proteolysis of α-spectrin to generate calpain-specific 145 kD SBDP and caspase-3-specific 120 kD SBDP, respectively, in course of apoptosis in the xenografts. In conclusion, miR-138 overexpression was more powerful than hTERT knockdown in enhancing pro-apoptotic effect of APG for controlling growth of human malignant neuroblastomas in vivo. Citation Format: Mrinmay Chakrabarti, Walden Ai, Swapan K. Ray. miR-138 overexpression most effectively enhanced efficacy of apigenin to impair cell cycle progression and induce apoptosis in human malignant neuroblastoma SK-N-DZ and SK-N-BE2 cells in vivo. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4393. doi:10.1158/1538-7445.AM2014-4393

Consensus cost-effectiveness model for treatment of chronic hepatitis B in Asia Pacific countries.

The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party to develop a consensus cost-effectiveness model for treatment of Hepatitis B in Asia Pacific countries in March 2010. The working party consisted of expert hepatologists, virologists and epidemiologists from 11 representative countries in the Asia Pacific region. Meetings were conducted at the 20th APASL Annual Meeting in 2010 to determine consensus estimates for modeling and at the 21st and 22nd APASL meetings in 2011 and 2012, respectively to review and approve the models. The consensus cost-effectiveness model used Singapore as base case analysis and was validated using actual data from the Singapore Cancer, Diseases and Death Registries. Simulation for Singapore, China, Thailand, Pakistan, Taiwan and Korea were performed. Antivirals with high resistance barriers like entecavir and tenofovir had the highest retail cost but were the most cost-effective therapy in developed countries such as Singapore, Taiwan and Korea while generic tenofovir was most cost effective in Thailand and Pakistan. The cost effectiveness of different treatment strategies varied significantly between countries and was affected by medication cost, economic affordability, access to liver transplantation and the prevailing health of the general population. Choosing treatment strategies for hepatitis B based on low retail drug cost can be misleading because more expensive drugs may be more cost effective when considering long-term health outcomes and costs. Cost-effectiveness data should be individualized to countries based on their unique socio-economic conditions. Governmental policies which subsidize more costly drugs that have lower risk of drug resistance can benefit more patients.

Analysis of Intervention Strategies for Inhalation Exposure to Polycyclic Aromatic Hydrocarbons and Associated Lung Cancer Risk Based on a Monte Carlo Population Exposure Assessment Model

It is difficult to evaluate and compare interventions for reducing exposure to air pollutants, including polycyclic aromatic hydrocarbons (PAHs), a widely found air pollutant in both indoor and outdoor air. This study presents the first application of the Monte Carlo population exposure assessment model to quantify the effects of different intervention strategies on inhalation exposure to PAHs and the associated lung cancer risk. The method was applied to the population in Beijing, China, in the year 2006. Several intervention strategies were designed and studied, including atmospheric cleaning, smoking prohibition indoors, use of clean fuel for cooking, enhancing ventilation while cooking and use of indoor cleaners. Their performances were quantified by population attributable fraction (PAF) and potential impact fraction (PIF) of lung cancer risk, and the changes in indoor PAH concentrations and annual inhalation doses were also calculated and compared. The results showed that atmospheric cleaning and use of indoor cleaners were the two most effective interventions. The sensitivity analysis showed that several input parameters had major influence on the modeled PAH inhalation exposure and the rankings of different interventions. The ranking was reasonably robust for the remaining majority of parameters. The method itself can be extended to other pollutants and in different places. It enables the quantitative comparison of different intervention strategies and would benefit intervention design and relevant policy making.

Reliability and validity of the adapted Dutch version of the revised Scoliosis Research Society 22-item questionnaire

Background contextAs in other fields of medicine, there is an increasing interest among orthopedic surgeons to measure health-related quality of life in adolescent idiopathic scoliosis patients and to evaluate the burden of disease and the effectiveness of different treatment strategies. The development of the revised Scoliosis Research Society 22-item patient questionnaire (SRS-22r) enabled a comprehensive evaluation of health-related quality of life of these patients. Over the years, the SRS-22r gained wide acceptance and has been used in several different countries, languages, and cultures. The SRS-22r has not been translated into Dutch to date. PurposeTo translate the SRS-22r into Dutch and adapt it cross-culturally as outlined by international guidelines and to test its psychometric properties to measure health-related quality of life of adolescent idiopathic scoliosis patients in the Netherlands. Study design/settingA cross-sectional, multicenter validation study. Patient sampleA total of 135 adolescent idiopathic scoliosis patients (mean age 15.1 years old) of three major scoliosis centers in the Netherlands were enrolled in this study. Ninety-two (68%) subjects completed the Dutch SRS-22r, Child Health Questionnaire (CHQ)-CF87 (golden standard for adolescents), and Short Form (SF)-36 (golden standard for adults). Two weeks later, 73 (79%) of 92 respondents returned a second SRS-22r. Demographics, curve type, Risser stage, and treatment status were documented. Outcome measuresFloor and ceiling effects, internal consistency, reproducibility, concurrent validity, and discriminative ability of the Dutch version of the SRS-22r questionnaire. MethodsFor content analysis, SRS-22r domain scores (function, pain, self-image, mental health, and satisfaction with management) were explored and floor and ceiling effects were determined. Cronbach's α was calculated for internal consistency of each domain of the questionnaires and reproducibility was assessed by test-retest reliability analysis. Using Pearson's correlation coefficient, comparison of the domains of the Dutch SRS-22r with the domains of the SF-36 and Child Health Questionnaire-CF87 assessed the concurrent validity. Differences in SRS-22r domain scores between untreated patients with different curve severity determined the discriminative ability of the questionnaire. ResultsThe SRS-22r domains as well as the SF-36 and CHQ-CF87 domains demonstrated no floor effects, but the function, pain, and satisfaction with management domains had ceiling effects, indicating the proportion of subjects with the maximum score between 19.6% and 33.0%. Internal consistency was very satisfactory for all SRS-22r domains: Cronbach's α was between 0.718 and 0.852. By omitting question 15, the internal consistency of the function domain increased from 0.746 to 0.827. Test-retest reliability was ≥0.799 for all SRS-22r domains. The function, pain, mental health, and self-image domains correlated under the 0.001 significance level with the corresponding CHQ-CF87 and SF-36 domains. The satisfaction with management domain did not correlate with the other questionnaires. The SRS-22r had the ability to detect differences between groups with different curve severity; patients with a severe scoliotic curvature had significantly lower pain and self-image domain scores than patients with relatively mild scoliosis. ConclusionsThe Dutch SRS-22r had the properties needed for the measurement of patient perceived health-related quality of life of adolescent idiopathic scoliosis patients in the Netherlands. The Dutch SRS-22r could be used for the longitudinal follow-up of adolescent idiopathic scoliosis patients from adolescence to adulthood and for establishing the effects of conservative or invasive surgical treatment.

Evaluation of the quality of the management of cancer of the corpus uteri — Selection of relevant quality indicators and implementation in Belgium

ObjectiveDescribe the methodology and selection of quality indicators (QI) to be implemented in the EFFECT (EFFectiveness of Endometrial Cancer Treatment) project. EFFECT aims to monitor the variability in Quality of Care (QoC) of uterine cancer in Belgium, to compare the effectiveness of different treatment strategies to improve the QoC and to check the internal validity of the QI to validate the impact of process indicators on outcome. MethodsA QI list was retrieved from literature, recent guidelines and QI databases. The Belgian Healthcare Knowledge Center methodology was used for the selection process and involved an expert's panel rating the QI on 4 criteria. The resulting scores and further discussion resulted in a final QI list. An online EFFECT module was developed by the Belgian Cancer Registry including the list of variables required for measuring the QI. Three test phases were performed to evaluate the relevance, feasibility and understanding of the variables and to test the compatibility of the dataset. Results138 QI were considered for further discussion and 82 QI were eligible for rating. Based on the rating scores and consensus among the expert's panel, 41 QI were considered measurable and relevant. Testing of the data collection enabled optimization of the content and the user-friendliness of the dataset and online module. ConclusionsThis first Belgian initiative for monitoring the QoC of uterine cancer indicates that the previously used QI selection methodology is reproducible for uterine cancer. The QI list could be applied by other research groups for comparison.

The effectiveness of different intervention strategies for the prevention of zoonotic metacercariae infection in cultured fish

Fish-borne zoonotic trematodes (FZT) are a major public health problem. It is estimated that in Vietnam 26,366 “disability-adjusted life years” (DALYs) are lost due to FZT. Fish from aquaculture are a main source of protein and of great economic importance in both rural and urban areas. The objective of this study was to compare the impact on transmission of FZT to juvenile fish of drug treatment intervention of final hosts, and pond management interventions on fingerlings produced in nurseries producing Rohu carp in Northern Vietnam. The study design was a parallel group design of nurseries with two intervention groups; a drug treatment of human and animal groups and a farm management group (control of snail vectors and fecal pollution of pond). A third group (non-intervention) served as control. Fish were examined for FZT metacercariae prevalence and intensity before and after interventions, along with density of potential host pond snails. Fecal exams for FZT infections in farm household humans, dogs and cats were also performed. The results showed that although FZT prevalence in fish was not significantly reduced, the intensity of metacercariae in fish from ponds receiving management interventions was reduced 91.7% compared to before interventions. The intensity of FZT was also significantly lower in the pond management group, compared to the drug treatment group and the control group after interventions. The results demonstrate that improving farm and pond management practices can be effective in reducing FZT infections without using drug treatment. This study also highlighted certain obstacles to attaining higher levels of protection for which more research is needed. A major challenge is the ability to completely isolate (or bio-secure) the pond from its surrounding environment, especially surrounding water sources which may harbor snails and cercariae that can contaminate the pond through water resupply or runoff. Another is the unknown risk from piscivorous birds, host for intestinal FZT. The strategies employed in this study now need long-term evaluation on a regional basis, the outcome of which could be the development of good management practices crucial to ensuring a good quality product that benefits farmers and the consumers.