Functional Status Scores Research Articles

Gastrointestinal symptoms are associated with trajectories of chemotherapy-induced nausea

Between 19 and 58% of oncology patients experience chemotherapy-induced nausea (CIN). In a sample of outpatients with breast, gastrointestinal (GI), gynecological, and lung cancer, the study purposes were to evaluate for inter-individual differences in the severity of CIN over two cycles of chemotherapy (CTX) and to determine which demographic and clinical characteristics and GI symptoms were associated with higher initial levels as well as with the trajectories of CIN severity. Patients completed study questionnaires at six time points over two cycles of CTX. These questionnaires provided information on demographic and clinical characteristics, as well as the occurrence of twelve GI symptoms. Hierarchical linear modeling based on full maximum likelihood estimation was performed. Of the 1251 patients, 47.2% reported CIN. Across two cycles of CTX, lower functional status scores and higher levels of comorbidity were associated with higher initial levels of CIN. Younger age and emetogenicity of the CTX regimen were associated with higher initial levels as well as worse trajectories of CIN. The occurrence of five GI symptoms (i.e., vomiting, lack of appetite, constipation, feeling bloated, and difficulty swallowing) was associated with higher initial levels of CIN. The occurrence of mouth sores was associated with higher initial levels as well as with worst trajectories of CIN. This study is the first to identify distinct demographic, clinical, and GI symptom characteristics associated with CIN severity. These findings suggest that the etiology of CIN is complex and may warrant interventions beyond standard antiemetics.

Functional Status of Patients After Transcatheter Aortic Valve Replacement Surgery in the Acute Care Setting

Purpose: Transcatheter aortic valve replacement is a minimally invasive treatment option for patients with aortic stenosis. This study aimed to describe the functional status and determine relationships between patient characteristics, such as age and functional outcomes, following a transcatheter aortic valve replacement procedure in the acute care setting. Methods: Retrospective chart review of 100 patients. Patients were divided into 4 groups: ≤69, 70 to 79, 80 to 89, and 90-plus years of age. General demographics, Functional Status Score for the Intensive Care Unit, and ambulation distance were collected. Results: Mean age was 79.7 (SD = 8.3) years with 56% female. The first day after surgery, 78% were able to participate in out-of-bed activities. Significant improvement in ambulation distance and Functional Status Score for the Intensive Care Unit scores from evaluation to discharge (P < .001) were noted in patients receiving 2 or more visits. No significant differences were found between age groups and outcome variables except that patients in the 90-plus age group were more likely to use an assistive device prior to surgery (P = .004). Conclusions: Patients' status post–transcatheter aortic valve replacement demonstrated improvement in their functional mobility during a short length of stay and were typically discharged home. Age did not appear to significantly impact the patients' ability to participate in early mobility or influence their discharge location.

Functional Outcome Of Mini-Open Carpal Tunnel Release In Carpal Tunnel Syndrome

Introduction: Carpal tunnel syndrome is the most common compression neuropathy in clinical practice and is also the most extensively studied. In Mini-open carpal tunnel release, the transverse carpal ligament is transected using a small open cut at the volar aspect of the proximal palm. The objectives of this study were to determine the functional outcome of mini-open carpal tunnel release procedure, to use the Boston Questionnaire to determine the functional outcome following mini open carpal tunnel release which includes pain, numbness, weakness and fine hand activities.
 Methods: This descriptive cross-sectional was conducted in National After informed consent, the cases who meet the informed criteria were examined and relevant details were filled up in the proforma preoperatively and two weeks post-operatively. Assessment of the patient’s symptom severity and functional status was done with the Boston questionnaire.
 Results: CTS was most common in the age group of 25-29 years (36.36%) and was predominant in housewives (18.20%). Mean symptom severity scores per person improved from 3.11 pre-operatively to 1.12 post-operatively. Mean functional status scores per person improved from 2.65 pre-operatively to 1.03 post-operatively. There was a statistically significant improvement in postoperative outcomes in our population.
 Conclusions: The findings in this study indicate that mini-open carpal tunnel release has a good functional outcome.
 Keywords: carpal tunnel syndrome; compression neuropathy; transverse carpal ligament.

Effect of cinobufagin capsule on coagulation state, therapeutic effect and quality of life in patients with advanced lung cancer

Objective To explore the effects of cinobufagin capsule on coagulation status, therapeutic effect and quality of life of patients with advanced lung cancer. Methods A total of 64 patients with advanced lung cancer admitted to the Second People's Hospital of Jinzhong from February 2017 to January 2018 were selected, and they were divided into control group and observation group by random number table method, with 32 cases in each group.The control group was treated with chemotherapy, and the observation group was treated with cinobufagin capsules combined with chemotherapy.Blood coagulation status, quality of life score, pain numerical rating scale (NRS) and functional status score(KPS) were observed before and after treatment in the two groups.The clinical efficacy was compared between the two groups. Results Before treatment, there were no statistically significant differences in plasma fibrinogen(FIB), platelet(PLT), D-dimer, quality of life score, NRS score and KPS score between the two groups(all P>0.05). After treatment, the FIB, PLI and D-dimers in the observation group were (3.6±0.9)g/L, (248.3±11.3)×109/L, (19.8±1.2)mg/L respectively, which were significantly lower than those in the control group [(4.5±0.6)g/L, (398.2±16.2)×109/L, (40.2±0.6)mg/L] (t=11.642, 21.045, 18.249, all P<0.05). The total effective rate of the observation group was 90.6%(29/32), which was significantly higher than 68.8%(22/32) of the control group(χ2=6.903, P<0.05). The quality of life scores of the two groups were improved, and the life scores of the observation group were significantly higher than those of the control group(t=11.642, 21.045, 18.249, 17.218, all P<0.05). The NRS score of the observation group (3.62±1.53)points was significantly lower than that of the control group[(5.01±2.34)points], and the KPS score of the observation group[(78.25±3.81)points] was significantly higher than that of the control group[(72.34±4.12)points], the differences were statistically significant (t=16.082, 15.082, all P<0.05). Conclusion Treatment of advanced lung cancer with cinobufagin capsule combined with chemotherapy can significantly improve the coagulation state, treatment effect and quality of life of patients. Key words: Lung neoplasms; Huachansu Jiaonang; Drug therapy, combination; Blood coagulation factors; Fibrinogen; Blood platelets; Quality of life; Treatment outcome; Controlled clinical trial

Clinical Effect of Emergency Gastroscopy on Acute Bleeding of Gastric Cancer

Objective: To explore the clinical effect of applying emergency gastroscopy in the treatment of patients with acute bleeding of gastric cancer. Methods: A total of 80 patients with upper gastrointestinal bleeding caused by gastric cancer who were admitted in our hospital from December 2018 to December 2019 were selected and recruited. These patients were divided into two groups, namely the control group and experimental group by random number method, and were given conventional drug treatment and emergency gastroscopy treatment respectively. There were 40 patients in each group. The treatment effect and complication rate of the patients in each group were compared. Results: The rate of efficacy of emergency gastroscopy treatment in patients of the experimental group was 95.00%, whereas the rate of efficacy of conventional drug treatment in patients of the control group was 82.50%. The efficacy rate in the experimental group was higher, and the data were significantly different after statistical comparison. Before treatment, the Karnofsky functional status scores of the patients in both control group and experimental group were not significantly different. After treatment, the patients' scores were all improved. Compared with the control group, the experimental group had a higher degree of improvement, and the effect was more significant. There was a statistically significant difference in data between the two groups (P &lt; 0.05). Conclusion: Gastroscopy treatment of patients with acute gastrointestinal bleeding caused by gastric cancer can effectively shorten the bleeding time of patients, reduce the incidence of postoperative complications, and have positive impact for the prognosis of patients.

MON-160 VIABILITY OF PALLIATIVE CARE AS A TREATMENT OPTION FOR ELDERLY PATIENTS WITH END-STAGE RENAL DISEASE IN TWO TERTIARY HOSPITALS IN SOUTHEAST NIGERIA; A PRELIMINARY REPORT

The number of elderly patients developing end-stage renal disease (ESRD) is on the increase in Nigeria. With multiple co-morbid conditions, evidence is needed to inform decision making for or against dialysis among these patients. A cross-sectional analysis of patients from 60 years and above with ESRD who were treated with either haemodialysis or palliative care over a period of two years in two tertiary hospitals in SouthEast Nigeria. The symptom burden, quality of life and functional status were assessed by standard validated methods. Survival was defined as time from diagnosis of ESRD to either death or been censored. Kaplan-Meier survival analysis and Log rank test was used to estimate and compare survival. Cox proportional hazard regression models were used to investigate the impact of independent variables on survival. Haemodialysis was offered to 114 (75%) while 38 (25%) choose palliative (non-aggressive) renal care for various reasons. Patients who opted for palliative care had a significantly higher mean symptom burden score and lower quality of life scores than their counterparts on dialysis treatment (p=0.760). There was no significant difference in mean functional status scores between the two groups (p=0.837). The mean survival time for those on dialysis treatment (7.1 months) was slightly higher than mean survival time for those on palliative care (5.8 months) but there is no significant evidence of difference in survival times for both groups (Log rank = 1.2, p=0.27). Palliative care may be a viable option for management of ESRD as it has comparable survival advantage with haemodialysis; howbeit with a higher symptom burden and lower quality of life.

Reliability and Validity of The Finnish Version of The Boston Carpal Tunnel Questionnaire among Surgically Treated Carpal Tunnel Syndrome Patients.

The Boston Carpal Tunnel Questionnaire is the most commonly used outcome measure in the assessment of carpal tunnel syndrome. The purpose of this study was to translate the original Boston Carpal Tunnel Questionnaire into Finnish and validate its psychometric properties. We translated and culturally adapted the Boston Carpal Tunnel Questionnaire into Finnish. Subsequently, 193 patients completed the Finnish version of the Boston Carpal Tunnel Questionnaire, 6-Item CTS Symptoms Scale, and EuroQol 5 Dimensions 12 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire was re-administered after a 2-week interval. We calculated construct validity, internal consistency, test-retest reliability, and coefficient of repeatability. We also examined floor and ceiling effects. The cross-cultural adaptation required only minor modifications to the questions. Both subscales of the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Functional Status Scale) correlated significantly with the CTS-6 and EuroQol 5 Dimensions, indicating good construct validity. The Cronbach's alpha was 0.93 for both the Symptom Severity Scale and Functional Status Scale, indicating high internal consistency. Test-retest reliability was excellent, with an intraclass correlation coefficient greater than 0.8 for both scales. The coefficient of repeatability was 0.80 for the Symptom Severity Scale and 0.68 for the Functional Status Scale. We observed a floor effect in the Functional Status Scale in 28% of participants. Our study shows that the present Finnish version of the Boston Carpal Tunnel Questionnaire is reliable and valid for the evaluation of symptom severity and functional status among surgically treated carpal tunnel syndrome patients. However, owing to the floor effect, the Functional Status Score may have limited ability to detect differences in patients with good post-operative outcomes.

Deleterious Effects of Higher Body Mass Index on Subjective and Objective Measures of Chemotherapy-Induced Peripheral Neuropathy in Cancer Survivors

ContextRecent, albeit, limited evidence suggests that body mass index (BMI) may be a modifiable risk factor to reduce the deleterious effects of chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors. ObjectivesTo evaluate for differences in demographic, clinical, pain, sensation, and balance characteristics among three BMI groups. We hypothesized that as BMI increased, survivors would report higher pain intensity scores and have significant decrements in measures of sensation and balance. MethodsA total of 416 survivors with CIPN were evaluated using subjective and objective measures of CIPN. Survivors were divided into three BMI groups (i.e., normal weight, overweight, and obese). Differences among the BMI groups were evaluated using parametric and nonparametric statistics. ResultsOf the 416 survivors, 45.4% were normal weight, 32.5% were overweight, and 22.1% were obese. Compared with the normal-weight group, survivors in the other two groups had lower functional status scores, a higher comorbidity burden, higher pain intensity scores, and higher interference scores. In addition, compared with the normal-weight group, survivors in the other two BMI groups had significantly worse balance scores. ConclusionOur findings support the hypothesis that as BMI increased, pain sensation and balance characteristics worsened. Our findings suggest that nutritional counseling as well as exercise and weight management programs in survivors with CIPN may improve these clinically important problems.

Turkish translation, cross-cultural adaptation, and assessment of psychometric properties of the Functional Status Score for the Intensive Care Unit

Purpose: To translate and cross-culturally adapt the Functional Status Score for the Intensive Care Unit instrument to Turkish and investigate its psychometric properties.Methods: An expert committee supervised forward and backward translation. Thirteen participants reviewed the pre-final version of Turkish Functional Status Score for the Intensive Care Unit instrument providing minor revisions to improve its readability. Two physiotherapists assessed patients (N = 50) from a coronary intensive care unit using the Turkish Functional Status Score for the Intensive Care Unit instrument.Results: Internal consistency was excellent (Cronbach's α = 0.949). Inter-rater reliability and intra-rater reliability were excellent for each of five functional tasks and total scores (intra-class correlation coefficient = 0.955–0.996). The Turkish Functional Status Score for the Intensive Care Unit score had moderate to high correlations with other functional measures as follows: Perme Intensive Care Unit Mobility Score (Spearman's r = 0.92), Katz Activities of Daily Living (r = 0.80), handgrip strength (r = 0.76–0.77), and knee extension strength (r = 0.70–0.71).Conclusion: The Functional Status Score for the Intensive Care Unit instrument was translated and culturally adapted to Turkish and demonstrated strong psychometric properties, including internal consistency, intra-rater and inter-rater reliability, construct validity, and floor and ceiling effects.Implications for rehabilitationRehabilitation professionals strive to assess and document patient status using validated and reliable outcome measures as part of good clinical practice.Longitudinal evaluation of physical function in the intensive care units is important.The Functional Status Score for the Intensive Care Unit is a validated and reliable physical functioning measurement instrument suitable for the intensive care units.The Functional Status Score for the Intensive Care Unit was translated and culturally adapted to Turkish, and demonstrated strong psychometric properties, including internal consistency, intra-rater reliability, inter-rater reliability, construct validity, and floor and ceiling effects.

Cross-cultural adaptation and Rasch validation of the Slovene version of the Orthotics and Prosthetics Users' Survey (OPUS) Client Satisfaction with Device (CSD) in upper-limb prosthesis users.

To validate the Slovene version of the Orthotics and Prosthetics Users' Survey (OPUS) 8-item Client Satisfaction with Device (CSD) questionnaire in upper-limb prosthesis users and to further verify measurement properties of this tool with Rasch analysis. Participants consisted of a convenience sample of 76 adults (54 men) using a prosthesis after unilateral upper-limb amputation who consecutively attended a follow-up visit at our centre. After translation and cross-cultural adaptation of the CSD into the Slovene language, we evaluated functioning of the rating scale categories, item fit (internal construct validity), reliability indices and dimensionality, as well as convergent and discriminant construct validity of the questionnaire. Rasch analysis indicated that: (1) functioning of the 4 response options was acceptable; (2) all items fitted the measured construct [information-weighted (infit) and outlier-sensitive (outfit) mean-square statistics 0.60 to 1.40]; (3) person separation reliability was 0.62 (and Cronbach α=0.76), item separation reliability was 0.83; (4) on principal component analysis (PCA) on the standardised residuals, the CSD showed borderline but acceptable unidimensionality and no local item dependency. Moreover, as expected, the CSD score showed good correlation with the QUEST 2.0 score (rs=0.57) and little to fair correlation with the OPUS Upper Extremity Functional Status score (rs=0.21). The metric properties of the Slovene version of CSD agree with previous studies. The present study confirms the validity of CSD for measuring patient satisfaction with an upper-limb device, enhances the confidence in this tool for assessing upper-limb prosthesis users, and contributes to further refining the technical quality of this measure.

Interrater Reliability of the Functional Status Score for the Intensive Care Unit: Erratum

Interrater Reliability of the Functional Status Score for the Intensive Care Unit: Erratum

Abstract MP40: Higher Intakes of Animal Protein Helps Maintain Functional Status and Grip Strength in Older Adults in the Framingham Offspring Study

Introduction: Dietary protein has been shown to prevent age-related functional decline and strength loss, but few studies have examined the separate effects of animal and plant proteins on these outcomes. Hypothesis: We hypothesized that animal protein might provide greater protection against strength loss and functional decline than plant protein in older adults (aged ≥ 50 years) in the Framingham Offspring Study (FOS). Methods: Dietary protein was assessed using 3-day diet records at exams 3 and 5 in the prospective FOS; intakes were adjusted for body weight using the residual method. Functional status scores (median follow-up 17.3 years) was derived from standardized questionnaires at exams 5-9, while grip strength (median follow-up 10.3 years) was measured by hand-held dynamometer at exams 7-9. Multivariable analyses included Cox proportional hazards modeling, repeated-measures mixed models, and analysis of covariance to adjust for sex, age, education, percent of calories from saturated fats, and physical activity. Models for animal protein were adjusted for plant protein intake and vice versa. Results: Subjects were categorized into 3 categories of sex-specific intakes of animal protein (&lt;50, 50-&lt;70, and ≥70 g/day for men; &lt;45, 45-&lt;65, and ≥65 g/day for women) and plant protein (&lt;20, 20-&lt;26 and ≥26 g/day for men; &lt;17, 17-&lt;22, and ≥22 g/day for women). At the end of follow-up, those with the highest (vs. lowest) animal protein intakes maintained the highest functional status levels (functional score: 20.4 vs.19.0, respectively p=0.0036). Similar results were observed for plant proteins (20.2 vs.18.4 for highest vs. lowest intakes, p ≤.0001). In stratified analyses, higher intakes of both animal and plant proteins, especially in combination with higher levels of activity, were associated with greater preservation of functional status over time. Among more sedentary individuals, dietary protein alone (from both animal and plant sources) protected against functional decline over time (p=0.0015 and p=0.0008 for animal and plant protein, respectively). For grip strength, however, only animal protein protected against decline over 10.3 years (change in grip strength: -0.41 vs. -0.60 kg/yr for highest vs. lowest intakes in men, p=0.0273; -0.15 vs. -0.29 kg/yr for highest vs. lowest intakes in women, p=0.0487). Higher plant protein intake was not associated preservation of grip strength over time. Conclusions: Higher intakes of both animal and plant protein were protective of self-reported functional status in these analyses while only animal protein was associated with the preservation of grip strength among older adults.

Discharge outcome after out-of-hospital cardiac arrest could be predicted with the functional status score for the ICU

Discharge outcome after out-of-hospital cardiac arrest could be predicted with the functional status score for the ICU

Limitation of Life-Sustaining Care in the Critically Ill: A Systematic Review of the Literature.

When life-sustaining treatments (LST) are no longer effective or consistent with patient preferences, limitations may be set so that LSTs are withdrawn or withheld from the patient. Many studies have examined the frequency of limitations of LST in intensive care unit (ICU) settings in the past 30 years. This systematic review describes variation and patient characteristics associated with limitations of LST in critically ill patients in all types of ICUs in the United States. A comprehensive search of the literature was performed by a medical librarian between December 2014 and April 2017. A total of 1,882 unique titles and abstracts were reviewed, 113 were selected for article review, and 36 studies were fully reviewed. Patient factors associated with an increased likelihood of limiting LST included white race, older age, female sex, poor preadmission functional status, multiple comorbidities, and worse illness severity score. Based on several large, multicenter studies, there was a trend toward a higher frequency of limitation of LST over time. However, there is large variability between ICUs in the proportion of patients with limitations and on the proportion of deaths preceded by a limitation. Increases in the frequency of limitations of LST over time suggests changing attitudes about aggressive end-of-life-care. Limitations are more common for patients with worse premorbid health and greater ICU illness severity. While some differences in the frequency of limitations of LST may be explained by personal factors such as race, there is unexplained wide variability between units.

Time between expanded disability status scale (EDSS) scores

BackgroundAlthough the expanded disability status scale (EDSS) is the most commonly used measure of disability for multiple sclerosis, measurement of disability accumulation is complex due to the unequal steps of the scale. ObjectiveTo estimate the time between EDSS scores in a large MS cohort from a single center and determine the impact of functional system scores on EDSS transitions. Methods31,394 clinical visits with EDSS scores from 2054 subjects in the CLIMB longitudinal cohort study were included in our analysis. The time to each EDSS score and the time between each EDSS score were calculated using the nonparametric maximum likelihood estimate for interval censored data. For each initial EDSS value, the association between functional status scores and subsequent EDSS value was assessed using a mixed effects linear regression model, and the association with time to EDSS increase was assessed using a Cox proportional hazards model. ResultsThe median time until EDSS 2, 3, 4, 5 and 6 in all subjects were 4.8, 15.1, 28.2, 31.2, and 32.4 years, respectively. The time intervals showed that the disability accumulation intervals from EDSS 4 to 6 were much shorter than the accumulation intervals from EDSS 0 to 3 or from EDSS 6 to 8. For EDSS of 1 or 1.5, pyramidal, cerebellar, sensory, bowel-bladder and mental system scores were associated with higher subsequent EDSS values. For higher EDSS values, only pyramidal and bowel-bladder scores maintained the association. ConclusionsTime between specific EDSS levels varies considerably. Certain functional system scores have greater predictive power for future EDSS-related disability despite same present EDSS level. These findings will assist in adaptation of the EDSS as an outcome measure to assess MS-related disability in clinical trials.

Abstract WP496: Early Mobility in the Neurosurgical Intensive Care Unit: A Quality Improvement Project

Bed rest is prevalent among patients in neurosurgical intensive care units (NSICU). The most common conditions that contribute to bed rest are acute ischemic or hemorrhagic strokes, neuromuscular weaknesses, spinal instability, post endovascular interventions, neurobehavioral disturbances, and mechanical ventilation. The immobility of bed rest causes numerous complications including critical illness myopathy, deep venous thrombosis (DVT), pressure ulcers, pulmonary dysfunction, bone demineralization, alterations in peripheral muscle mass, joint contractures, and general deconditioning. The purpose of this evidence-based quality improvement (QI) project was to evaluate the effectiveness of a practice change, which was the implementation of an early mobility program in the NSICU. The study design for this project was a retrospective analysis of a previous practice change. The algorithm for the practice change was specially designed for patients with neurological illnesses in the ICU. The number of days during which patients had mobility interventions, the frequency of mobility interventions, Functional Status Score for ICU (FSS-ICU), NSICU Length of Stay (LOS), the incidence of ICU delirium, and ventilator days were compared pre and post intervention. This QI project was conducted in an academic neuroscience hospital with 146 beds and receives referral patients from all over the nation. The principal investigator (PI) anticipated an increase in the physical activity, thereby improving the functional and cognitive outcomes of critically ill patients admitted to the NSICU through this QI project. The outcomes of this QI project were assessed and the results revealed a statistically significant improvement in the frequency of out of bed mobility activities (number of days patients had mobility interventions, p = 0.03; frequency of mobility steps, p = 0.002). The difference in mean LOS ( p = 0.5), FSS-ICU ( p = 0.7), and ICU delirium ( p = 0.99) did not prove any statistical significance. The intervention of early mobilization in the NSICU is safe and feasible to implement, providing a structured plan for increasing the activity level of neurologically injured patients.

Feasibility, Reliability, Responsiveness, and Validity of the Patient-Reported Functional Scale for the Intensive Care Unit: A Pilot Study

Although many performance-based measures assess patients' physical function in intensive care unit (ICU) survivors, to our knowledge, there are no patient-reported ICU rehabilitation-specific measures assessing function. We developed the Patient-Reported Functional Scale-ICU (PRFS-ICU), which measures patients' perceptions of their ability to perform 6 activities (rolling, sitting edge of bed, sit-to-stand and bed-to-chair transfers, ambulation, and stair climbing). Each item is scored from 0 (unable) to 10 (able to perform at pre-ICU level) to a maximum of 60. Estimate the feasibility, reliability, responsiveness, and validity of the PRFS-ICU. This was a substudy of TryCYCLE, a single-center, prospective cohort examining the safety and feasibility of early in-bed cycling with mechanically ventilated patients (NCT01885442). To determine feasibility, we calculated the number of patients with at least 1 PRFS-ICU assessment during their hospital stay. To assess reliability, 2 raters blinded to each other's assessments administered the PRFS-ICU within 24-hours of each other. We calculated the intraclass correlation coefficient (ICC; 95% confidence interval [CI]), standard error of measurement (SEM, 95% CI), and minimal detectable change (MDC90). To assess validity, we estimated convergent validity of the PRFS-ICU with the Functional Status Score for ICU (FSS-ICU), Medical Research Council Sum Score (MRC-SS), Physical Function Test for ICU (PFIT-s), Katz Index of Independence in Activities of Daily Living (Katz ADLs), and a pooled index using Pearson's correlation coefficient (r, 95% CI). Feasibility: 20 patients completed a PRFS-ICU assessment. Reliability and responsiveness: 16 patients contributed data. The ICC, SEM, and MDC90 were 0.91 (0.76, 0.97), 4.75 (3.51, 7.35), and 11.04 points, respectively. Validity: 19 patients contributed data and correlations were (r [95% CI]): FSS-ICU (0.40 [-0.14, 0.76]), MRC-SS (0.51 [0.02, 0.80]), PFIT-s (0.43 [-0.13, 0.78]), Katz ADLs (0.53 [0.10, 0.79]), and pooled index (0.48 [-0.14, 0.82]). Our pilot work suggests the PRFS-ICU may be a useful tool to assess and monitor patients' perceptions of function over time.

Effects of apatinib in the treatment of advanced hepatocellular carcinoma associated with hepatitis B

Objective To observe the effects of apatinib in the treatment of advanced hepatocellular carcinoma associated with hepatitis B. Methods The clinical data of 72 patients with advanced hepatocellular carcinoma associated with hepatitis B admitted to the First Affiliated Hospital of Bengbu Medical College from January 2015 to May 2017 were retrospectively analyzed. Among them, 37 patients were treated with apatinib once a day, as apatinib group; 35 patients were treated with FOLFOX4 (oxaliplatin+ calcium folinate+ 5-fluorouracil) palliative chemotherapy, as FOLFOX4 group. The objective response rate (ORR), disease control rate (DCR), serum alpha fetal protein (AFP), improvement of clinical symptoms, Karnofsky functional status (KPS) score improvement rate, median progression-free survival (PFS), median overall survival (OS), and the incidence of adverse reactions from both groups were contrastively analyzed. Results The ORR of apatinib group (27.03%, 10/37) was higher than that of FOLFOX4 group (17.14%, 6/35), and DCR (64.86%, 24/37) was also higher than that of FOLFOX4 group (48.57%, 17/35). However, there were no significant difference in ORR and DCR between the two groups (χ2=1.017, P=0.313; χ2=1.948, P=0.163). After 16 weeks of treatment, serum AFP of apatinib group [(280±20) ng/ml] was significantly lower than that in FOLFOX4 group [(450±20) ng/ml, t=36.049, P<0.001]. Improvement rate of KPS score (86.49%, 32/37) was significantly more than that of FOLFOX4 group (57.14%, 20/35; χ2=7.720, P=0.006). Improvement rate of clinical symptoms (72.97%, 27/37) was significantly more than that of FOLFOX4 group (42.86%, 15/35; χ2=6.712, P=0.010). The mean PFS of apatinib group was 6.2 months, which was significantly longer than that of FOLFOX4 group (2.8 months, χ2=4.815, P=0.028). The mean OS of apatinib group was 10.9 months, which was significantly longer than that of FOLFOX4 group (6.6 months, χ2=26.429, P<0.001). In apatinib group, the main adverse reactions were hypertension, proteinuria and hand-foot syndrome; and in FOLFOX4 group, the main adverse reactions were leukopenia, neurotoxicity and liver function damage. Moreover, the adverse reactions in both groups were mostly 1 or 2 grade, which could be relieved or improved through symptomatic treatment. Conclusion Apatinib is safe and effective in the treatment of advanced hepatocellular carcinoma associated with hepatitis B. It can significantly prolong the life of patients and improve the quality of life and the clinical symptoms of patients. Key words: Carcinoma, hepatocellular; Hepatitis B; Efficacy; Apatinib

Chilean version of the Functional Status Score for the Intensive Care Unit: a translation and cross-cultural adaptation.

The Functional Status Score for the Intensive Care Unit (FSS-ICU) is a valid and reliable instrument to measure physical functioning in the intensive care unit setting. Translation and cross-cultural adaptation in Chile has not been published for the FSS-ICU. To translate and cross-culturally adapt all associated documents of the original FSS-ICU for Chile. The Spanish version of FSS-ICU, available at www.ImproveLTO.com, was used as the starting point. This version was previously translated, with the original FSS-ICU developers, following established guidelines for this process. The Chilean pocket card version was newly developed based on the English version at www.ImproveLTO.com. Cognitive interviews were conducted for the adaptation of the FSS-ICU and pocket card version to assess understanding of relevant stakeholders (i.e., Chilean intensive care unit physiotherapists). Adaptations to the translation were made when agreement among the physiotherapists was less than 80%. Cognitive interviews of the Chilean FSS-ICU (85 items) and pocket card version (18 items) were performed with 30 Chilean physiotherapists from 18 hospitals (14 public and 4 private). During the interviews, modest adaptations mainly made in the general guidelines and specific instructions for three items of the FSS-ICU and two items of the pocket card. Finally, the frequently asked questions, pocket card and full version of the FSS-ICU were developed. The original developers accepted all adaptations. The Chilean version of the FSS-ICU was easy to understand by the physiotherapists. The FSS-ICU is freely available for non-commercial clinical and research use by Chilean Spanish-speakers.

Assessment of the measurement properties of the Brazilian versions of the Functional Status Score for the ICU and the Functional Independence Measure in critically ill patients in the intensive care unit

ObjectiveTo compare the measurement properties (internal consistency, intra and interrater reliability, construct validity, and ceiling and floor effects) of the Functional Status Score for the ICU (FSS-ICU) and the Functional Independence Measure (FIM-motor domain).MethodsIn this study of measurement properties, the FSS-ICU and FIM were applied to 100 patients (72.1 ± 15.9 years; 53% male; Sequential Organ Failure Assessment = 11.0 ± 3.5 points, Simplified Acute Physiology Score 3 = 50.2 ± 16.8 points) in an intensive care unit at baseline and after 2 hours by physiotherapist 1 (test and retest) and 30 minutes after baseline by physiotherapist 2. The measurement properties evaluated were internal consistency (Cronbach's alpha), intra- and interrater reliability (intraclass correlation coefficient), agreement (standard error of measurement) and minimum detectable change at a 90% confidence level, ceiling and floor effects (frequency of maximum and minimum scores) and construct validity (Pearson's correlation).ResultsThe FSS-ICU and FIM presented adequate internal consistency (Cronbach's alpha, FSS-ICU = 0.95 and FIM = 0.86), intra-and interrater reliability for overall FSS-ICU and FIM score (ICC > 0.75), agreement (minimum detectable change at a 90% confidence level: FSS-ICU and FIM = 1.0 point; standard error of measurement: FSS-ICU = 2% and FIM = 1%) and construct validity (r = 0.94; p < 0.001). However, the FSS-ICU and FIM presented ceiling effects (maximum score for 16% of patients for the FSS-ICU and 18% for the FIM).ConclusionThe FSS-ICU and FIM present adequate measurement properties to assess functionality in critically ill patients, although they present ceiling effects.