Heterogeneous Study Sample Research Articles

Academic Outcomes with Hearing Amplification Devices in Children with Unilateral Hearing Loss: A Systematic Review and Narrative Synthesis.

Many studies have shown increased academic problems in children with unilateral hearing loss (UHL). However, whether hearing devices can ameliorate the educational difficulties associated with UHL is not well studied. Therefore, the objective of the current systematic review was to answer the question: do nonsurgical amplification devices, bone-anchored hearing aids, and/or cochlear implants improve academic outcomes in school-aged children and adolescents with UHL? Embase, MEDLINE, Scopus, CINAHL, APA PsycInfo, <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, and Cochrane databases were searched from inception to December 21, 2022. Published, peer-reviewed studies comparing academic outcomes in patients with UHL aged ≥5 and ≤19 years with and without hearing devices (nonsurgical amplification devices, bone-anchored hearing aids, or cochlear implants) were included. Results of studies were qualitatively synthesized, and the risk of bias was evaluated with the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. A total of 5,644 non-duplicate publications were identified by the search, and four studies were included for synthesis, every one of which was investigating nonsurgical amplification. One small, single-arm study demonstrated significant improvement in subjective classroom listening difficulties after a 3- to 4-month trial with a behind-the-ear hearing aid. The other three studies of nonsurgical amplification devices showed no benefit across multiple academic outcomes with FM systems and conventional and CROS-style hearing aids. The small sample sizes, heterogeneous and/or ill-defined study samples, and overall low quality of the available literature ultimately make it hard to draw definitive conclusions regarding nonsurgical amplification devices' effectiveness in improving academic outcomes in children with UHL. No articles were identified that studied cochlear implants or bone-anchored hearing aids. Further studies with high-quality study design, large sample sizes, and long-term follow-up are needed to answer this clinically important question.

Effectiveness of psychosocial interventions for infertile women: A systematic review and meta-analysis with a focus on a method-critical evaluation.

Approximately seven to nine percent of couples of reproductive age do not get pregnant despite regular and unprotected sexual intercourse. Various psychosocial interventions for women and men with fertility disorders are repeatedly found in the literature. The effects of these interventions on outcomes such as anxiety and depression, as well as on the probability of pregnancy, do not currently allow for reliable generalisable statements. This review includes studies published since 2015 performing a method-critical evaluation of the studies. Furthermore, we suggest how interventions could be implemented in the future to improve anxiety, depression, and pregnancy rates. The project was registered with Prospero (CRD42021242683 13 April 2021). The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched and 479 potential studies were discovered. After reviewing the full texts, ten studies were included for the synthesis. Not all studies reported the three outcomes: four studies each for depression, three for anxiety and nine studies for pregnancy rates were included in the meta-analysis, which was conducted using the Comprehensive meta-analysis (CMA) software. Psychosocial interventions do not significantly change women's anxiety (Hedges' g -0,006; CI: -0,667 to 0,655; p = 0,985), but they have a significant impact on depression in infertile women (Hedges' g -0,893; CI: -1,644 to -0,145; p = 0,026). Implementations of psychosocial interventions during assisted reproductive technology (ART) treatment do not increase pregnancy rates (odds ratio 1,337; 95% CI 0,983 to 1,820; p = 0,064). The methodological critical evaluation indicates heterogeneous study design and samples. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. Study design (duration and timing of intervention, type of intervention, type of data collection) and samples (age of women, reason for infertility, duration of infertility) are very heterogeneous. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. In order to be able to better compare psychosocial interventions and their influence on ART treatment and thus also to achieve valid results, a standardised procedure to the mentioned factors is necessary.

Titanium miniplate removal after joint orthodontic-orthognathic surgery treatment: a 10-year retrospective hospital-based audit.

The reported incidence of titanium miniplate removal after orthognathic surgery varies widely, making delivery of risk information to patients problematic. This variation relates to potential biases introduced during the study design, for example, with the pooling of different patient types, creating heterogeneous study samples. This study reduces sampling bias by limiting the cohort to only consecutive orthognathic cases. The primary aim of the study was to identify the incidence of miniplate removal following orthognathic surgery. The secondary aim was to assess the indications and any risk factors for miniplate removal. Data from the clinical records of 907 orthognathic surgery cases treated within a centralised oral and maxillofacial hospital service over a 10-year period were collected by two operators and analysed. Every identified case qualified for inclusion. Patient demographics (age, sex, medical comorbidity, smoking), operations (type of surgery, duration, third molar removal, complications) and the indication, timing and site of miniplate removal were analysed. Only 19 patients required postoperative miniplate removal, with the most common indication being infection (63%). There was no significant difference in any of the factors assessed except that significantly more miniplates were removed from female patients (68%) (p<0.001) and from mandibular sites (84.2%) (p=0.003). The incidence of miniplate removal for this sample was 2.1%. Female sex and miniplate location in the mandible were the only statistically significant risk factors for miniplate removal.

Delirium prevention and management: Development and implementation of a non-pharmacological catalog of measures in the acute setting

Delirium prevention and management: Development and implementation of a non-pharmacological catalog of measures in the acute setting Abstract. Background: In October 2018, a new delirium management concept was developed in a university hospital for cardiovascular diseases. As part of a multi-professional approach, the previously established "Evidence-based Nursing working group (AK EBN)", consisting of academically qualified nurses from the hospital, was involved in the implementation process. Aim: The AK EBN aimed to identify effective non-pharmacological interventions to prevent and treat delirium and to establish how these interventions could influence delirium rates in hospital patients. Methods: The EbN method was employed to address the study question applying the PICO framework (Behrens & Langer, 2016) as the bases for systematic searches in different databases. Relevant studies were identified, data were extracted, displayed in tables and discussed within the AK using established critical appraisal tools for quality assessment. Results: Despite a heterogeneous study sample, results showed that there is meaningful evidence for the effectiveness of intervention bundles on the reduction of delirium rates. Bundles include for example, aspects of orientation and noise reduction. As a result, a catalogue of non-pharmacological interventions, communication aids, and a guide for involving caregivers in the prevention and treatment of delirium were developed. Additionally, continuing training events held by the participants of AK EBN were organized. Conclusions: To promote the successful implementation of projects in practice, the involvement of all stakeholders is important. As part of a skill-grade-mix, nurses made an important contribution in this multi-professional project.

Twelveyears of research domain criteria in psychiatric research and practice: claim and reality

The research domain criteria (RDoC) initiative of the National Institute of Mental Health (NIMH) was presented 12 years ago. The RDoC provides amatrix for the systematic, dimensional and domain-based study of mental disorders that is not based on established disease entities as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD). The primary aim of RDoC is to understand the nature of mental health and illness in terms of different extents of dysfunction in psychological/biological systems with interconnected diagnoses. This selective review article aims to provide acomprehensive overview of RDoC-based studies that have contributed to abetter conceptual organization of mental disorders. Numerous promising and methodologically sophisticated studies on RDoC were identified. The number of scientific studies increased over time, indicating that dimensional research is increasingly being pursued in psychiatry. In summary, the RDoC initiative has aconsiderable potential to more precisely define the complexity of pathomechanisms underlying mental disorders; however, major challenges (e.g. small and heterogeneous study samples, unclear biomarker definitions and lack of replication studies) remain to be overcome in the future. Furthermore, it is plausible that adiagnostic system of the future will integrate categorical and dimensional approaches to arrive at a stratification that can underpin aprecision medical approach in psychiatry.

Phenotyping the Association between Nocturia and Hypertension: A Systematic Review and Meta-Analysis.

The association between nocturia and hypertension has been widely reported yet remains poorly characterized, precluding a more refined understanding of blood pressure as it relates to the clinical urology setting. We synthesized current evidence on the relationship between nocturia and hypertension as a function of nocturia severity, age, gender, race, body mass index and diuretic use. We searched PubMed®, EMBASE® and Cochrane databases for studies published up to May 2020. Random effects meta-analyses were performed to identify pooled odds ratios for nocturia given the presence of hypertension. Meta-regression and subgroup analyses were performed to identify differences across study samples. Of 1,193 identified studies, 25 met the criteria for inclusion. The overall pooled OR for the association of nocturia with hypertension was 1.25 (95% CI 1.21-1.28, p <0.001). Pooled estimates were 1.20 (1.16-1.25, p <0.001) and 1.30 (1.25-1.36, p <0.001) using a 1-void and 2-void cutoff for nocturia, respectively (p <0.001 between cutoffs). The association was more robust in patient-based (1.74 [1.54-1.98], p <0.001) vs community-based (1.24 [1.24-1.29], p <0.001) study samples (p <0.001). The association was stronger in females compared to males (1.45 [1.32-1.58] vs 1.28 [1.22-1.35], p <0.001), and Black (1.56 [1.25-1.94]) and Asian (1.28 [1.23-1.33]) vs White subgroups (1.16 [1.08-1.24]; p <0.05 for both). No effect was observed for age or body mass index. Evidence on diuretics was limited. Hypertension is associated with a 1.2-fold to 1.3-fold higher risk of nocturia. This association is more robust at a higher nocturia cutoff, in patient-based study samples, among females and in Black and Asian patients, but unrelated to age or body mass index.

Differential mirror neuron system (MNS) activation during action observation with and without social-emotional components in autism: a meta-analysis of neuroimaging studies

BackgroundImpaired imitation has been found to be an important factor contributing to social communication deficits in individuals with autism spectrum disorder (ASD). It has been hypothesized that the neural correlate of imitation, the mirror neuron system (MNS), is dysfunctional in ASD, resulting in imitation impairment as one of the key behavioral manifestations in ASD. Previous MNS studies produced inconsistent results, leaving the debate of whether “broken” mirror neurons in ASD are unresolved.MethodsThis meta-analysis aimed to explore the differences in MNS activation patterns between typically developing (TD) and ASD individuals when they observe biological motions with or without social-emotional components. Effect size signed differential mapping (ES-SDM) was adopted to synthesize the available fMRI data.ResultsES-SDM analysis revealed hyperactivation in the right inferior frontal gyrus and left supplementary motor area in ASD during observation of biological motions. Subgroup analysis of experiments involving the observation of stimuli with or without emotional component revealed hyperactivation in the left inferior parietal lobule and left supplementary motor during action observation without emotional components, whereas hyperactivation of the right inferior frontal gyrus was found during action observation with emotional components in ASD. Subgroup analyses of age showed hyperactivation of the bilateral inferior frontal gyrus in ASD adolescents, while hyperactivation in the right inferior frontal gyrus was noted in ASD adults. Meta-regression within ASD individuals indicated that the right cerebellum crus I activation increased with age, while the left inferior temporal gyrus activation decreased with age.LimitationsThis meta-analysis is limited in its generalization of the findings to individuals with ASD by the restricted age range, heterogeneous study sample, and the large within-group variation in MNS activation patterns during object observation. Furthermore, we only included action observation studies which might limit the generalization of our results to the imitation deficits in ASD. In addition, the relatively small sample size for individual studies might also potentially overestimate the effect sizes.ConclusionThe MNS is impaired in ASD. The abnormal activation patterns were found to be modulated by the nature of stimuli and age, which might explain the contradictory results from earlier studies on the “broken mirror neuron” debate.

P222 Vitamin D in early rheumatoid arthritis

Abstract Background Rheumatoid arthritis (RA) is the commonest chronic inflammatory arthritis, predominantly affecting small/medium joints and associated with extra-articular features. Previous studies have linked RA risk and disease activity with vitamin D-deficiency, but a causal role for vitamin D in RA is still unclear, partly due to heterogeneous study methods and sample populations. Moreover, no studies have focused specifically on vitamin D status (serum levels of 25-hydroxyvitamin D, 25OHD) in early RA, or whether low 25OHD is linked to progression from undifferentiated inflammatory arthritis to RA. Our objectives were therefore (1) to analyse serum 25OHD in early inflammatory arthritis, (2) to compare 25OHD levels with disease activity and fatigue in early RA and (3) to determine whether low serum 25OHD is associated with progression to RA. Methods We analysed 791 patients enrolled in the Birmingham Early Arthritis Cohort from 2013-19 at Sandwell and West Birmingham Hospitals NHS Trust and University Hospitals Birmingham NHS Trust. We collect baseline demographic data, serum 25OHD (ng/ml), and clinical variables including: duration of symptoms, duration of early morning stiffness (EMS), CRP, ESR, anti-CCP antibody status, Rheumatoid factor status, tender and swollen joint counts, DAS28-ESR, DAS28-CRP, Visual Analogue Scale (VAS) pain/fatigue and FACIT scores. Diagnosis was recorded at 0 and 12 months onwards as either RA, psoriatic arthritis (PsA), Undifferentiated Inflammatory Arthritis (UIA; synovitis not meeting other classification/diagnostic criteria), Clinical Suspect Arthralgia (CSA; arthralgia of an inflammatory type without synovitis), or Other. Data were analysed using SPSSv25. Full ethical approval was given for the study (REC12/WM/0258). Results Baseline demographic data were similar between all groups, with a median symptom duration of 16.8-34.0 days. Baseline 25OHD was not significantly different between groups [median, interquartile range (IQR): RA 46.7, 30.0-73.3; PsA 41.2, 30.0-65.0; UIA 51.4, 30.0-72.3; CSA 47.7, 30.3-73.0; Other 37.0, 24.9-55.3]. In the RA group (n = 335), there were no significant differences between 25OHD and any measures of disease activity/fatigue. Finally, we found no association between 25OHD and progression from UIA (n = 121) or CSA (n = 150) to RA (p = 0.554 and p = 0.741 respectively). Conclusion Overall we found no clear association between serum 25OHD and baseline diagnosis, RA disease activity, or progression from UIA/CSA to RA in this large cohort of early RA patients. Limitations of the study include that we were unable to report on levels of vitamin D metabolites which may be more important than total vitamin D. In addition, we were unable to adjust for supplement use/ time of year the sample was taken due to missing data. Future studies into the role of different metabolites of vitamin D in aetiopathogenesis of inflammatory arthritis would provide invaluable insight into the role of vitamin D in inflammatory arthritis better defining the complex role of vitamin D in RA. Disclosures S.R. Harrison: None. G. Jutley: None. D. Li: None. I. Sahbudin: None. A. Filer: None. M. Hewison: None. K. Raza: None.

Reduced fronto-striatal volume in attention-deficit/hyperactivity disorder in two cohorts across the lifespan

Attention-Deficit/Hyperactivity Disorder (ADHD) has been associated with altered brain anatomy in neuroimaging studies. However, small and heterogeneous study samples, and the use of region-of-interest and tissue-specific analyses have limited the consistency and replicability of these effects. We used a data-driven multivariate approach to investigate neuroanatomical features associated with ADHD in two independent cohorts: the Dutch NeuroIMAGE cohort (n = 890, 17.2 years) and the Brazilian IMpACT cohort (n = 180, 44.2 years). Using independent component analysis of whole-brain morphometry images, 375 neuroanatomical components were assessed for association with ADHD. In both discovery (corrected-p = 0.0085) and replication (p = 0.032) cohorts, ADHD was associated with reduced volume in frontal lobes, striatum, and their interconnecting white-matter. Current results provide further evidence for the role of the fronto-striatal circuit in ADHD in children, and for the first time show its relevance to ADHD in adults. The fact that the cohorts are from different continents and comprise different age ranges highlights the robustness of the findings.

ETHNIC DIFFERENCES IN FACTORS INFLUENCING ATTITUDES TOWARD SUICIDE AND PHYSICIAN-ASSISTED SUICIDE AMONG ELDERS

This study examines differences in attitudes toward suicide and physician-assisted suicide in chronic pain scenarios among Latino and White elders. Face-to-face interviews were conducted with 204 elders at four community-based, outpatient care sites in the metropolitan area of San Antonio, Texas. In addition to ethnicity and the suicide-related questions, the interviews collected data on age, gender, marital status, education, income level, acculturation (Latinos only), depression, self-reported health status, daily living functioning, and religiosity/spirituality. In general, there were no ethnic group differences in attitudes, however, the factors associated with those attitudes varied between ethnic groups. Among Whites, attitudes toward suicide and toward physician-assisted suicide were significantly and negatively associated with religiosity. Among Latinos, depression was significantly and positively associated with attitudes toward suicide in chronic pain scenarios, while acculturation was significantly and negatively associated with attitudes toward physician-assisted suicide in chronic pain scenarios. This study’s findings suggest that depression among Latino elders and religion among White elders are determinant factors of attitudes toward suicide in chronic pain scenarios. Future research is needed to confirm our findings with a more heterogeneous study sample, including Latinos from different countries of origin (e.g. Mexican Americans, Puerto Ricans, Cubans); and more heterogeneous ethnic groups in terms of socioeconomic status and educational level characteristics.

A Methodological Approach to Retaining Accelerometers and Associated Data in Community-Based Studies

Recent technological advances allow for field-based data collection of accelerometers in community-based studies. Mail-based administration can markedly reduce the cost and logistic challenges and burden associated with in-person data collection. It necessitates, however, other resources, such as phone calls and mailed reminder prompts, to increase protocol compliance and data recovery. Additionally, lost accelerometers can impact the study’s budget and its internal validity due to missing data. In this article, we present an applied methodological approach used to define thresholds (or cutoff points) at which pursuing unreturned accelerometers is a worthwhile versus futile pursuit. This methodological approach was designed, specifically, to maximize scalability across multiple sectors. We used data from an on-going study that administered accelerometers through the mail to illustrate and encourage investigators to replicate the approach for use in their own studies. In heterogeneous study samples, investigators might consider repeating this approach by study-relevant strata to refine thresholds and improve the return percentages of data collection instruments, minimize the potential missing data, and optimize study staff time and resources.

Quality of life on long-term parenteral nutrition: can it be an indication for intestinal transplantation?

Long-term outcomes in patients with intestinal failure and following intestine transplantation have improved significantly over the last decade. With these improvements, listing criteria for intestine transplantation are reevaluated and the role of quality of life (QoL) in patients' outcome is increasingly studied and emphasized. Here, we review the recent literature on QoL before and after intestine transplantation and discuss whether QoL should be considered as a listing criterion for intestine transplantation. Patients on home parenteral nutrition, experience lower QoL compared with healthy population and equal or lower QoL than patients with other chronic diseases. After transplantation, QoL improves and is comparable in some QoL domains to that of the general population. These findings are limited by heterogeneous study designs and sample size. Although QoL improves after intestine transplantation, long-term survival of patients receiving HPN surpass postintestine transplantation survival. Poor QoL is not associated with an increased mortality in patients receiving HPN. Current survival outcomes of intestine transplantation do not justify poor QoL as a single listing criterion for intestine transplantation. However, intestine transplantation should be considered in patients with unique circumstances of extremely poor QoL. This approach may change once postintestine transplantation patient survival will further improve.

Health-related quality of life as a predictor of mortality in heterogeneous samples of older adults.

Health-related quality of life (HRQoL) is associated with survival in older people with multimorbidities and disabilities. However, older people differ in their characteristics, and less is known about whether HRQoL predicts survival in heterogeneous older population samples differing in their functional, cognitive, psychological or social disabilities. The aim of this study was to explore HRQoL in heterogeneous samples of older men and women, and to explore its prognostic significance for mortality. We analysed combined individual patient data from eight heterogeneous study samples all of which were assessed with the same methods. We used 15D, a generic, comprehensive instrument for measuring HRQoL, which provides a single index in addition to a profile. Two-year mortality was retrieved from central registers. Health-related quality of life measurements with 15D were available for 3153 older adults. The mean HRQoL was highest among older businessmen (0.878) and lowest among nursing home residents (0.601). 15D predicted independently and significantly the 2-year survival in the total sample [hazard ratio (HR)/SD 0.44, 95% CI 0.40-0.48)]. However, 15D did not predict mortality in samples of spousal caregivers, lonely older adults and cardiovascular patients. 15D captures health and disability factors associated with prognosis whereas in older populations suffering from psychological and social impairments such as caregiver burden or loneliness HRQoL may not reflect their health risks.

Plagiocephaly Severity Scale to Aid in Clinical Treatment Recommendations.

Studies have attempted to categorize infant cranial asymmetry in a variety of ways using both observational and quantitative techniques, but none have created a clinical tool that can serve as a treatment guide based on clinical outcomes. In 2006, a research team from Children's Healthcare of Atlanta published the results of a prospective analysis of 224 patients with cranial asymmetries and their treatment outcomes. As a continuation of the previous work, the researchers have identified a plagiocephaly severity scale based on those outcomes to assist medical professionals who treat patients with cranial abnormalities. Our hypothesis is to validate the proposed severity scale that categorizes the clinical presentation and severity of plagiocephaly.Of the 224 patients enrolled, 207 patients were placed in an experimental group and 17 patients who refused treatment were placed in a control group. Digital head shape data were collected. Cross-correlation matrices were computed across variables and regression models resulted in the identification of 5 meaningful variables. A 5-level clinical classification scale was created. Five 1 × 5 analyses of variance were computed to compare each classification level.Four of the 5 analyses of variance identified significant overall effects for classification. A model was developed from the empirical data and the model was tested for accuracy, resulting in 12.1% overall error. The model was validated for both experimental and control groups.The results show that the severity scale is a meaningful outcome-based scale that assists clinicians in developing a treatment plan for treating plagiocephaly. The scale has been validated across a large heterogeneous study sample.

Much More Than PTSD: Mothers\u2019 Narratives of the Impact of Trauma on Child Survivors and Their Families

This study examined the narratives of ten Caucasian mothers whose children had been impacted by ‘traumatic’ events and referred to a specialist trauma service in N. Ireland. The research question was whether the PTSD construct adequately represented the broad ‘lived’ experience of the impact of trauma on survivors’ wellbeing and their family relationships as articulated by mothers post trauma. Narrative Interviewing methodology was employed and the resulting data inductively organised into an evolving thematic framework. A quantitative analysis of the prevalence of particular themes is presented supplemented by qualitative quotations to illustrate the complexity of reported impact. The major components of the mothers’ narratives included family and relational distress (35.7%), non-pathological individual distress (24.4%), resilience (16.7%) and a prior history of adversity (16.6%). Prior history of adversity was resent in 8 out the 10 cases including a high level of suicide. PTSD symptomatology constituted a small proportion of the narratives (6.6%) and this suggests that the PTSD construct does not adequately represent the broad ‘lived’ experience of the impact of trauma. Although a small and heterogeneous study sample, the findings are sufficiently robust to suggest further investigation is required to understand the phenomenological experience of trauma of child victims/survivors and their families.

Efficacy of thickened liquids for eliminating aspiration in head and neck cancer: a systematic review.

To appraise the current videofluoroscopic evidence on the reduction of aspiration using thickened liquids in the head and neck cancer population. Search terms relating to deglutition or dysphagia or swallow and neoplasms and oncology or head and neck cancer and viscosity or texture and apira or residu* were combined with honey or nectar, xerostomia, and respiratory aspiration using Boolean operators. A multiengine literature search identified 337 nonduplicate articles, of which 6 were judged to be relevant. These underwent detailed review for study quality and qualitative synthesis. The articles reviewed in detail predominantly described heterogeneous study samples with small sample sizes, making for difficult interpretation and generalization of results. Rates of aspiration were typically not reported by bolus consistency, despite the fact that a variety of stimulus consistencies was used during a videofluoroscopic swallowing study. Studies confirmed that aspiration is a major concern in the head and neck cancer population and reported a trend toward more frequent aspiration after (chemo)radiotherapy. Overall, the literature on thickened liquids as an intervention to eliminate aspiration in the head and neck cancer population is limited. Because aspiration is known to be prevalent in the head and neck cancer population and thickened liquids are known to eliminate aspiration in other populations, it is important to determine the effectiveness of thickened liquids for reducing aspiration in the head and neck cancer population.

The Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF)--an expert rating scale for distress screening: development and psychometric properties.

The aim of this study is to validate the Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF), a six item interview-based expert rating scale for distress screening in cancer patients. Using a heterogeneous multicenter study sample (n = 1551), we examined validity, reliability, and dimensionality of the PO-Bado SF. The Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer, the Questionnaire on Stress in Cancer, and the Patient Health Questionnaire were used to investigate convergent validity. Confirmatory factor analysis was applied to address unidimensionality. An optimal cutoff point was determined by ROC analysis and the maximum of Youden's index. An additional study with n = 41 audio recorded PO-Bado SF interviews was carried out to assess inter-rater reliability. Mean age of the study sample was 64.0 (SD = 12.0), 42% were women. About 24% of the patients suffered from metastases. The one-factor solution was confirmed; internal consistency of the PO-Bado SF was high (α = 0.84). The PO-Bado SF total score correlated significantly with all psychosocial measures, the highest correlation was with the HADS total score (r = 0.64). Patients with severe disease conditions (metastases, psychological/psychiatric treatment in the past, low performance status) received higher distress ratings (p < 0.001). Using HADS total score (>13) as external criterion, an optimal PO-Bado SF cutoff score of >9 emerged (sensitivity 0.75; specificity 0.82). Inter-rater reliability was satisfactory for each of the six items (intra class correlation of 0.75 to 0.85). The PO-Bado SF is a short, reliable and valid expert rating scale to identify distressed cancer patients.

Assessments of Lumbar Flexion Range of Motion

Cross-sectional. To compare intertester reliability and concurrent validity of 2 frequently used methods for assessing lumbar flexion range of motion: the fingertip-to-floor distance (FFD) test and the modified Schober (mSchober) test. An assessment of lumbar flexion range of motion is often incorporated in the clinical evaluation of patients with low back pain, as well as in clinical studies when examining the effects of different therapies on these patients. In both cases, the validity and reliability of assessment methods are important. The FFD test and the mSchober test were used in a heterogeneous study sample (n = 98) including patients with low back pain, pelvic girdle pain, and individuals without pain in either of these areas. Each participant was examined by 2 of 3 randomly selected assessors on the same day. Intraclass correlation coefficient3,1, together with the Bland and Altman plot, were used to examine intertester reliability. Absolute reliability was calculated by the smallest detectable change. The relationship between the 2 tests was measured using Pearson correlation coefficient (r), which was used as the measure of concurrent validity. The FFD test and the mSchober test showed an intraclass correlation coefficient of 0.93 and 0.77, and a smallest detectable change of 9.8 and 1.8 cm, respectively. There was a medium negative correlation between the 2 tests; an increase in the mSchober test resulted in a decrease in the FFD test (r = -0.47, P ≤ 0.001). In our heterogeneous study sample, the FFD and the mSchober test showed excellent intertester reliability but with a relatively large smallest detectable change. However, the medium correlation between these 2 tests to measure lumbar flexion range of motion indicates that they do not fully assess the same phenomenon and hence should be used in combination when examining patients. 2.

Ceiling and floor effects on the Rivermead Behavioural Memory Test in patients with alcohol-related memory disorders and healthy participants

Objective. The Rivermead Behavioural Memory Test (RBMT) is a widely used measure of everyday memory performance. In the most recent revision of this test (RBMT-3) some important changes have been made compared with the RBMT. This study examines whether this revision has improved the quality of the clinical classifications using this test, as well as the frequency of floor and ceiling performances that were prominent on some subtests of the RBMT, using a heterogeneous study sample. Methods. Twenty-five healthy adults and 25 patients with alcohol-related memory impairment (including 15 Korsakoff patients) were examined using both the RBMT and the RBMT-3. The number of perfect scores and floor performances, as well as the percentage of individuals classified as impaired (< 5th percentile), were scored and compared. Results. Administration of the RBMT-3 results in less participants performing at or near individual subtest's ceiling, and resulted in less floor performances. Moreover, the RBMT-3 misclassifies less healthy participants as impaired than the RBMT. Conclusions. The RBMT-3 is a substantial improvement over the original RBMT, as it reduces the problem of ceiling and floor performances and the number of misclassifications. However, more research is needed on the ecological validity of the RBMT-3.

Multifactorial Vascular Risk Factor Intervention to Prevent Cognitive Impairment after Stroke and TIA: A 12-month Randomized Controlled Trial

Vascular risk factor control may not only prevent stroke but also reduce the risk of dementia. We investigated whether a multifactorial intervention program reduces the incidence of cognitive symptoms one-year after stroke and transient ischemic attack in first ever stroke patients without cognitive decline prior to the stroke. Patients suffering their first ever stroke were included in this randomized, evaluator-blinded, controlled trial with two parallel groups. Baseline examination included extensive assessment of exposure to vascular risk factors and cognitive assessments regarding memory, attention, and executive function. After discharge, patients were allocated to either intensive vascular risk factor intervention or care as usual. The primary end points were changes in trailmaking test A and 10-word test from baseline to 12 months follow-up. One hundred ninety-five patients were randomized. The difference between groups in trail-making test A, adjusted for baseline measurements, was 3·8 s (95% confidence interval: -4·2 to 11·9; P=0·35) in favor of the intervention group. The difference between groups in the 10-word recall test was 1·1 words (95% confidence interval: -0·5 to 2·7; P=0·17) in favor of the intervention group. We did not observe any differences in the secondary outcomes of incident dementia or mild cognitive impairment. We could not demonstrate cognitive effects of an intensive risk factor intervention at one-year poststroke. Longer follow-up and a more heterogeneous study sample might have lead to larger effects. More effective methods for managing the risk of further cognitive decline after stroke are needed.