Clinical Assessment Methods Research Articles

Infrared thermographic assessment of spinal anaesthesia-related cutaneous temperature changes during caesarean section

IntroductionAssessment of adequacy of spinal anaesthesia, prior to obstetric surgery is extremely important but can be problematic because currently available clinical assessment methods are indirect and subjective. As the sympathectomy associated with spinal anaesthesia is known to cause vasodilation and heat redistribution, we sought to assess whether spinal anaesthesia led to significant and consistent cutaneous temperature changes as measured by infrared thermography. MethodsFollowing ethics committee approval, this observational study was conducted in a tertiary level obstetric centre. Participants included women undergoing elective caesarean section under spinal anaesthesia. Following consent, a Flir T540 infrared camera captured thermographic images over the feet, patella, buttock, iliac crests, xiphisternum and axilla. Temperature was measured prior to spinal needle insertion (T0) and following clinical assessment when the block was deemed adequate. ResultsThirty patients were included. Baseline temperature varied considerable by site. Spinal anaesthesia altered skin temperature in all areas of interest: right and left hallux (mean of differences (MD) +4.0°C and 5.2°C respectively, P <0.0001), right and left plantar (MD +6.1°C and 6.8°C respectively, P <0.0001), patella (MD −0.33°C, P=0.0445), buttock (MD −0.5°C, P=0.009), iliac crest (MD −0.7°C, P=0.0004), xiphisternum (MD −0.95°C, P <0.0001) and axilla (MD −0.71°C, P=0.0002). ConclusionsFollowing spinal anaesthesia thermographic imaging identified different patterns of skin temperature changes, with pronounced temperature increases measured in the feet and cooling of a lesser amplitude in the thoracic and lumbar dermatomes. Infrared thermography has the potential to provide objective measurement of sympathectomy.

CLINICAL PROGRESSION OF LEPROSY IN EURASIAN RED SQUIRRELS (SCIURUS VULGARIS) IN A NATURALLY INFECTED WILD POPULATION.

Leprosy has been described in Eurasian red squirrel (Sciurus vulgaris; ERS) carcasses since 2014. Studies of ERS carcasses have not provided information about incubation or disease progression in this host but have provided important insights into pathogen presence and distribution throughout the United Kingdom. Here we present field study data on 31 live ERS from an island population naturally infected with Mycobacterium leprae that were assessed longitudinally over a 2-yr time period. Clinical assessment, serologic (anti-phenolic glycolipid-I antibody [αPGL-I] detection) and molecular methods (polymerase chain reaction) were used to diagnose and categorize ERS at each assessment as a leprosy case, a leprosy suspect, colonized by M. leprae, or a contact ERS. Eight ERS (25.8%) were identified as leprosy cases: four at initial assessment, two at 6 mon and two at 24 mon after initial assessment. One ERS was categorized a leprosy suspect when it developed typical lesions 12 mon after initial assessment, despite negative serologic and molecular test results at this time, though M. leprae DNA had been isolated during the initial assessment. Seven ERS (22.6%) were categorized as colonized and of these, six were reassessed but did not develop clinical signs of leprosy within 6 (n = 2), 12 (n = 3), and 18 (n = 1) mon. Most (48.4%, n = 15) were categorized as contact ERS. Progression of leprosy lesions varied between ERS, but always increased in severity over time and was paralleled with increased antibody response. Based on our dataset, we propose the hypotheses: 1) leprosy in ERS is a chronic, slowly progressing disease in this species, similar to that described for other hosts; 2) lesions can undergo repeated ulceration-healing cycles; and 3) in some instances M. leprae DNA and αPGL-I antibodies are detectable before the onset of clinical signs of disease. Future studies addressing the progression of leprosy in ERS should follow affected animals over a longer time period and include tissue samples to pair molecular diagnostics with serologic results.

Patient‐reported outcome measures (PROMs) to guide clinical care: recommendations and challenges

PROMs collection is encouraged to involve patients in their health care The patient is the most reliable reporter of their symptoms, function and health-related quality of life, and can provide a holistic viewpoint of the benefits and risks of treatments or the severity of their conditions. Including the patient’s voice is critical for shared decision making and patient-centred care. Patient-reported outcomes (PROs) are defined as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else”.1 Patient-reported outcome measures (PROMs) are validated tools or questionnaires used to collect PROs. PROMs can complement traditional methods of clinical assessment, such as medical history and physical examination. The use of systematically collected PROMs to inform the delivery of care has been researched for many years,2, 3 with patient and health service impacts including reduced symptom burden, improved quality of life and increased survival of patients with advanced cancer,4 and reduced emergency department presentations in a broad population of patients with cancer.5 As research suggests, the collection of PROMs in the clinical setting could better measure differences in the effects of health care interventions.6 PROMs collection is encouraged in the 2020–25 National Health Reform Agreement to empower patients to be involved in their health care, improve care across the health system, and focus on outcomes that matter to patients.7 This article outlines recommendations from the Health Services Research Association of Australia and New Zealand (HSRAANZ) for implementing PROMs to guide clinical care. It also describes the challenges that may arise and future research that may assist in the effective implementation of PROMs. The recommendations presented in this article have been developed by members of the HSRAANZ PROMs Special Interest Group. Health systems are encouraged to provide incentives to clinicians and practices (eg, funding through the National Health Reform Agreement) to implement these measures effectively. This will motivate clinicians to routinely incorporate their patients’ perspective into their busy schedules. They will be more likely to implement PROMs if there is a benefit to patient care and their clinical practice, by making care easier and more timely and reducing the administrative burden. There are several challenges to consider when integrating PROMs into clinical care. As patients are recruited to PROMs collection, challenges can arise at different time points through the journey of their care (Box). It is important to note that while these exist, they are not insurmountable and can be overcome with further research on implementation in general practice and hospital clinics. Already, research into the integration of PROMs in clinical care in Australia has shown that implementation is feasible and effective. The New South Wales Agency for Clinical Innovation Patient Reported Measures program completed a pilot study8 and demonstrated the feasibility of implementing PROMs in local health districts, community services and general practice. Principles to support the analysis and use of PROMs have been developed.9 CALD = culturally and linguistically diverse population. CALD = culturally and linguistically diverse population. There is increased focus by health care systems to improve the value of care in terms of both value for investment and outcomes that patients value. Embedding patient-reported measures into the clinical setting is a key component towards achieving this. Further research is underway to evaluate the applicability and benefits and harms of collecting PROMs in routine clinical care.10 Future research should focus on investigating the feasibility of prompt feedback of patient-reported data to clinicians and incorporating the results of patient-reported measures into clinical practice. With advances in technology and increased engagement by clinicians and health systems, the implementation of PROMs will be a routine part of health care provision in the future. Rachael Morton receives salary support from a University of Sydney Robinson Fellowship and a National Health and Medical Research Council Investigator Award (APP1194703). The funding source has no role in the planning, writing or publication of this work. No relevant disclosures. Not commissioned; externally peer reviewed.

Evaluasi Penilaian Model Mini CEX pada Praktik Klinik Asuhan Kebidanan Komprehensif Continuity of Care

Mini CEX is an authentic assessment method, carried out in a clinic with direct clients and equipped with feedback as a development for the next student's skills. Mini CEX has not been widely used in assessing the Continuity of Care Comprehensive Midwifery Clinical Practice. Evaluation is needed to see the suitability of clinical assessment with reference standards. The aim of the study was to evaluate the mini CEX assessment at the planning, implementation and outcome stages of the assessment. Descriptive evaluation research using the CIPP model. Taking a total sample of samples, a total of 176 respondents who were involved in midwifery clinical practice activities in the Yogyakarta and Purworejo areas. Collecting data using a questionnaire that has been tested for the validity of Aiken, all instruments are valid with a result of 0.75 (≥ 0.72). The evaluation results of the assessment planning were very good (77.86%), the implementation by the preceptor was in the good category (76%) and the assessment by the mentor was in the poor category (56%). Midwifery clinical practice assessment method using Mini CEX and feedback is concluded as good and can be continued. Instructor clinical input needs to be provided intensively or given CEX mini assessment training.Key words: evaluation, mini CEX, midwifery clinical practice

POSSIBILITIES, EXPEDIENCY AND NECESSITY OF INTRODUCING ELEMENTS OF CLINICAL AND ECONOMIC ANALYSIS INTO THE PRACTICE OF A LARGE TRAUMA CENTER

Abstract: It is proved that the costs incurred at different points in time should be "weighted" or discounted to reflect the fact that those that occur in the near future are more important than those that occur in the distant future. This raises the question: should the advantages or consequences of alternative procedures also be discounted? The main arguments against discounting benefits are, firstly, that health is not a commodity resource that can be invested to create future health flows, nor does it have a monetary value that can be expected to increase over time with income, and, secondly, there is no evidence to support the opinion that people value future health conditions less highly than current ones. It is necessary to recommend this approach as a standard practice in the development of new methods and technologies of treatment not only in traumatology and orthopedics, but also in other fields of medicine, first of all, these methods of clinical and economic assessment should be applied in dissertation works to demonstrate the survival of the dissertation product in the economic link of domestic healthcare, and, accordingly, its demand in general. The purpose of the work: to find out the prerequisites for the introduction into routine practice of planning the use of various medical benefits in the provision of trauma care on the basis of an economic and clinical approach.

Functional Testing Using a Force Motion Capture Device for Hand Surgery Outcome Assessment: A Proof of Concept.

Osteoarthritis is the leading cause of loss of hand function in America and most commonly affects the carpometacarpal joint of the thumb. Although medication and exercise are possible treatments in mild cases, in cases of severe thumb osteoarthritis, surgery may be the only treatment option. One surgical approach is Mini TightRope (Arthrex, Inc., Naples, Fla.) suspensionplasty, which uses a suture wire to attach the base of the thumb metacarpal to the second metacarpal after removal of the trapezium. Current methods of clinical outcome assessment following hand surgery, such as questionnaires and goniometry, do not provide data that are well suited for improving surgical or mechanical design. Also, current in vivo studies investigating changes following this operation have primarily focused on pain, and not function. Surgical design and surgical devices require engineering, and data from patient outcomes by questionnaires and current clinical tests may not provide data that are well suited to improving surgical or mechanical design. To improve patient care and to foster device design, it is critical to understand how the function of the thumb—specifically, motion and forces—changes because of surgery to give patients the best treatment possible. We have developed a force motion capture device that records the joint range of motion of the thumb coupled with measurement of applied forces at different points within the range or motion. The goal of this work was to illustrate how the force motion capture device could be used to quantify function preoperatively and postoperatively for basal joint arthroplasty. A patient who was scheduled for Mini TightRope suspensionplasty was tested before surgery, 6 weeks after surgery, and again 12 weeks after surgery. Thumb forces and the kinematic range of motion were measured over the kinematic space and analyzed to determine changes between preoperatively and postoperatively in magnitude, the range of force directions, and the volume of the kinematic space used to apply forces (Fig. 1).Fig. 1.: Force motion capture. Force capabilities were measured using both a six-axis load cell and motion capture at multiple positions and directions; shown are palm at (left) 0 degrees (horizontal) and force directed medially (right) and palm at 60 degrees with respect to horizontal with force directed toward the ground. Range of motion was also measured using reflective markers and motion capture and through full flexion of the metacarpophalangeal and interphalangeal joints of the thumb and full ranges of opposition and abduction.Functional changes in the participant’s hand were quantified using force motion capture. Figure 2 was the result of force motion capture for the individual. It describes how the participant’s kinematic range of motion (gray space) changed relative to a healthy individual (white space), and how the forces that participant was able to apply changed because of force application (colored arrows). Overall, the forces that this participant could apply decreased in both magnitude and volume of the kinematic space used to apply the force, drastically following the surgery, then returned to a similar but not significantly improved degree of function after 12 weeks from their initial condition. The range of directions the participant was able to apply forces in did not change because of the surgery.Fig. 2.: Differences in force production for one participant. Visualized force profiles over the range of motion for a participant at each testing point. The white space is that from a healthy thumb (two-dimensional projection). The grey-shaded region is the kinematic space from the participant at each time point (left, before surgery; center, 6 weeks after surgery; right, 12 weeks after surgery and at completion of physical therapy). The colored arrows indicate the force production, with hotter colors indicating more force. The direction of the arrow indicates direction of the force application.Force motion capture provides a descriptive, accurate, and efficient method to measure the functional abilities of the thumb and compare them over time. These functional test results make force motion capture a novel method of quantifying functional changes in the thumb and can be used track function throughout recovery and to compare different surgical treatments and device designs to determine which leads to the most function recovered. DISCLOSURE Dr. Clarkson has previously worked with Arthrex, the developer of the surgical device. Drs. Drost and Bush have no financial disclosures to report.

A comparative multi-tiered immunogenicity assessment of biosimilar pegylated filgrastim: validation of methods for clinical assessment of INTP5

ABSTRACT Background and Objective Validated and highly sensitive assays are required for comparative assessment of immunogenicity of biosimilars. For INTP5, a biosimilar pegylated filgrastim, the immunogenicity assessment included tiers that allowed for assessment of antibodies against the PEG and the Filgrastim moieties for comparative clinical immunogenicity assessment. Methods Electrochemiluminescence immunoassay (ECLIA) was used for Screening, Specificity, and Titer assays for detecting anti-drug antibodies (ADAs) and cell-based method for neutralizing ADAs. The methods were validated to enable use of same methods irrespective of biosimilar or reference arms. Results The ADA and cell-based assay for neutralizing antibody detection were validated with a sensitivity capable of detecting binding Anti-Pegfilgrastim antibody at ~40 ng/mL and Neutralizing antibody at ~380 ng/mL and used for a comparative immunogenicity study. Of 194 subjects, 10 subjects had confirmed positive anti-drug-antibody in the biosimilar arm and 9 in the reference arm. None of the subjects were detected with neutralizing anti-drug antibodies. Conclusion This work demonstrates the application of a rigorous approach toward validation of assays for immunogenicity studies for biosimilars. Highly sensitive, precise, and robust assays were used to conclude comparable low incidences of anti-drug antibodies in both biosimilar and innovator arms of the clinical study for Pegfilgrastim.

Recommendations for Standardizing Clinical Trial Design and Endoscopic Assessment in Postoperative Crohn's Disease.

The lack of standardized methods for clinical trial design and disease activity assessment has contributed to an absence of approved medical therapies for the prevention of postoperative Crohn's disease (CD). We developed recommendations for regulatory trial design for this indication and for endoscopic assessment of postoperative CD activity. An international panel of 19 gastroenterologists was assembled. Modified Research and Development/University of California Los Angeles methodology was used to rate the appropriateness of 196 statements using a 9-point Likert scale in 2 rounds of voting. Results were reviewed and discussed between rounds. Inclusion of patients with a history of completely resected ileocolonic CD in regulatory clinical trials for the prevention of postoperative recurrence was appropriate. Given the absence of approved medical therapies, a placebo-controlled design with a primary end point of endoscopic remission at 52 weeks was appropriate for drug development for this indication; however, there was uncertainty regarding the appropriateness of a coprimary end point of symptomatic and endoscopic remission and the use of currently available patient-reported outcome measures. The modified Rutgeerts Score, endoscopic assessment of the anastomosis, and a minimum of 5cm of neoterminal ileum were also appropriate; although the appropriateness of other indices including the Simple Endoscopic Score for CD for endoscopic assessment of postoperative CD activity was uncertain. A framework for regulatory trial design for the prevention of postoperative CD recurrence and endoscopic assessment of disease activity has been developed. Research to empirically validate end points for these trials is needed.

The reliability of clinical assessment of distal radioulnar joint instability.

Accurate assessment of distal radioulnar joint (DRUJ) stability is increasingly recognized as an important part of clinical examination of the wrist. The ability of 30 specialist UK hand surgeons to clinically determine the stability of four volunteers' wrists was assessed. Volunteers' wrist stability had previously been confirmed with a validated measurement rig. Use of the wrist ballottement test as the primary examination technique yielded a positive predictive value of 81%, a negative predictive value of 55%, a specificity of 94% and a sensitivity of only 24%, for the detection of DRUJ instability. No correlation between background speciality (orthopaedic versus plastic surgery), nor years of clinical experience was found. Clinical assessment of DRUJ instability among experienced clinicians appears unreliable and instability is typically under recognized. Previous research to date using this clinical assessment method as a parameter of success is therefore brought into question.Level of evidence: IV.

An Internet of Medical Things-Based Model for Real-Time Monitoring and Averting Stroke Sensors.

In recent years, neurological diseases have become a standout amongst all the other diseases and are the most important reasons for mortality and morbidity all over the world. The current study's aim is to conduct a pilot study for testing the prototype of the designed glove-wearable technology that could detect and analyze the heart rate and EEG for better management and avoiding stroke consequences. The qualitative, clinical experimental method of assessment was explored by incorporating use of an IoT-based real-time assessing medical glove that was designed using heart rate-based and EEG-based sensors. We conducted structured interviews with 90 patients, and the results of the interviews were analyzed by using the Barthel index and were grouped accordingly. Overall, the proportion of patients who followed proper daily heart rate recording behavior went from 46.9% in the first month of the trial to 78.2% after 3–10 months of the interventions. Meanwhile, the percentage of individuals having an irregular heart rate fell from 19.5% in the first month of the trial to 9.1% after 3–10 months of intervention research. In T5, we found that delta relative power decreased by 12.1% and 5.8% compared with baseline at 3 and at 6 months and an average increase was 24.3 ± 0.08. Beta-1 remained relatively steady, while theta relative power grew by 7% and alpha relative power increased by 31%. The T1 hemisphere had greater mean values of delta and theta relative power than the T5 hemisphere. For alpha (p < 0.05) and beta relative power, the opposite pattern was seen. The distinction was statistically significant for delta (p < 0.001), alpha (p < 0.01), and beta-1 (p < 0.05) among T1 and T5 patient groups. In conclusion, our single center-based study found that such IoT-based real-time medical monitoring devices significantly reduce the complexity of real-time monitoring and data acquisition processes for a healthcare provider and thus provide better healthcare management. The emergence of significant risks and controlling mechanisms can be improved by boosting the awareness. Furthermore, it identifies the high-risk factors besides facilitating the prevention of strokes. The EEG-based brain-computer interface has a promising future in upcoming years to avert DALY.

Are remote clinical assessments a feasible and acceptable method of assessment? A systematic review

The COVID-19 pandemic presented an enormous and immediate challenge to assessing clinical skills in healthcare professionals. Many institutions were unable to deliver established face-to-face assessment methods such as Objective Structured Clinical Examinations (OSCEs). Assessors needed to rapidly institute alternative assessment methods to ensure that candidates met the clinical competences required for progression. Using a systematic review, we aimed to evaluate the feasibility, and acceptability of remote methods of clinical skills assessment, including remote structured clinical assessments and the submission of video recordings. We searched for studies reporting on Remote Clinical Assessments or its variants in MEDLINE, Embase and The Cochrane library from 2000 to March 2021. Twenty eight studies were included in the review; 20 studies related to remote structured clinical examinations or OSCEs and 8 reported the use of video submissions. The participants of the different studies included medical students, nursing students, dental students and doctors in training. A variety of different online platforms were utilised including Zoom, Skype, webcams, and Adobe Connect online. The studies found that delivery of remote clinical assessments is possible and provides an alternative method of assessing many clinical skills, but most also acknowledge limitations and challenges. They are acceptable to both candidates and examiners, and where measured, show moderate agreement with on-site clinical assessments. Current evidence is based on studies with low methodological quality and for the most part, small sample sizes.

Validity and reliability of a clinical non-exercise method for assessment of cardiorespiratory fitness using seismocardiography

Abstract Introduction Low cardiorespiratory fitness expressed as a low maximal oxygen consumption (V̇O2max) is associated with cardiovascular disease and all-cause mortality (1). Thus, V̇O2max is recognised as an important clinical tool in the assessment of patients (1,2). However, assessment of V̇O2max by exercise testing is both physically demanding and methodologically challenging and hence the clinical applicability is limited. Purpose Therefore, the aim of this study was to investigate the accuracy and precision of a clinical non-exercise method for assessment of V̇O2max. Methods On three separate days 20 healthy men (n=10) and women (n=10) with varying age (22–72 years) and fitness levels performed two tests for determination of V̇O2max; (a) a non-exercise test using seismocardiography (SCG V̇O2max) and (b) a graded exercise test to voluntary exhaustion on a cycle ergometer based on indirect calorimetry (IC V̇O2max). These tests were performed in order to examine the day-to-day reliability and the validity of SCG V̇O2max, respectively. Furthermore, SCG V̇O2max was assessed twice on each test day to investigate test-retest reliability. The SCG V̇O2max was performed in prone position following a short resting period by placing the SCG recording device on the xiphisternal joint with double adhesive tape. V̇O2max was assessed during a 5-minute recording of the sternal movement using SCG in combination with demographic data of the participants (3). In addition, body composition was measured and a resting blood sample collected each test day. Results On average SCG V̇O2max was 3.3±2.4 ml/min/kg (mean ± 95% CI) lower than IC V̇O2max (p=0.013, SCG V̇O2max: 36.6±3.3 ml/min/kg, IC V̇O2max: 39.9±3.0 ml/min/kg). A significant positive correlation was found between SCG V̇O2max and IC V̇O2max (Pearson, r=0.72, p&amp;lt;0.001). Both SCG V̇O2max and IC V̇O2max was similar between test days (p=0.972) and the intra-individual coefficient of variation was 4.5±2.9% and 4.0±2.5%, respectively. Within each test day SCG V̇O2max was highly correlated (r=0.99, p&amp;lt;0.0001) and no difference was observed between tests (p=0.993). Conclusions The accuracy of the current non-exercise assessment of cardiorespiratory fitness based on seismocardiography is not optimal as SCG V̇O2max was systematically lower than the gold standard assessment applying indirect calorimetry during a graded exercise test. Despite the abovementioned difference, SCG V̇O2max and IC V̇O2max were highly correlated. Furthermore, the precision of SCG V̇O2max is very high as both day-to-day and test-retest reliability were high. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): VentriJect ApS, Copenhagen, Denmark

Development and Validation of a Novel Gene Signature for Predicting the Prognosis by Identifying m5C Modification Subtypes of Cervical Cancer.

Background: 5-Methylcytidine (m5C) is the most common RNA modification and plays an important role in multiple tumors including cervical cancer (CC). We aimed to develop a novel gene signature by identifying m5C modification subtypes of CC to better predict the prognosis of patients.Methods: We obtained the expression of 13 m5C regulatory factors from The Cancer Genome Atlas (TCGA all set, 257 patients) to determine m5C modification subtypes by the “nonnegative matrix factorization” (NMF). Then the “limma” package was used to identify differentially expressed genes (DEGs) between different subtypes. According to these DEGs, we performed Cox regression and Kaplan-Meier (KM) survival analysis to establish a novel gene signature in TCGA training set (128 patients). We also verified the risk prediction effect of gene signature in TCGA test set (129 patients), TCGA all set (257 patients) and GSE44001 (300 patients). Furthermore, a nomogram including this gene signature and clinicopathological parameters was established to predict the individual survival rate. Finally, the expression and function of these signature genes were explored by qRT-PCR, immunohistochemistry (IHC) and proliferation, colony formation, migration and invasion assays.Results: Based on consistent clustering of 13 m5C-modified genes, CC was divided into two subtypes (C1 and C2) and the C1 subtype had a worse prognosis. The 4-gene signature comprising FNDC3A, VEGFA, OPN3 and CPE was constructed. In TCGA training set and three validation sets, we found the prognosis of patients in the low-risk group was much better than that in the high-risk group. A nomogram incorporating the gene signature and T stage was constructed, and the calibration plot suggested that it could accurately predict the survival rate. The expression levels of FNDC3A, VEGFA, OPN3 and CPE were all high in cervical cancer tissues. Downregulation of FNDC3A, VEGFA or CPE expression suppressed the proliferation, migration and invasion of SiHa cells.Conclusions: Two m5C modification subtypes of CC were identified and then a 4-gene signature was established, which provide new feasible methods for clinical risk assessment and targeted therapies for CC.

Prioritized Commitment-Based Clinical Assessment: A New Method for Assessment of Orthodontic Treatment Outcomes.

Quality assessment is an essential part of orthodontic treatment. Most of the current indices are essentially based on occlusal assessment. However, an ideal occlusion is only one aspect of an ideal treatment. The aim of this article is to introduce a new prioritized commitment-based clinical assessment (PCCA) method and present its reliability and linear correlation test in comparison with the comprehensive clinical outcome assessment (CCA). One hundred treated cases were scored with the conventional assessment tool--the CCA--and the newly developed assessment tool--the PCCA--with 2 calibrated examiners at 2 different time intervals. These cases were randomly selected including equal numbers of the main malocclusions managed with fixed conventional edgewise appliances within the past 3 years and had complete pre-treatment and post-treatment routine records. The intraclass correlation coefficient (ICC) was used to assess the intra- examiner repeatability of the total scores of both methods. Pearson's correlation coefficients were computed to assess the linear relationships between the CCA and PCCA scores. The intra-examiner reliability assessed for CCA and PCCA showed high repeatability for both examiners (ICC: 0.93 and 0.945, respectively). The inter-examiner reliability values for CCA and PCCA, assessed by ICC, were 0.84 and 0.96, respectively. The linear correlation between the 2 methods, assessed by comparing the mean score of each case by the 2 examiners was significant, at 0.01. The PCCA method can be used for quality assessment in treated orthodontic patients. The preliminary test of the new method presented good inter- and intra-observer agreements and a significant linear correlation with the CCA method.

Influence of nutritional status in the postoperative period of patients with inflammatory bowel disease.

Inflammatory bowel diseases (IBDs) are a group of chronic inflammatory diseases that affect the gastrointestinal tract, including Crohn's disease (CD) and ulcerative colitis. Surgery is a treatment option, and more than half of the patients with CD will undergo surgical interventions over the course of the disease. Postoperative complications are common in IBD patients, the most frequent being intra-abdominal sepsis, infection of the surgical site, and adynamic ileum, and nutritional status is a factor that can influence postoperative outcome. Recent studies have shown that malnutrition, obesity, sarcopenia, and myosteatosis are predictors of surgical complications. However, most were retrospective studies with small patient samples and heterogeneity of clinical and nutritional assessment methods, which limit the extrapolation of data. Therefore, knowing the pathophysiological mechanisms of IBD and identifying the best parameters for assessing nutritional status are essential for prompt implementation of adequate nutritional interventions.

Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study

ObjectivesEvaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum.DesignA multicentre inter-rater reliability study.SettingThree primary care rehabilitation centres in Sweden.ParticipantsA total...

Factors Associated With Fitness to Drive for Older Adults With Dementia or MCI: A Pilot Study

Abstract Date Presented 04/21/21 This study examined the relationship of clinical and road portions of Vanderbilt University Medical Center's driver evaluation. Data were collected retrospectively on adults with mild cognitive impairment or dementia. Findings revealed a significant relationship between the driving recommendation and the road assessment scores but not the clinical scores. Results indicated a need for OT practitioners to explore clinical assessment methods to more accurately predict road performance for determining fitness-to-drive recommendations. Primary Author and Speaker: Susan L. Iliff Contributing Authors: Patricia Bowyer

Geriatric patients in the intensive care unit

Der Anteil geriatrischer Patienten auf der Intensivstation an allen dort behandelten Patienten beträgt bis zu 30 %. Das Alter per se ist jedoch kein Prognosekriterium für das therapeutische Outcome einer intensivmedizinischen Behandlung. Prognostisch wichtiger sind der funktionelle Status und geriatrische Syndrome. Hierbei sind die Gebrechlichkeit (Frailty) und das Delir von zentraler Bedeutung. Zum jeweiligen Screening sollten Clinical Frailty Scale (CFS) bzw. Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) zur Anwendung kommen. Darüber hinaus spielen altersphysiologische Organveränderungen sowie Multimorbidität und die damit assoziierte Polypharmazie eine wichtige Rolle. Letztere sollte bereits bei Aufnahme auf ihre absolute Notwendigkeit hin überprüft werden. Ein weiteres Ziel der intensivmedizinischen Behandlung von geriatrischen Patienten ist die Erhaltung und Verbesserung ihres Ernährungszustands. Zu seiner Erfassung sollte ein Screening mithilfe eines etablierten Tools (z. B. Nutritional Risk Screening [NRS] 2002) erfolgen. Bei der Behandlung von kritisch kranken geriatrischen Patienten mit Coronoaviruserkrankung 2019 (COVID-19) hat die Gebrechlichkeit ebenfalls eine entscheidende Bedeutung. Grundsätzlich ist bei jeder Therapieanwendung gerade auch bei geriatrischen Patienten die Frage nach der Sinnhaftigkeit der intensivmedizinischen Behandlung unter Beachtung des (mutmaßlichen) Patientenwillens und seiner Lebensperspektive zu klären. Dabei ist zu prüfen, ob ein angestrebtes Therapieziel erreicht werden kann und ob die Belastungen während der Behandlung gerechtfertigt ist. Weiterhin spielt bei der intensivmedizinischen Versorgung geriatrischer Patienten die sektorenübergreifende Zusammenarbeit eine wichtige Rolle.

Activity of free radical processes in oral fluid of patients with recurrent upper respiratory tract infections

Background: Upper respiratory tract infections occupy a leading position in the infectious pathology. According to the World Health Organization (WHO), up to 500 million people fall ill with acute respiratory infections in the world every year, of which 2 million people die from various complications. At the same time, a number of researchers note the lack of methods for clinical and laboratory assessment of the condition of patients with this pathology. Aims: To evaluate the parameters of free radical oxidation in oral fluid of patients with recurrent upper respiratory tract infections (RIURT). Methods: The study involved 64 apparently healthy people who suffered respiratory infections up to 2 times a year, and 85 patients with RIURT (4 or more times a year), who at the time of the study were in remission. The determination of the parameters of the pro / antioxidant systems was carried out using two methods (photometric: the content of lipid peroxidation products and the level of ceruloplasmin and luminol-dependent chemiluminescence (LDCL) were measured, making it possible to assess the complex interaction of two systems prooxidants and antioxidants). Results: The studies have demonstrated that, for most of the RIURT patients during remission, the levels of certain prooxidant components (diene conjugates, ketodienes, Schiff bases), as well as of an oral fluid antioxidant (ADS: ceruloplasmin) were elevated compared to the controls. At the same time, the LDCL parameters of oral fluid did not go beyond the reference interval, although they were changed relative to the median of the control group. This allows us to consider the observed fluctuations as a balance in the system of pro- and antioxidants. Conclusions. The use of oral fluid as a biological material for the assessment of the pro-/antioxidant system opens up new possibilities in the diagnosis of respiratory disease.

Relation Between Early Disturbance of lymphatic transport Visualized With Lymphofluoroscopy and Other Clinical Assessment Methods in Patients With Breast Cancer

IntroductionLymphedema of the upper extremity is one of the most feared complications following breast cancer treatment. Lymphofluoroscopy is a sensitive instrument for detection of lymphedema and visualization of superficial lymphatic transport, thus suitable for early detection. Early detection of lymphedema is important as it can prevent lymphedema to progress into more severe stages and minimalize impact on quality of life and medical costs. ObjectiveTo determine agreement between the presence of early disturbance of the lymphatic transport and outcome of clinical measurement tools evaluating the development of lymphedema. MethodsA prospective study was conducted in 128 breast cancer patients scheduled for breast cancer surgery. Patients were evaluated before surgery and 1, 3-, 6-, 9-, and 12-months’ post-surgery. Cohen's Kappa was used to determine agreement between presence of early disturbance in lymphatic transport and presence of pitting/increased skinfold thickness/increased Percentage Water Content ratio (PWC)/increased arm-hand volume (circumference measures and water displacement). ResultsFor pitting status (Kappa 0.23), for skinfold thickness (Kappa 0.29) and the PWC ratio (Kappa 0.21) a minimal agreement was found. The circumference measurement had a minimal agreement for 5% volume difference (Kappa 0.22) and no agreement for 3% volume difference (Kappa 0.19). Sensitivity was weak for all clinical assessments. The specificity was excellent for pitting status, skinfold thickness, PWC ratio, and for 5% volume difference. For 3% a high specificity was found. ConclusionThe clinical tools assessed in this study were not able to predict an early disturbance of the lymphatic transport seen on lymphofluoroscopy.