Nagelkerke R2 Research Articles

Prognostication of long-term outcomes after aneurysmal subarachnoid hemorrhage: external validation of the FRESH score

Background and Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) affects 6.3 persons per 100.000 annually. Patient outcomes still vary greatly. Prognostication remains challenging and both Hunt & Hess (H&H) and World Federation of Neurosurgical Societies (WFNS) grading scales lack long term accuracy. The “Functional Recovery Expected after Subarachnoid Hemorrhage“ (FRESH) scale, incorporating 4 variables - admission H&H score, Acute Physiology And Chronic Health Evaluation 2 (APACHE 2) score, patient age and aneurysmal rebleed within 48 hours – has been reported to predict long-term outcome. In this retrospective study, we assessed the external validity of this scale. Methods: We retrospectively analyzed all intensive care unit (ICU) aSAH patients between Jan 1st and December 31st, 2017. 69 patients were identified. Patient baseline characteristics (age, sex, Glasgow Coma Scale (GCS), H&H, WFNS, APACHE 2 score, presence of rebleed) and outcome measures were obtained. FRESH scores were calculated accordingly. Functional outcome after 1 year was measured using the modified Rankin Scale (mRS). mRS was dichotomized into good (mRS 0-3) and poor (mRS 4-6) outcome to calculate the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results: All patients underwent endovascular aneurysm treatment. Poor outcome was observed in 20 patients (30%); one year mortality was 24 % (16 patients). We achieved an AUC of 89% for discriminating between good and poor outcomes 12 months after hospital admission. Goodness-of-fit was calculated to be 36% using Nagelkerke R2. Sensitivity and specificity were 60% and 90% respectively. Conclusion: In our retrospective analysis, the FRESH score performed well in the prediction of poor outcome (mRS 4-6) one year after aSAH. However, FRESH score calculations are cumbersome and prone to error.

Auricular acupuncture for sleep quality in participants with mental and behavioral disorders due to prior multiple drug use: a retrospective consecutive case series.

Poor sleep quality is associated with psychoactive substance abuse/addiction/withdrawal. Auricular acupuncture (AA) is a nonpharmacological method used for the treatment of sleep disturbances. This study aimed to examine the quality of sleep before and after AA in participants with mental and behavioral disorders due to prior multiple drug use in the therapeutic community. This was a consecutive case series of 27 participants (25 male [92.6%]). The median age was 35.0 years (interquartile range [IQR], 29.0-37.2 years), methadone/buprenorphine were not used, and the participants were treated with AA (median number of treatments, 15.0 [IQR, 12.0-18.0]) during a median period of 51.0 days (IQR, 49.0-51.0 days) according to the National Acupuncture Detoxification Association (NADA)-Acudetox protocol. Sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI), a self-rated questionnaire that assesses sleep quality and disturbances over a 1-month interval. The global PSQI score dropped (indicating better sleep quality) by a median of 3.0 points (IQR, 0.0-8.0 points) after treatment. In the multivariate logistic regression analysis, with an increase in global PSQI score during AA by 1 point, there was a 0.73-fold reduction in the risk of poor sleep quality post-AA (adjusted odds ratio, 0.73; 95% confidence interval, 0.52-1.01; p<0.055; Nagelkerke's R2=0.66). The results revealed a positive effect of AA (by the NADA-Acudetox protocol) on sleep quality (as measured by PSQI) among participants in a treatment center with mental and behavioral disorders due to multiple drug use.

Prevalence of dental attrition and its relationship with dental erosion and salivary function in young adults.

The aim of this study was to estimate the prevalence of dental attrition in a young adult population and to explore associated factors. Dental students aged 18-40 years old with a minimum of 24 natural teeth were invited to take part in this cross-sectional study. Their demographic information, medical history, perceived stress, frequency of dietary acid intake, and frequency of oral habits were obtained through several questionnaires. Assessment of each type of tooth wear (erosion, attrition, and abrasion) was performed according to Tooth Wear Evaluation System (TWES 1.0). All participants underwent salivary tests. Statistical analysis was performed by chi-squared or Mann-Whitney tests and logistic regression models. In total, 178 participants (88 women and 90 men) with a median age of 22 years were included and of those 74.7% (95% confidence interval [CI] 68%-81%) had dental attrition. Univariate analysis revealed positive associations for male gender, age, body mass index, awake bruxism frequency, and erosive tooth wear with the presence of dental attrition. Multivariable logistic regression (Nagelkerke r2 = 0.31) indicated that dental attrition was associated with erosive tooth wear (adjusted odds ratio [aOR], 6.3; 95% CI, 2.8-14.2), body mass index (aOR, 1.3 [95% CI 1.1-1.5]), and age (aOR, 1.2 [95% CI 1.0 to 1.3]). Dental attrition is present in most young adults of Catalonia. The associated factors were erosive tooth wear, body mass index, and age. Slight alterations of salivary parameters do not seem to predict dental attrition.

Revised service metrics partially explain variation in outcomes across facilities in a state-wide advanced practice public musculoskeletal service.

Revised service metrics partially explain variation in outcomes across facilities in a state-wide advanced practice public musculoskeletal service.

Risk of falls, vestibular multimodal processing, and multisensory integration decline in the elderly-Predictive role of the functional head impulse test.

Age-related degeneration of the vestibular system, also known as presbyastasis, leads to unstable gait and higher risk of falls. These conditions affect lifestyle and may have non-negligible social repercussions due to fear-related states of anxiety and depression. In order to develop a model for predicting risk of falls, we assessed vestibulo-ocular function by video and functional Head Impulse Tests (vHIT and fHIT) and their possible correlations with Tinetti Balance Test score. Thirty-one patients over 65 years of age admitted with trauma due to falls were recruited. Vestibular evaluation (complete otoneurological assessment, vHIT, fHIT), cognitive tests (Mini Mental State Examination), anxiety and depression evaluation and Tinetti Balance Test were performed. The possibility of a correlation between the head impulse tests (vHIT, fHIT) and the Tinetti Balance Test was investigated by logistic regression analysis (Nagelkerke r 2 and Wald test). A linear correlation was found between the Tinetti Balance Test score and fHIT, whereas no correlation was found for vHIT. Functional HIT is an effective test for predicting the risk of falls in elderly patients.

Factors Influencing Stopping Locations of Motorcycle Riders on Signalized Urban Intersection Approaches

In developing countries, motorcycle riders normally attempt to stop at their desired locations during queue formation on signalized intersection approaches. Under mixed-traffic conditions, motorcycle positioning in a queue affects the operational and safety performance of the intersection. This study aimed to identify factors influencing motorcycle riders’ stopping locations at signalized urban intersections. This study applied Unmanned Aerial Vehicles (UAVs) to observe the stopping behavior of 1413 motorcycle riders on 24 approaches from 10 signalized intersections in Thailand (N = 1413). Multinomial logistic regression analysis was used to determine the relationship between the stopping locations of motorcycle riders and rider- and motorcycle-related variables and traffic- and environmental-related variables. The statistical analyses presented a Cox and Snell R2 and Nagelkerke R2 of 0.466 and 0.499, respectively, indicating that the model accounted for almost 50% of the variation among the five stopping locations of motorcycle riders. The results showed that, under mixed-traffic conditions in Thailand with left-hand traffic, motorcycle riders intending to turn right, the morning peak period, the presence of shadows, motorcycle riders not wearing helmets, the presence of a larger vehicle in the queue, and the density of desired stopping locations significantly influenced the motorcyclists’ choice of stopping locations on signalized intersection approaches. Practical policy-related recommendations drawn from the findings are provided to improve motorcyclists’ safety on signalized intersection approaches.

A Dutch prediction tool to assess the risk of incidental gallbladder cancers after cholecystectomies for benign gallstone disease

BackgroundDespite the increasing implementation of selective histopathologic policies for post-cholecystectomy evaluation of gallbladder specimens in low-incidence countries, the fear of missing incidental gallbladder cancer (GBC) persists. This study aimed to develop a diagnostic prediction model for selecting gallbladders that require additional histopathological examination after cholecystectomy. MethodsA registration-based retrospective cohort study of nine Dutch hospitals was conducted between January 2004 and December 2014. Data were collected using a secure linkage of three patient databases, and potential clinical predictors of gallbladder cancer were selected. The prediction model was validated internally by using bootstrapping. Its discriminative capacity and accuracy were tested by assessing the area under the receiver operating characteristic curve (AUC), Nagelkerke's pseudo-R2, and Brier score. ResultsUsing a cohort of 22,025 gallbladders, including 75 GBC cases, a prediction model with the following variables was developed: age, sex, urgency, type of surgery, and indication for surgery. After correction for optimism, Nagelkerke's R2 and Brier score were 0.32 and 88%, respectively, indicating a moderate model fit. The AUC was 90.3% (95% confidence interval, 86.2%–94.4%), indicating good discriminative ability. ConclusionWe developed a good clinical prediction model for selecting gallbladder specimens for histopathologic examination after cholecystectomy to rule out GBC.

Morbidity, Mortality Patterns and Factors Associated With Mortality among Neonates Admitted in Wajir County Referral Hospital

Background: Neonatal morbidity and mortality is a global burden despite management measures that has been developed. Approximately 75% of all newborn deaths occur in the first week of life. In 2018 alone, around 2.5 million neonates died globally as a result of preventable causes such as prematurity, complications at birth, infections, and congenital abnormalities. Objective: The objective of the study was to determine neonatal morbidity and mortality patterns, and factors associated with mortality among neonates admitted in Wajir County Referral Hospital. Methodology: A hospital-based retrospective cross-sectional study was conducted among all neonates admitted to the New Born Unit of the WCRH from 01 January 2019 to 31 December 2020. A consecutive sampling technique based on the inclusion criteria was used. A data abstraction tool was used to extract data from the medical records of neonates admitted to the New Born Unit of the hospital. Results: A total of 615 neonates were included in the study. There were 336 (54.6%) male and 279 (45.4%) female neonates. Almost all the deliveries 566 (92.0%) were performed at the health facility with a minority of about 49 (8%) delivered at home. The home deliveries and referrals admissions from tertiary hospitals together were 66 (10.7%). Neonatal morbidity included birth asphyxia 335 (54.5%), neonatal sepsis 144 (23.4%), 57 (9.3%) meconium aspiration syndrome and 52 (8.5%) low birth weight/preterm. Overall mortality in 2019 at the health facility was 45 (12.97%) and in 2020, 35 (13.06%) presenting no significant difference. The deaths that occurred in the first 24 hours of life was 36 (45%). Bivariate and multivariate analysis produced a significant association between the factors associated with neonatal mortality. The multivariate analysis with day of admission (OR 2.872, 95% CI 1.293, 6.375), Sex, (OR 1.02, 95% CI 1.0.627, 1.66) and Birth weight, (OR 0.936, 95% CI 0.423, 2.068) at p&lt;0.05. The logistic regression model was statistically significant, χ2(7) = 20.770, p &lt;0.001. The model explained 27% (Nagelkerke R2) of the variance in discharge outcome and correctly classified 87% of cases. The male gender were 1.02 times more likely to die than females while the place of delivery was 0.572 times likely to result in death. Conclusions: Birth asphyxia was found to be the leading cause of admission, followed by neonatal sepsis and meconium aspiration syndrome respectively. The leading cause of death was birth asphyxia and neonatal sepsis. The mortality rate at the facility was 13%. Neonatal fatality of the newborns admitted to NBU is high in Wajir County. Since majority of the deaths are from preventable causes, this offers chances to improve newborn survival. Key Words: Morbidity, Mortality, Neonates, Asphyxia

Does Fitzpatrick Score Predict Flap Loss? Microsurgical Breast Reconstruction Outcomes of Varying Skin Color.

This is a retrospective study conducted on patients who underwent any type of autologous flap breast reconstruction performed by the two senior authors at an academic center between January 2010 and December 2021. The sole primary outcome variable was flap loss. Patient skin tone was assessed using the Fitzpatrick scale on clinical photographs of patients. A total of 1115 pateints underwent autologous flap breast reconstruction, of which only 56 met both exclusion and inclusion criteria with 58 individual breasts being included in the final study population. The most common race of subjects was White (n = 33; 56.9%) while the most common Fitzpatrick score skin tone was type II (n = 22; 37.9%). The Cochran-Armitage test of trend showed a statistically significant linear trend, P = 0.006, with darker Fitzpatrick score skin tones associated with a higher proportion of flap loss in patients who had vascular compromise. A logistic regression showed that none of the predictor variables were significant. Patients with darker Fitzpatrick skin tones were associated with flap loss after vascular compromise. To prevent flap loss in patients who have darker Fitzpatrick score skin tones, more aggressive flap monitoring should be taken into consideration in the immediate postoperative setting.

The prediction capability of a cataract surgery risk stratification model based on a large electronic medical record dataset.

The aim of this study was to develop a risk stratification system that predicts visual outcomes (uncorrected corrected visual acuity at one week and five weeks postoperative) in patients undergoing cataract surgery. This was a retrospective analysis in a multitier ophthalmology network. Data from all patients who underwent phacoemulsification or manual small-incision cataract surgery between January 2018 and December 2019 were retrieved from an electronic medical record system. There were 122,911 records; 114,172 (92.9%) had complete data included. Logistic regression analyzed unsatisfactory postoperative outcomes using a main effects model only. The final model was cross-checked using forward stepwise selection. The Hosmer-Lemeshow goodness of fit test, the Bayesian information criterion, and Nagelkerke's R2 assessed model fit. Dispersion was calculated from deviance and degrees of freedom and C-stat from receiving operating characteristics analysis. The final phacoemulsification model (n = 48,169) had a dispersion of 1.08 with a Hosmer-Lemeshow goodness of fit of 0.20, a Nagelkerke R2 of 0.19, and a C-stat of 0.72. The final manual small-incision cataract surgery model (n = 66,003) had a dispersion of 1.05 with a Hosmer-Lemeshow goodness of fit of 0.00015, a Nagelkerke R2 of 0.14, and a C-stat of 0.68. The phacoemulsification model had reasonable model fit; the manual small-incision cataract surgery model had poor fit and was likely missing variables. The predictive capability of these models based on a large, real-world cataract surgical dataset was suboptimal to determine which patients could benefit most from sight-restoring surgery. Appropriate patient selection for cataract surgery in developing settings should still rely on clinician thought processes, intuition, and experience, with more complex cases allocated to more experienced surgeons.

Systemic infection drives urgent care needs and outcome in adults with long-term neurological conditions

It is estimated that 1 in 6 people are living with a long-term neurological condition (LTNC). Although it is likely that systemic infections are a common trigger for urgent tertiary care needs in LTNCs, there is a lack of data. Yet this is important since systemic infections are a modifiable risk factor, and hence the motivation for a formal evaluation. We undertook case note review of 155 consecutive unselected adult patients with LTNC receiving urgent care at a tertiary hospital between November and December 2019. Data were collected on presenting symptoms, diagnosis, length of stay, complications, and change in social needs. The most common LTNCs were neurocognitive disorders (n = 68, 44%), cerebrovascular disorders (n = 65, 42%), and epilepsy (n = 19, 12%). Respiratory infections were most common (n = 40, 62.5%), followed by urinary (n = 16, 25%), skin (n = 4, 6%), gastrointestinal (n = 3, 5%) and bone (n = 1, 1.5%). Systemic infection was the trigger for urgent care in 41.3% of patients and in multivariable regression was associated with an increased likelihood of admission (p < 10−5, OR = 7.8, Nagelkerke R2 = 0.37), longer length of stay (p = 0.03, β = 5.91, R2 = 0.06), and death (p = 0.045, OR = 4.3, Nagelkerke R2 = 0.22). Altered mental status was the presenting symptom most frequently associated with infection (p < 10−8, χ2 test). In conclusion, systemic infections are a major trigger of acute tertiary care needs in adults with LTNCs, and play a role in determining clinical outcome. Since systemic infections are preventable or can be treated if identified early, they may represent a modifiable target to improve quality of life, clinical outcomes and health service efficiency.

Perceived cognitive impairment in high school students in the United States.

IntroductionSome youth experience cognitive difficulties that interfere with their ability to learn and function well in a school environment. We examined correlates of perceived cognitive impairment among high school students who completed a national survey conducted by the United States Centers for Disease Control and Prevention (CDC) in 2019.MethodsParticipants were high school students (grades 9–12) who completed the Youth Risk Behavior Survey (YRBS) in 2019. The CDC uses this survey to monitor risk behaviors. Students answered the following question ‘Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions?’ as either ‘yes’ or ‘no.’ Student responses to this question were analyzed in relation to demographic variables and variables pertaining to adversity, mental health problems, and drug use.ResultsThe sample included 8,349 students between the ages of 14 and 18, with 4,093 boys (49%) and 4,256 girls (51%). A large proportion reported having serious difficulty concentrating, remembering, or making decisions due to physical, mental, or emotional problems (38%). A significantly larger proportion of girls (45%) than boys (30%) reported experiencing cognitive impairment [χ2(1) = 212.23, p < 0.001; Odds Ratio = 1.95, 95% confidence interval = 1.78–2.13]. Youth who exercised regularly were significantly less likely to report cognitive impairment. Binary logistic regression was used to examine the associations between perceived cognitive impairment and adversity, mental health, and lifestyle variables separately for boys [χ2(11) = 569.158, p < 0.001; Nagelkerke R2 = 0.212] and girls [χ2(11) = 1,026.189, p < 0.001; Nagelkerke R2 = 0.321]. Being bullied, feeling unsafe or threatened at school, getting very low grades, insufficient sleep, and using illicit drugs were independently associated with perceived cognitive impairment in both boys and girls—after controlling for associations with depression and suicidality. Youth who denied mental health problems, psychosocial adversities, and using illicit drugs reported much lower rates of perceived cognitive impairment (boys = 13%, girls = 15%).ConclusionA remarkably large proportion of high school students in the United States reported experiencing serious difficulty with their cognitive functioning over the past year. Girls were significantly more likely to endorse perceived cognitive difficulties compared to boys. There was a strong association between perceived cognitive impairment and the experience of psychosocial adversity.

CHARACTERISTICS, OUTCOMES, AND MORTALITY PREDICTORS IN HOSPITALIZATIONS WITH MYXEDEMA COMA

CHARACTERISTICS, OUTCOMES, AND MORTALITY PREDICTORS IN HOSPITALIZATIONS WITH MYXEDEMA COMA

Prolonged grief disorder in Arabic-speaking treatment-seeking populations: Relationship with socio-demographic aspects, loss- and trauma-related characteristics, and mental health support.

IntroductionProlonged grief disorder (PGD) has been included as a new diagnosis in the ICD-11 and is set to be included in the DSM-5-TR. To better identify vulnerable individuals, different factors associated with PGD have to be taken into account, but results regarding these factors remain equivocal. Moreover, few studies on PGD are available from Arabic-speaking populations and from different countries dealing with conflicts and wars. The objective was thus to examine PGD prevalence and associated characteristics in these populations.Materials and methodsA total of N = 1,051 bereaved participants from Arabic-speaking populations completed the PG-13 as part of a screening procedure for an online mental health intervention. Multiple linear regression was conducted to examine associated factors for PGD symptom severity, and multiple logistic regression was applied to investigate associated factors for PGD according to PG-13 diagnostic criteria.ResultsOf the participants, 18.8% (n = 198) met the PGD diagnostic criteria, at an average of about 6 years post-loss. The multiple linear regression yielded eight associated factors for PGD symptom severity (age, gender, number of losses, number of traumatic event types, relationship with the deceased, age at loss, impairment during first year post-loss, perceived social support), which explained 40.2% of the variance [F(17, N=1,033) = 40.82, p < 0.001, R2 = 0.402]. The multiple logistic regression yielded five significant associations with PGD (gender, relationship with the deceased, number of lost persons, impairment during first year post-loss, perceived social support), which explained 33.0% (Nagelkerke R2) of the variance in PGD according to PG-13 diagnostic criteria.DiscussionA substantial proportion of the participants met the PG-13 criteria for PGD, emphasizing that therapeutic services are indispensable in this population. The associated factors for PGD found in our Arab-speaking sample are largely consistent with those found in studies from other regions. The slightly differing numbers of associated factors between the linear and logistic regression underline that a continuous score reflects the continuum between normal and dysfunctional grieving, and therefore also a range of factors associated with PGD.

A modifiable factors-based model for detecting inactive individuals: are the European assessment tools fit for purpose?

The lack of systematic factors affecting physical inactivity (PIA) challenges policymakers to implement evidence-based solutions at a population level. The study utilizes the Eurobarometer to analyse PIA-modifiable variables. Special Eurobarometer 412 physical activity (PA) data were analysed (n = 18 336), including 40 variables along with the International PA Questionnaire. PIA was used as the dependent variable. Variables considered were alternatives to car, places, reasons and barriers to engaging in PA, memberships to clubs and categorical responses about the agreement extent with the area, provision of activities and local governance statements. Logistic regression was used to identify variables contributing to PIA. Beta values (β), standard errors, 95% confidence intervals, the exponentiation for odds ratio and Cox & Snell and Nagelkerke R2 were indicated. The resulting model correctly identified 10.7% inactives and 96.9% of actives (R2 of Nagelkerke: 0.153). Variables contributing to the detection of PIA were (P ≤ 0.01): having a disability or an illness, not having friends to do sport with, lacking motivation or interest in and being afraid of injury risk. Additionally, totally agreeing, tend to agree and tend to disagree regarding the extent of local providers offering enough opportunities to be more active also contributed to the model. The model reported a limited ability to detect modifiable factors affecting PIA, identifying a small percentage of inactive individuals correctly. New questions focused on understanding inactive behaviour are needed to support the European PA public health agenda.

Predictors of pain catastrophizing in women with systemic lupus erythematosus.

SUMMARYOBJECTIVE:The aim of this study was to identify predictive factors associated with pain catastrophizing in women with systemic lupus erythematosus (SLE).METHODS:A total of 104 volunteered women with a diagnosis of systemic lupus erythematosus participated in the study. Pain Catastrophizing Scale, Body Awareness Questionnaire, Tampa Scale of Kinesiophobia, and Beck Depression Inventory were used to assess patients. Correlations between pain catastrophizing (dependent variable) and independent variables (age, body mass index, disease activity, organ damage, depression, kinesiophobia, and body awareness) were analyzed with Pearson’s rho correlation analysis. The multiple stepwise linear regression models with R2 were used to compare across the models and explain the total variance. The significance level of a p-value was considered significant if p≤0.05.RESULTS:There were no correlations between Pain Catastrophizing Scale and age, Beck Depression Inventory, disease activity, and organ damage (p>0.05). Pain Catastrophizing Scale was correlated with Tampa Scale of Kinesiophobia (r=0.585; p<0.001), Beck Depression Inventory (r=0.511; p<0.001), and Body Awareness Questionnaire (r=0.277; p<0.005). The regression analysis showed that the predictor factors of pain catastrophizing in women with systemic lupus erythematosus were TSK (B 0.411; p<0.001), Beck Depression Inventory (B 0.363; p<0.001), Body Awareness Questionnaire (B 0.273; p<0.001), and body mass index (B -0.169; p=0.02) (Nagelkerke R2=0.52).CONCLUSIONS:As a result, the most related factors on pain catastrophizing were kinesiophobia, depression, body awareness, and body mass index in women with systemic lupus erythematosus. We suggest assessing these parameters as predictive of pain catastrophizing throughout systemic lupus erythematosus management.

In the Shoulder or in the Brain? Behavioral, Psychosocial and Cognitive Characteristics of Unilateral Chronic Shoulder Pain with Symptoms of Central Sensitization.

The recognition of central sensitization (CS) is crucial, as it determines the results of rehabilitation. The aim of this study was to examine associations between CS and catastrophizing, functionality, disability, illness perceptions, kinesiophobia, anxiety, and depression in people with chronic shoulder pain (SP). In this cross-sectional study, 64 patients with unilateral chronic SP completed a few questionnaires including the Central Sensitization Inventory, the Oxford Shoulder Score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, the Brief Illness Perception Questionnaire and the “arm endurance” test. On the basis of three constructed linear regression models, it was found that pain catastrophizing and depression (model 1: p < 0.001, R = 0.57, R2 = 0.33), functionality (model 2: p < 0.001, R = 0.50, R2 = 0.25), and helplessness (model 3: p < 0.001, R = 0.53, R2 = 0.28) were significant predictors for CS symptoms in chronic SP. Two additional logistic regression models also showed that depression (model 4: p < 0.001, Nagelkerke R2 = 0.43, overall correct prediction 87.5%) and functionality (model 5: p < 0.001, Nagelkerke R2 = 0.26, overall correct prediction 84.4%) can significantly predict the classification of chronic SP as centrally sensitized. Patients who were classified as centrally sensitized (n = 10) were found to have significantly worse functionality, psychological factors (anxiety, depression, kinesiophobia, catastrophizing), and pain intensity (p < 0.05). Catastrophizing, depression, and functionality are predictive factors of CS symptoms in patients with chronic shoulder pain. Health care providers should adopt a precision medicine approach during assessment and a holistic rehabilitation of patients with unilateral chronic SP.

Investigation of the relationship between the use of complementary alternative medicine and illness perception and illness cognition in patients with diabetic foot ulcer

Objective: to examine the relationship between illness perception, illness cognition, and other sociodemographic characteristics of individuals with diabetic foot ulcer (DFU) and their complementary alternative therapies (CAM) use within the framework of self-regulation model (SRM). Material and methodsThis cross-sectional descriptive study was carried out with 220 individuals with DFU in the Endocrinology and Metabolic Diseases outpatient clinic of two training and research hospitals between December 5, 2020, and June 5, 2021. Research data were collected by using the Patient Information Form, Brief Illness Perception Scale (BIPS), and Illness Cognition Questionnaire (ICQ). Descriptive statistical methods and the Mann-Whitney U test were used to were used in the evaluation of the data. The determinants of the CAM use status of the patients were evaluated by logistic regression analysis. ResultsIt was determined that 136 (61.81%) patients who used CAM mostly preferred herbal methods. Patients' mean scores were 42.23 ± 5.66 on the total BIPS, 39.65 ± 16.01 on the total ICQ. Increasing age, female gender, increased disease perception (BIPS) and disease cognition (ICQ) increased the use of CAM (Nagelkerke R2:0.552; Model: x2 = 168.579 p = 0.00) ConclusionsIt was determined that our patients frequently preferred CAM. Predictors of CAM use were identified as female gender, advanced age, illness perception, and illness cognition. Accordingly, for effective management of DFU, besides the comprehensive evaluation of individuals with DFU and the provision of wound care by health care professionals, illness perceptions, illness cognition, and CAM use should be considered carefully.

A-227 A Story Told in Four Parts: Embedded Validity Indicators’ Effectiveness in Predicting Dot Counting Test Validity Classification

Abstract Objective: Combining multiple embedded performance validity tests (PVTs) can produce similar classification accuracy to freestanding PVTs. However, there is a lack of research on the incremental predictive power of various combinations of PVTs. Thus, we compared eight embedded PVTs to assess those that best predict classification accuracy on the Dot Counting Test (DCT). Method: Sample included 225 patients (mean age=45.96; mean education=13.96; 56% female, 44% male; 35% White, 40% Black, 17% Hispanic, 5% Asian, 2% Other) undergoing neuropsychological evaluation that included multiple embedded PVTs, including: Brief Visuospatial Memory Test-Revised Recognition Discrimination (BVMT-R RD), Stroop Color and Word Test Word Reading T-Score (Stroop-T), Trail Making Test Part A T-Score (TMT-A), Rey Auditory Verbal Learning Test (RAVLT) Forced Choice, RAVLT Effort Score, Digit Span Age Corrected Scaled Score, Reliable Digit Span, and Letter Fluency T-Score. Patients were classified into valid/invalid groups based on four independent criterion PVTs. Results: A forward stepwise logistic regression was performed to predict DCT pass/fail using the aforementioned embedded PVTs as predictors. The model was achieved in three steps (p&amp;lt;.05); Step 1: BVMT-R RD (Classification Accuracy=87.6%; Nagelkerke R2 =.30), Step 2: BVMT-R RD + Stroop-T (Classification Accuracy=89.6%; Nagelkerke R2 =.44); Step 3: BVMT-R RD + Stroop-T + TMT-A (Classification Accuracy=90.1%; Nagelkerke R2 =.49). Conclusion: BVMT-R RD + Stroop-T + TMT-A reliably predicted the DCT pass/fail group. Thus, this combination of embedded PVTs may be reliable predictors of validity classification when time prohibits delivery of freestanding PVTs, such as the DCT.

A-228 A Story Told in Four Parts: Embedded Validity Indicators’ Effectiveness in Predicting Medical Symptom Validity Test Validity Classification

Abstract Objective: Prior cross-validation studies have demonstrated the utility of embedded Performance Validity Tests (PVT) as reliable indicators of performance validity, though studies of the incremental predictive power from potential combinations of embedded PVTs remain sparse. The goal of the study was to compare the relative utility of eight embedded PVTs to predict pass/fail on the Medical Symptom Validity Test (MSVT). Methods: The study comprised 225 mixed neuropsychiatric patients referred for outpatient neuropsychological evaluation. The sample was 56% female and racially diverse (40% Black, 35% White, 17% Hispanic, 5% Asian, and 2% other ethnicities). The patients were administered the following eight embedded PVTs: Rey Auditory Verbal Learning Test Forced Choice (RAVLT-FC), RAVLT Effort Score, Digit Span Age Corrected Scaled Score (DS-ACSS), Stroop Color and Word Test Word Reading T-Score, Brief Visual Memory Test-Revised Recognition Discrimination (BVMT-RD), Reliable Digit Span, Letter Fluency T-Score, and Trail Making Test Part A T-Score. The patients were classified into valid/invalid groups based on standard MSVT cut scores. Results: A forward entry logistic regression model was attained in three steps (p&amp;lt;.05); Step 1: RAVLT-FC (Classification Accuracy=83.2%; Nagelkerke R2 =.27), Step 2: RAVLT-FC + DS-ACSS (Classification Accuracy=84.2%; Nagelkerke R2 =.36); Step 3: RAVLT-FC + DS-ACSS + Stroop Word-T (Classification Accuracy=85.1%; Nagelkerke R2 =.39). Conclusion: The RAVLT-FC + DS-ACSS + Stroop Word-T combination provides robust predictive power. The study provided a novel approach to selecting embedded PVTs that best stand in place of the MSVT when time constraints limit the use of freestanding PVTs.