Physical Component Summary Scale Score Research Articles

Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department: a multicentre randomised clinical trial

BackgroundChest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients...

Performing a Safe and Effective Total Hip Arthroplasty on Patients With Inactive or Stably Active Systemic Lupus Erythematosus With Osteonecrosis.

Patients with systemic lupus erythematosus (SLE) are typically treated with total hip arthroplasty (THA) because of osteonecrosis of the femoral head (ONFH). This study evaluated the outcome of THA in this patient group. From January 2004 to January 2017, we retrospectively studied 92 THAs for patients with SLE and 92 THAs for age- and sex-matched patients suffering from ONFH due to nonrheumatic etiologies Both groups were treated with cementless THA and followed up for an average of 50.9 ± 30.6 months. Their surgical outcomes and complications were evaluated and compared. No significant difference existed in age, sex, weight, height, follow-up time, and Ficat staging between the groups. All patients with SLE were in inactive or stably active disease conditions. For all patients, the Harris hip score (HHS) (from 52.6 to 92.8; P < 0.001), Physical Component Summary Scale score (PCS) (from 29.4 to 49.3; P < 0.001), and Mmental Component Summary Scale score (MCS) (from 50.5 to 55.5; P < 0.001) of the Short Form-12 improved significantly after surgery. At the final follow-up, the HHS and MCS were comparable between the two groups. The PCS remained lower in the SLE group (P = 0.017), and no recorded revision surgieries in either group. Corticosteroid intake and testing positive for antiphospholipid antibodies, rather than having a SLE disease activity index score greater than zero, were risk factors for higher complications. Performing THA for patients with SLE in an inactive or stably active disease condition resulted in comparable postoperative HHS and MCS scores, a lower PCS score, and shorter term postoperative complications compared with patients with ONFH resulting from nonrheumatic diseases. Patients with SLE had a higher risk for postoperative complications. It is generally safe and effective to perform THA in patients with inactive or stably active SLE. However, they still have an increased risk of short-term complications.

The effects of nausea, vomiting, and social support on health-related quality of life during early pregnancy: A prospective cohort study

ObjectiveTo date, no previous study has examined the independent association between nausea, vomiting, and social support and health-related quality of life among early pregnant women. MethodsTo fill this gap, we investigated these associations within this group using repeated-measurement data. MethodsA prospective cohort design was conducted from August 2018 to February 2019 with perinatal outpatients in a general hospital. Participants were 153 pregnant women aged 20 years or older and under 20 weeks of gestation at their first prenatal visit. Along with reporting their sociodemographic data, participants completed the Index of Nausea, Vomiting, and Retching (INVR), the 12-item Short Form Health Survey (SF-12), and the Multidimensional Scale of Perceived Social Support (MSPSS) and re-completed INVR, and SF-12 at follow-up checkups a maximum of three times. ResultsAfter controlling for internal correlations and confounding factors, INVR was found to be significantly negatively associated with the physical component summary scale score of SF-12; however, MSPSS showed no association with the physical component summary scale score. Conversely, the scores for both INVR and MSPSS were negatively and positively, respectively, significantly associated with the mental component summary scale score of SF-12. ConclusionThe severity of nausea and vomiting significantly impacts physical quality of life during early pregnancy. Both nausea and vomiting and social support significantly and independently affect mental quality of life. Health professionals should recognize these impacts and be aware that social support contributes to improving mental quality of life.

Nutrition-related parameters predict the health-related quality of life in home care patients.

There is evidence that nutritional status is one of the major factors affecting quality of life. Low quality of life is an important reason that reflects the risk of malnutrition as well as dependency and frailty. The present study aimed to examine nutritional risk factors and sociodemographic features affecting health-related quality of life in home care patients. The data of 209 adult or elderly eligible subjects were evaluated in the study. A general questionnaire including sociodemographic and nutritional characteristics, 'Mini Nutritional Assessment (MNA)', 'Short Form-36 (SF-36) health related life quality scale' and '24-hour dietary recall' were applied with face-to-face interview. Anthropometric measurements were performed using standard measurement protocols and, height and weight measurements of bedridden patients were calculated by equality formulas. While 52.6% of patients were malnourished according to the MNA, only 7.7% were underweight according to the body mass index (BMI). The SF-36 summary component scores (physical and mental component summary scale scores) of malnourished patients were significantly lower than patients at risk of malnutrition or normal (p < 0.05). There were significant positive correlations between SF-36 physical component summary scale scores were significantly correlated with MNA scores (r = 0.517), BMI (r = 0.140) and daily dietary macronutrient intake (energy (r = 0.328), protein (r = 0.165), carbohydrate (r = 0.305), fat (r = 0.275) and fiber (r = 0.268)) (p < 0.05). Besides there were significant positive correlation between SF-36 mental component summary scale scores and MNA scores (r = 0.719), BMI (r = 0.318), daily dietary macronutrient intake (energy (r = 0.388), protein (r = 0.204), carbohydrate (r = 0.335), fat (r = 0.365) and fiber (r = 0.349)) (p < 0.05). It was also determined that MNA had the greatest positive effect and 'having a caregiver' had the greatest negative effect on the physical and mental component summary scale scores. Periodic nutritional screening of home care patients is important and necessary for early nutritional intervention and thus prevention of morbidity and mortality.

Impact of patient-education on health related quality of life of diabetic foot ulcer patients: A randomized study

BackgroundDiabetic foot is the most serious and disabling long term complication of diabetes, adversely affecting the health related quality of life (HRQoL). ObjectivesTo evaluates the impact of patient-education (PE) on HRQoL of diabetic foot ulcer (DFU) patients. MethodsThis randomized controlled study on the effect of PE on improvement of HRQoL, conducted in Kasturba Hospital, Manipal, India consisted of 135 DFU patients with 65 subjects in the control group (CG) and 70 subjects in the intervention group (IG). RAND-36 questionnaire was employed for evaluating HRQoL scores of DFU patients in both groups at baseline and after six months of PE. ResultsSubjects in the both IG and CG reported poor HRQoL scores, on all the eight subscales at baseline. After six months of PE, HRQoL improved substantially in IG with respect to CG and IG at baseline (p < 0.05). Likewise, in both CG and IG, the physical component summary scale (PCS) scores (24.1 ± 6.6 vs 25.6 ± 7.3) and the mental component summary scale (MCS) scores (27.3 ± 5.4 vs 28.8 ± 7.1) were similar and poor before PE. However, six months post PE, in IG, the Both PCS and MCS scores increased dramatically from 25.6 ± 7.3 to 42.9 ± 9.7 and 28.8 ± 7.1 to 48.8 ± 8.4 (p < 0.05) respectively. ConclusionThe remarkable improvement in the HRQoL in IG at six months follow-up suggests that PE significantly improves HRQoL in DFU patients. Overworked physicians and paucity of trained doctors in resource-poor settings obligate task-sharing with non-physician healthcare providers.

Determinants of Health Related Quality of Life in Home Dwelling Elderly Population: Appetite and Nutritional Status.

The present study aimed to examine nutritional risk factors such as poor appetite, malnutrition or obesity affecting health related quality of life in elderly. This is a cross-sectional population-based study consisted of 407 elderly (142 men and 265 women) mean aged 71.7±6.54 years. Questionnaire including the demographic and general characteristics, health information, nutritional habits was performed by face-to-face interviews. Daily food consumption was assessed using 24-hour dietary recall. Mini Nutrition Assessment (MNA) and Mini Nutrition Assessment-Short Form (MNA-SF) were used for assessment of nutrition status. Appetite was evaluated using the Simplified Nutritional Appetite Questionnaire (SNAQ). Health related life quality scale (Short Form Health Survey -SF36) was used for evalution health related quality of life. According to MNA and MNA-SF 6.1%; 4.2% of elderly people were malnutrition and 40.3%; 21.9% of them were at risk of malnutrition respectively. Accordingly, SNAQ 28.7% of elderly were risk at loss of weight. Health related quality of life scores of women were significantly lower than men. Good nutritional (MNA-SF) and good appetite (SNAQ) status, increased 1.69, 1.48 fold in the mental component summary scale scores respectively. SNAQ was the best determinant of physical component summary scale score had the greatest positive effect, good appetite status increased approximately 2.2 fold in physical scores. Polypharmacy and high BMI decreased health related quality of life in elderly. Determinants of quality of life are preventable and treatable with early and appropriate interventions in elderly.

Longterm health-related quality of life after living liver donation.

There are little data on longterm outcomes, health-related quality of life (HRQoL), and issues related to living donor right hepatectomy specifically. We studied longterm HRQoL in 127 living liver donors. A donor-specific survey (DSS) was used to evaluate the living liver donor morbidity, and the 36-item short-form health survey (short-form 36 health survey, version 1 [SF-36]) was used to assess generic outcomes. The DSS was completed by 107 (84.3%) donors and the SF-36 by 62 (49%) donors. Median follow-up was 6.9 years. Of the 107 donors, 12 (11.2%) donors reported their health as better, whereas 84 (78.5%) reported their health the same as before donation. Ninety-seven (90.7%) are currently employed. The most common postdonation symptom was incisional discomfort (34%). Twenty-four donors (22.4%) self-reported depression symptoms after donation. Ninety-eight (91.6%) rated their satisfaction with the donation process ≥ 8 (scale of 1-10). Three factors-increased vitality (correlation, 0.44), decreased pain (correlation, 0.34), and a recipient who was living (correlation, 0.44)-were independently related to satisfaction with the donor experience. Vitality showed the strongest association with satisfaction with the donor experience. Mental and physical component summary scale scores for donors were statistically higher compared to the US population norm (P < 0.001). Donors reported a high satisfaction rate with the donation process, and almost all donors (n = 104, 97.2%) would donate again independent of experiencing complications. Our study suggests that over a longterm period, liver donors continue to have above average HRQoL compared to the general population.

SF-36v2 norms and its’ discriminative properties among healthy households of tuberculosis patients in Malaysia

The aim of the study was to obtain norms of the SF-36v2 health survey and the association of summary component scores with socio-demographic variables in healthy households of tuberculosis (TB) patients. All household members (18 years and above; healthy; literate) of registered tuberculosis patients who came for contact tracing during March 2010 to February 2011 at the respiratory clinic of Penang General Hospital were invited to complete the SF-36v2 health survey using the official translation of the questionnaire in Malay, Mandarin, Tamil and English. Scoring of the questionnaire was done using Quality Metric's QM Certified Scoring Software version 4. Multivariate analysis was conducted to uncover the predictors of physical and mental health. A total of 649 eligible respondents were approached, while 525 agreed to participate in the study (response rate = 80.1 %). Out of consenting respondents, 46.5 % were male and only 5.3 % were over 75 years. Internal consistencies met the minimum criteria (α > 0.7). Reliability coefficients of the scales were always less than their own reliability coefficients. Mean physical component summary scale scores were equivalent to United States general population norms. However, there was a difference of more than three norm-based scoring points for mean mental component summary scores indicating poor mental health. A notable proportion of the respondents was at the risk of depression. Respondents aged 75 years and above (p = 0.001; OR 32.847), widow (p = 0.013; OR 2.599) and postgraduates (p < 0.001; OR 7.865) were predictors of poor physical health while unemployment (p = 0.033; OR 1.721) was the only predictor of poor mental health. The SF-36v2 is a valid instrument to assess HRQoL among the households of TB patients. Study findings indicate the existence of poor mental health and risk of depression among family caregivers of TB patients. We therefore recommend that caregivers of TB patients to be offered intensive support and special attention to cope with these emotional problems.

Pill Burden, Adherence, Hyperphosphatemia, and Quality of Life in Maintenance Dialysis Patients

Dialysis patients have a high burden of co-existing diseases, poor health-related quality of life (HR-QOL), and are prescribed many medications. There are no data on daily pill burden and its relationship to HR-QOL and adherence to therapy. Two hundred and thirty-three prevalent, chronic dialysis patients from three units in different geographic areas in the United States underwent a single, cross-sectional assessment of total daily pill burden and that from phosphate binders. HR-QOL, adherence to phosphate binders, and serum phosphorus levels were the three main outcome measures studied. The median daily pill burden was 19; in one-quarter of subjects, it exceeded 25 pills/d. Higher pill burden was independently associated with lower physical component summary scale scores on HR-QOL on both univariate and multivariate analyses. Phosphate binders accounted for about one-half of the daily pill burden; 62% of the participants were nonadherent. There was a modest relationship between pill burden from phosphate binders and adherence and serum phosphorus levels; these associations persisted on multivariate analyses. There was no relationship between adherence and serum phosphorus levels. The daily pill burden in dialysis patients is one of the highest reported to date in any chronic disease state. Higher pill burden is associated with lower HR-QOL. There are many reasons for uncontrolled serum phosphorus levels; increasing the number of prescribed pills does not seem to improve control and may come at the cost of poorer HR-QOL.

Correlation of Health-Related Quality of Life After Liver Transplant With the Model for End-Stage Liver Disease Score

To determine whether a correlation exists between the Model for End-Stage Liver Disease (MELD) score and health-related quality of life (HRQOL) after liver transplant (LT). Prospective cohort. University hospital. Adult LT recipients (N = 209). Postoperative HRQOL over a 1-year period after LT as measured via multiple regression-based path analysis testing the effects of the MELD score, preoperative variables, and postoperative variables on scores on the physical component summary and mental component summary scales of the 36-Item Short Form Health Survey and on composite physical and mental HRQOL scores derived from multiple scales. The MELD score (beta = .16), cholestatic cirrhosis (beta = .12), autoimmune/metabolic disease (beta = .18), neoplasm (beta = .23), time after LT (beta = .16), and the Karnofsky score (beta = .49) had significant effects on the physical component summary scale score. Autoimmune/metabolic disease (beta = .16) and the Karnofsky score (beta = .25) had significant effects on the mental component summary scale score. The MELD score (beta = .15), high school education (beta = .15), college education (beta = .17), autoimmune/metabolic disease (beta = .15), neoplasm (beta = .23), time after LT (beta = .11), and the Karnofsky score (beta = .51) had significant effects on the composite physical HRQOL score. Autoimmune/metabolic disease (beta = .23), neoplasm (beta = .15), and the Karnofsky score (beta = .42) had significant effects on the composite mental HRQOL score. An increasing MELD score, when computed without any diagnosis-based exception points, was associated with improved physical HRQOL in the first year after LT. The MELD score did not affect mental HRQOL.

Development and validation of the self-administered Fibromyalgia Assessment Status: a disease-specific composite measure for evaluating treatment effect.

IntroductionThe Fibromyalgia Impact Questionnaire (FIQ) is a composite disease-specific measure validated for fibromyalgia (FM), but it is rarely used in clinical practice. The objective was to develop and analyse the psychometric properties of a new composite disease-specific index (Fibromyalgia Assessment Status, FAS), a simple self-administered index that combines a patient's assessment of fatigue, sleep disturbances and pain evaluated on the basis of the 16 non-articular sites listed on the Self-Assessment Pain Scale (SAPS) in a single measure (range 0 to 10).MethodsThe FAS index was constructed using a traditional development strategy, and its psychometric properties were tested in 226 FM patients (209 women, 17 men); whose disease-related characteristics were assessed by means of an 11-numbered circular numerical rating scale (NRS) for pain, fatigue, sleep disturbances and general health (GH), the tender point score (TPS), the SAPS, the FIQ, and the SF-36. A group of 226 rheumatoid arthritis (RA) patients was used for comparative purposes. Of the 179 FM patients who entered the follow-up study, 152 completed the three-month period and were included in the responsiveness analyses. One hundred and fifty-four patients repeated the FAS questionnaire after an interval of one week, and its test/re-test reliability was calculated. Responsiveness was evaluated on the basis of effect size and the standardised response mean.ResultsThe FAS index fulfilled the established criteria for validity, reliability and responsiveness. Factor analysis showed that SAPS and fatigue contributed most, and respectively explained 47.4% and 31.2% of the variance; sleep explained 21.3%. Testing for internal consistency showed that Cronbach's alpha was 0.781, thus indicating a high level of reliability. As expected, closer significant correlations were found when FAS was compared with total FIQ (rho = 0.347; P < 0.0001) and the FIQ subscales, particularly job ability, tiredness, fatigue and pain (all P < 0.0001), but the correlation between FAS and the mental component summary scale score (MCS) of the SF-36 (rho = -0.531; P < 0.0001) was particularly interesting. Test/re-test reliability was satisfactory. The FAS showed the greatest effect size. The magnitude of the responsiveness measures was statistically different between FAS (0.889) and the FIQ (0.781) (P = 0.038), and between the SF-36 MCS (0.434) and the SF-36 physical component summary scale score (PCS) (0.321) (P < 0.01).ConclusionsThe self-administered FAS is a reliable, valid and responsive disease-specific composite measure for assessing treatment effect in patients with FM.

Anxiety and depression and their influence on the quality of life after total hip replacement: preliminary report

Objective. The study investigated health-related quality of life in relation to mental status (anxiety and depression) and demographic factors in patients before and after total hip replacement due to osteoarthrosis. Methods. The SF-36, HADS, socio-demographic data questionnaire was delivered to a group of 184 subjects (108 females, 76 males) at the mean age at the time of surgery of 59 years. Questionnaires were delivered to the subjects 2 weeks before the surgery and 6 months after the operation (by mail). Results. Patients after hip replacement showed significant improvement in health-related quality of life in most domains of SF-36 score and summary scale of PCS (Physical Component Summary Scale) and MCS (Mental Component Summary Scale). They also showed improvement in mental status. Elderly patients were more likely to show worse score in MCS and PCS before and after surgery. BMI (body mass index) was correlated only with preoperative PCS. Mental status was associated with postoperative PCS and MCS. Patients who were satisfied with the results of the surgery showed higher PCS and MCS score. Conclusion. Hip replacement surgery brings significant improvement to the quality of life. Age and mental status of those patients influence markedly their postoperative performance.

The use of the SF-36 questionnaire in adult survivors of childhood cancer: evaluation of data quality, score reliability, and scaling assumptions

BackgroundThe SF-36 has been used in a number of previous studies that have investigated the health status of childhood cancer survivors, but it never has been evaluated regarding data quality, scaling assumptions, and reliability in this population. As health status among childhood cancer survivors is being increasingly investigated, it is important that the measurement instruments are reliable, validated and appropriate for use in this population. The aim of this paper was to determine whether the SF-36 questionnaire is a valid and reliable instrument in assessing self-perceived health status of adult survivors of childhood cancer.MethodsWe examined the SF-36 to see how it performed with respect to (1) data completeness, (2) distribution of the scale scores, (3) item-internal consistency, (4) item-discriminant validity, (5) internal consistency, and (6) scaling assumptions. For this investigation we used SF-36 data from a population-based study of 10,189 adult survivors of childhood cancer.ResultsOverall, missing values ranged per item from 0.5 to 2.9 percent. Ceiling effects were found to be highest in the role limitation-physical (76.7%) and role limitation-emotional (76.5%) scales. All correlations between items and their hypothesised scales exceeded the suggested standard of 0.40 for satisfactory item-consistency. Across all scales, the Cronbach's alpha coefficient of reliability was found to be higher than the suggested value of 0.70.Consistent across all cancer groups, the physical health related scale scores correlated strongly with the Physical Component Summary (PCS) scale scores and weakly with the Mental Component Summary (MCS) scale scores. Also, the mental health and role limitation-emotional scales correlated strongly with the MCS scale score and weakly with the PCS scale score. Moderate to strong correlations with both summary scores were found for the general health perception, energy/vitality, and social functioning scales.ConclusionThe findings presented in this paper provide support for the validity and reliability of the SF-36 when used in long-term survivors of childhood cancer. These findings should encourage other researchers and health care practitioners to use the SF-36 when assessing health status in this population, although it should be recognised that ceiling effects can occur.

Influence of Advanced Orthopaedic Certification on Clinical Outcomes of Patients with Low Back Pain

PURPOSE: To determine differences in outcomes of care for patients treated by clinicians with or without advanced orthopaedic certification. Levels of certification studied included orthopaedic clinical specialist certification (OCS), graduation from residency programs approved by the American Academy of Orthopaedic Manual Therapy (AAOMPT) and miscellaneous manual therapy certifications (MTC). SUBJECTS: Retrospective study was performed using Focus On Therapeutic Outcomes, Inc. (Knoxville, TN) data, which was obtained from 930 therapists (28 OCS, 7 AAOMPT, 7 MTC, 2 OCS/AAOMPT) from 39 states who treated 24,276 patients with lumbar impairments in 1999 and 2000. METHODS: Patients completed health status surveys at intake and discharge. Three health status measures were calculated: overall health status (OHS), SF-12 Physical Component Summary scale (PCS), and SF-36 physical functioning scale (PF-10). Change in health status over the episode of rehabilitation was risk adjusted by developing linear mixed models and analyzed across certification processes. RESULTS: Patients treated by therapists with MTC reported higher OHS, PCS, and PF-10 discharge scores than patients treated by therapists without MTC (P<.001). CONCLUSIONS: Findings suggest a positive influence of therapist manual therapy certification on patient outcomes.

Quality-of-life assessment in an outpatient parenteral antibiotic program.

To measure changes and to identify predictors of change of health-related quality of life (HRQoL) for enrollees into an outpatient parenteral antibiotic therapy (OPAT) program. A multidisciplinary, single-center, prospective investigation was conducted at a 1000-bed Canadian adult tertiary-care teaching hospital. Over a 15-month study period, consenting patients who were enrolled in the OPAT program completed paired Short Form-36 (SF-36) questionnaires within 48 hours prior to discharge from the hospital and again 26-30 days after discharge. Sociodemographic data and clinical variables were also collected for the purpose of determining potential predictors of change in quality of life. During the study period, 134 patients were enrolled in the OPAT program and 82 completed the paired SF-36 questionnaires. Study participants experienced a significant improvement in 3 SF-36 domains (physical functioning, bodily pain, role emotional) and the mental component summary scale (MCS) scores when they were transferred from the hospital to home setting. The SF-36 scores for all domains and summary scales were lower than the Canadian population average (all p < 0.001). Multiple linear-regression analysis revealed that infectious disease diagnosis and baseline physical component summary scale (PCS) scores were predictors of the change in the PCS score when patients transferred from the hospital to the home setting. Length of hospital stay and baseline MCS scores were predictors of the change in MCS scores when patients transferred from the hospital to the home setting. This study reveals that some domains in HRQoL appear to improve 4 weeks after discharge for adults enrolled in an OPAT program and that there are different predictors for changes in physical and mental health.

The Impact of Liver Transplantation on Health-Related Quality of Life

755 Health-related quality of life (HRQL) has become an important outcome for liver transplantation (OLT). AIMS: 1. To measure HRQL pre and post-transplantation 2. To determine the effects of clinico-demographic factors on HRQL. 3. To assess the effect of HRQL on resource utilization. DESIGN: Generic (SF-36) and liver-specific questionnaires (Chronic Liver Disease Questionnaire or CLDQ) were administered at baseline and every 3 months post-OLT. HRQL was reported as SF-36 Mental Component Summary scale (MCS), Physical Component Summary scale (PCS) and overall CLDQ scores. Clinical, demographic, galactose elimination capacity (GEC) and laboratory data were recorded. Liver transplant candidates' pre-OLT scores were compared to those of general population and patients with CHF and COPD. Total cost per case (TCPC) and length of stay (LOS) were used to assess resource utilization. RESULTS: 37 OLT candidates were evaluated, 25 male, age:50.2±12, Child's class A=3, B=30, C=4 and GEC=277±81.2. Over 10 months of follow up, ten patients underwent OLT. 1. In patients waiting for OLT, HRQL scores were significantly lower than COPD, CHF and general population. Gender, age, GEC and etiology of liver disease did not have further impact on HRQL. There was a significant inverse correlation between some aspects of HRQL and worsening Child-Pugh score. 2. Of 10 OLT recipients, all aspects of HRQL scores at 3 months post-OLT showed significant improvement. In these patients, 3 months post-OLT mental health scores (CLDQ and SF-36) were similar to normal population. 3. There was an inverse correlation between post-OLT MCS, PCS and CLDQ scores and TCPC (−0.73, −0.70 and −0.63 respectively, p≤0.05). A rapid improvement in CLDQ scores only (3 months post-OLT) was associated with lower TCPC (−0.67, p=0.05). No associations were seen between HRQL and LOS. CONCLUSIONS: 1. Liver transplant candidates have severely impaired HRQL. 2. Substantial improvement in HRQL is seen 3 months post-OLT. 3. This early HRQL improvement is associated with lower TCPC. (Figure)Figure

Development and testing of the Medical Outcomes Study 36-Item Short Form Health Survey summary scale scores in the United Kingdom. Results from a large-scale survey and a clinical trial.

Investigators have suggested that reduction of the number of dimensions on a health status measure decreases the number of statistical comparisons and consequently diminishes the role of chance in testing hypotheses relating to health outcomes.1 Consequently, statistical procedures have been used by the developers of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) to reduce the number of dimensions on this instrument. Work by Ware et al2 has outlined a method of gaining two summary scores from the 35 items comprising the eight dimensions of the SF-36. Using data from the Medical Outcomes Study, a Physical Component Summary Scale Score (PCS) and a Mental Component Summary Scale Score (MCS) were generated, and their validity and reliability were evaluated. The intention of the developers when constructing the PCS and MCS was to reduce the SF-36 from an eight-scale profile to two summary measures without substantial loss of information. This article documents the construction of summary measures from a large-scale data set from the United King-

Intestinal absorption in the "contaminated small-bowel syndrome".

<h3>Background</h3> Chest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. <h3>Methods</h3> Pragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings. <h3>Results</h3> 2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1–8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1–8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%). <h3>Conclusions</h3> Short-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. <h3>Trial registration number</h3> NTR6163.