Point Increase In Score Research Articles

QOLP-26. PATIENT REPORTED SOCIAL FUNCTION AND SURVIVAL IN GLIOMA PATIENTS

Abstract PURPOSE Research among patients with cancer suggests that health related quality of life (HRQOL) may be more predictive of survival than performance status. Social function is a HRQOL outcome influenced by both physical and mental health. To our knowledge, no work has analyzed the potential association between survival and social function in patients with brain tumors. METHODS In the SEER Medicare Health Outcomes Survey, 158 patients were identified with 1) diagnosis of glioma between 1976 and 2013 2) no other cancer diagnosis 3) at least one post-diagnosis HRQOL survey. We examined the relationship between social function and mortality using a multivariable Cox proportional hazard model. We also examined factors correlated with social function score using linear regression. RESULTS At last follow up, 48% of the patients had died, 53% were female, 59% had trouble with ≥1 ADL, 53% were married, 27% had glioblastoma, 74% were white, and 32% had no reported comorbidities. Median time from cancer diagnosis to survey was 79 months and median age at survey was 60 years. For patients alive at last follow-up, there was a difference of >5 points for the social function subscale (38.2 vs 30.6) compared to those who died during the median 163 month follow up interval. On multivariable Cox proportion hazard model adjusting for covariates, higher social function scores were significantly associated with improved survival (5 point increase in score, HR 0.86, p = 0.0029). Worse social function was associated with patient-reported neurologic deficits in vision and speech and report of depression, but not marital status, sex, race, or patient-reported income. DISCUSSION Patient-reported social function score on post-diagnosis surveys, even after accounting for important clinical factors, was significantly associated with survival. The impact of patient reported social function in those with glioma should be further examined in confirmatory longitudinal studies.

Is there an association between consent rates in Swiss hospitals and critical care staffs' attitudes towards organ donation, their knowledge and confidence in the donation process?

This study investigated the critical care staff’s attitude, knowledge and involvement with donation, skills and confidence with donation-related tasks and their association with consent rates at the hospital level. In 2015, we conducted a cross-sectional survey among critical care staff of hospitals involved in organ donation using an anonymous online questionnaire with a response rate of 56.4% (n = 2799). The hospital level consent rate was obtained from the Swiss Monitoring of Potential Donors database (2013–2015). For each hospital, we calculated a mean score for each predictor of interest of the Hospital Attitude Survey and investigated the association with hospital consent rates with generalized linear mixed-effect models. In univariable analysis, one score point increase in doctors' confidence resulted in a 66% (95% CI: 45%–80%) reduction in the odds to consent, and one score point increase in nurses' attitudes resulted in a 223% (95% CI: 84%–472%) increase in the odds to consent. After simultaneously adjusting for all major predictors found in the crude models, only levels of education of medical and nursing staff remained as significant predictors for hospital consent rates. In Switzerland, efforts are needed to increase consent rates for organ donation and should concentrate on continuous support as well as specific training of the hospital staff involved in the donation process.

The impact of spelling errors on trained raters’ scoring decisions

Second language (L2) writing assessments seldom allow a spellchecker and often have a time limit. Naturally, test takers often submit responses with spelling errors. However, little is known about whether and how spelling errors in test taker responses affect trained raters’ scoring decisions. In this study, we investigated the impact of spelling errors on trained raters’ holistic evaluation of response quality. We selected 148 responses to four L2 writing tasks, and created error-free versions of the responses by correcting spelling errors in the original responses. Both the original and corrected responses were randomly assigned to trained raters, who scored the responses according to the same holistic scoring rubrics. We compared the resulting scores of original and corrected responses to gauge the impact of spelling errors. We also examined whether the impact of spelling errors varied across different task types and spelling error characteristics. The results showed that the spelling error correction led to an average of more than a half score point increase. The score gains from the error correction varied across task types and the quantity of corrected errors. These findings have multiple implications, including suggestions for rater training and assessment development.

Predictive value of the patient reported outcome “living with cancer” instrument on overall survival in advanced cancer patients: A tool for guiding timing of palliative care consultations.

10025 Background: The Living with Cancer (LWC) patient reported outcome (PRO) instrument evaluates distress from the point of view of the advanced cancer pt. The 7-item Likert survey measures 4 personhood domains (performance status, pain, burden [financial and family], depression) with scores ranging 0-112. In a pilot study of 433 cancer pts at a single center a score of >28 was associated with an increased likelihood of physician’s (blinded) opinion of need for end-of-life care discussions ( J Palliative Med 2016). Methods: The LWC instrument is a statistically validated PRO (ASCO Palliative Care Symposium 2016). LWC was administered to 1024 cancer pts receiving non-curative therapy at 7 centers (Regional Cancer Care Associates, NJ) from Sept 2015 - Oct 2016. LWC surveys were linked to the Cota database, which extracts and enriches data from EHRs. Date of survey was used as the start point in time-to-event analysis. Results: 290 (28%) pts expired during the study (median f/u 9.9 months). 267 (26%) pts exceeded the threshold score of 28 defined in the pilot set (28 was also independently this study’s optimal cut point). Pts with an LWC score >28 had inferior 6 and 12 mo overall survival (69% and 54%) vs pts with scores <29 (88% and 73%) (log rank p<0.001). A Cox model demonstrated that LWC score and cancer type were significant (LWC: p<0.001, cancer types (compared to B): GI p<0.001, GU: p=0.013, T: p<0.001, M: p=0.334) A one point score increase in LWC resulted in a 1.8% increase in expected hazard. Among solid tumor pts with LWC >28, 20% died within the next 3 mo and 35% died within the next 6 mo, indicating appropriate timing for hospice and palliative care consults, respectively. Conclusions: Pt responses to the LWC instrument predict survival among advanced cancer pts and may be useful in guiding timing of palliative care consultations. [Table: see text]

Prenatal phthalate biomarker concentrations and performance on the Bayley Scales of Infant Development-II in a population of young urban children

IntroductionEvidence suggests prenatal phthalate exposures may have neurodevelopmental consequences. Our objective was to investigate prenatal exposure to phthalates and cognitive development in a cohort of young urban children. Materials and methodsWe recruited pregnant women in New York City from 1998 to 2002 and measured concentrations of nine phthalate metabolites in urine collected in late pregnancy. We administered a neurodevelopmental screening instrument, the Bayley Scales of Infant Development II (BSID-II), to children who returned for follow-up at approximately 24 months (n=276). We estimated associations between phthalate metabolite concentrations in maternal urine and BSID-II indices (Mental Development Index (MDI), Psychomotor Development Index (PDI)). ResultsWe observed no associations between phthalate metabolite concentrations and performance on the MDI or PDI in boys and girls combined. We did, however, observe evidence of effect measure modification by sex. We observed several negative associations between metabolite concentrations and both MDI and PDI scores among girls, suggesting poorer performance across multiple metabolites, with estimates equal to a 2–3 point decrease in score per ln-unit increase in creatinine-standardized metabolite concentration. Conversely, we observed multiple weakly positive associations among boys, equal to a 1–2 point increase in score per ln-unit increase in metabolite concentration. The strongest associations were for the metabolites mono-n-butyl phthalate, mono-isobutyl phthalate, monobenzyl phthalate, and mono(3-carboxylpropyl) phthalate (MCPP). ConclusionsGirls of mothers with higher urinary concentrations of MCPP and metabolites of dibutyl phthalates had lower MDI scores on the BSID-II. These same biomarker concentrations were often associated with improved scores among boys. We observed similar results for MnBP, MCPP, and MBzP on the PDI. Given the prevalence of phthalate exposures in reproductive aged women, the implications of potential neurotoxicity warrant further investigation.

Significance of baseline and change in quality of life scores in predicting clinical outcomes in an international phase III trial of advanced pancreatic cancer: NCIC CTG PA.3

BackgroundThere is insufficient information regarding the prognostic significance of baseline and change in quality of life (QoL) scores on overall survival (OS) in advanced pancreatic cancer. MethodsQoL was assessed prospectively using the EORTC QLQ-C30 as part of the PA.3 trial of gemcitabine + erlotinib (G + E) vs. gemcitabine + placebo (G + P). Relevant variables and QoL scores at baseline and change at 8 weeks were analyzed by Cox stepwise regression to determine predictors of OS. Results222 of 285 patients (pts) treated with G + E and 220 of 284 pts treated with G + P completed baseline QoL assessments. In a multivariable Cox analysis combining all pts, better QoL physical functioning (PF) score independently predicted longer OS (HR 0.86; CI: 0.80–0.93), as did non-white race (HR 0.64; CI: 0.44–0.95), PS 0–1 (HR 0.65; CI: 0.50–0.85), locally advanced disease (HR 0.55; CI: 0.43–0.71) and G + E (HR 0.78; CI: 0.64–0.96). Improvement in physical function at week 8 also predicted for improved survival (HR 0.89; CI: 0.81–0.97 for 10 point increase in score, p = 0.02). ConclusionIn addition to clinical variables, patient reported QoL scores at baseline and change from baseline to week 8 added incremental predictive information regarding survival for advanced pancreatic cancer patients.

Association between the cardiovascular health score and new-onset atrial fibrillation

To observe the association between the cardiovascular health score and new-onset atrial fibrillation. A total of 95 026 participants who participated the health examination between July 2006 and October 2007 at Kailuan group and without history of atrial fibrillation were selected as the observation cohort. The second, the third and the fourth health examination were performed between July 2008 to October 2009, July 2010 to October 2011, July 2012 to October 2013, respectively.A total of 85 028 participants were included in the final analysis after excluding participants who had new-onset valvular atrial fibrillation and participants lost to follow-up. The participants were divided into 4 subgroups by cardiovascular health score at baseline according to the definition of AHA and cardiovascular health scoring system, namely group of 0-6 points (n=11 103), 7-8 points (n=24 487), 9-10 points (n=32 556), and 11-14 points (n=16 882). The incidence of atrial fibrillation in each subgroup was observed, and the association between cardiovascular health score and risk of new-onset atrial fibrillation was analyzed using multiple Cox regression analysis. A total of 254 participants developed atrial fibrillation during the median of (5.6±1.4) years follow-up. The total incidence of new-onset atrial fibrillation was 0.53/1 000 person-year. The incidence of atrial fibrillation was 0.69/1 000 person-year, 0.60/1 000 person-year, 0.56/1 000 person-year, and 0.30/1 000 person-year, respectively in 0-6 points, 7-8 points, 9-10 points, and 11-14 points subgroups, respectively(P<0.01). After adjustment of age, gender, education level, income, drink, history of myocardial infarction, history of stroke, serum uric acid and C reactive protein level, multiple Cox regression analysis showed that one health score point increase was related to 8% reduction of new onset atrial fibrillation(HR=0.92, 95%CI 0.86-0.99, P<0.05). Compared with the group of 0-6 points group, the risk of atrial fibrillation in the group of 11-14 points group was reduced by 49% (HR=0.51, 95%CI 0.31-0.83, P<0.01). The risk of new-onset atrial fibrillation is reduced in proportion to increase of cardiovascular health score. Clinical Trail Registry: Chinese Clinical Trail Registry, ChiCTR-TNRC-11001489.

Risk stratification and preoperative evaluation of the patient with known or suspected liver disease

Surgical risk for patients with liver disease increases in those with advanced portal hypertension and acute liver injury. Although a general approach is shown in Figure ​Figure1,1, risk stratification should be individualized. Improved prognostication with tools such as the MELD score and preoperative optimization can help guide a discussion of the risks and benefits to help patients make educated decisions about invasive procedures. Open in a separate window Figure 1 Recommended approach for preoperative risk assessment. Abbreviation: OR, operating room.

High fidelity simulator experience for enhancing communication effectiveness: Applications to quality and safety education for nurses

The United States Joint Commission identified miscommunication as the main cause of unexpected injuries and mortality not related to the patient’s medical condition. One strategy for improving information transfer and inter-professional communication is the Situation-Background-Assessment-Recommendation (SBAR) communication model. The purpose of this study was to test the effects of exposure to a real time high fidelity simulation experience. A quasi-experimental design, consisting of one treatment group was conducted. A purposeful sample of N = 45 respondents was drawn from students registered in an undergraduate level clinical course. Pre-tests and post-tests based on the American Association of Colleges of Nursing's (AACN's) Quality and Safety in Nursing Education (QSEN) were administered to measure if exposure to the simulation training impacted knowledge and attitudes regarding communication in the delivery of patient care. Results based on a paired t-test revealed an 8.27 point increase in scores after exposure to the intervention. This outcome was highly significant ( df = 44, t = -4.86, p = .000). Although a few students did not appear to benefit, results suggest that exposure to the SBAR model during a high fidelity simulation experience is generally a successful method for enhancing student knowledge and attitudes regarding effective communication in health care.

Abstract 31: Prediction of coronary artery and abdominal aortic calcium in middle-aged adults using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) risk score: the CARDIA study

Background: Risk scores to predict coronary and abdominal atherosclerosis have been developed from autopsy specimens from the right coronary artery and descending aorta and risk factors measured post-mortem in the Pathobiological Determinants of Atherosclerosis in Youth Study (PDAY), cohort aged 15-34 years. While the PDAY risk score predicts coronary artery calcium (CAC) up to 15 years before its assessment in Coronary Artery Risk Development in Young Adults (CARDIA), the clinical validity at 25 years follow up and of the abdominal score to predict abdominal aortic calcium (AAC) has not been tested. Objectives: To test the hypotheses: 1) PDAY risk scores at CARDIA baseline (cohort aged 18-30 years) predict CAC and abdominal aortic calcium (AAC) at year 25 better than PDAY risk scores measured at subsequent time points. 2) Change in risk over time will improve associations in Aim 1. Methods: The CARDIA study assessed CAC and AAC by computed tomography in young adults participating at year 25. The PDAY risk score was calculated from risk factors measured at the CARDIA examinations at years 0 (cohort aged 18-30 years), 5, 10, 15 and 25 (age 43-55 years). Results: Age and gender independent PDAY risk scores increased from CARDIA year 0 to year 25 (coronary from 1.80 to 4.95, abdomen from 1.88 to 3.18). Prevalence of any CAC was 28% and AAC was 53%. For a one point increase in risk score, baseline risk predicted CAC and AAC better than year 25 risk; change in risk improved the prediction further (Table). C-statistics for CAC prediction were higher at year 0 but similar at years 0 and 25 for AAC. Further analyses using PDAY scores calculated at 5 year intervals prior to the CT scan confirmed that CAC at baseline and AAC at year 5 had the highest Odds Ratios for a one point increase in score (AAC year 5 Odds Ratio 1.35 (1.30-1.41)). Conclusions: PDAY risk scores, applied to living adults in the CARDIA study, predicted CAC and AAC in 43-55 year old adults; including change in risk slightly improves model performance.

Training and nutritional components of PMTCT programmes associated with improved intrapartum quality of care in Mali and Senegal

Scale-up of prevention of mother-to-child transmission (PMTCT) of HIV programmes in sub-Saharan Africa has stimulated interest to assess whether these programmes can indirectly affect other health priorities. This study assesses whether PMTCT programmes, or components of these programmes, are associated with better obstetrical quality of care and how PMTCT may reinforce existing maternal health programmes. Cross-sectional analysis of data from a cluster-randomized trial called QUARITE. Mali and Senegal, West Africa. Thirty-one referral hospitals and 612 obstetrical patients. The exposure of interest was PMTCT measured with a scale containing 10 components describing different prongs of a hospital PMTCT programme. Other variables of interest included: presence of a quality of care improvement programme, hospital resources and patient demographic characteristics. Obstetrical quality of care measured through a validated chart abstraction tool. Of 45 points, the mean hospital PMTCT score was 26.1 (SD: 6.7). Total PMTCT score was not significantly associated with quality of care, but programme component scores were. After adjustment for known predictors of quality of care, staff training in PMTCT (P = 0.03) and complementary nutritional services (P = 0.03) were significantly associated with better quality obstetrical care. A point increase in scores for either of these components was associated with 40% greater odds of good obstetrical care. PMTCT training and nutritional components are significantly associated with better quality intrapartum care. Health professionals' training in maternal healthcare and PMTCT could be combined to improve the quality of obstetric care in the region.

Orthopaedic patient outcomes following interdisciplinary inpatient rehabilitation

Aims: This study's primary aim was to identify factors associated with discharge disposition and length of stay (LOS) at an interdisciplinary inpatient rehabilitation unit for patients who underwent total knee arthroplasty/unilateral or bilateral knee surgery (TKA/KS) or total hip arthroplasty (THA). Methods: This was a retrospective medical chart review of 119 veterans receiving post joint replacement rehabilitation at a United States Department of Veterans Affairs Medical Center at an interdisciplinary inpatient rehabilitation unit between December 2008 and May 2010 following joint replacement surgery. Patient demographic, health/function, and outcome factors were abstracted. Findings: Approximately 96% of patients who received post joint replacement rehabilitation were discharged to a home setting. For every 1 point score increase on the Functional Independence Measurement (FIM) scale at discharge, patients were 1.29 times more likely to be discharged to home (95% CI=1.02–1.63; P&lt;0.04), but this effect diminished after accounting for age. Older veterans had longer LOS. Discharge to a non-home setting following inpatient rehabilitation was associated with older age, lower functional independence at admission, and poorer functional gain between admission and discharge. Conclusions: Interdisciplinary inpatient rehabilitation is an effective transitional step from the surgical intervention to the home setting for veterans undergoing TKA/KS or THA.

Determinants of postpartum weight variation in a cohort of adult women; a hierarchical approach.

Retention of the weight gained during pregnancy or the weight gain postpartum has been associated with increased prevalence of obesity in women of childbearing age. To identify determinants of weight variation at 24 months postpartum in women from 2 towns in Bahia, Brazil. Dynamic cohort data of 325 adult women were collected for 24 months postpartum. Weight variation at 24 months postpartum was considered a response variable. Socioeconomic, demographic, reproductive, related with childbirth variables and lifestyle conditions were considered exposure variables. A linear mixed-effects regression model with a hierarchical approach was used for data analysis. Suitable sanitary conditions in the household (2.175 kg; p = 0.001) and participation social programs for income transfer (1.300 kg; p = 0.018) contributed to weight gain in distal level of determinants, while at intermediate level, pre gestational overweight and surgical delivery had effects on postpartum weight, causing an average increase of 3.380 kg (p < 0.001) and loss of 2.451 kg (p < 0.001), respectively. At proximal level, a score point increase for breastfeeding yielded an average postpartum loss of 70 g (p = 0.002). Our results indicate the need to promote weight control during and after pregnancy, encourage extended breastfeeding, and improve living conditions through intersectoral interventions.

Cognitive impairment and depression in the early 60s: which is more problematic in terms of instrumental activities of daily living?

We evaluated the impact of cognitive impairment and depression on functional impairment in people aged in their early 60s. This cross-sectional study included 3034 inhabitants of a rural area of Korea aged 60-64 years. The Korean version of the Mini-Mental State Examination (MMSE-K), the Geriatric Depression Scale (GDS-15), and Lawton's Instrumental Activities of Daily Living (IADL) Scale were used to assess cognitive impairment, depression and functional impairment. A total of 30.8% of participants reported that they were dependent for at least one of the items on the IADL scale, and the overall prevalence of cognitive impairment and depression was 17.3% and 25.9%, respectively. The results showed that cognitive impairment had a stronger relationship with IADL impairment than did depression (odds ratio [OR] = 4.91, 95% confidence interval [CI] 3.91-6.17; c-statistics = 0.647 and OR = 2.05, 95% CI 1.67-2.50; c-statistics = 0.622, respectively). In particular, subclinical levels of the MMSE-K and GDS-15 score were associated with IADL impairment in participants without cognitive impairment or depression (OR = 0.73, 95% CI 0.67-0.80, OR = 1.09, 95% CI 1.03-1.16, per 1 point score increase, respectively). Only the MMSE-K score showed a significant association in participants with either cognitive impairment or depression, or both. Our findings also showed the independent association of IADL impairment with age, employment status, education and type of insurance. Compared with depression, cognitive impairment was more strongly associated with IADL impairment. Subclinical level of cognitive impairment and depression were also associated with IADL impairment in mentally healthy participants. Therefore, early intervention is required to prevent further decline.

Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study

The mortality rate from upper gastrointestinal bleeding (UGIB) remains high, at 5 % - 10 %. The aim of the current study was to describe the epidemiological characteristics, prognostic factors, and actual practice in a cohort of patients with UGIB admitted to French general hospitals. From March 2005 to February 2006, a prospective multicenter study was conducted at 53 French hospitals. A total of 3298 patients admitted for UGIB were enrolled consecutively. Patient data were collected up to the date of discharge from hospital. Data were available for 2130 men and 1073 women (mean age 63 ± 18 years), one-third of whom were taking drugs that would increase the risk of UGIB. The two main causes of bleeding were peptic ulcers (38 %) and esophagogastric varices (EGV) or portal hypertensive gastropathy (24.5 %). Mean Rockall score was 5.0 ± 2.3. Endoscopy was performed on 96 % of patients (within 24 hours in 79 %), and 66 % of those with ulcers and 62.5 % of the EGV patients underwent hemostatic therapy when indicated. Rebleeding occurred in 9.9 % of the patients, and 8.3 % died. Independent predictors of rebleeding were: need for transfusion (odds ratio [OR] 19.1; 95 % confidence interval [95 %CI] 10.1 - 35.9); hemoglobin < 10 g/dL (OR: 1.7; 95 %CI 1.1 - 3.3); Rockall score (OR: 1.4 for each 1 point score increase; 95 %CI 1.0 - 1.9), systolic blood pressure < 100 mmHg (OR: 1.9; 95 %CI 1.4 - 2.5), and signs of recent bleeding (OR: 2.4; 95 %CI 1.7 - 3.5). Independent predictors of mortality were: Rockall score (OR: 2.8; 95 %CI 2.0 - 4.0), co-morbidities (OR: 3.6 for each additional co-morbidity; 95 %CI 2.0 - 6.3), and systolic blood pressure < 100 mmHg (OR: 2.1; 95 %CI 1.8 - 2.8). Rockall score, blood pressure and co-morbidities were taken as continuous variables meaning that the OR was 1.4 for every point increase, it was the same for blood pressure. UGIB still occurs mainly as a result of peptic ulcers and portal hypertension in France, and causes significant rates of mortality. There is scope for improvement via better prevention (better use of UGIB-facilitating drugs), endoscopic therapy, and management of co-morbidities.

Matching parenting support needs to service provision in a universal 13‐month child health surveillance visit

The Glasgow Parenting Support Framework is an intervention to support families with preschool children. It provides structured support through universal and targeted interventions. Two routine family visits by health visitors have been piloted, one involving a home assessment when the child is 13 months old. To establish the need for parenting support in the population at 13 months and whether or not the home assessment improved the match of service provision to need. Health visitors were asked to collect data on existing problems and service provision to families, the mental state of the child's principal carer, an observation of the parent-child relationship and details of management plans. Data from the Child Health Surveillance System were also used. Data were obtained for 549 families. Nine families were noted to have problems in the parent-child relationship. Carers in these families had poorer mental health. In all, 20% of families had a revisit scheduled: they were also more likely to have poor mental health. All families with possible problems in the relationship had a revisit scheduled. Depression scores measured during the pilot were a significant predictor of revisiting and referral, with an odds ratio of 1.37 for every one point increase in score on the Adult Wellbeing Scale depression subscale. Current service provision matches need to some extent but routine visits focused on parenting difficulties at 13 months, particularly parental depression, may help to identify families needing support who would not otherwise have received it.

Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial

Objective: To evaluate and compare efficacy of 20-, 40-, and 60-minute mental practice sessions on affected upper extremity impairment and functional limitation. Design: Randomized controlled study with multiple baseline design. Subjects: Twenty-nine subjects with chronic stroke and exhibiting stable, mild hemiparesis. Interventions: Subjects were given 30-minute rehabilitative sessions 3 days/week for 10 weeks, emphasizing affected upper extremity use during valued activities. Directly after these sessions, randomly selected subjects were given audiotaped mental practice for 20, 40, or 60 minutes. Subjects assigned to a control group received the same therapy as the mental practice groups, and an audiotaped sham intervention directly after therapy sessions. Main outcome measures: Fugl-Meyer (FM) motor assessment and Action Research Arm Test (ARAT). Results: No pre-existing differences were found between groups on any demographic variable or movement scale. On the FM, mental practice duration significantly predicted pretesting to post change (P = 0.05), with increasing duration related to larger FM score increases (5.4 point score increase for the 60-minute duration group). On the ARAT, a non-significant trend was seen (P = 0.78), favoring the 20-minute dosing condition (4.5 point increase). Importantly, regardless of dosing condition, subjects administered mental practice exhibited markedly larger score changes on both the FM and ARAT than subjects not receiving mental practice. Conclusions: Sixty minutes of mental practice appears to most significantly reduce affected arm impairment. However, no clear change pattern was seen in affected arm functional limitation according to mental practice duration. Results suggest that a stroke rehabilitative regimen augmented by mental practice renders a greater functional impact than therapy only.

Abstract B15: Feasibility and acceptability of promoting colorectal cancer screening in an Internet weight loss community through narratives and navigational guidance

Abstract Because obesity increases the risk for colorectal cancer (CRC), efficient and sustainable interventions are needed to promote colorectal cancer screening (CRCS) among obese individuals. A novel approach would be to empower members of Internet weight loss communities to promote CRCS screening among other members by sharing personal narratives about CRCS experiences or providing navigational guidance through the healthcare system to undergo CRCS. However, feasibility and acceptability of this strategy have not been evaluated. Therefore, we conducted an online survey of members of an Internet weight loss community who were eligible for CRCS to assess: CRCS status (colonoscopy within 10 years, sigmoidoscopy within 5 years, or fecal occult blood test within 1 year was considered up-to-date with CRCS); predictors of CRCS; stage of change for CRCS; attitudes towards CRCS (4-point Likert-type items — strongly agree, agree, disagree, strongly disagree); and interest in an intervention featuring narratives or navigation. The 2508 respondents were primarily female (92%) and white (90%). Sixty-eight percent were up-to-date with CRCS, mostly by colonoscopy. Being up-to-date with CRCS was associated with male gender, older age, lower body mass index, being married, Bachelor's degree education, healthcare provider's CRCS recommendation, other cancer screening in the past year, primary care visit in the past year, health insurance, and non-smoking. Among those not up-to-date with CRCS, taking steps to be screened for CRC (compared to earlier stages) was associated with a one point increase in scores for social influence of others (OR = 7.5, 95% CI: 4.5-12.6), perceived salience of CRCS (OR = 5.1, 95% CI: 3.1-8.5), self-efficacy for navigating the healthcare system (OR = 3.8, 95% CI: 2.3-6.2), self-efficacy for CRCS (OR = 2.0, 95% CI: 1.4-2.9), and perceived susceptibility to CRC (OR = 1.9, 95% CI: 1.2-3.1). Considering CRCS within 6 months or taking steps to be screened (compared to earlier stages) was associated with a one point increase in scores for social influence of others (OR = 12.2, 95% CI: 7.8-19.1), perceived salience of CRCS (OR = 5.8, 95% CI: 4.1-8.3), self-efficacy for navigating the healthcare system (OR = 3.7, 95% CI: 2.6-5.3), perceived susceptibility to CRC (OR = 2.5, 95% CI: 1.7-3.5), perceived efficacy of CRCS (OR = 2.2, 95% CI: 1.6-3.0), self-efficacy for CRCS (OR = 1.5, 95% CI: 1.2-2.0), and CRC worries (OR = 1.3, 95% CI: 1.1-1.6). Among those not up-to-date, 63% were interested in learning about other members’ CRCS narratives and 36% were interested in receiving navigational guidance for undergoing CRCS. Among those who were up-to-date, 39% were interested in promoting CRCS by sharing narratives and 37% by providing navigational guidance. In conclusion, leveraging social relationships within Internet weight loss communities may be a feasible and acceptable strategy for promoting CRCS among obese individuals. Results inform how we could tailor the intervention according to demographic characteristics and healthcare experiences; target specific attitudes; and utilize narratives and navigational guidance. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B15.

Assessing the Prognostic Value of Cardiovascular Imaging

Cardiovascular imaging has become the focus of attention from both physicians and payers. The former see the potential of newer modalities to permit new and exciting insights into the diagnosis and management of coronary artery disease (CAD), that, in turn, may result in enhanced patient care strategies and new efficient clinical algorithms. On the other hand, payers have understandable concerns about the excessive use and enormous costs associated with cardiovascular imaging. These concerns have been exacerbated by the rapid expansion of the imaging devices used for the assessment of patients with known or suspected CAD. Cardiovascular stress imaging has long been the domain of stress single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) and stress echocardiography wall motion studies. At present, stress positron emission tomography (PET) MPI, cardiac computed tomography coronary angiography (CTA) (and, possibly, stress CT MPI), as well as cardiac magnetic resonance imaging (CMR) MPI and wall motion studies are utilized in daily practice. Whether all of these modalities will be reimbursed in the future is uncertain, but little doubt remains that their rigorous validation will be compulsory. Article see p 1390 Cardiac magnetic resonance imaging is an evolving technique with growing indications within the clinical cardiology setting. Whereas late gadolinium enhancement (LGE) has gained acceptance as an accurate approach for viability assessment, CMR stress imaging use is increasing as well. Nonetheless, stress CMR techniques are in their relative infancy, and evidence is only now beginning to accumulate justifying their use. Whereas several studies have examined the diagnostic accuracy of stress CMR, only recently have sufficient numbers of patients been collected to assess the prognostic value of this approach1–5 (Table).6 The validation of stress CMR is more complex than that of previous modalities, inasmuch as a routine study would include rest function and …

Rice Yield Gap due to Iron Toxicity in West Africa

AbstractIron toxicity is a widespread nutrient disorder in lowland rice, notably in West Africa. It occurs in irrigated or rain‐fed rice crops when the soil contains excessive amounts of iron. Associated with leaf discoloration symptoms (bronzing), this excessive iron uptake causes poor growth and tillering and leads to severe yield reductions. Field experiments were carried out in West Africa from 1994 to 1998 at two sites with high iron toxicity and one non‐toxic site to assess the effects of iron toxicity on rice cropping and evaluate the tolerance of promising rice cultivars available in West Africa. To estimate yield losses caused by iron toxicity, the yield potential was simulated using the ORYZA‐S rice growth and yield model. Based on the potential yield, the yield loss in an iron‐toxic site is the combination of the yield gap caused by unknown site factors and the yield gap caused by iron toxicity. Compared to the referential yield obtained in a non‐iron‐toxic site, iron toxicity reduced rice yields by 16–78 % (mean 43 %). The extent of the yield loss depended on rice cultivar, iron toxicity intensity and crop management strategy (water control and mineral fertilisation). A strong correlation obtained between yield and the iron toxicity score, based on visual symptoms indicated an approx. 400 kg ha−1 yield loss for each visual score point increase. The high genetic variability in iron toxicity tolerance and close correlation between leaf symptom score and grain yield between rice genotypes provide a good basis for breeding varieties that can produce higher yields under iron‐toxic conditions.