Vertical Visual Analogue Scale Research Articles

EQ-5D-5L health utility scores in Australian adults with inherited retinal diseases: A cross-sectional survey.

Economic evaluations of interventions for ocular disease require utility scores that accurately represent quality of life in the target population. This study aimed to describe the distribution of EQ-5D-5L utility values among Australian adults with symptomatic inherited retinal diseases (IRDs) and to assess the relationship between these scores and vision-related quality of life. A survey was administered predominantly online in 2021. Participants completed the EQ-5D-5L general health utility instrument, the EQ vertical visual analogue scale (EQ-VAS) and the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). Self-reported IRD diagnoses were classified as being associated with central or widespread retinal involvement. Responses from 647 participants aged 18-93 years were included, 50.1% were men and 77.6% had an IRD associated with widespread retinal involvement. The majority reported no problems with self-care and no pain/discomfort but did report anxiety/depression and problems with work, study, housework, or family/leisure activities. Most people with widespread involvement reported problems with mobility. Median EQ-5D-5L utility was 0.88 and 0.91 among people with widespread and central involvement, respectively (age and sex-adjusted p = 0.029); and median EQ-VAS was 75 and 80, respectively (adjusted p = 0.003). A moderate curvilinear correlation was observed between EQ-5D-5L and NEI-VFQ-25 composite score (Spearman's ρ 0.69), but not all people with poor vision-related quality of life had low EQ-5D-5L utility values. EQ-5D-5L health utility values are correlated with vision-related quality of life among adults with IRDs. However, the EQ-5D-5L may not be sensitive to the full impact of vision impairment on quality of life.

The Surprise Question and Health-Related Quality of Life in Patients on Hemodialysis: A Cross-Sectional Multicenter Study.

The Surprise Question (SQ) is a common method aimed at identifying frail patients who need serious illness conversations to integrate a palliative approach. However, little is known about whether the SQ identifies patients on hemodialysis who perceive that they are declining or have low health-related quality of life (HRQoL)-important aspects when considering the need for serious illness conversations. To explore how nurses and physicians' responses to the SQ are associated with patients' self-reported HRQoL. Cross-sectional study. In total, 282 patients on hemodialysis were included. One nurse and one physician responded to the SQ for each patient. The patient-reported HRQoL was measured with the RAND 36-Item Health Survey 1.0 (RAND-36) and the EuroQual vertical visual analogue scale (EQ-VAS) from the EuroQual-5 Dimension Questionnaire (EQ-5D). Nurses' responses "no, not surprised" to the SQ were associated with patient-reported worsened health compared to one year ago (RAND-36), and lower perceived overall health (EQ-VAS). Physicians' responses "no, not surprised" were associated with lower overall health and lower physical functioning. Patient-reported pain, general health, fatigue, and emotional and social aspects were not associated with responses to the SQ. The findings indicate that the SQ identifies patients on hemodialysis who report low overall health and low physical functioning. However, the SQ did not identify patients who reported pain, emotional problems, or fatigue, which are also important aspects to consider in identifying needs for serious illness conversations, symptom management, and to be able to integrate a palliative approach.

Reliability of clinical examination methods for postoperative pain after primary root canal treatment

Background/purposeClinical test results may have lower reliability due to the varying range of test stimulation or patient subjectiveness. This study aimed to verify a reliable clinical test method by comparing pain intensity levels of a tooth at rest, during function, and after the clinical tests of percussion and chewing. Materials and methodsA total of 36 asymptomatic necrotic teeth that required root canal treatment, one in each patient, were included. All treatment procedures were performed in a single visit by an experienced endodontist. Patients were asked to mark their pain levels on a vertical visual analog scale (VAS) while the relevant tooth was at rest and during function 24 h after the treatment. In addition, patients marked their pain levels after the clinical tests of percussion and chewing. Finally, the pain levels were compared using Pearson's correlation for the reliability of the test methods at a significance level of 95%. ResultsThe postoperative pain levels measured during the clinical tests and functions were significantly higher than the pain levels at rest (P < 0.05). The pain levels after percussion tests were significantly higher than that during the function and chewing tests (P < 0.05). Pain intensity during the function was simulated with a higher correlation when using the chewing strip method rather than the percussion method. ConclusionThe bite test using the chewing strips as a pain intensity assessment can mimic the actual postoperative pain experience, whereas the percussion test fails to provide the accuracy of this pain experience.

Dizziness in older persons at high risk of future hospitalization: prevalence, differences between those with and without dizziness, and effect of a proactive primary care intervention

BackgroundDizziness is a common reason for seeking care, and frequently affects older persons. The aims were to determine the prevalence of dizziness in older persons at high risk of hospitalization, to compare subjects with and without dizziness, and to examine the effects on dizziness of a proactive primary care intervention in comparison with conventional care after one year.MethodsData were derived from a prospective multicentre clinical trial in persons aged 75 and older and at high risk of hospitalization. A baseline questionnaire included demographic data, use of aids, questions about everyday physical activity and exercise, pain (intensity, frequency, and duration), activities of daily living measured using the ADL Staircase, and health-related quality of life measured using the EQ-5D-3L vertical visual analogue scale. Both at baseline and after one year, subjects were asked about dizziness, and those with dizziness answered the Dizziness Handicap Inventory – Screening version. Subjects in the intervention group were evaluated by a primary care team and when needed proactive care plans were established. Groups were compared using the Mann Whitney U-test or chi-squared test.ResultsOf the 779 subjects, 493 (63%) experienced dizziness. Persons with dizziness differed regarding sex, homecare service, aids, activities of daily living, health-related quality of life, physical activity, and pain. The intervention did not significantly reduce the level of dizziness.ConclusionsDizziness is common in vulnerable older persons, and individuals with dizziness differ in several respects. Further studies are needed employing more dizziness-specific assessment and individually tailored interventions.Trial registrationClinicalTrials.gov 170608, ID: NCT03180606.

Quality of Life of Post Stroke Patients and their Caretaker in Chennai

Stroke is one of the leading causes of death in India. Around 2 million Indians suffer from stroke everyyear in India, and the most important cause of severe adult disability. Stroke not only severely affectsan individual’s quality of life, but also their caretaker’s. This burden can result in a deterioration of thecaretaker’s health, social life, and psychological well being such as, emotional health, morale, work life,finances, social mobility, interpersonal relationship and their own family. Here in this study, the quality oflife of 50 stroke patients and their caretaker staying in a tertiary care hospital in Chennai, South India, isassessed using a pretested and validated questionnaire EuroQol EQ-5D-5L which contains questions in 5domains in which each dimensions having five response levels and The EQ-VAS scale which records therespondent’s overall current health on the day of examination on a vertical visual analogue scale from 0-100.The data were entered and coded in Microsoft Excel and analysed based on their frequency, proportion,and severity. About 80% of stroke patients return home after the acute hospitalization and at least onehalf of them require permanent or temporary help from other people in the home setting. Many caregiverssuffer from anxiety/ depression. This study will be useful in analysing the QOL of the patient’s and theircaretaker’s and provide us a new perspective in not only treating the physical aspects of stroke but also itspsychological impact.

Community-Based Peer-Led Intervention for Healthy Ageing and Evaluation of the 'HAPPY' Program.

ObjectivesPopulation ageing impacts many areas of society from health and social care cost to housing and future workforce, and whole-of-society approach is required to promote healthy ageing. The Decade of Healthy Ageing report has called upon multi-sectoral collaboration to promote age-friendly communities. The Healthy Ageing Promotion Program for You (HAPPY) is a community-based dual-task exercise program for older adults led by health coaches (HC) or trained volunteers (HAPPY leaders) to promote healthy ageing. The primary objective was to observe improvement in cognition. The secondary objective was to observe improvement in frailty status, functional status, perceived health and reduction of social isolation. We also aim to evaluate the effectiveness and describe the implementation of the HAPPY program.DesignTo engage older adults with prefrailty, frailty and/or cognitive impairment in dual-task exercise program. Recruitment and publicity were through country-wide multisectoral collaboration.SettingCommunity settingParticipantsMore than 700 older adults participated in ≥ 50 different sites including senior activity centres. Five hundred and sixty-nine participants attended phase 1 screening. Pre-frail or frail ambulant participants or those with underlying cognitive impairment were invited to participate in phase 2 screening. Among them 296 participants enrolled in phase 2 with 66.6% follow up rate at 3 months.MeasurementsPhase 1 and 2 screening consisted of screening for frailty (FRAIL), cognition (Montreal Cognitive Assessment [MoCA]), falls, vision, grip strength, perceived health (EuroQol vertical visual analogue scale), depression (geriatric depression scale), social network (6-item Lubben Social Network Scale), gait speed and physical function (Short physical performance battery [SPPB]).ResultsHC led 61.7% of the participants, and HAPPY was conducted twice weekly for 64% of the participants. There was significant improvement in the MoCA scores both in the HC and HAPPY leaders’ led groups. Overall physical function, chair-stand and balance domain improved significantly especially in the groups led by HC and those participating in twice-weekly exercises. There was significant improvement in perceived health, reduction in social isolation, improvement in frailty status and reduction of falls at 3 months.ConclusionCommunity embedded peer-led program to promote healthy ageing like HAPPY can improve cognition, physical function, and frailty status, reduce social isolation, and improve perceived health. It takes a “village” to promote healthy ageing, and the need to have a life course approach to healthy longevity which must involve local government and ministerial organisations, non-profit organisations, industries, academia, and community to redesign health.

Decolonizing care of Black, Asian and Minority Ethnic patients in the critical care environment: A practical guide.

The authors comment on how the coronavirus disease-2019 (COVID-19) pandemic has demonstrated how structural racism is transcribed and enacted in the health of Black, Asian and Minority Ethnic (BAME) people Topics covered include ways through which critical and intensive care nurses can decolonize care for BAME patients, the importance for nurses to consider a patient's cultural needs, and how failure to consider culture can lead to a deficit in racially appropriate care

The association between PM10 and Quality of Life (QoL) in South Korea

TPS 732: Neurological effects in adults, Exhibition Hall, Ground floor, August 27, 2019, 3:00 PM - 4:30 PM Background/Aim: There are limited studies about the association between exposure to PM10 and quality of life(QoL). We aimed to investigate the association between exposure to PM10 and perceived QoL index in South Korea. Methods: In this cross-sectional study, a total of 3,911 adults having no diseases in 73 districts (‘gu’) of 7 major cities were identified in the Korea National Health and Nutrition Examination Study IV (2007-2009). QoL was measured by EQ-5D that comprises descriptive system and EQ-VAS. Descriptive system records condition of five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) which was divided into two categories in this study. The scores on these dimensions are also converted to a single summary index (SI) which was divided into tertiles in this study. EQ-VAS score records self-rated health on a vertical visual analogue scale which was divided into quartiles in this study. Both in SI and EQ-VAS, higher score means good QoL. We analyzed the association between annual average of PM10 concentration and QoL using logistic linear regression. We adjusted for sex, age, health behaviors and individual socio-economic status. Results: There was a positive association between 10μg/m3 increase in annual average of PM10 and SI (Odds ratio (OR) for lowest tertile vs the highest tertile: 1.24(95%CI: 1.08-1.42)). In the analysis for each score of 5 dimensions, only pain/discomfort and anxiety/depression were significantly associated with higher concentration of PM10 (OR for good condition vs bad condition: 1.16(95%CI: 1.02-1.32); 1.26(95%CI: 1.08-1.48), respectively). Higher exposure to PM10 was associated with lower EQ-VAS (1st quartile (lowest QoL) 1.25(95%CI: 1.08-1.44); 2nd quartile 1.13(95%CI: 0.99-1.29); 3rd quartile 1.08(95%CI: 0.95-1.23), respectively compared with 4th quartile). Conclusions: This study suggests that higher long-term exposure to PM10 may be associated with lower QoL in general population and PM10 may be an important factor that affects individual’s well-being, even if it is not the point of view of disease.

Psychometric Evaluation of the Chinese Respiratory Distress Observation Scale on Critically Ill Patients With Cardiopulmonary Diseases.

Respiratory distress is a common and distressing experience that strikes most critically ill patients with cardiopulmonary diseases. Now, most dyspnea assessment tools rely on patient's self-report. Only one instrument, the Respiratory Distress Observation Scale (RDOS), is valid for assessing respiratory distress when the patient cannot provide a dyspnea self-report. The aims of this study were to develop the Chinese version of RDOS through two-way translation and examine its reliability and validity. The first step was the translation and back-translation to establish the Chinese RDOS and examine the semantic equivalence between the back-translation version and the original one. The second step was the psychometric testing of the Chinese RDOS including internal reliability, interrater reliability, concurrent validity, convergent validity, and content and construct validity. The Chinese RDOS was reported with an internal consistency (Cronbach's α value) of .73, an interobserver reliability of .97, and a content validity index of .97. In the conscious critically ill patients, significant correlations were found between the Chinese RDOS and Spielberger State Anxiety Inventory scores or Dyspnea Vertical Visual Analog Scale scores (r = .69 and r = .76, respectively; p < .001). In the unconscious critically ill patients, there was a significantly positive correlation between the Chinese RDOS scores and fraction of inspiration O2 (r = .26, p < .05) and a significantly negative correlation between the Chinese RDOS scores and saturation peripheral oxygen (SpO2; r = -.42, p = .001). In addition, it also could effectively identify the dyspnea differences between the first and last days in the intensive care units (p < .001). The Chinese RDOS showed good reliability and validity in conscious critically ill patients. The assessment with the Chinese RDOS could be completed within a short period no matter whether the assessor has nursing background in respiratory care or not. It could help the professionals systematically manage and track the change of respiratory distress in patients.

Perkaitan antara Kemahiran Pengurusan Stres dan Kepuasan Hidup Remaja

Adolescent levels are challenging and stressful. The stress management skills for these groups are important to achieve quality and life satisfaction. The main objective of this study was to evaluate the association between stress management skills and life satisfaction among secondary school students. In addition, this study also examines the differences stress management skills and life satisfaction by gender. This survey study involved 1,067 respondents consisting of students from form one to six (aged 13 to 18 years old) around Kota Kinabalu and Kudat, Sabah. The research instrument used in this study is the Emotional Quotient Inventory Youth Version (EQ-i: YV) and Cantril's Vertical Visual-Analog Scale Ladder of Life Satisfaction which has been translated into Malay. Data were analyzed by using correlation test and independent sample t-test. Results showed that there was a positive correlation between stress management skills and life satisfaction among secondary school students. Meanwhile, the results of the independent sample t-test analysis showed that there was a difference in stress management and life satisfaction by gender. Results indicated that stress management skills are very important because it is directly related to life satisfaction, especially for adolescents or generation Z nowadays.

Assessment of the Impact of Male Urinary Incontinence on Health-Related Quality of Life: A Population Based Study.

To assess the impact of male urinary incontinence on health-related quality of life by population based study. A two-stage systematic sampling method was adopted. A total of 5830 men participated in this survey. Face -to-face interviews were used to collect data. Urinary incontinence and symptom bother were measured with the Urogenital Distress Inventory-6 (UDI-6). General health-related quality of life (QoL) was measured using EQ-VAS, which evaluates the respondent's self-rated health on a vertical visual analogue scale. The age-adjusted prevalence of Korean male UI was 5.5%. Incontinent men reported higher score of UDI-6 and lower score of EQ-VAS than continent men. Men with mixed urinary incontinence reported significantly lower QoL than men with pure stress or urge incontinence. Urinary incontinence affects men's QoL negatively. In particular, mixed urinary incontinence has the greatest impact on QoL.

No Difference in Lumbar Disk Height between Operated and Nonoperated Patients at 9-Year Follow-Up

Introduction Degeneration of the lumbar spine is a common and age-related finding in the normal population (1;2). Several factors may contribute to lumbar disk degeneration, such as ageing, genetic, and fusion (3). Patients treated for disk degeneration and CLBP may be more prone to further degeneration than the rest of the population. We hypothesized that degeneration of the disks will proceed independent of fusion, also within the fused segments. Materials and Methods A total of 124 patients were included in the original two studies (4–6). At 9-year follow-up, baseline and long-term radiographs were available in 48 patients, 23 had lumbar fusion, and 25 had no lumbar fusion. Measurements of disk height were performed with Distortion Compensated Roentgen Analysis (DCRA) (7). Three levels were examined; one operated level (L4/L5), and two nonoperated levels (L2/L3 and L3/L4). The Norwegian version (1.0) of the Oswestry disability index (ODI) (8;9) was used to evaluate condition-specific disability and pain. Back pain was measured on a vertical visual analogue scale from 0 to 100 wherein 100 reflected the worst pain imaginable. Maximum pain, minimum pain, and current pain were scored on three different scales. The mean of the three scores provided the pain index for back pain (10) Results Disk height was reduced in both groups at levels L3/L4, and L4/L5, but not formally significant ( p = 0.06) at L2/L3 with no disk height differences between the operated and nonoperated group at any level at 9-year follow-up. ODI and back pain were improved in both groups from baseline to 9-year follow-up, but ODI and back pain correlated poorly with disk degeneration at 9-year follow-up. Conclusion Disk height was decreased from baseline to 9-year follow-up with no differences between groups and no association between pain and back disability and disk height. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Carragee EJ, Paragioudakis SJ, Khurana S. 2000 Volvo Award winner in clinical studies: Lumbar high-intensity zone and discography in subjects without low back problems. Spine (Phila Pa 1976 ) 2000;25(23):2987–2992 Kanayama M, Togawa D, Takahashi C, Terai T, Hashimoto T. Cross-sectional magnetic resonance imaging study of lumbar disk degeneration in 200 healthy individuals. Journal of Neurosurgery Spine 2009;11(4):501–507 Battie MC, Videman T, Parent E. Lumbar disk degeneration: epidemiology and genetic influences. Spine (Phila Pa 1976 ) 2004;29(23):2679–2690 Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disk degeneration. Spine (Phila Pa 1976 ) 2003;28(17):1913–1921 Brox JI, Reikeras O, Nygaard O, Sorensen R, Indahl A, Holm I, et al. Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disk herniation: a prospective randomized controlled study. Pain 2006;122(1–2):145–55 Brox JI, Nygaard OP, Holm I, Keller A, Ingebrigtsen T, Reikeras O. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis 2010;69(9):1643–1648 Frobin W, Brinckmann P, Biggemann M, Tillotson M, Burton K. Precision measurement of disk height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech (Bristol, Avon ) 1997;12(1):S1-S63 Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 66(8):271–273 Holm I, Friis A, Storheim K, Brox JI. Measuring self-reported functional status and pain in patients with chronic low back pain by postal questionnaires: a reliability study. Spine 2003;28(8):828–833 Fritzell P, Hagg O, Wessberg P, Nordwall A. 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976 ) 2001;26(23):2521–2532

Visual Analogue Scale: Evaluation of the Instrument for the Assess­ment of Pruritus

The aim of this study was to evaluate the visual analogue scale (VAS) as a method of pruritus assessment. A total of 310 subjects with pruritic dermatoses (148 Caucasian subjects and 162 Asian subjects) were recruited. The patients assessed pruritus intensity using the horizontal and vertical VAS, numeric rating scale (NRS) and verbal rating scale (VRS). All scales showed very good reproducibility (intraclass coefficient (ICC) > 0.8). No significant differences were found between the horizontal and vertical VAS (5.3 ± 2.9 vs. 5.3 ± 3.0 points, p = 0.34). Using NRS, patients rated their pruritus significantly higher than with VAS (5.7 ± 2.6 points, p < 0.01). VRS showed the highest correlation with NRS (R = 0.82, p < 0.001), followed by horizontal (R = 0.75, p < 0.001) and vertical VAS (R=0.74, p < 0.001). Based on detailed analysis following VAS categories were proposed: 0 = no pruritus, > 0-< 4 points = mild pruritus, ≥ 4-< 7 points = moderate pruritus, ≥ 7-< 9 points = severe pruritus, and ≥ 9 points = very severe pruritus. In conclusion, the VAS is a valuable method of pruritus measurement.

Quality of life of eye amputated patients

To evaluate eye-amputated patients' health-related quality of life, perceived stress, self-rated health, job separation because of illness or disability and socioeconomic position. Patients were recruited from a tertiary referral centre situated in Copenhagen. Inclusion criteria were eye amputation, i.e. evisceration, enucleation, orbital exenteration or secondary implantation of an orbital implant during the period 1996-2003, and participation in a previous investigation (2005). In total, 159 eye-amputated patients were included, and completed a self-administered questionnaire containing health-related quality of life (SF-36), the perceived stress scale and answered questions about self-rated health, job changes because of illness or disability and socioeconomic status. These results were compared with findings from the Danish Health Interview Survey 2005. The eye-amputated patients had significantly (p < 0.05) lower scores (poorer health) on all SF-36 subscales and more perceived stress compared to the general population. In all, 43.3% of the patients rated their health as excellent or very good compared to 52.1% of the general population. In total, 25% of the study population has retired or changed to a part-time job because of eye disease. The percentage of eye amputated patients, who were divorced or separated, was twice as high as in the general population. The impact of an eye amputation is considerable. The quality of life, perceived stress and self-rated health of many eye-amputated patients are drastically changed. Eye amputation has a marked negative influence on job separation because of illness or disability and on socioeconomic position.

Job Resumption Status, Hindering Factors, and Interpersonal Relationship Within Post–Heart Transplant 1 to 4 Years as Perceived by Heart Transplant Recipients in Taiwan: A Between-Method Triangulation Study

Introduction This project examined heart transplant (HT) recipients' perspectives of (a) the changes in their working competence (WC), status for job resumption and related factors at 1- to 2-year, 2- to 3-year, and 3- to 4-year stages; and (b) impacts of HT on interpersonal relationships (IPR). Method We used a between-method triangulation (including qualitative and quantitative data) design. Quantitative data were collected using the Vertical Visual Analogue Scale and Taiwan's version of the World Health Organization Health-Related Quality-of-Life (HRQoL) questionnaire. Six qualitative semistructured questions were further applied to explore social and environmental domains. Results The Fifty subjects (86% males and 14% females) had an age range from 20 to 70 years old (mean, 47.68 years). Their post-HT time ranged from 1 to 4.1 years with 42%, 42%, and 16% at 1- to 2-, 2- to 3-, or 3- to 4-years post-HT, respectively. Within 6 months, 10% of administration or restaurant staff, and police resumed their jobs. At 6 to 12 months, 8% of administration, quality control, and design and planning staff resumed their jobs. At 12 months, 14% of educators, insurance personnel, managers, informatics engineers, and ironworkers resumed their jobs. Hindering factors to returning to work included (a) physical (ie, lack of energy, second heart attack, recurrence of rejection, physical discomforts of dizziness, memory lapses/lack of concentration or bone pain from osteoporosis); (b) psychological (ie, lack of confidence, worries about discrimination, being different, maladaptation); and (c) environmental (inadequate job opportunities due to poor socioeconomic conditions). Additionally, 34% reported worse IPR after HT due to diet limitations, slower pacing, less contacts with friends, and changes in personality. Reflections on both the meaning and value of life caused 10% to report better IPR with a better personality and positive mindset. By the end of the first postoperative year, the mean score of HRQoL in the preoperative extracorporeal membrane oxygenation (ECMO) group was similar to the non-preoperative ECMO group; the mean scores of WC and physical functions for the preoperative ECMO group were even higher than the non-preoperative ECMO group. Meanwhile, the mean scores of HRQoL and WC were higher in the Clinical Trail Plan (CTP) group than non-CTP groups across the three stages. As such, the use of preoperative ECMO and CTP groups are suggested to be both clinically and significantly associated with HTs recovery in heath status, positive HRQoL, and job resumption in the society. Finally, HRQoL and related domains of physical, psychological, social, and environmental health were stable at 12 months post-HT, with no significant change between 1- to 2-, 2- to 3-, and 3- to 4-years post-HT.

Perceived Health-Related Quality of Life in Heart Transplant Recipients With vs Without Preoperative ECMO in Taiwan: Between-Method Triangulation Study

ObjectiveTo compare changes in overall health-related quality of life (HRQoL), working competence, and physical functions in heart transplant (HTx) recipients with vs without preoperative extracorporeal membrane oxygenation (ECMO) at 3 crucial stages post-HTx: 1 and 6 months and 1 year. Patients and MethodsThis between-method triangulation study included qualitative and quantitative data for patients recruited from a medical center with 2200 beds. Quantitative data were obtained using a vertical visual analog scale and the Taiwan version of the World Health Organization Quality of Life Questionnaire. Six semistructured qualitative questions were added to further explore factors that influence changes in Social domains of HRQoL between the 4 groups across recovery stages. ResultsThe 50 patients (86% men and 14% women) ranged in age from 20 to 70 years (mean age, 47.68 years). Time post-HTx ranged from 1 year to 4 years and 1 month, and 16% had received preoperative ECMO therapy. Mean (SD) HRQoL, working competence, and physical functions improved from 54.76 (24.44), 31.8 (26.53), and 80.00 (33.67), respectively, at 1 month post-HTx (r = .48) to 65.76 (20.24), 50.90 (25.23), and 96.80 (11.05) at 6 months (r = .52) and 74.40 (13.65), 64.30 (21.48), and 98.8 (7.80) at 12 months (r = .44), with moderately significant differences. Compared with the non-ECMO group, the preoperative ECMO group perceived lower (stage 1), similar (stage 2), and higher (stage 3) working competence. Thirty-two percent of recipients resumed stable jobs across the 3 stages (10%, 8%, and 14%, respectively), and reported higher working competence and physical functions compared with other patients (68%) (P < .001). Recipients with stable marriages (P = .046), higher educational achievement level (P = .004), and stable jobs (P = .001) reported greater overall HRQoL across the 3 stages. ConclusionHeart transplant recipients reported higher overall HRQoL, working competence, and physical functions across the 3 recovery stages during 12 months post-HTX. Three major influencing factors identified included stable marriage, higher educational achievement level, and stable job status.

Pain evaluation in the intensive care unit: listen to the patient, a new approach!

Contrary to wards that manage usually chronic or acute pain (algology, gerontology, surgery, recovery room, and so forth), a comparison of the five most popular self-report pain tools (vertical and horizontal Visual Analog Scale (VAS-V, VAS-H), 0 to 10 oral Numeric Rating Scale (NRS-O), 0 to 10 visual enlarged NRS (NRS-V), Verbal Descriptor Scale (VDS)) has never been evaluated in an ICU setting.

Grading Contact Lens Complications: The Effect of Knowledge on Grading Accuracy

Purpose: Grading contact lens complications is a time-effective process, which, if performed accurately, may improve patient management significantly. Multiple factors have been identified that influence grading accuracy, such as the knowledge, training, and experience of the observer. The aim of this study was to further explore the effect of knowledge on grading accuracy, both in terms of intensity and specificity, and to do so by avoiding the need to require the subjects to interpolate between whole number grades.Material and Methods: Optometry students were divided into three knowledge groups according to their academic progress and in such a way that knowledge intensity and specificity could be evaluated separately. A vertical visual analog scale was devised to allow subjects to grade three different conditions of medium severity (position 50 of the scale) from the Institute for Eye Research grading scale, mainly, bulbar hyperemia, limbal vascularization, and lid redness.Results: Bulbar hyperemia was graded lowest (mean = 21.5; SD = 1.4), followed by limbal vascularization (mean = 40.7; SD = 1.6) and lid redness (mean = 51.2; SD = 1.3), and these differences were found to be statistically significant (ANOVA, p = 0.000). Knowledge was found to influence the grading process, resulting in statistically significant differences in the overall grading performance of the three knowledge groups (ANOVA, p = 0.048). Furthermore, even if knowledge intensity failed to improve grading accuracy over a certain threshold, a combination of knowledge intensity and specificity resulted in an enhancement of the homogeneity of the grading data.Conclusions: Knowledge intensity and specificity both contribute to improve grading skills, albeit through different mechanisms. An intermediate knowledge of contact lens complications is required to attain good grading accuracy, and a basic training in pathology is also advised.

A Vertical VAS is a Valid Instrument for Monitoring Headache Pain Intensity

Visual analogue scales (VAS) are well-validated instruments for assessing pain intensity, but have an impractical format. The aim of the study was to validate a vertical against a horizontal VAS for pain intensity registration. Out-patients with headache or non-headache pain were included. Participants completed a horizontal and a vertical VAS. Both were completed twice for test-retest. Headache was diagnosed according to the International Classification of Headache Disorders, 2nd edition. The results on vertical and horizontal VAS did not differ significantly in the different headache or chronic pain groups. For test-retest evaluation, effect sizes and Cohen's delta values were < 0.029 with < 1.5% change from test to retest (P < 0.01). Correlation coefficients were > 0.95. Bland-Altman analysis showed good agreement between vertical and horizontal scores with correlation coefficients > 0.84. A vertical VAS is equally valid as a horizontal VAS for registration of pain intensity in headache and non-headache patients.

Shoulder pain and external rotation in spastic hemiplegia do not improve by injection of botulinum toxin A into the subscapular muscle

Objective:To study the effect of botulinum toxin A in the subscapular muscle on shoulder pain and humerus external rotation.Methods:22 stroke patients with spastic hemiplegia, substantial shoulder pain and reduced external...