Systematic review of the agreement of tonometers with goldmann applanation tonometry

This review was part of the Surveillance for Ocular Hypertension study funded by the UK National Institute for Health Research Health Technology Assessment Programme (Project No. 07/46/02). J.C. held a Medical Research Council UK fellowship (G0601938). AA-B was a grantholder on an AstraZeneca (London, UK) funded study of a new medication for glaucoma. The Health Services Research Unit receives core funding from the Chief Scientist Office of the Scottish Government Health Directorates. Views and opinions expressed are those of the authors and do not necessarily reflect those of the Chief Scientist Office, National Institute for Health Research Health Technology Assessment Programme, or the Department of Health. None of the funders had a role in the design or conduct of this researchPeer reviewedPostprin

Reliability of the modified Rankin Scale: a systematic review

<p><b>Background and Purpose:</b> A perceived weakness of the modified Rankin Scale is potential for interobserver variability. We undertook a systematic review of modified Rankin Scale reliability studies.</p> <p><b>Methods:</b> Two researchers independently reviewed the literature. Crossdisciplinary electronic databases were interrogated using the following key words: Stroke*; Cerebrovasc*; Modified Rankin*; Rankin Scale*; Oxford Handicap*; Observer variation*. Data were extracted according to prespecified criteria with decisions on inclusion by consensus.</p> <p><b>Results:</b> From 3461 titles, 10 studies (587 patients) were included. Reliability of modified Rankin Scale varied from weighted κ=0.95 to κ=0.25. Overall reliability of mRS was κ=0.46; weighted κ=0.90 (traditional modified Rankin Scale) and κ=0.62; weighted κ=0.87 (structured interview).</p> <p><b>Conclusion:</b> There remains uncertainty regarding modified Rankin Scale reliability. Interobserver studies closest in design to large-scale clinical trials demonstrate potentially significant interobserver variability.</p&gt

Assessment scales in stroke: clinimetric and clinical considerations

As stroke care has developed, there has been a need to robustly assess the efficacy of interventions both at the level of the individual stroke survivor and in the context of clinical trials. To describe stroke-survivor recovery meaningfully, more sophisticated measures are required than simple dichotomous end points, such as mortality or stroke recurrence. As stroke is an exemplar disabling long-term condition, measures of function are well suited as outcome assessment. In this review, we will describe functional assessment scales in stroke, concentrating on three of the more commonly used tools: the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index. We will discuss the strengths, limitations, and application of these scales and use the scales to highlight important properties that are relevant to all assessment tools. We will frame much of this discussion in the context of "clinimetric" analysis. As they are increasingly used to inform stroke-survivor assessments, we will also discuss some of the commonly used quality-of-life measures. A recurring theme when considering functional assessment is that no tool suits all situations. Clinicians and researchers should chose their assessment tool based on the question of interest and the evidence base around clinimetric properties

Final report for Project no. 1904. Prevention of selected diseases and parasites in organic pig hreds - by means of HACCP based management and surveillance programme (CorePig)

The project partners comprised about 20 researchers from 9 research institutes in eight countries (DK, DE, SE, UK, CH, IT, AU and FR). The project is composed of three work packages: WP1 „Coordination of the project, dissemination and Knowledge synthesis‟, WP2: „Epidemiological study in organic herds‟ and WP3: „Development and evaluation of a HACCP based surveillance and management system‟. WP1 and WP2 started in 2007, while WP3 that built on the results from WP1 and WP2 started later - in 2008. The UK and CH-partners only participated in WP1 and WP3 while the remaining partners participated in all three WP‟s. The project was initiated at the project kick-off meeting in Denmark, August 30-31st 2007, where all project partners met to discuss the planning of the project in detail. Further 6 project meetings were carried out in the project period. The second project meeting was organised in Austria, December 10-11th 2007, the third project meeting in Denmark, February 18-19th 2008, the fourth in France, July 7-9th 2008, the fifth in Italy, December 4.-7th 2008, the sixth in Sweden, June 29-30th 2009 and the final and seventh project meeting took place in Germany, April 7-10th 2010

Functional assessment for acute stroke trials: properties, analysis, and application

A measure of treatment effect is needed to assess the utility of any novel intervention in acute stroke. For a potentially disabling condition such as stroke, outcomes of interest should include some measure of functional recovery. There are many functional outcome assessments that can be used after stroke. In this narrative review, we discuss exemplars of assessments that describe impairment, activity, participation, and quality of life. We will consider the psychometric properties of assessment scales in the context of stroke trials, focusing on validity, reliability, responsiveness, and feasibility. We will consider approaches to the analysis of functional outcome measures, including novel statistical approaches. Finally, we will discuss how advances in audiovisual and information technology could further improve outcome assessment in trials

Measuring Youth Program Quality: A Guide to Assessment Tools

Thanks to growing interest in the subject of youth program quality, many tools are now available to help organizations and systems assess and improve quality. Given the size and diversity of the youth-serving sector, it is unrealistic to expect that any one tool or process will fit all programs or circumstances. This report compares the purpose, history, structure, methodology, content and technical properties of nine different program observation tools

Identifying patient concerns during consultations in tertiary burns services: development of the Adult Burns Patient Concerns Inventory

ObjectivesIdentifying the issues and concerns that matter most to burns survivors can be challenging. For a number of reasons, but mainly relating to patient empowerment, some of the most pressing concerns patients may have during a clinical encounter may not naturally be the focal point of that encounter. The Patient Concerns Inventory (PCI) is a tried and tested concept initially developed in the field of head and neck cancer that empowers patients during a clinical encounter through provision of a list of prompts that allows patients to self-report concerns prior to consultation. The aim of this study was to develop a PCI for adult burns patients.DesignContent for the PCI was generated from three sources: burns health-related quality of life tools, thematic analysis of one-to-one interviews with 12 adult burns patients and 17 multidisciplinary team (MDT) members. Content was refined using a Delphi consensus technique, with patients and staff members, using SurveyMonkey.SettingWithin outpatient secondary care.ParticipantsTwelve adult burns patients and MDT members from two regional burns centres.ResultsA total of 111 individual items were generated from the three sources. The Delphi process refined the total number of items to 58. The main emergent domains were physical and functional well-being (18 items), psychological, emotional and spiritual well-being (22 items), social care and social well-being (7 items) and treatment-related concerns (11 items).ConclusionsThe Adult Burns Patient Concerns Inventory is a 58-item, holistic prompt list, designed to be used in the outpatient clinic. It offers a new tool in burn care to improve communication between healthcare professionals and patients, empowering them to identify their most pressing concerns and hence deliver a more focused and targeted patient-centred clinical encounter

Variability in modified rankin scoring across a large cohort of observers

<br>Background and Purpose— The modified Rankin scale (mRS) is the most commonly used outcome measure in stroke trials. However, substantial interobserver variability in mRS scoring has been reported. These studies likely underestimate the variability present in multicenter clinical trials, because exploratory work has only been undertaken in single centers by a few observers, all of similar training. We examined mRS variability across a large cohort of international observers using data from a video training resource.</br> <br>Methods— The mRS training package includes a series of “real-life” patient interviews for grading. Training data were collected centrally and analyzed for variability using kappa statistics. We examined variability against a standard of “correct” mRS grades; examined variability by country; and for UK assessors, examined variability by center and by professional background of the observer.</br> <br>Results— To date, 2942 assessments from 30 countries have been submitted. Overall reliability for mRS grading has been moderate to good with substantial heterogeneity across countries. Native English language has had little effect on reliability. Within the United Kingdom, there was no significant variation by profession.</br> <br>Conclusion— Our results confirm interobserver variability in mRS assessment. The heterogeneity across countries is intriguing because it appears not to be related solely to language. These data highlight the need for novel strategies to improve reliability.</br&gt

mHealth Series:mHealth project in Zhao County, rural China - Description of objectives, field site and methods

BACKGROUND: We set up a collaboration between researchers in China and the UK that aimed to explore the use of mHealth in China. This is the first paper in a series of papers on a large mHealth project part of this collaboration. This paper included the aims and objectives of the mHealth project, our field site, and the detailed methods of two studies. FIELD SITE: The field site for this mHealth project was Zhao County, which lies 280 km south of Beijing in Hebei Province, China. METHODS: We described the methodology of two studies: (i) a mixed methods study exploring factors influencing sample size calculations for mHealth–based health surveys and (ii) a cross–over study determining validity of an mHealth text messaging data collection tool. The first study used mixed methods, both quantitative and qualitative, including: (i) two surveys with caregivers of young children, (ii) interviews with caregivers, village doctors and participants of the cross–over study, and (iii) researchers’ views. We combined data from caregivers, village doctors and researchers to provide an in–depth understanding of factors influencing sample size calculations for mHealth–based health surveys. The second study, a cross–over study, used a randomised cross–over study design to compare the traditional face–to–face survey method to the new text messaging survey method. We assessed data equivalence (intrarater agreement), the amount of information in responses, reasons for giving different responses, the response rate, characteristics of non–responders, and the error rate. CONCLUSIONS: This paper described the objectives, field site and methods of a large mHealth project part of a collaboration between researchers in China and the UK. The mixed methods study evaluating factors that influence sample size calculations could help future studies with estimating reliable sample sizes. The cross–over study comparing face–to–face and text message survey data collection could help future studies with developing their mHealth tools