Post-discharge follow-up of patients with spine trauma in the National Spinal Cord Injury Registry of Iran during the COVID-19 pandemic:Challenges and lessons learned

Purpose: The purpose of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) is to create an infrastructure to assess the quality of care for spine trauma and in this study, we aim to investigate whether the NSCIR-IR successfully provides necessary post-discharge follow-up data for these patients. Methods: An observational prospective study was conducted from April 11, 2021 to April 22, 2022 in 8 centers enrolled in NSCIR-IR, respectively Arak, Rasht, Urmia, Shahroud, Yazd, Kashan, Tabriz, and Tehran. Patients were classified into 3 groups based on their need for care resources, respectively: (1) non-spinal cord injury (SCI) patients without surgery (group 1), (2) non-SCI patients with surgery (group 2), and (3) SCI patients (group 3). The assessment tool was a self-designed questionnaire to evaluate the care quality in 3 phases: pre-hospital, in-hospital, and post-hospital. The data from the first 2 phases were collected through the registry. The post-hospital data were collected by conducting follow-up assessments. Telephone follow-ups were conducted for groups 1 and 2 (non-SCI patients), while group 3 (SCI patients) had a face-to-face visit. This study took place during the COVID-19 pandemic. Data on age and time interval from injury to follow-up were expressed as mean ± standard deviation (SD) and response rate and follow-up loss as a percentage. Results: Altogether 1538 telephone follow-up records related to 1292 patients were registered in the NSCIR-IR. Of the total calls, 918 (71.05%) were related to successful follow-ups, but 38 cases died and thus were excluded from data analysis. In the end, post-hospital data from 880 patients alive were gathered. The success rate of follow-ups by telephone for groups 1 and 2 was 73.38% and 67.05% respectively, compared to 66.67% by face-to-face visits for group 3, which was very hard during the COVID-19 pandemic. The data completion rate after discharge ranged from 48% – 100%, 22% – 100% and 29% – 100% for groups 1 – 3. Conclusions: To improve patient accessibility, NSCIR-IR should take measures during data gathering to increase the accuracy of registered contact information. Regarding the loss to follow-ups of SCI patients, NSCIR-IR should find strategies for remote assessment or motivate them to participate in follow-ups through, for example, providing transportation facilities or financial support.</p

Post-discharge follow-up of patients with spine trauma in the National Spinal Cord Injury Registry of Iran during the COVID-19 pandemic:Challenges and lessons learned

PURPOSE: The purpose of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) is to create an infrastructure to assess the quality of care for spine trauma and in this study, we aim to investigate whether the NSCIR-IR successfully provides necessary post-discharge follow-up data for these patients.METHODS: An observational prospective study was conducted from April 11, 2021 to April 22, 2022 in 8 centers enrolled in NSCIR-IR, respectively Arak, Rasht, Urmia, Shahroud, Yazd, Kashan, Tabriz, and Tehran. Patients were classified into three groups based on their need for care resources, respectively: (1) non-spinal cord injury (SCI) patients without surgery (group 1), (2) non-SCI patients with surgery (group 2), and (3) SCI patients (group 3). The assessment tool was a self-designed questionnaire to evaluate the care quality in 3 phases: pre-hospital, in-hospital, and post-hospital. The data from the first 2 phases were collected through the registry. The post-hospital data were collected by conducting follow-up assessments. Telephone follow-ups were conducted for groups 1 and 2 (non-SCI patients), while group 3 (SCI patients) had a face-to-face visit. This study took place during the COVID-19 pandemic. Data on age and time interval from injury to follow-up were expressed as mean ± standard deviation (SD) and response rate and follow-up loss as a percentage.RESULTS: Altogether 1538 telephone follow-up records related to 1292 patients were registered in the NSCIR-IR. Of the total calls, 918 (71.05%) were related to successful follow-ups, but 38 cases died and thus were excluded from data analysis. In the end, post-hospital data from 880 patients alive were gathered. The success rate of follow-ups by telephone for groups 1 and 2 was 73.38% and 67.05% respectively, compared to 66.67% by face-to-face visits for group 3, which was very hard during the COVID-19 pandemic. The data completion rate after discharge ranged from 48% to 100%, 22%-100% and 29%-100% for groups 1 - 3.CONCLUSIONS: To improve patient accessibility, NSCIR-IR should take measures during data gathering to increase the accuracy of registered contact information. Regarding the loss to follow-ups of SCI patients, NSCIR-IR should find strategies for remote assessment or motivate them to participate in follow-ups through, for example, providing transportation facilities or financial support.</p

Cross-cultural adaptation and determination of the reliability and validity of PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge), a questionnaire for patients with lateral epicondylalgia, in a Swedish population

<p>Abstract</p> <p>Background</p> <p>In Sweden, as well as in Scandinavia, there is no easy way to evaluate patients' difficulties when they suffer from lateral epicondylitis/epicondylalgia. However, there is a Canadian questionnaire, in English, that could make the evaluation of a patient's pain and functional loss both quick and inexpensive. Therefore, the aim of this study was to translate and cross-culturally adapt the questionnaire "Patient-rated Tennis Elbow Evaluation" into Swedish (PRTEE-S; "Patientskattad Utvärdering av Tennisarmbåge"), and to evaluate the reliability and validity of the test.</p> <p>Methods</p> <p>The Patient-rated Tennis Elbow Evaluation was cross-culturally adapted for the Swedish language according to well-established guidelines. Fifty-four patients with unilateral epicondylitis/epicondylalgia were assessed using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge), the Disabilities of Arm, Shoulder, and Hand questionnaire, and the Roles & Maudsley score to establish the validity and reliability of the PRTEE-S. Reliability was determined via calculation of the intra-class correlation coefficient (ICC) the internal consistency was assessed by Cronbach's alpha, and validity was calculated using Spearman's correlation coefficient.</p> <p>Results</p> <p>The test-retest reliability, using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge) intraclass correlation coefficient, was 0.95 and the internal consistency was 0.94. The PRTEE-S correlated well with the Disabilities of the Arm, Shoulder, and Hand questionnaire (r = 0.88) and the Roles & Maudsley score (r = 0.78).</p> <p>Conclusion</p> <p>The PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge) represents a reliable and valid instrument to evaluate the subjective outcome in Swedish speaking patients with lateral epicondylitis/epicondylalgia, and can be used in both research and clinical settings.</p

Life expectancy in the province of Halland, Sweden. A historic to modern, socio-epidemiological perspective with focus on cardiovascular diseases

Introduction One of the most concrete expressions of mortality in a population is the so-called life expectancy, i.e. a figure that indicates the average life span of an individual under the prevailing conditions. The life expectancy of a population is considered as a generic measure of public health. The province of Halland is situated in the Southwestern part of Sweden and has today a population of approximately 270 000 inhabitants. The province has retained its agrarian character, more so than the country as a whole. Today, the population of Halland has a life expectancy of 79.37 years, which is the highest in Sweden.The aim of the thesis was to study life expectancy and causes of death, in particular cardiovascular diseases in the province of Halland, compared to Sweden as a whole, for the purpose of identifying, from a socio-epidemiological perspective, important factors contributing to life expectancy during the 20th century.Material and Method Data on population, death rates and causes of death in Halland and Sweden between 1911 and 1950 were processed in a computer program specially designed for the purpose of studying life expectancy and causes of death from a historical perspective. From a modern perspective, mortality from cardiovascular diseases in both Halland and Sweden between 1980-1990 was investigated by means of a prospective design, the aim being to establish whether or not any association with socio-economic status exists. In addition, the incidence of acute myocardial infarction in the period 1980-1992 as well as chest pain in 1997 was studied with socio-economic status as a background variable. Poisson distribution, Poisson regression and logistic regression with 95% CI and p-value were employed.Results Since 1911, Halland has shown a longer life expectancy when compared to Sweden as a whole. From a historical perspective, this difference could be explained by lower infant mortality in combination with lower mortality from infectious diseases while, from a modern perspective, the explanations are lower mortality from cardiovascular diseases in general and ischaemic heart disease in particular. The favourable conditions in Halland can most likely be explained by the socio-structural differences in past times and individual differences in the present day.Conclusion The favourable health situation in Halland is based on a combination of a high standard of living and the associated rich nutritional intake resulting from the agricultural development of the province, in addition to the agrarian environment and the relatively homogeneous social structure

Developing and establishing the psychometric properties of an Ethos towards Wellness Questionnaire (EtWeQ)

Aim: Validated instruments exist measuring parts of personal health, ill-health and lifestyle, but there are few, if any, instruments “grasping the big picture” of wellness and ethos. Accordingly the aim was to develop and establish the psychometric properties of a 74-item Ethos towards Wellness Questionnaire (EtWeQ) with regards to content and construct validity, as well as homogeneity and stability reliability.  Methods: A questionnaire based on a methodological and developmental design was sent out twice with a four week gap between, on 221 healthy middle-aged participants in four steps: item generating, content validating, statistical analyzing and establishing the final questionnaire.  Results: The substantial base, consisting of content validity resulted in, besides basic characteristics, six well-defined and sufficient indexes comprising of; two health indexes (healthiness and ill-healthiness), three life context indexes (work, family, spare time), and one brief comprehensive index (ethos). The three life context as well as the ethos indexes at an ordinal scale level, identified overall satisfactory communalities of &gt;0.30, factor loadings &gt; 0.30, and factor total variance &gt; 50% with regard to construct validity. The homogeneity reliability, in terms of Cronbach’s alpha coefficient &gt; 0.70, at both occasions with a four week gap between, as well as the stability reliability in terms of intraclass correlation coefficient &gt; 0.70, were also considered satisfactory in the same indexes.  Conclusions: This newly developed, and likely the only questionnaire focusing on “grasping the big human picture”, was based on both a philosophical reasoning and empirical recommendations of wellness, is shown to be a valid and reliable measurement in screening or in follow-up of healthy people’s wellness and ethos

Stress and self-rated health : comparison between 26-year old Swedish women at intervals of twenty years

In society of today there are great demands on young women concerning education, work and social life and also concerning health and beauty expectations. The aim of this study was to compare 26-year old Swedish women studied at intervals of twenty years concerning stress in daily life and self-rated health. The participants in 2002 (n=386) answered the same questionnaire that was used twenty years ago in a prospective population study (n=85). The result showed no difference in self-rated health between the two groups. However, women in 2002 reported more stress and health complaints such as exhaustion, sleep disorders, restlessness and difficulty concentration. They also reported low energy level and bad appetite. This discomfort must be interpreted with caution and not necessarily as ill health. However, it is important to take the experience of stress in daily life and the increase in health complaints into consideration even if women today rate their health as good in order to avoid lasting imbalance and thereby future diseases

Developing and testing the psychometric properties of a short-form questionnaire regarding the psychosocial condition after a cardiac event

Psychosocial difficulties in patients after a cardiac event is well-known concept yet no systematic or routine assessment with focus on their psychosocial condition with regard to coping, social support and sense of coherence is established. Accordingly the aim of this pilot study was to develop and test the psychometric properties of a short-form questionnaire regarding patients’ psychosocial condition after a cardiac event to be used in every day clinical practice. This pilot study, which had a methodological design, used selected sample of 30 participants to answer a questionnaire built on 37 items in order to determine face, content and construct validity and homogeneity reliability. Five factors built on 18 items emerged, all with good values for the psychometric tests chosen, and labelled according to their theoretical belongings: closeness, belongingness, availability, concordance and outlook. This short-form questionnaire measuring the psychosocial condition after a cardiac event useful in every day clinical practice seems appropriate but needs further psychometric development carried out in large scale studies with regard to cultural-socio-demographics and diagnoses

Questionnarie for patient participation in emergency departments : development and psychometric testing

Aim The aim of the study was to develop and test the psychometric properties of a patient participation questionnaire in emergency departments.   Background Patient participation is an important indicator of quality of healthcare. International and national health care policy guidelines promote patient participation. While patients cared for in emergency departments generally express dissatisfaction with their care, a review of the literature fails to reveal any scientifically tested research instruments for assessing patient participation from the perspective of patients.   Methods A methodological study was conducted involving a convenience sample of 356 patients recently cared for in emergency departments in Sweden. Data was collected in 2008 and the analyses performed were tested for construct and criterion validity and also homogeneity and stability reliability.   Results A 17- item questionnaire was developed. Two separate factor analyses revealed a distinct four- factor solution which was labelled: fight for participation, requirement for participation, mutual participation and participating in getting basic needs satisfied. Criterion validity presented showed 9 out of 20 correlations above 0.30 and of those 3 moderate correlations of 0.62, 0.63 and 0.70. Cronbach’s alpha coefficient ranged from 0.63 - 0.84 and test- retest varied between 0.59 and 0.93.   Conclusion The results signify evidence of acceptable validity and reliability and the questionnaire makes it possible to evaluate patient participation in ED caring situations. In addition it produces data which is useable by a diverse range of healthcare professionals.  The definitive version is available at www.blackwell-synergy.com</p

Patient participation in the emergency department : an evaluation using a specific instrument to measure patient participation (PPED

Aim:  This study aimed at evaluating patient participation from the perspective of patients who received care in emergency departments, with a separate examination of the relationship between participation and age, sex, education and priority level. Background: International and national guidelines encourage patient participation. High patient participation is required to ensure a high quality of care. No studies evaluating patient participation at an emergency department have been published. Methods: An evaluating study, with the Patient Participation Emergency Department questionnaire, was conducted at emergency departments in Sweden. A consecutive sample of 356 patients participated. Data was collected in 2008: participants were 49% women and with an average age of 56 years. The statistical methods used were Student’s t-test, one-way ANOVA and Spearman correlation. Results: The results revealed that patients experienced good requirement such as time and information for participation. Mutual participation demonstrated a reasonable level but patient participation is low in two dimensions (Fight for participation, Participation in getting basic needs satisfied). Young and well‑educated patients fought more to participate in their care and gained less attention for basic needs than older and less well‑educated patients. Conclusions: Patient participation in a mutual care situation between patients and healthcare professionals requires further improvement to ensure that patients are satisfied and do not have to struggle and fight in order to participate in their care.The definitive version is available at www.blackwell-synergy.com</p