Exploration of health dimensions to be included in multi-attribute health-utility assessment

Objective Measurement of health utility is important for quality improvement, but instruments vary in their content. Multi-attribute health utility measures typically assess a small number of health problems, e.g. the EuroQoL EQ-5D questionnaire explores five dimensions of health. We aimed to examine whether a small number of dimensions explains a sufficient amount of variance in self-perceived health, and what can be gained from adding additional dimensions. Design Cross-sectional mail survey that explored health utility and self-perceived health. Setting General resident population of French-speaking Switzerland. Participants Non-institutionalized adults. Main outcome measures EQ-5D (which measures mobility, self-care, usual activities, pain/discomfort, anxiety/depression and a visual analogue health scale between 0 and 100 (VAS)). A subsample rated five additional health dimensions (sleep, memory/concentration, energy/fatigue, sight/hearing, contacts with others). Results In total, 349 adults returned the extended 10-item questionnaire. All added items were strongly and significantly associated with the VAS for perceived health. The proportion of variance explained (R2) in the VAS was 0.47 for the original EQ-5D items (adjusted for attenuation: 0.65), 0.47 for the new items (adjusted for attenuation: 0.65) and 0.56 for the 10 items together (adjusted for attenuation: 0.78). Forty-four percent of the respondents who had a perfect health utility on the EQ-5D reported at least one problem in the new health dimensions. Conclusion Self-perceived health among the general public is influenced by more health dimensions than are typically measured in a multi-attribute health-utility instrumen

Handheld vs. Laptop Computers for Electronic Data Collection in Clinical Research: A Crossover Randomized Trial

AbstractObjective To compare users' speed, number of entry errors and satisfaction in using two current devices for electronic data collection in clinical research: handheld and laptop computers. Design The authors performed a randomized cross-over trial using 160 different paper-based questionnaires and representing altogether 45,440 variables. Four data coders were instructed to record, according to a random predefined and equally balanced sequence, the content of these questionnaires either on a laptop or on a handheld computer. Instructions on the kind of device to be used were provided to data-coders in individual sealed and opaque envelopes. Study conditions were controlled and the data entry process performed in a quiet environment. Measurements The authors compared the duration of the data recording process, the number of errors and users' satisfaction with the two devices. The authors divided errors into two separate categories, typing and missing data errors. The original paper-based questionnaire was used as a gold-standard. Results The overall duration of the recording process was significantly reduced (2.0 versus 3.3 min) when data were recorded on the laptop computer (p < 0.001). Data accuracy also improved. There were 5.8 typing errors per 1,000 entries with the laptop compared to 8.4 per 1,000 with the handheld computer (p < 0.001). The difference was even more important for missing data which decreased from 22.8 to 2.9 per 1,000 entries when a laptop was used (p < 0.001). Users found the laptop easier, faster and more satisfying to use than the handheld computer. Conclusions Despite the increasing use of handheld computers for electronic data collection in clinical research, these devices should be used with caution. They double the duration of the data entry process and significantly increase the risk of typing errors and missing data. This may become a particularly crucial issue in studies where these devices are provided to patients or healthcare workers, unfamiliar with Computer Technologies, for self-reporting or research data collection processe

Acoustic radiation force impulse imaging—normal values of liver stiffness in healthy children

Background: Acoustic radiation force impulse imaging (ARFI) is a recent ultrasound technique to assess tissue stiffness. Objective: Our aim was to describe the feasibility and to define normal ARFI values in liver in children. Materials and methods: ARFI values were measured in 103 children (ages 2weeks to 17years) divided into four age groups, at a minimum depth of 3cm. In 20 children, measurements were done at 3-, 4- and 5-cm depth in the liver to assess the suitability of measurement location. The impact of age groups and of depth groups was examined using multilevel models. The precision of the measurements was determined using intraclass correlation coefficient (ICC). Results: There was no statistical difference between measurements taken at different ages, with a mean propagation velocity of 1.12m/s (range: 0.73 to 1.45m/s). There was no significant difference according to the depth of the regions of interest (up to 5cm). The ICC was 0.77 (95% CI 0.69-0.83). Conclusion: ARFI is feasible in children at any age with an acceptable reliability. The depth of measurements in the liver seems to have no influence on test results. We set the standard ARFI elastography values for healthy liver in childre

Does Prevalence Matter to Physicians in Estimating Post-test Probability of Disease? A Randomized Trial

ABSTRACT: BACKGROUND: The probability of a disease following a diagnostic test depends on the sensitivity and specificity of the test, but also on the prevalence of the disease in the population of interest (or pre-test probability). How physicians use this information is not well known. OBJECTIVE: To assess whether physicians correctly estimate post-test probability according to various levels of prevalence and explore this skill across respondent groups. DESIGN: Randomized trial. PARTICIPANTS: Population-based sample of 1,361 physicians of all clinical specialties. INTERVENTION: We described a scenario of a highly accurate screening test (sensitivity 99% and specificity 99%) in which we randomly manipulated the prevalence of the disease (1%, 2%, 10%, 25%, 95%, or no information). MAIN MEASURES: We asked physicians to estimate the probability of disease following a positive test (categorized as 99.9%). Each answer was correct for a different version of the scenario, and no answer was possible in the "no information” scenario. We estimated the proportion of physicians proficient in assessing post-test probability as the proportion of correct answers beyond the distribution of answers attributable to guessing. KEY RESULTS: Most respondents in each of the six groups (67%-82%) selected a post-test probability of 95-99.9%, regardless of the prevalence of disease and even when no information on prevalence was provided. This answer was correct only for a prevalence of 25%. We estimated that 9.1% (95% CI 6.0-14.0) of respondents knew how to assess correctly the post-test probability. This proportion did not vary with clinical experience or practice setting. CONCLUSIONS: Most physicians do not take into account the prevalence of disease when interpreting a positive test result. This may cause unnecessary testing and diagnostic error

Procalcitonin levels during pregnancy, delivery and postpartum

Aims: To determine the normal value ranges of procalcitonin (PCT) in women with uncomplicated pregnancies. Methods: This prospective cohort study was conducted between May 2009 and February 2010 among 60 women without signs of clinical infection (31 vaginal deliveries, 29 cesarean sections) attending the maternity unit of the University of Geneva Hospitals. Sequential follow-up of PCT levels was performed at 24-28 weeks (n=7), 36-40 weeks (n=60), at delivery (n=59), and at days 2-3 (n=58) and 10 (n=53) postpartum using a sensitive PCT assay with a functional sensitivity of 0.06 μg/L. Results: Median levels of PCT were: 24-28 weeks: 0.043 μg/L (range 0.010-0.080); 36-40 weeks: 0.061 μg/L (range 0.010-0.110); at delivery: 0.068 μg/L (range 0.010-0.170); days 2-3: 0.200 μg/L (range 0.030-5.00); and day 10: 0.060 μg/L (range 0.020-0.120). At days 2-3 postpartum, three women had a PCT level between 0.25 μg/L and 0.5 μg/L and two women had a level higher than 0.5 μg/L. Conclusions: This study provides reference values for PCT during the third trimester, at delivery and at the immediate postpartum period. A cut-off PCT level of 0.25 μg/L can be used during the third trimester, at delivery, and at the immediate postpartum period to rule out infectio

When Illegitimate Tasks Threaten Patient Safety Culture: A Cross-Sectional Survey in a Tertiary Hospital.

Objectives: The current study investigates the prevalence of illegitimate tasks in a hospital setting and their association with patient safety culture outcomes, which has not been previously investigated. Methods: We conducted a cross-sectional survey in a tertiary referral hospital. Patient safety culture outcomes were measured using the Hospital Survey on Patient Safety Culture questionnaire; the primary outcome measures were a low safety rating for the respondent's unit and whether the respondent had completed one or more safety event reports in the last 12 months. Analyses were adjusted for hospital department and staff member characteristics relating to work and health. Results: A total of 2,276 respondents answered the survey (participation rate: 35.0%). Overall, 26.2% of respondents perceived illegitimate tasks to occur frequently, 8.1% reported a low level of safety in their unit, and 60.3% reported having completed one or more safety event reports. In multivariable analyses, perception of a higher frequency of illegitimate tasks was associated with a higher risk of reporting a low safety rating and with a higher chance of having completed event reports. Conclusion: The prevalence of perceived illegitimate tasks was rather high. A programme aiming to reduce illegitimate tasks could provide support for a causal effect of these tasks on safety culture outcomes

Expression of mitofusin 2R94Q in a transgenic mouse leads to Charcot-Marie-Tooth neuropathy type 2A

Charcot-Marie-Tooth disease type 2A is an autosomal dominant axonal form of peripheral neuropathy caused by mutations in the mitofusin 2 gene. Mitofusin 2 encodes a mitochondrial outer membrane protein that participates in mitochondrial fusion in mammalian cells. How mutations in this protein lead to Charcot-Marie-Tooth disease type 2A pathophysiology remains unclear. We have generated a transgenic mouse expressing either a mutated (R94Q) or wild-type form of human mitofusin 2 in neurons to evaluate whether the R94Q mutation was sufficient for inducing a Charcot-Marie-Tooth disease type 2A phenotype. Only mice expressing mitofusin 2R94Q developed locomotor impairments and gait defects thus mimicking the Charcot-Marie-Tooth disease type 2A neuropathy. In these animals, the number of mitochondria per axon was significantly increased in the distal part of the sciatic nerve axons with a diameter smaller than 3.5 μm. Importantly, the analysis of R94Q transgenic animals also revealed an age-related shift in the size of myelinated axons leading to an over-representation of axons smaller than 3.5 μm. Together these data suggest a link between an increased number of mitochondria in axons and a shift in axonal size distribution in mitofusin 2R94Q transgenic animals that may contribute to their neurological phenotyp

Acoustic radiation force impulse (ARFI) elastography for the noninvasive diagnosis of liver fibrosis in children

Background: Acoustic radiation force impulse (ARFI) imaging) is correlated with histopathological findings using METAVIR and semiquantitative scoring system (SSS) criteria for liver fibrosis. Objective: To compare acoustic radiation force impulse imaging with biopsy results in the evaluation of liver fibrosis in children. Materials and methods: Children with chronic liver disease and healthy children underwent acoustic radiation force impulse imaging liver measurements. ARFI gives a shear-wave velocity corresponding to tissue elasticity. In 39 children with liver disease, the values obtained were correlated with biopsy results. Receiver-operating characteristic (ROC) curves were used to determine the reliability of ARFI in estimating liver fibrosis in children. Results: ARFI mean value was 1.12 in the healthy group and 1.99 in children with chronic liver disease. ROC curves show that an ARFI cutoff of 1.34m/s is predictive of both METAVIR and SSS scores with a sensitivity of SSS > 2:0.85; METAVIR > F0:0.82. A cutoff of 2m/s yielded a sensitivity of 100% to detect SSS > 4 or METAVIR > F2. Conclusion: Acoustic radiation force impulse imaging is a reliable, noninvasive and rapid method to estimate moderate to severe liver fibrosis in children. It might prove useful to clinicians for fibrosis monitoring in children with liver disease and postpone the time of liver biops