Reliability and validity of the Patient Benefit Assessment Scale for Hospitalised Older Patients (P-BAS HOP)

Background: The Patient Benefit Assessment Scale for Hospitalised Older Patients (P-BAS HOP) is a tool which is capable of both identifying the priorities of the individual patient and measuring the outcomes relevant to him/her, resulting in a Patient Benefit Index (PBI) with range 0–3, indicating how much benefit the patient had experienced from the admission. The aim of this study was to evaluate the reliability, validity, responsiveness and interpretability of the P-BAS HOP. Methods: A longitudinal study among hospitalised older patients with a baseline interview during hospitalisation and a follow-up by telephone 3 months after discharge. Test-retest reliability of the baseline and follow-up questionnaire were tested. Percentage of agreement, Cohen’s kappa with quadratic weighting and maximum attainable kappa were calculated per item. The PBI was calculated for both test and retest of baseline and follow-up and compared with Intraclass Correlation Coefficient (ICC). Construct validity was tested by evaluating pre-defined hypotheses comparing the priority of goals with experienced symptoms or limitations at admission and the achievement of goals with progression or deterioration of other constructs. Responsiveness was evaluated by correlating the PBI with the anchor question ‘How much did you benefit from the admission?’. This question was also used to evaluate the interpretability of the PBI with the visual anchor-based minimal important change distribution method. Results: Reliability was tested with 53 participants at baseline and 72 at follow-up. Mean weighted kappa of the baseline items was 0.38. ICC between PBI of the test and retest was 0.77. Mean weighted kappa of the follow-up items was 0.51. ICC between PBI of the test and retest was 0.62. For the construct validity, tested in 451 participants, all baseline hypotheses were confirmed. From the follow-up hypotheses, tested in 344 participants, five of seven were confirmed. The Spearman’s correlation coefficient between the PBI and the anchor question was 0.51. The optimal cut-off point was 0.7 for ‘no important benefit’ and 1.4 points for ‘important benefit’ on the PBI. Conclusions: Although the concept seems promising, the reliability and validity of the P-BAS HOP appeared to be not yet satisfactory. We therefore recommend adapting the P-BAS HOP. Keywords: Older adults, Hospitalisation, Patient perspective, Goal setting, Patient-reported outcomes, Validity, Reliability, Responsiveness, Minimal important change (MIC), Value-based health car

Reinsertion of an inverted osteochondral lesion of the talus: A case report

Osteochondral lesions of the talus (OLTs) occur infrequently and are missed at the initial presentation in up to 67% of cases. Probably more than 1500 OLTs have been reported in published studies, of which, thus far, only 5 cases have been an inverted anterolateral OLT. An anterolateral OLT results from a hypersupination trauma, in which the talar dome is caught behind the fibula. Apparently, if the forces are large enough a " flip of the coin" phenomenon occurs, causing the fragment to invert 180° upside down. We present the case of a young female patient with an inverted OLT that was treated with open reduction and internal fixation using bioabsorbable pins. Follow-up radiographs and computed tomography showed a congruent joint and complete healing of the osteochondral fragment. At the short-term follow-up visit, the functional outcome was promising

Recycled effluent irrigation in vineyards : an Australian case study. II. management for sustainability

The grape industry is reliant on water, and the future of the Australian viticulture industry could be affected by the rising salinity of irrigation water. Areas irrigated with recycled waters are especially at risk. Management can often ameliorate the adverse affects of low quality water, however this may require land-use practices that reduce commercial return from farming activities. With land application of wastewater in agriculture becoming an increasingly popular practice, the scientific challenge for viticulture will be to identify appropriate management strategies for sustainability of soil resources, so that maximum returns are achieved without the operation being compromised

Recycled effluent irrigation in vineyards : an Australian case study. I. issues and monitoring

The viticultural industry is becoming an increasingly significant part of the Australian agricultural sector, with gross earnings of over $4 billion in 2002. Expansion of the industry in the last decade has been rapid, however its heavy reliance on irrigation has resulted in further expansion in many wine growing regions being limited by the availability of water. This problem is not confined to the viticultural industry, with ever increasing pressures on water resources worldwide. As demands for water continue to rise, new strategies to meet demands must be adopted. One of the strategies being increasingly employed is the recycling of waste waters for a number of applications such as irrigation and industrial uses. The use of recycled water for vineyard irrigation provides a number of benefits. Among them are the reduced demands on potable supplies, reduced waste discharges to surface waters, and the opportunity for expansion of production. Recycled waters however, contain constituents which have the potential to cause deleterious effects to both production and the environment. Therefore, the use of recycled water for irrigation requires targetted monitoring and management to ensure the long-term sustainability of both the vineyard and the surrounding environment. Traditional monitoring techniques including water quality monitoring and soil testing can be complimented by new technologies and techniques which provide large quantities of information with relatively less labour and time. Such techniques can be used to monitor the vineyard environment to identify impacts arising from management practices, allowing vineyard managers to adjust management for sustainable production<br /

Acetaminophen for self-reported sleep problems in an elderly population (ASLEEP): Study protocol of a randomized placebo-controlled double-blind trial

Background: The prevalence of sleep disorders increases with age. Sleep disorders may have serious health implications and may be related to serious underlying diseases. Many older people use hypnotics, like benzodiazepines, although these medications have serious side effects and often lead to habituation. Acetaminophen is one of the most frequently used off-label drugs for sleep disorders, although little is known about its effects. Our objective is to investigate whether acetaminophen is effective in treating self-reported sleep disorders in older people. Methods/Design: Participants, aged 65 years or older (n = 150), who have sleep disorders will be randomized for treatment with either acetaminophen 1000 mg or placebo, once daily at bedtime in a double-blind design. Eligible patients should be able to give informed consent, should not be cognitively impaired (Minimal Mental State Examination (MMSE) score ≥ 20), should not have pain, and should not use acetaminophen on a regular basis because of pain complaints. The study will take three weeks to complete. During these three weeks, the participants register their sleep behavior in a sleep diary. The participants will use the study medication during the second and third week. The primary endpoint will be the self-reported sleep disorders at the end of week three, as measured by means of the Insomnia Severity Index (ISI). To validate these subjective sleep parameters against objectively measured indices of the sleep-wake pattern, we will measure the periods of wakefulness and sleep in a subgroup of participants, using an actigraph worn on the wrist during the entire study period. Discussion: The proposed study will contribute to our knowledge about the treatment of sleep disorders in an older population. There is a need for treatments for sleep disorders without serious adverse effects. Acetaminophen might be a simple and inexpensive alternative for the regimes that are currently used with older people. Trial registration: The Netherlands National Trial Register NTR2747

The impact of gender on the risk of cardiovascular events in older adults with advanced chronic kidney disease

Background. Patients with chronic kidney disease (CKD) are at a higher risk of major adverse cardiovascular events (MACE) compared with the general population, but gender differences in this risk, especially in older adults, are not fully known.We aim to identify gender differences in the risk of MACE in older European CKD patients, and explore factors that may explain these differences. Methods. The European Quality study (EQUAL) is a prospective study on stage 4-5 CKD patients, ≥65 years old, not on dialysis, from Germany, Italy, the Netherlands, Poland, Sweden and the UK. Cox regression and cumulative incidence competing risk curves were used to identify gender differences in MACE risks. Mediation analysis was used to identify variables which may explain risk differences between men and women. Results. A total of 417 men out of 1134 (37%) and 185 women out of 602 women (31%) experienced at least one MACE, over a follow-up period of 5 years.Women had an 18% lower risk of first MACE compared with men (hazard ratio 0.82; 95% confidence interval 0.69-0.97; P = .02), which was attenuated after adjusting for pre-existing cardiometabolic comorbidities and cardiovascular risk factors. There were no significant gender differences in the risk of recurrent MACE or fatal MACE. The risk difference in MACE by gender was larger in patients aged 65-75 years, compared with patients over 75 years. Conclusions. In a cohort of older adults with advanced CKD, women had lower risks of MACE. These risk differences were partially explained by pre-existing cardiometabolic comorbidities and cardiovascular risk factors.</p