Modelling costs and outcomes of newborn hearing screening: The economic part of a German health technology assessment project

The prevalence of newborn hearing disorders is 1-3 per 1000. Crucial for later outcome are correct diagnosis and effective treatment in the first year of life. With BERA and TEOAE low-risk techniques for early detection are available. Universal screening is recommended but not realised in most European health care systems. Objective of the study was to examine the scientific evidence of newborn hearing screening, thus to compare cost-effectiveness of different programmes, differentiated by type of strategy (risk screening, universal screening, no screening). Methods: In an interdisciplinary health technology assessment project all relevant studies on newborn hearing screening were identified and data on medical outcome, costs and cost-effectiveness extracted. A Markov model was designed to calculate cost-effectiveness ratios. Results: Economic data were extracted from 20 relevant publications. In the model total costs for screening of 100.000 newborns with a time horizon of ten years were calculated: 2.0 Mio . for universal screening (U), 1.0 Mio. for risk screening (R) and 0.6 Mio. for no screening (N). The costs per child detected: 13,395 (U) respectively 6,715 (R) and 4,125 (N). Conclusions: A remarkable small number of economic publications mainly of low methodo-logical quality was found. In our own model we found reasonable cost-effectiveness ratios also for universal screening. Considering the outcome advantages of higher numbers of cases detected a universal newborn hearing screening is recommended. --

Goals of patients with rehabilitation needs in acute hospitals: goal achivement is an indicator for improved functioning

OBJECTIVE: To identify goals of patients with rehabilitation needs in the acute hospital setting using the International Classification of Functioning, Disability and Health (ICF), to examine association of goal achievement with improvement in overall functioning, and to examine whether ICF Core Sets for the acute hospital cover patients goals. DESIGN: Multi-centre cohort study. PATIENTS: A total of 397 patients (50 female, mean age 63 years) from 5 hospitals in Austria, Switzerland and Germany. METHODS: A semi-structured questionnaire was used to assess patient goals and goal achievement. Overall functioning from the patients' and health professionals' perspective was assessed on a numerical rating scale. Improvement in functioning was calculated using a residualized gain score. Association between goal achievement and improvement in overall functioning was assessed with logistic regression. RESULTS: A total of 397 patients reported achievement of at least 1 goal. Eighty-eight percent of the goals were translated into categories of the ICF. Logistic regression analyses revealed significant association between goal achievement and overall functioning. CONCLUSION: The ICF might be useful to identify and structure patient's goals in acute hospital care. The association between goal achievement and improved functioning underlines that it is essential to involve the patient in the process of planning rehabilitation interventions in acute hospitals

Patient goals in post-acute geriatric rehabilitation: goal attainment is an indicator for improved functioning

OBJECTIVE: To identify goals of older patients in geriatric rehabilitation and to measure their improvement in overall functioning. DESIGN: A prospective multi-centre cohort study. METHODS: A semi-structured questionnaire was used to identify patient goals and to assess improvement in overall functioning from patients' and health professionals' perspectives. Patients' goals were linked to the International Classification of Functioning, Disability and Health (ICF). Using a residualized change score, we identified patients who improved more than statistically expected. RESULTS: A total of 209 patients gave 476 statements. Of these, 346 (72.7) statements were linked to 58 different ICF categories. More than 90 of the ICF categories were part of the comprehensive geriatric ICF Core Set. "Walking", "getting rid of pain", "autonomy" and "returning home" were the most frequently reported goals. Multivariable analysis identified shorter length of inpatient stay and goal attainment to be significant predictors for an improvement in overall functioning from the patients' perspective. CONCLUSION: The ICF can be used to identify and structure patients' goals in geriatric rehabilitation. The association between goal attainment and improved overall functioning underlines the necessity of considering the patients' perspective in the rehabilitation process

Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health

Purpose: Aims of this study were to identify aspects of functioning and health relevant to patients with vertigo expressed by ICF categories and to explore the potential of the ICF to describe the patient perspective in vertigo. Methods: We conducted a series of qualitative semi-structured face-to-face interviews using a descriptive approach. Data was analyzed using the meaning condensation procedure and then linked to categories of the International Classification of Functioning, Disability and Health (ICF). Results: From May to July 2010 12 interviews were carried out until saturation was reached. Four hundred and seventy-one single concepts were extracted which were linked to 142 different ICF categories. 40 of those belonged to the component body functions, 62 to the component activity and participation, and 40 to the component environmental factors. Besides the most prominent aspect "dizziness" most participants reported problems within "Emotional functions (b152), problems related to mobility and carrying out the daily routine. Almost all participants reported "Immediate family (e310)" as a relevant modifying environmental factor. Conclusions: From the patients' perspective, vertigo has impact on multifaceted aspects of functioning and disability, mainly body functions and activities and participation. Modifying contextual factors have to be taken into account to cover the complex interaction between the health condition of vertigo on the individuals' daily life. The results of this study will contribute to developing standards for the measurement of functioning, disability and health relevant for patients suffering from vertigo

Chronic Vestibular Hypofunction Is Associated with Impaired Sleep: Results from the DizzyReg Patient Registry

Temporary or permanent vestibular hypofunction has been hypothesized to affect circadian rhythm, sleep, and thermoregulation. Chronic or long-term vestibular disorders such as unilateral vestibular hypofunction may have an even greater negative impact on sleep quality than acute vestibular problems. This study examines self-reported sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI), and its association with vestibular symptom duration in a group of patients with vestibular disorders. We used data from the cross-sectional DizzyReg patient registry of the German Center for Vertigo and Balance Disorders outpatient clinic. Vestibular diagnoses were ascertained based on the International Classification of Vestibular Disorders. A total of 137 patients were included (60% female, mean age 55.4 years, standard deviation, SD, 16.7). The mean PSQI total score was 6.3 (SD = 3.2), with 51% reporting overall poor sleep quality. Patients who had vertigo for two years or longer reported significantly poorer global sleep quality (63% vs. 37%, p = 0.021) and significantly more difficulties with sleep latency (79% vs. 56%, p = 0.013) and sleep efficiency (56% vs. 34%, p = 0.022). The association of poor sleep quality with a longer duration of vertigo remained significant after multivariable adjustment. Further research should investigate the interaction of vestibular disorders, sleep, and their potential mechanisms

Susceptibility to Fear of Heights in Bilateral Vestibulopathy and Other Disorders of Vertigo and Balance

Aims: To determine the susceptibility to visual height intolerance (vHI) in patients with acquired bilateral vestibulopathy (BVP). The question was whether postural instability in BVP, which is partially compensated for by visual substitution of the impaired vestibular control of balance, leads to an increased susceptibility. This is of particular importance since fear of heights is dependent on body posture, and visual control of balance at heights can no longer substitute vestibular input. For comparison susceptibility to vHI was determined in patients with other vestibular or functional disorders. Methods: A total of 150 patients aged 18 or above who had been referred to the German Center for Vertigo and Balance Disorders and diagnosed to have BVP were surveyed with a standardized questionnaire by specifically trained neurological professionals. Further, 481 patients with other vestibular or functional disorders were included. Results: Susceptibility to vHI was reported by 29% (32 % in females, 25% in males) of the patients with BVP. Patients with vHI were slightly younger (67 vs. 71 years). Seventy percent of those with vHI reported avoidance of climbing, hiking, stairs, darkness, cycling or swimming (84% of those without vHI). Mean age for onset of vHI was 40 years. Susceptibility to vHI was higher in patients with other vertigo disorders than in those with BVP: 64% in those with phobic postural vertigo, 61% in vestibular migraine, 56% in vestibular paroxysmia, 54% in benign paroxysmal positional vertigo, 49% in unilateral vestibulopathy and 48% in Menière's disease. Conclusions: The susceptibility to vHI in BVP was not higher than that of the general population (28%).This allows two explanations that need not be alternatives but contribute to each other: (1) Patients with a bilateral peripheral vestibular deficit largely avoid exposure to heights because of their postural instability. (2) The irrational anxiety to fall from heights triggers increased susceptibility to vHI, not the objective postural instability. However, patients with BVP do not exhibit increased comorbid anxiety disorders. This view is supported by the significantly increased susceptibility to vHI in other vestibular syndromes, which are characterized by an increased comorbidity of anxiety disorders

Development and validation of a classification algorithm to diagnose and differentiate spontaneous episodic vertigo syndromes: results from the DizzyReg patient registry

BACKGROUND Spontaneous episodic vertigo syndromes, namely vestibular migraine (VM) and Menière's disease (MD), are difficult to differentiate, even for an experienced clinician. In the presence of complex diagnostic information, automated systems can support human decision making. Recent developments in machine learning might facilitate bedside diagnosis of VM and MD. METHODS Data of this study originate from the prospective patient registry of the German Centre for Vertigo and Balance Disorders, a specialized tertiary treatment center at the University Hospital Munich. The classification task was to differentiate cases of VM, MD from other vestibular disease entities. Deep Neural Networks (DNN) and Boosted Decision Trees (BDT) were used for classification. RESULTS A total of 1357 patients were included (mean age 52.9, SD 15.9, 54.7% female), 9.9% with MD and 15.6% with VM. DNN models yielded an accuracy of 98.4 ± 0.5%, a precision of 96.3 ± 3.9%, and a sensitivity of 85.4 ± 3.9% for VM, and an accuracy of 98.0 ± 1.0%, a precision of 90.4 ± 6.2% and a sensitivity of 89.9 ± 4.6% for MD. BDT yielded an accuracy of 84.5 ± 0.5%, precision of 51.8 ± 6.1%, sensitivity of 16.9 ± 1.7% for VM, and an accuracy of 93.3 ± 0.7%, precision 76.0 ± 6.7%, sensitivity 41.7 ± 2.9% for MD. CONCLUSION The correct diagnosis of spontaneous episodic vestibular syndromes is challenging in clinical practice. Modern machine learning methods might be the basis for developing systems that assist practitioners and clinicians in their daily treatment decisions

Patient goals in post-acute geriatric rehabilitation: goal attainment is an indicator for improved functioning

OBJECTIVE: To identify goals of older patients in geriatric rehabilitation and to measure their improvement in overall functioning. DESIGN: A prospective multi-centre cohort study. METHODS: A semi-structured questionnaire was used to identify patient goals and to assess improvement in overall functioning from patients' and health professionals' perspectives. Patients' goals were linked to the International Classification of Functioning, Disability and Health (ICF). Using a residualized change score, we identified patients who improved more than statistically expected. RESULTS: A total of 209 patients gave 476 statements. Of these, 346 (72.7) statements were linked to 58 different ICF categories. More than 90 of the ICF categories were part of the comprehensive geriatric ICF Core Set. "Walking", "getting rid of pain", "autonomy" and "returning home" were the most frequently reported goals. Multivariable analysis identified shorter length of inpatient stay and goal attainment to be significant predictors for an improvement in overall functioning from the patients' perspective. CONCLUSION: The ICF can be used to identify and structure patients' goals in geriatric rehabilitation. The association between goal attainment and improved overall functioning underlines the necessity of considering the patients' perspective in the rehabilitation process

Functioning and health in patients with cancer on home-parenteral nutrition: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Malnutrition is a common problem in patients with cancer. One possible strategy to prevent malnutrition and further deterioration is to administer home-parenteral nutrition (HPN). While the effect on survival is still not clear, HPN presumably improves functioning and quality of life. Thus, patients' experiences concerning functioning and quality of life need to be considered when deciding on the provision of HPN. Currently used quality of life measures hardly reflect patients' perspectives and experiences. The objective of our study was to investigate the perspectives of patients with cancer on their experience of functioning and health in relation to HPN in order to get an item pool to develop a comprehensive measure to assess the impact of HPN in this population.</p> <p>Methods</p> <p>We conducted a series of qualitative semi-structured interviews. The interviews were analysed to identify categories of the International Classification of Functioning, Disability and Health (ICF) addressed by patients' statements. Patients were consecutively included in the study until an additional patient did not yield any new information.</p> <p>Results</p> <p>We extracted 94 different ICF-categories from 16 interviews representing patient-relevant aspects of functioning and health (32 categories from the ICF component 'Body Functions', 10 from 'Body Structures', 32 from 'Activities & Participation', 18 from 'Environmental Factors'). About 8% of the concepts derived from the interviews could not be linked to specific ICF categories because they were either too general, disease-specific or pertained to 'Personal Factors'. Patients referred to 22 different aspects of functioning improving due to HPN; mainly activities of daily living, mobility, sleep and emotional functions.</p> <p>Conclusions</p> <p>The ICF proved to be a satisfactory framework to standardize the response of patients with cancer on HPN. For most aspects reported by the patients, a matching concept and ICF category could be found. The development of categories of the component 'Personal Factors' should be promoted to close the existing gap when analyzing interviews using the ICF. The identification and standardization of concepts derived from individual interviews was the first step towards creating new measures based on patients' preferences and experiences which both catch the most relevant aspects of functioning and are sensitive enough to monitor change associated to an intervention such as HPN in a vulnerable population with cancer.</p

Correction to: Barriers and facilitators for the management of vertigo: a qualitative study with primary care providers

After publication of the original article 1 it was brought to the authors' attention that a sentence was missing in the acknowledgement section. The full acknowledgement is included in this Correction article