Validity of the self-administered comorbidity questionnaire in patients with inflammatory bowel disease

Background: The International Consortium for Health Outcomes Measurement has selected the self-administered comorbidity questionnaire (SCQ) to adjust case-mix when comparing outcomes of inflammatory bowel disease (IBD) treatment between healthcare providers. However, the SCQ has not been validated for use in IBD patients. Objectives: We assessed the validity of the SCQ for measuring comorbidities in IBD patients. Design: Cohort study. Methods: We assessed the criterion validity of the SCQ for IBD patients by comparing patient-reported and clinician-reported comorbidities (as noted in the electronic health record) of the 13 diseases of the SCQ using Cohen’s kappa. Construct validity was assessed using the Spearman correlation coefficient between the SCQ and the Charlson Comorbidity Index (CCI), clinician-reported SCQ, quality of life, IBD-related healthcare and productivity costs, prevalence of disability, and IBD disease activity. We assessed responsiveness by correlating changes in the SCQ with changes in healthcare costs, productivity costs, quality of life, and disease activity after 15 months. Results: We included 613 patients. At least fair agreement (κ &gt; 0.20) was found for most comorbidities, but the agreement was slight (κ &lt; 0.20) for stomach disease [κ = 0.19, 95% CI (−0.03; 0.41)], blood disease [κ = 0.02, 95% CI (−0.06; 0.11)], and back pain [κ = 0.18, 95% CI (0.11; 0.25)]. Correlations were found between the SCQ and the clinician-reported SCQ [ρ = 0.60, 95% CI (0.55; 0.66)], CCI [ρ = 0.39, 95% CI (0.31; 0.45)], the prevalence of disability [ρ = 0.23, 95% CI (0.15; 0.32)], and quality of life [ρ = −0.30, 95% CI (−0.37; −0.22)], but not between the SCQ and healthcare or productivity costs or disease activity (|ρ| ⩽ 0.2). A change in the SCQ after 15 months was not correlated with a change in any of the outcomes.Conclusion: The SCQ is a valid tool for measuring comorbidity in IBD patients, but face and content validity should be improved before being used to correct case-mix differences.</p

Reduced scan time and superior image quality with 3D flow MRI compared to 4D flow MRI for hemodynamic evaluation of the Fontan pathway

Long scan times prohibit a widespread clinical applicability of 4D flow MRI in Fontan patients. As pulsatility in the Fontan pathway is minimal during the cardiac cycle, acquiring non-ECG gated 3D flow MRI may result in a reduction of scan time while accurately obtaining time-averaged clinical parameters in comparison with 2D and 4D flow MRI. Thirty-two Fontan patients prospectively underwent 2D (reference), 3D and 4D flow MRI of the Fontan pathway. Multiple clinical parameters were assessed from time-averaged flow rates, including the right-to-left pulmonary flow distribution (main endpoint) and systemic-to-pulmonary collateral flow (SPCF). A ten-fold reduction in scan time was achieved [4D flow 15.9 min (SD 2.7 min) and 3D flow 1.6 min (SD 7.8 s), p<0.001] with a superior signal-to-noise ratio [mean ratio of SNRs 1.7 (0.8), p<0.001] and vessel sharpness [mean ratio 1.2 (0.4), p=0.01] with 3D flow. Compared to 2D flow, good-excellent agreement was shown for mean flow rates (ICC 0.82-0.96) and right-to-left pulmonary flow distribution (ICC 0.97). SPCF derived from 3D flow showed good agreement with that from 4D flow (ICC 0.86). 3D flow MRI allows for obtaining time-averaged flow rates and derived clinical parameters in the Fontan pathway with good-excellent agreement with 2D and 4D flow, but with a tenfold reduction in scan time and significantly improved image quality compared to 4D flow.Developmen

Breakup processes in the 28Si(α, tp) reaction at Eα=120 MeV

Proton-triton coincidence data from the reaction 28Si(α, tp) at Eα = 120 MeV show, in addition to contributions from direct breakup and stripping to unbound states, a process which is strongly forward peaked for Et < 63 MeV. This process has a maximum cross section for excitations of the target system in the region of 15 < Ex < 45 MeV. The data are most likely due to direct inelastic breakup with a proton spectator. The pt coincidence yield at θt = 10° accounts for about 50% of the inclusive continuum (α, t) cross section at θt = 10°

Development and validation of prognostic models designed to predict wheelchair skills at discharge from spinal cord injury rehabilitation

Objective: To develop and validate a statistical model to predict wheelchair skills at discharge (

Different Level, but a Similar Day Pattern of Physical Activity in Workers and Sick-Listed People With Chronic Nonspecific Musculoskeletal Pain

Reneman MF, de Vries RI, van den Hengel EJ, Brouwer S. van der Woude LH. Different level, but a similar day pattern of physical activity in workers and sick-listed people with chronic nonspecific musculoskeletal pain. Arch Phys Med Rehabil 2012;93:1864-7. Objective: To investigate whether physical activity (PA) levels and day patterns of sick-listed workers with chronic nonspecific musculoskeletal pain (CMP) admitted for multidisciplinary rehabilitation are different from those of workers with CMP. Design: Cross-sectional. Setting: Outpatient rehabilitation center and general community. Participants: A convenience sample of sick-listed patients with CMP (n = 27) referred for multidisciplinary pain rehabilitation, and a volunteer sample of workers with CMP (n = 107; Intervention: Participants wore an accelerometer for 5 to 7 consecutive days. Main Outcome Measure: PA, expressed as activity counts. All analyses were corrected for confounders. Results: PA levels of workers with CMP were higher than those of sick-listed patients (P = .01). After correction for confounders, work status explained 3.5% of the variance observed in activity counts (F-change = 5.27, P=.024). In the mornings, group status significantly contributed to the variance in mean activity counts (F-change = 5.32, P = .02). In afternoons (F-change =3.29, P = .07) and evenings (F-change = 2.41, P = .12), the effect of group status on PA level was nonsignificant. No Significant interaction was observed between time and group status (Wilks' lambda = .92, F-14,F-104 = .66, P = .80). Conclusions: Workers with CMP have a higher PA level compared with sick-listed patients. The PA day pattern did not differ significantly between the 2 groups

Peak oxygen consumption in older adults with a lower limb amputation.

Objective: To investigate whether the aerobic capacity of older adults who underwent a lower limb amputation is associated with the presence, cause (traumatic or vascular), and level of amputation (transtibial or transfemoral). Design: Cross-sectional descriptive. Setting: Human motion laboratory at a rehabilitation center. Participants: Older subjects (n=36) who underwent lower limb amputation and age-matched, able-bodied controls (n=21). All subjects were able to walk for a minimum of 4 minutes. Interventions: Not applicable. Main Outcome Measure: Peak oxygen consumption (V

Changes in physical capacity during and after inpatient rehabilitation in subjects with a spinal cord injury

Haisma JA, Bussmann JB, Stam HJ, Sluis TA, Bergen MP, Dallmeijer AJ, de Groot S, van der Woude LH. Changes in physical capacity during and after inpatient rehabilitation in subjects with a spinal cord injury. Objective: To assess changes in physical capacity and its determinants in persons with a spinal cord injury. Design: Prospective cohort study. Measurements at the start of active rehabilitation (t1), 3 months later (t2), at discharge (t3), and 1 year after discharge (t4). Setting: Eight rehabilitation centers in The Netherlands. Participants: A total of 186 subjects at t1 and 123 subjects at t4. Interventions: Not applicable. Main Outcome Measures: Peak aerobic power output (POpeak), peak oxygen uptake (V

Observation of strongly deformed shapes in 154-152 Dy nuclei at medium temperatures

The γ-decay of the giant dipole resonance (GDR) built on excited states of 154-152 Dy nuclei is studied. The selection of GDR decay from high spin states leading to specific exit channels was made possible by triggering on high spin isomers. The deduced energy splitting of the GDR implies large deformations (|β|{all equal to}0.4-0.5). The resonance widths of the components are comparable to those of the GDR built on the ground state indicating small shape fluctuations