A group of research analysing the feet of people with rheumatoid arthritis

Rheumatoid arthritis (RA) shows high prevalence and morbidity worldwide and its biggest impact can be observed in the small joints of the hands and feet. Pharmacological and other non-pharmacological interventions such as foot orthoses can play an important role in managing foot pathologies in patients whose systemic disease is controlled. However, the current situation is that there is a lack of qualitative and quantitative research to provide enough information about this topic. Furthermore, reliable and valid tools to assess the disease and interventions effect are vital to assess the effect that RA has on the feet. This thesis comprises six separate studies: first, four quantitative studies were performed to help to understand the potential role of RA and RA treatments on patients’ feet. Next, a protocol was developed to compare physical activity, general and foot health and foot health experiences in patients with RA when wearing three different types of foot orthoses. Finally, a qualitative study aimed at understanding the RA patients' experiences before and after wearing foot orthoses for 6 months. The findings of the quantitative and qualitative studies focused on foot orthoses suggest that the use of foot orthoses alleviate foot pain, reduce disability and improve physical activity. The systematic review which evaluates biologics on RA patients’ feet shows that postoperative surgical site infection or delayed wound healing were not associated with biologics use. Furthermore, the Self-Reported Foot and Ankle Score questionnaire presents acceptable methodological quality to assess the foot and ankle in patients with RA. Taken together, the results of this work show that foot orthoses are effective in the management of foot pain in patients with RA, reducing disability and improving physical activity. Some valid questionnaires are available to assess the disease and interventions effect in terms of foot and ankle, especially in clinical practice

Identifying Cancer-Related Cognitive Impairment Using the FACT-Cog Perceived Cognitive Impairment.

Cancer-related cognitive impairment (CRCI) is a concerning problem for many cancer survivors. Evaluating patients for CRCI has been a challenge, in part because of a lack of standardized practices. Self-report instruments are often used to assess CRCI, but there are no validated cutpoints. We present the results of receiver operating characteristic curve analysis identifying cutpoints of the Functional Assessment of Cancer Therapy-Cognition perceived cognitive impairment (PCI) in female breast cancer survivors for identifying CRCI cases. We defined presence of CRCI based on elevated complaints on the Patient's Assessment of Own Functioning Inventory compared with healthy control scores. Our results indicate that scores less than 54 in PCI scores using 18 items and scores less than 60 in PCI scores using 20 items exhibited good ability to discriminate CRCI cases from noncases (area under the receiver operating characteristic curve was 0.84 [95% CI = 0.73 to 0.94]). These preliminary results represent an important contribution toward standardizing practices across CRCI studies

A new approach to hierarchical data analysis: Targeted maximum likelihood estimation for the causal effect of a cluster-level exposure

We often seek to estimate the impact of an exposure naturally occurring or randomly assigned at the cluster-level. For example, the literature on neighborhood determinants of health continues to grow. Likewise, community randomized trials are applied to learn about real-world implementation, sustainability, and population effects of interventions with proven individual-level efficacy. In these settings, individual-level outcomes are correlated due to shared cluster-level factors, including the exposure, as well as social or biological interactions between individuals. To flexibly and efficiently estimate the effect of a cluster-level exposure, we present two targeted maximum likelihood estimators (TMLEs). The first TMLE is developed under a non-parametric causal model, which allows for arbitrary interactions between individuals within a cluster. These interactions include direct transmission of the outcome (i.e. contagion) and influence of one individual's covariates on another's outcome (i.e. covariate interference). The second TMLE is developed under a causal sub-model assuming the cluster-level and individual-specific covariates are sufficient to control for confounding. Simulations compare the alternative estimators and illustrate the potential gains from pairing individual-level risk factors and outcomes during estimation, while avoiding unwarranted assumptions. Our results suggest that estimation under the sub-model can result in bias and misleading inference in an observational setting. Incorporating working assumptions during estimation is more robust than assuming they hold in the underlying causal model. We illustrate our approach with an application to HIV prevention and treatment

Estimating cost savings from regionalizing cardiac procedures using hospital discharge data

<p>Abstract</p> <p>Background</p> <p>We examined whether higher procedure volumes for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions (PCI) were associated with lower costs per patient, and if so, estimated the financial savings from regionalizing cardiac procedures.</p> <p>Methods</p> <p>Cost regressions with hospital-specific dummy variables measured within-hospital cost reductions associated with increasing hospital volume. We used the regression estimates to predict the change in total costs that would result from moving patients in low-volume hospitals to higher volume facilities.</p> <p>Results</p> <p>A 10% increase in PCI procedure volume lowered costs per patient by 0.7%. For the average hospital performing CABG in 2000, a 10% increase in volume was associated with a 2.8% reduction in average costs. Despite these lower costs, the predicted savings from regionalizing all PCI procedures in the sample from lower to high-volume hospitals amounted to only 1.1% of the entire costs of performing PCI procedures for the sample in 2000. Similarly, the cost savings for CABG were estimated to be only 3.5%.</p> <p>Conclusion</p> <p>Higher volumes were associated with lower costs per procedure. However, the total potential savings from regionalizing cardiac procedures is relatively minor, and may not justify the risks of reducing access to needed services.</p

Nancy Tatom Ammerman: Studying Lived Religion: Contexts and Practices

Book review of Nancy Tatom Ammerman: Studying Lived Religion: Contexts and Practices. New York University Press, 2021, 257 pp

Relationship between Kinesiophobia, Foot Pain and Foot Function, and Disease Activity in Patients with Rheumatoid Arthritis

Physical activity should be promoted in all people with RA, even in challenging times, such as a pandemic, to improve disease outcomes, well-being, and mental health, despite functional disability. The level of pain is related to the level of kinesiophobia in patients with RA.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Escaping the Courthouse: Private Alternative Dispute Resolution in Los Angeles

Formal dispute resolution, long thought to be the province of the state, seems to have piqued the interest of the private sector in recent years as a possible sphere of activity. In settings where courts are clogged and criminal cases are forcing civil cases off the calendar, where public juries are perceived as out of control, and where many individuals are disillusioned with incremental tort reform; a growing number of private individuals are selling their services as neutrals to facilitate dispute resolution. For-profit firms, both independent and national networks, are springing up and positioning themselves in major metropolitan areas. Nonprofit organizations, both new and well-established, are actively marketing an expanding array of alternative dispute resolution (ADR) services to an increasingly diverse audience of potential consumers

Systematic review of the psychometric properties of patient-reported outcome measures for foot and ankle in rheumatoid arthritis

Background Foot problems and pain are common in patients with rheumatoid arthritis. Patient-reported outcome measures provide a standardized method of capturing patients’ perspectives of their functional status and wellbeing. There are many instruments specific to people with feet affected by rheumatoid arthritis but knowledge of their psychometric validation or methodological quality is lacking Objectives To identify patient-reported outcome measures specific to the foot and ankle and rheumatoid arthritis and investigate their methodological quality and psychometric properties Design Systematic review. Data source : A search was conducted for psychometric or validation studies on patient-reported outcomes in Rheumatoid Arthritis published in different languages, by examining the Pubmed; Scopus, CINAHL; PEDro and Google Scholar databases. Review methods . The systematic review performed was based on the following inclusion criteria: psychometric or clinimetric validation studies on patient-reported outcomes specific to the foot and ankle that included patients with Rheumatoid arthritis. Two authors independently assessed the quality of the studies and extracted datas Results Of the initial 431 studies, fourteen instruments met the inclusion criteria. Significant methodological flaws were detected in most with only SEFAS met the COSMIN quality criteria. Conclusion SEFAS had the best quality and was ranked most appropriate for use with patients living with Rheumatoid Arthriti