Prediction Of The Nerve Conduction Abnormalities Frequently Associated With Carpal Tunnel Syndrome From Clinical Features

This study was undertaken to develop a clinically useful model for predicting electrophysiological abnormality in the nerve conduction tests used in the diagnosis of carpal tunnel syndrome (CTS). The prediction model combined commonly recorded clinical history, signs, and symptoms in a multivariate analysis. Electrophysiological abnormality and adjustments for the influencing variables (sex, distance, and temperature) were based on normative nerve conduction values obtained in a control group (n = 104). This was the first study in this topic area in which prediction bands were used to adjust the criteria for assigning abnormality to account for influencing variables. The variables used to represent nerve conduction abnormality were selected based on the literature, clinical usage, and investigation of their interrelationships.;Two hundred and eighty-five subjects with signs and symptoms of CTS who were referred for nerve conduction testing were evaluated by interview and physical examination by an investigator who was blind to the electrodiagnosis. Electrodiagnosis was performed without knowledge of the clinical information. The univariate relationships of the clinical variables with nerve conduction abnormality were examined by Chi square analyses to determine the variables to be included in the model.;The model most highly predictive of nerve conduction abnormality included the variables Flick sign, nocturnal discomfort, and family history (P = 0.910). Two other specifications of abnormality, based on the numbers of abnormal variables, were used to test the robustness of the prediction model with similar results, but symptom duration was also included in the model. Tests such as Tinel\u27s sign and Phalen\u27s test which are often recommended in diagnosing CTS were less useful in this study in the prediction of abnormality than information obtained from the history. It was noted that prediction based upon the inclusion of a number of variables in a multivariate analysis, was better than prediction based upon any single variable. This study strongly suggests that the probability of nerve conduction abnormality can be predicted from clinical signs and symptoms and thus could be particularly useful to clinicians who lack easy access to nerve conduction testing

Development of the interRAI Pressure Ulcer Risk Scale (PURS) for use in long-term care and home care settings

<p>Abstract</p> <p>Background</p> <p>In long-term care (LTC) homes in the province of Ontario, implementation of the Minimum Data Set (MDS) assessment and The Braden Scale for predicting pressure ulcer risk were occurring simultaneously. The purpose of this study was, using available data sources, to develop a bedside MDS-based scale to identify individuals under care at various levels of risk for developing pressure ulcers in order to facilitate targeting risk factors for prevention.</p> <p>Methods</p> <p>Data for developing the interRAI Pressure Ulcer Risk Scale (interRAI PURS) were available from 2 Ontario sources: three LTC homes with 257 residents assessed during the same time frame with the MDS and Braden Scale for Predicting Pressure Sore Risk, and eighty-nine Ontario LTC homes with 12,896 residents with baseline/reassessment MDS data (median time 91 days), between 2005-2007. All assessments were done by trained clinical staff, and baseline assessments were restricted to those with no recorded pressure ulcer. MDS baseline/reassessment samples used in further testing included 13,062 patients of Ontario Complex Continuing Care Hospitals (CCC) and 73,183 Ontario long-stay home care (HC) clients.</p> <p>Results</p> <p>A data-informed Braden Scale cross-walk scale using MDS items was devised from the 3-facility dataset, and tested in the larger longitudinal LTC homes data for its association with a future new pressure ulcer, giving a c-statistic of 0.676. Informed by this, LTC homes data along with evidence from the clinical literature was used to create an alternate-form 7-item additive scale, the interRAI PURS, with good distributional characteristics and c-statistic of 0.708. Testing of the scale in CCC and HC longitudinal data showed strong association with development of a new pressure ulcer.</p> <p>Conclusions</p> <p>interRAI PURS differentiates risk of developing pressure ulcers among facility-based residents and home care recipients. As an output from an MDS assessment, it eliminates duplicated effort required for separate pressure ulcer risk scoring. Moreover, it can be done manually at the bedside during critical early days in an admission when the full MDS has yet to be completed. It can be calculated with established MDS instruments as well as with the newer interRAI suite instruments designed to follow persons across various care settings (interRAI Long-Term Care Facilities, interRAI Home Care, interRAI Palliative Care).</p

Pain Reports by Older Adults in Long-Term Care: A Pilot Study of Changes Over Time

PURPOSE: To document self-reported pain descriptions throughout residency in a long-term care facility for a convenience sample of older adults (Canadian war veterans)

Tool for Rapid & Easy Identification of High Risk Diabetic Foot: Validation & Clinical Pilot of the Simplified 60 Second Diabetic Foot Screening Tool

<div><p>Background</p><p>Most diabetic foot amputations are caused by ulcers on the skin of the foot i.e. diabetic foot ulcers. Early identification of patients at high risk for diabetic foot ulcers is crucial. The ‘Simplified 60-Second Diabetic Foot Screening Tool’ has been designed to rapidly detect high risk diabetic feet, allowing for timely identification and referral of patients needing treatment. This study aimed to determine the clinical performance and inter-rater reliability of ‘Simplified 60 Second Diabetic Foot Screening Tool’ in order to evaluate its applicability for routine screening.</p><p>Methods and Findings</p><p>The tool was independently tested by n=12 assessors with n=18 Guyanese patients with diabetes. Inter-rater reliability was assessed by calculating Cronbach’s alpha for each of the assessment items. A minimum value of 0.60 was considered acceptable. Reliability scores of the screening tool assessment items were: ‘monofilament test’ 0.98; ‘active ulcer’ 0.97; ‘previous amputation’ 0.97; ‘previous ulcer’ 0.97; ‘fixed ankle’ 0.91; ‘deformity’ 0.87; ‘callus’ 0.87; ‘absent pulses’ 0.87; ‘fixed toe’ 0.80; ‘blisters’ 0.77; ‘ingrown nail’ 0.72; and ‘fissures’ 0.55. The item ‘stiffness in the toe or ankle’ was removed as it was observed in only 1.3% of patients. The item ‘fissures’ was also removed due to low inter-rater reliability. Clinical performance was assessed via a pilot study utilizing the screening tool on n=1,266 patients in an acute care setting in Georgetown, Guyana. In total, 48% of patients either had existing diabetic foot ulcers or were found to be at high risk for developing ulcers.</p><p>Conclusions</p><p>Clinicians in low and middle income countries such as Guyana can use the Simplified 60-Second Diabetic Screening Tool to facilitate early detection and appropriate treatment of diabetic foot ulcers. Implementation of this screening tool has the potential to decrease diabetes related disability and mortality.</p></div

Differences between the Inlow 60-second screening tool and the Simplified 60-Second Diabetes Foot Screen Tool.

<p>Differences between the Inlow 60-second screening tool and the Simplified 60-Second Diabetes Foot Screen Tool.</p

Simplified 60-Second Diabetes Foot Screen Tool Clinical Pilot: Percentage of 1,163^* persons with diabetes who tested positively for each of the items.

<p>* No data entered on 59 people.</p><p>Simplified 60-Second Diabetes Foot Screen Tool Clinical Pilot: Percentage of 1,163^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0125578#t003fn001" target="_blank">*</a>} persons with diabetes who tested positively for each of the items.</p