The longitudinal link between visual acuity and health-related quality of life in patients with diabetic retinopathy

<p>Abstract</p> <p>Background</p> <p>This study characterized the degree of change in health-related quality of life (HRQL) associated with change in visual acuity among patients with diabetic retinopathy.</p> <p>Methods</p> <p>Data are from a randomized, placebo-controlled trial of ruboxistaurin for vision loss in patients with diabetic retinopathy. Visual acuity was quantified as letters on the ETDRS visual acuity chart. HRQL was assessed with the 25-Item Visual Function Questionnaire (VFQ-25) and the SF-36. Patients were categorized into groups based on visual acuity change from baseline to month 18. HRQL change of these groups was compared using general linear models. Regression analyses examined visual acuity change defined continuously.</p> <p>Results</p> <p>Patients (N = 535) were primarily Caucasian (81.9%) and male (64.1%); mean age = 59.3 years. Compared to patients whose visual acuity did not change, the group with > 10 letters vision loss had significantly greater decreases in all VFQ-25 subscales except ocular pain. SF-36 change scores did not correspond as closely to change in vision. Change in visual acuity defined continuously was significantly associated with change in all VFQ-25 scales except ocular pain (p < 0.0001).</p> <p>Conclusion</p> <p>Change in visual acuity was associated with corresponding changes in HRQL among patients with diabetic retinopathy. Previous research has often defined vision loss as a loss of at least 15 letters on the ETDRS visual acuity chart. In the current study, however, a loss of at least 10 letters was associated with substantial declines in HRQL domains such as driving, dependency, role limitations, and mental health. These findings suggest that patients who experience vision loss of at least 10 letters may be appropriate targets of future research and clinical intervention.</p

Further analysis of ASCS and PSS SACE data: Case studies of local authority (LA) practice

The Maximising the value of survey data in adult social care (MAX) project aims to develop toolkits, with local authority (LA) staff where possible, to encourage and support LAs to make more use of data drawn from the ASCS and PSS SACE1 to inform local policy and practice. The initial fact-finding phase (MAX Phase 1) activities aimed to:learn more about how LAs currently use ASCS and PSS SACE data, including identifying local practices and barriers; identify potential uses of the data to inform local decision-making; and inform the development of a toolkit to support LAs to make better local use of the data. Along with two analysis and interpretation consultation panel workshops conducted early in the second phase of the project, 139 staff from 95 LAs have so far taken part in MAX. In summary, the findings from these activities demonstrate that LAs generally seem to value the ASCS and PSS SACE and, to some extent, are using the views of service users and carers to inform local service planning and delivery. However, there were several challenges. One of these, identified by just over half of the LAs, concerned analysing the survey data and interpreting the findings to address local questions. A number of barriers seem to underlie this challenge, including difficulties with: identifying local information needs; managing and analysing ASCS and PSS SACE data; and being allocated sufficient time to conduct further analysis. While some LAs find analysing ASCS and PSS SACE data challenging, others are carrying out local statistical analysis, over and above those required for national (ASCOF) reporting. The case studies reported here describe how three local authorities have used and analysed the ASCS and PSS SACE data to support local decision-making. In turn, the case studies will be used to inform the development of ‘how to’ guides and tools to help LAs analyse and interpret survey data, as well as report and interpret analysis finding

Meeting local information needs with ASCS and PSS SACE data

Blog summarising the key findings from the case study of further analysis, conducted with three local authorities during the fact-finding phase of the MAX project, which identified three local practices that maximised the local relevance and value of survey data: adding questions to the surveys, conducting further analysis and drawing on supplementary sources of data

How can MAX help local authorities to use social care data to inform local policy? Maximising the value of survey data in adult social care [MAX] project [Full report]

Executive summary of the MAX working paper - How can MAX help local authorities to use social care data to inform local policy? Maximising the value of survey data in adult social care [MAX] projec

The Fatigue Associated with Depression Questionnaire (FAsD): responsiveness and responder definition

PURPOSE: The Fatigue Associated with Depression Questionnaire (FAsD) was developed to assess fatigue and its impact among patients with depression. The purpose of this study was to examine the questionnaire’s responsiveness to change and identify a responder definition for interpretation of treatment-related changes. METHODS: Data were collected at baseline and at 6 weeks from patients with depression starting treatment with a new antidepressant. RESULTS: Of the 96 participants, 55.2% were women, with a mean age of 43.4 years. The total score and both subscales demonstrated statistically significant change with moderate to large effect sizes (absolute values ≥0.76). FAsD change scores were significantly correlated with change on the Brief Fatigue Inventory (r ≥ 0.73; p < 0.001). FAsD mean change scores discriminated among patient subgroups differing by degree of improvement in patient- and clinician-reported fatigue and depression. Responder definition for the two subscales and total score (0.67, 0.57, 0.62) was estimated primarily based on mean change among patients who reported a small but important improvement in fatigue. DISCUSSION: The FAsD was responsive to change, and the responder definition may be used when interpreting treatment-related change. Results add to previous findings suggesting the FAsD is a useful measure of fatigue among patients with depression

Identifying the impact of adult social care: interpreting outcomes data for use in the Adult Social Care Outcomes Framework.

The primary aim of this IIASC study is to develop outcome indicators that better reflect the contributions made by adult social care. Specifically, the IIASC study aims to identify a way by which data collected from the ASCS and SACE could be used to generate a measure of ‘added value’ reflecting the impact of support provided by LAs on social care-related outcomes. The IIASC study collected in-depth information from service users and carers across 22 local authorities (LAs) in England. By including a wide range of measures of social care service use and non-service-related factors, the study aims to identify the best adjustment methodology to ensure a fair comparison between organisations and over time, and to provide recommendations for the use of this measure and the supplementary items to be collected in the ASCS and SACE. The study does not aim to address theoretical questions on the use of outcome measures in adult social care

Incremental benefit in correlation with histology of native T1 mapping, partition coefficient and extracellular volume fraction in patients with aortic stenosis

Background: We investigated the histological correlation of native T1 maps, partition coefficient and extracellular volume fraction (ECV) using an 11 heart beat (11 HB) MOLLI for identification of overall burden of fibrosis. Methods: Ten patients (8 male, age 73 ± 7 years; all in sinus rhythm, 2 with ventricular ectopy) with severe aortic stenosis (3 with coexisting coronary artery disease) scheduled for surgical aortic valve replacement underwent CMR on a 1.5T scanner (MAGNETOM Avanto, Siemens Healthcare, Erlangen). The 11HB MOLLI sequence (Siemens investigational prototype WIP 448B) was acquired before and 15 minutes post 0.1 mmol/kg gadolinium administration. Incorporating hematocrit results from the same day. This allowed native T1 maps, partition coefficient and ECV calculation. Images were obtained twice at end diastole at basal, and twice at mid left ventricular level. The average of all measurements was used to calculate ECV using the standard formula Partition Coefficient= [(1/T1myocardium post contrast-1/T1 myocardium native)]/[(1/T1 blood post contrast-1/T1 blood native)] with x(1-HCt) for ECV. Similar regions of interest were drawn in the septum at both levels for T1 values. Intraoperatively, trucut biopsies were taken from the left ventricular apical anterior/ lateral wall through the epicardium to allow histological characterization of the full myocardial wall, and fixed in warm buffered formalin. Histological analysis of formalin-fixed paraffin-embedded, transmural myocardial biopsies of the left ventricle was performed on hematoxylin/eosin and Picrosirius red-stained 3-micron-thick sections by a blinded experienced cardiac pathologist. Images were analysed using a purpose-built software (Nikon NIS elements BR) on a NIKON Eclipse light projection microscope to determine the extent of overall and reactive interstitial fibrosis, which was expressed as collagen volume fraction (%) per square millimetre. Results: Native T1 mapping, partition coefficient and ECV all correlated with histologically measured fibrosis. However, native T1 mapping showed the least accuracy (panel A, R2 = 0.42) and ECV showed the highest accuracy (panel B, R2 = 0.83). Partition coefficient was more accurate than native T1 mapping but only very marginally less so than ECV (panel C, R2 = 0.80). Conclusions: These results suggest that native T1 mapping is less accurate than partition coefficient and ECV for overall fibrosis. Therefore, post gadolinium images to enable calculation of partition coefficient and ECV should be routinely obtained to increase accuracy