Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research

Health-related functional status: concepts, measurement and psychometric propertie

Social support as a predictor of perceived health status in patients with multiple sclerosis

Objective: The main aim of this study was to investigate whether different levels of perceived social support are associated with different levels of perceived health status in multiple sclerosis (MS) patients. Methods: Two hundred and seven MS patients (38.4 +/- 10.6 years, 66.2% female) completed the Short-Form-36 Health Survey (SF-36) as the measure for perceived health status, and the perceived social support scale (PSSS) as the measure for social support. Functional disability was assessed using Kurtzke's expanded disability status scale (EDSS). The contribution of EDSS and PSSS for explaining the variance in SF-36 was investigated with multiple linear regression analysis. Results: Demographic variables and EDSS explained 44% of the variance of the physical health summary scale in the SF-36. Demographic variables, EDSS and PSSS front family and friends explained 24% of the variance in mental health summary scale in the SF-36. Results varied according to the multiple linear regression analyses of predictors of variance in the eight dimensions of the SF-36. Conclusion: PSSS from significant others was positively associated with general health dimension of perceived physical health status, while PSSS from family and friends was positively associated with perceived mental health status in MS patients. Practice implications: The results show the importance of supporting social ties and relationships between MS patients and others. (C) 2008 Elsevier Ireland Ltd. All rights reserved

Operative treatment of anterior thoracic spinal cord herniation:three new cases and an individual patient data meta-analysis of 126 case reports

OBJECTIVE: Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. METHODS: An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. RESULTS: Brown-Séquard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P < 0.036). CONCLUSION: Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Séquard syndrome have a better prognosis with respect to postoperative motor function improvement. In this review, spinal cord release and subsequent widening of the dura defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder

The validity and reliability of an instrument to assess nursing competencies in spiritual care

Aim.This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses' competencies in providing spiritual care.Background.Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature.Design.Survey.Method.The participants were students from Bachelor-level nursing schools in the Netherlands (n = 197) participating in a cross-sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbach's alpha and the average inter-item correlation. In addition, the test-retest reliability of the instrument was determined at a two-week interval between baseline and follow-up (n = 109).Results.The spiritual care competence scale comprises six spiritual-care-related nursing competencies. These domains were labelled:1 assessment and implementation of spiritual care (Cronbach's alpha 0 center dot 82)2 professionalisation and improving the quality of spiritual care (Cronbach's alpha 0 center dot 82)3 personal support and patient counseling (Cronbach's alpha 0 center dot 81)4 referral to professionals (Cronbach's alpha 0 center dot 79)5 attitude towards the patient's spirituality (Cronbach's alpha 0 center dot 56)6 communication (Cronbach's alpha 0 center dot 71). These subscales showed good homogeneity with average inter-item correlations &gt; 0 center dot 25 and a good test-retest reliability.Conclusion.This study conducted in a nursing-student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale.Relevance to clinical practice.The spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care.</p

The impact of the intensity of fear on patient’s delay regarding health care seeking behavior: a systematic review

This systematic review focuses on the role of the intensity of fear in patient's delay in cancer and in myocardial infarction. In a search of literature published between 1990 and June 2009, 161 articles were found. After the use of inclusion and exclusion criteria, 11 articles in cancer and 4 articles in myocardial infarction remained. High levels of fear are associated with earlier help-seeking in both diseases; for low levels of fear, the picture is unclear. The level of fear is an important factor, which should be taken into account when facilitating help-seeking by patients

Differences between Slovak and Dutch patients scheduled for coronary artery bypass graft surgery regarding clinical and psychosocial predictors of physical and mental health-related quality of life

BACKGROUND: Differences in health-related quality of life in coronary artery disease patients and associated factors between patients of central and western European descent are rarely investigated. We aim to test differences between Dutch and Slovak health-related quality of life, whether nationality predicted health-related quality of life and if standardised beta weights of health-related quality of life determinants differ across countries. DESIGN: An observational multicentre study at university cardiac centres in the Netherlands and Slovakia. METHODS: In 226 coronary artery disease patients, health-related quality of life was measured by the Short Form Health Survey 36, anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and type D personality was assessed with the 14-item Type D Scale. Multivariate analysis was used to explore the effect of patient characteristics on the physical and mental component summaries. Estimates of each predictor's beta value of the physical and mental component summaries in the Slovak and Dutch patient sample were separately calculated using the Cummings criterion for comparison of two independent betas. RESULTS: Stronger predictors of physical health-related quality of life in Slovak patients were educational level, current smoking, poor functional status, history of diabetes and amount of social support. In Dutch patients, only more symptoms of depression was a stronger predictor ( P<0.05). Regarding Slovak mental health-related quality of life, stronger predictors were educational level, current smoking and amount of social support. Female gender, history of myocardial infarction and more symptoms of depression were stronger predictors in Dutch patients ( P<0.05). CONCLUSION: Descent and differences between both populations in determinants of health-related quality of life should be considered while planning care, follow-up, health education and rehabilitation