The psychometric performance of generic preference-based measures for patients with pressure ulcers

© 2015 Palfreyman and Mulhern. Background: Pressure ulcers are wounds that result from reduced mobility, and can have a significant impact on morbidity, mortality and quality of life. As pressure ulcers are a consequence of a wide range of conditions and interventions, it is unclear whether the best means of capturing the quality of life impacts is via generic or condition specific Patient Reported Outcome Measures (PROMs). The aim of this study was to investigate the psychometric performance of the generic EQ-5D and SF-6D amongst patients identified as having or being at risk of developing pressure ulceration. Methods: A survey of patients who were using pressure relieving mattresses and other equipment was undertaken within inpatient and community settings using a handheld tablet and postal survey. Data on EQ-5D-3L, SF-12 (used to calculate SF-6D), an EQ-5D dignity bolt-on question, demographic and wound specific questions were collected. Convergent validity was assessed using Spearman's correlations, and agreement using Bland-Altman plots. Known group validity was assessed by examining whether the instruments discriminated between different pressure ulcer severity groups. Multivariate linear regression was used to examine the impact of a range of pressure ulcer related variables. Results: The total number of participants was 307, including 273 from the acute setting (52% response rate) and 41 from the community (32%). SF-6D and EQ-5D were moderately correlated (0.61), suggesting that both instruments were capturing similar quality of life impacts. Both measures were able to significantly discriminate between groups based on the ulcer grade. Presence of a pressure ulcer and number of comorbidities were significant explanatory variables of EQ-5D and SF-6D score. Conclusions: The results suggest that generic PROMs can effectively capture the impact of pressure ulcers on quality of life, although there are significant challenges in collecting data from this group of patients related to poor clinical condition and mental capacity. The most effective method for obtaining survey data was through the hand held devices and interviewers

Temporal Evolution of the Vela Pulsar's Pulse Profile

The mechanisms of emission and changes in rotation frequency ('glitching') of the Vela pulsar (J0835-4510) are not well understood. Further insight into these mechanisms can be achieved by long-term studies of integrated pulse width, timing residuals, and bright pulse rates. We have undertaken an intensive observing campaign of Vela and collected over 6000 hours of single pulse data. The data shows that the pulse width changes with time, including marked jumps in width after micro-glitches (frequency changes). The abundance of bright pulses also changes after some micro-glitches, but not all. The secular changes in pulse width have three possible cyclic periods, that match with X-ray periodicities of a helical jet that are interpreted as free precession.Comment: 6 pages, 8 figures. Accepted for publication in The Astrophysical Journa

Prescribing for the management of venous leg ulceration

Venous leg ulceration affects a large proportion of the elderly population and can have a profound impact on quality of life. Most patients with leg ulcers receive care from community nurses who are principally responsible for prescribing decisions in the management of venous leg ulceration. There is evidence to support the use of potable tap water for cleansing. Evidence supports the use of compression bandaging or compression hosiery for all patients with adequate arterial supply to the lower leg. There is also good evidence to support the prescription of oral pentoxifylline, preferably as an adjunct to compression or, for patients unable to tolerate compression, as a stand-alone therapy. The evidence base for dressings is less robust, but simple low-cost, low-adherent dressings are a reasonable first-line choice for under-compression

Patient reported out come measures in patients with abdominal a ortic a neurysms: a systematic review p rotocol

Background: Abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta, which is usually asymptomatic. However, rupture of the aneurysm can be fatal or require complex surgery with potential complications, leading to a poor quality of life. Patient reported outcome measures (PROMs) are becoming increasing ly important in the current era of healthcare management. PROMs are used to directly assess how patients feel or function in relation to their health condition without any interpretation . Generic, disease - specific and preference - based PROMs ca n be used to assess the quality of life (QoL), symptoms and functional limitations in patients with AAA including those under surveillance or undergoing endovascular or open surgery or screening . However, these tools vary in terms of their reliability, validity and suitability for use in patients with AAA in a clinical setting. Objectives: To identify, summarise and assess PROMs that have been administered to patients with a diagnosis of AAA including those under surveillance or undergoing endovascular or open surgery or screening . Methods: Key electronic databases and research registers will be searched including: MEDLINE and MEDLINE in Process, EMBASE, PsycINFO, PROQOLID, CINAH L, PROMS Bibliography (Oxford University), Web of Science and the Cochrane Library databases from inception. A two - stage search approach will be used. The first stage will utilise general terms for PROMs to identify studies. These will be retrieved and t he title and abstract will be examined for additional PROM terms. Stage 2 will incorporate these terms with the preliminary search strategy and a methodological search filter . Searches will be supplemented by hand - searching reference lists of relevant reviews and included studies. Study selection, data extraction and quality assessment will be performed independently by at least 2 reviewers. All English language instruments identified as PROMs for patients with AAA will be included. Data will be extracted regarding type of PROM, methods and results. Methodological quality of included studies will be assessed using the CO nsensus - based S tandards for the selection of health st atus Measurement IN struments checklist (COSMIN) and the psychometric properties of the PROMs will be assessed on criteria bas ed in published recommendations. Findings will be presented as narrative and tabular summaries. Discussion : This systematic review will identify PROMs that are used to assess QoL , symptoms and functional limitations in patients with AAA and assess their effectiveness for this population and application to clinical practice. The findings of the review will help inform a project examining the re-configuration of vascular services in the UK, and identify targets for future research

Burkholderia cenocepacia ET12 strain activates TNFR1 signalling in cystic fibrosis airway epithelial cells

Burkholderia cenocepacia is an important pulmonary pathogen in individuals with cystic fibrosis (CF). Infection is often associated with severe pulmonary inflammation, and some patients develop a fatal necrotizing pneumonia and sepsis (‘cepacia syndrome’). The mechanisms by which this species causes severe pulmonary inflammation are poorly understood. Here, we demonstrate that B. cenocepacia BC7, a potentially virulent representative of the epidemic ET12 lineage, binds to tumour necrosis factor receptor 1 (TNFR1) and activates TNFR1-related signalling pathway similar to TNF-α, a natural ligand for TNFR1. This interaction participates in stimulating a robust IL-8 production from CF airway epithelial cells. In contrast, BC45, a less virulent ET12 representative, and ATCC 25416, an environmental B. cepacia strain, do not bind to TNFR1 and stimulate only minimal IL-8 production from CF cells. Further, TNFR1 expression is increased in CF airway epithelial cells compared with non-CF cells. We also show that B. cenocepacia ET12 strain colocaizes with TNFR1 in vitro and in the lungs of CF patients who died due to infection with B. cenocepacia, ET12 strain. Together, these results suggest that interaction of B. cenocepacia , ET12 strain with TNFR1 may contribute to robust inflammatory responses elicited by this organism.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73011/1/j.1462-5822.2007.01029.x.pd

Detection of Gamma-Ray Emission from the Vela Pulsar Wind Nebula with AGILE

Pulsars are known to power winds of relativistic particles that can produce bright nebulae by interacting with the surrounding medium. These pulsar wind nebulae (PWNe) are observed in the radio, optical, x-rays and, in some cases, also at TeV energies, but the lack of information in the gamma-ray band prevents from drawing a comprehensive multiwavelength picture of their phenomenology and emission mechanisms. Using data from the AGILE satellite, we detected the Vela pulsar wind nebula in the energy range from 100 MeV to 3 GeV. This result constrains the particle population responsible for the GeV emission, probing multivavelength PWN models, and establishes a class of gamma-ray emitters that could account for a fraction of the unidentified Galactic gamma-ray sources.Comment: Accepted by Science; first published online on December 31, 2009 in Science Express. Science article and Supporting Online Material are available at http://www.sciencemag.or

Patient-reported outcome measures in patients with peripheral artery disease: Protocol for a systematic review

Peripheral arterial disease (PAD) results in reduced health-related quality of life and significant functional impairment. Patient-reported outcome measures (PROMs) are important when considering the impact of treatments and management strategies in patients with PAD. A variety of studies have reported the use of different PROMs in patients with PAD. However, PROMs should provide valid and reliable findings to help in healthcare decision-making. The aim of this proposed systematic review is to comprehensively evaluate the psychometric properties of PROMs developed and/ or validated in patients with PAD

Sources of evidence in HIV/AIDS care: pilot study comparing family physicians and AIDS service organization staff

BACKGROUND: The improvement of the quality of the evidence used in treatment decision-making is especially important in the case of patients with complicated disease processes such as HIV/AIDS for which multiple treatment strategies exist with conflicting reports of efficacy. Little is known about the perceptions of distinct groups of health care workers regarding various sources of evidence and how these influence the clinical decision-making process. Our objective was to investigate how two groups of treatment information providers for people living with HIV/AIDS perceive the importance of various sources of treatment information. METHODS: Surveys were distributed to staff at two local AIDS service organizations and to family physicians at three community health centres treating people living with HIV/AIDS. Participants were asked to rate the importance of 10 different sources of evidence for HIV/AIDS treatment information on a 5-point Likert-type scale. Mean rating scores and relative rankings were compared. RESULTS: Findings suggest that a discordance exists between the two health information provider groups in terms of their perceptions of the various sources of evidence. Furthermore, AIDS service organization staff ranked health care professionals as the most important source of information whereas physicians deemed AIDS service organizations to be relatively unimportant. The two groups appear to share a common mistrust for information from pharmaceutical industries. CONCLUSIONS: Discordance exists between medical "experts" from different backgrounds relating to their perceptions of evidence. Further investigation is warranted in order to reveal any effects on the quality of treatment information and implications in the decision-making process. Possible effects on collaboration and working relationships also warrant further exploration

Effectiveness of acupuncture, special dressings and simple, low-adherence dressings for healing venous leg ulcers in primary healthcare: study protocol for a cluster-randomized open-labeled trial

<p>Abstract</p> <p>Background</p> <p>Venous leg ulcers constitute a chronic recurring complaint that affects 1.0–1.3% of the adult population at some time in life, and which corresponds to approximately 75% of all chronic ulcers of the leg. Multilayer compression bandaging is, at present, the only treatment that has been proved to be effective in treating this type of ulcer. There is no consensus, however, about the dressings that may be applied, beneath the compression, to promote the healing of this type of ulcer, as there does not seem to be any added benefit from using special dressings rather than simple, low-adherence ones. As well as analgesia, acupuncture provokes peripheral vasodilation, in skin and muscles – which has been demonstrated both experimentally and in clinical practice – probably due to the axon reflex, among other mechanisms. The aim of the present study is to measure the effectiveness and cost of compression treatment for venous leg ulcers combined with special dressings, in comparison with low-adherence ones and acupuncture.</p> <p>Methods/design</p> <p>Cluster-randomized open-labeled trial, at 15 primary healthcare clinics in the Sevilla-Sur Healthcare District, with a control group treated with compression bandaging and low-adherence dressings; the experiment will consist, on the one hand, of the compression treatment applied in combination with special dressings (Treatment 1), and on the other, the compression treatment applied in association with low-adherence dressings, together with acupuncture (Treatment 2).</p> <p>Discussion</p> <p>The results will be measured and recorded in terms of the median time elapsed until complete healing of the ulcer, and the rate of complete healing at 3 months after beginning the treatment. An economic analysis will also be made.</p> <p>This study, carried out in the context of real clinical practice, will provide information for decision-taking concerning the effectiveness of special dressings. Moreover, for the first time a high-quality study will evaluate the effectiveness of acupuncture in the process of healing venous leg ulcers.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN26438275.</p