Patient satisfaction is biased by renovations to the interior of a primary care office: a pretest-posttest assessment

Abstract Background Measuring quality of care is essential to improve primary care. Quality of primary care for patients is usually assessed by patient satisfaction questionnaires. However, patients may not be able to judge quality of care without also reflecting their perception of the environment. We determined the effect that redesigning a primary care office had on patient satisfaction. We hypothesized that renovating the interior would make patients more satisfied with the quality of medical care. Methods We performed a Pretest-Posttest analysis in a recently renovated single-practice primary care office in Grenchen, Switzerland. Before and after renovation, we distributed a questionnaire to assess patient satisfaction in four domains. We chose a Likert scale (1 = very poor to 6 = very good), and 12 quality indicators, and included two consecutive samples of patients presenting at the primary care office before (n = 153) and after (n = 153) interior design renovation. Results Response rate was high (overall 85 %). The sample was similar to the enlisted patient collective, but the sample population was older (60 years) than the collective (52 years). Patient satisfaction was higher for all domains after the office was renovated (p < 0.01–0.001). Results did not change when we included potential confounders in the multivariable model (p < 0.01). Conclusions Renovating the interior of a primary care office was associated with improved patient satisfaction, including satisfaction in domains otherwise unchanged. Physician skills and patient satisfaction sometimes depend on surrounding factors that may bias the ability of patients to assess the quality of medical care. These biases should be taken into account when quality assessment instruments are designed for patients

R ates and factors associated with falls in older European Americans, Afro-Caribbeans, African-Americans, and Hispanics

Purpose: To evaluate rates and factors associated with older adult falls in different ethnic groups. Participants and methods: Information on demographics, medical and falls history, and pain and physical activity levels was collected from 550 community-dwelling older adults (75±9 years old, 222 European Americans, 109 Afro-Caribbeans, 106 African-Americans, and 113 Hispanics). Results: Taking medications for anxiety (risk ratio [RR] =1.4, 95% confidence interval [CI] =1.1–2.0), having incontinence (RR =1.4, 95% CI =1.1–1.8, P=0.013), back pain (RR =1.4, 95% CI =1.0–1.8), feet swelling (RR =1.3, 95% CI =1.1–1.7), and age $75 years (RR =1.3, 95$75 years were associated with falls, and Afro-Caribbeans presented lower prevalence of falls. These findings need to be taken into consideration in clinical interventions in aging. Keywords: ethnicity, falls, risks, community dwelling, older adult

Hierarchical Spatial Organization of Geographical Networks

In this work we propose the use of a hirarchical extension of the polygonality index as a means to characterize and model geographical networks: each node is associated with the spatial position of the nodes, while the edges of the network are defined by progressive connectivity adjacencies. Through the analysis of such networks, while relating its topological and geometrical properties, it is possible to obtain important indications about the development dynamics of the networks under analysis. The potential of the methodology is illustrated with respect to synthetic geographical networks.Comment: 3 page, 3 figures. A wokring manuscript: suggestions welcome

A systematic comparison of supervised classifiers

Pattern recognition techniques have been employed in a myriad of industrial, medical, commercial and academic applications. To tackle such a diversity of data, many techniques have been devised. However, despite the long tradition of pattern recognition research, there is no technique that yields the best classification in all scenarios. Therefore, the consideration of as many as possible techniques presents itself as an fundamental practice in applications aiming at high accuracy. Typical works comparing methods either emphasize the performance of a given algorithm in validation tests or systematically compare various algorithms, assuming that the practical use of these methods is done by experts. In many occasions, however, researchers have to deal with their practical classification tasks without an in-depth knowledge about the underlying mechanisms behind parameters. Actually, the adequate choice of classifiers and parameters alike in such practical circumstances constitutes a long-standing problem and is the subject of the current paper. We carried out a study on the performance of nine well-known classifiers implemented by the Weka framework and compared the dependence of the accuracy with their configuration parameter configurations. The analysis of performance with default parameters revealed that the k-nearest neighbors method exceeds by a large margin the other methods when high dimensional datasets are considered. When other configuration of parameters were allowed, we found that it is possible to improve the quality of SVM in more than 20% even if parameters are set randomly. Taken together, the investigation conducted in this paper suggests that, apart from the SVM implementation, Weka's default configuration of parameters provides an performance close the one achieved with the optimal configuration

Most published meta-regression analyses based on aggregate data suffer from methodological pitfalls: a meta-epidemiological study.

BACKGROUND Due to clinical and methodological diversity, clinical studies included in meta-analyses often differ in ways that lead to differences in treatment effects across studies. Meta-regression analysis is generally recommended to explore associations between study-level characteristics and treatment effect, however, three key pitfalls of meta-regression may lead to invalid conclusions. Our aims were to determine the frequency of these three pitfalls of meta-regression analyses, examine characteristics associated with the occurrence of these pitfalls, and explore changes between 2002 and 2012. METHODS A meta-epidemiological study of studies including aggregate data meta-regression analysis in the years 2002 and 2012. We assessed the prevalence of meta-regression analyses with at least 1 of 3 pitfalls: ecological fallacy, overfitting, and inappropriate methods to regress treatment effects against the risk of the analysed outcome. We used logistic regression to investigate study characteristics associated with pitfalls and examined differences between 2002 and 2012. RESULTS Our search yielded 580 studies with meta-analyses, of which 81 included meta-regression analyses with aggregated data. 57 meta-regression analyses were found to contain at least one pitfall (70%): 53 were susceptible to ecological fallacy (65%), 14 had a risk of overfitting (17%), and 5 inappropriately regressed treatment effects against the risk of the analysed outcome (6%). We found no difference in the prevalence of meta-regression analyses with methodological pitfalls between 2002 and 2012, nor any study-level characteristic that was clearly associated with the occurrence of any of the pitfalls. CONCLUSION The majority of meta-regression analyses based on aggregate data contain methodological pitfalls that may result in misleading findings

Uses and misuses of the STROBE statement: bibliographic study

Objectives Appropriate reporting is central to the application of findings from research to clinical practice. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations consist of a checklist of 22 items that provide guidance on the reporting of cohort, case-control and cross-sectional studies, in order to facilitate critical appraisal and interpretation of results. STROBE was published in October 2007 in several journals including The Lancet, BMJ, Annals of Internal Medicine and PLoS Medicine. Within the framework of the revision of the STROBE recommendations, the authors examined the context and circumstances in which the STROBE statement was used in the past. Design The authors searched the Web of Science database in August 2010 for articles which cited STROBE and examined a random sample of 100 articles using a standardised, piloted data extraction form. The use of STROBE in observational studies and systematic reviews (including meta-analyses) was classified as appropriate or inappropriate. The use of STROBE to guide the reporting of observational studies was considered appropriate. Inappropriate uses included the use of STROBE as a tool to assess the methodological quality of studies or as a guideline on how to design and conduct studies. Results The authors identified 640 articles that cited STROBE. In the random sample of 100 articles, about half were observational studies (32%) or systematic reviews (19%). Comments, editorials and letters accounted for 15%, methodological articles for 8%, and recommendations and narrative reviews for 26% of articles. Of the 32 observational studies, 26 (81%) made appropriate use of STROBE, and three uses (10%) were considered inappropriate. Among 19 systematic reviews, 10 (53%) used STROBE inappropriately as a tool to assess study quality. Conclusions The STROBE reporting recommendations are frequently used inappropriately in systematic reviews and meta-analyses as an instrument to assess the methodological quality of observational studies

Emotional responses to motion sickness in autonomous driving

In future autonomous cars, users, free from the primary task of driving, will have time and space to engage in other activities while traveling, such as reading a book, working on a laptop or watching a movie. Although the option for these activities are one of the great advantages of autonomous cars, this will also likely increase motion sickness (MS) inside the car. MS affects numerous individuals, and it occurs when the information received through the eyes differs from what is perceived by the body and the inner ear. Plus, MS can have an impact on the emotional component of the individuals experiencing it, making the experience of traveling in autonomous cars uncomfortable and difficult. Emotional design studies focus on the emotional response of individuals to a product or service. These studies typically employ self-report scales as assessment tools, such as SAM (Self-Assessment Manikin) and PrEmo (Product Emotion Measurement instrument). We present the first study measuring emotional responses to MS using both SAM and PrEmo scales. In our study, we induced MS by asking participants to watch a highly dynamic video of a first-person car trip. We also asked subjects to answer to SAM and PrEmo before and after the visualization of the video. Our results showed a change in the answers in time, that is, before vs. after the experience of MS. MS significantly altered individuals' emotional responses, worsening their condition. These results support the need for studies that reduce MS to improve the experience and well-being of individuals in autonomous cars.Landscape, Heritage and Territory Laboratory (Lab2PT), Ref. UID/04509/2020, financed by national funds (PIDDAC) through the FCT/MCTES and the European Structural and Investment Funds in the FEDER component, through the Operational Competitiveness and Internationalization Programme (COMPETE 2020) [Project n° 039334; Funding Reference: POCI- 01-0247-FEDER-039334]

Interventions to Decrease Carotid-Intima Media Thickness in Children and Adolescents With Type 1 Diabetes: A Systematic Review and Meta-Analysis.

INTRODUCTION Hyperglycemia is associated with a higher cardiovascular risk, as evidenced by increased carotid-intima media thickness (CIMT) in youth with diabetes. We conducted a systematic review and meta-analysis to assess the effect of pharmacological or non-pharmacological interventions on CIMT in children and adolescents with prediabetes or diabetes. METHODS We conducted systematic searches of MEDLINE, EMBASE, and CENTRAL, together with supplementary searches in trial registers and other sources for studies completed up to September 2019. Interventional studies assessing ultrasound CIMT in children and adolescents with prediabetes or diabetes were considered for inclusion. Where appropriate, data were pooled across studies using random-effect meta-analysis. Quality was assessed using The Cochrane Collaboration's risk-of-bias tool and a CIMT reliability tool. RESULTS Six studies involving 644 children with type 1 diabetes mellitus were included. No study involved children with prediabetes or type 2 diabetes. Three randomized controlled trials (RCTs) evaluated the effects of metformin, quinapril, and atorvastatin. Three non-randomized studies, with a before-and-after design, evaluated the effects of physical exercise and continuous subcutaneous insulin infusion (CSII). The mean CIMT at baseline ranged from 0.40 to 0.51 mm. The pooled difference in CIMT was -0.01 mm (95% CI: -0.04 to 0.01) for metformin compared to placebo (2 studies; 135 participants; I2: 0%). The difference in CIMT was -0.01 mm (95% CI: -0.03 to 0.01) for quinapril compared to placebo (1 study; 406 participants). The mean change from baseline in CIMT was -0.03 mm (95% CI: -0.14 to 0.08) after physical exercise (1 study; 7 participants). Inconsistent results were reported for CSII or for atorvastatin. CIMT measurement was rated at a higher quality on all reliability domains in 3 (50%) studies. The confidence in results is limited by the low number of RCTs and their small sample sizes, as well as the high risk of bias in before-and-after studies. CONCLUSIONS Some pharmacological interventions may decrease CIMT in children with type 1 diabetes. However, there is great uncertainty with respect to their effects and no strong conclusions can be drawn. Further evidence from larger RCTs is required. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42017075169

Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis

Objective: To evaluate the effectiveness and safety of viscosupplementation for pain and function in patients with knee osteoarthritis. Design: Systematic review and meta-analysis of randomised trials. Data sources Searches were conducted of Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to 11 September 2021. Unpublished trials were identified from the grey literature and trial registries. Eligibility criteria for study selection: Randomised trials comparing viscosupplementation with placebo or no intervention for knee osteoarthritis treatment. Main outcome measures: The prespecified primary outcome was pain intensity. Secondary outcomes were function and serious adverse events. Pain and function were analysed as standardised mean differences (SMDs). The prespecified minimal clinically important between group difference was −0.37 SMD. Serious adverse events were analysed as relative risks. Methods: Two reviewers independently extracted relevant data and assessed the risk of bias of trials using the Cochrane risk of bias tool. The predefined main analysis was based only on large, placebo controlled trials with ≥100 participants per group. Summary results were obtained through a random effects meta-analysis model. Cumulative meta-analysis and trial sequential analysis under a random effects model were also performed. Results: 169 trials provided data on 21 163 randomised participants. Evidence of small study effects and publication biases was observed for pain and function (Egger’s tests with P<0.001 and asymmetric funnel plots). Twenty four large, placebo controlled trials (8997 randomised participants) included in the main analysis of pain indicated that viscosupplementation was associated with a small reduction in pain intensity compared with placebo (SMD −0.08, 95% confidence interval −0.15 to −0.02), with the lower bound of the 95% confidence interval excluding the minimal clinically important between group difference. This effect corresponds to a difference in pain scores of −2.0 mm (95% confidence interval −3.8 to −0.5 mm) on a 100 mm visual analogue scale. Trial sequential analysis for pain indicated that since 2009 there has been conclusive evidence of clinical equivalence between viscosupplementation and placebo. Similar conclusions were obtained for function. Based on 15 large, placebo controlled trials on 6462 randomised participants, viscosupplementation was associated with a statistically significant higher risk of serious adverse events than placebo (relative risk 1.49, 95% confidence interval 1.12 to 1.98). Conclusion: Strong conclusive evidence indicates that viscosupplementation leads to a small reduction in knee osteoarthritis pain compared with placebo, but the difference is less than the minimal clinically important between group difference. Strong conclusive evidence indicates that viscosupplementation is also associated with an increased risk of serious adverse events compared with placebo. The findings do not support broad use of viscosupplementation for the treatment of knee osteoarthritis