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Subjective Assessment (subjective + assessment)
Selected AbstractsA biomechanical assessment of the relation between the oral implant stability at insertion and subjective bone quality assessmentJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2007Ghada Alsaadi Abstract Aim: The study was set to evaluate the validity of subjective jaw bone quality assessment. Materials and Methods: A total of 298 patients (198 females, mean age 56.4) were treated with oral implants at the Periodontology Department at the University Hospital of KUL. A total of 761 TiUniteÔ implants have been installed. Subjective bone quality assessment was performed on radiographs and by the surgeon's tactile sensation and was compared with torque measurements. In a subset of patients, implant stability was also assessed by implant stability quotient and/or periotest values. Results: Subjective assessment of bone quality was related to the PTV, ISQ and placement torque [in the crestal, the second and the apical third (N cm)], respectively; in grade 1: ,5.3, 73.3 (4.2, 9.6, 15.2), and grade 3 or 4: ,1.6, 55 (3.3, 5.5, 8.4). For the surgeon's tactile sensation, a good correlation was noted for the presence of a thick cortex: ,4.6, 70.3 (4.2, 9.7, 15.1), or a thin one: ,0.3, 65.9 (3.6, 6.9, 10.1). For dense trabecular bone, the values were ,2.8, 69.4 (4.4, 9.7,14.8), while for poor trabecular bone, the values were,1.7, 66.4 (3.6, 6.4, 9.8). Conclusions: Subjective assessment of bone quality is related to PTV, ISQ and placement torque measurements at implant insertion. [source] SENSATION RECOVERY IMPROVED BY GREAT AURICULAR NERVE PRESERVATION IN PAROTIDECTOMY: A PROSPECTIVE DOUBLE-BLIND STUDYANZ JOURNAL OF SURGERY, Issue 5 2007Dacita T. K. Suen Background: The great auricular nerve (GAN) is frequently sacrificed during parotidectomy and causes sensory disturbance of the auricle. Our study is to investigate whether GAN preservation can improve the sensory recovery. Methods: Patients undergoing superficial or total conservative parotidectomy for benign tumours were recruited consecutively from November 1998 to September 2001. Different sensory methods (light touch, two-point discrimination and sharp pain) of the auricle were evaluated by a designated physiotherapist preoperatively as well as at 1, 3, 6 and 12 months postoperatively. The patients and the physiotherapist were blinded to the integrity of the GAN. Long-term subjective assessment was also carried out beyond 2 years postoperatively. Results: A total of 21 patients were recruited for the study. GAN were preserved in 10 patients. The mean follow up was 16 months (12,42 months). There was no difference in sex distribution, type of operation and pathology of parotid tumour between the two groups. No postoperative mortality occurred and postoperative morbidity did not differ between the two groups. Patients with GAN preserved had significantly better light touch and sharp pain recovery at 1 year postoperatively. Subjective assessment of sensory dysfunction also favoured GAN preservation. Conclusion: Great auricular nerve preservation minimizes the postoperative sensory disturbance and should be considered whenever tumour clearance is not compromised. [source] The value of laparoscopic skills coursesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009George CONDOUS Objectives: To evaluate the effectiveness of ,hands-on' laparoscopic skills course. Methods: A prospective observational study conducted between May 2005 and June 2006. All gynaecologists who attended ,hands-on' laparoscopic skills course held over a five-day period were assessed initially and at the end of the intensive course. Subjective assessment involved each attendee self-scoring their own knowledge in laparoscopy in different fields; this was done using visual analog scoring (VAS). Objective assessment was done through multiple choice questions (MCQs) and motor skill tasks. The difference between the performances of each of the candidates at pre- and post-course periods was evaluated using the Wilcoxon signed rank test. P -values < 0.05 represented statistical significance. Setting: Centre for Advanced Reproductive Endosurgery (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia. Results:, Twenty-four consecutive gynaecologists have been enrolled in the study , 14 were specialists and ten were obstetrics and gynaecology trainees. Mean age was 44.4 years (range 35,58 years). Pre- and post-course subjective assessment measuring VAS improved significantly for all variables. Objective measurements of pre- and post-course mean MCQ results also improved significantly from 71% to 84.5%, respectively (P -value < 0.0001). There was dramatic improvement in the performing of motor skills in the dry laboratory. Conclusions: Laparoscopic skills workshops can improve both knowledge base and motor skills. Such courses result in a short-term measurable improvement. Future studies should focus on assessing the impact of such ,hands-on' courses to see if these skills are transferred to the operating room. [source] The effect of interocclusal appliances on temporomandibular joints as assessed by 3D reconstruction of MRI scansAUSTRALIAN DENTAL JOURNAL, Issue 1 2001Sandra A. Chu Abstract Magnetic resonance imaging (MRI) enables simulataneous visualization of hard and soft tissues. The aims of the present study were to computer generate three-dimensional (3D) images, reconstructed from MRI scans of normal temporomandibular joints (TMJ), to assess the relative positions of the disc, condyle and articular surface of the temporal bone and to study the effects of two mandibular group function interocclusal appliances (IOAs). Bilateral MRI scans of 2mm slice thickness were generated for the TMJs of 12 asymptomatic subjects with the image acquisition coils orientated in a corrected oblique sagittal plane. MRI scans were generated for all subjects with 3mm interincisal distance IOAs, while a subgroup (n=4) was also scanned with a 5mm interincisal IOA in situ.. An average of 10 slices through each TMJ were generated for the closed mouth and IOA positions. Three-dimensional reconstruction was performed on a 486 IBM compatible computer using a suite of nine programs not commercially available. Three-dimensional images allowed visualization of composite images of joint relationships. Subjective assessment indicated that joint relations in 3D were more informative than multiple separate 2D MRI scans. With the 3mm IOA in situ, the disc was positioned posteriorly and superiorly to the condyle in three of 12 cases. In four of 12 cases the condyle, and in two of 12 cases both the disc and condyle, were positioned anteriorly and inferiorly. With the 5mm IOA changes in condyle/disc and condyle/fossa relationships were more variable. It was concluded that 3D images of TMJs enabled the assessment of the positional changes of the condyle/disc and condyle/fossa relationships as altered by IOAs. However, the role of IOAs on the internal arrangements within the TMJ remains variable and is deserving of further study. [source] A longitudinal study over 5 to 10 years of clinical outcomes in women with idiopathic detrusor overactivityBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2008AR Morris Objective, To evaluate the long-term clinical outcome in women with idiopathic detrusor overactivity (IDO) and to identify significant prognostic factors. Design, Longitudinal study incorporating retrospective case note review and a postal questionnaire. Setting, Tertiary referral urogynaecology clinic in Australia. Population, Women with a sole urodynamic diagnosis of IDO. Methods, Audit of urodynamic records and case notes. Postal questionnaire incorporating validated disease-specific quality-of-life (QoL) instruments. Main outcome measure, Subjective assessment of overall improvement on a 4-point scale followed by scoring of short forms of the urogenital distress inventory and incontinence impact questionnaire. Results, One hundred and thirty two women were identified following examination of 1975 consecutive records with 76 (67%) returning questionnaires. Median follow up was 8 years (6,9), and the duration of symptoms was 13 years (9,18). Improvement was achieved in 25 (35%) women. Disease symptoms fluctuated in severity and QoL were worse in nonresponders to therapy (P < 0.0001). Urge incontinence at presentation was associated with treatment failure (P= 0.001) as was nocturia (P= 0.04), but urodynamic variables were not associated with outcome. Only 3 of 46 (6.5%) women not responding to therapy thought that their symptoms would improve with time. Conclusions, IDO seldom resolves and fluctuates in severity. Individual response is unpredictable, although the presence of urge incontinence is associated with a significantly worse prognosis. [source] Variations in the evaluation of colorectal cancer riskCOLORECTAL DISEASE, Issue 3 2005R. J. Hodder Abstract Objectives, To test the variability in estimating cancer risk and demonstrate the consequences that subjectivity has on patient care. Subjects and methods, Forty-three clinicians were each asked to assess 40 symptomatic colorectal referrals. Each clinician was provided with a comprehensive history on the 40 patients. The clinicians graded the referral according to a malignancy risk score, decided on the required first line investigation and the priority of that investigation. The main outcome measures used was accuracy in cancer detection and appropriateness of investigations selected. Results, There was a wide degree of variation among all clinicians grading both benign and malignant disease with the overall correct classification of 54% (P -value of <0.001). On average, the clinicians correctly diagnosed 71.3% of the cancer patients as compared to 44% of the benign patients. Of the cancer patients, 47% were correctly classified as an urgent referral whilst 52% of the benign patients were over classified and graded as an urgent referral. The mean number chosen by clinicians to have a flexible sigmoidoscopy as the appropriate first investigation was 13 (of 40 patients); this was despite the diagnosis being possible in all cases with a flexible sigmoidoscopy. The choice to use full colonic investigation was seen throughout all disciplines. Junior doctors demonstrated the highest tendency choosing full colonic investigation in 92.3%. Consultants and senior grades showed the least tendency to choose full colonic imaging although even here colonoscopy or barium enema represented 48.5%. Conclusion, Subjective assessment of cancer referrals is a significant problem that needs to be confronted. Improvements are needed to resolve the inherent problems of subjectivity and operator bias if uniform quality of patient care and best use of resources is to be achieved. [source] Fractional Photothermolysis for Photoaging of HandsDERMATOLOGIC SURGERY, Issue 1 2008MING H. JIH MD BACKGROUND Laser treatment for photoaging of the hands should ideally address pigmentary alteration as well as associated skin roughness and wrinkling. Fractional resurfacing has been previously shown to effectively treat facial rhytids and dyschromia. OBJECTIVE We examined the effect of fractional resurfacing for photoaging of the hands. METHODS AND MATERIALS Ten patients (skin phototypes II to IV) with hand photodamage were randomized to receive five treatments with a 1,550-nm diode-pumped erbium fiber laser (Fraxel SR, Reliant Technologies) laser on either the right or left hand. Treatments were performed at settings of 8 to 9 mJ/microscopic treatment zone and density of 2,500 microscopic treatment zones/cm2. Subjective assessments by the patients and investigator were performed for skin roughness, wrinkling, and pigmentation using a 5-point scale. Skin biopsies were taken at baseline and at 1 and 3 months. RESULTS Patient subjective assessment and physician clinical assessment at 1 and 3 months revealed a mean 51% to 75% improvement in skin pigmentation and 25% to 50% improvement in skin roughness and wrinkling. Biopsies of the skin showed increased density of dermal collagen. Patients experienced transient erythema and edema and none had scarring or other adverse effects. LIMITATIONS This was a small study. CONCLUSION Fractional resurfacing appears to be an effective and safe treatment modality for correcting both the pigmentary and the textural aspects of photoaging of the hand. [source] Subjective assessments of the quality of life, well-being and self-efficacy in patients with schizophreniaPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 4 2009Bun Chino md Aim:, The present study examined three kinds of subjective assessment scales in the same patient group with schizophrenia to analyze the correlations among scores obtained in relation to the background data. Method:, Thirty-six patients with schizophrenia were examined with the 26-item short form of the World Health Organization Quality of Life (WHO-QOL 26), Subjective Well-being under Neuroleptic drug treatment: Short Japanese version (SWNS) and Self-Efficacy for Community Life scale (SECL) for subjective assessment scales, five kinds of neurocognitive tests, Positive and Negative Syndrome Scale (PANSS) for clinical symptom, Social Functioning Scale (SFS), and Global Assessment of Functioning (GAF) scale for social functioning. Result:, The scores for delusions (components of positive syndrome), anxiety and depression (components of general psychopathology) on the PANSS significantly correlated with QoL and subjective well-being scores. In contrast, the scores for components of negative syndrome were not correlated with the subjective assessment scores. Furthermore, none of the clinical symptom scores were correlated with the score in self-efficacy scale. The SFS and GAF scores were significantly correlated with the subjective assessment scores. There were significant correlations among the scores on the three subjective assessment scales. Conclusion:, Each scale has different features and should be utilized depending upon the expected effect of treatment or the purpose of assessment. The treatments provided to patients must be directed at improving both psychological and social impairments, in order to enhance the social functioning and QoL of patients. [source] Improved safety with equivalent asthma control in adults with chronic severe asthma on high-dose fluticasone propionateRESPIROLOGY, Issue 3 2001Norbert Berend Objective: High-dose inhaled corticosteroids (ICS) have been associated with the same side-effects as oral corticosteroids. Beclomethasone dipropionate (BDP) and budesonide (BUD) in doses greater than 2000 ,g/day are used regularly in severe asthma, despite the fact that safety and efficacy data at such high doses are limited. Fluticasone propionate (FP) has been promoted as being twice as potent clinically as BDP or BUD at doses of 2000 ,g/day or less with a similar safety profile. The aim of this study was to compare the efficacy and safety of FP with BDP and BUD in 133 symptomatic adult asthmatics requiring at least 1750 ,g/day of BDP or BUD. Methodology: Patients fulfilling the entry criteria were randomized to receive either their regular ICS medication or FP at approximately half the microgram dose for 6 months in an open, parallel group study. The primary efficacy measure was based on morning peak expiratory flow measurements recorded by patients on daily record cards, while determination of safety was based on a number of endpoints including changes in bone turnover indices, the incidence of topical side-effects and assessments of quality of life. Results: It was shown that patients who were switched to FP, but not those continuing with BDP or BUD, had significant increases in levels of morning serum cortisol and the urine cortisol:creatinine ratio while maintaining asthma control. Serum osteocalcin and the pyridinoline:creatinine ratio, as well as the deoxypyridinoline:creatinine ratio, were also shown to increase only in the FP group. Subjective assessments such as quality of life score, the incidence and ease of bruising, and reports of hoarseness also favoured the FP group. Conclusions: It is concluded that, at the doses studied and with the delivery devices used clinically, FP is at least as effective as BDP/BUD in the management of severe asthma and may offer clinical advantages with respect to steroid-related adverse effects. [source] Pulsed dye laser treatment of telangiectasia after radiotherapy for carcinoma of the breastBRITISH JOURNAL OF DERMATOLOGY, Issue 1 2003S.W. Lanigan Summary Background Chronic radiodermatitis after radiotherapy for carcinoma of the breast is a common sequela of treatment and can be distressing for the patient. The skin is atrophic and shows prominent telangiectasia due to dilatation of a reduced or poorly supported skin vasculature. The pulsed dye laser (PDL) is an established treatment of cutaneous telangiectatic disorders including facial telangiectasia and spider naevi, and is safe and efficacious. Objectives To study the efficacy of the PDL in the treatment of postradiation telangiectasia of the breast or chest wall. Methods Prospective open study of the treatment of eight females with the Candela SPTL1B PDL. Subjective assessments of vessel clearance, adverse effects and patient questionnaires. Results All treated patients showed complete clearance of vessels. Two patients developed hypopigmentation. All patients reported a high degree of satisfaction with the treatment. Conclusions PDL therapy clears postirradiation telangiectasia of the breast and chest wall successfully with minimal adverse reactions, and can be recommended for patients distressed by this disorder. [source] The association of subjective nasal patency with peak inspiratory nasal flow in a large healthy populationCLINICAL OTOLARYNGOLOGY, Issue 4 2003J. Jose The association of subjective nasal patency with peak inspiratory nasal flow in a large healthy population This study, performed on 303 healthy volunteers, tested the null hypothesis that normal subjects were unable to assess their nasal patency when compared with objective measurement using peak inspiratory nasal flow rate (PINFR). Subjective assessments were made on a categorical scale and PINFR was measured using an In-Check meter. Analysis of variance showed that the peak inspiratory nasal flow rate, when grouped by the subjective scores, was significantly different. [source] Fractional Photothermolysis for Photoaging of HandsDERMATOLOGIC SURGERY, Issue 1 2008MING H. JIH MD BACKGROUND Laser treatment for photoaging of the hands should ideally address pigmentary alteration as well as associated skin roughness and wrinkling. Fractional resurfacing has been previously shown to effectively treat facial rhytids and dyschromia. OBJECTIVE We examined the effect of fractional resurfacing for photoaging of the hands. METHODS AND MATERIALS Ten patients (skin phototypes II to IV) with hand photodamage were randomized to receive five treatments with a 1,550-nm diode-pumped erbium fiber laser (Fraxel SR, Reliant Technologies) laser on either the right or left hand. Treatments were performed at settings of 8 to 9 mJ/microscopic treatment zone and density of 2,500 microscopic treatment zones/cm2. Subjective assessments by the patients and investigator were performed for skin roughness, wrinkling, and pigmentation using a 5-point scale. Skin biopsies were taken at baseline and at 1 and 3 months. RESULTS Patient subjective assessment and physician clinical assessment at 1 and 3 months revealed a mean 51% to 75% improvement in skin pigmentation and 25% to 50% improvement in skin roughness and wrinkling. Biopsies of the skin showed increased density of dermal collagen. Patients experienced transient erythema and edema and none had scarring or other adverse effects. LIMITATIONS This was a small study. CONCLUSION Fractional resurfacing appears to be an effective and safe treatment modality for correcting both the pigmentary and the textural aspects of photoaging of the hand. [source] Medium-term results of percutaneous vertebroplasty in multiple myelomaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 1 2006Luis Ramos Abstract:, Vertebral compression fractures (VCFs) are common in multiple myeloma (MM). Percutaneous vertebroplasty (PVP) is used to stabilize vertebral collapse and treat the pain. Few studies have been carried out on PVP in MM and follow-up has tended to be short. We have prospectively evaluated the safety and efficacy of PVP in the VCFs resulting from MM or plasmacytomas. Nineteen PVP were performed in 12 consecutive patients. We monitored their pain and functional status using visual analog (VAS) and Eastern Cooperative Oncology Group (ECOG) scale, respectively. For a subjective assessment, every patient was asked about his/her degree of satisfaction. The mean age of the participants was 66 yr. Significant improvement occurred 1 d after PVP according to the VAS score (7.5 pre-PVP to 3.7, P < 0.0001) and ECOG assessment (3.1 to 2.5, P = 0.002). This significant improvement was maintained after 3.2 yr of follow-up. Sixty-three percent of patients were highly satisfied with the result of the PVP and 37% were satisfied. The peri-operative mortality was 0%. Leakage of the cement outside of the vertebral body was noted in 16 of 19 injected vertebrae (84%) but none of the patients developed any clinical or neurological symptoms. At the last follow-up, no further collapse in the treated or neighboring vertebrae was noted. VCFs caused by MM or plasmacytomas can be effectively treated by vertebroplasty. PVP is associated with early clinical improvement of pain and function and can be maintained after a long follow-up without major procedure-related complications. [source] The prevalence of lipodystrophy in an ambulant HIV-infected population: it all depends on the definitionHIV MEDICINE, Issue 3 2001VM Carter Objectives This study's objective was to determine the prevalence of body shape changes and metabolic abnormalities in an ambulant population with HIV infection. Three different definitions of lipodystrophy were used to assess these changes. Patients' anthropometric measures and dual-energy X-ray absorptiometry (DEXA) scans were compared in order to estimate fat distribution in this population. We sought to evaluate potential predictors for lipodystrophy according to each of the three definitions. Methods We performed a cross-sectional study in the outpatient clinic of a tertiary referral hospital in Melbourne, Australia. We enrolled a total of 167 HIV-infected ambulatory patients over 3 months in mid-1998. Data on 159 males, 149 of whom were receiving triple combination antiretroviral therapy, were evaluated. Anthropometric measures, clinical examination, self-report of body shape changes, biochemical measures and DEXA scan were used to assess lipodystrophy and risk factors for cardiovascular disease. Patients described body shape changes in the face, trunk, arms and legs. Laboratory parameters measured included fasting triglyceride (TG), cholesterol, high-density lipoproteins (HDL), glucose, insulin, CD4 cell count and plasma HIV RNA. Current and past antiretroviral therapies were ascertained. Results According to one proposed Australian national definition of lipodystrophy (LDNC), the prevalence of lipodystrophy in this population was 65%. This definition included an objective assessment with major and minor criteria. Patient-defined lipodystrophy (LDP), which involved a subjective assessment of thinning arms and legs and central adiposity, occurred in 19%. Patient-defined lipoatrophy (LAP), which involved a subjective assessment of thinning arms and legs without central adiposity, occurred in 21.3%. No change in body habitus was noted by 37% of the cohort. Hypercholesterolaemia was recorded in 44%, hypertriglyceridaemia in 52% and elevated insulin levels in 23%. Anthropometry was predictive of the per cent total body fat recorded by DEXA scan, but produced consistently lower values. In multivariate analysis, LDP and LAP were significantly associated with stavudine (d4T) use, while LAP was also associated with zidovudine (ZDV) treatment. There were no treatment associations with LDNC. Protease inhibitor (PI) exposure was associated with metabolic changes but not patient perceived body shape changes, while d4T and ZDV exposure was associated with increased triglycerides and reduced peripheral fat stores. Conclusions The prevalence of body shape changes in a single population varied depending on the definition applied. The LDNC definition overestimated body shape abnormalities in comparison with patient perception. LAP was associated with significantly lower fat stores measured by anthropometry and DEXA scan than those identified under the LDNC definition. In contrast to LDNC, LAP was associated with d4T exposure, nucleoside reverse transcriptase inhibitor (NRTI) and ZDV duration of use, but not PI use. Until a consensus definition for lipodystrophy is developed, including agreement on objective measurement and thresholds for abnormality, careful description of the individual components of the syndrome is required to enable cohort comparisons so that predictors of the syndrome can be assessed more accurately and outcome studies made feasible. [source] Quantifying subjective assessment of sleep and life-quality in antidepressant-treated depressed patientsHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 1 2003Andrew G. Mayers Abstract This study sought to establish a method of quantifying subjective perceptions of sleep against perceptions of life-quality and mood, using amended versions of the Pittsburgh sleep diary (PghSD) and quality of life of insomniacs (QOLI) questionnaire. Diaries and questionnaires were self-completed in participants' homes. Outpatients with a DSM-IV diagnosis of major depressive disorder were compared with a healthy control group (with no history, or family history, of depression). Poorer sleepers, as determined by the sleep diary, were significantly more likely to report poorer life-quality and mood perceptions on the subsequent questionnaire. Furthermore, the depressed group reported significantly poorer perceptions of sleep quality and poorer perceptions of life-quality and mood than the control group, even though estimates of sleep disturbance were similar. This may indicate that depressed individuals experience more ,sleep distress' than healthy individuals. These results confirm the extent of subjectively reported sleep disruption in depression and demonstrate the merit of combining the amended PghSD and QOLI to quantify sleep perceptions. Copyright © 2002 John Wiley & Sons, Ltd. Copyright © 2002 John Wiley & Sons, Ltd. [source] Effects of flexible-dose fesoterodine on overactive bladder symptoms and treatment satisfaction: an open-label studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2009J.-J. Wyndaele Summary Aims:, To evaluate the efficacy and tolerability of flexible-dose fesoterodine in subjects with overactive bladder (OAB) who were dissatisfied with previous tolterodine treatment. Methods:, This was a 12-week, open-label, flexible-dose study of adults with OAB (, 8 micturitions and , 3 urgency episodes per 24 h) who had been treated with tolterodine (immediate- or extended-release) for OAB within 2 years of screening and reported dissatisfaction with tolterodine treatment. Subjects received fesoterodine 4 mg once daily for 4 weeks; thereafter, daily dosage was maintained at 4 mg or increased to 8 mg based on the subject's and physician's subjective assessment of efficacy and tolerability. Subjects completed 5-day diaries, the Patient Perception of Bladder Condition (PPBC) and the Overactive Bladder Questionnaire (OAB-q) at baseline and week 12 and rated treatment satisfaction at week 12 using the Treatment Satisfaction Question (TSQ). Safety and tolerability were assessed. Results:, Among 516 subjects treated, approximately 50% opted for dose escalation to 8 mg at week 4. Significant improvements from baseline to week 12 were observed in micturitions, urgency urinary incontinence episodes, micturition-related urgency episodes and severe micturition-related urgency episodes per 24 h (all p < 0.0001). Approximately 80% of subjects who responded to the TSQ at week 12 reported satisfaction with treatment; 38% reported being very satisfied. Using the PPBC, 83% of subjects reported improvement at week 12 with 59% reporting improvement , 2 points. Significant improvements from baseline (p < 0.0001) exceeding the minimally important difference (10 points) were observed in OAB-q Symptom Bother and Health-Related Quality of Life (HRQL) scales and all four HRQL domains. Dry mouth (23%) and constipation (5%) were the most common adverse events; no safety issues were identified. Conclusion:, Flexible-dose fesoterodine significantly improved OAB symptoms, HRQL, and rates of treatment satisfaction and was well tolerated in subjects with OAB who were dissatisfied with prior tolterodine therapy. [source] A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of managementINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2005R. D. HOLMES Summary. Objective. The aim of the present study was to determine the validity of subjective anxiety assessment and the outcomes of management of children receiving operative dental treatment. Setting., The study was conducted at the Departments of Sedation and Child Dental Health, Newcastle Dental Hospital, Newcastle upon Tyne, UK. Subjects and methods., One hundred children and adolescents aged between 8 and 15 years participated in the study. Clinicians subjectively allocated 50 children for treatment with local analgesia alone (low anxiety), and identified 50 children who had the potential to benefit from nitrous oxide and oxygen sedation (high anxiety). Participants then completed the State-Trait Anxiety Inventory for Children (STAIC), the Venham Picture Test (VPT) and the Child Fear Survey Schedule , Dental Subscale (CFSS-DS). A global rating scale classified behaviour during dental treatment. Results., State anxiety and dental fear prior to treatment were significantly higher in children allocated to receive inhalation sedation (P = 0·004 and P = 0·005, respectively). There was no significant difference in trait anxiety or post-treatment state anxiety between the two groups (P = 0·69 and P = 0·06, respectively). Only 11% displayed ,negative' behaviour during treatment: 82% of this group represented those allocated to receive sedation. Conclusion., Children receiving inhalation sedation were significantly more anxious prior to treatment than children receiving treatment with local analgesia alone. The findings support the subjective assessment of anxiety in children; however, objective anxiety measures may assist clinicians in identifying specific fears, which may ultimately aid patient management. [source] An AHP/DEA methodology for ranking decision making unitsINTERNATIONAL TRANSACTIONS IN OPERATIONAL RESEARCH, Issue 2 2000Z. Sinuany-Stern Abstract This paper presents a two-stage model for fully ranking organizational units where each unit has multiple inputs and outputs. In the first stage, the Data Envelopment Analysis (DEA) is run for each pair of units separately. In the second stage, the pairwise evaluation matrix generated in the first stage is utilized to rank scale the units via the Analytical Hierarchical Process (AHP). The consistency of this AHP/DEA evaluation can be tested statistically. Its goodness of fit with the DEA classification (to efficient/inefficient) can also be tested using non-parametric tests. Both DEA and AHP are commonly used in practice. Both have limitations. The hybrid model AHP/DEA takes the best of both models, by avoiding the pitfalls of each. The nonaxiomatic utility theory limitations of AHP are irrelevant here: since we are working with given inputs and outputs of units, no subjective assessment of a decision maker evaluation is involved. AHP/DEA ranking does not replace the DEA classification model, rather it furthers the analysis by providing full ranking in the DEA context for all units, efficient and inefficient. [source] An Internalist View on the Value of Life and Some Tricky Cases Relevant to itJOURNAL OF APPLIED PHILOSOPHY, Issue 1 2001Theo van Willigenburg If we understand death as the irreversible loss of the good of life, we can give meaning to the idea that for suffering patients in the end stage of their illness, life may become an evil and death no longer a threat. Life may lose its good already in the living person. But what does the good of life consist in, then? I defend an internalist view according to which the goodness of life is intrinsically related to the attitudes, concerns, interests and experiences of the person who is leading the life. This results in the contention that the core of what we understand as the value of a person's life is to be identified with what makes life go well for the person living the particular life. This internalist view does not presuppose (or imply) hedonism or mentalism, nor does it pose an experience requirement. Something may be good for you, because it is valuable as seen from your authentic viewpoint, even if you do not actually experience this goodness, or think otherwise because you are mistaken about your own well-being. To test this position, and the authenticity-requirement it includes, I discuss three cases of patients who are persistent in denying that in their life any value is left and who contend that death is no worse than further living. Internalism acknowledges that in the life of these patients there may be 'functionings' and 'beings' that are worthwhile, where the test of value is at least partially independent of subjective assessment. Still, internalism claims that something truly valuable can only contribute to the good of one's life of it has positive meaning as seen from the attitudinal viewpoint that identifies oneself. [source] Molecular aspects of diagnostic nucleolar and nuclear envelope changes in prostate cancerJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 1 2004Andrew H. Fischer Abstract Prostate cancer is still diagnosed by pathologists based on subjective assessment of altered cell and tissue structure. The cellular-level structural changes diagnostic of some forms of cancer are known to be induced by cancer genes, but the relation between specific cellular-level structural features and cancer genes has not been explored in the prostate. Two important cell structural changes in prostate cancer,nucleolar enlargement and nuclear envelope (NE) irregularity,are discussed from the perspective that they should also relate to the function of the genes active in prostate cancer. Enlargement of the nucleolus is the key diagnostic feature of high-grade prostatic intraepithelial neoplasia (PIN), an early stage that appears to be the precursor to the majority of invasive prostate cancers. Nucleolar enlargement classically is associated with increased ribosome production, and production of new ribosomes appears essential for cell-cycle progression. Several cancer genes implicated in PIN are known (in other cell types) to augment ribosome production, including c-Myc, p27, retinoblastoma, p53, and growth factors that impact on ERK signaling. However, critical review of the available information suggests that increased ribosome production per se may be insufficient to explain nucleolar enlargement in PIN, and other newer functions of nucleoli may therefore need to be invoked. NE irregularity develops later in the clonal evolution of some prostate cancers, and it has adverse prognostic significance. Nuclear irregularity has recently been shown to develop dynamically during interphase following oncogene expression, without a requirement for post-mitotic NE reassembly. NE irregularity characteristic of some aggressive prostate cancers could reflect cytoskeletal forces exerted on the NE during active cell locomotion. NE irregularity could also promote chromosomal instability because it leads to chromosomal asymmetry in metaphase. Finally, NE irregularity could impact replication competence, transcriptional programming and nuclear pore function. © 2003 Wiley-Liss, Inc. [source] The validation of a rating scale to assess dietitians' use of behaviour change skillsJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2008G. Bonner Background:, Evidence suggests that education alone is unlikely to elicit dietary-behavioural change (Contento, 1995). Consequently, many dietitians are moving from a traditional advice-giving role to one which utilises ,behaviour change skills' (BCS) in dietary counselling. BCS is an umbrella term used to cover a wide range of skills and techniques drawn from the fields of counselling, motivational interviewing (MI) and cognitive behavioural therapy (CBT). In order to assess the efficacy of this approach, a means of quantifying BCS-use is required. This two-stage study aimed to validate a newly-devised scale to assess dietitians' BCS-use in one-to-one dietary counselling. Methods:, Items for the scale were generated by drawing on the literature, syllabi for training in BCS and its parent disciplines (counselling, MI and CBT), and specialist dietitians. The resulting scale and manual were revised following assessment of content validity by expert panel and piloting. In stage one, 21 dietetic consultations were audiotaped and rated for BCS-use by three BCS-trained dietitians. Inter-rater agreement was calculated using the kappa statistic and intra-class correlation (ICC), to give a ,chance corrected' measure of agreement. Validity was tested using a psychologist's subjective assessment of BCS-use as a proxy ,gold-standard' compared with the dietitians' ratings, again using kappa and ICC. In stage two the scale was further revised before an additional 20 audiotaped consultations were analysed using the same procedure. Ethical approval for the study was given by the appropriate NHS and university research ethics committees. Results:, At stage one, although kappas were fairly poor for agreement on individual criteria, the ICC for overall scores indicated a ,fair' level of agreement, according to Shrout's (1998) classifications: ICC = 0.584 (CI 0.339,0.784). Results for validity were poor with the psychologist frequently rating higher than the dietitians. At stage two, following scale revision, results for inter-rater agreement improved with more criteria showing ,moderate' or ,substantial' agreement. Ten out of the 21 criteria achieved levels of agreement classified as ,fair' or higher for all three rater pairs. The ICC for overall scores improved to indicate ,moderate' agreement: ICC = 0.640 (CI 0.404,0.821). Validity results remained poor. Discussion:, The moderate level of overall inter-rater agreement observed in the revised scale is considered acceptable (Jones, 2006) and indicates this tool is useful. This measure is more relevant to the purpose of the tool than agreement on individual criteria given it is intended to classify consultations overall as low/medium/high use of BCS rather than to examine individual skills. However, in terms of validity, the discrepancy between dietitian and psychologist ratings requires further investigation. It is hypothesized that the dietitians had higher expectations of what a dietitian could achieve in terms of proficiency in BCS and, as such, rated more stringently than the psychologist. Achieving a clear picture of validity usually necessitates a series of assessments (Murphy & Davidshofer, 2005); the BCS rating scale is no exception with further testing required. Conclusions:, The revised scale shows acceptable inter-rater reliability and robust content validity in our study sample. However, quantitative examination of validity gave poor results and further assessment is required to provide a tool with which we can confidently assess dietitians' use of BCS. References, Contento, I., Balch, G.I., Bronner, Y.L. et al. (1995) The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of the research. J. Nutr. Educ.27, 355,364. Jones, J.M. (2006) Nutritional Screening and Assessment Tools. New York: Nova Science Publishers. Murphy, K.R. & Davidshofer, C.O. (2005) Psychological Testing , Principles and Applications, 6th edn. New Jersey: Pearson Education Inc. Shrout, P. (1998) Measurement reliability and agreement in psychiatry. Stat. Methods Med. Res. 7, 301,317. [source] Validation of a Simple Approach to Caries Risk AssessmentJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2005James D. Bader DDS Abstract Objective: This study examined the predictive validity of a simple subjective method promoted to dentists for assessing their patients' caries risk. Methods: Data from two large group practices that have used guideline-assisted caries risk assessment (CRA) for several years were analyzed retrospectively to determine the receipt of caries-related treatment following a CRA. Patient age and receipt of caries preventive treatment subsequent to the CRA were control variables in logistic regressions to determine the likelihood of caries-related treatment for low, moderate, and high risk groups. Results: Among 45,693 individuals in the two plans, those categorized as being at high caries risk were approximately four times as likely to receive any caries-related treatment as those categorized as being at low caries risk. Those categorized as at moderate risk were approximately twice as likely to receive any treatment. In addition, for those at elevated risk who required any treatment, the number of teeth requiring treatment was larger. Conclusion: The results of this study provide the first large-scale, generalizable evidence for the validity of dentists' subjective assessment of caries risk. [source] A prospective, split face, single-blinded study looking at the use of an infrared device with contact cooling in the treatment of skin laxity in asiansLASERS IN SURGERY AND MEDICINE, Issue 2 2008FRCP, Henry H. Chan MBBS Abstract Background Although monopolar radiofrequency treatment is effective in the improvement of skin laxity, the pain and cost that are associated with this method suggest the need for alternative treatment options. Recently, an infrared device with contact cooling has been shown to be effective in the treatment of skin laxity, with ultrastructural changes observed that are similar to those that are observed following treatment with a monopolar radiofrequency device. However, no control was included in previous studies. Objective To conduct a prospective, split-face, single-blinded study to look at the efficacy and complications among Asians of treatment for skin tightening with an infrared device with contact cooling. Method Thirteen Chinese women were treated. An infrared device with contact cooling (Titan, Cutera, Brisbane, CA) was used to treat one side of the face and the untreated side served as the control. The treatment was performed twice with a 4-week interval between the treatments and the patients were followed up by subjective assessment using a structured questionnaire 1 and 3 months after the second (and last) treatment. In all cases, pre- and post-treatment clinical photographs were taken. Two independent observers assessed the photographs. Results Twenty-three percentage of patients reported mild improvement, 15% reported moderate improvement, and 54% reported significant improvement 3 months after their second (and last) treatment. In terms of objective assessment, 41% of patients were identified to have some degree of improvement of the treated side 3 months after their second treatment. Compared with the untreated side, the treated side improved significantly (P,=,0.031) at 1 and 3 months after the second treatment. Blistering occurred in one patient, which had resolved completely by the 3-month follow-up visit. Conclusion An infrared device with contact cooling can be used effectively and safely for the treatment of skin laxity, especially in smaller anatomical areas. Lesers Surg. Med. 40:146,152, 2008. © 2008 Wiley-Liss, Inc. [source] Recommendations for assessing Patient-Reported Outcomes and Health-Related quality of life in clinical trials on allergy: a GA2LEN taskforce position paperALLERGY, Issue 3 2010I. Baiardini To cite this article: Baiardini I, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, van Wijk RG, La Grutta S, Lombardi C, Maurer M, Pinto AM, Ridolo E, Senna GE, Terreehorst I, Todo Bom A, Bousquet J, Zuberbier T, Braido F. Recommendations for assessing Patient-Reported Outcomes and Health-Related quality of life in clinical trials on allergy: a GA2LEN taskforce position paper. Allergy 2010; 65: 290,295. Abstract The aim of this Global Allergy and Asthma European Network (GA2LEN) consensus report is to provide recommendations for patient-reported outcomes (PROs) evaluation in clinical trials for allergic diseases, which constitute a global health problem in terms of physical, psychological economic and social impact. During the last 40 years, PROs have gained large consideration and use in the scientific community, to gain a better understanding of patients' subjective assessment with respect to elements concerning their health condition. They include all health-related reports coming from the patient, without involvement or interpretation by physician or others. PROs assessment should be performed by validated tools (disease-specific tools when available or generic ones) selected taking into account the aim of the study, the expected intervention effects and the determinant and confounding factors or patient-related factors which could influence PROs. Moreover, each tool should be used exclusively in the patient population following the authors' indications without modification and performing a cross-cultural validation if the tool must be used in a language that differs from the original. The result analysis also suggests that the relevance of PROs results in any interventional study should include a pre,post assessment providing information concerning statistical differences within or among groups, rates of response for the PROs and a minimal important difference for the population. The report underlines the importance of further investigation on some topics, such as the quality assessment of existing PROs tools, the definition of inclusion and exclusion criteria and a more extensive evaluation of the correlation between PROs, besides health-related quality of life, and clinical data. [source] Detrusor overactivity and urge urinary incontinence following trans obturator versus midurethral slingsNEUROUROLOGY AND URODYNAMICS, Issue 1 2007Sylvia M. Botros Abstract Aims To compare the rates of resolution of detrusor overactivity (DO) and subjective urge urinary incontinence (UUI) as well as de novo DO and UUI between the Monarc, TVT, and SPARC midurethral sling procedures. Methods Two hundred and seventy-six subjects with urodynamic stress or mixed urinary incontinence underwent retropubic midurethral slings (TVT, N,=,99; SPARC, N,=,52) or transobturator slings (Monarc, N,=,125). All evaluable subjects had a routine office evaluation, subjective assessment of UUI, and multichannel urodynamic testing pre- and 3 months postoperatively. Comparisons were made using Student's t -test, ANOVA, McNemar's test, and Chi-Square test where appropriate. Multivariate logistic regression was performed to detect possible confounding factors such as sling type, and differences in concomitant surgical procedures. Results De novo subjective UUI differed significantly between the Monarc and the other two slings (33% TVT vs. 8% Monarc vs. 17% SPARC, P,=,0.04). Fourteen to Sixteen percents of patients with preoperative UUI who underwent TVT or SPARC had worsening of their UUI symptoms while only 6% of the Monarc group did (P,=,0.02). There was no difference in rates of resolution of DO among the three groups (40% vs. 48% vs. 32%, P,=,0.39) or de novo DO (32% vs. 22% vs. 22%, P,=,0.64) at 3 months. Conclusions Patients who undergo transobturator procedures have significantly lower rates of de novo UUI than those who undergo midurethral sling procedures. Rates of resolution of DO, UUI, and de novo DO do not differ between groups. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Dissatisfied with Life but Having a Good Day: Time-use and Well-being of the Unemployed,THE ECONOMIC JOURNAL, Issue 547 2010Andreas Knabe We apply the Day Reconstruction Method to compare unemployed and employed people with respect to their subjective assessment of emotional affects, differences in the composition and duration of activities during the course of a day and their self-reported life satisfaction. Employed persons are more satisfied with their life than the unemployed and report more positive feelings when engaged in similar activities. Weighting these activities with their duration shows, however, that average experienced utility does not differ between the two groups. Although the unemployed feel sadder when engaged in similar activities, they can compensate this by using the time the employed are at work in more enjoyable ways. [source] Effects of Written Information Material on Help-Seeking Behavior in Patients with Erectile Dysfunction: A Longitudinal StudyTHE JOURNAL OF SEXUAL MEDICINE, Issue 2 2008Michael M. Berner MD ABSTRACT Introduction., Neither men with erectile dysfunction (ED) nor their physicians are willing to discuss sexual problem sufficiently. Written information material could facilitate a dialogue and encourage men to seek treatment. Aim., The central task of this article was to determine the effectiveness and acceptance of patient information material for sexual dysfunction. Methods., Through an information campaign, men received informational material. Eight thousand men also received a first survey, which asked about the intention to seek treatment and to discuss the sexual problem with a physician or partner. A second follow-up questionnaire, 3,6 months after the first one, asked for the implementation of these intentions. Descriptive and regression-based analyses were applied. Main Outcome Measures., Help-seeking behavior, subjective assessment of change in disease severity and partnership quality, satisfaction. Results., Four hundred forty-three men participated in both surveys. Nearly 90% of them became active after reading the information material. More than half talked with their partner (57.8%) and a physician (65%), and one-third sought treatment (31.8%). Especially discussing the problem with the partner and receiving treatment improved erectile functioning and led to an increase in the quality of partnership (P , 0.05). The initial intention to become active was a good predictor for completing an action. The main reasons for not becoming active were inhibitions to talk about ED (46.8%) and fear of a medical examination (27.7%). Conclusions., Overall, the results demonstrate that written information material is a useful resource for men with ED, because it evokes a high help-seeking behavior. It was perceived both to improve the sexual problem as well as to increase the quality of partnership. Providing such material in the medical practice may be an appropriate way to overcome inhibitions and to initiate dialogue with affected men. However, the results must be interpreted with caution because of possible motivationally driven self-selection bias. Berner MM, Leiber C, Kriston L, Stodden V, and Günzler C. Effects of written information material on help-seeking behavior in patients with erectile dysfunction: A longitudinal study. J Sex Med 2008;5:436,447. [source] Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis,THE LARYNGOSCOPE, Issue 9 2010Follow-Up at Six Months Abstract Objectives/Hypothesis: To determine whether injection laryngoplasty or medialization laryngoplasty is more effective in the long-term treatment of unilateral vocal fold paralysis (UVFP). Study Design: A retrospective study of patients with UFVP who underwent either injection or medialization laryngoplasty at the University of Arkansas for Medical Sciences between July 29, 2003 and November 18, 2005. Methods: The data analyzed included patient characteristics and type of intervention, along with the pretreatment and post-treatment parameters of videostrobolaryngoscopy, perceptual voice analysis, and patients' subjective assessment of voice handicap. Results: Thirty-four patients were evaluated, 15 new and 19 from a previous study. The average time from intervention to post-treatment evaluation in the new cohort was 4.8 months (range, 1.5,10.5 months). The average time from intervention to post-treatment in the combined cohort was 6.4 months (range, 1,24 months). Improvements were demonstrated in each of the measured voice parameters in both the injection and the medialization groups, and no significant differences were found in the degree of improvement between the two groups. Limited data on aerodynamic and acoustic voice measurements showed a trend toward improvement in each treatment group. Conclusions: Injection and medialization laryngoplasty were comparable in achieving voice improvement at the average long-term follow-up of 6 months. Laryngoscope, 2010 [source] On Being a Good Listener: Setting Priorities for Applied Health Services ResearchTHE MILBANK QUARTERLY, Issue 3 2003JONATHAN LOMAS In the last decade, explicit priority setting has become an integral part of health care systems. Indeed, there is even an International Society on Priorities in Health Care, created in 1997 (Ham 1997). Whether it is Oregon's priority ordering of symptom treatment pairs to maximize the impact of a limited Medicaid budget (Fox and Leichter 1991), England's National Institute for Clinical Excellence's assessing priorities for new therapeutic innovations in the National Health Service (Rawlins 1999), or New Zealand's setting priorities for patients' access to cardiovascular treatment (Hadorn and Holmes 1997), techniques for judging the relative worth of different health service investments abound. As these techniques are refined, the most common addition is the incorporation of public values as part of the assessment. Priority setting is increasingly seen as combining an objective assessment of costs and effects with a more subjective assessment of patient or public preferences (Lenaghan, New, and Mitchell 1996; Lomas 1997; National Institute for Clinical Excellence 2002; Stronks et al. 1997). [source] A comparison of the intubating laryngeal mask airway and the Bonfils intubation fibrescope in patients with predicted difficult airways,ANAESTHESIA, Issue 7 2004B. Bein Summary Tracheal intubation with the intubating laryngeal mask airway or the Bonfils intubation fibrescope was performed in 80 patients with predicted difficult airways. Mallampati score, thyromental distance, mouth opening and mobility of the atlanto-occipital joint were used to predict difficult airways. The overall success rate, time to the first adequate lung ventilation and time taken for the successful placement of the tracheal tube were recorded, as well as a subjective assessment of the handling of the device and the incidence of postoperative sore throat and hoarseness. The median [range] time to the first adequate ventilation was significantly shorter with the intubating laryngeal mask airway than with the Bonfils intubation fibrescope (28 [6,85] s vs. 40 [23,77] s, p < 0.005). Tracheal intubation was significantly slower with the intubating laryngeal mask airway than with the Bonfils intubation fibrescope (76 [45,155] s vs. 40 [23,77] s, p < 0.0001. Patients in the Bonfils group suffered less sore throat and hoarseness than those in the other group. [source] | ||||||||||||||||||||||||||||||||||||||||