Western Ontario (western + ontario)

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Discussion on ,Personality psychology as a truly behavioural science' by R. Michael Furr

Article first published online: 14 JUL 200
Yes We Can! A Plea for Direct Behavioural Observation in Personality Research MITJA D. BACK and BORIS EGLOFF Department of Psychology, Johannes Gutenberg University Mainz, Germany mback@uni-leipzig.de Furr's target paper (this issue) is thought to enhance the standing of personality psychology as a truly behavioural science. We wholeheartedly agree with this goal. In our comment we argue for more specific and ambitious requirements for behavioural personality research. Specifically, we show why behaviour should be observed directly. Moreover, we illustratively describe potentially interesting approaches in behavioural personality research: lens model analyses, the observation of multiple behaviours in diverse experimentally created situations and the observation of behaviour in real life. Copyright © 2009 John Wiley & Sons, Ltd. The Categories of Behaviour Should be Clearly Defined PETER BORKENAU Department of Psychology, Martin-Luther University Halle-Wittenberg, Germany p.borkenau@psych.uni-halle.de The target paper is helpful by clarifying the terminology as well as the strengths and weaknesses of several approaches to collect behavioural data. Insufficiently considered, however, is the clarity of the categories being used for the coding of behaviour. Evidence is reported showing that interjudge agreement for retrospective and even concurrent codings of behaviour does not execeed interjudge agreement for personality traits if the categories being used for the coding of behaviour are not clearly defined. By contrast, if the behaviour to be registered is unambiguously defined, interjudge agreement may be almost perfect. Copyright © 2009 John Wiley & Sons, Ltd. Behaviour Functions in Personality Psychology PHILIP J. CORR Department of Psychology, Faculty of Social Sciences, University of East Anglia, Norwich, UK Philip.Corr@btopenworld.com Furr's target paper highlights the importance, yet under-representation, of behaviour in published articles in personality psychology. Whilst agreeing with most of his points, I remain unclear as to how behaviour (as specifically defined by Furr) relates to other forms of psychological data (e.g. cognitive task performance). In addition, it is not clear how the functions of behaviour are to be decided: different behaviours may serve the same function; and identical behaviours may serve different functions. To clarify these points, methodological and theoretical aspects of Furr's proposal would benefit from delineation. Copyright © 2009 John Wiley & Sons, Ltd. On the Difference Between Experience-Sampling Self-Reports and Other Self-Reports WILLIAM FLEESON Department of Psychology, Wake Forest University, Winston-Salem, NC, USA fleesonW@wfu.edu Furr's fair but evaluative consideration of the strengths and weaknesses of behavioural assessment methods is a great service to the field. As part of his consideration, Furr makes a subtle and sophisticated distinction between different self-report methods. It is easy to dismiss all self-reports as poor measures, because some are poor. In contrast, Furr points out that the immediacy of the self-reports of behaviour in experience-sampling make experience-sampling one of the three strongest methods for assessing behaviour. This comment supports his conclusion, by arguing that ESM greatly diminishes one the three major problems afflicting self-reports,lack of knowledge,and because direct observations also suffer from the other two major problems afflicting self-reports. Copyright © 2009 John Wiley & Sons, Ltd. What and Where is ,Behaviour' in Personality Psychology? LAURA A. KING and JASON TRENT Department of Psychology, University of Missouri, Columbia, USA kingla@missouri.edu Furr is to be lauded for presenting a coherent and persuasive case for the lack of behavioural data in personality psychology. While agreeing wholeheartedly that personality psychology could benefit from greater inclusion of behavioural variables, here we question two aspects of Furr's analysis, first his definition of behaviour and second, his evidence that behaviour is under-appreciated in personality psychology. Copyright © 2009 John Wiley & Sons, Ltd. Naturalistic Observation of Daily Behaviour in Personality Psychology MATTHIAS R. MEHL Department of Psychology, University of Arizona, Tucson, AZ, USA mehl@email.arizona.edu This comment highlights naturalistic observation as a specific method within Furr's (this issue) cluster direct behavioural observation and discusses the Electronically Activated Recorder (EAR) as a naturalistic observation sampling method that can be used in relatively large, nomothetic studies. Naturalistic observation with a method such as the EAR can inform researchers' understanding of personality in its relationship to daily behaviour in two important ways. It can help calibrate personality effects against act-frequencies of real-world behaviour and provide ecological, behavioural personality criteria that are independent of self-report. Copyright © 2009 John Wiley & Sons, Ltd. Measuring Behaviour D. S. MOSKOWITZ and JENNIFER J. RUSSELL Department of Psychology, McGill University, Montreal, Canada dsm@psych.mcgill.ca Furr (this issue) provides an illuminating comparison of the strengths and weaknesses of various methods for assessing behaviour. In the selection of a method for assessing behaviour, there should be a careful analysis of the definition of the behaviour and the purpose of assessment. This commentary clarifies and expands upon some points concerning the suitability of experience sampling measures, referred to as Intensive Repeated Measurements in Naturalistic Settings (IRM-NS). IRM-NS measures are particularly useful for constructing measures of differing levels of specificity or generality, for providing individual difference measures which can be associated with multiple layers of contextual variables, and for providing measures capable of reflecting variability and distributional features of behaviour. Copyright © 2009 John Wiley & Sons, Ltd. Behaviours, Non-Behaviours and Self-Reports SAMPO V. PAUNONEN Department of Psychology, University of Western Ontario, London, Canada paunonen@uwo.ca Furr's (this issue) thoughtful analysis of the contemporary body of research in personality psychology has led him to two conclusions: our science does not do enough to study real, observable behaviours; and, when it does, too often it relies on ,weak' methods based on retrospective self-reports of behaviour. In reply, I note that many researchers are interested in going beyond the study of individual behaviours to the behaviour trends embodied in personality traits; and the self-report of behaviour, using well-validated personality questionnaires, is often the best measurement option. Copyright © 2009 John Wiley & Sons, Ltd. An Ethological Perspective on How to Define and Study Behaviour LARS PENKE Department of Psychology, The University of Edinburgh, Edinburgh, UK lars.penke@ed.ac.uk While Furr (this issue) makes many important contributions to the study of behaviour, his definition of behaviour is somewhat questionable and also lacks a broader theoretical frame. I provide some historical and theoretical background on the study of behaviour in psychology and biology, from which I conclude that a general definition of behaviour might be out of reach. However, psychological research can gain from adding a functional perspective on behaviour in the tradition of Tinbergens's four questions, which takes long-term outcomes and fitness consequences of behaviours into account. Copyright © 2009 John Wiley & Sons, Ltd. What is a Behaviour? MARCO PERUGINI Faculty of Psychology, University of Milan,Bicocca, Milan, Italy marco.perugini@unimib.it The target paper proposes an interesting framework to classify behaviour as well as a convincing plea to use it more often in personality research. However, besides some potential issues in the definition of what is a behaviour, the application of the proposed definition to specific cases is at times inconsistent. I argue that this is because Furr attempts to provide a theory-free definition yet he implicitly uses theoretical considerations when applying the definition to specific cases. Copyright © 2009 John Wiley & Sons, Ltd. Is Personality Really the Study of Behaviour? MICHAEL D. ROBINSON Department of Psychology, North Dakota State University, Fargo, ND, USA Michael.D.Robinson@ndsu.edu Furr (this issue) contends that behavioural studies of personality are particularly important, have been under-appreciated, and should be privileged in the future. The present commentary instead suggests that personality psychology has more value as an integrative science rather than one that narrowly pursues a behavioural agenda. Cognition, emotion, motivation, the self-concept and the structure of personality are important topics regardless of their possible links to behaviour. Indeed, the ultimate goal of personality psychology is to understanding individual difference functioning broadly considered rather than behaviour narrowly considered. Copyright © 2009 John Wiley & Sons, Ltd. Linking Personality and Behaviour Based on Theory MANFRED SCHMITT Department of Psychology, University of Koblenz-Landau, Landau, Germany schmittm@uni-landau.de My comments on Furr's (this issue) target paper ,Personality as a Truly Behavioural Science' are meant to complement his behavioural taxonomy and sharpen some of the presumptions and conclusions of his analysis. First, I argue that the relevance of behaviour for our field depends on how we define personality. Second, I propose that every taxonomy of behaviour should be grounded in theory. The quality of behavioural data does not only depend on the validity of the measures we use. It also depends on how well behavioural data reflect theoretical assumptions on the causal factors and mechanisms that shape behaviour. Third, I suggest that the quality of personality theories, personality research and behavioural data will profit from ideas about the psychological processes and mechanisms that link personality and behaviour. Copyright © 2009 John Wiley & Sons, Ltd. The Apparent Objectivity of Behaviour is Illusory RYNE A. SHERMAN, CHRISTOPHER S. NAVE and DAVID C. FUNDER Department of Psychology, University of California, Riverside, CA, USA funder@ucr.edu It is often presumed that objective measures of behaviour (e.g. counts of the number of smiles) are more scientific than more subjective measures of behaviour (e.g. ratings of the degree to which a person behaved in a cheerful manner). We contend that the apparent objectivity of any behavioural measure is illusory. First, the reliability of more subjective measures of behaviour is often strikingly similar to the reliabilities of so-called objective measures. Further, a growing body of literature suggests that subjective measures of behaviour provide more valid measures of psychological constructs of interest. Copyright © 2009 John Wiley & Sons, Ltd. Personality and Behaviour: A Neglected Opportunity? LIAD UZIEL and ROY F. BAUMEISTER Department of Psychology, Florida State University, Tallahassee, FL, USA Baumeister@psy.fsu.edu Personality psychology has neglected the study of behaviour. Furr's efforts to provide a stricter definition of behaviour will not solve the problem, although they may be helpful in other ways. His articulation of various research strategies for studying behaviour will be more helpful for enabling personality psychology to contribute important insights and principles about behaviour. The neglect of behaviour may have roots in how personality psychologists define the mission of their field, but expanding that mission to encompass behaviour would be a positive step. Copyright © 2009 John Wiley & Sons, Ltd. [source]


The Changing Family in the New Millennium
A year ago, our journal had the opportunity to publish the inaugural Meyer Elkin Address by Jonah, Peter, and Marian Wright Edelman. This past summer, the Association of Family and Conciliation Courts was honored to have George Thomson speak at its conference in Vancouver, British Columbia. Thomson was presented with this honor for his hard work and dedication to family law in Canada and throughout the world. The Family and Conciliation Courts Review is honored to publish this speech by Thomson. Described by his colleagues as a "miracle worker" and "superman", Thomson has led a fascinating career that has followed several different paths. As an undergraduate student, Thomson attained a B.A. in philosophy and English from Queen's University in Kingston, Ontario. He remained at Queen's University and received an LL.B., then completed his formal education with an LL.M. from the University of California. Thomson has had a diverse background in the legal field, serving as an educator, a judge, and a government official. From 1968 until 1971, he worked as both an associate professor and assistant dean at the University of Western Ontario in London, Ontario. After his brief stint with the university, he was appointed judge of the Provincial Court for the Province of Ontario. Thomson held this position for five years before becoming an associate deputy minister of Community and Social Services, where he served as the head of the Children's Services Division. In the 1980s, Thomson returned to the bench in the provincial court. Additionally, he was the director of education for the Law Society of Upper Canada. Most notably, however, Thomson chaired a provincial committee on social welfare reform. By 1989, Thomson had moved from the bench into governmental work. He briefly served as the deputy minister of citizenship for Ontario. He was then appointed the deputy minister of labor until 1992. From 1992 until 1994, Thomson served as Ontario's deputy attorney general. He then became the deputy minister of justice and deputy attorney general of Canada. Most recently, Thomson has been a special advisor to the minister of justice and attorney general of Canada. The following Meyer Elkin address was presented at the annual Convention of the Association of Family and Conciliation Courts in Vancouver, Canada, in June 1999. [source]

The International Quotidian Dialysis Registry: Annual report 2006

Abstract Interest in short daily and nocturnal hemodialysis (HD) regimens continues to grow worldwide. Despite growing optimism that these therapies will afford better patient outcomes over conventional HD, the current literature has not been viewed as sufficiently compelling to affect widespread implementation in most jurisdictions. Before these therapies can gain wider acceptance, larger and more rigorous studies will likely be needed. In June 2004, the Quotidian Dialysis Registry, based at the Lawson Health Research Institute at the University of Western Ontario, Canada, began recruiting patients across North America. By using an Internet-based data entry platform, patients from various centers worldwide will eventually be recruited, and studied prospectively. This paper constitutes the second annual update on patient and center recruitment, patient and treatment characteristics, and future directions for the registry. [source]

Glucosamine sulphate in the treatment of knee osteoarthritis: cost-effectiveness comparison with paracetamol

S. Scholtissen
Summary Introduction:, The aim of this study was to explore the cost-effectiveness of glucosamine sulphate (GS) compared with paracetamol and placebo (PBO) in the treatment of knee osteoarthritis. For this purpose, a 6-month time horizon and a health care perspective was used. Material and methods:, The cost and effectiveness data were derived from Western Ontario and McMaster Universities Osteoarthritis Index data of the Glucosamine Unum In Die (once-a-day) Efficacy trial study by Herrero-Beaumont et al. Clinical effectiveness was converted into utility scores to allow for the computation of cost per quality-adjusted life year (QALY) For the three treatment arms Incremental Cost-Effectiveness Ratio were calculated and statistical uncertainty was explored using a bootstrap simulation. Results:, In terms of mean utility score at baseline, 3 and 6 months, no statistically significant difference was observed between the three groups. When considering the mean utility score changes from baseline to 3 and 6 months, no difference was observed in the first case but there was a statistically significant difference from baseline to 6 months with a p-value of 0.047. When comparing GS with paracetamol, the mean baseline incremental cost-effectiveness ratio (ICER) was dominant and the mean ICER after bootstrapping was ,1376 ,/QALY indicating dominance (with 79% probability). When comparing GS with PBO, the mean baseline and after bootstrapping ICER were 3617.47 and 4285 ,/QALY, respectively. Conclusion:, The results of the present cost-effectiveness analysis suggested that GS is a highly cost-effective therapy alternative compared with paracetamol and PBO to treat patients diagnosed with primary knee OA. [source]

A double blind, randomized, placebo controlled study to evaluate the efficacy of erythromycin in patients with knee effusion due to osteoarthritis

Abstract Objective:, The efficacy of erythromycin in treatment of knee effusion due to osteoarthritis was evaluated. Method:, We assessed efficacy and safety of erythromycin during 16 weeks in patients enrolled in a randomized double-blind study. One hundred and eight patients with knee effusion due to osteoarthritis (OA) received 12-week courses of erythromycin or placebo allocated randomly, and were followed for 4 months. Acetaminophen 650 mg/day was used in both groups, while they received no other anti-inflammatory drugs (such as corticosteroid or nonsteroidal anti-inflammatory drugs) during the course of the study. Our patients were divided in two groups, erythromycin in doses of 200 mg four times per day was given to the first group (51 patients) over the first 3 months of the study and in the second group we used placebo with the same dosage and schedule (53 patients). Outcomes improvement for the erythromycin-treated group was assessed by a significantly higher mean score from baseline to the end of the trial, compared with placebo group. Patients were examined monthly during the treatment period. Measurement values included recording of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire subscales (pain, stiffness and function), range of motion and knee circumference. Results:, Erythromycin produced a higher response rate than placebo in treatment of knee effusion due to OA. Significant reduction in knee circumference (P < 0.0005) and pain (P < 0.001) with functional improvement (P < 0.0005) were seen. At the first month after treatment, 11.8% (6 patients) in erythromycin and 9.4% (5 patients) in placebo groups had 50% pain reduction, which was not significant (P = 0.75). At the fourth month, 50% reduction of pain was seen in 45.1% (23 patients) of the erythromycin and 11.3% (6 patients) of the placebo group. This was statistically significant (P < 0.0005). Erythromycin treatment was well tolerated and mild adverse events caused no discontinuation during the study. Conclusion:, This is a placebo-controlled study of macrolid efficacy on knee effusion due to OA in a short period. Results of this research showed the better efficacy of erythromycin in controlling effusion and pain with functional improvement in patients with knee effusion due to OA. [source]

The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis

Nurcan Y
Aims and objectives., The aim in this study was to evaluate the effect of local heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. Background., Local heat application is used as a non-pharmacological practice for the treatment of knee osteoarthritis. On the other hand, literature reveals limited information on the effects of heat application. Design., The study was a comparative study. Methods., The patients with knee osteoarthritis were divided into two groups (23 patients in each) as intervention and control groups, and patients in the control group were applied with the routine medication of the physician. The intervention group received 20-minute heat application every other day for four weeks in addition to the routine medication. The data were collected using data collection form, Western Ontario and McMaster Universities Index and SF-36. Results., The Western Ontario and McMaster Universities pain and Western Ontario and McMaster Universities disability scores of the patients with knee osteoarthritis in control and intervention groups before and after the intervention were compared, and the differences for both scores in the change were found to be statistically significant (p < 0·05). Moreover, statistically significant differences were found between the control and intervention group patients in terms of changes in the scores for physical function, pain and general health perception (p < 0·05). Conclusions., It was found that heat application every other day decreased pain and disability of the patients with knee osteoarthritis. Also, heat application was found to improve the subdimensions of quality of life scores of physical function, pain and general health perception of patients. Relevance to clinical practice., The data obtained in this study on the efficiency of heat application on pain, stiffness, physical function and general health perception of patients with knee osteoarthritis may offer an insight into decision-making process for appropriate intervention. [source]

Continuous femoral nerve block after total knee arthroplasty?

Background: A continuous femoral nerve block is frequently used as an adjunct therapy after total knee arthroplasty (TKA). However, there is still debate on its benefits. Methods: In this prospective, randomized study, patients received a basic analgesic regimen of paracetamol and dicloflenac for the first 48 h postoperatively. In addition, the study group received a continuous femoral nerve block. A morphine patient-controlled analgesia pump was also available as a rescue analgesic to all the patients. Patients' numeric rating scores for pain, the amount of morphine consumed and its side effects during the first 48 h were recorded. Knee flexion angles achieved during the first week were registered. Three months postoperatively, patients completed Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score. Results: The study group (n=27) had less pain (P=0.0016) during the first 48 h, was more satisfied with the analgesia (P<0.001) and used less morphine (P=0.007) compared with the control group (n=26). Fewer patients were nauseated, vomited or were drowsy in the study group (P=0.001). Also, the study group achieved better knee flexion in the first 6 days after surgery (P=0.001), with more patients reaching 90° flexion than the control group. However, after 3 months, there were no significant functional differences between the groups. Conclusion: A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after TKA. Early functional recovery is improved, resulting in more patients reaching 90° knee flexion after 6 days. However, after 3 months, no significant functional benefits were found. [source]

Different hip and knee priority score systems: are they good for the same thing?

Antonio Escobar MD PhD
Abstract Objective, The aim of the present study was to compare two priority tools used for joint replacement for patients on waiting lists, which use two different methods. Methods, Two prioritization tools developed and validated by different methodologies were used on the same cohort of patients. The first, an IRYSS hip and knee priority score (IHKPS) developed by RAND method, was applied while patients were on the waiting list. The other, a Catalonia hip,knee priority score (CHKPS) developed by conjoint analysis, was adapted and applied retrospectively. In addition, all patients fulfilled pre-intervention the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Correlation between them was studied by Pearson correlation coefficient (r). Agreement was analysed by means of intra-class correlation coefficient (ICC), Kendall coefficient and Cohern kappa. The relationship between IHKPS, CHKPS and baseline WOMAC scores by r coefficient was studied. Results, The sample consisted of 774 consecutive patients. Pearson correlation coefficient between IHKPS and CHKPS was 0.79. The agreement study showed that ICC was 0.74, Kendall coefficient 0.86 and kappa 0.66. Finally, correlation between CHKPS and baseline WOMAC ranged from 0.43 to 0.64. The results according to the relationship between IHKPS and WOMAC ranged from 0.50 to 0.74. Conclusions, Results support the hypothesis that if the final objective of the prioritization tools is to organize and sort patients on the waiting list, although they use different methodologies, the results are similar. [source]

Waiting list management: priority criteria or first-in first-out?

A case for total joint replacement
Abstract Background, Total joint replacements are interventions with large waiting times from indication to the surgery management. These patients can be managed in two ways; first-in first-out or through a priority tool. The aim of this study was to compare real time on waiting list (TWL) with a priority criteria score, developed by our team, in patients awaiting joint replacement due to osteoarthritis. Methods, Consecutive patients placed on waiting list were eligible. Patients fulfilled a questionnaire which included items of our priority tool and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) specific questionnaire. Other priority items were extracted from the clinical history. The priority tool gives a score from 0 to 100 points, and three categories (urgent, preferent and ordinary). We studied the differences among categories and TWL by means of one-way analysis of variance. Correlational analysis was used to evaluate association among priority score and TWL and WOMAC baseline and gains at 6 months with priority score and TWL. Results, We have studied 684 patients. Women represented 62% of sample. The mean age was 70 years. There were not association between the categories of priority score and TWL (P = 0.12). The rho correlation coefficient between TWL and priority score was ,0.11. Among baseline WOMAC scores and priority score, the rho coefficients were 0.79, 0.7 and 0.52 with function, pain and stiffness dimensions, respectively. There were differences in the mean scores of WOMAC dimensions according to the three priority categories (P < 0.001) but no with TWL categories. Data of gains in both health-related quality of life dimensions at 6 months were similar, with differences according to priority categories but no regarding TWL. Conclusions, The results of the study support the necessity of implementing a prioritization system instead of the actual system if we want to manage the waiting list for joint replacement with clinical equity. [source]

Pain, physical functioning and quality of life of individuals awaiting total joint replacement: a longitudinal study

Gretl A. McHugh PhD MSc
Abstract Objectives, To investigate if pain, physical function and the quality of life changed among adults with osteoarthritis while on the waiting list for hip or knee joint replacement. Methods, A longitudinal study of patients listed for primary hip or knee joint replacement. Participants were interviewed at baseline (n = 105) and followed up at 3 (n = 84), 6 (n = 47) and 9 months (n = 24), or until their joint replacement. Measurement tools used were a visual analogue scale (VAS), Western Ontario and McMaster's Universities (WOMAC) Osteoarthritis Index and the Medical Outcomes Study Short Form Health Survey (SF-36). Results, Baseline data indicated high levels of pain as measured by VAS [mean 7.0 (SD 2.2)] and WOMAC pain [mean 11.2 (SD 3.5)]. At baseline, the mean physical function measured by WOMAC was 40.3 (SD 12.1). At the 3-month follow-up, there was significant deterioration in VAS pain scores (0.6; 95% CI mean difference 0.3, 1.0); WOMAC pain scores (1.2; 95% CI mean difference 0.7, 1.8) and WOMAC physical function scores (4.8; 95% CI mean difference 2.8, 6.7) compared with baseline. Conclusion, The often long wait for joint replacement surgery and deterioration in pain and physical function has highlighted the need for active management by health professionals while patients are on the waiting list. [source]

Using an osteoarthritis-specific pain measure in elders with cognitive impairment: a pilot study

Aim and background, The Western Ontario and McMaster Osteoarthritis Index pain scale has not been used with cognitively impaired elders to measure their knee or hip pain. This study therefore examined the usefulness of the Western Ontario and McMaster Osteoarthritis Index pain scale for measuring pain in this population. Method, Fourteen cognitively impaired elders with osteoarthritis of the knee or hip participated in the study. Elders' pain was assessed with the Western Ontario and McMaster Osteoarthritis Index pain scale, the Verbal Descriptor Scale and the Present Pain Intensity Scale, twice 5 minutes apart. Proxy report of pain was provided by the nursing staff. Results, The correlations among the Western Ontario and McMaster Osteoarthritis Index pain scale, Verbal Descriptor Scale and Present Pain Intensity were between 0.77 and 1.00 (P < 0.01). All pain measures showed high test,retest reliability (r = 0.98,1.00, P < 0.01). Staff's pain ratings using the Western Ontario and McMaster Osteoarthritis Index pain scale were strongly correlated with elders' pain ratings using any pain measure (r = 0.68,0.80, P < 0.05 or P < 0.01). However, staff's pain ratings using either the Verbal Descriptor Scale or Present Pain Intensity had no association with elders' pain ratings (r = ,0.07 to ,0.30, P = NS). Conclusion, The study confirmed that the Western Ontario and McMaster Osteoarthritis Index pain scale is as valid and reliable as the Verbal Descriptor Scale and Present Pain Intensity for elders with moderate and mild cognitive impairment. When used by staff, the Western Ontario and McMaster Osteoarthritis Index pain scale provides a better pain assessment for cognitively impaired elders than the Verbal Descriptor Scale or Present Pain Intensity. [source]

Medical students' first clinical experiences of death

Emily Kelly
Medical Education 2010: 44: 421,428 Objectives, Many medical students feel inadequately prepared to address end-of-life issues, including patient death. This study aimed to examine medical students' first experiences of the deaths of patients in their care. Methods, Final-year medical students at the Schulich School of Medicine & Dentistry, University of Western Ontario were invited to share their first experience of the death of a patient in their care. The students could choose to participate through telephone interviews, focus groups or e-mail. All responses were audiotaped, transcribed verbatim and analysed using a grounded theory approach. Results, Twenty-nine students reported experiencing the death of a patient in their care. Of these, 20 chose to participate in an interview, five in a focus group and four through e-mail. The issues that emerged were organised under the overlying themes of ,young', ,old' or ,unexpected' deaths and covered seven major themes: (i) preparation; (ii) the death event; (iii) feelings; (iv) the role of the clinical clerk; (v) differential factors between deaths; (vi) closure, and (vii) relationships. These themes generated a five-stage cyclical model of students' experiences of death, consisting of: (i) preparation; (ii) the event itself; (iii) the crisis; (iv) the resolution, and (v) the lessons learned. ,Preparation' touches on personal experience and pre-clinical instruction. ,The event itself' could be categorised as referring to a ,young' patient, an ,old' patient or a patient in whom death was ,unexpected'. In the ,resolution' phase, coping mechanisms included rationalisation, contemplation and learning. The ,lessons learned' shape medical students' experiences of future patient deaths and their professional identity. Conclusions, A tension between emotional concern and professional detachment was pervasive among medical students undergoing their first experience of the death of a patient in their care. How this tension was negotiated depended on the patient's clinical circumstances, supervisor role-modelling and, most importantly, the support of supervisors and peers, including debriefing opportunities. Faculty members and residents should be made aware of the complexities of a medical student's first experience of patient death and be educated regarding sympathetic debriefing. [source]

Women with Pain due to Osteoarthritis: The Efficacy and Safety of a Once-Daily Formulation of Tramadol

PAIN MEDICINE, Issue 6 2009
FRCP, Walter F. Kean MB ChB
ABSTRACT Objective., This analysis assesses the efficacy and safety of treatment with a once-daily oral formulation of tramadol for up to 12 weeks compared with placebo in women with moderate-to-severe pain due to osteoarthritis of the knee. Design., Two parallel, placebo-controlled phase III clinical trials were analyzed; patients were randomized to a fixed dosage of Tramadol Contramid® once a day (OAD) 100, 200, and 300 mg daily, or placebo. Outcome Measures., The primary efficacy end points were the percentage difference from baseline of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) subscale scores for pain and physical function, and the patient global rating of pain relief after 12 weeks of maintenance therapy. Results., The analysis included 405 women receiving tramadol and 280 receiving placebo. At week 12, 179 of 204 women (87.7%) receiving tramadol rated their overall pain relief as effective or very effective compared with 134 of 177 (75.7%) receiving placebo. A time-weighted analysis revealed statistically significant improvements over placebo for all the WOMAC subscale scores across all three dosages. The percentage improvements from baseline of the WOMAC pain scores were significantly better than placebo for the 100-mg (58.8 ± 37.1%, P = 0.018) and 300-mg (58.9 ± 38.8%, P = 0.023) treatment arms; however, the 200-mg dosage was not significant (53.0 ± 38.5%, P = 0.175). The WOMAC physical function scores showed significant improvement for the 100 (56.9 ± 36.4%, P = 0.009), 200 (54.0 ± 33.8%, P = 0.034), and 300 mg (53.4 ± 41.4%, P = 0.043) daily dosages. Conclusion., For moderate-to-severe pain due to osteoarthritis of the knee, women experience significant analgesia and improvement of physical function over time with treatment with Tramadol Contramid® OAD. [source]

Effect of pine bark extract (Pycnogenol®) on symptoms of knee osteoarthritis

Peter Cisár
Abstract Objective. The safe and efficacious use of Pycnogenol® (French maritime pine bark extract) in other inflammatory diseases prompted this study of its antiinflammatory effects in patients with osteoarthritis (OA). The aim of the study was to evaluate whether Pycnogenol® reduces the symptoms of OA in a double-blind, placebo-controlled, randomly allocated trial with patients suffering from knee osteoarthritis stages I and II. Methods. 100 patients were treated for 3 months either by 150 mg Pycnogenol® per day at meals or by placebo. Patients had to report any change of use of previously prescribed antiinflammatory medication during the study period. Patients filled the Western Ontario and Mc Masters University (WOMAC) questionnaire for osteoarthritis every 2 weeks and evaluated weekly pain symptoms using a visual analogue scale for pain intensity. Results. Following treatment with Pycnogenol® patients reported an improvement of WOMAC index (p < 0.05), and a significant alleviation of pain by visual analogue scale (p < 0.04), the placebo had no effect. The use of analgesics diminished in the verum group but increased under the placebo. Treatment with Pycnogenol® was well tolerated. Conclusion. Results show that Pycnogenol® in patients with mild to moderate OA improves symptoms and is able to spare NSAIDs. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Roentgen stereophotogrammetric analysis and clinical assessment of unipolar versus bipolar hemiarthroplasty for subcapital femur fracture: a randomized prospective study

Benjamin Jeffcote
Abstract Background:, Hemiarthroplasty is a well-established treatment for displaced subcapital fracture, but controversy exists about the optimal implant type. Bipolar hemiarthroplasty has proposed advantages over unipolar hemiarthroplasty in terms of better clinical results and decreased wear of acetabular cartilage. Methods:, This study is a randomized prospective study of 51 patients (52 hips) receiving either bipolar or unipolar hemiarthroplasty for displaced subcapital fractures. The outcome measurements were clinical scores and Roentgen stereophotogrammetric analysis (RSA) analysis to determine the rate of acetabular wear. Results:, Twenty-three patients completed 2-year follow-up. The RSA data demonstrated that there was slightly less acetabular wear by bipolar prostheses than by unipolar. The combined mean three-dimensional wear of the bipolar prostheses was 0.6 mm compared with 1.5 mm for the unipolar prostheses (P= 0.04). The bipolar group generally achieved higher scores in terms of the Harris Hip Score, Western Ontario and McMaster University Index of Osteoarthritis (WOMAC) questionnaire and 6-min walk test. These results were statistically significant at 3 months but not at 12 and 24 months. Conclusion:, This study suggests that while the bipolar prosthesis performs slightly better than the unipolar in terms of acetabular cartilage wear and clinical outcomes, it remains debatable whether the benefits are worth the increased cost of the prosthesis. [source]

Comparative analysis of gene expression profiles between primary knee osteoarthritis and an osteoarthritis endemic to Northwestern China, Kashin-Beck disease

Chen Duan
Objective To investigate the differences in gene expression profiles of adult articular cartilage from patients with Kashin-Beck disease (KBD) versus those with primary knee osteoarthritis (OA). Methods The messenger RNA expression profiles of articular cartilage from patients with KBD, diagnosed according to the clinical criteria for KBD in China, were compared with those of cartilage from patients with OA, diagnosed according to the Western Ontario and McMaster Universities OA Index. Total RNA was isolated separately from 4 pairs of the KBD and OA cartilage samples, and the expression profiles were evaluated by Agilent 4×44k Whole Human Genome density oligonucleotide microarray analysis. The microarray data for selected transcripts were confirmed by quantitative real-time reverse transcription,polymerase chain reaction (RT-PCR) amplification. Results For 1.2 × 104 transcripts, corresponding to 58.4% of the expressed transcripts, 2-fold changes in differential expression were revealed. Expression levels higher in KBD than in OA samples were observed in a mean ± SD 6,439 ± 1,041 (14.6 ± 2.4%) of the transcripts, and expression levels were lower in KBD than in OA samples in 6,147 ± 1,222 (14.2 ± 2.8%) of the transcripts. After application of the selection criteria, 1.85% of the differentially expressed genes (P < 0.001 between groups) were detected. These included 233 genes, of which 195 (0.4%) were expressed at higher levels and 38 (0.08%) were expressed at lower levels in KBD than in OA cartilage. Comparisons of the quantitative RT-PCR data supported the validity of our microarray data. Conclusion Differences between KBD and OA cartilage exhibited a similar pattern among all 4 of the pairs examined, indicating the presence of disease mechanisms, mainly chondrocyte matrix metabolism, cartilage degeneration, and apoptosis induction pathways, which contribute to cartilage destruction in KBD. [source]

Effect of hyaluronic acid in symptomatic hip osteoarthritis: A multicenter, randomized, placebo-controlled trial,

Pascal Richette
Objective To evaluate the efficacy and tolerability of a single intraarticular (IA) injection of hyaluronic acid (HA) for the treatment of hip osteoarthritis (OA). Methods A multicenter, randomized, parallel-group, placebo-controlled trial was conducted over 3 months. Patients (older than 30 years) with symptomatic hip OA (pain score of >40 mm on a visual analog scale [VAS]) and a Kellgren/Lawrence grade of 2 or 3 were randomly assigned to receive 1 fluoroscopically guided IA injection of HA (2.5 ml) or placebo (2.5 ml). Patients were followed up for 3 months. The main outcome measure was pain score on a VAS (100 mm) at month 3 compared with baseline. Secondary outcome measures were the proportion of responders defined by Osteoarthritis Research Society International criteria; Western Ontario and McMaster Universities Osteoarthritis Index subscores for pain, stiffness, and disability; and patient and physician global assessment. Randomization was computer generated. HA and placebo preparations were placed in numbered identical containers, and syringes were covered with masking tape. Physicians assessing outcomes were blinded with regard to group assignment. Results Eighty-five patients were randomized to the HA group (n = 42) or placebo group (n = 43). Baseline characteristics were similar between the 2 groups. At 3 months, the decrease in pain score did not differ between the HA and placebo groups in the intent-to-treat analysis (mean ± SD decrease 7.8 ± 24.9 mm with HA versus 9.1 ± 27.4 mm with placebo; P = 0.98). The responder rates were 33.3% and 32.6% in the HA and placebo groups, respectively (P = 0.94). Other secondary end points did not differ between the groups, nor did use of rescue medication or frequency of adverse events. Conclusion Our findings indicate that a single IA injection of HA is no more effective than placebo in treating the symptoms of hip OA. [source]

Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis

Shreyasee Amin
Objective To determine the effect of quadriceps strength in individuals with knee osteoarthritis (OA) on loss of cartilage at the tibiofemoral and patellofemoral joints (assessed by magnetic resonance imaging [MRI]) and on knee pain and function. Methods We studied 265 subjects (154 men and 111 women, mean ± SD age 67 ± 9 years) who met the American College of Rheumatology criteria for symptomatic knee OA and who were participating in a prospective, 30-month natural history study of knee OA. Quadriceps strength was measured at baseline, isokinetically, during concentric knee extension. MRI of the knee at baseline and at 15 and 30 months was used to assess cartilage loss at the tibiofemoral and patellofemoral joints, with medial and lateral compartments assessed separately. At baseline and at followup visits, knee pain was assessed using a visual analog scale, and physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Results There was no association between quadriceps strength and cartilage loss at the tibiofemoral joint. Results were similar in malaligned knees. However, greater quadriceps strength was protective against cartilage loss at the lateral compartment of the patellofemoral joint (for highest versus lowest tertile of strength, odds ratio 0.4 [95% confidence interval 0.2, 0.9]). Those with greater quadriceps strength had less knee pain and better physical function over followup (P < 0.001). Conclusion Greater quadriceps strength had no influence on cartilage loss at the tibiofemoral joint, including in malaligned knees. We report for the first time that greater quadriceps strength protected against cartilage loss at the lateral compartment of the patellofemoral joint, a finding that requires confirmation. Subjects with greater quadriceps strength also had less knee pain and better physical function over followup. [source]

A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis,

Kristin Baker
Objective In uncontrolled studies, a lateral-wedge insole has reduced knee pain in patients with medial knee osteoarthritis (OA). The aim of this study was to test the efficacy of this simple, low-cost intervention for pain in patients with medial knee OA. Methods We conducted a double-blind, randomized, crossover trial designed to detect a small effect of treatment. Participants were at least 50 years of age and had medial joint space narrowing on posteroanterior semiflexed radiographs and scores indicating moderate pain for 2 of the 5 items on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale. Participants were randomized to receive a 5° lateral-wedge insole or a neutral insole for 6 weeks. Following a 4-week washout period, participants crossed over to the other treatment for 6 weeks. Knee pain, the primary outcome, was assessed by the WOMAC pain scale (visual analog scale version). Secondary outcomes included the WOMAC disability subscale, overall knee pain, 50-feet walk time, chair-stand time, and use of medications for knee pain. Results Ninety patients were randomized. The mean difference in pain between the 2 treatments was 13.8 points on the WOMAC pain scale (95% confidence interval ,3.9, 31.4 [P = 0.13]). We observed similar small effects for the secondary outcomes. Conclusion The effect of treatment with a lateral-wedge insole for knee OA was neither statistically significant nor clinically important. [source]

Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: A randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator,

Gabriel Herrero-Beaumont
Objective To assess the effects of the prescription formulation of glucosamine sulfate (1,500 mg administered once daily) on the symptoms of knee osteoarthritis (OA) during a 6-month treatment course. Methods Three hundred eighteen patients were enrolled in this randomized, placebo-controlled, double-blind trial in which acetaminophen, the currently preferred medication for symptomatic treatment of OA, was used as a side comparator. Patients were randomly assigned to receive oral glucosamine sulfate 1,500 mg once daily (n = 106), acetaminophen 3 gm/day (n = 108), or placebo (n = 104). The primary efficacy outcome measure was the change in the Lequesne index after 6 months. Secondary parameters included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and response according to the Osteoarthritis Research Society International criteria. These outcome measures were assessed using an intent-to-treat analysis. Results At baseline, the study patients had moderately severe OA symptoms (mean Lequesne index ,11 points). Glucosamine sulfate was more effective than placebo in improving the Lequesne score, with a final decrease of 3.1 points, versus 1.9 with placebo (difference between glucosamine sulfate and placebo ,1.2 [95% confidence interval ,2.3, ,0.8]) (P = 0.032). The 2.7-point decrease with acetaminophen was not significantly different from that with placebo (difference ,0.8 [95% confidence interval ,1.9, 0.3]) (P = 0.18). Similar results were observed for the WOMAC. There were more responders to glucosamine sulfate (39.6%) and acetaminophen (33.3%) than to placebo (21.2%) (P = 0.004 and P = 0.047, respectively, versus placebo). Safety was good, and was comparable among groups. Conclusion The findings of this study indicate that glucosamine sulfate at the oral once-daily dosage of 1,500 mg is more effective than placebo in treating knee OA symptoms. Although acetaminophen also had a higher responder rate compared with placebo, it failed to show significant effects on the algofunctional indexes. [source]

Acupuncture in patients with osteoarthritis of the knee or hip: A randomized, controlled trial with an additional nonrandomized arm

Claudia M. Witt
Objective To investigate the effectiveness of acupuncture in addition to routine care, compared with routine care alone, in the treatment of patients with chronic pain due to osteoarthritis (OA) of the knee or hip. Methods In a randomized, controlled trial, patients with chronic pain due to OA of the knee or hip were randomly allocated to undergo up to 15 sessions of acupuncture in a 3-month period or to a control group receiving no acupuncture. Another group of patients who did not consent to randomization underwent acupuncture treatment. All patients were allowed to receive usual medical care in addition to the study treatment. Clinical OA severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and health-related quality of life (Short Form 36) were assessed at baseline and after 3 months and 6 months. Results Of 3,633 patients (mean ± SD age 61.8 ± 10.8 years; 61% female), 357 were randomized to the acupuncture group and 355 to the control group, and 2,921 were included in the nonrandomized acupuncture group. At 3 months, the WOMAC had improved by a mean ± SEM of 17.6 ± 1.0 in the acupuncture group and 0.9 ± 1.0 in the control group (3-month scores 30.5 ± 1.0 and 47.3 ± 1.0, respectively [difference in improvement 16.7 ± 1.4; P < 0.001]). Similarly, quality of life improvements were more pronounced in the acupuncture group versus the control group (P < 0.001). Treatment success was maintained through 6 months. The changes in outcome in nonrandomized patients were comparable with those in randomized patients who received acupuncture. Conclusion These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA,associated pain of the knee or hip. [source]

Risedronate decreases biochemical markers of cartilage degradation but does not decrease symptoms or slow radiographic progression in patients with medial compartment osteoarthritis of the knee: Results of the two-year multinational knee osteoarthritis structural arthritis study

Clifton O. Bingham III
Objective Bisphosphonates have slowed the progression of osteoarthritis (OA) in animal models and have decreased pain in states of high bone turnover. The Knee OA Structural Arthritis (KOSTAR) study, which is the largest study to date investigating a potential structure-modifying OA drug, tested the efficacy of risedronate in providing symptom relief and slowing disease progression in patients with knee OA. Methods The study group comprised 2,483 patients with medial compartment knee OA and 2,4 mm of joint space width (JSW), as determined using fluoroscopically positioned, semiflexed-view radiography. Patients were enrolled in 2 parallel 2-year studies in North America and the European Union. These studies evaluated the efficacy of risedronate at dosages of 5 mg/day, 15 mg/day, 35 mg/week (in Europe), and 50 mg/week (in North America) compared with placebo in reducing signs and symptoms, as measured by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and patient global assessment (PGA) scores, and in slowing radiographic progression. Results A reduction of ,20% in signs and symptoms, as measured by WOMAC subscales and PGA scores, was observed in all groups, with no treatment effect of risedronate demonstrated. Risedronate did not significantly reduce radiographic progression as measured by decreased JSW or using a dichotomous definition of progression (joint space loss of ,0.6 mm). Thirteen percent of patients receiving placebo demonstrated significant disease progression over 2 years. A dose-dependent reduction in the level of C-terminal crosslinking telopeptide of type II collagen, a cartilage degradation marker associated with progressive OA, was seen in patients who received risedronate. No increase in the number of adverse events was demonstrated for risedronate compared with placebo. Conclusion Although risedronate (compared with placebo) did not improve signs or symptoms of OA, nor did it alter progression of OA, a reduction in the level of a marker of cartilage degradation was observed. A sustained clinically relevant improvement in signs and symptoms was observed in all treatment and placebo groups. [source]

Knee pain reduces joint space width in conventional standing anteroposterior radiographs of osteoarthritic knees

Steven A. Mazzuca
Objective A suspected, but heretofore undemonstrated, limitation of the conventional weight-bearing anteroposterior (AP) knee radiograph, in which the joint is imaged in extension, for studies of progression of osteoarthritis (OA) is that changes in knee pain may affect extension, thereby altering the apparent thickness of the articular cartilage. The present study was undertaken to examine the effect of changes in knee pain of varying magnitudes on radiographic joint space width (JSW) in the weight-bearing extended and the semiflexed AP views, in which radioanatomic positioning of the knee was carefully standardized by fluoroscopy. Methods Fifteen patients with knee OA underwent a washout of their analgesic/nonsteroidal antiinflammatory drug (NSAID) agents (duration 5 half-lives), after which standing AP and semiflexed AP knee radiographs of both knees were obtained. Examinations were repeated 1,12 weeks later (median 4.5 weeks, mean 6.0 weeks), after resumption of analgesic/NSAID therapy. Knee pain was measured with the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index (Likert scale). JSW was measured with a pair of calipers and a magnifying lens. Mixed model analyses of variance were used to test the significance of changes in pain and JSW within and between 2 groups of knees with mild-to-moderate radiographic severity of OA: (a) "flaring knees," in which the patient rated standing knee pain as severe or extreme after the washout and in which pain decreased to any degree after resumption of analgesics and/or NSAIDs (n = 12) and (b) "nonflaring knees," in which standing knee pain was absent, mild, or moderate after the washout or did not decrease after resumption of treatment (n = 15). Results After reinstitution of treatment, WOMAC pain scores decreased significantly in both flaring and nonflaring knees (,44%; P < 0.0001 and ,18%; P < 0.01, respectively). After adjustment for the within-subject correlation between knees, mean JSW (±SEM) in the extended view of the flaring OA knee increased significantly from the first to second examination (0.20 ± 0.06 mm; P = 0.005). In contrast, the change in adjusted mean JSW in the extended view of the nonflaring OA knee was negligible (,0.04 ± 0.04 mm) and significantly smaller than that observed in flaring knees (P < 0.01). Mean JSW in the semiflexed AP view was unaffected by the severity or responsiveness of standing knee pain in flaring and nonflaring OA knees. Conclusion JSW in weight-bearing extended-view radiographs of highly symptomatic OA knees can be altered significantly by changes in joint pain. In clinical trials and in epidemiologic studies of OA progression that use this radiographic technique, longitudinal variations in pain may confound changes in the apparent thickness of the articular cartilage. [source]