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O Sangha

Publications and source records attributed to O Sangha.

At least 37 records · Page 2Linked to original sources
PubMed2000

Association between clinical factors, socioeconomic status, and organ damage in recent onset systemic lupus erythematosus.

OBJECTIVE: To determine the prevalence and socioeconomic and clinical predictors of early organ damage in a cohort of patients with systemic lupus erythematosus (SLE) of 2-7 years' duration randomly sampled at 5 centers and balanced by socioeconomic status and race. METHODS: The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index was measured in 200 patients who met the ACR criteria for SLE with a mean disease duration of 3.8 years. The SLICC/ACR scores for each organ system and the prevalence of damage within organ systems were assessed. Logistic regression analyses evaluated the simultaneous effects of age at diagnosis, disease duration, disease activity, and sociodemographic factors. RESULTS: Sixty-one percent of the patients had damage within 7 years of onset (mean 3.8 yrs). Neuropsychiatric (20.5%) and musculoskeletal (18.5%) systems were the most frequently involved, followed by renal (15.5%) and skin (12.5%) systems, all with median SLICC/ACR organ system scores of 1. In multivariate models, African-American race was associated with skin damage but not with damage in other specific organ systems. Socioeconomic status was not associated with organ system damage. Older age at diagnosis correlated with cardiovascular, musculoskeletal, gastrointestinal, ocular, and pulmonary damage. Clinical factors such as longer disease duration correlated with higher renal and cardiovascular damage, and greater disease activity at diagnosis of SLE correlated with greater renal, musculoskeletal, and pulmonary damage. CONCLUSION: There is evidence of organ system damage in SLE within a mean of 3.8 years after onset. We found little evidence for differences in early organ damage according to race or socioeconomic status. Damage to most organ systems was related to age at diagnosis of SLE and clinical factors such as disease duration.

Adult↗
PubMed1999

Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease.

BACKGROUND: Previous follow-up studies of patients with Lyme disease suggest that disseminated infection may be associated with long-term neurologic and musculoskeletal morbidity. OBJECTIVE: To determine clinical and functional outcomes in persons who were treated for Lyme disease in the late 1980s. DESIGN: Population-based, retrospective cohort study. SETTING: Nantucket Island, Massachusetts. PARTICIPANTS: 186 persons who had a history of Lyme disease (case-patients) and 167 persons who did not (controls). MEASUREMENTS: Standardized medical history, physical examination, functional status measure (Medical Outcomes Study 36-item Short Form Health Survey [SF-36]), mood state assessment (Profile of Mood States), neurocognitive tests, and serologic examination. RESULTS: The prevalence of Lyme disease among adults on Nantucket Island was estimated to be 14.3% (95% CI, 9.3% to 19.1%). In multivariate analyses, persons with previous Lyme disease (mean time from infection to study evaluation, 6.0 years) had more joint pain (odds ratio for having joint pain in any joint, 2.1 [CI, 1.2 to 3.5]; P = 0.007), more symptoms of memory impairment (odds ratio for having any memory problem, 1.9 [CI, 1.1 to 3.5]; P = 0.003), and poorer functional status due to pain (odds ratio for 1 point on the SF-36 scale, 1.02 [CI, 1.01 to 1.03]; P < 0.001) than persons without previous Lyme disease. However, on physical examination, case-patients and controls did not differ in musculoskeletal abnormalities, neurologic abnormalities, or neurocognitive performance. Persons with previous Lyme disease who had persistent symptoms after receiving treatment (n = 67) were more likely than those who had completely recovered to have had fever, headache, photosensitivity, or neck stiffness during their acute illness (87% compared with 13%; odds ratio, 2.4 [CI, 1.0 to 5.5]; P = 0.045); however, the performance of the two groups on neurocognitive tests did not significantly differ. CONCLUSIONS: Because persons with previous Lyme disease exhibited no sequelae on physical examination and neurocognitive tests a mean of 6.0 years after infection, musculoskeletal and neurocognitive outcomes seem to be favorable. However, long-term impairment of functional status can occur.

Adult↗
PubMed1999

Evaluation of a German version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Dougados Functional Index (D-FI).

OBJECTIVE: Transcultural adaptation of the two most widely used and accepted functional indices in ankylosing spondylitis, the Bath Ankylosing Spondylitis Functional Index (BASFI) and Dougados Functional Index (D-FI). METHODS: The instruments were translated and tested for internal consistency (Cronbach's coefficient alpha), test-retest reliability (intraclass correlation coefficient, ICC), construct validity (testing for association with Schober's test, finger floor distance, occiput wall distance, frequency and duration of awakenings at night, and a visual analog scale pain), and responsiveness (standardized response mean, SRM). RESULTS: The study sample consisted of 72 patients of a randomized, controlled clinical trial receiving either Diclofenac or placebo. Visual assessment of distribution patterns revealed a ceiling effect of both instruments. Both questionnaires had a high internal consistency (Cronbach alpha: 0.81 [BASFI], 0.85 [D-FI] and a high test-retest reliability (ICC: 0.92 [BASFI], 0.89 [D-FI]). The limited responsiveness to Diclofenac treatment (SRM: 0.46 [BASFI], 0. 33 [D-FI]) may be related to the selected study sample. The BASFI was significantly correlated with all tested validation parameters. The D-FI was only significantly correlated with finger floor distance, occiput wall distance, and duration of awakenings at night. CONCLUSION: The transculturally adapted version of both functional indices are valid, reliable, and internally consistent. Because of psychometric advantages, the BASFI may be preferred in clinical trial settings.

Activities of Daily Living↗
PubMed1999

Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities.

OBJECTIVE: To compare the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a questionnaire format of the Lequesne-Algofunctional Index in patients with OA of the lower extremities. METHODS: Longitudinal analysis of the instruments' responsiveness [standardized response mean (SRM), effect size (ES)] in ambulatory patients undergoing hip or knee arthroplasty. RESULTS: At six months 36, and at one year 40 out of 43 patients undergoing hip (N=30) or knee arthroplasty (N=13) could be examined. Both responsiveness statistics revealed the same order of responsiveness. For both indices and for both locations, the pain sections were more responsive than the function sections. However, the WOMAC scales and the WOMAC global index (hip at 12 months: SRM=2.4; knee at 12 months: SRM=2.0 ) were more responsive than the comparable Lequesne sections and Lequesne index (hip at 12 months: SRM=2.1; knee at 12 months: SRM=1.5). CONCLUSIONS: Although our results are based on a German version using a self-report format, the WOMAC scales appear to be more responsive than the Lequesne index in patients with OA of the lower extremities.

Adult↗
PubMed1999

[Examples and proposed solutions for methodological problems in hospital appropriateness assessment].

Inappropriate hospital care has become a recurring theme since the publication of the results of the model project on the appropriateness of hospital care (Section 275 a SGB V) by the medical service of the National Associations of Health Insurers (MDS) in Spring 1997. Nationwide, an increased number of appropriateness assessments have since been conducted by the medical service of the health insurers (MDK). The basis for an objective assessment of the appropriateness of hospital care is a diligent, comprehensive, and methodologically valid examination of the actual situation. At first, it was unknown to what extent current methods in Germany conformed to international scientific standards in Epidemiology, Biometry, and Health Services Research. Following a thorough scientific examination of several typical methodologies, it became clear that current methods are insufficient, and hence do not allow valid conclusions regarding inappropriate hospital admissions or hospital days. This statement does not deny that inappropriate hospital use is very likely, but our current assessment tools do not permit further conclusions to be drawn. The purpose of this article is to identify typical mistakes in the fundamental aspects of a valid assessment based on selected examples. Proposals are made regarding methodology and the presentation of results that follow from this critical examination.

Germany↗
PubMed1999

Comparative responsiveness of 3 functional indices in ankylosing spondylitis.

OBJECTIVE: To compare the responsiveness of the Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), and the ankylosing spondylitis-specific version of the Health Assessment Questionnaire (HAQ-S). METHODS: Using data from a placebo controlled, randomized clinical trial we designed a responsiveness model including both hypothesized improvement (n = 39; continuous diclofenac treatment) and hypothesized deterioration (n = 40; patients who withdrew from the clinical trial because of a flare) of functional performance. Instrument responsiveness was examined using 4 statistics including standardized response mean (SRM), effect size (ES), the Guyatt method, and the variance method. Ceiling and floor effects were visualized using histograms for cross sectional and time-path diagrams for longitudinal analysis. RESULTS: The BASFI ranked superior compared to the DFI and HAQ-S in detecting both improvement and deterioration of functional performance. All 4 responsiveness statistics consistently confirmed this superiority of the BASFI. However, the median baseline scores of all 3 questionnaires were close to the lower end of the instrument and the score distribution showed skewed patterns. CONCLUSION: The BASFI appears to be more responsive than the DFI and the HAQ-S in situations of both improvement and deterioration of functional performance. However, addition of particular difficult items may improve the performance of the BASFI as well as of the other 2 instruments.

Adult↗
PubMed1998

Lack of cardiac manifestations among patients with previously treated Lyme disease.

BACKGROUND: Cardiac involvement is common in acute Lyme disease, and case reports suggest that cardiac abnormalities might also occur years after the primary infection. OBJECTIVE: To determine the prevalence of cardiac abnormalities in persons with previously treated Lyme disease. DESIGN: Population-based, retrospective cohort study with controls. SETTING: Nantucket Island, Massachusetts. PARTICIPANTS: From among 3703 adult respondents to a total-population (n = 6046) mail survey, 336 (176 case-patients and 160 controls) were randomly selected for clinical evaluation. MEASUREMENTS: Current cardiac symptoms and major or minor abnormal electrocardiographic features, including heart rate; rhythm; axis; PR, QRS, and QT intervals; QRS structure; atrioventricular blocks; and ST-segment and T-wave changes. RESULTS: Persons with Lyme disease (case-patients, n = 176) (mean duration from disease onset to study evaluation, 5.2 years) and persons without evidence of previous Lyme disease (controls, n = 160) did not differ significantly in their patterns of current cardiac symptoms and electrocardiographic findings, including heart rate (P > 0.2), PR interval (P = 0.15), QRS interval (P > 0.2), QT interval (P > 0.2), axis (P > 0.2), presence of arrhythmias (P > 0.2), first-degree heart block (P = 0.12), bundle-branch block (P > 0.2), and ST-segment abnormalities (P > 0.2). In multivariate analyses that adjusted for age, sex, and previous heart disease, a history of previously treated Lyme disease was not associated with either major (odds ratio, 0.78; P > 0.2) or minor (odds ratio, 1.09; P > 0.2) electrocardiographic abnormalities. CONCLUSION: Persons with a history of previously treated Lyme disease do not have a higher prevalence of cardiac abnormalities than persons without a history of Lyme disease.

Adult↗
PubMed1998

[Vitamin E in therapy of rheumatic diseases].

Over the past years, antioxidants, and particularly vitamin E, have received considerable attention in the treatment of human diseases. In rheumatology, interest has been given to the treatment and prevention of rheumatoid arthritis and osteoarthritis. However, the concept of using antioxidant nutrients as potential remedies is not new. As early as the sixties, first case reports have described beneficial effects of vitamin E in the therapy of osteoarthritis. Nonetheless, most of the following studies were not conducted properly, thus, not allowing valid inferences about the efficacy of vitamin E. Newer studies with sound methodology have shown a beneficial effect in rheumatic diseases, mainly in the reduction of pain. This paper reviews current and past studies about vitamin E in the treatment of rheumatic diseases.

Antioxidants↗
PubMed1998

Comparison of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index and a self-report format of the self-administered Lequesne-Algofunctional index in patients with knee and hip osteoarthritis.

OBJECTIVE: To compare the metric properties and validity of German versions of the WOMAC (Western Ontario and McMaster Universities) and a self-administered questionnaire-format of the Lequesne-Algofunctional-Index in patients with osteoarthritis (OA) of the lower extremities. DESIGN: Cross-sectional analysis of the instruments' internal consistency (Cronbach's coefficient alpha) and construct validity (correlation with radiological OA-severity and limitation in range-of-motion) in ambulatory patients and patients before hip arthroplasty. Test-retest reliability was assessed on a subsample after 10 days. RESULTS: Data from 51 patients out of 91 contacted could be analyzed. Twenty-nine patients had knee and 22 patients had hip OA. Both the WOMAC and Lequesne OA-indices and their scales or sections had a satisfactory test-retest reliability (Intraclass correlation coefficient 0.43-0.96). All scales of the WOMAC were internally consistent (Cronbach's coefficient alpha 0.81-0.96) and associated with radiological OA-severity and joint range of motion. However, only the function but not the symptom sections (Cronbach's coefficient alpha knee: 0.55; hip: 0.63) of the self-administered Lequesne OA index were internally consistent for both, patients with knee and hip OA. Also, the symptom components were not or only weakly associated with radiological OA-severity and joint range of motion. CONCLUSIONS: Although our results are based on a German version using a self-report format we may caution using the self-administered Lequesne OA index without prior testing of its metric properties and validity.

Aged↗
PubMed1998

Weighting for joint surface area improves the information provided by a reduced 28-joint articular index of swollen joints.

The objective of our study was to examine whether weighting for joint surface area or recording of simultaneously tender and swollen joints increases the association of a reduced 28-joint articular index with clinical and outcome parameters. In a cross-sectional study we examined 61 consecutive outpatients with RA fulfilling the American Rheumatism Association 1987 revised criteria. Tender, swollen, and simultaneously tender and swollen joints were recorded. The association of 28- and 68-joint articular indices with clinical and outcome parameters were estimated with nonparametric correlation analyses. Weighting for joint surface yielded consistently increased correlation of clinical and outcome parameters with swollen and tender and swollen but not with tender joint counts. The correlation of the 28-joint articular and 68-articular indices with these parameters were similar. In conclusion, weighting for joint surface notably improves the information provided by swollen joint counts, whereas it does not appear to improve the information provided by tender joint counts.

Adult↗
PubMed1998

Progression in early erosive rheumatoid arthritis: 12 month results from a randomized controlled trial comparing methotrexate and gold sodium thiomalate.

OBJECTIVE: To compare radiographic outcomes in patients with active early erosive rheumatoid arthritis (RA) who were treated with methotrexate (MTX) and gold sodium thiomalate (GSTM). METHODS: A total of 174 patients from two centres were randomly assigned to receive weekly i.m. injections for 12 months of either 15 mg MTX or 50 mg GSTM in a double-blind fashion. Radiographic evaluations including standardized scoring of 38 joints of the hands, wrists and forefeet, and count of eroded joints, were carried out at baseline and after 6 and 12 months in all patients, including withdrawals. RESULTS: An intention-to-treat analysis revealed no statistically significant difference in the progression of radiographic scores between treatment groups after 6 months (3.4 with MTX vs 2.6 with GSTM, P = 0.66) and after 12 months (6.0 vs 4.8, P = 0.44). A similar pattern was observed for the number of joints with erosions. The slope of radiographic progression was significantly reduced in the second half-year compared to the first 6 months in both groups. Erythrocyte sedimentation rate and C-reactive protein at baseline, and the presence of rheumatoid factor (RF), were the main predictors of progression in bivariate analysis. RF remained as the only predictor for radiographic outcome in multivariable analysis. CONCLUSION: In parallel to clinical improvement, both GSTM and MTX reduce the slope of radiographic progression in patients with active erosive RA.

Aged↗
PubMed1998

RheumaNet--a novel Internet-based rheumatology information network in Germany.

Knowledge transfer in medicine has traditionally been achieved through personal communication, the medical literature, conferences and continuous medical education. However, many of these methods of communication have the problem of currentness, and the latest knowledge is mostly transferred with a certain delay. In particular, chronic disease management is frequently burdened by missing, incomplete or delayed communication. We present the implementation of a novel, Internet-based information system (RheumaNet) to facilitate rapid communication and information transfer between the 21 German Multipurpose Arthritis Centres (MACs). Medical information, agendas, urgent notifications, guidelines, etc., can be exchanged easily via electronic mail, file transfer protocol or the World Wide Web. RheumaNet allows interactive on-line communication as a common platform for joint projects or remote consultation. It supports a set of 'core documentation' that has been used by all German MACs for several years. RheumaNet was used for the organization, on-line presentation and evaluation of the 1997 annual meeting of the German Rheumatology Society and is currently appointed to establish its public representation in the 'Web'. An on-line version of the 'Quality Assurance Textbook' of German rheumatology is achieved with database-derived 'dynamic' Web pages, allowing easy access to any information within it. Advances in the future include the development of on-line patient information bulletin boards, on-line questionnaires, the coordination of rehabilitation and educational tools for medical students, and professional training.

Arthritis, Rheumatoid↗
PubMed1998

Comparative responsiveness of generic versus disease-specific and weighted versus unweighted health status measures in carpal tunnel syndrome.

OBJECTIVES: The authors evaluated the relative responsiveness to change of generic versus disease-specific and unweighted versus weighted health status measures in carpal tunnel syndrome (CTS). METHODS: Data were obtained from 196 subjects followed in a prospective community-based cohort study in Maine who underwent carpal tunnel release (The Maine Carpal Tunnel Syndrome Study). Patients were evaluated before and 6 months after surgery. The disease-specific, unweighted severity score was derived from the validated Carpal Tunnel Syndrome Assessment Questionnaire. Patients were asked to rate the importance of each symptom included in the severity score. Each severity question was weighted by its importance, creating a disease-specific weighted score. Generic instruments were the SF-36, SF-12, and a Quality of Life Rating Scale. Sensitivity to change was calculated with the standardized response mean (SRM, mean change/standard deviation of change) as well as the effect size (ES, mean change/standard deviation of baseline values). The ability of the instruments to distinguish clinically important differences was assessed by correlating the changes in scores with global ratings on satisfaction and perceived improvement as external criteria. RESULTS: The disease-specific weighted score (SRM: 1.56, ES: 1.99) was more responsive than the unweighted score (SRM: 1.36, ES: 1.57). The Quality of Life Rating Scale, SF-36, and SF-12 subscales were less sensitive to change, with standardized response means and effect sizes that ranged from -0.23 to 0.88. The ability to distinguish clinically important differences was higher for the two disease-specific scales. The coefficients of correlation with the external criteria ranged from 0.50 to 0.56 for the unweighted score and 0.56 to 0.62 for the weighted score and were significantly stronger than the correlations between external measures and the most responsive subscale of the SF-36 (Bodily Pain subscale, r = 0.36). The SF-12 health survey performed as well as the SF-36 in term of responsiveness and ability to distinguish clinically important change. CONCLUSIONS: Disease-specific measures were superior to generic measures in capturing clinical change after carpal tunnel release, and a weighted score was slightly more responsive than the unweighted score. The SF-12 showed comparable psychometric properties compared with the longer 36-item Short-Form Survey.

Adult↗
PubMed1998

Outcomes of children treated for Lyme disease.

OBJECTIVE: To study the outcome of Lyme disease (LD) in children identified in a total population survey of an endemic island. METHODS: We conducted a population-based retrospective cohort study off the coast of Massachusetts. Twenty-five children who met the Centers for Disease Control case definition for prior LD were compared with 26 children without LD from the same community. All children with LD received antibiotics during the acute phase of their disease. All 51 children were invited for a clinical evaluation, including 12-lead electrocardiogram (EKG), and measurement of antibodies to Borrelia burgdorferi by antibody-capture ELISA and Western blot. RESULTS: At a mean of 3.2 years from the initial manifestation of LD, children with prior LD did not have a higher prevalence of musculoskeletal or neurological symptoms, examination abnormalities, abnormal EKG, or behavioral difficulties, compared to children with no history of LD. CONCLUSION: Children who receive appropriate antimicrobial therapy for LD appear to have no demonstrable longterm morbidity.

Administration, Oral↗
PubMed1997

[Patient-centered evaluation of illness outcome in musculoskeletal diseases: model of illness sequelae and definition of the concept].

Musculoskeletal conditions usually cause pain, physical, psychological and social disability, and consequently reduce a patient's quality of life. Nowadays, it is generally accepted that patients are truly capable to assess disease consequences, if they are questioned with appropriate instruments. Models of disease and the disabling process provide the conceptual background for the measurement of disease consequences. To date, standardized assessment of outcomes with psychometrically sound instruments is commonplace in clinical trials, clinical epidemiology, economic studies, and health services research. However, standardized assessment tools are not yet widely used in clinical practice.

Activities of Daily Living↗
PubMed1997

[Patient-centered evaluation of illness outcome in musculoskeletal diseases: selection and testing of outcome instruments].

Effectiveness research, economic evaluation, epidemiologic studies of disease consequences and clinical quality management all rely on standardized assessment of disease consequences with psychometrically sound questionnaires. For scientific, ethical and economical reasons, careful selection and evaluation of instruments is critical. Selection of instruments includes searches of medical databases (e.g. MEDLINE), testing of face-validity (does the instrument measure what we intend to measure?), and compatibility (is the instrument used internationally?). Evaluation of instruments includes the assessment of reliability, internal consistency and sensitivity. Most important is careful consideration of the practical usefulness (Interpretation of scores and scales, acceptance in the study population). Contact with instrument developers is advisable (Copyright issues, scoring, current version).

Arthritis, Rheumatoid↗