The Riyadh Intensive Care Programme.
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Algorithms↗
Biomedical subjects
R W Chang
Publications and source records attributed to R W Chang.
Estimates and determinants of valid self-reports of musculoskeletal disease in the elderly.
This study examined the extent and nature of bias associated with self-reported versus standardized physician-examination/assessment-based accounts of musculoskeletal disease in a sample of 406 persons chosen to represent an aging and dependency continuum. Prevalence of musculoskeletal disease based on standardized physician examination/assessments was 97%. Using the standardized findings as the criterion, the self-report underestimated prevalence by 16%. Overall, the results indicated that self-reports of musculoskeletal conditions by the elderly capture the vast majority of persons with painful or functionally significant disease and are most valid for persons from ages 65 to 74 but do not reflect the presence of asymptomatic joint pathology. Standardized physician examinations/assessments would more accurately determine the presence of risk factors in epidemiological studies of musculoskeletal disability.
Aged↗
Life after total hip arthroplasty.
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Aged↗
Comparative study of the use of systolic and asystolic kidney donors between 1988 and 1991. The South Thames Transplant Group.
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Adult↗
The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis.
OBJECTIVE: To develop and validate revised criteria for global functional status in rheumatoid arthritis (RA). METHODS: Revised criteria were formulated and tested for criterion and discriminant validity in 325 patients with RA. RESULTS: The revised criteria developed are as follows: class I = able to perform usual activities of daily living (self-care, vocational, and avocational); class II = able to perform usual self-care and vocational activities, but limited in avocational activities; class III = able to perform usual self-care activities but limited in vocational and avocational activities; class IV = limited in ability to perform usual self-care, vocational, and avocational activities. Usual self-care activities include dressing, feeding, bathing, grooming, and toileting; vocational and avocational activities are both patient-desired and age-, and sex-specific. The distribution properties of this classification schema were superior to those of the original Steinbrocker criteria. Mean Health Assessment Questionnaire scores were significantly (P less than 0.0001) different between, and increased across, the 4 classes. CONCLUSION: Although there are limitations inherent in the use of global ordinal scales, the American College of Rheumatology revised criteria will be useful in describing the functional consequences of RA. A more detailed quantitative measure of physical disability should be used, however, for optimal monitoring of patients' clinical status in office practice and clinical research.
Activities of Daily Living↗
Effect of ultrasound on mobility in osteoarthritis of the knee. A randomized clinical trial.
Ultrasound increases soft tissue extensibility and may be an effective adjunct in the treatment of knee contractures secondary to connective tissue shortening. A randomized clinical trial was conducted to determine the effectiveness of ultrasound in relieving stiffness and pain in patients (age mean = 67.5 years, SD = 13.0) who had osteoarthritis (OA) and a chronic knee contracture. Subjects received 12 treatments of exercise preceded by either ultrasound (n = 34) or sham ultrasound (n = 35) and a blinded evaluation at baseline, after treatment, and 2 months after treatment. MANCOVA controlling for baseline scores showed that there were no significant differences in knee active range of motion (ROM) (goniometry) or pain (visual analogue scale) between experimental and control groups. Possible explanations for the no difference finding involve dosage issues, muscle shortening, transiency of effects, and the effects of exercise. Paired t-tests revealed that both groups significantly improved (p less than 0.05) in active ROM, pain, and gait velocity, and maintained improvement for at least 2 months. Although ultrasound may not contribute to the management of patients with chronic knee stiffness and OA, benefits of the exercise program and increased activity secondary to program participation probably influenced the overall improvement.
Aged↗
Rehabilitation and biomechanics.
Advances in our understanding of disability is important to the development of new rehabilitation ideas for patients with rheumatic disease. Large epidemiologic and focused clinical and laboratory studies that deal with risk factors and treatment for physical and social disability, exercise, gait analysis, and biomechanics are reviewed.
Arthritis↗
Joint impairment and hand function in the elderly.
OBJECTIVE: To test the contribution of joint impairment to observed hand function (grip strength and Williams Test) in the elderly, using a multivariate model. DESIGN: Cross-sectional observational data (baseline data from an ongoing longitudinal study). SUBJECTS: Five hundred forty-one persons over age 60, including continuing care retirement community (n = 222), homebound (n = 72), and ambulatory (n = 247) respondents. Mean age at assessment 76.7, (SD = 9.0). MEASUREMENT: Independent variables included sociodemographics, physician measures of upper joint impairment, an index of comorbidities derived from physical examination or chart abstract, self-assessed arthritis pain, depression, and anxiety. The dependent variables included grip strength and a modified Williams Test [Williams Test (M)]. MAIN RESULTS: The multiple regression explained 59% (Adjusted R2 = .59) of the variance in grip strength, with joint impairment accounting for a change in R2 of .07. Upper joint impairment and grip strength accounted for 3% and 5%, respectively, of the variance in the Williams Test (M) (total amount of explained variance = 45%). CONCLUSIONS: Demographics explain most of the variance in grip strength and performance on the Williams Test (M). Controlling for demographics, musculoskeletal disease represented by joint impairment is associated with diminished grip strength. Reduced grip strength is associated with poorer performance on the Williams Test (M).
Activities of Daily Living↗
Self-reported functional status predicts change in level of care in independent living residents of a continuing care retirement community.
OBJECTIVE: To test the hypothesis that self-reported functional status predicts change in level of care from independent to dependent in residents of a continuing care retirement community (CCRC). DESIGN: Two-year longitudinal descriptive study of change in level of care and survival. SUBJECTS: One hundred fifty-two residents in the independent-living unit of a non-profit CCRC. Mean age at initial evaluation was 82.3 years, SD 6.2. MEASUREMENT: Predictor variables assessed at baseline were age, sex, physician estimate of functionally significant disease, self-reported functional status, and performance-based hand function. Criterion variables collected at 2-year follow-up were level of care (independent/dependent) and survival (alive/dead). MAIN RESULTS: Self-reported functional status (P less than 0.01) and age (P less than 0.05) were significant predictors of change in level of care in a logistic regression analysis containing all predictor variables. No variable predicted survival. CONCLUSIONS: Self-reported functional status may help to predict dependency in older adults in good health who have few markers of dependency risk.
Activities of Daily Living↗
Seeing the forest despite the trees. The benefit of exploratory data analysis to program evaluation research.
In the present article, it is argued that there is a benefit to applying techniques of exploratory data analysis (EDA) to program evaluation. To exemplify this, an evaluation of a rehabilitation program for people with rheumatoid arthritis is presented. The perceived health status of patients receiving intensive rehabilitation services from a major rehabilitation institute was compared with that of patients receiving customary office-based care over an 18-month period. The data were analyzed in a conventional way (analysis of variance) and then by way of EDA techniques (graphic display of medians and boxplots). The conventional analysis suggested that all patients improved over time and that intensive rehabilitation services provided no particular benefit or harm. The exploratory analysis showed that the distribution of the outcome variable was patently nonnormal, thus casting doubt on the validity of the conventional analysis. The EDA further showed that the rehabilitation group lagged behind the comparison group for a year, with a precipitious improvement at the 18-month period. This suggests that a selection factor was operating (i.e., those in the rehabilitation group could have been sicker) or that the patients in the rehabilitation group were made more aware of their condition by the intensive health services they received. The EDA provided an important insight.
Analysis of Variance↗
The GERI-AIMS. Reliability and validity of the arthritis impact measurement scales adapted for elderly respondents.
We adapted the Arthritis Impact Measurement Scales (AIMS) for use with frail elderly respondents. The new instrument, called the GERI-AIMS, generates both generic and arthritis-specific impairment scores, to control for comorbid conditions that are commonly found in an older population. An analysis of scores obtained on 438 elderly persons (mean age 76) indicated that more than half of the total disability measured by the generic GERI-AIMS scores is related to arthritis. The GERI-AIMS scales have standardized-item alpha levels greater than 0.70 and correlate well with clinical measures of arthritis severity. Information gained by using the GERI-AIMS has important public policy implications, insofar as information on both generic and disease-specific functional impairment is needed to establish priorities for basic research, epidemiologic, and intervention studies.
Aged↗
The superior laryngeal nerve loop and its surgical implications.
Based upon findings from 60 cadavers (120 sides), the incidence of superior laryngeal nerve loop, connecting the cervical sympathetic chain and the superior laryngeal nerve and its branches, the external and internal laryngeal nerve, was 98.3% (118 out of 120 sides). In most cases the loop connected the sympathetic chain and the external laryngeal nerve. The external laryngeal nerve was looped, and not linear as traditionally thought. The loop could be divided into three categories, V-shaped, U-shaped and mixed, and subdivided into 5 types and 17 subtypes according to morphological variation. The loop without exception innervated not only the cricothyroid muscle, but also the thyroid gland. The loop is one of the origins of the thyroid nerve. It seems that for thyroid surgery the loop, when lower in position, should be carefully separated from the superior thyroid vessels before the latter are ligated, in order to preserve a normal nerve supply to the muscle as well as to the part of the gland that remains after surgery.
Adult↗
APACHE II and clinical sickness score.
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Humans↗
Self report and performance-based hand function tests as correlates of dependency in the elderly.
Preventing or minimizing functional dependency in older adults rests, in part, upon the ability to predict who is at risk. The purpose of this study was to compare the ability of five tests of hand function to discriminate the degree of dependency in older adults. Seven hundred sixty four subjects were assessed for hand function on performance-based (Williams Test of Hand Function, a test of Williams Board items only, Jebsen Test of Hand Function, grip strength), and self-reported (Dexterity Scale of the Geriatrics-Arthritis Impact Measurement Scale (GERI-AIMS] measures of hand function, and self-reported multidimensional functional status (GERI-AIMS). A trichotomous variable representing a continuum of dependency based upon living site (independent living, home-bound, institutional) was used as the measure of dependency. Sixty-two cases were dropped for incomplete data. Discriminant function analyses of the 702 subjects (age X = 76.78 years, SD = 8.79) showed that basic demographic variables explain 40.8% of the variance in dependency; all hand function tests significantly correlated with dependency; the Williams Board correlated best (additional 12.5% variance explained). However, a multidimensional functional status measure explains substantially more variance in dependency (16.9%) after controlling for demographic variables and performance on the Williams Board. This comparison of methods and tests available for measuring hand function was made to provide criteria for selecting an instrument for a given setting.
Activities of Daily Living↗
Acute physiology and chronic health evaluation (APACHE II) scoring in a cardiothoracic intensive care unit.
OBJECTIVE: To evaluate the predictive value of the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system in cardiothoracic surgical patients. DESIGN: Prospective survey with follow-up to hospital discharge. SETTING: A cardiothoracic surgical ICU in a tertiary referral center. PATIENTS: Eight hundred sixty-nine consecutive patients admitted to the ICU were entered into this study. Data on 12 patients were incomplete. Forty-three patients had nonsurgical diagnoses. Three patients had noncardiothoracic operations. These exclusions left 811 patients for analysis, and all results pertain to these 811 cardiothoracic surgical patients. INTERVENTIONS: Demographic and physiologic data relevant to the APACHE II score were collected on all patients and entered into a microcomputer database for analysis. MEASUREMENTS AND MAIN RESULTS: The following procedures were performed: 65% of patients had coronary artery bypass grafts; 23% had heart valve surgery; 5% had thoracic surgical procedures; and the remainder had a variety of cardiothoracic operations. The mean duration of ICU care was 2.3 days and the mean age was 57 yrs. The mean APACHE II score was 9.5 and the overall predicted risk of dying was 4.59%, with an actual ICU mortality rate of 4.56%. The relationship between the APACHE II score and mortality rate was linear and significant (p less than .001). Patients with an APACHE II score of less than 10 had a mortality rate of 0.93%. Only a score of greater than 30 was uniformly associated with death, and then only in one patient. A chronic disease history, emergency surgery, and a longer ICU stay were significant markers for mortality. CONCLUSIONS: There was a good relationship between the APACHE II score and mortality rate. Low APACHE II scores accurately predicted survival but only very high scores accurately predicted death.
Adolescent↗
Exogenous sex hormones and the risk of rheumatoid arthritis.
The use of exogenous sex hormones in relation to the risk of rheumatoid arthritis (RA) was examined in a cohort of married nurses 30-55 years of age followed since 1976 in the Nurses' Health Study. Baseline information on the use of oral contraceptives, replacement estrogens, and other potential risk factors was obtained in 1976 and updated every 2 years. During 8 years of followup, 217 incident cases of polyarthritis were ascertained (115 RA and 102 undifferentiated polyarthritis). When compared with women who had never used oral contraceptives, the age-adjusted relative risk was 1.0 (95% confidence interval [CI] 0.7-1.3) for past users; however, too few women were currently using oral contraceptives for a reliable estimate of its effect. Among postmenopausal women, 123 cases of RA were reported. Compared with postmenopausal women who never used replacement estrogens, current users had an age-adjusted relative risk of 1.3 (95% CI 0.9-2.0), past users had an age-adjusted relative risk of 0.7 (95% CI 0.5-1.2), and ever users had a relative risk of 1.0 (95% CI 0.7-1.4). These data do not show a protective effect of past use of oral contraceptives or replacement estrogens for RA; however, a modest protective effect of current oral contraceptive use cannot be excluded.
Adult↗
In support of prognostic scoring in intensive care.
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Critical Care↗
Prerandomization: an alternative to classic randomization. The effects on recruitment in a controlled trial of arthroscopy for osteoarthrosis of the knee.
Possibly the greatest threat to the success of a randomized clinical trial is the inability to recruit an adequate number of subjects. Concern that the randomized clinical trial will adversely affect the physician-patient relationship is the most common reason for physicians' reluctance to enroll patients in such trials. We report a modification of a prerandomized design, first described by Zelen, which was implemented in a randomized clinical trial of arthroscopy for patients who had osteoarthrosis of the knee. The method was associated with a sixfold increase in the rate of accrual of patients as compared with the use of a classic randomization trial. We propose the design as a potential solution to the problem of recruitment of subjects, particularly for clinical studies.
Arthroscopy↗