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At least 271 records · Page 15Linked to original sources
PubMed2004

Clinicians tend to overestimate improvements in asthma control: an unexpected observation.

AIM: The original purpose of this study was to determine the Minimal Important Difference for the Asthma Control Questionnaire (ACQ) but an unexpected tendency of clinicians to overestimate improvements in asthma control thwarted the endeavour. We describe the observed clinician bias and discuss its implications for clinical practice and research. METHODS: Ninety-four adults with inadequately controlled asthma received a full clinical consultation with one of nine asthma specialists. Medications were adjusted according to clinical needs. Four weeks later the same clinician estimated change in asthma control on a 15-point scale (-7 = a very great deal worse, 0 = no change, +7 a very great deal better). All patients completed the ACQ before each consultation but responses were not shown to the clinician. RESULTS: Clinicians consistently recorded that patients improved more than their change in ACQ scores suggested (p = 0.018). CONCLUSION: Clinicians should be aware of potential biases that may occur when estimating change in asthma control compared with measuring absolute status at each visit.

Journal Article↗
PubMed2004

Measurement properties and interpretation of three shortened versions of the asthma control questionnaire.

The Asthma Control Questionnaire (ACQ) measures the adequacy of asthma treatment as identified by international guidelines. It consists of seven items (5 x symptoms, rescue bronchodilator use and FEV1% of predicted normal). A validation study suggested that in clinical studies measurement of FEV1 and bronchodilator use may not be needed but this has never formally been tested in a clinical trial. The aims of this analysis were (1) to examine the measurement properties of three shortened versions of the ACQ (symptoms alone, symptoms plus FEV1 and symptoms plus short-acting beta2-agonist) and (2) to determine whether using the shortened versions would alter the results of a clinical trial. In the randomised trial, 552 adults completed the ACQ at baseline and after 13 and 26 weeks of treatment. The analysis showed that the measurement properties of all four versions of the ACQ are very similar. Agreement between the original ACQ and the reduced versions was high (intraclass correlation coefficients: 0.94-0.99). Mean differences between the ACQ and the shortened versions were less than 0.04 (on the 7-point scale). Clinical trial results using the four versions were almost identical with the mean treatment difference ranging from -0.09 (P=0.17), to -0.13 (P=0.07). For interpretability, the minimal important difference for all four versions was close to 0.5. In conclusion, these three shortened versions of the ACQ can be used in large clinical trials without loss of validity or change in interpretation.

Adolescent↗
PubMed2005

Non-nicotine pharmacotherapies for smoking cessation.

International chronic obstructive pulmonary disease guidelines recommend that smokers be strongly advised to quit, and should be offered help in doing so. The most effective smoking-cessation interventions combine behavioural support with pharmacotherapies. For smokers who do not wish to use nicotine replacement treatments, bupropion is a safe and effective non-nicotine alternative first-line treatment. Nortriptyline and clonidine have demonstrated efficacy in aiding smoking cessation, but are regarded as second-line therapies. A number of other non-nicotine treatments show promise, but more data are required before these can be recommended in assisting smokers to stop.

Adrenergic alpha-Agonists↗
PubMed2005

Identifying 'well-controlled' and 'not well-controlled' asthma using the Asthma Control Questionnaire.

The 7-item Asthma Control Questionnaire (ACQ) has been validated to measure the goals of asthma management as defined by international guidelines (minimisation of day- and night-time symptoms, activity limitation, beta(2)-agonist use and bronchoconstriction). Responses are given on a 7-point scale and the overall score is the mean of the responses (0=totally controlled, 6=severely uncontrolled). The aim of this analysis was to determine the cut-point on the ACQ that best differentiates between 'well-controlled' and 'not well-controlled' for (a) clinical practice (low risk of missing 'not well-controlled') and (b) clinical trials (low risk of including 'well-controlled'). All 1323 patients who provided data sets at week 12 in the Gaining Optimal Asthma Control (GOAL) clinical trial were included in the analysis. The gold standard for 'well-controlled' was a composite based on the GINA/NIH guidelines and derived from data collected in the clinical trial diaries and clinic records. The analysis showed that the crossover point between 'well-controlled' and 'not well-controlled' is close to 1.00 on the ACQ. However, to be confident that a patient has well-controlled asthma, the optimal cut-point is 0.75 (negative predictive value=0.85). To be confident that the patient has inadequately controlled asthma, the optimal cut-point is 1.50 (positive predictive value=0.88). In conclusion, knowledge of these cut-points will enhance practising clinicians ability to identify patients whose asthma requires additional treatment, enable investigators to enroll poorly controlled patients into studies and for both clinicians and investigators to evaluate whether treatment goals are being achieved.

Adolescent↗
PubMed1982

Caffey's disease.

Caffey's disease or infantile cortical hyperostosis is a rare condition affecting infants in the first five months of life. Varying forms of its presentation are illustrated by the four case reports described. The aetiology, pathology, differential diagnosis and management are discussed. It is possible that Caffey's Disease is becoming more frequent, and as the mandible is involved in over 90 per cent of cases, the oral surgeon increasingly may be presented with these cases which can be very difficult to diagnose.

Diagnosis, Differential↗
PubMed1988

Temporomandibular joint arthrography: dynamic study by videorecording.

Temporomandibular joint symptoms are common. Patients not successfully treated by conservative methods require accurate assessment of the internal derangements of the joint. Temporomandibular joint arthrography using only videorecorded intensifier fluorography displays the anatomy and function accurately with a low radiation dose.

Arthrography↗
PubMed1990

Aqueous beclomethasone diproprionate nasal spray: regular versus "as required" use in the treatment of seasonal allergic rhinitis.

OBJECTIVE: to determine the effect of alternative regimens of nasal steroid administration on symptoms and quality of life. DESIGN: randomized, double-blind, parallel-group comparison. SUBJECTS: sixty ragweed-sensitive adults recruited from participants of previous studies and through media advertising. INTERVENTIONS: 200 micrograms of aqueous beclomethasone diproprionate nasal spray, twice daily, from 1 week before until 1 week after the ragweed-pollen season (regular) or 100 micrograms of the spray, taken as required, up to 400 micrograms daily; troublesome nasal symptoms were treated, in both groups, by increasing the daily dose to 800 micrograms until symptoms were controlled. If this treatment was insufficient, 120 mg of terfenadine, daily, was added. RESULTS: One subject in the "as required"-treated group withdrew with uncontrolled nasal symptoms. In the remaining subjects, sneezing, stuffy nose, and rhinorrhea, measured by a daily diary, were significantly better controlled in the regular-treated group (p less than 0.025). Impairment of quality of life, including sleep disturbance, nonhay fever symptoms, practical problems, and uncomfortable emotions were greater in the as required-treated group (p less than 0.001). Subjects in the regular-treated group required less additional terfenadine (0.27 tablets per subject versus 1.40; p = 0.022). Eye symptoms and eye-drop use were similar in the two treated groups. CONCLUSION: In patients with seasonal allergic rhinitis, regular use of inhaled steroids results in fewer symptoms and better quality of life than when the spray is taken only as required.

Adolescent↗
PubMed1997

Measuring health-related quality of life in rhinitis.

Patients with rhinitis are bothered both by the nasal symptoms themselves and by associated symptoms such as headache and fatigue. The combination can produce quite severe impairment of day-to-day physical, emotional, occupational, and social functioning and can cause emotional distress. This breadth of impairment of health-related quality of life in patients with rhinitis is often not recognized and is sometimes trivialized by some health care professionals. One of the aims of treating patients with rhinitis must be to ensure that all individual patient problems are recognized and treated appropriately. Several studies now show that correlations between conventional nasal symptom-severity diaries and health-related quality of life are only weak to moderate. Therefore, to get an overall picture of a patient's health status, it is essential to measure quality of life. Genetic health-status questionnaires are able to compare burden of illness across different medical conditions, but they are often not responsive enough to small but clinically important changes in patients' quality of life. As a result, we have seen the emergence of disease-specific instruments for rhinitis that have strong measurement properties and that are much more sensitive to these changes. Most clinical trials in rhinitis now include a measure of health-related quality of life as a primary outcome, and many clinicians are incorporating quality of life into routine clinical assessments.

Clinical Trials as Topic↗
PubMed1998

Measuring quality of life in children with rhinoconjunctivitis.

OBJECTIVE: The objective of this study was to develop, pretest, and validate a questionnaire to measure quality of life in children with seasonal allergic rhinoconjunctivitis (SAR). METHODS (DEVELOPMENT STUDY): Thirty-four children with SAR were enrolled from summer camps, notices in the media, and an allergy clinic (Southern Ontario). After generating a pool of 48 potentially important quality of life items, the children identified the ones that they experienced with their SAR and scored each for bother (1 = a little bothered to 4 = extremely bothered). Items identified most frequently and with the highest bother score were included in the Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ). The PRQLQ was pretested for ease completion and accuracy of understanding. RESULTS (DEVELOPMENT STUDY): The PRQLQ has 23 items in five domains (nose symptoms, eye symptoms, practical problems, other symptoms, and activities). Responses are given on a seven-point scale, and children are asked to score their experiences during the previous 7 days. METHODS (VALIDATION STUDY): Seventy-five children with symptomatic SAR were enrolled from notices in the media and a pediatric allergy clinic (Austin, Tex.). A single cohort design was used, with children assessed at 0, 1, and 3 weeks. The PRQLQ was administered to the children by a trained interviewer at 1 and 3 weeks. A conventional nasal symptom daily diary was completed for 1 week before each of these clinic visits. Global ratings were completed at the final visit. RESULTS (VALIDATION STUDY): In patients who were stable between clinic visits, the PRQLQ demonstrated good reliability (intraclass correlation coefficient = 0.93). The questionnaire was very responsive to change (p < 0.001) and was able to differentiate between patients who were in a stable clinical state and those whose clinical state changed between visits (p = 0.005). Correlations between the PRQLQ and diary scores were close to predicted and supported both the cross-sectional and longitudinal validity of the PRQLQ. CONCLUSIONS: The PRQLQ measures the quality of life impairments important to children with SAR. Children provide reliable and accurate responses, the measurement properties are strong, and the questionnaire can be used with confidence in clinical trials, clinical practice, and surveys.

Child↗
PubMed1999

Validation of the standardized version of the Rhinoconjunctivitis Quality of Life Questionnaire.

BACKGROUND: In the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), the 3 activity questions are selected by the patients themselves. For greater efficiency, a version with standardized activities is required. OBJECTIVE: Our purpose was to develop and validate a standardized version of the RQLQ, the RQLQ(S). METHODS: With use of 5 RQLQ databases, we identified the activities most frequently selected by patients and formulated 3 generic questions that would encompass the majority of these activities. The RQLQ(S) was tested in a 5-week observational study in 100 adults with symptomatic rhinoconjunctivitis. Patients completed the RQLQ(S), the RQLQ, and other measures of health status at baseline and 1 and 5 weeks. RESULTS: The activity domain of the RQLQ(S) consistently gave lower scores than did the activity domain of the RQLQ (P <.001). However, this made very little difference to the overall scores (RQLQ[S] = 2.36 +/- 1.23, RQLQ = 2.43 +/- 1.23), and overall concordance was high (intraclass correlation coefficient = 0.996). In patients whose rhinoconjunctivitis was stable between clinic visits, reliability (reproducibility and ability to discriminate between patients of different impairment) was high for both instruments and almost identical (intraclass correlation coefficient = 0.97). Responsiveness to change was also very similar and good (P <.001). Construct validity (correlation with other index values of health status) was strong for both the RQLQ(S) and the RQLQ. CONCLUSIONS: The RQLQ(S) has strong measurement properties and measures the same construct as the original RQLQ. The choice of questionnaire should depend on the task at hand.

Activities of Daily Living↗
PubMed2000

The effect of exposure to oestrous ewes on rams' sexual behaviour, plasma testosterone concentration and ability to stimulate ovulation in seasonally anoestrous ewes.

Previous research has shown that the proportion of seasonal anoestrous ewes that ovulate in response to the introduction of rams ('ram effect') is dependent upon pheromonal and sexual behavioural stimuli emitted by the rams. Close contact with oestrous ewes is likely to increase the rams' libido and level of testosterone secretion, which in turn has been suggested to positively influence the production of pheromones. Thus, the sexual stimulation of rams could be used to improve the efficacy of the 'ram effect'. In the present experiment, 272 ewes were introduced (1) to rams without recent experience of oestrous ewes, (2) to rams recently exposed to oestrous ewes, (3) and (4) to oestrous ewes and rams with or without recent experience with oestrous ewes, or (5) remained isolated from rams. Serum testosterone concentration of rams was elevated equally (P<0.05) when oestrous or anoestrous were introduced. Exposure to oestrous ewes before or after introduction increased (P<0.05) the various measures of ram sexual behaviour directed towards anoestrous ewes. However, there was no statistical evidence that increased sexual activity resulted in an improvement in the ability of rams to stimulate ovulation in anoestrous ewes.

Journal Article↗