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Gates E, Hole B, Hayward S, Chesnaye NC, Meuleman Y, Dekker FW, Evans M, Heimburger O, Torino C, Porto G, Szymczak M, Drechsler C, Wanner C, Jager KJ, Roderick P, Caskey F. Converting from face-to-face to postal follow-up and its effects on participant retention, response rates and errors: lessons from the EQUAL study in the UK. BMC Med Res Methodol 2022; 22:44. [PMID: 35148682 PMCID: PMC8832416 DOI: 10.1186/s12874-021-01453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prospective cohort studies are challenging to deliver, with one of the main difficulties lying in retention of participants. The need to socially distance during the COVID-19 pandemic has added to this challenge. The pre-COVID-19 adaptation of the European Quality (EQUAL) study in the UK to a remote form of follow-up for efficiency provides lessons for those who are considering changing their study design. METHODS The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced chronic kidney disease. Initially, patients were invited to complete a questionnaire (SF-36, Dialysis Symptom Index and Renal Treatment Satisfaction Questionnaire) at research clinics every 3-6 months, known as "traditional follow-up" (TFU). In 2018, all living patients were invited to switch to "efficient follow-up" (EFU), which used an abbreviated questionnaire consisting of SF-12 and Dialysis Symptom Index. These were administered centrally by post. Response rates were calculated using returned questionnaires as a proportion of surviving invitees, and error rates presented as the average percentage of unanswered questions or unclear answers, of total questions in returned questionnaires. Response and error rates were calculated 6-monthly in TFU to allow comparisons with EFU. RESULTS Of the 504 patients initially recruited, 236 were still alive at the time of conversion to EFU; 111 of these (47%) consented to the change in follow-up. In those who consented, median TFU was 34 months, ranging from 0 to 42 months. Their response rates fell steadily from 88% (98/111) at month 0 of TFU, to 20% (3/15) at month 42. The response rate for the first EFU questionnaire was 60% (59/99) of those alive from TFU. With this improvement in response rates, the first EFU also lowered errors to baseline levels seen in early follow-up, after having almost trebled throughout traditional follow-up. CONCLUSIONS Overall, this study demonstrates that administration of shorter follow-up questionnaires by post rather than in person does not negatively impact patient response or error rates. These results may be reassuring for researchers who are trying to limit face-to-face contact with patients during the COVID-19 pandemic.
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Affiliation(s)
- Emer Gates
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. .,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Barnaby Hole
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Samantha Hayward
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Evans
- Renal Unit, Department of Clinical Intervention and technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Olof Heimburger
- Renal Unit, Department of Clinical Intervention and technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Claudia Torino
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - Gaetana Porto
- GOM Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Wurzburg, Wurzburg, Germany
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Paul Roderick
- School of Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Fergus Caskey
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Kutschar P, Osterbrink J, Weichbold M. Interviewer effects in a survey examining pain intensity and pain interference in nursing home residents. Age Ageing 2022; 51:6530460. [PMID: 35180286 PMCID: PMC8856601 DOI: 10.1093/ageing/afac008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction Face-to-face surveys are applied frequently when conducting research in older populations. Interviewers play a decisive role in data quality, may affect measurement and influence results. This study uses survey data about pain in nursing home residents and analyses, whether affiliation-of-interviewer (internal vs. external to nursing home) and gender-of-interviewer affect residents’ responses in terms of interviewer variance and systematically varying pain reports. Methods Overall, 258 nursing home residents with up to moderate cognitive impairment were examined by 61 interviewers about pain intensity and interference applying the Brief Pain Inventory. Interviewer variance was measured using intra-interviewer correlation coefficients (ρ). Two-factorial covariance analysis was applied to analyse whether pain intensity and interference scores differ by interviewer characteristics. Results Interviewer heterogeneity accounts for almost one quarter of total variance on average. Interviewer variance is higher for internal and male interviewers than for external and female interviewers. Covariance analyses show significant effects of interviewer characteristics on pain reports. Average pain intensity and interference scores vary considerably by interviewer gender and affiliation. Highest pain intensity was reported towards female internal and male external interviewers; highest pain interference was reported towards male external interviewers. Conclusion Residents’ answers substantially differ in relation to who is assessing pain. There is a risk of imprecise and biased survey estimates on sensitive topics like pain in nursing homes. Interviewer gender and affiliation seem to evoke gender-specific and status-related expectations and attributions which influence residents’ response process. Interviewer effects pose a considerable threat to survey data quality in institutionalised older populations.
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Affiliation(s)
- Patrick Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Juergen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Martin Weichbold
- Department of Sociology, Paris Lodron University Salzburg, A-5020 Salzburg, Austria
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Time Course of Acute Vertebral Fractures: A Prospective Multicenter Cohort Study. J Clin Med 2021; 10:jcm10245961. [PMID: 34945257 PMCID: PMC8704362 DOI: 10.3390/jcm10245961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/08/2021] [Accepted: 12/17/2021] [Indexed: 01/29/2023] Open
Abstract
To date, it is still unclear how fresh osteoporotic vertebral fractures (OVFs) affect the patient's quality of life and low back pain during a follow-up period of more than 1 year. In the previous trial, women with fresh OVF were randomized to rigid or soft brace for 12 weeks, then both groups were followed for the subsequent 48 weeks. In women completing this trial at our affiliated hospitals, we conducted a follow-up study to investigate the long-term course of an acute vertebral fracture in terms of pain and quality of life. When comparing visual analog scale scores for low back pain and European Quality of Life-5 Dimensions Questionnaire scores between consecutive time points, a significant difference was found between 0 and 12 weeks, but not between 12 and 48 weeks or between 48 weeks and final follow-up. A total 25% had residual low back pain at the final follow-up. A stepwise logistic regression analysis identified age and previous vertebral fracture as predictors of residual low back pain at the final follow-up. Therefore, the degree of low back pain and impairment of the quality of life improved by 12 weeks after injury and did not change thereafter until a mean follow-up of 5.3 years.
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Burton JK, Fearon P, Noel-Storr AH, McShane R, Stott DJ, Quinn TJ. Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the detection of dementia within a secondary care setting. Cochrane Database Syst Rev 2021; 7:CD010772. [PMID: 34278561 PMCID: PMC8406705 DOI: 10.1002/14651858.cd010772.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The diagnosis of dementia relies on the presence of new-onset cognitive impairment affecting an individual's functioning and activities of daily living. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is a questionnaire instrument, completed by a suitable 'informant' who knows the patient well, designed to assess change in functional performance secondary to cognitive change; it is used as a tool for identifying those who may have dementia. In secondary care there are two specific instances where patients may be assessed for the presence of dementia. These are in the general acute hospital setting, where opportunistic screening may be undertaken, or in specialist memory services where individuals have been referred due to perceived cognitive problems. To ensure an instrument is suitable for diagnostic use in these settings, its test accuracy must be established. OBJECTIVES To determine the accuracy of the informant-based questionnaire IQCODE for detection of dementia in a secondary care setting. SEARCH METHODS We searched the following sources on the 28th of January 2013: ALOIS (Cochrane Dementia and Cognitive Improvement Group), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), BIOSIS Previews (Thomson Reuters Web of Science), Web of Science Core Collection (includes Conference Proceedings Citation Index) (Thomson Reuters Web of Science), CINAHL (EBSCOhost) and LILACS (BIREME). We also searched sources specific to diagnostic test accuracy: MEDION (Universities of Maastricht and Leuven); DARE (Database of Abstracts of Reviews of Effects - via the Cochrane Library); HTA Database (Health Technology Assessment Database via the Cochrane Library) and ARIF (Birmingham University). We also checked reference lists of relevant studies and reviews, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on IQCODE for dementia diagnosis to try to find additional studies. We developed a sensitive search strategy; search terms were designed to cover key concepts using several different approaches run in parallel and included terms relating to cognitive tests, cognitive screening and dementia. We used standardised database subject headings such as MeSH terms (in MEDLINE) and other standardised headings (controlled vocabulary) in other databases, as appropriate. SELECTION CRITERIA We selected those studies performed in secondary-care settings, which included (not necessarily exclusively) IQCODE to assess for the presence of dementia and where dementia diagnosis was confirmed with clinical assessment. For the 'secondary care' setting we included all studies which assessed patients in hospital (e.g. acute unscheduled admissions, referrals to specialist geriatric assessment services etc.) and those referred for specialist 'memory' assessment, typically in psychogeriatric services. DATA COLLECTION AND ANALYSIS We screened all titles generated by electronic database searches, and reviewed abstracts of all potentially relevant studies. Two independent assessors checked full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool, and reporting quality using the STARD tool. MAIN RESULTS From 72 papers describing IQCODE test accuracy, we included 13 papers, representing data from 2745 individuals (n = 1413 (51%) with dementia). Pooled analysis of all studies using data presented closest to a cut-off of 3.3 indicated that sensitivity was 0.91 (95% CI 0.86 to 0.94); specificity 0.66 (95% CI 0.56 to 0.75); the positive likelihood ratio was 2.7 (95% CI 2.0 to 3.6) and the negative likelihood ratio was 0.14 (95% CI 0.09 to 0.22). There was a statistically significant difference in test accuracy between the general hospital setting and the specialist memory setting (P = 0.019), suggesting that IQCODE performs better in a 'general' setting. We found no significant differences in the test accuracy of the short (16-item) versus the 26-item IQCODE, or in the language of administration. There was significant heterogeneity in the included studies, including a highly varied prevalence of dementia (10.5% to 87.4%). Across the included papers there was substantial potential for bias, particularly around sampling of included participants and selection criteria, which may limit generalisability. There was also evidence of suboptimal reporting, particularly around disease severity and handling indeterminate results, which are important if considering use in clinical practice. AUTHORS' CONCLUSIONS The IQCODE can be used to identify older adults in the general hospital setting who are at risk of dementia and require specialist assessment; it is useful specifically for ruling out those without evidence of cognitive decline. The language of administration did not affect test accuracy, which supports the cross-cultural use of the tool. These findings are qualified by the significant heterogeneity, the potential for bias and suboptimal reporting found in the included studies.
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Affiliation(s)
- Jennifer K Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Patricia Fearon
- Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK
| | | | | | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow , UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Gillies K, Kearney A, Keenan C, Treweek S, Hudson J, Brueton VC, Conway T, Hunter A, Murphy L, Carr PJ, Rait G, Manson P, Aceves-Martins M. Strategies to improve retention in randomised trials. Cochrane Database Syst Rev 2021; 3:MR000032. [PMID: 33675536 PMCID: PMC8092429 DOI: 10.1002/14651858.mr000032.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Poor retention of participants in randomised trials can lead to missing outcome data which can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to improve retention but few have been formally evaluated. OBJECTIVES To quantify the effect of strategies to improve retention of participants in randomised trials and to investigate if the effect varied by trial setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Scopus, PsycINFO, CINAHL, Web of Science Core Collection (SCI-expanded, SSCI, CPSI-S, CPCI-SSH and ESCI) either directly with a specified search strategy or indirectly through the ORRCA database. We also searched the SWAT repository to identify ongoing or recently completed retention trials. We did our most recent searches in January 2020. SELECTION CRITERIA We included eligible randomised or quasi-randomised trials of evaluations of strategies to increase retention that were embedded in 'host' randomised trials from all disease areas and healthcare settings. We excluded studies aiming to increase treatment compliance. DATA COLLECTION AND ANALYSIS We extracted data on: the retention strategy being evaluated; location of study; host trial setting; method of randomisation; numbers and proportions in each intervention and comparator group. We used a risk difference (RD) and 95% confidence interval (CI) to estimate the effectiveness of the strategies to improve retention. We assessed heterogeneity between trials. We applied GRADE to determine the certainty of the evidence within each comparison. MAIN RESULTS We identified 70 eligible papers that reported data from 81 retention trials. We included 69 studies with more than 100,000 participants in the final meta-analyses, of which 67 studies evaluated interventions aimed at trial participants and two evaluated interventions aimed at trial staff involved in retention. All studies were in health care and most aimed to improve postal questionnaire response. Interventions were categorised into broad comparison groups: Data collection; Participants; Sites and site staff; Central study management; and Study design. These intervention groups consisted of 52 comparisons, none of which were supported by high-certainty evidence as determined by GRADE assessment. There were four comparisons presenting moderate-certainty evidence, three supporting retention (self-sampling kits, monetary reward together with reminder or prenotification and giving a pen at recruitment) and one reducing retention (inclusion of a diary with usual follow-up compared to usual follow-up alone). Of the remaining studies, 20 presented GRADE low-certainty evidence and 28 presented very low-certainty evidence. Our findings do provide a priority list for future replication studies, especially with regard to comparisons that currently rely on a single study. AUTHORS' CONCLUSIONS Most of the interventions we identified aimed to improve retention in the form of postal questionnaire response. There were few evaluations of ways to improve participants returning to trial sites for trial follow-up. None of the comparisons are supported by high-certainty evidence. Comparisons in the review where the evidence certainty could be improved with the addition of well-done studies should be the focus for future evaluations.
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Affiliation(s)
- Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anna Kearney
- Dept. of Health Data Science, University of Liverpool, Liverpool, UK
| | - Ciara Keenan
- Campbell UK & Ireland, Centre for Evidence and Social Innovation, Queen's University, Belfast, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Valerie C Brueton
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College, London, UK
| | - Thomas Conway
- Clinical Research Facility Galway, National University of Ireland Galway, Galway, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Louise Murphy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Peter J Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Paul Manson
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
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Tan LF, Chan YH, Tay A, Jayasundram J, Low NA, Merchant RA. Practicality and Reliability of Self Vs Administered Rapid Geriatric Assessment Mobile App. J Nutr Health Aging 2021; 25:1064-1069. [PMID: 34725662 PMCID: PMC8432277 DOI: 10.1007/s12603-021-1672-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/22/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To develop and cross-validate self-administered Rapid Geriatric Assessment (SA-RGA) app against administered Rapid Geriatric Assessment (A-RGA) to identify seniors with geriatric syndromes such as frailty, sarcopenia, and anorexia of ageing who may benefit from targeted intervention. DESIGN Prospective observational study. SETTING Primary Care and Community. PARTICIPANTS A-RGA and SA-RGA app were administered to older adults ≥ 60 years old from December 2020 to April 2021. MEASUREMENTS The RGA app screens for frailty (FRAIL), sarcopenia (SARC-F), anorexia of aging (SNAQ) and cognition (Rapid Cognitive Screen) with assisted management pathway. Patient Health Questionnaire 9 is administered for those who score positive for fatigue. The diagnostic performance of SA-RGA was compared against A-RGA as a reference by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and positive likelihood ratio (+LR). RESULTS 123 participants with a mean age of 71 ± 5.9 years completed both the SA-RGA and A-RGA. Questions on fatigue, 5 or more illnesses, loss of weight and falls in the past year performed better with high sensitivity, specificity, NPV and +LR than self-functional assessment where SA-RGA participants reported lower prevalence on the FRAIL scale aerobic and resistance components, and higher prevalence on the SARC-F strength and rising from a chair components. CONCLUSION The SA-RGA app performed well in certain domains such as assessment for weight loss, falls, number of chronic illness and fatigue. Self-functional assessment can be improved further by removing ambiguity in wordings such as "some" or "a lot" and replacing it with functional difficulty scale. SA-RGA has the potential to be incorporated in the eHEALTH platforms worldwide for early identifications of older adults at risk and to reduce health inequalities, at the same time building community resilience in the era of Covid-19 pandemic.
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Affiliation(s)
- L F Tan
- Associate Professor Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, , ORCID iD: 0000-0002-9032-0184
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Validation of the French version of the LEIPAD in community-dwelling people aged 80 years and above. PLoS One 2019; 14:e0213907. [PMID: 30889200 PMCID: PMC6424406 DOI: 10.1371/journal.pone.0213907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/05/2019] [Indexed: 11/19/2022] Open
Abstract
Background Few studies have addressed health-related quality of life in community-dwelling individuals aged 80 years and above and very few self-assessment quality of life questionnaires have been formally validated in these populations. This study aimed to validate a French version of the LEIPAD, a self-administered questionnaire assessing the health-related quality of life of people aged 80 years and over. Method A cross-sectional study of people aged 80 years and over living at home in France was conducted. All subjects recruited were sent a letter explaining the study and requesting their consent to take part. Those who accepted then received the questionnaires, including the LEIPAD, which assesses health-related quality of life in the subjects aged 65 years and above. We assessed its psychometric properties: data completeness, score distribution, floor and ceiling effects, internal consistency, item-total correlations, inter-scale correlations, reliability and convergent validity with the Medical Outcome Study Short-Form 36 (SF-36). Results The results obtained from 184 older people (mean age of 83.9 years, standard deviation 3.3) showed very good acceptability (missing data between 1.1% and 11.4% for LEIPAD scales) Factor analysis of the instrument confirmed the multi-dimensional structure in seven independent scales similar to the original version. Good internal consistency (Cronbach’s alpha ranging from 0.68 to 0.87) and strong test-retest reliability of the LEIPAD scales (intraclass correlation coefficients ranging from 0.77 to 0.95) were found. Convergent validity with the SF-36 showed moderate to strong correlations, consistent with the hypotheses stated. Conclusions The validation of this specific questionnaire will make it possible to investigate individually the health-related quality of life of French older people living at home and will enable French-speaking investigators to contribute to national and international research projects.
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Jones D, Story D, Clavisi O, Jones R, Peyton P. An Introductory Guide to Survey Research in Anaesthesia. Anaesth Intensive Care 2019; 34:245-53. [PMID: 16617649 DOI: 10.1177/0310057x0603400219] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surveys allow convenient and inexpensive research. Surveys include mail-out questionnaires, email questionnaires, telephone interviews, and personal interviews. Despite a widespread perception that surveys are easy to conduct, good surveys need rigorous design, implementation and analysis. This requires substantial planning, time and effort. The most important step in designing a survey is to clearly define the question (s) the survey aims to answer. The target population, measured variables and types of associations being investigated should be specific and unambiguous. Investigators should concentrate on what they ‘need to know’ rather than what would be ‘nice to know’. During development surveys should be piloted to identify problems. The main goal when implementing a survey is to maximize the response rate to avoid misleading results. Evidence-based strategies, including brief personalized surveys with stamped return envelopes, can be used to maximize the response rate. A poorly conducted survey can lead to misleading or invalid conclusions and may undermine participation in subsequent surveys by the target population.
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Affiliation(s)
- D Jones
- Trials Group, Australian and New Zealand College of Anaesthetists, Melbourne, Victoria, Australia
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Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties. Crit Care Med 2015; 43:1731-44. [PMID: 25821917 DOI: 10.1097/ccm.0000000000000980] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties. DATA SOURCES We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013. STUDY SELECTION Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility. DATA EXTRACTION Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies. DATA SYNTHESIS The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce. CONCLUSIONS Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.
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Malavige LS, Wijesekara P, Epa DS, Ranasinghe P, Levy JC. Ethnicity and neighbourhood deprivation determines the response rate in sexual dysfunction surveys. BMC Res Notes 2015; 8:410. [PMID: 26338674 PMCID: PMC4558757 DOI: 10.1186/s13104-015-1387-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/24/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Self-administered questionnaires provide a better alternative to disclose sensitive information in sexual health research. We describe the factors that determine the positive response (initial recruitment) to an initial invitation and subsequent completion of study to a postal questionnaire on sexual dysfunction. METHODS South Asians (SA) and Europids with and without diabetes (DM) were recruited from GP clinics in UK. Men who returned the properly filled consent form ('recruited-group') were sent the questionnaire and those who returned it were considered as the 'completed-group'. Index of Multiple Deprivation Scores (IMDs) were generated using UK postcodes. We calculated the recruitment rate and completion rate of the recruited and the study-completed groups respectively. RESULTS Total approached sample was 9100 [DM: 2914 (32%), SA: 4563 (50.1%)]. Recruitment rate was 8.8% and was higher in Europids and in patients with DM. Mean IMDs for the recruited group was 20.9 ± 11.9, and it was higher among recruited SA compared to Europids (p < 0.001). Mean IMDs was higher in the recruited group compared to non-recruited (p < 0.01). All four recruited groups (SA/Europid and DM/non-DM) had lower IMDs compared to non-recruited. Completion rate was 71.5% (n 544) (SA: 62.3%, Europids: 77.4%; p < 0.05). CONCLUSION Recruitment for postal sexual health surveys is positively influenced by presence of investigated disease, older age, being from lesser deprived areas and Europid ethnicity. Furthermore, Europids were more likely to complete survey than South Asians irrespective of disease status.
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Affiliation(s)
- Lasantha S Malavige
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ, UK. .,Genetech Research Institute, Colombo, Sri Lanka.
| | | | | | - Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Jonathan C Levy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ, UK.
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de Graaf MW, El Moumni M, Heineman E, Wendt KW, Reininga IHF. Short Musculoskeletal Function Assessment: normative data of the Dutch population. Qual Life Res 2015; 24:2015-23. [PMID: 25676859 PMCID: PMC4493935 DOI: 10.1007/s11136-015-0929-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND The Short Musculoskeletal Function Assessment (SMFA) is widely used in both research and clinical practice. Despite its frequent use, normative data of the SMFA have remained limited. Aim of this study was to gather normative data for the Dutch SMFA (SMFA-NL). METHODS The SMFA-NL consists of two indices (function index and bother index) and four subscales (upper extremity dysfunction, lower extremity dysfunction, mental and emotional problems, and problems with daily activities). A total of 900 patients were invited to fill in the SMFA-NL. Six age groups (18-24, 25-34, 35-44, 45-54, 55-64, and 65-75 years) were constructed. Analysis of variance, t tests, and regression analyses were used to assess age and gender effects. RESULTS The response rate was 97 %. There was a significant difference between men and women in scores on all indices and subscales (range p < 0.001 to p = 0.002), except for the upper extremity dysfunction subscale (p = 0.06). A significant interaction effect was found between gender and age for the upper extremity dysfunction subscale; a larger decrease in score with increasing age was observed for women, compared with men. Significant differences were found between age groups for the bother index (p < 0.001), lower extremity dysfunction subscale (p = 0.001), and the problems with daily activities subscale (p = 0.002). CONCLUSION Significant differences in SMFA-NL scores were found between men and women and between different age groups. These SMFA-NL normative data provide an opportunity of benchmarking health status of participants with musculoskeletal disorders or injuries against their age- and gender-matched peers in the Dutch population.
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Affiliation(s)
- M W de Graaf
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands,
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12
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van Leeuwen KM, Jansen APD, Muntinga ME, Bosmans JE, Westerman MJ, van Tulder MW, van der Horst HE. Exploration of the content validity and feasibility of the EQ-5D-3L, ICECAP-O and ASCOT in older adults. BMC Health Serv Res 2015; 15:201. [PMID: 25976227 PMCID: PMC4435604 DOI: 10.1186/s12913-015-0862-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/05/2015] [Indexed: 11/30/2022] Open
Abstract
Background In economic evaluations of care services for older adults health-related quality of life (QoL) measures such as the EQ-5D are increasingly replaced by the ICECAP-O and ASCOT, which cover a broader scope of QoL than health alone. Little is known about the content validity and feasibility of these measures. The purpose of this study was to explore the content validity and feasibility of the EQ-5D-3L, ICECAP-O and ASCOT in older adults. Methods Ten older adults were purposively sampled using a maximum variation principle. Think-aloud and verbal probing techniques were used to identify response issues encountered during the interpretation of items and the selection of response options. We used constant comparative methods to analyse the data. Results Two types of response issues were identified for various items in all three measures: interpretation issues and positive responses. Issues with the mapping of a response on one of the response options were least often encountered for the EQ-5D-3L items. Older adults considered the items of the ICECAP-O and ASCOT valuable though more abstract than the EQ-5D-3L. Conclusions Researchers who intend to use the EQ-5D, ICECAP-O or ASCOT in economic evaluations of care services for older adults, should be aware of the response issues that occur during the administration of these measures. Older adults perceived none of the measures as providing a comprehensive picture of their QoL. A preference from older adults for one of the measures depends on the extent to which the items reflect current personal concerns in life.
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Affiliation(s)
- Karen M van Leeuwen
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Aaltje P D Jansen
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Maaike E Muntinga
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Medical Humanities and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Judith E Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Marjan J Westerman
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Maurits W van Tulder
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Henriette E van der Horst
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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O'Caoimh R, Cornally N, Weathers E, O'Sullivan R, Fitzgerald C, Orfila F, Clarnette R, Paúl C, Molloy DW. Risk prediction in the community: A systematic review of case-finding instruments that predict adverse healthcare outcomes in community-dwelling older adults. Maturitas 2015; 82:3-21. [PMID: 25866212 DOI: 10.1016/j.maturitas.2015.03.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 12/18/2022]
Abstract
Few case-finding instruments are available to community healthcare professionals. This review aims to identify short, valid instruments that detect older community-dwellers risk of four adverse outcomes: hospitalisation, functional-decline, institutionalisation and death. Data sources included PubMed and the Cochrane library. Data on outcome measures, patient and instrument characteristics, and trial quality (using the Quality In Prognosis Studies [QUIPS] tool), were double-extracted for derivation-validation studies in community-dwelling older adults (>50 years). Forty-six publications, representing 23 unique instruments, were included. Only five were externally validated. Mean patient age range was 64.2-84.6 years. Most instruments n=18, (78%) were derived in North America from secondary analysis of survey data. The majority n=12, (52%), measured more than one outcome with hospitalisation and the Probability of Repeated Admission score the most studied outcome and instrument respectively. All instruments incorporated multiple predictors. Activities of daily living n=16, (70%), was included most often. Accuracy varied according to instruments and outcomes; area under the curve of 0.60-0.73 for hospitalisation, 0.63-0.78 for functional decline, 0.70-0.74 for institutionalisation and 0.56-0.82 for death. The QUIPS tool showed that 5/23 instruments had low potential for bias across all domains. This review highlights the present need to develop short, reliable, valid instruments to case-find older adults at risk in the community.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland.
| | - Nicola Cornally
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; School of Nursing and Midwifery, University College Cork, Ireland
| | - Elizabeth Weathers
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; School of Nursing and Midwifery, University College Cork, Ireland
| | - Ronan O'Sullivan
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland
| | - Carol Fitzgerald
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland
| | - Francesc Orfila
- Institute for Research Primary Healthcare, Jordi Gol University, Barcelona, Spain
| | - Roger Clarnette
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia
| | - Constança Paúl
- Institute of Biomedical Sciences Abel Salazar - University of Porto, Porto, Portugal
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland
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Harrison JK, Fearon P, Noel-Storr AH, McShane R, Stott DJ, Quinn TJ. Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia within a secondary care setting. Cochrane Database Syst Rev 2015:CD010772. [PMID: 25754745 DOI: 10.1002/14651858.cd010772.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The diagnosis of dementia relies on the presence of new-onset cognitive impairment affecting an individual's functioning and activities of daily living. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is a questionnaire instrument, completed by a suitable 'informant' who knows the patient well, designed to assess change in functional performance secondary to cognitive change; it is used as a tool to identifying those who may have dementia.In secondary care there are two specific instances where patients may be assessed for the presence of dementia. These are in the general acute hospital setting, where opportunistic screening may be undertaken, or in specialist memory services where individuals have been referred due to perceived cognitive problems. To ensure an instrument is suitable for diagnostic use in these settings, its test accuracy must be established. OBJECTIVES To determine the diagnostic accuracy of the informant-based questionnaire IQCODE, for detection of all-cause (undifferentiated) dementia in adults presenting to secondary-care services. SEARCH METHODS We searched the following sources on the 28th of January 2013: ALOIS (Cochrane Dementia and Cognitive Improvement Group), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), BIOSIS Previews (Thomson Reuters Web of Science), Web of Science Core Collection (includes Conference Proceedings Citation Index) (Thomson Reuters Web of Science), CINAHL (EBSCOhost) and LILACS (BIREME). We also searched sources specific to diagnostic test accuracy: MEDION (Universities of Maastricht and Leuven); DARE (Database of Abstracts of Reviews of Effects - via the Cochrane Library); HTA Database (Health Technology Assessment Database via the Cochrane Library) and ARIF (Birmingham University). We also checked reference lists of relevant studies and reviews, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on IQCODE for dementia diagnosis to try to find additional studies. We developed a sensitive search strategy; search terms were designed to cover key concepts using several different approaches run in parallel and included terms relating to cognitive tests, cognitive screening and dementia. We used standardised database subject headings such as MeSH terms (in MEDLINE) and other standardised headings (controlled vocabulary) in other databases, as appropriate. SELECTION CRITERIA We selected those studies performed in secondary-care settings, which included (not necessarily exclusively) IQCODE to assess for the presence of dementia and where dementia diagnosis was confirmed with clinical assessment. For the 'secondary care' setting we included all studies which assessed patients in hospital (e.g. acute unscheduled admissions, referrals to specialist geriatric assessment services etc.) and those referred for specialist 'memory' assessment, typically in psychogeriatric services. DATA COLLECTION AND ANALYSIS We screened all titles generated by electronic database searches, and reviewed abstracts of all potentially relevant studies. Two independent assessors checked full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool, and reporting quality using the STARD tool. MAIN RESULTS From 72 papers describing IQCODE test accuracy, we included 13 papers, representing data from 2745 individuals (n = 1413 (51%) with dementia). Pooled analysis of all studies using data presented closest to a cut-off of 3.3 indicated that sensitivity was 0.91 (95% CI 0.86 to 0.94); specificity 0.66 (95% CI 0.56 to 0.75); the positive likelihood ratio was 2.7 (95% CI 2.0 to 3.6) and the negative likelihood ratio was 0.14 (95% CI 0.09 to 0.22).There was a statistically significant difference in test accuracy between the general hospital setting and the specialist memory setting (P = 0.019), suggesting that IQCODE performs better in a 'general' setting.We found no significant differences in the test accuracy of the short (16-item) versus the 26-item IQCODE, or in the language of administration.There was significant heterogeneity in the included studies, including a highly varied prevalence of dementia (10.5% to 87.4%). Across the included papers there was substantial potential for bias, particularly around sampling of included participants and selection criteria, which may limit generalisability. There was also evidence of suboptimal reporting, particularly around disease severity and handling indeterminate results, which are important if considering use in clinical practice. AUTHORS' CONCLUSIONS The IQCODE can be used to identify older adults in the general hospital setting who are at risk of dementia and require specialist assessment; it is useful specifically for ruling out those without evidence of cognitive decline. The language of administration did not affect test accuracy, which supports the cross-cultural use of the tool. These findings are qualified by the significant heterogeneity, the potential for bias and suboptimal reporting found in the included studies.
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Affiliation(s)
- Jennifer K Harrison
- Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Leicester, UK, LE1 5WW
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Kelfve S, Lennartsson C, Agahi N, Modig K. Do postal health surveys capture morbidity and mortality in respondents aged 65 years and older? A register-based validation study. Scand J Public Health 2015; 43:348-55. [DOI: 10.1177/1403494815575340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
Abstract
Aims: Non-response to population surveys is a common problem in epidemiological and public health research. Systematic non-response threatens the validity of results. Researchers rarely evaluate the magnitude of systematic non-response because of limited access to population data. This study explores how well morbidity and mortality in postal survey respondents aged 65 years and older represented that of the target population. Methods: The 2010 Stockholm Public Health Survey and the Swedish Population Register were linked to the Cause of Death Register and the National Patient Register in Sweden. Differences were analysed between the response group and the corresponding population in mortality, hospital admission, days spent in hospital and number of diagnoses. Finally, data were weighted for non-response to see if this improved generalizability. Results: Non-response increased with age, and this increase was more pronounced among women than men. Respondents were marginally less often admitted to hospital, hospitalized fewer days and had slightly fewer diagnoses than the population, in particular after age 80. Significantly fewer women died in the response group than in the population as a whole. In terms of mortality among men and in terms of hospitalizations for most age groups, the respondents represented the population fairly well. Non-response weighting adjustment did not improve generalizability. Conclusions: Postal questionnaires are likely to capture morbidity (hospitalization) among women and men aged 65-80 years old and mortality among men, while morbidity after age 80 and mortality in women are likely to be underestimated.
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Affiliation(s)
- Susanne Kelfve
- Aging Research Center, Karolinska Institutet & Stockholm University, Sweden
- Department of Sociology, Stockholm University, Sweden
| | - Carin Lennartsson
- Aging Research Center, Karolinska Institutet & Stockholm University, Sweden
| | - Neda Agahi
- Aging Research Center, Karolinska Institutet & Stockholm University, Sweden
| | - Karin Modig
- Institute of Environmental Epidemiology, Karolinska Institutet, Sweden
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A survey on biosecurity and management practices in selected Belgian cattle farms. Prev Vet Med 2014; 117:129-39. [PMID: 25156945 DOI: 10.1016/j.prevetmed.2014.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/25/2014] [Accepted: 07/31/2014] [Indexed: 11/22/2022]
Abstract
The shift from cure towards prevention in veterinary medicine involves the implementation of biosecurity, which includes all measures preventing pathogens from entering a herd and reducing the spread of pathogens within a herd. In Belgium no studies have considered the implementation of biosecurity measures in the daily management of cattle farms. Therefore the aim of the study was to map the current application of biosecurity measures in Belgian cattle farms in the prevention of disease transmission within and between farms. Between March 2011 and April 2013 the data were collected as part of a larger cross-sectional study, conducted to identify risk factors for reinfection with BVDV in cattle herds assumed free from BVDV. Questionnaire data from 33 dairy farms, 16 beef farms and 25 mixed (dairy and beef cattle) farms were analyzed using a combination of a linear scoring system, a categorical principal component analysis and a two-step cluster analysis to differentiate these farms based on their biosecurity levels and visit frequencies. Further enhancement of preventive measures considering external and internal biosecurity was still possible for each farm, as none of the farms obtained an overall high biosecurity level. Three groups of cattle farms were differentiated with a biosecurity level varying from low to high-medium, of which the group with the lowest biosecurity level mainly consisted of mixed farms. Animal-to-animal contacts with cattle from other herds were frequently possible as only 12% of the farmers purchasing cattle quarantined purchased animals at least three weeks and contacts over fences on pasture were possible in 70% of the herds. Basic biosecurity measures such as farm-specific protective clothing and boots were present in the majority of the farms, but they were insufficiently or incorrectly used. Cattle farms were very often visited by professional visitors of which the herd veterinarian, the AI technician and the cattle salesman most frequently entered the farm. It can be concluded that few biosecurity measures were undertaken by Belgian cattle farmers, thereby exposing themselves to the risk of disease transmission within and between farms. Especially in regions with a high cattle density, small distances to neighbouring farms and high frequencies of professional visits, a farm-specific preventive strategy should be developed, thereby using the facilities often already present on the farm.
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Brueton VC, Tierney J, Stenning S, Harding S, Meredith S, Nazareth I, Rait G. Strategies to improve retention in randomised trials. Cochrane Database Syst Rev 2013:MR000032. [PMID: 24297482 PMCID: PMC4470347 DOI: 10.1002/14651858.mr000032.pub2] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Loss to follow-up from randomised trials can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to reduce loss to follow-up and improve retention but few have been formally evaluated. OBJECTIVES To quantify the effect of strategies to improve retention on the proportion of participants retained in randomised trials and to investigate if the effect varied by trial strategy and trial setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PreMEDLINE, EMBASE, PsycINFO, DARE, CINAHL, Campbell Collaboration's Social, Psychological, Educational and Criminological Trials Register, and ERIC. We handsearched conference proceedings and publication reference lists for eligible retention trials. We also surveyed all UK Clinical Trials Units to identify further studies. SELECTION CRITERIA We included eligible retention trials of randomised or quasi-randomised evaluations of strategies to increase retention that were embedded in 'host' randomised trials from all disease areas and healthcare settings. We excluded studies aiming to increase treatment compliance. DATA COLLECTION AND ANALYSIS We contacted authors to supplement or confirm data that we had extracted. For retention trials, we recorded data on the method of randomisation, type of strategy evaluated, comparator, primary outcome, planned sample size, numbers randomised and numbers retained. We used risk ratios (RR) to evaluate the effectiveness of the addition of strategies to improve retention. We assessed heterogeneity between trials using the Chi(2) and I(2) statistics. For main trials that hosted retention trials, we extracted data on disease area, intervention, population, healthcare setting, sequence generation and allocation concealment. MAIN RESULTS We identified 38 eligible retention trials. Included trials evaluated six broad types of strategies to improve retention. These were incentives, communication strategies, new questionnaire format, participant case management, behavioural and methodological interventions. For 34 of the included trials, retention was response to postal and electronic questionnaires with or without medical test kits. For four trials, retention was the number of participants remaining in the trial. Included trials were conducted across a spectrum of disease areas, countries, healthcare and community settings. Strategies that improved trial retention were addition of monetary incentives compared with no incentive for return of trial-related postal questionnaires (RR 1.18; 95% CI 1.09 to 1.28, P value < 0.0001), addition of an offer of monetary incentive compared with no offer for return of electronic questionnaires (RR 1.25; 95% CI 1.14 to 1.38, P value < 0.00001) and an offer of a GBP20 voucher compared with GBP10 for return of postal questionnaires and biomedical test kits (RR 1.12; 95% CI 1.04 to 1.22, P value < 0.005). The evidence that shorter questionnaires are better than longer questionnaires was unclear (RR 1.04; 95% CI 1.00 to 1.08, P value = 0.07) and the evidence for questionnaires relevant to the disease/condition was also unclear (RR 1.07; 95% CI 1.01 to 1.14). Although each was based on the results of a single trial, recorded delivery of questionnaires seemed to be more effective than telephone reminders (RR 2.08; 95% CI 1.11 to 3.87, P value = 0.02) and a 'package' of postal communication strategies with reminder letters appeared to be better than standard procedures (RR 1.43; 95% CI 1.22 to 1.67, P value < 0.0001). An open trial design also appeared more effective than a blind trial design for return of questionnaires in one fracture prevention trial (RR 1.37; 95% CI 1.16 to 1.63, P value = 0.0003).There was no good evidence that the addition of a non-monetary incentive, an offer of a non-monetary incentive, 'enhanced' letters, letters delivered by priority post, additional reminders, or questionnaire question order either increased or decreased trial questionnaire response/retention. There was also no evidence that a telephone survey was either more or less effective than a monetary incentive and a questionnaire. As our analyses are based on single trials, the effect on questionnaire response of using offers of charity donations, sending reminders to trial sites and when a questionnaire is sent, may need further evaluation. Case management and behavioural strategies used for trial retention may also warrant further evaluation. AUTHORS' CONCLUSIONS Most of the retention trials that we identified evaluated questionnaire response. There were few evaluations of ways to improve participants returning to trial sites for trial follow-up. Monetary incentives and offers of monetary incentives increased postal and electronic questionnaire response. Some other strategies evaluated in single trials looked promising but need further evaluation. Application of the findings of this review would depend on trial setting, population, disease area, data collection and follow-up procedures.
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Affiliation(s)
| | - Jayne Tierney
- Meta-analysis Group, MRC Clinical Trials Unit at UCLLondon, UK
| | | | - Seeromanie Harding
- Social and Public Health Sciences Unit, Medical Research CouncilGlasgow, UK
| | | | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College LondonLondon, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College LondonLondon, UK
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McLean C, Kerse N, Moyes SA, Ng T, Lin SYS, Peri K. Recruiting older people for research through general practice: the Brief Risk Identification Geriatric Health Tool trial. Australas J Ageing 2013; 33:257-63. [PMID: 24520915 DOI: 10.1111/ajag.12058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To describe successful methods of recruitment and identify practice characteristics related to increased recruitment of older people for a randomised controlled trial. METHODS General practices in three regions of New Zealand and community-dwelling patients aged 75+ were recruited for the Brief Risk Identification Geriatric Health Tool trial. General practitioners (GPs) were faxed invitations with telephone follow-up. Reply-paid cards with telephone follow-up were used to invite older people. GP and practice characteristics were examined in relationship to recruitment rate. RESULTS During 2007-2008, 158 of 438 GPs (36%) in 60 of 116 practices approached (52%) were recruited. Regional variation was marked and 3893 of 8308 invited (49%) older people were recruited. The GP's length of time at the practice and training in New Zealand was associated with recruitment success. CONCLUSIONS Despite variability in practice recruitment, a reasonably large and representative sample of older people was recruited through general practices.
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Affiliation(s)
- Christine McLean
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
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Thorén ES, Oberg M, Wänström G, Andersson G, Lunner T. Internet access and use in adults with hearing loss. J Med Internet Res 2013; 15:e91. [PMID: 23659867 PMCID: PMC3650922 DOI: 10.2196/jmir.2221] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/02/2012] [Accepted: 03/26/2013] [Indexed: 11/23/2022] Open
Abstract
Background The future rehabilitation of adults with hearing loss is likely to involve online tools used by individuals at home. Online tools could also be useful for people who are not seeking professional help for their hearing problems. Hearing impairment is a disability that increases with age, and increased age is still associated with reduced use of the Internet. Therefore, to continue the research on online audiological rehabilitative tools for people with hearing loss, it is important to determine if and to what extent adults with hearing loss use the Internet. Objective To evaluate the use of the Internet and email in a group of adults with hearing loss and to investigate if their use of Internet and email differed between genders, among different age groups, and how it compared with the general population in Sweden. Methods Questionnaires containing multiple-choice questions about Internet access, email use, and educational level were mailed to individuals with hearing loss, who were registered as patients at a hearing aid clinic. Out of the 269 invited participants, 158 returned a completed questionnaire, which was a response rate of 58.7%. Results The results showed that 60% (94/158) of the participants with hearing loss used computers and the Internet. The degree of hearing loss in the group of participants did not explain the level of Internet usage, while factors of age, gender, and education did (P<.001). More men than women used the Internet (OR 2.54, 95% CI 1.32-4.91, P<.001). Use of the Internet was higher in the youngest age group (25-64 years) compared to the oldest age group (75-96 years, P=.001). A higher usage of the Internet was observed in the participants with hearing loss, especially the elderly, when compared with the general population of Sweden (OR 1.74, 95% CI 1.23-3.17, P=.04). Conclusions We conclude that the use of computers and the Internet overall is at least at the same level for people with hearing loss as for the general age-matched population in Sweden, but that this use is even higher in specific age groups. These results are important for the future work in developing and evaluating rehabilitative educational online tools for adults with hearing loss.
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Affiliation(s)
- Elisabet Sundewall Thorén
- Division of Technical Audiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Haywood KL, Garratt AM, Fitzpatrick R. Quality of life in older people: a structured review of self-assessed health instruments. Expert Rev Pharmacoecon Outcomes Res 2012; 6:181-94. [PMID: 20528554 DOI: 10.1586/14737167.6.2.181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A range of terms (including quality of life, health-related quality of life and health status) describe a broad set of aspects of self-reported health that can be captured by questionnaires and related instruments. Health in older people particularly requires attention to broader aspects of the impact of health on physical, social and psychological function. A structured review was performed to assess how well such issues are measured by available instruments. A total of 45 instruments were identified that have received some degree of evaluation to establish their use in assessing the health of older individuals. Two types of instruments were included in the review: generic and older-people-specific instruments. The SF-36 has by far the largest evidence base to support its use in older people. The OMFAQ has the best evidence base amongst older-people-specific instruments. Many instruments have only minimal evidence of measurement properties. Concepts such as quality of life are still defined and used in a variety of ways, and major questions must be addressed before uniform practice emerges in this important area of health policy.
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Affiliation(s)
- Kirstie L Haywood
- College of Nursing Institute, Radcliffe Infirmary, Royal, Woodstock Road, Oxford, OX2 6HE, UK.
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de Waal MWM, van der Weele GM, van der Mast RC, Assendelft WJJ, Gussekloo J. The influence of the administration method on scores of the 15-item Geriatric Depression Scale in old age. Psychiatry Res 2012; 197:280-4. [PMID: 22353401 DOI: 10.1016/j.psychres.2011.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 08/26/2011] [Accepted: 08/28/2011] [Indexed: 11/18/2022]
Abstract
Many rating scales can be self-administered or interviewer-administered, and the influence of administration method on scores is unclear. We aimed to study this influence on scores of the Geriatric Depression Scale (GDS-15), used as a screening instrument in general practice. In two general practices 376 registered patients aged 75 years and older were asked to participate. Exclusion criteria were dementia and current treatment for depression. The GDS-15 was administered twice within 1 month: self-administered by mail, and interviewer-administered during home visits. The sequence of administering the methods was different for the two practices. We analyzed differences in total and item GDS-scores. Of 141 subjects who participated (response rate 55%) 59 were men (42%). Mean age was 81.4 years (SD 4.8). When the GDS-15 was self-administered, 33 subjects (23.4%) left items unanswered. There were no items unanswered when the GDS-15 was interviewer-administered. On average the self-administered total GDS scores were 0.70 points higher than interviewer-administered scores (95% confidence interval=0.41; 0.98), with a large range of variation in the scores (limits of agreement -2.69 to 4.08). Item-item comparisons showed high percentages of agreement. Chance-corrected agreement (kappa) was moderate to fair, but three items showed only slight agreement (kappa values <0.21). In conclusion, compared to interviewer-administered scores, scores on the GDS-15 when self-administered were higher. The method of administration should be taken into account when interpreting scores.
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Affiliation(s)
- Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
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Kharicha K, Iliffe S, Harari D, Swift CG, Goodman C, Manthorpe J, Gillmann G, Stuck AE. Feasibility of repeated use of the Health Risk Appraisal for Older people system as a health promotion tool in community-dwelling older people: retrospective cohort study 2001-05. Age Ageing 2012; 41:128-31. [PMID: 21984330 DOI: 10.1093/ageing/afr126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kalpa Kharicha
- Research Department of Primary Care and Population Health, UCL, London, UK.
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Tucker S, Brand C, O'Shea S, Abendstern M, Clarkson P, Hughes J, Wenborn J, Challis D. An Evaluation of the Use of Self-Assessment for the Provision of Community Equipment and Adaptations in English Local Authorities. Br J Occup Ther 2011. [DOI: 10.4276/030802211x12996065859201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: The Government plans to transform adult social care in England. Future services will place more emphasis on prevention and enablement, and promoting personalisation and choice. Self-assessment is one possible facilitator of this agenda. However, little is known about its utility in social care. This evaluation examined how eight local authorities employed self-assessment in the provision of community equipment and adaptations, and explored the implications for service delivery. Method: A multiple case study was employed, using a mixed methods approach. This drew on internal documents, management interviews, and service user and administrative records. Findings: Self-assessment was primarily used to facilitate service access. Although the authorities differed in the way in which they operationalised self-assessment, professional staff were almost always involved. The differences between people receiving self and traditional assessments were modest, but the people undertaking self-assessments in preventative services formed a particularly healthy subgroup. There was little consensus about the items suitable for provision through self-assessment. Conclusion: The concept of self-assessment was variously interpreted and not all its possible uses were explored. Nevertheless, the evaluation suggested that self-assessment can facilitate access to community equipment and adaptations and has the potential to extend the population traditionally served by social care services, thereby addressing the preventative agenda.
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Affiliation(s)
- Sue Tucker
- Research Fellow, Personal Social Services Research Unit, University of Manchester, Manchester
| | - Christian Brand
- Research Associate, Personal Social Services Research Unit, University of Manchester, Manchester
| | - Susan O'Shea
- PhD Researcher and Teaching Assistant, formerly at the Personal Social Services Research Unit, University of Manchester, Manchester
| | - Michele Abendstern
- Research Associate, Personal Social Services Research Unit, University of Manchester, Manchester
| | - Paul Clarkson
- Research Fellow, Personal Social Services Research Unit, University of Manchester, Manchester
| | - Jane Hughes
- Lecturer, Personal Social Services Research Unit, University of Manchester, Manchester
| | - Jennifer Wenborn
- Clinical Research Fellow, Department of Mental Health Sciences, University College, London
| | - David Challis
- Professor of Community Care Research and Director of PSSRU, Personal Social Services Research Unit, University of Manchester, Manchester
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Anastario MP, Rodriguez HP, Gallagher PM, Cleary PD, Shaller D, Rogers WH, Bogen K, Safran DG. A randomized trial comparing mail versus in-office distribution of the CAHPS Clinician and Group Survey. Health Serv Res 2010; 45:1345-59. [PMID: 20579126 DOI: 10.1111/j.1475-6773.2010.01129.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the effect of survey distribution protocol (mail versus handout) on data quality and measurement of patient care experiences. DATA SOURCES/STUDY SETTING Multisite randomized trial of survey distribution protocols. Analytic sample included 2,477 patients of 15 clinicians at three practice sites in New York State. DATA COLLECTION/EXTRACTION METHODS Mail and handout distribution modes were alternated weekly at each site for 6 weeks. PRINCIPAL FINDINGS Handout protocols yielded an incomplete distribution rate (74 percent) and lower overall response rates (40 percent versus 58 percent) compared with mail. Handout distribution rates decreased over time and resulted in more favorable survey scores compared with mailed surveys. There were significant mode-physician interaction effects, indicating that data cannot simply be pooled and adjusted for mode. CONCLUSIONS In-office survey distribution has the potential to bias measurement and comparison of physicians and sites on patient care experiences. Incomplete distribution rates observed in-office, together with between-office differences in distribution rates and declining rates over time suggest staff may be burdened by the process and selective in their choice of patients. Further testing with a larger physician and site sample is important to definitively establish the potential role for in-office distribution in obtaining reliable, valid assessment of patient care experiences.
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Abduelkarem AR, Sackville MA, Morgan RM, Sackville MP, Hildreth AJ. Views and practices of community pharmacists regarding services for people with type 2 diabetes. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/0022357021990] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To describe the views and practices of community pharmacists regarding services for people with type 2 diabetes.
Method
A cross-sectional questionnaire survey of a convenience sample of 317 community pharmacists in the North East of England. The 26-item questionnaire covered the setting of the pharmacy, dispensing medication, and the pharmacist's role in the primary prevention of diabetes, detecting undiagnosed diabetes and prevention of complications.
Key findings
There was a 51% response rate. More than 80% of respondents reported that they saw patients with diabetes “very often” or “often” when they collected their prescriptions, but three-quarters reported that they “never/rarely” or only “sometimes” advised patients what to expect from their medication and gave information to help them have a better understanding of their disease. More than 90% of the pharmacists believed that a healthy lifestyle is important, but the majority were “never/rarely” or only “sometimes” involved in its promotion. Around 10 per cent of the respondents reported that they “often” or “very often” promoted regular eye examinations. Home blood glucose monitoring was promoted by 50% of the respondents. The majority reported that they checked prescriptions for drug interactions.
Conclusion
This study found that community pharmacists' advice and services to people with type 2 diabetes fell short of the standards and objectives set out in the National Service Framework for Diabetes. Our findings can be used to promote discussion in the profession and with stakeholders about the future role of the community pharmacist in diabetes care.
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Affiliation(s)
- Abduelmula R Abduelkarem
- Department of Clinical Pharmacy, Ajman University of Science and Technology, United Arab Emirates
| | - Mike A Sackville
- Pharmacy Practice Department, Sunderland School of Pharmacy, University of Sunderland, England
| | - Rae M Morgan
- Pharmacy Practice Department, Sunderland School of Pharmacy, University of Sunderland, England
| | - Margaret P Sackville
- Pharmacy Practice Department, Sunderland School of Pharmacy, University of Sunderland, England
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Vasconcelos MEL, Fonseca MJM, Rozenfeld S, Acurcio FA. Acurácia de informações sobre classes de medicamentos obtidas com questionário postal aplicado a idosos - Rio de Janeiro, RJ. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2009. [DOI: 10.1590/s1415-790x2009000400008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVOS: verificar a confiabilidade e a validade das informações sobre medicamentos obtidas em questionário postal, respondido por idosos, sendo a entrevista face a face o padrão-ouro. MÉTODOS: estudo seccional (Perfil de Utilização de Medicamentos por Aposentados Brasileiros), onde foram utilizadas duas abordagens (postal e domiciliar) para coleta de informações de aposentados pelo Instituto Nacional do Seguro Social (INSS) com sessenta anos de idade ou mais. Foram utilizadas também as estatísticas kappa (simples (k), ajustado (PABAK) e ponderado), índices de correlação intra-classe, indicadores de sensibilidade e especificidade, e o gráfico de Luiz et al. RESULTADOS: 234 idosos (M = 42%; F = 58%) responderam às duas abordagens (média = 71,7 anos). A concordância entre postal e entrevista domiciliar foi excelente (k = 0,94) para hipoglicemiantes; muito boa (k = 0,83-0,82) para inibidores da enzima conversora de angiotensina e anti-hipertensivos; boa (k = 0,71) para diuréticos; e razoável (k = 0,47) para antiinflamatórios não esteróides. A concordância foi boa (k = 0,61) para o número total de medicamentos usados. A validade da abordagem postal foi elevada, às vezes total, para os fármacos empregados no tratamento do diabetes (sensibilidade e especificidade = 100%), seguidos dos anti-hipertensivos. Os menores valores obtidos foram para antiinflamatórios não esteróides (sensibilidade = 64%; especificidade = 88%). CONCLUSÃO: a abordagem postal pode ser usada para se obter informações acuradas sobre classes de medicamentos usados por população com idade igual ou superior a 60 anos, considerando idosos com perfil social semelhante ao dos beneficiários do INSS.
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Kalfoss M, Halvorsrud L. Important issues to quality of life among norwegian older adults: an exploratory study. Open Nurs J 2009; 3:45-55. [PMID: 19738913 PMCID: PMC2737120 DOI: 10.2174/1874434600903010045] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 06/03/2009] [Accepted: 06/09/2009] [Indexed: 11/22/2022] Open
Abstract
The increasing numbers of older people and higher expectations of a “good life” within societies, has lead to international interest in the enhancement of quality of life (QoL) among older adults. Understanding whether the same aspects of life are equally important to the life quality of subgroups of older people is important in helping health professionals plan social and health care policy and caring strategies. The purpose of this study was to describe the importance given to 38 areas of QoL among Norwegian older adults and to identify differences in importance ratings by age, gender, marital and health status. This exploratory study was conducted with 379 older adults (mean age 73.3 years, SD 6.9) consisting of two cohorts. The first cohort (n = 287) comprised of non-hospitalized participants, were recruited from two national senior organizations, two political senior organizations and a voluntary organization in Eastern Norway. Participants responded to a postal survey. The second cohort (n = 92) comprised of hospitalized and ambulatory patients, were recruited from three medical wards and one outpatient clinic at a county hospital in Eastern Norway. Data was collected by personal interviews and interview assisted. All importance ratings were found to reflect substantial areas of importance. Highest mean importance was assigned to activities of daily living, mobility, sensory abilities, health and home environment. Least important was sex life, adequate social help, chance to learn new skills, body image and appearance and free of dependence on medications and treatment. There were a number of significant mean group differences by age, gender, marital and health status. Sixteen of the items detected significant between- group differences. Future application of the importance questions could facilitate understanding and recognition of important issues in subgroups of older adults.
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Affiliation(s)
- Mary Kalfoss
- Diakonova University College, Linstowsgate 5, 0166, Oslo, Norway.
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Claire LS, He Y. How Do I Know if I Need a Hearing Aid? Further Support for the Self‐Categorisation Approach to Symptom Perception. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 2008. [DOI: 10.1111/j.1464-0597.2008.00380.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Mallen CD, Dunn KM, Thomas E, Peat G. Thicker paper and larger font increased response and completeness in a postal survey. J Clin Epidemiol 2008; 61:1296-1300. [PMID: 18945586 DOI: 10.1016/j.jclinepi.2008.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 07/14/2008] [Accepted: 07/22/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the effect of font size and paper thickness on the response to, and completion of, a self-completion postal questionnaire among older people with joint pain. STUDY DESIGN AND SETTING Randomized trial. People aged 50 years and older with joint pain who consulted a general practitioner at one of five general practices in Central Cheshire were sent a postal questionnaire. Questionnaire format (large or small font size, thick or thin paper) was randomly allocated using a 2 x 2 factorial design. RESULTS Questionnaires were received from 502 out of 650 participants (crude response 77%). Response was significantly higher for participants receiving questionnaires with a larger font size (79.3% vs. 75.2%; hazard ratio 1.26, 95% confidence interval: 1.02, 1.56). Paper thickness had no significant effect on response. Completion (measure by assessing double-page turnover error) was increased in participants receiving questionnaires printed on thicker paper (3.2% vs. 7.1%; P=0.049) but was not affected by font size. CONCLUSION This study demonstrates that questionnaires in larger font and on thicker paper may produce higher and more complete responses than surveys using standard size font and standard thickness paper, and should therefore be considered in studies among older people.
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Affiliation(s)
- Christian D Mallen
- Arthritis Research Campaign National Primary Care Center, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | - Kate M Dunn
- Department of Epidemiology, Arthritis Research Campaign National Primary Care Center, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Elaine Thomas
- Department of Biostatistics, Arthritis Research Campaign National Primary Care Center, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - George Peat
- Department of Clinical Epidemiology, Arthritis Research Campaign National Primary Care Center, Keele University, Keele, Staffordshire ST5 5BG, UK
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Ribeiro AQ, Acurcio FDA, César CC, Rozenfeld S, Klein CH. Utilização de medicamentos por aposentados brasileiros: 2 - Taxa de resposta e preenchimento de questionário postal em Belo Horizonte, Minas Gerais, Brasil. CAD SAUDE PUBLICA 2008; 24:2171-81. [DOI: 10.1590/s0102-311x2008000900023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 12/21/2007] [Indexed: 11/22/2022] Open
Abstract
São descritos a taxa de resposta e o preenchimento de questionários auto-administrados num inquérito postal sobre o perfil de utilização de medicamentos por aposentados e pensionistas do INSS, de 60 anos ou mais de idade no Município de Belo Horizonte, Minas Gerais, Brasil, em 2003. Os questionários foram enviados duas vezes para os endereços de 800 indivíduos sorteados por amostragem aleatória simples, com base no banco de dados do INSS. A taxa de resposta ao inquérito postal foi de 47,8% e não houve diferença significativa tanto entre participantes e não participantes quanto entre respondentes iniciais e tardios em relação às características selecionadas. Para a maioria das variáveis sócio-demográficas e de saúde, os percentuais de omissão de respostas não ultrapassaram 5%, tanto no total da amostra, quanto em cada um dos subgrupos de respondentes. As informações mais omitidas ocorreram para as variáveis relativas ao uso de medicamentos, com destaque para a não-utilização de medicamentos que deveriam ser usados, a dose e laboratório fabricante do medicamento. Nossos resultados indicam que o detalhamento de aspectos relacionados ao uso de medicamentos deve ser reconsiderado em questionários de autopreenchimento.
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Abstract
OBJECTIVE the size of the burden of unmet needs of older people living in the community is unknown. We aim to validate a brief postal questionnaire, the Brief Risk Identification of Geriatric Health Tool (BRIGHT) questionnaire, to find cases of older people with disabilities (case-finding) living in the community. METHODS community-dwelling patients over the age of 75 years were invited from two general practitioners in Auckland, New Zealand. Participants completed the 11-item BRIGHT questionnaire twice and were assessed at home using the Minimum Dataset for Home Care (MDS-HC) comprehensive geriatric assessment tool by a trained gerontology nurse. Retest reliability of the BRIGHT was assessed with a correlation coefficient, and receiver operator characteristic (ROC) curves were used to assess the utility of the tool against standard outputs from the MDS-HC reflecting level of disability; the instrumental activities of daily living clinical assessment protocol (IADL CAP), and the MAPle score for dependency. RESULTS 101 participants completed both the BRIGHT questionnaires and the comprehensive MDS-HC assessment. Test-retest reliability was modest with a correlation of 0.77. A sensitivity of 0.86 and specificity of 0.86 were observed for a score of 3 or more on the questionnaire in relationship to the IADL CAP. A sensitivity of 0.65 and specificity of 0.84 were observed when BRIGHT questionnaire score of 3+ was related to the MAPLe score from the MDS-HC assessment. CONCLUSIONS the BRIGHT questionnaire has acceptable utility in identifying community-dwelling older people with disability, and excellent utility in ruling them out of needing further assessment. This tool may be useful as part of an intervention process to detect unmet needs and to improve systematic surveillance of primary care populations.
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Affiliation(s)
- Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Private Bag 92019, New Zealand.
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Jansen APD, van Hout HPJ, Nijpels G, van Marwijk HWJ, Gundy C, de Vet HCW, Stalman WAB. Self-reports on the IQCODE in older adults: a psychometric evaluation. J Geriatr Psychiatry Neurol 2008; 21:83-92. [PMID: 18474717 DOI: 10.1177/0891988707311558] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Informant Questionnaire on Cognitive Decline (IQCODE) has been successful in identifying demented persons in a general population. In this study, this questionnaire was used as a self-report screening for dementia symptoms. The object was to investigate the feasibility, homogeneity, and construct validity of self-reports on the IQCODE. Participants were 4823 community-dwelling older adults who received an IQCODE-SR. Feasibility was assessed on the basis of response rate, the proportion of missing data for each item, and the number of persons who received help in completing the questionnaire. Homogeneity was checked with Cronbach's alpha. To investigate construct validity, hypotheses on performance of the IQCODE-SR were tested. Feasibility was acceptable, with a response rate of 58.9%. Missing answers per item ranged from 2.5% to 7.3%, and 915 of 2841 participants received help in completing the questionnaire. Homogeneity was good, with Cronbach's alpha = .94. The majority of hypotheses on construct validity were confirmed. It was concluded that the IQCODE-SR meets the basic requirements of a good measurement instrument.
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Affiliation(s)
- Aaltje P D Jansen
- EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands, Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands
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Halvorsrud L, Kalfoss M, Diseth Å. Reliability and validity of the Norwegian WHOQOL-OLD module. Scand J Caring Sci 2008; 22:292-305. [DOI: 10.1111/j.1471-6712.2007.00523.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Themessl-Huber M, Humphris G, Dowell J, Macgillivray S, Rushmer R, Williams B. Audio-visual recording of patient-GP consultations for research purposes: a literature review on recruiting rates and strategies. PATIENT EDUCATION AND COUNSELING 2008; 71:157-168. [PMID: 18356003 DOI: 10.1016/j.pec.2008.01.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 01/16/2008] [Accepted: 01/17/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To identify ethical processes and recruitment strategies, participation rates of studies using audio or video recording of primary health care consultations for research purposes, and the effect of recording on the behaviour, attitudes and feelings of participants. METHODS A structured literature review using Medline, Embase, Cochrane Library, and Psychinfo. This was followed by extensive hand search. RESULTS Recording consultations were regarded as ethically acceptable with some additional safeguards recommended. A range of sampling and recruitment strategies were identified although specific detail was often lacking. Non-participation rates in audio-recording studies ranged from 3 to 83% for patients and 7 to 84% for GPs; in video-recording studies they ranged from 0 to 83% for patients and 0 to 93% for GPs. There was little evidence to suggest that recording significantly affects patient or practitioner behaviour. CONCLUSIONS Research involving audio or video recording of consultations is both feasible and acceptable. More detailed reporting of the methodical characteristics of recruitment in the published literature is needed. PRACTICE IMPLICATIONS Researchers should consider the impact of diverse sampling and recruitment strategies on participation levels. Participants should be informed that there is little evidence that recording consultations negatively affects their content or the decisions made. Researchers should increase reporting of ethical and recruitment processes in order to facilitate future reviews and meta-analyses.
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Affiliation(s)
- Markus Themessl-Huber
- School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK.
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Peel NM, Bartlett HP, Marshall AL. Measuring quality of life in older people: Reliability and validity of WHOQOL-OLD. Australas J Ageing 2007. [DOI: 10.1111/j.1741-6612.2007.00249.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haywood KL. Patient-reported outcome II: selecting appropriate measures for musculoskeletal care. Musculoskeletal Care 2007; 5:72-90. [PMID: 17542045 DOI: 10.1002/msc.101] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The first article in this series outlined the important contribution that well developed patient reported outcome measures (PROMs) can make to healthcare, clinical decision making and evaluation. The increasing focus on patient reported health means that there are now hundreds of questionnaires available; selecting the appropriate measure is both challenging and essential. This article will introduce potential users of PROMs to key information to consider when selecting and using PROMs in research, routine practice or quality assurance. Important concepts, such as measurement reliability, validity and responsiveness to important change in health, will be explored and illustrated with examples from musculoskeletal healthcare. Practical properties, such as acceptability and feasibility, will also be introduced.
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Affiliation(s)
- Kirstie L Haywood
- Patient Reported Outcome, Royal College of Nursing Institute, Whichford House, Oxford Business Park, Lowley, Oxford, UK.
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Collerton J, Barrass K, Bond J, Eccles M, Jagger C, James O, Martin-Ruiz C, Robinson L, von Zglinicki T, Kirkwood T. The Newcastle 85+ study: biological, clinical and psychosocial factors associated with healthy ageing: study protocol. BMC Geriatr 2007; 7:14. [PMID: 17594470 PMCID: PMC1924857 DOI: 10.1186/1471-2318-7-14] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 06/26/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UK, like other developed countries, is experiencing a marked change in the age structure of its population characterised by increasing life expectancy and continuing growth in the older fraction of the population. There is remarkably little up-to-date information about the health of the oldest old (over 85 years), demographically the fastest growing section of the population. There is a need, from both a policy and scientific perspective, to describe in detail the health status of this population and the factors that influence individual health trajectories. For a very large proportion of medical conditions, age is the single largest risk factor. Gaining new knowledge about why aged cells and tissues are more vulnerable to pathology is likely to catalyse radical new insights and opportunities to intervene. The aims of the Newcastle 85+ Study are to expose the spectrum of health within an inception cohort of 800 85 year-olds; to examine health trajectories and outcomes as the cohort ages and their associations with underlying biological, medical and social factors; and to advance understanding of the biological nature of ageing. METHODS A cohort of 800 85 year olds from Newcastle and North Tyneside will be recruited at baseline and followed until the last participant has died. Eligible individuals will be all those who turn 85 during the year 2006 (i.e. born in 1921) and who are registered with a Newcastle or North Tyneside general practice. Participants will be visited in their current residence (own home or institution) by a research nurse at baseline, 18 months and 36 months. The assessment protocol entails a detailed multi-dimensional health assessment together with review of general practice medical records. Participants will be flagged with the NHS Central Register to provide details of the date and cause of death. DISCUSSION The Newcastle 85+ Study will address key questions about health and health-maintenance in the 85+ population, with a particular focus on quantitative assessment of factors underlying variability in health, and on the relationships between health, nutrition and biological markers of the fundamental processes of ageing.
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Affiliation(s)
- Joanna Collerton
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Barrass
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - John Bond
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Martin Eccles
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Jagger
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Oliver James
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Carmen Martin-Ruiz
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | | | - Tom Kirkwood
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Williams B, Irvine L, McGinnis AR, McMurdo MET, Crombie IK. When "no" might not quite mean "no"; the importance of informed and meaningful non-consent: results from a survey of individuals refusing participation in a health-related research project. BMC Health Serv Res 2007; 7:59. [PMID: 17462081 PMCID: PMC1866231 DOI: 10.1186/1472-6963-7-59] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 04/26/2007] [Indexed: 11/10/2022] Open
Abstract
Background Low participation rates can lead to sampling bias, delays in completion and increased costs. Strategies to improve participation rates should address reasons for non-participation. However, most empirical research has focused on participants' motives rather than the reasons why non-participants refuse to take part. In this study we investigated the reasons why older people choose not to participate in a research project. Methods Follow-up study of people living in Tayside, Scotland who had opted-out of a cross-sectional survey on activities in retirement. Eight hundred and eighty seven people aged 65–84 years were invited to take part in a home-based cross-sectional survey. Of these, 471 refused to take part. Permission was obtained to follow-up 417 of the refusers. Demographic characteristics of people who refused to take part and the reasons they gave for not taking part were collected. Results 54% of those invited to take part in the original cross-sectional survey refused to do so. However, 61% of these individuals went on to participate in the follow-up study and provided reasons for their original refusal. For the vast majority of people initial non-participation did not reflect an objection to participating in research in principle but frequently stemmed from barriers or misunderstandings about the nature or process of the project itself. Only 28% indicated that they were "not interested in research". The meaningfulness of expressions of non-consent may therefore be called into question. Hierarchical log-linear modelling showed that refusal was independently influenced by age, gender and social class. However, this response pattern was different for the follow-up study in which reasons for non-participation in the first survey were sought. This difference in pattern and response rates supports the likely importance of recruitment issues that are research and context specific. Conclusion An expression of non-consent does not necessarily mean that a fully informed evaluation of the pros and cons of participation and non-participation has taken place. The meaningfulness of expressions of non-consent may therefore be a cause for concern and should be subject to further research. Many reasons for non-participation may be specific to a particular research topic or population. Information sheets should reflect this by going beyond standardised guidelines for their design and instead proactively seek out and address areas of concern or potential misunderstanding. The use of established behavioural theory in their design could also be considered.
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Affiliation(s)
- Brian Williams
- Section of Public Health, Division of Community Health Sciences, Mackenzie Building, Kirsty Semple Way, University of Dundee, Dundee, UK
| | - Linda Irvine
- Section of Public Health, Division of Community Health Sciences, Mackenzie Building, Kirsty Semple Way, University of Dundee, Dundee, UK
| | - Alison R McGinnis
- Section of Public Health, Division of Community Health Sciences, Mackenzie Building, Kirsty Semple Way, University of Dundee, Dundee, UK
| | - Marion ET McMurdo
- Division of Medicine & Therapeutics, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - Iain K Crombie
- Section of Public Health, Division of Community Health Sciences, Mackenzie Building, Kirsty Semple Way, University of Dundee, Dundee, UK
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Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Neurorehabil Neural Repair 2007; 21:161-8. [PMID: 17312091 DOI: 10.1177/1545968306292255] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Stroke-Specific Quality of Life Scale (SS-QOL) is a recently developed measure to assess health-related quality of life in stroke patients. The objective of this study was to translate the American version of the SS-QOL and examine the validity of the German proxy version, in both ischemic and hemorrhagic stroke survivors. METHODS The translation was conducted according to published guidelines. The validation was performed in consecutive adult stroke survivors. Data were obtained 1 year after discharge. To examine the dimensionality of the SS-QOL, factor analyses were conducted. The validity was examined by the associations of the subscales with the Functional Independence Measure and Short Form 36. RESULTS The literal translation revealed no major changes between the American and the German versions of the SS-QOL. Three hundred seven stroke survivors were included in the study. Unlike the 1st validation study, most of the variance could be explained by 8 instead of 12 factors; therefore, the 8-factor solution was further examined. The validity of the SS-QOL total score and "observable" scales such as "activities" was shown. CONCLUSIONS For the German proxy version of the SS-QOL, an 8-factor solution was found to be the most appropriate. The psychometric properties of these 8 subscales were good or excellent with respect to internal consistency. The validity of the total score was shown, but some subscales (energy, mood, and thinking) failed the hypothesized associations. Therefore, the SS-QOL needs to be further explored in other settings and populations.
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Affiliation(s)
- Thomas Ewert
- Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians-University, Munich, Germany
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Abstract
The rapid population growth of individuals 65 years and older in the United States is predicted to continue through 2050. As people age, the complexity of their healthcare needs increase and can be attributed to the normal aging process as well as an increased frequency of chronic illness with associated morbidity. There are many geriatric assessment instruments that can be used to evaluate the complex health needs of the older adult, but there is a need for a geriatric screening assessment process that can address the domains of the aging individual in a practical, holistic, and cost-effective manner. There are multiple quality-of-life instruments that can be used for this screening of health needs in the aging population, and 3 will be discussed, the LEIPAD instrument, the Medical Short Form-36, and the WHOQOL-BREF. The rationale for introducing a screening assessment into the clinical practice of the clinical nurse specialist for positive patient outcomes will be examined.
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Affiliation(s)
- Kimberly S McClane
- California State University, Dominguez Hills, Carson, Calif. 90747, USA.
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Brotons C, Monteserín R, Martínez M, Sellarès J, Baulies A, Fornasini M. [Assessment of the effectiveness of an instrument to identify health an social problems in an elderly population from a primary health care center]. Aten Primaria 2005; 36:317-23. [PMID: 16238942 PMCID: PMC7681920 DOI: 10.1157/13079866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the response rate to a multi-dimensional, self administered questionnaire in patients > or =75 years old attending a primary health care center and to establish the prevalences of problems in the following dimensions: socio-economical, cognitive, morbidity, polypharmacy, physical activity, falls, and activities of the daily living. DESIGN Cross-sectional descriptive study based on a self-administered questionnaire posted by mail. SETTING A primary health care center in Barcelona. PARTICIPANTS A total of 1299 patients > or =75 years old. MAIN MEASUREMENTS Social surroundings, activities of the daily living, sensorial problems, morbidity, physical symptoms including sphincter's incontinence, cognitive status, and medication use. RESULTS The response rate was 68% (95% CI, 0.65-0.70). The average age of the women who participated was significantly greater than the one of the men (82.5+/-5.3 vs 81.6+/-5.0, respectively). A significantly greater proportion of women than of men lived single (38.2 vs 10.9%); they had difficulties to maintain its house cosy (15.6 vs 8.8%) and they had difficulties to make ends meet (18.0 vs 13.6%). Globally, there were a greater proportion of women than of men whom they had: medical problems, cognitive problems, depression, and difficulties to carry out activities of the daily living. Overall, subjects that have had difficulties to make ends meet had greater prevalences of problems in all the dimensions of this evaluation. On the other hand, subjects that lived single had lower prevalences of problems in all the dimensions except they had a greater prevalence of depression. CONCLUSION The multidimensional evaluation in elderly patients by the postal method is an efficient procedure that allows identifying many socioeconomic and health problems. In addition, it is feasible to identify to most fragile subjects and latter on to carry out preventive and curative interventions on them as well as to make their follow up.
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Affiliation(s)
- C Brotons
- Centro de Atención Primaria Sardenya, Servei Català de la Salut, Barcelona, Spain.
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Abstract
This article explores the meaning and significance of 'self-assessment', a term that is increasingly being used in relation to developments affecting community practice. Self-assessment for health and social care needs has been used over a considerable period of time and for purposes as diverse as case finding for depression to assessment of housing options. Self-assessment has usually involved the use of short scales and questionnaires, but it can involve the use of physiological tests (such as testing urine for glucose) or complex, computerized decision-support systems. Although often explored as a simple means for extending the 'reach' of professional assessments (e.g. mass screening) and ensuring 'appropriate' use of health services (e.g. self-care algorithms), self-assessment is increasingly being advocated as a means of actively involving and empowering service users. However, a recent review of the topic (Griffiths et al, 2005) revealed the complexity of the topic and the pitfalls of a simplistic approach to self-assessment, which those engaged in developing the process should bear in mind.
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Affiliation(s)
- Peter Griffiths
- King's College London, Florence Nightingale School of Nursing and Midwifery.
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Haywood KL, Garratt AM, Fitzpatrick R. Quality of life in older people: a structured review of generic self-assessed health instruments. Qual Life Res 2005; 14:1651-68. [PMID: 16119178 DOI: 10.1007/s11136-005-1743-0] [Citation(s) in RCA: 259] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To review evidence relating to the measurement properties of multi-item generic patient or self-assessed measures of health in older people. METHODS Systematic literature searches to identify instruments. Pre-defined criteria relating to reliability, validity and responsiveness. RESULTS 122 articles relating to 15 instruments met the inclusion criteria. The most extensive evidence was found for the SF-36, COOP Charts, EQ-5D, Nottingham Health Profile (NHP) and SIP. Four instruments have evidence of both internal consistency and test-retest reliability--NHP, SF-12, SF-20, SF-36. Four instruments lack evidence of reliability--HSQ-12, IHQL, QWB, SQL. Most instruments were assessed for validity through comparisons with other instruments, global judgements of health, or clinical and socio-demographic variables. Five instruments lack evidence of responsiveness--GQL, HSQ-12, IHQL, QLI and QWB. CONCLUSION There is good evidence for reliability, validity and responsiveness for the SF-36, EQ-5D and NHP. There is more limited evidence for the COOP, SF-12 and SIP. The SF-36 is recommended where a detailed and broad ranging assessment of health is required, particularly in community dwelling older people with limited morbidity. The EQ-5D is recommended where a more succinct assessment is required, particularly where a substantial change in health is expected. Instrument content should be assessed for relevance before application. The concurrent evaluation of generic instruments in older people is recommended.
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Affiliation(s)
- K L Haywood
- National Centre for Health Outcomes Development, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford, UK.
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Pinnock H, Juniper EF, Sheikh A. Concordance between supervised and postal administration of the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) was very high. J Clin Epidemiol 2005; 58:809-14. [PMID: 16018916 DOI: 10.1016/j.jclinepi.2005.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Revised: 12/05/2004] [Accepted: 01/07/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE There is increasing international interest in using patient-based outcome measures to evaluate interventions. We compared responses to postal administration of Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and Asthma Control Questionnaire (ACQ) with the gold standard of supervised self-completion. STUDY DESIGN AND SETTING Validation study involving 96 adults, recruited from U.K. general practice, sent the postal questionnaires with an instruction sheet 1 week before supervised self-completion. Responses for those whose quality of life (n=56) or asthma control (n=61) had 'not changed' between postal and supervised completions were compared using paired-sample t-tests, Pearson's correlation coefficient (r), and intraclass correlation coefficient (ICC). RESULTS For the MiniAQLQ, overall mean scores were similar in both groups: Postal=5.14 (SD=1.42) vs. Supervised=5.17 (SD=1.39), with mean difference of -0.03 (95% CI=-0.14, 0.08; P=.59), with a high degree of correlation (r=.96, P<.001) and concordance (ICC=0.96; 95% CI=0.93, 0.98; P<.001). For the ACQ, overall mean scores (with SD) were also similar in both groups: Postal=1.24 (SD=1.09) vs. Supervised=1.26 (SD=1.10), with mean difference of -0.02 (95% CI=-0.12, 0.08; P=.74), with good correlation (r=.94, P<.01) and concordance (ICC=0.94; 95% CI=0.90, 0.96; P<.01). CONCLUSIONS Correlation and concordance between supervised and postal administration of the MiniAQLQ and ACQ are very high. Users may confidently choose the mode of administration most appropriate to their needs.
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Affiliation(s)
- Hilary Pinnock
- Division of Community Health Sciences, GP Section, University of Edinburgh, 20, West Richmond Street, Edinburgh, EH8 9DX, UK.
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Haywood KL, Garratt AM, Fitzpatrick R. Older people specific health status and quality of life: a structured review of self-assessed instruments. J Eval Clin Pract 2005; 11:315-27. [PMID: 16011644 DOI: 10.1111/j.1365-2753.2005.00538.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To review evidence relating to the measurement properties of older people specific self-assessed, multi-dimensional measures of health status. DESIGN Systematic literature searches to identify instruments. Pre-defined criteria relating to reliability, validity, responsiveness, precision and acceptability. RESULTS A total of 46 articles relating to 18 instruments met the inclusion criteria. Most evidence was found for the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), CARE, Functional Assessment Inventory (FAI) and Quality of Life Profile--Seniors Version (QOLPSV). Most instruments have been evaluated in single studies. Four instruments have evidence of internal consistency and test-retest reliability--LEIPAD, Philadelphia Geriatrics Centre Multilevel Assessment Inventory, Perceived Well-being Scale, Wellness Index (WI). Two instruments lack evidence of reliability--Brief Screening Questionnaire, Geriatric Quality of Life Questionnaire (GQLQ). Older people contributed to the content of the GQLQ, QOLPSV and WI. Most instruments were assessed for validity through comparisons with other instruments, global judgements of health, or clinical and socio-demographic variables. Limited evidence of responsiveness was found for five instruments--GQLQ, OMFAQ, PGCMAI, QOLPSV, Self-Evaluation of Life Scale (SELF). CONCLUSION Although most evidence was found for the OMFAQ this was largely for the ADL domain; evidence for reliability and responsiveness is limited. Limited evidence of reliability, validity and responsiveness was found for the PGCMAI, QOLPSV and SELF. The lack of evidence for measurement properties restricts instrument recommendation. Instrument content should be assessed for relevance before application and the concurrent evaluation of specific and widely used generic instruments is recommended. Several instruments, including the BSQ and EASY-Care, were developed recently and further evidence of instrument performance is required.
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Affiliation(s)
- Kirstie L Haywood
- Research Officer, National Centre for Health Outcomes Development, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF, UK.
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Dobscha SK, Corson K, Solodky J, Gerrity MS. Use of videoconferencing for depression research: enrollment, retention, and patient satisfaction. Telemed J E Health 2005; 11:84-9. [PMID: 15785225 DOI: 10.1089/tmj.2005.11.84] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The goal of this study was to describe the effects of using videoconferencing on participant enrollment, research measure administration and responses, study retention, and satisfaction. We recruited 400 patients from the Portland Veterans Affairs Primary Care Clinics for a randomized clinical trial of a care management intervention for depression. Patients recruited from distant clinic sites had the option of traveling to Portland, Oregon, for initial interviews or being interviewed using videoconferencing. Interviews included obtaining informed consent and administration of research measures. Remote participants were subsequently asked to complete a 12-item mail survey regarding the interview. There were no significant problems with the process of interviewing and obtaining informed consent by videoconferencing, as reported by patients and clinic staff. Twenty of the 31 participants interviewed by videoconferencing returned the satisfaction questionnaire. Participants indicated a high degree of satisfaction with these interviews, and expressed willingness to recommend videoconferencing to others. No differences were observed between the Patient Health Questionnaire depression scores of videoconferencing and in-person participants, and there was no significant difference in the 6-month rate of loss to follow-up in the randomized trial. Videoconferencing allows patients in rural and remote locations to participate in psychiatric research and expands sources of recruitment for research projects.
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Affiliation(s)
- Steven K Dobscha
- Behavior Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, Oregon 97207, USA.
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Hewitt J, Smeeth L, Bulpitt CJ, Tulloch AJ, Fletcher AE. Respiratory symptoms in older people and their association with mortality. Thorax 2005; 60:331-4. [PMID: 15790990 PMCID: PMC1747384 DOI: 10.1136/thx.2004.029579] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A study was undertaken to assess the prevalence of reported respiratory symptoms in a population aged over 75 years and their association with mortality. METHODS A total of 14 458 people aged 75 years and over participating in a trial of health screening of older people in general practice answered questions on three respiratory symptoms: cough, sputum production, and wheeze. The association of symptoms with mortality was examined for all cause and respiratory causes of death taking account of potential confounders. RESULTS Coughing up phlegm in winter mornings had a prevalence of 27.0% (95% confidence interval (CI) 26.8 to 27.2). Those with this symptom had an adjusted hazard ratio for all cause mortality of 1.35 (95% CI 1.21 to 1.50), p<0.001 and for respiratory specific mortality of 2.01 (95% CI 1.66 to 2.41), p<0.001. Phlegm at any time of the day in winter had a prevalence of 16.5% (95% CI 16.3 to 16.7) with hazard ratios for all cause and respiratory specific mortality of 1.28 (95% CI 1.15 to 1.42) and 2.28 (95% CI 1.92 to 2.70), p<0.001. Wheeze or whistling from the chest had a prevalence of 14.3% (95% CI 14.1 to 14.5) with hazard ratios of 1.45 (95% CI 1.31 to 1.61) and 2.86 (95% CI 2.45 to 3.35), p<0.001. CONCLUSIONS The prevalence of respiratory symptoms is widespread among elderly people and their presence is a strong predictor of mortality.
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Affiliation(s)
- J Hewitt
- Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Coppin RJ, Wicke DM, Little PS. Managing nocturnal leg cramps--calf-stretching exercises and cessation of quinine treatment: a factorial randomised controlled trial. Br J Gen Pract 2005; 55:186-91. [PMID: 15808033 PMCID: PMC1463088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Quinine is a common treatment for nocturnal leg cramps but has potential side effects. An uncontrolled study suggested that calf-stretching exercises could prevent nocturnal leg cramps (night cramps) but these findings have never been confirmed. AIM To assess the effect of calf-stretching exercises and cessation of quinine treatment for patients with night cramps taking quinine. DESIGN OF STUDY Randomised controlled trial. SETTING Twenty-eight general practices in southern England. METHOD One hundred and ninety-one patients prescribed quinine for night cramps were randomised to one of four groups defined by two "advice" factors: undertake exercises and stop quinine. After 6 weeks they were advised that they could take quinine and undertake the exercises freely. Documentation of cramp at 12 weeks was achieved in 181 (95%) patients. Main outcome measures were: symptom burden score, and frequency of night cramps and quinine usage. RESULTS At 12 weeks there was no significant difference in number of cramps in the previous 4 weeks (exercise = 1.95, 95% confidence interval [CI] = -3.01 to 6.90; quinine cessation = 3.45, 95% CI = -1.52 to 8.41) nor symptom burden or severity of cramps. However, after 12 weeks 26.5% (95% CI = 13.3% to 39.7%) more patients who had been advised to stop quinine treatment reported taking no quinine tablets in the previous week (odds ratio [OR] = 3.32, 95% CI = 1.37 to 8.06), whereas advice to do stretching exercises had no effect (OR = 0.73, 95% CI = 0.27 to 1.98). CONCLUSIONS Calf-stretching exercises are not effective in reducing the frequency or severity of night cramps. Advising those on long-term repeat prescriptions to try stopping quinine temporarily will result in no major problems for patients, and allow a significant number to stop medication.
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Affiliation(s)
- Richard J Coppin
- The Surgery, Station Road, Overton, Basingstoke, Hants RG25 3DZ, UK.
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Iliffe S, Kharicha K, Harari D, Swift C, Stuck AE. Health risk appraisal for older people in general practice using an expert system: a pilot study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2005; 13:21-29. [PMID: 15717903 DOI: 10.1111/j.1365-2524.2005.00525.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The prevention of disability in later life is a major challenge facing industrialised societies. Primary care practitioners are well positioned to maintain and promote health in older people, but the British experience of population-wide preventive interventions has been disappointing. Health risk appraisal (HRA), an emergent information-technology-based approach from the USA, has the potential for fulfilling some of the objectives of the National Service Framework for Older People. Information technology and expert systems allow the perspectives of older people on their health and health risk behaviours to be collated, analysed and converted into tailored health promotion advice without adding to the workload of primary care practitioners. The present paper describes a preliminary study of the portability of HRA to British settings. Cultural adaptation and feasibility testing of a comprehensive health risk assessment questionnaire was carried out in a single group practice with 12,500 patients, in which 58% of the registered population aged 65 years and over participated in the study. Eight out of 10 respondents at all ages found the questionnaire easy or very easy to understand and complete, although more than one-third had or would have liked assistance. More than half felt that the length of the questionnaire was about right, and one respondent in 10 disliked some questions. Of those who completed the questionnaire and received tailored, written health promotion advice, 39% provided feedback on this with comments that can be used for increasing the acceptability of tailored advice. These findings have informed a wider exploratory study in general practice.
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Affiliation(s)
- S Iliffe
- Department of Primary Care and Population Sciences, Royal Free and University College London Medical School, London, UK.
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Fletcher AE, Price GM, Ng ESW, Stirling SL, Bulpitt CJ, Breeze E, Nunes M, Jones DA, Latif A, Fasey NM, Vickers MR, Tulloch AJ. Population-based multidimensional assessment of older people in UK general practice: a cluster-randomised factorial trial. Lancet 2004; 364:1667-77. [PMID: 15530627 DOI: 10.1016/s0140-6736(04)17353-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The benefit of multidimensional assessment and management of older people remains controversial. Most trials have been too small to produce adequate evidence to inform policy. We aimed to measure the effects of different approaches to assessment and management of older people. METHODS We undertook a cluster-randomised factorial trial in 106 general practices (43219 eligible patients aged 75 years and older, 78% participation), comparing (1) universal versus targeted assessment and (2) subsequent management by hospital outpatient geriatric team versus the primary-care team. All participants received a brief multidimensional assessment followed by a nurse-led in-depth assessment in the universal group, whereas in the targeted group the in-depth assessment was offered only to those with problems established at the brief assessment. Referrals to the randomised team (geriatric management or primary care), other medical or social services, health-care workers, or agencies, and emergency referrals to the general practitioner were based on a standard protocol at the in-depth assessment. The primary endpoints were mortality, admissions to hospital and institution, and quality of life. Analysis was by intention to treat and per protocol. This trial has been assigned the International Standardised Randomised Controlled Trial Number ISRCTN23494848. FINDINGS Mortality and hospital or institutional admissions did not differ between groups. During 3 years' follow-up, significant improvements in quality of life resulted from universal versus targeted assessment in terms of homecare, and from management by geriatric team versus primary-care team, in terms of mobility, social interaction, and morale. However, only the result for social interaction was consistent with a small but important effect. INTERPRETATION The different forms of multidimensional assessment offered almost no differences in patient outcome.
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Affiliation(s)
- Astrid E Fletcher
- Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, London, UK.
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