Exploring and modelling impacts of third molar experience on quality of life: a real-time qualitative study using Twitter. Associations between serum 25-hydroxyvitamin D concentrations and multiple health conditions, physical performance measures, disability, and all-cause mortality: the Concord Health and Ageing in Men Project. Fluorescence and reflectance device variability throughout the progression of a phase II clinical trial to detect and screen for cervical neoplasia using a fiber optic probe. The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of Health-Related Quality of Life Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity: A report of the American Dental Association. Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women: validation of a short assessment tool – the KINDEX Greek version Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults Development and evaluation of an instrument for the critical appraisal of randomized controlled trials of natural products The evidence‐based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome Case-Finding Instruments for Depression in Primary Care Settings Is a Condition-Specific Instrument for Patients with Low Back Pain/Leg Symptoms Really Necessary?: The Responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36 The validity of EORTC QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability Psychological Factors Are Associated with Changes in the Health-related Quality of Life in Inflammatory Bowel Disease An in-house prevocational training program for newly discharged psychiatric inpatients: exploring its employment outcomes and the predictive factors. Patient-Reported Outcomes Measurement Information System (PROMIS) instruments among individuals with symptomatic knee osteoarthritis: a cross-sectional study of floor/ceiling effects and construct validity Measuring quality of life in cosmetic surgery patients with a condition-specific instrument: the Derriford Scale. Evaluating the Quality of Randomized Controlled Trials that Examine the Efficacy of Natural Health Products: A Systematic Review of Critical Appraisal Instruments Validity of the Assessment of Quality of Life (AQoL) utility instrument in patients with operable and inoperable lung cancer. Diagnostic utility of the glucagon stimulation test in comparison to the insulin tolerance test in patients following pituitary surgery. The Value of Medical History and Physical Examination in Diagnosing Sacroiliac Joint Pain Effects of the German 1993 health reform law upon primary care practitioners' individual performance: results from an empirical study in sentinel practices. A randomized comparison of the Pipelle, Accurette, and Explora endometrial sampling devices.
OBJECTIVES This study had two objectives : ( i ) to explore and model domains describing the real-time impact of third molars ( TMs ) on quality of life ( QoL ) ; and ( ii ) to assess the percentage coverage , in some generic health-related quality of life ( HRQoL ) and oral health-related quality of life ( OHRQoL ) instruments , of the TM QoL domains identified in this study . METHODOLOGY A global cross-sectional sample of tweets containing ' wisdom tooth ' over a 1-week period retrieved 3,537 tweets . After r and om quota sampling , classification and filtering , only 843 tweets were included in the thematic analysis . A  TM QoL model  was constructed based on the associations of the identified domains . Domains for the selected generic HRQoL and OHRQoL instruments were plotted against the domains identified in the study to calculate the percentage coverage for each . RESULTS The QoL domains identified were pain ( n = 348 , 41 % ) , mood ( n = 173 , 20 % ) , anxiety and fear ( n = 54 , 7 % ) , enjoying food ( n = 41 , 4 % ) , coping ( n = 37 , 4 % ) , daily activities ( n = 34 , 4 % ) , sleep ( n = 24 , 2 % ) , social life ( n = 19 , 2 % ) , physical health ( n = 17 , 2 % ) , ability to think ( n = 9 , 1 % ) , self-care ( n = 8 , 1 % ) and sporting & recreation ( n = 2 , < 1 % ) . The Assessment Quality of Life instrument ( AQoL-8D ) covers 87 % of the TM QoL domains , while the rest of the HRQoL and OHRQoL instruments cover 33 - 60 % . CONCLUSION This study shows how Twitter can be used to obtain real-time QoL data , which might be used to model how TMs impact on QoL. The TM QoL domains identified in the study were generally under-represented among the generic OHRQoL instruments assessed while , the HRQoL AQoL-8D covered most of the TM QoL domains . The QoL domains identified in the study might be used to develop a new OHRQoL measure for TMs OBJECTIVES To explore associations between serum  25-hydroxyvitamin D ( 25(OH)D ) levels and a wide range of health conditions , physical performance measures , disability , and mortality in a large epidemiological study to identify an optimum range for 25(OH)D concentrations . DESIGN Cross-sectional study , with additional prospect i ve data on falls and mortality . SETTING Concord Health and Ageing in Men Project , Sydney , Australia . PARTICIPANTS Community-dwelling men aged 70 and older ( N = 1,659 ) . MEASUREMENTS  Serum 25(OH)D levels , general health status , self-reported diseases , physical performance measures , disability ( activities of daily living and instrumental activities of daily living ) and falls . RESULTS Fair , poor , and very poor health ; self-reported diabetes mellitus ; hyperglycemia ; depression ; muscle weakness ; poor balance ; and all-cause mortality were all associated with serum 25(OH)D levels less than 50 nmol/L , even after adjustment for confounding . The findings also suggest that , in older men , for a wide range of health conditions , physical performance measures , disability , falls , and mortality , the optimum range of 25(OH)D is between 50.0 and 74.9 nmol/L , with no additional benefit for 25(OH)D levels of 75.0 nmol/L or greater . CONCLUSION Programs aim ed at achieving an optimum range of serum 25(OH)D at levels between 50.0 and 74.9 nmol/L may have overall health benefits and such levels are adequate for older men Large phase II trials of fluorescence and reflectance spectroscopy using a fiber optic probe in the screening and diagnostic setting s for detecting cervical neoplasia have been conducted . We present accrual and histopathology data , instrumentation , data processing , and the preliminary results of interdevice consistencies throughout the progression of a trial . Patients were recruited for either a screening trial ( no history of abnormal Papanicolaou smears ) or a diagnostic trial ( a history of abnormal Papanicolaou smears ) . Colposcopy identified normal and abnormal squamous , columnar , and transformation zone areas that were subsequently measured with the fiber probe and biopsied . In the course of the clinical trial , two generations of spectrometers ( FastEEM2 and FastEEM3 ) were design ed and utilized as optical instrumentation for in vivo spectroscopic fluorescence and reflectance measurements . Data processing of fluorescence and reflectance data is explained in detail and a preliminary analysis of the variability across each device and probe combination is explored . One thous and patients were recruited in the screening trial and 850 patients were recruited in the diagnostic trial . Three clinical sites attracted a diverse range of patients of different ages , ethnicities , and menopausal status . The fully processed results clearly show that consistencies exist across all device and probe combinations throughout the diagnostic trial . Based on the stratification of the data , the results also show identifiable differences in mean intensity between normal and high- grade tissue diagnosis , pre- and postmenopausal status , and squamous and columnar tissue type . The mean intensity values of stratified data show consistent separation across each of the device and probe combinations . By analyzing trial spectra , we provide more evidence that biographical variables such as menopausal status as well as tissue type and diagnosis significantly affect the data . Underst and ing these effects will lead to better modeling parameters when analyzing the performance of fluorescence and reflectance spectroscopy This paper describes constructing the Assessment of Quality of Life ( AQoL ) instrument ; design ed to measure health-related quality of life ( HRQoL )  , and to be the descriptive system for a multi-attribute utility instrument . Unlike previous utility instruments ' descriptive systems , the AQoL 's has been developed using state-of-the-art psychometric procedures . The result is a descriptive system which emphasizes five different facets of HRQoL and which can cl aim to have construct validity . Based on the WHO 's definition of health a model of HRQoL was developed . Items were written by focus groups of doctors and the research ers . These were administered to a construction sample , comprising hospital patients , and community members chosen at r and om . Final construction was through an iterative process of factor and reliability analyses . The AQoL measures 5 dimensions : illness , independent living , social relationships , physical senses and psychological wellbeing . Each has three items . Exploratory factor analysis showed the dimensions were orthogonal , and each was unidimensional . Internal consistency was α = 0.81 . Structural equation modeling explored its internal structure ; the comparative fit index was 0.90 . These preliminary results indicate the AQoL has the prerequisite qualities for a psychometric HRQoL instrument for evaluation ; replication with a larger sample is needed to verify these findings . Scaling it for economic evaluation using utilities is being undertaken . Respondents have indicated the AQoL is easy to underst and and is quickly completed . Its initial properties suggest it may be widely applicable BACKGROUND An expert panel convened by the American Dental Association ( ADA ) Council on Scientific Affairs and the Center for Evidence -Based Dentistry conducted a systematic review and formulated clinical recommendations to inform primary care clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions , including potentially malignant disorders ( PMDs ) , in the oral cavity . TYPES OF STUDIES REVIEW ED This is an up date of the ADA 's 2010 recommendations on the early diagnosis of PMDs and oral squamous cell carcinoma . The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid and the Cochrane Central Register of Controlled Trials to identify r and omized controlled trials and diagnostic test accuracy studies . The authors used the Grading of Recommendations Assessment , Development and Evaluation approach to assess the certainty in the evidence and to move from the evidence to the decisions . RESULTS The panel formulated 1 good practice statement and 6 clinical recommendations that concluded that no available adjuncts demonstrated sufficient diagnostic test accuracy to support their routine use as triage tools during the evaluation of lesions in the oral cavity . For patients seeking care for suspicious lesions , immediate performance of a biopsy or referral to a specialist remains the single most important recommendation for clinical practice . In exceptional cases , when patients decline a biopsy or live in rural areas with limited access to care , the panel suggested that cytologic testing may be used to initiate the diagnostic process until a biopsy can be performed ( conditional recommendation , low- quality evidence ) . CONCLUSIONS AND PRACTICAL IMPLICATION S The authors urge clinicians to remain alert and take diligent action when they identify a PMD . The authors emphasize the need for counseling because patients may delay diagnosis because of anxiety and denial Background Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and , in most cases , nonexistent in obstetrical care . In this study we aim ed to evaluate if the KINDEX , a short instrument developed in Germany , is a useful tool in the h and s of non-trained medical staff , in order to identify and refer women in psychosocial risk to the adequate mental health and social services . We also examined the criterion-related concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist . Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for the psychosocial risk assessment to the obstetric care providers . Methods Two obstetricians and five midwives carried out 93 KINDEX interviews  ( duration 20 minutes ) with pregnant women to assess psychosocial risk factors present during pregnancy . Afterwards they referred women who they identified having two or more psychosocial risk factors to the mental health attention unit of the hospital . During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a r and omized sub sample of 50 pregnant women based on established diagnostic instruments for stress and psychopathology , like the PSS-14 , ESI , PDS , HSCL-25 . Results Significant correlations between the results obtained through the assessment using the KINDEX and the risk areas of stress , psychopathology and trauma load assessed in the validation interview demonstrate the criterion-related concurrent validity of the KINDEX . The referral accuracy of the medical staff is confirmed through comparisons between pregnant women who have and have not been referred to the mental health attention unit . Conclusions Prenatal screenings for psychosocial risks like the KINDEX are feasible in public health setting s in Greece . In addition , validity was confirmed in high correlations between the KINDEX results and the results of the validation interviews . The KINDEX Greek version can be considered a valid tool , which can be used by non-trained medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and social services . These kind of assessment s are indispensable for the promotion of a healthy family environment and child development Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors . Despite an explosion of mobile phone applications aim ed at physical activity and other health behaviors , few have been based on theoretically derived constructs and empirical evidence . Eighty adults ages 45 years and older who were insufficiently physically active , engaged in prolonged daily sitting , and were new to smartphone technology , participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence . An “ analytically ” framed custom application focused on personalized goal setting , self-monitoring , and active problem solving around barriers to behavior change . A “ socially ” framed custom application focused on social comparisons , norms , and support . An “ affectively ” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar , whose movements and behaviors reflected the physical activity and sedentary levels of the user . To explore the applications ' initial efficacy in changing regular physical activity and leisure-time sitting , behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity question naire and the Australian sedentary behavior question naire . User acceptability of and satisfaction with the applications was explored via a post-intervention user survey . The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period . Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology . Preliminary data exploring sustained use of the applications across a longer time period yielded promising results . The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors Background The efficacy of natural products ( NPs ) is being evaluated using r and omized controlled trials ( RCTs ) with increasing frequency , yet a search of the literature did not identify a widely accepted critical appraisal instrument developed specifically for use with NPs . The purpose of this project was to develop and evaluate a critical appraisal instrument that is sufficiently rigorous to be used in evaluating RCTs of conventional medicines , and also has a section specific for use with single entity NPs , including herbs and natural source d chemicals . Methods Three phases of the project included : 1 ) using experts and a Delphi process to reach consensus on a list of items essential in describing the identity of an NP ; 2 ) compiling a list of non-NP items important for evaluating the quality of an RCT using systematic review methodology to identify published instruments and then compiling item categories that were part of a vali date d instrument and /or had empirical evidence to support their inclusion and 3 ) conducting a field test to compare the new instrument to a published instrument for usefulness in evaluating the quality of 3 RCTs of a NP and in applying results to practice . Results Two Delphi rounds result ed in a list of 15 items essential in describing NPs . Seventeen item categories fitting inclusion criteria were identified from published instruments for conventional medicines . The new assessment instrument was assembled based on content of the two lists and the addition of a Review er 's Conclusion section . The field test of the new instrument showed good criterion validity . Participants found it useful in translating evidence from RCTs to practice . Conclusion A new instrument for the critical appraisal of RCTs of NPs was developed and tested . The instrument is distinct from other available assessment instruments for RCTs of NPs in its systematic development and validation . The instrument is ready to be used by pharmacy students , health care practitioners and academics and will continue to be refined as required New insights into the phenotype of Joint Hypermobility Syndrome ( JHS ) and Ehlers‐Danlos Syndrome‐hypermobile type ( hEDS ) have raised many issues in relation to classification , diagnosis , assessment , and treatment . Within the multidisciplinary team , physical therapy plays a central role in management of individuals with hypermobility related disorders . However , many physical therapists are not familiar with the diagnostic criteria , prevalence , common clinical presentation , and management . This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children , adolescents , and adults with JHS/hEDS . Due to the complexity of the symptoms in the profile of JHS/hEDS , the International Classification of Functioning , Disability and Health ( ICF ) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions , activities and participation , as well as environmental and personal factors . The current evidence ‐based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions . Multicenter r and omized controlled trials are warranted to assess the clinical and cost‐effectiveness of interventions for children and adults . Until further multicenter trials are conducted , clinical decision‐making should be based on theoretical and the current limited research evidence . For all individuals diagnosed with JHS/hEDS , international consensus and combined efforts to identify risk profiles would create a better underst and ing of the pathological mechanisms and the potential for optimizing health care for affected individuals . © 2017 Wiley Periodicals , Depressive disorders are common , persistent , and recurring afflictions among primary care patients . They cause substantial suffering for patients and their families and are associated with a loss of personal productivity and a markedly increased risk for suicide . Further , the presence of depression puts persons with comorbid conditions , such as recent myocardial infa rct ion , at increased risk for illness and death . Persons with depression spend more time with their physicians during office visits and use more health care than persons without depression [ 1 ] . The annual health care cost associated with depression in the United States is estimated to be $ 43.7 billion [ 2 ] . Underscoring the importance of identifying patients with depression is that the effectiveness of therapy , including antidepressants , psychotherapy , and counseling , has clearly been established [ 3 ] . Despite these issues , primary care providers fail to diagnose and treat as many as 35 % to 50 % of patients with depressive disorders [ 4 , 5 ] . Obstacles to the appropriate recognition of depression include inadequate provider knowledge of diagnostic criteria ; competing comorbid conditions and priorities among primary care patients ; time limitations in busy office setting s ; concern about the implication s of labeling ; poor reimbursement mechanisms ; and uncertainty about the value , accuracy , and efficiency of screening mechanisms for identifying patients with depression . We address the last of these obstacles and assess the feasibility and operating characteristics of several case-finding instruments that have been used to detect depressive disorders in primary care setting s. Our ultimate goal is to familiarize providers with the advantages and disadvantages of these instruments so that they can make informed decisions about incorporating them into practice . Methods Data Acquisition We did a MEDLINE search of the English- language medical literature published from 1966 through February 1994 . Search terms included depressive disorder or depression , diagnosis , and the specific names of each of 11 case-finding instruments cited in previous relevant review s or bibliographies [ 6 - 9 ] . Other sources were references identified from pertinent articles and national experts in the field of depression . Experts included authors of papers that were selected for review and two members of the Agency for Health Care Policy and Research Guideline Panel on Depression . Of 906 articles identified through MEDLINE , 210 were deemed potentially relevant . These were review ed to identify studies that met the following selection criteria . Study sample s had to have been composed of primary care patients attending clinic . Patients were excluded if they had been selected because they had specific conditions ( such as chronic pain or cancer ) or because they had specific demographic characteristics ( for example , they were immigrants in a particular ethnic group ) . Both a case-finding instrument and a diagnostic criterion st and ard had to have been administered . The criterion st and ard had to have had formal st and ardized diagnostic criteria for depression . Accepted criterion st and ards were the Diagnostic Schedule Manual-3 criteria ( DSM-III or DSM-III-R ) and the Research Diagnostic Criteria , or a close approximation of these . St and ard interview procedures , such as the Diagnostic Interview Schedule or the Structured Clinical Interview for DSM-III , had to have been used to arrive at the diagnosis . Chart or physician diagnoses of depression that were made without specified formal interview procedures and diagnostic criteria were excluded . Nineteen studies involving nine case-finding instruments met the selection criteria : Fourteen were found during the MEDLINE search ; 1 came from a relevant bibliography ; and 4 were unpublished at the time of the search and came from experts [ 10 - 28 ] . Of the remaining articles screened , 92 % were excluded because they did not involve primary care patients , 6 % were excluded because they had used an inadequate criterion st and ard , and 2 % were excluded because they involved selected population s [ 29 , 30 ] or because they had tested modified and unvali date d versions of case-finding instruments [ 31 ] . Data Extraction Articles were abstract ed by two independent review ers . Determination of study quality was made on the basis of 1 ) whether the case-finding instrument was administered and interpreted independently of the criterion st and ard and 2 ) whether the proportion of persons receiving the criterion st and ard assessment was less than or more than 50 % of those approached for criterion st and ard assessment . Quality assessment addressed method ologic issues relevant to the evaluation of diagnostic tests ( such as independent assessment and selection bias ) and did not necessarily reflect the ability of studies to address their original aims . There were no disagreements about quality assessment s. Data Synthesis Established cut-points for case-finding instruments ( Table 1 ) were used . Two-by-two tables were constructed that categorized numbers of screened-positive and screened-negative persons who did and did not meet criterion st and ard diagnosis for major depression and major depression or dysthymia . Kraemer 's method [ 32 ] was used to adjust for verification bias for studies that used two-stage assessment techniques ; whereby the criterion st and ard was administered only to a r and om sample of persons who screened negative on case-finding instruments [ 33 ] . The authors of all but one study provided us with additional data and analyses when two-by-two tables could not be derived from abstract ion of the published article . This one study [ 28 ] was dropped from further review because its authors could not be contacted and tables could not be derived from published information . Table 1 . Characteristics of  Case-Finding Instruments That Have Been Used to Detect Depression in Primary Care Setting s * A scattergram ( Figure 1 ) plotting true-positive against false-positive rates was constructed to visually evaluate variability among studies [ 34 ] . To provide a visual reference for the consistency of study results , we modeled a summary receiver-operating curve based on the logit transformations of the true-positive and false-positive rates . Figure 1 . Plot of true-positive rate against false-positive rate for case-finding instruments to detect major depression . Average sensitivities and specificities , weighted by study size and corrected for two-stage assessment techniques when indicated , were computed both by case-finding instrument and by overall instruments [ 35 ] . The point estimates and 95 % CIs were calculated using a linear r and om-effects model [ 36 , 37 ] . Approximate 95 % CIs were estimated using quadratic root formulae because most of the point estimates were near unity [ 37 ] . Differences in weighted average sensitivities and specificities between case-finding instruments were evaluated using the z statistic with the Scheffe multiple-comparison adjustment [ 37 ] . Stratified analyses were done to evaluate whether estimated sensitivities and specificities varied between high- quality studies and those with major selection bias or lack of independent assessment . Regression analysis was used to determine associations between reported study prevalences and sensitivity estimates [ 37 ] . Results Descriptions of Case-Finding Instruments Characteristics of the nine case-finding instruments that have been evaluated in primary care setting s are presented in Table 1 . All of the question naires are written either at the easy ( 3rd to 5th grade ) or average ( 6th to 9th grade ) reading level [ 38 ] . Almost all can be self-administered in less than 5 minutes . Except for the General Health Question naire , all include specific questions aim ed at assessing depressed mood or whether a patient feels sad or blue . All include questions assessing anhedonia . Most are available in language s other than English , such as Spanish . The Beck Depression Inventory , the Center for Epidemiologic Studies Depression Screen , and the Zung Self- Assessment Depression Scale  are three commonly used , traditional instruments that were developed specifically to identify depression . They include similar numbers of questions and use response formats that rely either on ranking symptom severity or on classifying frequency of symptoms . The time frames of questions are today for the Beck Depression Inventory , over the past week for the Center for Epidemiologic Studies Depression Screen , and recently for the Zung Self- Assessment Depression Scale . These three instruments have been used in numerous setting s ( including the community , the clinic , and the hospital ) not only to identify depression but also to rate severity of depression and to monitor response to therapy . The General Health Question naire and the Hopkins Symptom Checklist are question naires that screen for general psychiatric illness ; the Hopkins Checklist has a specific category for depression . Both of these instruments have several versions with different numbers of questions . The Medical Outcomes Study Depression Screen is a depression-specific screening instrument that was developed by combining two questions from the Diagnostic Interview Schedule [ 39 ] with six questions from the Center for Epidemiologic Studies Depression Screen . A logistic regression scoring method is used ; this requires a calculator . The Primary Care Evaluation of Mental Disorders ( PRIME-MD ) and the Symptom Driven Diagnostic System- Primary Care instruments are recently developed , multidimensional question naires . Each has screening questions arranged in several categories ( for example , mood or depression , anxiety , alcohol abuse , and somatization ) that are used to trigger more extensive diagnostic interviewing sections for specific DSM-III-R diagnoses . The depression components of these two instruments include the fewest questions of all case-finding instruments that have been studied in primary care setting s. Descriptions of Studies and Study Design . Analysis of longitudinal data collected prospect ively from patients seen in 27 National Spine Network member centers across the United States . Objective . To evaluate the responsiveness of the Oswestry Disability Index , MODEMS scales , and all scales and summary scales of the MOS Short-Form 36 ( SF-36 ) for patients with low back pain/leg symptoms . Summary of Background Data . The responsiveness of general and condition-specific health status instruments is a key concept for clinicians and scientists . Various authors have explored responsiveness in common surveys used to assess spine patients . Although it is generally believed that condition-specific measures are more responsive to change in the condition under study , in the case of low back pain , most authors agree that further exploration is necessary . Methods . Patients with diagnoses of herniated disc , spinal stenosis , and spondylosis from the National Spine Network data base who completed baseline and 3-month follow-up surveys were analyzed . Patient-provider consensus regarding improvement , worsening , or no change in the condition was selected as the external criterion . Responsiveness was evaluated using ROC curve analysis and effect size calculations . Results . Nine hundred and seventy patients had complete data at baseline and 3 months . At follow-up , 68 % of the patients had consensus improvement . Based on ROC analysis , scales assessing pain were significantly more responsive than scales assessing function . There were no significant differences between the condition-specific scales and their equivalent general-health counterpart . The scales with the highest probabilities of correctly identifying patient ’s improvement were : the condition-specific pain scale from MODEMS ( PAIN , ROC = 0.758 ) ; the combined pain and function scale from MODEMS ( MPDL , ROC = 0.755 ) ; the general pain scale from the SF-36 ( BP , ROC = 0.753 ) ; the combined pain and function scale from the SF-36 ( PCS , ROC = 0.745 ) ; the condition-specific function measure from the Oswestry ( ODI , ROC = 0.723 ) ; and the physical function measure from the SF-36 ( PF , ROC = 0.721 ) . A similar rank order was typically maintained with effect size calculations . Results were nearly identical in patients with multiple non-spine-related comorbidities and in patients with high degrees of perceived  disability . The BP scale was most responsive to worsening of symptoms . Conclusion . For studies of patients with low back problems , the general SF-36 may be a sufficient measure of health status and patient function , without the need for additional condition-specific instruments .  Pain scales  appear to be the most responsive measures in patients with low back pain Fatigue is a major complaint among advanced cancer patients . Several instruments are available for measuring fatigue . The EORTC QLQ-C30 is one of the most frequently used health-related quality of life ( HRQOL ) instruments , and it includes a three-item fatigue subscale . Limited knowledge exists about the validity , performance and sensitivity of EORTC QLQ-C30 fatigue scale as compared with a fatigue-specific instrument . The aim of the present study was to vali date the EORTC QLQ-C30 fatigue scale ( FA ) against the Fatigue Question naire ( FQ ) . The FQ is frequently used and was developed to measure fatigue in both cancer and noncancer population s. The FQ measures physical ( PF , seven items ) and mental fatigue ( MF , four items ) . The study population included two different cohorts : A ) patients with advanced metastatic cancer included in a prospect i ve r and omized study of palliative radiotherapy ( n = 238 ) ; B ) patients with leukaemia and malignant lymphoma curatively treated with stem-cell transplantation and high-dose chemotherapy ( n = 128 ) . The analysis demonstrated that the FA correlated higher with the PF scale ( r = 0.67–0.75 ) as compared with the MF scale ( r = 0.49–0.61 ) . The item – scale correlations between FA items and the PF scale were consistently higher than between FA items and the MF scale . A factor analysis including all the items within the FA and the FQ identified two factors . All FA items loaded on a PF factor ( 0.70–0.85 ) . A floor/ ceiling effect , indicating a high number of respondents with lowest , respectively , highest scores was observed more frequently in the FA as compared with the FQ . The PF discriminated better between diagnostic groups with different levels of fatigue than the FA did . In conclusion , the EORTC QLQ-C30 fatigue scale is measuring physical fatigue . A floor/ ceiling effect seems to appear for the EORTC QLQ-C30 fatigue scale . The validity of the EORTC QLQ-C30 fatigue scale is to be question ed for use in palliative care patients . In studies with fatigue as a defined end point , a domain-specific instrument should , therefore , be added Background Reading skills are important for accessing health information , using health care services , managing one 's health and achieving desirable health outcomes . Our objective was to assess the diagnostic accuracy of the Single Item Literacy Screener ( SILS ) to identify limited reading ability , one component of health literacy , as measured by the S-TOFHLA . Methods Cross-sectional interview with 999 adults with diabetes residing in Vermont and bordering states . Participants were r and omly recruited from Primary Care practice s in the Vermont Diabetes Information System June 2003 – December 2004 . The main outcome was limited reading ability . The primary predictor was the SILS . Results Of the 999 persons screened , 169 ( 17 % ) had limited reading ability .  The sensitivity of the SILS in detecting limited reading ability was 54 % [ 95 % CI : 47 % , 61 % ] and the specificity was 83 % [ 95 % CI : 81 % , 86 % ] with an area under the Receiver Operating Characteristics Curve ( ROC ) of 0.73 [ 95 % CI : 0.69 , 0.78 ] . Seven hundred seventy ( 77 % ) screened negative on the SILS and 692 of these subjects had adequate reading skills ( negative predictive value = 0.90 [ 95 % CI : 0.88 , 0.92 ] ) . Of the 229 who scored positive on the SILS , 92 had limited reading ability ( positive predictive value = 0.4 [ 95 % CI : 0.34 , 0.47 ] ) . Conclusion The SILS is a simple instrument design ed to identify patients with limited reading ability who need help reading health-related material s. The SILS performs moderately well at ruling out limited reading ability in adults and allows providers to target additional assessment of health literacy skills to those most in need . Further study of the use of the SILS in clinical setting s and with more diverse population s is warranted Background : The effect of different sociodemographic and clinical variables on the health-related quality of life ( HRQOL ) of patients with inflammatory bowel disease ( IBD ) is currently known , but the influence of psychological factors has not been sufficiently explored . The objective of this study was to identify psychological predictors of HRQOL in patients with IBD . Methods : A cross-sectional prospect i ve study was undertaken including 875 consecutive IBD patients . Independent variables were measured using a  sociodemographic and clinical question naire , the Hospital Anxiety and Depression Scale ( HADS ) question naire , the Perceived Stress Scale ( PSS ) question naire , and the COPE question naire . Dependent variables were measured using the  Short Form 36 Health Survey ( SF-36 )  and the  Inflammatory Bowel Disease Question naire ( IBDQ-36 ) .  Logistic regression was performed to identify factors associated with HRQOL . Results : The participation rate was 91.3 % . Patients with IBD had a poorer HRQOL than the general population except on the Physical Function , Social Function , and Emotional Function Scale . Moreover , high levels of anxiety , depression , and stress were found to be associated with low levels in all quality of life measurements . No significant relationship was found between HRQOL and coping strategies . Conclusions : In patients with IBD , stress , anxiety and depression are important determinants of HRQOL and should therefore be considered in the management of this patient population Individuals with severe mental disorders continue to experience low employment rates .  Occupational therapists play an important role in helping these individuals develop the skills and obtain the supports necessary for productive living . This retrospective cohort study aim ed to explore employment outcomes and identify factors predictive of the outcomes of an in-house prevocational training program design ed for newly discharged psychiatric in patients . Data retrieved from the files of 58 participants including demographics , diagnostic history , physical fitness , functional assessment results , the use of vocational counselling service and employment status were analyzed . The overall employment rates among the participants were high ( 67.2 - 79.3 % ) within the 6 months following the prevocational training program . No significant differences were found in the employment rates across the 1 , 3 and 6-month time periods post-training . Vocational counselling service post-training and h and function were two factors predictive of participants ' employment outcomes . Occupational therapists should attend to the clients ' need for continuous vocational support and carefully identify the personal , functional and environmental factors contributing to successful employment . Caution in interpreting the results is warranted because of the lack of control and r and omization in this retrospective study . Additional longitudinal cohort or experimental studies would add further certainty to the current findings Background The psychometric properties of Patient Reported Outcomes Measurement Information System ( PROMIS ) instruments have been explored in a number of general and clinical sample s. No study , however , has evaluated the psychometric function of these measures in individuals with symptomatic knee osteoarthritis ( KOA ) . The aim of this project was to evaluate the construct ( structural ) validity and floor/ceiling effects of four PROMIS measures in this population . Methods We conducted a secondary analysis of baseline data from a r and omized trial comparing Tai Chi and physical therapy . Participants completed four PROMIS static short-form instruments ( i.e. , Anxiety , Depression , Physical Function , and Pain Interference ) as well as six well-vali date d ( legacy ) measures that assess pain , function , and psychological health . We calculated descriptive statistics and percentages of participants scoring the minimum ( floor ) and maximum ( ceiling ) possible scores for PROMIS and legacy measures . We also estimated the association between PROMIS scores and scores on legacy measures using Spearman ’s rank correlations coefficients . Results Data from 204 participants were analyzed . Mean age of the sample was 60 years ; 70 % were female .  The PROMIS Anxiety and Depression had floor effects with 17 and 24 % of participants scoring the minimum , respectively . PROMIS Anxiety and Depression scores had strongest associations with general mental health , including stress ( Perceived Stress Scale , r ≥ 0.65 ) and depression ( Beck Depression Index-II , r = 0.70 ) . PROMIS Pain Interference scores correlated most strongly with measures of whole body pain ( Short-Form 36 Bodily Pain , r = −0.73 ) and physical health ( Short-Form 36 Physical-Component Summary , r = −0.73 ) ; their correlations were lower with other legacy measures , including with the WOMAC knee-specific pain ( r = 0.47 ) . PROMIS Physical Function scores had stronger associations with scores on the Short-Form 36 Physical Function ( r = 0.79 ) than with scores on other legacy measures . Conclusion The four PROMIS static-short forms performed well among individuals with symptomatic knee osteoarthritis as evidence d in correlations with legacy measures . PROMIS Anxiety and Depression target general mental health ( e.g. , stress , depression ) , and PROMIS Pain Interference and Physical Function static-short forms target whole-body outcomes among participants with symptomatic knee osteoarthritis . Floor effects in the PROMIS Anxiety and Depression scores should be considered if needing to distinguish among patients with very low levels of these outcomes .Trial registration Clinical trials.gov NCT01258985 . Registered 10 December OBJECTIVE To assess the reliability , validity and sensitivity to change of the Derriford Scale , a quality of life instrument design ed to assess the distress and dysfunction experienced by people who are self-conscious about their physical appearance . SUBJECTS AND DESIGN Postal question naire survey of 656 cosmetic surgery patients recruited from new referral letters and plastic surgery waiting list reports . A total of 443 subjects completed and returned the question naire .  Of these respondents , 203 were sent a second question  naire to assess reproducibility , of whom 155 subjects responded . MAIN OUTCOME MEASURES Reliability was assessed in terms of internal consistency and reproducibility . Face , content and construct validity were also investigated . RESULTS The analyses led to mixed results . There was some evidence of internal consistency , but a number of items had low endorsement levels and there may be scope for reducing the overall size of the instrument . When assessed for reproducibility , the level of agreement between scores of individuals completing the question naire on two occasions was high , but an important systematic shift in responses was also detected . Correlations between the other health status measures and the Derriford Scale provided some evidence of construct validity . CONCLUSION In its present form the Derriford Scale has good descriptive value , but there are some measurement problems identified in this report that need to be addressed before the scale is taken up into general use The purpose of this project was to conduct a systematic review to identify instruments design ed to evaluate the quality of r and omized controlled trials ( RCTs ) of natural health products ( NHPs ) . Instruments were examined for inclusion of items assessing methods , identity and content of the NHP , generalizability of results and instructions for use . Online data bases , websites , textbooks and reference lists were search ed to identify instruments . Relevance assessment and data extraction of articles were completed by two investigators and disagreements were settled by the third investigator . Data were analyzed using descriptive statistics . Of the 4442 citations identified , 29 were potentially relevant with 16 meeting the criteria for inclusion . None of the instruments stated they were vali date d ; content in the four areas of interest varied considerably . The most common items included r and omization sequence generation ( 100 % ) , blinding ( 100 % ) , allocation concealment ( 75 % ) and participant flow ( 75 % ) . Only nine of the NHP instruments included at least one item to appraise the specific content of the NHP . The CONSORT Statement for Herbal Interventions most closely addressed the four areas of interest ; however , this instrument was specific for herbs . There is a need for the development of a vali date d instrument for assessment of the quality of RCTs that would be useful for herbs as well as other NHPs There have been few longitudinal studies of quality of life in patients with all stages of lung cancer , particularly those that have included measures of utility . The purpose of this study was to examine the psychometric properties of the Assessment of Quality of Life instrument ( AQoL )  in patients with lung cancer . The AQoL is a health-related quality of life question naire and provides a descriptive system for a multi-attribute utility instrument ( MAU ) , so that scores can be used in cost-utility evaluations . In the present study the reliability ( internal consistency ) of the AQoL was examined and the concurrent validity was assessed using the Medical Outcomes 36-item Short Form Health Survey ( SF-36 ) as the comparator instrument . The sensitivity to different health states of the AQoL and the responsiveness to change over time was also examined . A prospect i ve , non-experimental cohort study was undertaken . Ninety-two participants with all stages of lung cancer were recruited from a tertiary multi-disciplinary lung cancer clinic . Ninety participants had non-small cell lung cancer ( NSCLC ) and two had limited stage small cell lung cancer . The  AQOL and SF-36 surveys  were administered concurrently at baseline . In patients with NSCLC the surveys were then repeated 3 and 6 months later . Correlations between the baseline AQoL summary scales and SF-36 summary scales support the divergent and convergent validity of the AQoL.  Reliability was also found to be sufficient ( Cronbach 's Alpha=0.76 ) . In addition , in patients with inoperable NSCLC , baseline AQoL scores were found to be predictive of survival at 6 months in Cox proportional hazards multivariate analysis . However , the physical components summary score of the SF-36 was more sensitive to differences in health states between patients with different stages of NSCLC at 6 months of follow-up and more responsive to change over time in both operable and inoperable patients with NSCLC than the AQoL. The findings support the construct validity and reliability of the  AQoL  in this population . However , there remains some uncertainty about whether the AQoL has sufficient sensitivity to different health states in this population . Further studies using other MAU instruments may determine whether alternative instruments are more sensitive to different health states in individuals with lung cancer OBJECTIVE The glucagon stimulation test ( GST ) like the insulin tolerance test ( ITT ) stimulates both ACTH and GH secretion . However , there are limited data with modern assays on sensitivity and specificity for GST in comparison to ITT . The aim of this study was to evaluate the diagnostic utility of the GST for GH deficiency ( GHD ) and adrenal insufficiency ( AI ) in patients following pituitary surgery . DESIGN AND PATIENTS ITT and GST were performed within 7 days in 49 patients at least 3 months after transsphenoidal surgery .  Serum GH and cortisol were measured by Immulite 2000 assay ( Siemens AG ) . Receiver-operating characteristic ( ROC ) analysis was performed to identify the thresholds for GST . RESULTS In ITT , 18/49 cases were classified as AI . ROC analysis revealed a peak cortisol value > 599 nmol/l in GST for adrenal sufficiency with 100 % specificity and 32 % sensitivity , and a peak cortisol < 277 nmol/l with > 95 % specificity and 72 % sensitivity for AI . Of the 49 subjects , 25 ( 51 % ) demonstrated levels between these cut-offs and could not be diagnosed by GST alone with sufficient accuracy . Regarding GHD , 21/49 cases were classified as insufficient by ITT . ROC analysis revealed a cut-off of 2.5 ng/ml with 95 % sensitivity and 79 % specificity . Of the 49 cases , seven ( 14 % ) were discordant in terms of defining GHD , with six subjects being treated for GHD according to GST although being sufficient in ITT . CONCLUSION In our prospect i ve series of patients with pituitary disease , GST is a potential alternative test for the assessment of GH reserve , but is a poor test for ACTH reserve . Test-specific cut-offs should be applied to avoid misinterpretation Study Design This prospect i ve study evaluated the diagnostic utility of historically accepted sacroiliac joint tests . A multidisciplinary expert panel recommended 12 of the “ best ” sacroiliac joint tests to be evaluated against a criterion st and ard of unequivocal pain relief after an intra‐articular injection of local anesthetic into the sacroiliac joint . Objectives To identify a single sacroiliac joint test or ensemble of tests that are sufficiently useful in diagnosing sacroiliac joint disorders to be clinical ly valuable . Summary of Background Data No previous research has been done to evaluate any physical test of sacroiliac joint pain against an accepted criterion st and ard . Methods Historical data was obtained , and the 12 tests were performed by two examiners on 85 patients who subsequently underwent sacroiliac joint blocks .  Ninety percent or more relief was considered a positive response , and less then 90 % relief was considered a negative response . Results There were 45 positive and 40 negative responses . No historical feature , none of the 12 sacroiliac joint tests , and no ensemble of these 12 tests demonstrated worthwhile diagnostic value . Conclusion Sacroiliac joint pain is resistant to identification by the historical and physical examination data from tests evaluated in this study An empirical study in Lower Saxony aim ed to investigate any changes in primary care physicians ' diagnostic and therapeutic strategies as a result of Germany 's 1993 health reform act ( known as the Gesundheitsstruktur Gesetz or GSG ) , which included the countrywide implementation of a strict drug budget . A sentinel network consisting of a 37 % sample of 350 r and omly selected doctors ( n = 130 , GPs , general internists ) was established in Lower Saxony . Four cross sectional surveys , each focussing on one group of health problems , were carried out during 1993 . These aim ed to show whether sentinel practice networks are suitable for reporting physicians ' attitudes towards health care cost containment policies and , secondly , changes in physicians ' quantitative and qualitative assessment s of the 1993 reform act during its first year of implementation . Participating physicians reported patient consultations ( n = 3728 ) . St and ardised question naires ascertained sociodemographic variables and major reasons for the patients ' visit . Data on the diagnoses associated with the patient 's main reason for the consultation , the doctor 's assessment of the severity of the problem , and diagnostic and treatment strategies were also recorded . The question naire focussed on changes in therapy made by the physician together with the reasons for these changes . A number of treatment changes made with regard to cost containment were recorded . During the course of 1993 a decrease in reported changes in treatment was noticed . As expected , some doctors recorded a reduction in successful outcomes of treatment and ascribed this to the reform act . Differences between the four surveys with regard to the influence of the health reform act on the frequency of changes in treatment and the physicians ' expectations can not be explained sufficiently by the physicians ' adaptation to the cost containment policies within the year OBJECTIVES Our aim was to compare the Pipelle , Accurette , and Explora endometrial sampling devices . STUDY DESIGN Patients ( n = 248 ) undergoing endometrial biopsy  were r and omized to one of the three sampling instruments . Diagnostic accuracy , ability to obtain sufficient tissue for histologic diagnosis , and patient discomfort during sampling of the three devices were compared . When available , endometrial biopsy specimens were compared with subsequent pathologic findings at hysterectomy . Statistical analysis was performed with one-way variance of the means , chi 2 , and Kruskal-Wallis statistic . RESULTS In successful biopsies there was no statistical difference among groups in specimen adequacy and there was no discrepancy between endometrial biopsy and hysterectomy pathologic findings . However , 42 % of Accurette biopsies either were failed attempts or obtained insufficient tissue ( p < 0.01 ) . Pain scores were similar among the groups . CONCLUSION The results with the Pipelle and Explora endometrial sample rs appear to be comparable . However , given a 42 % unusable specimen rate , the Accurette can not be recommended for routine endometrial sampling
Even though some instruments and methods exhibited good to excellent reliability and validity and can be recommended for research and clinical practice , they do not allow assessing all components of physical oral health .
OBJECTIVE This study aim ed at exploring available clinical instruments and methods for assessing physical oral health , and at identifying those with sufficient diagnostic performance .