Stroke is a prototype disorder that disables as well as kills people. The disability-adjusted life years (DALY) metric developed by the World Health Organization to measure the global burden of disease integrates healthy life years lost due to both premature mortality and living with disability. Accordingly, it is well suited to stroke research. The DALY has previously been applied only to large but relatively crude population-level data analyses, but now it is possible to calculate the DALY lost in individual stroke patients. Measuring each patient's stroke outcome with DALY lost has expanded its application to the analysis of treatment effect in acute stroke trials, delineating the poststroke complication impact, the differential weighting of discrete vascular events, and estimating a more refined stroke burden in a specific population. The DALY metric has several advantages over conventional stroke outcome measures: 1) Since the DALY measures the burden of diverse health conditions with a common metric of life years lost, stroke burden and benefits of stroke interventions can be directly compared to other health conditions and their treatments. 2) Quantifying stroke burden or interventional benefits as the life years lost or gained makes the DALY metric more intuitively accessible for public and health system planners. 3) As a continuous, equal-interval scale, the DALY analysis might be statistically more powerful than either binary or ordinal rank outcome analyses in detecting the treatment effects of clinical trials. 4) While currently employed stroke outcome measures take one-time snapshots of disability or mortality and implicitly indicate long-term health impact, the DALY explicitly indicates the burdens of living with disability for an individual's remaining life.
Humans ; Mortality, Premature ; Outcome Assessment (Health Care) ; Statistics as Topic ; Stroke ; World Health Organization

BACKGROUND: Work-related fatigue has a strong impact on performance and safety but so far, no agreed upon method exists to detect and quantify it. It has been suggested that work-related fatigue cannot be quantified with just one test alone, possibly because fatigue is not a uniform construct. The purpose of this study is therefore to measure work-related fatigue with multiple tests and then to determine the underlying factorial structure. METHODS: Twenty-eight employees (mean: 36.11; standard deviation 13.17) participated in five common fatigue tests, namely, posturography, heart rate variability, distributed attention, simple reaction time, and subjective fatigue before and after work. To evaluate changes from morning to afternoon, t tests were conducted. For further data analysis, the differences between afternoon and morning scores for each outcome measure and participant (Δ scores) were submitted to factor analysis with varimax rotation and each factor with the highest-loading outcome measure was selected. The Δ scores from tests with single and multiple outcome measures were submitted for a further factor analysis with varimax rotation. RESULTS: The statistical analysis of the multiple tests determine a factorial structure with three factors: The first factor is best represented by center of pressure (COP) path length, COP confidence area, and simple reaction time. The second factor is associated with root mean square of successive difference and useful field of view (UFOV). The third factor is represented by the single Δ score of subjective fatigue. CONCLUSION: Work-related fatigue is a multidimensional phenomenon that should be assessed by multiple tests. Based on data structure and practicability, we recommend carrying out further studies to assess work-related fatigue with manual reaction time and UFOV Subtest 2.
Fatigue* ; Fibrinogen ; Heart Rate ; Methods ; Outcome Assessment (Health Care) ; Reaction Time ; Statistics as Topic

BACKGROUNDMusculoskeletal disorders (MSD) comprise a wide range of conditions, associated with an enormous pain and impaired mobility, and are affecting people's lives and work. Management of musculoskeletal disorders typically involves a multidisciplinary team approach. Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies, though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service (NHS) setting.

OBJECTIVETo determine the feasibility of all aspects of a pragmatic observational study designed: (1) to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK; (2) to determine the acceptability of the study design and research process to patients; (3) to explore patients' expectation and experience of receiving integrated treatments.

METHODSThis is an observational feasibility study, with 1-year recruitment and 1-year follow-up, conducted in Royal London Hospital for Integrated Medicine, University College London Hospital Trust, UK. All eligible patients with MSDs newly referred to the hospital were included in the study. Interventions are integrated packages of care (conventional and complementary) as currently provided in the hospital. SF-36™ Health Survey, short form Brief Pain Inventory, Visual Analogue Scale, and modified Client Service Receipt Inventory will be assessed at 4/5 time points. Semi-structured interview/focus group will be carried out before treatment, and 1 year after commence of treatment.

DISCUSSIONWe intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital. It will inform the design of a future trial including recruitment, retention, suitability of the outcome measures and patients experiences.

Data Collection ; Feasibility Studies ; Humans ; Musculoskeletal Diseases ; therapy ; Outcome Assessment (Health Care) ; Statistics as Topic

OBJECTIVES: The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care. METHODS: All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities. RESULTS: For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR. CONCLUSIONS: We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.
*Hospital Mortality ; Hospitals/*statistics & numerical data ; Humans ; Logistic Models ; Outcome Assessment (Health Care)/standards ; Quality of Health Care/standards ; Republic of Korea

BACKGROUND: The goal of this study was to evaluate whether a modified fluoroscopic technique for positioning a hook plate affected the clinical results of treating Neer type II distal clavicle fractures and Rockwood type V acromioclavicular (AC) joint separations with this device. METHODS: The study was a retrospective consecutive case series with data analysis. Sixty-four patients with a Neer type II distal clavicle fracture or a Rockwood type V AC joint injury treated between March 2009 and June 2013 were divided into 2 groups: traditional fluoroscopic technique (traditional view, 31 patients) or modified fluoroscopic technique ('hook' view, 33 patients). A visual analogue scale (VAS) score, the modified University of California-Los Angeles (UCLA) shoulder scale score, and radiographic osteolysis were the main outcome measures. RESULTS: The traditional group included a significantly larger number of patients with acromial osteolysis than the hook view group: 23 patients (74.2%) vs. 11 patients (33.3%), respectively (p=0.01). Before plate removal, the hook group reported less pain and higher UCLA shoulder scale scores than the traditional group: average VAS score, 1.55 vs. 2.26, respectively; average UCLA score, 30.88 vs. 27.06, respectively. However, there was no significant difference after plate removal. CONCLUSIONS: The hook view allows more accurate bending of the hook plate around the contour of the acromion, resulting in decreased osteolysis, decreased pain, and better function with the plate in situ.
Acromioclavicular Joint ; Acromion ; Clavicle* ; Dislocations ; Humans ; Joints ; Osteolysis ; Outcome Assessment (Health Care) ; Retrospective Studies ; Shoulder ; Statistics as Topic

BACKGROUND: The goal of this study was to evaluate whether a modified fluoroscopic technique for positioning a hook plate affected the clinical results of treating Neer type II distal clavicle fractures and Rockwood type V acromioclavicular (AC) joint separations with this device. METHODS: The study was a retrospective consecutive case series with data analysis. Sixty-four patients with a Neer type II distal clavicle fracture or a Rockwood type V AC joint injury treated between March 2009 and June 2013 were divided into 2 groups: traditional fluoroscopic technique (traditional view, 31 patients) or modified fluoroscopic technique ('hook' view, 33 patients). A visual analogue scale (VAS) score, the modified University of California-Los Angeles (UCLA) shoulder scale score, and radiographic osteolysis were the main outcome measures. RESULTS: The traditional group included a significantly larger number of patients with acromial osteolysis than the hook view group: 23 patients (74.2%) vs. 11 patients (33.3%), respectively (p=0.01). Before plate removal, the hook group reported less pain and higher UCLA shoulder scale scores than the traditional group: average VAS score, 1.55 vs. 2.26, respectively; average UCLA score, 30.88 vs. 27.06, respectively. However, there was no significant difference after plate removal. CONCLUSIONS: The hook view allows more accurate bending of the hook plate around the contour of the acromion, resulting in decreased osteolysis, decreased pain, and better function with the plate in situ.
Acromioclavicular Joint ; Acromion ; Clavicle ; Dislocations ; Humans ; Joints ; Osteolysis ; Outcome Assessment (Health Care) ; Retrospective Studies ; Shoulder ; Statistics as Topic

Stroke trials are broadly categorized into acute stroke trials and secondary stroke prevention trials. In acute stroke trials, National Institute of Health Stroke Scale is the most widely employed neurological scale measuring stroke severity. Modified Rankin scale and Glasgow Outcome Scale are global functional scales, while Barthel Index is a measure of activity of daily living. To analyze therapeutic efficacy, measured outcomes are usually dichotomized into "good" or "bad" according to arbitrary criteria set based on expert consensus. While the dichotomized analysis allows physicians to easily interpret clinical trials' findings, it has weaknesses of cut-off point dilemma, and a great chance of missing clinically meaningful but modest therapeutic efficacy. Shift analysis, which incorporates therapeutic effects over the entire range of clinical outcomes, is recognized for greater sensitivity in detecting treatment efficacy, but it is not easy to clinically interpret trial findings with shift analysis. In the field of stroke clinical research, recent studies have introduced a metric of disability-adjusted life years (DALY) lost which has been widely employed in population level data analysis to estimate global and regional burden of diseases. DALY lost metric indicating healthy life years lost due to disability and premature death has several advantages: a continuous scale measured with a more powerful statistical method; a common metric of life years lost that enables to compare stroke with other health conditions; an easier-to-understand metric to laymen. In secondary stroke prevention trials, most common primary outcome measures are recurrent stroke and composite of major vascular events. Composite endpoint analysis can index the overall therapeutic impact over polyvascular beds as well as cerebrovascular bed, and capture more vascular events to reduce sample size requirements. However, it has a widely-known limitation of equal weighting of all endpoint components, irrespective of their different impact on patients' lives. A recent study introduced a new weighting strategy of DALY lost analysis which indicates, compared to a nonfatal myocardial infarction, a 1.48-fold greater DALY lost with a nonfatal stroke, and a 2.25-fold greater loss of DALY with vascular death.
Consensus ; Glasgow Outcome Scale ; Mortality, Premature ; Myocardial Infarction ; Outcome Assessment (Health Care) ; Sample Size ; Statistics as Topic ; Stroke ; Treatment Outcome ; Weights and Measures

OBJECTIVEThe number of analyzed outcome variables is important in the statistical analysis and interpretation of research findings. This study investigated published papers in the field of environmental health studies. We aimed to examine whether differences in the number of reported outcome variables exist between papers with non-significant findings compared to those with significant findings. Articles on the maternal exposure to mercury and child development were used as examples.

METHODSArticles published between 1995 and 2013 focusing on the relationships between maternal exposure to mercury and child development were collected from Medline and Scopus.

RESULTSOf 87 extracted papers, 73 used statistical significance testing and 38 (43.7%) of these reported 'non-significant' (P>0.05) findings. The median number of child development outcome variables in papers reporting 'significant' (n=35) and 'non-significant' (n=38) results was 4 versus 7, respectively (Mann-Whitney test P-value=0.014). An elevated number of outcome variables was especially found in papers reporting non-significant associations between maternal mercury and outcomes when mercury was the only analyzed exposure variable.

CONCLUSIONAuthors often report analyzed health outcome variables based on their P-values rather than on stated primary research questions. Such a practice probably skews the research evidence.

Bias ; Child ; Child Development ; drug effects ; physiology ; Environmental Exposure ; statistics & numerical data ; Environmental Health ; statistics & numerical data ; Female ; Humans ; Maternal Exposure ; statistics & numerical data ; Mercury ; toxicity ; Outcome Assessment (Health Care) ; standards ; Periodicals as Topic ; standards ; statistics & numerical data

Aromatic traditional Chinese medicines have a long history in China, with wide varieties. Volatile oils are active ingredients extracted from aromatic herbal medicines, which usually contain tens or hundreds of ingredients, with many biological activities. Therefore, volatile oils are often used in combined prescriptions and made into various efficient preparations for oral administration or external use. Based on the sources from the database of Newly Edited National Chinese Traditional Patent Medicines (the second edition), the author selected 266 Chinese patent medicines containing volatile oils in this paper, and then established an information sheet covering such items as name, dosage, dosage form, specification and usage, and main functions. Subsequently, on the basis of the multidisciplinary knowledge of pharmaceutics, traditional Chinese pharmacology and basic theory of traditional Chinese medicine, efforts were also made in the statistics of the dosage form and usage, variety of volatile oils and main functions, as well as the status analysis on volatile oils in terms of the dosage form development, prescription development, drug instruction and quality control, in order to lay a foundation for the further exploration of the market development situations of volatile oils and the future development orientation.
Databases, Pharmaceutical ; statistics & numerical data ; Drug Therapy ; statistics & numerical data ; Humans ; Medicine, Chinese Traditional ; Nonprescription Drugs ; Oils, Volatile ; classification ; therapeutic use ; Outcome Assessment (Health Care) ; statistics & numerical data ; Phytotherapy ; statistics & numerical data ; Plant Oils ; classification ; therapeutic use

There is a lack of information on critical care in Korea. The aim of this study was to determine the current status of Korean intensive care units (ICUs), focusing on the organization, characteristics of admitted patients, and nurse and physician staffing. Critical care specialists in charge of all 105 critical care specialty training hospitals nationwide completed a questionnaire survey. Among the ICUs, 56.4% were located in or near the capital city. Only 38 ICUs (17.3%) had intensive care specialists with a 5-day work week. The average daytime nurse-to-patient ratio was 1:2.7. Elderly people > or = 65 yr of age comprised 53% of the adult patients. The most common reasons for admission to adult ICUs were respiratory insufficiency and postoperative management. Nurse and physician staffing was insufficient for the appropriate critical care in many ICUs. Staffing was worse in areas outside the capital city. Much effort, including enhanced reimbursement of critical care costs, must be made to improve the quality of critical care at the national level.
Adult ; Aged ; Aged, 80 and over ; Critical Care/*organization & administration ; Hospitals ; Humans ; Intensive Care Units ; Middle Aged ; Nursing Staff, Hospital/*statistics & numerical data ; Outcome Assessment (Health Care) ; Physicians/*statistics & numerical data ; Questionnaires ; Republic of Korea