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Biomedical subjects

Eva Grill

Publications and source records attributed to Eva Grill.

At least 19 recordsLinked to original sources
PubMed2007

Assessing observer agreement when describing and classifying functioning with the International Classification of Functioning, Disability and Health.

OBJECTIVE: The International Classification of Functioning, Disability and Health (ICF) is used increasingly to describe and classify functioning in medicine without being a psychometrically sound measure. All categories of the ICF are quantified using the same generic 0-4 scale. The objective of this study was to assess observer agreement when describing and classifying functioning with the ICF. DESIGN: A second-level category of the ICF, d430 lifting and carrying objects, was used as an example. To the qualifiers of this category, clinically meaningful definitions were assigned. Data were collected in a cross-sectional survey with repeated measurement. We report raw, specific and chance-corrected measures or agreement, a graphical method and the results of log-linear models for ordinal agreement. SUBJECTS/PATIENTS: A convenience sample of patients requiring physical therapy in an acute hospital. RESULTS: Twenty-five patients were assessed twice by 2 observers. Raw agreement was 0.52. Kappa was 0.36, indicating fair agreement. Different hierarchical log-linear models indicated that the strength of agreement was not homogeneous over all categories. CONCLUSION: Observer agreement has to be evaluated when describing and classifying functioning using the ICF Qualifiers'scale. When assessing inter-observer reliability, the first step is to calculate a summary statistic. Modelling agreement yields valuable insight into the structure of a contingency table, which can lead to further improvement of the scale.

Cross-Sectional Studies↗
PubMed2006

A comparative study of patient-reported functional outcomes in acute rheumatoid arthritis.

OBJECTIVE: To assess the performance of the Barthel Index (BI) in patients with rheumatoid arthritis (RA) in the acute care hospital, as compared to the Stanford Health Assessment Questionnaire (HAQ) and the Hannover Functional Questionnaire (Funktionsfragebogen Hannover, FFbH). METHODS: A prospective study of 97 patients with RA admitted to an acute rheumatology hospital with new onset or acute flare of RA. Patients were required to self-complete the BI, the HAQ, and the FFbH. Disease activity was measured using the Disease Activity Score (DAS28). RESULTS: Seventy-eight percent of patients were female, average age was 61.5 (SD 12.5) years, and 72.2% were rheumatoid factor-positive. The median HAQ was 1.29 (range 0-3), median FFbH was 50% (6-100%), and median BI was 95 (0-100), and distribution was highly skewed. All measures of physical functioning were significantly correlated with each other and with the DAS28; however, the BI discriminated poorly between low and high disease activity. CONCLUSION: The BI is not a useful instrument to assess physical functioning in patients with acute symptoms of RA, but may have a role in assessing patients with comorbidities and in assessing nursing care needs in the acute care hospital.

Acute Disease↗
PubMed2006

Systematic review of measures and their concepts used in published studies focusing on the treatment of acute inflammatory arthritis.

To identify outcome measures and concepts cited in published studies focusing on the treatment of acute inflammatory arthritis, and to identify and quantify the concepts contained in these measures using the International Classification of Functioning, Disability and Health (ICF) as a reference. This 'research perspective' is part of the development process for an ICF core set in acute arthritis. Electronic searches of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Pedro and the Cochrane Library from January 2000 to July 2004 were carried out. Data on the outcome measures and patient characteristics for the included studies were extracted. The items of the identified questionnaires and their underlying concepts were specified and then linked to ICF categories using standardized linkage rules. From the 401 abstracts retrieved, 104 studies met the inclusion criteria. From these studies, 38 formal assessment instruments, 62 single clinical measures, 66 technical measures and 14 clinical criteria were identified. A total of 966 concepts were extracted, and 84.7% of these concepts could be linked to ICF categories. The concepts contained in measures named in more than 5% of the studies were represented by 34 second-level ICF categories. Ten (30%) of the 34 categories belong to the component "Body Functions", 3 (9%) to the component "Body Structures" and 21 (61%) to the component "Activities and Participation". The ICF provides a valuable reference to identify and quantify the concepts of outcome measures focusing on the management of patients with acute inflammatory arthritis. Our findings indicate there is good agreement on 'what should be measured' in acute inflammatory arthritis to allow for a comparison of patient populations.

Acute Disease↗
PubMed2006

Neonatal hearing screening: modelling cost and effectiveness of hospital- and community-based screening.

BACKGROUND: Children with congenital hearing impairment benefit from early detection and management of their hearing loss. These and related considerations led to the recommendation of universal newborn hearing screening. In 2001 the first phase of a national Newborn Hearing Screening Programme (NHSP) was implemented in England. Objective of this study was to assess costs and effectiveness for hospital and community-based newborn hearing screening systems in England based on data from this first phase with regard to the effects of alterations to parameter values. METHODS DESIGN: Clinical effectiveness analysis using a Markov Model. OUTCOME MEASURE: quality weighted detected child months (QCM). RESULTS: Both hospital and community programmes yielded 794 QCM at the age of 6 months with total costs of 3,690,000 pound sterling per 100,000 screened children in hospital and 3,340,000 pound sterling in community. Simulated costs would be lower in hospital in 48% of the trials. Any statistically significant difference between hospital and community in prevalence, test sensitivity, test specificity and costs would result in significant differences in cost-effectiveness between hospital and community. CONCLUSION: This modelling exercise informs decision makers by a quantitative projection of available data and the explicit and transparent statements about assumptions and the degree of uncertainty. Further evaluation of the cost-effectiveness should focus on the potential differences in test parameters and prevalence in these two settings.

Community Health Services↗
PubMed2006

Validation of International Classification of Functioning, Disability, and Health (ICF) Core Sets for early postacute rehabilitation facilities: comparisons with three other functional measures.

OBJECTIVE: Short lists of International Classification of Functioning, Disability, and Health (ICF) categories, ICF Core Sets, have been developed as reference standards for clinical practice and research. The objective of this study was to validate the ICF Core Sets for early postacute rehabilitation facilities against the measures most commonly used in early postacute rehabilitation, the FIM instrument, the Functional Assessment Measure, and the Barthel index. DESIGN: Linking study matching the concepts of three commonly used outcome measures to corresponding ICF categories. RESULTS: Corresponding ICF categories could be found for all of the items of the FIM instrument + Functional Assessment Measure and Barthel index. The 40 items of these three measures were linked to 33 different ICF categories. Four items could be linked to ICF categories that were not part of any of the Postacute ICF Core Sets. CONCLUSIONS: The Postacute ICF Core Sets cover the concepts of the most frequently used measures in early postacute rehabilitation. Yet, many aspects of human functioning are not measured by the FIM instrument + Functional Assessment Measure and the Barthel index. If this information is considered relevant, these items would have to be added by using supplementary measures. Our comparison demonstrates the benefit of using a common language when comparing items using different wordings and concepts.

Activities of Daily Living↗
PubMed2006

[Development and use of the ICF from the nursing point of view--a position statement of the German speaking working group "ICF and Nursing"].

The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive and internationally acknowledged framework for the description of human functional health, which covers all aspects of health and some health-related elements of well-being. The ICF is part of the classification family of the World Health Organisation (WHO) and can be used by different health care disciplines as well as for different purposes. In order to promote the discussion about ICF within the nursing profession, the German speaking working group "ICF and Nursing" developed a position statement that critically reflects both the potentials and the restrictions of the ICF for use in nursing care, particularly for diagnostical purposes.

Activities of Daily Living↗
PubMed2005

Comparing the clinical effectiveness of different new-born hearing screening strategies. A decision analysis.

BACKGROUND: Children with congenital hearing impairment benefit from early detection and treatment. At present, no model exists which explicitly quantifies the effectiveness of universal newborn hearing screening (UNHS) versus other programme alternatives in terms of early diagnosis. It has yet to be considered whether early diagnosis (within the first few months) of hearing impairment is of importance with regard to the further development of the child compared with effects resulting from a later diagnosis. The objective was to systematically compare two screening strategies for the early detection of new-born hearing disorders, UNHS and risk factor screening, with no systematic screening regarding their influence on early diagnosis. METHODS DESIGN: Clinical effectiveness analysis using a Markov Model. DATA SOURCES: Systematic literature review, empirical data survey, and expert opinion. TARGET POPULATION: All newborn babies. TIME SCALE: 6, 12 and 120 months. PERSPECTIVE: Health care system. COMPARED STRATEGIES: UNHS, Risk factor screening (RS), no systematic screening (NS). OUTCOME MEASURES: Quality weighted detected child months (QCM). RESULTS: UNHS detected 644 QCM up until the age of 6 months (72,2%). RS detected 393 child months (44,1%) and no systematic screening 152 child months (17,0%). UNHS detected 74,3% and 86,7% weighted child months at 12 and 120 months, RS 48,4% and 73,3%, NS 23,7% and 60,6%. At the age of 6 months UNHS identified approximately 75% of all children born with hearing impairment, RS 50% and NS 25%. At the time of screening UNHS marked 10% of screened healthy children for further testing (false positives), RS 2%. UNHS demonstrated higher effectiveness even under a wide range of relevant parameters. The model was insensitive to test parameters within the assumed range but results varied along the prevalence of hearing impairment. CONCLUSION: We have shown that UNHS is able to detect hearing impairment at an earlier age and more accurately than selective RS. Further research should be carried out to establish the effects of hearing loss on the quality of life of an individual, its influence on school performance and career achievement and the differences made by early fitting of a hearing aid on these factors.

Cost-Benefit Analysis↗
PubMed2003

Incidence and risk factors of respiratory syncytial virus-related hospitalizations in premature infants in Germany.

UNLABELLED: Premature infants have an increased risk of developing complicated respiratory syncytial virus (RSV) infections. Epidemiological data on RSV-related hospitalizations are a prerequisite to develop guidelines for the use of preventive measures. The objective of this study was to determine incidence and risk factors of RSV-related rehospitalizations (RSV-RH) of premature infants. We recruited 1,103 infants with a gestational age of less than 35 weeks, primarily admitted to nine neonatologic care units in southern Germany between Nov. 1, 1998 and Oct. 31, 1999. Questionnaires were sent to all parents of infants discharged from neonatal care units to determine the risk of rehospitalization for acute respiratory infections (ARI-RH) and RSV-RH in the 1999-2000 season. The questionnaire response rate was 68.4%. The 717 included infants of the responders had a mean gestational age of 31.6 weeks (Range: 23-35) and a mean birth weight of 1,747 g (range: 430-4,050 g). The risk for an ARI-RH was 10.6% and the risk for RSV-RH 5.2% during the observation period. Premature infants with chronic lung disease (CLD) had a probability of 24.5% for ARI-RH and of 15% for RSV-RH. The following factors were independently associated with an increased risk of RSV-RH: male gender (adjusted Odds-Ratio (OR): 8.7; 95% confidence interval (CI): 2.6-29.1), chronic lung disease (OR: 3.99; 95%CI: 1.4-11.2), discharge between October and December (OR: 2.1; 95%CI: 0.99-4.4), day-care attendance of siblings (OR: 3.9; 95%CI: 1.9-8.3). CONCLUSIONS: The risk for RSV rehospitalization among premature infants discharged from neonatal care facilities in southern Germany was low. Additional risk factors and high costs of prophylaxis have to be considered when infants are selected for RSV prophylaxis using monoclonal antibodies.

Acute Disease↗
PubMed2003

Economic evaluation of possible prevention of RSV-related hospitalizations in premature infants in Germany.

UNLABELLED: Palivizumab (Synagis, MedImmune Inc./Abbott Laboratories) has been shown to reduce the number of respiratory syncytial virus (RSV)-related hospitalizations in premature infants. The cost-effectiveness ratio of this prophylaxis, however, has not been evaluated in the German health-care system to date. The aim of the study was to assess the costs and benefits of Palivizumab among premature infants </=35 weeks with different risk factors. Projecting a societal perspective, we used decision analysis to compare the strategies of a prophylaxis with and without Palivizumab. Probabilities and costs of hospitalization were derived from a retrospective, population-based cohort study on 1,103 prematurely born infants primarily admitted to nine neonatologic care units in southern Germany between November 1998 and October 1999. Costs of prophylaxis were based on hospital sources. Efficacy of prophylaxis and estimates of RSV mortality were derived from the literature. Effectiveness was defined as the number of averted hospitalizations. The cost-effectiveness ratio of Palivizumab varied strongly among the different risk groups. While demonstrating no net cost savings related to RSV prophylaxis for any of the risk groups analyzed, Palivizumab showed the best cost-effectiveness ratio among male infants with chronic lung disease, discharge from primary neonatal care between October and December, and the presence of siblings visiting a day-care group. One averted hospitalization in this high-risk group was associated with costs of Euro 6,639 (number needed to treat (NNT): 4). For infants in other risk groups, the ratios varied from Euro 25,288 (NNT: 8) to Euro 204,684 (NNT: 54) per hospitalization averted. The cost-effectiveness ratios were sensitive to varying assumptions about probabilities and costs of rehospitalization, efficacy, and costs of Palivizumab prophylaxis. CONCLUSIONS: The results of this cost-effectiveness analysis do not justify the widespread use of Palivizumab among preterm infants. Lowering the costs of prophylaxis would be the most direct way to improve the cost-effectiveness ratio of Palivizumab.

Antibodies, Monoclonal↗
PubMedDate not supplied

ICF Core Set for patients with cardiopulmonary conditions in early post-acute rehabilitation facilities.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with cardiopulmonary conditions in early post-acute rehabilitation facilities. METHODS: The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Seventeen experts selected a total of 84 second-level categories. The largest number of categories was selected from the ICF component Body Functions (33 categories or 39% of all ICF Core Set categories). Four (5%) of the categories were selected from the component Body Structures, 23 (27%) from the component Activities and Participation, and 24 (29%) from the component Environmental Factors. CONCLUSIONS: The Post-acute ICF Core Set for patients with cardiopulmonary conditions is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Set for geriatric patients in early post-acute rehabilitation facilities.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for geriatric patients in early post-acute rehabilitation facilities. METHODS: The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Fifteen experts selected a total of 123 second-level categories. The largest number of categories was selected from the ICF component Body Functions (51 categories or 41%). 14 (11%) of the categories were selected from the component Body Structures, 30 (29%) from the component Activities and Participation, and 28 (23%) from the component Environmental Factors. CONCLUSION: The Post-acute ICF Core Set for geriatric patients is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first version of the ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Sets development for the acute hospital and early post-acute rehabilitation facilities.

The goal of this paper is to report on the background and the methods used in the ICF Core Set development for patients in the acute hospital and early post-acute rehabilitation facilities. ICF Core Sets are sets of categories out of the International Classification of Functioning, Disability and Health (ICF) which can serve as minimal standards for the assessment, communication and reporting of functioning and health for clinical studies, clinical encounters and multi-professional comprehensive assessment and management. The ICF Core Sets were developed in a formal decision-making and consensus process, integrating evidence gathered from preliminary studies and expert opinion. The Acute ICF Core Sets for patients with neurological, musculoskeletal and cardiopulmonary conditions are intended for use by physicians, nurses, therapists and other health professionals working in the acute hospital on medical, surgical or other units not specialised in rehabilitation. The Post-acute ICF Core Sets for geriatric patients and patients with neurological, musculoskeletal or cardiopulmonary conditions are intended for use by physicians, nurses, therapists and other health professionals involved in early post-acute rehabilitation. The Acute and Post-acute ICF Core Sets are first versions and need to be tested and validated in the patient and professional perspective and in different countries, regions, health care and provider settings.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Set for patients with cardiopulmonary conditions in the acute hospital.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with cardiopulmonary conditions in the acute hospital. METHODS: The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Twenty-two experts selected a total of 48 second-level categories. The largest number of categories was selected from the ICF component Body Functions (21 categories or 44%). Four (8%) of the categories were selected from the component Body Structures, 10 (21%) from the component Activities and Participation, and 13 (27%) from the component Environmental Factors. CONCLUSION: The Acute ICF Core Set for patients with cardiopulmonary conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Set for patients with neurological conditions in the acute hospital.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with neurological conditions in the acute hospital. METHODS: The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Twenty-one experts selected a total of 85 second-level categories. The largest number of categories was selected from the ICF component Body Functions (41 categories or 48%). Five (6%) of the categories were selected from the component Body Structures, 18 (21%) from Activities and Participation and 21 (25%) from Environmental Factors. CONCLUSIONS: The Acute ICF Core Set for patients with neurological conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗
PubMedDate not supplied

ICF Core Set for patients with neurological conditions in early post-acute rehabilitation facilities.

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for neurological patients in early post-acute rehabilitation facilities. METHODS: The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Seventeen experts selected a total of 116 second-level categories. The largest number of categories was selected from the ICF component Body Functions (54 categories or 47%). Eleven (9%) of the categories were selected from the component Body Structures, 34 (29%) were of the categories from the component Activities and Participation, and 17 (15%) from the component Environmental Factors. CONCLUSION: The Post-acute ICF Core Set for neurological patients is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

Activities of Daily Living↗
PubMedDate not supplied

Identification of relevant ICF categories by health professionals in the acute hospital.

PURPOSE: To identify the most relevant problems of patients in the acute hospital in the view of health professionals using focus groups followed by a Delphi process. METHODS: Focus group and Delphi methodology were applied. The focus groups were conducted at three university hospitals. Three groups focusing on the problems in patients with neurological/neurosurgical, cardiopulmonary and musculoskeletal conditions were conducted at each hospital. The participants had to decide about which categories of the International Classification of Functioning, Disability and Health are relevant to patients in the acute hospital. The results from the focus groups were then followed by a Delphi process. RESULTS: Forty health professionals participated in the nine focus groups, 14 in the three neurological/neurosurgical groups, 13 in the three musculoskeletal groups, 13 in the three cardiopulmonary groups. One hundred and sixty-four of the second-level ICF categories (61.7% of all second-level categories) were considered as relevant by the health professionals of the neurological group, 100 categories (37.6%) by the musculoskeletal group and 91 (34.2%) by the cardiopulmonary group. CONCLUSIONS: The involvement of experts from different health professions is a valuable tool to identify typical patient characteristics, expressed as distinct ICF categories, which can be used across different acute conditions.

Activities of Daily Living↗
PubMedDate not supplied

Identification of relevant ICF categories by patients in the acute hospital.

PURPOSE: To describe functioning and health of patients in the acute hospital and to identify the most common problems using the International Classification of Functioning, Disability and Health (ICF). METHODS: Cross-sectional survey in a convenience sample of neurological, musculoskeletal and cardiopulmonary patients requiring rehabilitation in the acute hospital. The second level categories of the ICF were used to collect information on patients' problems. For the ICF components Body Functions, Body Structures and Activities and Participation absolute and relative frequencies of impairments/limitations in the study population were reported. For the component Environmental Factors absolute and relative frequencies of perceived barriers or facilitators were reported. RESULTS: The mean age in the sample was 57.6 years with a median age of 60.5, 49% of the patients were female. In 101 patients with neurological conditions, 115 ICF categories had a prevalence of 30% and more: 32 categories of Body Functions, 13 categories of Body Structures, 32 categories of Activities and Participation and 38 categories of Environmental Factors. In 105 patients with cardiopulmonary conditions, 80 categories had a prevalence of 30% and more: 36 categories of Body Functions, eight categories of Body Structures, 10 categories of Activities and Participation and 26 categories of Environmental Factors. In 90 patients with musculoskeletal conditions, 61 categories had a prevalence of 30% and more: 14 categories of Body Functions, five categories of Body Structures, 16 categories of Activities and Participation and 26 categories of Environmental Factors. CONCLUSION: This study is a first step towards the development of ICF Core Sets for patients in the acute hospital.

Activities of Daily Living↗