PubMed Health⌕ Search

Biomedical subjects

O Sangha

Publications and source records attributed to O Sangha.

At least 19 recordsLinked to original sources
PubMed2003

Validation of a German version of the 'Disabilities of Arm, Shoulder and Hand' questionnaire (DASH-G).

OBJECTIVE: In 1994 the American Academy of Orthopedic Surgeons' outcome research committee developed and validated a functional outcome questionnaire for disabilities of the upper extremity (DASH). The objective of our study was to translate the DASH into German and to evaluate its reliability and validity for German-speaking patients with shoulder pain. METHODS: Translation-backtranslation of the DASH was performed according to published guidelines. Psychometric properties and validity were assessed in 49 consecutive patients with shoulder pain originating from within the shoulder girdle. Age, duration of symptoms and current pain were obtained. Test-retest reliability was assessed in a subset of 18 patients who filled in the questionnaire 10 days later. Internal consistency was evaluated with Cronbach's alpha coefficient. Test-retest reliability was assessed using Spearman correlations and the Bland and Altman plot. To study the validity, we examined the correlation of the DASH with other measures of function of the upper extremity including the HAQ subscales relating to the upper extremity and pain measures (e.g. numerical rating scale, SF-36 pain scale). We also examined our hypothesis that the DASH is moderately correlated with measures of range-of-motion (e.g., forward flexion and abduction). RESULT: Translation-backtranslation revealed no major difficulties. The mean age of the patients was 59 years, mean duration of symptoms 60 months and current pain score 5.6 (NRS). Test-retest reliability was 0.90 for the total DASH. The internal consistency was 0.96. Strong correlations (p<0.01) were found between the DASH and the mean among the five subscales of the HAQ representing upper extremity function (0.88) and pain as measured with the SF-36 bodily pain scale (-0.79). As hypothesized, the DASH was also moderately correlated with measures of range-of-motion (e.g. forward flexion rho=-0.49; abduction rho=-0.57). CONCLUSION: Our data confirm that the German version of the DASH retains the characteristics of the American original and is a reliable and valid instrument to measure functional disability in German speaking patients with shoulder pain.

Adult↗
PubMed2002

Independent living after fractures in the elderly.

Although fractures are an important source of disability among the growing elderly populations of industrialized societies, patient-centered multidimensional outcome information is scarce. The purpose of this study was to quantify the natural history of recovery from fractures of the upper and lower extremities. From the 1994/95 WHO MONICA survey in Augsburg, Germany, we selected all persons aged 58-78 years who had experienced a fracture during the preceeding 10 years, along with a control population twice as large. The Health Assessment Questionnaire (HAQ) and the Medical Outcomes Study Short Form 36 (SF-36) were administered to these subjects in 1998. Patients' recollection of fracture type and location were validated against medical records. The most recent fracture was in the upper extremity in 45 cases, lower extremity in 55 cases and elsewhere in 46 cases. Extremity fractures resulted in persistent and measurable impairment of the activities of daily living or general quality of life in patients 65 years or older, especially if the femur was involved. More than 40% of the interindividual variation of functional disability in the study group could be explained by age, sex, history of a fracture within 12 years and perceived difficulties walking. Existing generic and specific musculoskeletal outcome measurement instruments thus allow the assessment of functional recovery and health status after fractures in an elderly population. Geriatric assessment following fractures at higher age may improve ability to live independently. Difficulty walking deserves special attention, as it is associated with more general functional disability among the elderly.

Activities of Daily Living↗
PubMed2002

[Epidemiology of limb fractures].

To analyze age- and sex-specific frequencies of peripheral fractures, we used data from the third MONICA-Augsburg Survey (1994/95). The study comprises 2404 male and 2450 female participants (age 25 to 74 years) who were questioned regarding fracture history. We investigated fracture prevalence, age-specific incidence rates, and the circumstances under which the fractures occurred. The age-standardized, cumulative fracture prevalence among men (m) 25 to 74 years of age was 45% and among women (w) of the same age 31%. Fracture prevalence among women was more than 10% lower than among men in the younger age groups (age 25 to 64 years), but after an significant increase in the 65 to 74-year-olds the fracture prevalence corresponded to that of men (m: 42%, w: 40%). A peak of incidence rates was found among men at age 15-24 (overall incidence rate: 2017 fractures/100,000 person-years) and at age 45-54 (overall incidence rate: 1640 fractures/100,000 PY), respectively, and among women at age 65-74 (overall incidence rate: 3214 fractures/100,000 PY). The prevalence of self-reported osteoporosis (age 25 to 74 years) was higher in women (7%) than in men (1%). Falls caused 43% (w: 59%, m: 33%) of all fractures, external violence 40% (m: 47%, w: 29%), and sports activities 15% (m: 18%, w: 10%). Further investigation of risk factors related to fractures can contribute to the development of specific preventive measures in that field. In the future, the prevention and efficient treatment of an existing or an often undiagnosed osteoporosis and also the prevention of falls in elderly persons should be an important public health concern.

Adolescent↗
PubMed2002

Radiographic outcome after three years of patients with early erosive rheumatoid arthritis treated with intramuscular methotrexate or parenteral gold. Extension of a one-year double-blind study in 174 patients.

OBJECTIVE: To compare the radiographic outcomes after 36 months in patients with early erosive rheumatoid arthritis (RA) who were treated with methotrexate (MTX) or gold sodium thiomalate (GSTM). METHODS: In a randomized, double-blind fashion, 174 patients from two centres were assigned to receive weekly intramuscular injections of either 15 mg MTX or 50 mg GSTM. After 12 months, the study was continued as an open prospective study for an additional 2 yr, administering the same amount of MTX and half of the GSTM dose. Radiographic outcomes were assessed by standardized methods in all patients at baseline and after 6, 12, 24 and 36 months. RESULTS: Intention-to-treat analysis showed that patients treated with MTX had higher radiographic scores and more erosive joints at all follow-up points. However, there was no statistically significant difference between the two treatment groups. The progression rate was significantly slower during the second and third years of follow-up in both groups. Baseline and time-integrated (area under the curve over 6 months) disease activity parameters were good predictors of radiographic outcome after 3 yr. Seropositivity was not an independent predictor of progression. However, patients who were positive for rheumatoid factor had higher time-integrated disease activity (with less response to treatment) and thus their disease was significantly more progressive. CONCLUSION: Both of the disease-modifying compounds used in this study, MTX and GSTM, were able to reduce the slope of radiographic progression during 3 yr of follow-up. There was some advantage for parenteral gold but no significant intergroup difference.

Antirheumatic Agents↗
PubMed2001

[An update of the German version of AEP (Appropriateness Evaluation Protocol): metric properties and practical experiences].

The development of a German version of the Appropriateness Evaluation Protocol (AEP) allows for the first time the evaluation of hospital admissions and bed days in Germany. The instrument is based on international experience and has been adopted in cooperation with acknowledged members of German surgical and medical societies. The AEP showed excellent reliability in general internal medicine as well as in surgery. The validity is comparable to international studies, although further research is necessary. Approximately 90% of surgical cases could be evaluated according to the criteria of the AEP; the remaining patients were evaluated using the "override option". The majority of inappropriate care is due to poor documentation in medical records and management deficiencies during inpatient care.

Geriatrics↗
PubMed2001

[Outcome measurement in musculoskeletal diseases: recommendation for a core set of scales for use in rehabilitation].

By application of a standardized core set of outcome measurement instruments, comparison between studies as well as meta-analyses in rehabilitation research can be facilitated. The German Society for Rheumatology has commissioned its working group on rehabilitation with the development of a proposal for such a core set of outcome measurement instruments. In a first step, dimensions for outcome measurement in rehabilitation were defined by a group of experts which represented rehabilitation hospitals, acute care hospitals, and research groups specialized in outcome measurement. The Delphi method was used in a multiple step consensus process. In a second step, instruments and procedures to operationalize the relevant dimensions were chosen. Reliability, validity, sensitivity to change, and practicability were used as criteria for selecting measurement instruments. The main intention of the proposed core set of outcome measurement instruments is to facilitate the processes of planning and carrying out rehabilitation research studies. Furthermore, the proposed instruments can be used for clinical documentation systems as well as for internal or external quality assurance programs.

Arthritis, Rheumatoid↗
PubMed2001

Lyme disease and preventive behaviors in residents of Nantucket Island, Massachusetts.

BACKGROUND: To determine the age-specific prevalence of Lyme disease and whether preventive behaviors on Nantucket Island correlate with Lyme disease, we surveyed island residents. METHODS: A survey with questions on Lyme disease symptoms, history, and preventive behaviors was mailed to all residents. Respondents were stratified by likelihood of having had Lyme disease. A subsample was selected for examination, and then classified according to the Lyme disease national surveillance case definition. RESULTS: The overall lifetime prevalence of Lyme disease for Nantucket residents was 15% (CI, 10%-19.8%): 19% among females, and 11% among males. The prevalence was highest among age groups 0-16 and 30-49 years. Overall, 86% of the population practiced at least one behavior. The most frequently reported preventive behavior was checking oneself for ticks (80%), followed by wearing protective clothing (53%), avoiding tick areas (34%), and using tick repellent (11%). Younger individuals practiced fewer preventive behaviors than older individuals (p=0.001). Although males reported greater tick exposure than females, females uniformly practiced preventive behaviors more frequently (p=0.001). The practice of preventive behaviors was not associated with a history of Lyme disease, but finding more than 5 ticks per year on oneself was (p=0.001). CONCLUSION: Lyme disease is highly prevalent on Nantucket Island. Young people are particularly at risk and health education should emphasize preventive behaviors less frequently practiced: using tick repellent, avoiding tick areas, and wearing protective clothing.

Adolescent↗
PubMed2001

[Patient-centered evaluation of the health status in a longitudinal quality management system in the hospital].

OBJECTIVE: The objective was to assess the value of self-reported health status as an indicator of outcomes of acute hospital care, to identify potential practical limitations, and develop strategies for future applications. METHODS: 180 patients from 4 acute care hospitals in Germany participated in a comprehensive and longitudinal assessment of outcome of care in general internal medicine between 8/1/99 and 10/31/99. Self-administered SF-36 surveys were completed at admission and 4 weeks after discharge. Additionally, nurses and physicians answered questions regarding the patients' health status. Linear relations between health status assessments were quantified as correlation coefficients. Odds ratios (OR) and 95% confidence limits from multivariate logistic regression models were reported for predictors of non-returned questionnaires. RESULTS: 33% of SF-36 surveys handed out at discharge were returned. Patients with impairments and referred patients were more likely not to return the survey (OR = 1.3 [1.09; 1.66] and OR = 3.7 [1.37; 9.87]). The linear relation of SF-36 and SF-12 scores in the same patients were r = 0.95 [0.91; 0.97] for physical health and r = 0.91 [0.85; 0.94] for mental health. Physicians and nurses moderately agreed in their assessment of patients' health (r = 0.38 [0.22; 0.52]) but both professional groups showed poor agreement with self-reported health (r = 0.15 [-0.08; 0.36] and r = -0.01 [-0.23; 0.21]). CONCLUSIONS: 1. Self-reported health status should be considered in the assessment of outcomes of acute care as a dimension that is to some extent independent of health status assessment by professionals, 2. shorter instruments, i.e., the SF-12, can be used instead of the SF-36, 3. a self-reported health status assessment is feasible 4 weeks after discharge, and 4. patients with multiple impairments or those who are transferred should get specific support in the completion of questionnaires to increase response or to receive at least minimal information about their health status.

Aged↗
PubMed2000

Coexposure to Borrelia burgdorferi and Babesia microti does not worsen the long-term outcome of lyme disease.

Previous studies suggest that concurrent Lyme disease and babesiosis produce a more sever illness than either disease alone. The majority of babesiosis infections, however, are subclinical. Our objective was to characterize on the basis of a total-population survey of Nantucket Island, Massachusetts, whether coexposure to Lyme disease and babesiosis causes more severe illness or poorer long-term outcomes than Lyme disease alone. In this retrospective cohort study, residents indicating a history of Lyme disease were compared with randomly selected population controls on a standardized medical history, blinded physical examination, and serological studies for Borrelia burgdorferi and Babesia microti. Serological evidence of exposure to babesiosis was not associated with increased severity of acute Lyme disease. The groups did not differ with regard to the prevalence of constitutional, musculoskeletal, or neurological symptoms a mean of 6 years after acute Lyme disease. Prior Lyme disease and serological exposure to B. microti are not associated with poorer long-term outcomes or more persistent symptoms Lyme disease alone.

Adult↗
PubMed2000

[Evaluation of the appropriateness of hospital care in internal medicine. Reliability of a German adaptation of the procedure].

BACKGROUND AND OBJECTIVE: The evaluation of the appropriateness of hospital admissions and hospital stays has become an increasingly important issue in Germany. Evaluations by the German Physicians Review Organizations (MDS, MDK) demonstrated the need for a standardized, valid and reliable assessment tool for inappropriate hospital use. Objective of this study was to test the reliability of a German adaptation of the "Appropriateness Evaluation Protocol" (AEP). PATIENTS AND METHODS: From the 2317 admissions to medical wards of a teaching hospital in Hessia in 1997 we randomly selected 52 patients to test the inter-rater-reliability (54% female, mean age = 66 years +/- 18). Another 49 patients were randomly selected to test the intra-rater-reliability of the AEP (53% female, mean age = 61 years +/- 20). We estimated general agreement, specific agreement and Kappa statistics for the agreement of the evaluation of hospital admissions and hospital days. 95% confidence intervals were reported. RESULTS: The German adaptation of the AEP showed an inter-rater-agreement of 92% (88-96%) for hospital admissions and 76% (73-80%) for hospital days. Correspondingly, we observed an intra-rater-agreement of 96% (88-100%) for hospital admissions and 93% (91-95%) for hospital days. The high agreement was independent of the length of hospital stay and independent of the proportion of inappropriate hospital days. CONCLUSION: A standard instrument for the assessment of the appropriateness of hospital care with known metric properties may be useful for quality management in hospitals and provide competitive advantages in a consolidating health care market. The AEP could be such an instrument.

Aged↗
PubMed2000

[Validity and reliability of proband recall of fractures].

The validity and reliability of patient recall of diseases depends on the kind of disease. The validity and reliability of patients' recall of fractures was assessed among the 146 cases of a nested case-control study on independent living following fractures in the elderly. On declaration of a fracture a letter was sent to the general practitioner requesting medical information on the latest fracture receiving treatment. A total of 99 medical discharge letters (68%) could be collected for further evaluation. The information on fracture localisation which was obtained both during the patients interviews 1994/95 and 1998 and through the medical discharge letters were coded with reference to the AO (Arbeitsgemeinschaft für Osteosynthesefragen)-classification and compared. The Kappa-statistic for the reliability of patient information was 0.80-0.89, and 0.77-0.89 for the validity, depending on the degree of specified concordance. Obtaining information on fractures from patients appears as a valid and reliable source of epidemiologic data. Patients who generally are affected physically or had to stay in a hospital due to a fracture or its treatment seem to have a good recall of this event. It appears that it can be remembered years after the event with sufficient reliability and validity.

Aged↗
PubMed2000

[Reproducibility of a German scale for assessing the need for inpatient treatment in surgery].

During the past years, the assessment of the appropriateness of hospital utilization has become increasingly important in the German health care system. Previous evaluations by regional review organizations in several states demonstrated the need for a standardized, reliable, and valid instrument to evaluate the appropriateness of inpatient care. Objective of the study is to test the reliability of a German adaptation of the "Appropriateness Evaluation Protocol" (AEP). Among all 2672 admissions from the department of surgery of a regional medical center during one calendar year, 54 patients were randomly selected to evaluate the inter-rater reliability and 51 patients to test intra-rater reliability. Overall agreement, specific agreement and Kappa statistics were estimated for every hospital admissions and all consecutive hospital days. The German AEP showed an inter-rater agreement of 74% (62-86%) for hospital admissions (Kappa = 0.44) and 84% (79%-88%) for all hospital days (K = 0.55). Intra-rater reliability was 88% (79%-97%) for hospital admissions (K = 0.60) and 88% (85%-92%) for all hospital days (K = 0.70). The observed agreement is independent of length of hospital stay and proportion of appropriate days. A standardized instrument with known metric properties is essential for quality management in hospitals to prepare for an increasingly consolidating health care market in Germany. The German AEP is a reliable instrument, which will allow to identify inefficiencies in the management of surgical inpatients.

Adult↗
PubMed2000

[Effect size in clinical studies of patients with rheumatoid arthritis. EULAR guidelines and OMERACT core-sets].

Clinical trials in rheumatology are confronted with new challenges. The pharmaceutical industry must be more efficient in identifying and marketing new drugs, regulatory authorities require additional evidence about the effectiveness of new compounds, and the consumer including physicians require more transparency in the selection and use of appropriate outcomes in clinical trials. These challenges find their common denominator in a further standardization of clinical trials that extends beyond the application of Good Clinical Practice. For years, national and international organizations have developed recommendations for the selection of appropriate outcomes in RA clinical trials. However, these recommendations have rarely been data driven or evidence based. The international informal collaboration Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) has contributed enormously towards the application of a standardized methodology in the development of recommendations to enhance the quality of research in clinical rheumatology. The scope of this initiative goes now far beyond rheumatoid arthritis and now covers all major rheumatic conditions.

Antirheumatic Agents↗
PubMed2000

[Corroboration of concurrent assessment of inappropriate hospitalization with retrospective evaluation based on patient records].

BACKGROUND AND PURPOSE: Since the availability of a German adaptation of the "appropriateness Evaluation Protocol" (AEP) for hospital utilization review, physicians and health care managers were concerned about a potential overestimation of the extent of inappropriate hospital use in a retrospective assessment. The objective was to assess the agreement of concurrent and retrospective assessment of inappropriate hospital use. METHODS: The appropriateness of 42 admissions to surgical wards in a teaching hospital was tested concurrent to the admission. In 25 hospitalized patients the appropriateness of hospital days was assessed. Results were compared with the retrospective testing of the same patients after three months. RESULTS: Agreement between concurrent and retrospective assessment within the same reviewer was 86% of admissions (95% CI = 75%-96%) and 96% of hospital days (88%-100%). Kappa showed values of 0.85 and 0.78, which can be described as excellent. A comparison of two different reviewers, one testing concurrently, the other retrospectively showed agreements of 86% and 90%. The proportion of inappropriate days was the same in both designs. CONCLUSIONS: The results refute prior concerns that a retrospective assessment of the appropriateness of hospital use is impossible because in a retrospective design important clinical information would remain unconsidered or clinical information not yet available at that time would be used for the evaluation. The possibility of an incorrect assessment due to a retrospective design is within the variability inherent to the instrument. Despite the strong agreement, the small sample of surgical patient limits the generalizability of results.

Concurrent Review↗
PubMed2000

[Incidence of operations in Germany via telephone survey in 4 selected cities].

Considerable regional variation of surgical procedure rates has been reported for a number of countries. Influential variables that have been discussed are patient-related, physician-related and health care system-specific factors. A representative computer-assisted telephone survey was conducted in four selected regions for a study sponsored by the German Federal Ministry of Health. These regions were the townships of Aachen and Hamm in North Rhine-Westphalia and Chemnitz and Görlitz in Saxony. During the telephone survey 1897 persons were contacted and 1041 interviews completed. Multiple logistic regression showed a surgical procedure frequency which was by 40% higher in Aachen than in Hamm. During further analysis the regional localisation was replaced by region-specific structural health care information variables. During this analysis the regional frequency of medical specialists was significant at a 5% level (odds ratio: 1.07; 95% confidence interval: 1.02-1.12). This result can be interpreted as an increase in surgical procedures by 7% for each additional specialist per 10,000 persons. However, no definite conclusion can be reached based on the available data. Intensifying the presented survey-based health services research has the potential to identify regional over- or undersupply of medical services, to objectify and accompany informational, administrative or political action and thereby to support equity in access and health care in the sense of an optimized allocation of resources.

Adult↗
PubMed2000

Epidemiology of rheumatic diseases.

Rheumatic diseases are among the oldest diseases recognized. The classification of rheumatic diseases is sometimes difficult due to unknown aetiology and heterogeneity in their clinical presentation. Osteoarthritis (OA) and rheumatoid arthritis (RA) are the two most common rheumatic diseases, accounting for a large percentage of disability worldwide. The economic and social burden of these diseases is great. Their impact on both individuals and society results from a decreased quality of life, lost productivity and increased costs of health care. Without appropriate approaches to patient management and control of these diseases, this impact can be expected to increase as the population ages. One of the challenges in studying OA and RA, and rheumatic diseases in general, is deriving epidemiological data that can be used to understand better the factors that contribute to the initiation and progression of these diseases. Only with such an understanding can significant progress be made in the diagnosis, treatment and management of patients.

Arthritis, Rheumatoid↗