A Schrijvers

Patient-reported outcome in total hip replacement: A COMPARISON OF FIVE INSTRUMENTS OF HEALTH STATUS

Our aim was to define the minimum set of patient-reported outcome measures which are required to assess health status after total hip replacement (THR). In 114 patients, we compared the pre-operative characteristics and sensitivity to change of the Oxford hip score (OHS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the SF-36, the SF-12 (derived from the SF-36), and the Euroqol questionnaire (EQ-5D). At one year after operation, very large effect sizes were found for the disease-specific measures, the physical domains of the SF-12, SF-36 and the EQ-5Dindex (1.3 to 3.0). Patients in Charnley class A showed more change in the OHS, WOMAC pain and function, the physical domains of the SF-36 and the EQ-5Dvas (p < 0.05) compared with those in the Charnley B and C group. In this group, the effect size for the OHS more than doubled the effect sizes of WOMAC pain and physical function. We found high correlations and correlations of change between the OHS, the WOMAC, the physical domains of the SF-12 and the SF-36 and EQ-5Dindex. The SF-36 and EQ-5D scores at one year after operation approached those of the general population. Furthermore, we found a binomial distribution of the pre-operative EQ-5Dindex score and a pre-operative discrepancy and post-operative agreement between the EQ-5Dvas and EQ-5Dindex. We recommend the use of the OHS and SF-12 in the assessment of THR. The SF-36 may be used in circumstances when smaller changes in health status are investigated, for example in the follow-up of THR. The EQ-5D is useful in situations in which utility values are needed in order to calculate cost-effectiveness or quality-adjusted life years (QALYs), such as in the assessment of new techniques in THR.

The Impact of Severe Sepsis on Health-Related Quality of Life: A Long-Term Follow-Up Study

BACKGROUND:Severe sepsis is frequently complicated by organ failure and accompanied by high mortality. Patients surviving severe sepsis can have impaired health-related quality of life (HRQOL). The time course of changes in HRQOL in severe sepsis survivors after discharge from the intensive care unit (ICU) and during a general ward stay have not been studied. METHODS:We performed a long-term prospective study in a medical-surgical ICU. Patients with severe sepsis (n = 170) admitted for >48 h were included in the study. We used the Short-form 36 to evaluate the HRQOL of severe sepsis patients before ICU and hospital stay and at 3 and 6 mo after ICU discharge. Furthermore, we compared the results for ICU admission and 6 mo after ICU discharge with those of an age-matched general Dutch population. RESULTS:At 6 mo after ICU discharge, 95 patients could be evaluated (eight patients were lost to follow-up, 67 died). HRQOL showed a multidimensional decline during the ICU stay and gradual improvement over the 6 mo after ICU discharge for the social functioning, vitality, role-emotional, and mental health dimensions. However, 6 mo after ICU discharge, scores for the physical functioning, role-physical, and general health dimensions were still significantly lower than preadmission values. Physical and Mental Component Scores changed significantly over time. In particular, the Mental Component Score showed a small decline at ICU discharge but recovered rapidly, and at 6 mo after ICU discharge had improved to near normal values. In addition, Short-form 36 scores were lower than those in a matched general population in six of the eight dimensions, with the exception of social functioning and bodily pain. Interestingly, the preadmission HRQOL in surviving patients was already lower in three of the eight dimensions (role-physical, mental health, and vitality) when compared with the general population. CONCLUSIONS:Severe sepsis patients demonstrate a sharp decline of HRQOL during ICU stay and a gradual improvement during the 6 mo after ICU discharge. Recovery begins after ICU discharge to the general ward. Nevertheless, recovery is incomplete in the physical functioning, role-physical, and general health dimensions at 6 mo after ICU discharge compared with preadmission status.

Predicting admission and mortality with the Emergency Severity Index and the Manchester Triage System: a retrospective observational study.

Objective: To compare the degree to which the Emergency Severity Index (ESI) and the Manchester Triage System (MTS) predict admission and mortality. Methods: A retrospective observational study of four emergency department (ED) databases was conducted. Patients who presented to the ED between 1 January and 18 July 2006 and were triaged with the ESI or MTS were included in the study. Results: 37 974 patients triaged with the ESI and 34 258 patients triaged with the MTS were included. The likelihood of admission decreased significantly with urgency categories in both populations, and was greater for patients triaged with the ESI than with the MTS. Mortality rates were low in both populations. Most patients who died were triaged in the most urgent triage categories of both systems. Conclusion: Both the ESI and MTS predicted admission well. The ESI was a better predictor of admission than the MTS. Mortality is associated with urgency categories of both triage systems.

Quality of life before intensive care unit admission is a predictor of survival

IntroductionPredicting whether a critically ill patient will survive intensive care treatment remains difficult. The advantages of a validated strategy to identify those patients who will not benefit from intensive care unit (ICU) treatment are evident. Providing critical care treatment to patients who will ultimately die in the ICU is accompanied by an enormous emotional and physical burden for both patients and their relatives. The purpose of the present study was to examine whether health-related quality of life (HRQOL) before admission to the ICU can be used as a predictor of mortality.MethodsWe conducted a prospective cohort study in a university-affiliated teaching hospital. Patients admitted to the ICU for longer than 48 hours were included. Close relatives completed the Short-form 36 (SF-36) within the first 48 hours of admission to assess pre-admission HRQOL of the patient. Mortality was evaluated from ICU admittance until 6 months after ICU discharge. Logistic regression and receiver operating characteristic analyses were used to assess the predictive value for mortality using five models: the first question of the SF-36 on general health (model A); HRQOL measured using the physical component score (PCS) and mental component score (MCS) of the SF-36 (model B); the Acute Physiology and Chronic Health Evaluation (APACHE) II score (an accepted mortality prediction model in ICU patients; model C); general health and APACHE II score (model D); and PCS, MCS and APACHE II score (model E). Classification tables were used to assess the sensitivity, specificity, positive and negative predictive values, and likelihood ratios.ResultsA total of 451 patients were included within 48 hours of admission to the ICU. At 6 months of follow up, 159 patients had died and 40 patients were lost to follow up. When the general health item was used as an estimate of HRQOL, area under the curve for model A (0.719) was comparable to that of model C (0.721) and slightly better than that of model D (0.760). When PCS and MCS were used, the area under the curve for model B (0.736) was comparable to that of model C (0.721) and slightly better than that of model E (0.768). When using the general health item, the sensitivity and specificity in model D (sensitivity 0.52 and specificity 0.81) were similar to those in model A (0.45 and 0.80). Similar results were found when using the MCS and PCS.ConclusionThis study shows that the pre-admission HRQOL measured with either the one-item general health question or the complete SF-36 is as good at predicting survival/mortality in ICU patients as the APACHE II score. The value of these measures in clinical practice is limited, although it seems sensible to incorporate assessment of HRQOL into the many variables considered when deciding whether a patient should be admitted to the ICU.

Health-related quality of life in critically ill patients: How to score and what is the clinical impact?

Purpose of reviewTraditionally, the assessment of critical care has focused largely on mortality. However, in the last few years, there is more attention on the quality of survival. Health-related quality of life (HRQOL) is an important issue for both patients and family. The purpose of this review is to describe HRQOL scoring in critically ill patients and to discuss the clinical impact on HRQOL. Recent findingsStudies on the effect of critical illness on HRQOL show contradicting results. Several studies found that HRQOL at the time of discharge from hospital was impaired and that a gradual improvement occurred during follow-up, in some cases to preadmission hospital levels. Others show a full recovery to preadmission HRQOL. SummaryIn this article, we reviewed the methods and description of measurement instruments used in critically ill patients. The most recently used instruments to measure HRQOL, how to score HRQOL before ICU admission and the impact of critical illness on HRQOL are discussed. Assessment of HRQOL can improve the answers given by critical care physicians and nurses about the prospects of their patients. To get insights in these issues regarding the impact of ICU treatment, we should incorporate not only short-term outcomes, for example length of stay and mortality, but also HRQOL.

Vroegsignalering van opvoed- en opgroeiproblemen bij peuters: validiteit en betrouwbaarheid van een gestructureerd interview

SPARK (Signaleren van Problemen en Analyse van Risico bij opvoeden en ontwikkeling van Kinderen) is een gestructureerd vraaggesprek voor gebruik binnen de Jeugdgezondheidszorg (JGZ) om (risico op) opvoedings- en ontwikkelingsproblemen bij jonge kinderen vroegtijdig te signaleren. SPARK combineert het perspectief van de ouders met de expertise van de JGZprofessional. In een groep van 2012 kinderen van 18 maanden in Zeeland zijn de meeteigenschappen van de SPARK onderzocht. De SPARK maakt op valide en betrouwbare wijze onderscheid tussen kinderen met hoog, verhoogd en laag risico op opvoedings- en ontwikkelingsproblemen. De SPARK is goed toepasbaar in de dagelijkse praktijk, levert snel inzicht in wat er speelt in een gezin en draagt bij aan een zorgvuldige risicotaxatie door de jeugdverpleegkundigen. De SPARK levert in samenspraak met de ouders direct bruikbare informatie op voor het bepalen van welke en hoeveel zorg nodig is. Met het afnemen van alleen zelfrapportagevragenlijsten wordt een risicovolle groep gemist. Met ouders systematisch doornemen van hun zorgen en steunbehoefte op het brede terrein van opvoeding en ontwikkeling is een goede manier van risicosignalering door JGZ-professionals. Implementatie van de SPARK in de rest van Nederland lijkt zinvol.

Lebensqualität 5 Jahre nach ITS-Aufenthalt

Nach Behandlung auf einer Intensivtherapiestation (ITS) kann die gesundheitsbezogene Lebensqualitat auch nach Entlassung von der Station und aus der Klinik deutlich beeintrachtigt bleiben. Es gibt aber nur wenige systematische Untersuchungen dazu, auch weil die Beurteilung der Lebensqualitat relativ aufwendig ist. Eine niederlandische Gruppe hat sich dieser Frage angenommen. Die letzte Auswertung nach 5 Jahren liegt nun vor.