Byron J. Gajewski

Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed.

OBJECTIVE Results of reliability and agreement studies are intended to provide information about the amount of error inherent in any diagnosis, score, or measurement. The level of reliability and agreement among users of scales, instruments, or classifications is widely unknown. Therefore, there is a need for rigorously conducted interrater and intrarater reliability and agreement studies. Information about sample selection, study design, and statistical analysis is often incomplete. Because of inadequate reporting, interpretation and synthesis of study results are often difficult. Widely accepted criteria, standards, or guidelines for reporting reliability and agreement in the health care and medical field are lacking. The objective was to develop guidelines for reporting reliability and agreement studies. STUDY DESIGN AND SETTING Eight experts in reliability and agreement investigation developed guidelines for reporting. RESULTS Fifteen issues that should be addressed when reliability and agreement are reported are proposed. The issues correspond to the headings usually used in publications. CONCLUSION The proposed guidelines intend to improve the quality of reporting.

DHA supplementation and pregnancy outcomes

BACKGROUND Observational studies associate higher intakes of n-3 (omega-3) long-chain polyunsaturated fatty acids (LCPUFAs) during pregnancy with higher gestation duration and birth size. The results of randomized supplementation trials using various n-3 LCPUFA sources and amounts are mixed. OBJECTIVE We tested the hypothesis that 600 mg/d of the n-3 LCPUFA docosahexaenoic acid (DHA) can increase maternal and newborn DHA status, gestation duration, birth weight, and length. Safety was assessed. DESIGN This phase III, double-blind, randomized controlled trial was conducted between January 2006 and October 2011. Women (n = 350) consumed capsules (placebo, DHA) from <20 wk of gestation to birth. Blood (enrollment, birth, and cord) was analyzed for red blood cell (RBC) phospholipid DHA. The statistical analysis was intent-to-treat. RESULTS Most of the capsules were consumed (76% placebo; 78% DHA); the mean DHA intake for the treated group was 469 mg/d. In comparison with placebo, DHA supplementation resulted in higher maternal and cord RBC-phospholipid-DHA (2.6%; P < 0.001), longer gestation duration (2.9 d; P = 0.041), and greater birth weight (172 g; P = 0.004), length (0.7 cm; P = 0.022), and head circumference (0.5 cm; P = 0.012). In addition, the DHA group had fewer infants born at <34 wk of gestation (P = 0.025) and shorter hospital stays for infants born preterm (40.8 compared with 8.9 d; P = 0.026) than did the placebo group. No safety concerns were identified. CONCLUSIONS A supplement of 600 mg DHA/d in the last half of gestation resulted in overall greater gestation duration and infant size. A reduction in early preterm and very-low birth weight could be important clinical and public health outcomes of DHA supplementation. This trial was registered at clinicaltrials.gov as NCT00266825.

Elderspeak Communication: Impact on Dementia Care

Resistiveness to care is common in older adults with dementia. Resistiveness to care disrupts nursing care, increasing costs of care by 30%. Elderspeak (infantilizing communication used by nursing staff) may trigger resistiveness to care in individuals with dementia. Videotaped care episodes (n = 80) of nursing home residents with dementia (n = 20) were coded for type of staff communication (normal talk and elderspeak) and subsequent resident behavior (cooperative or resistive to care). Bayesian statistical analysis tested relationships between staff communication and subsequent resident resistiveness to care. The probability of resistiveness to care varied significantly with communication (Bayes P = .0082). An increased probability of resistiveness to care occurred with elderspeak (.55, 95% CrI, .44-.66), compared with normal talk (.26, 95% CrI, .12-.44). Communication training has been shown to reduce elderspeak and may reduce resistiveness to care in future research.

Unit Type Differences in RN Workgroup Job Satisfaction

Using cross-sectional data from the 2004 National Database of Nursing Quality Indicators (NDNQI) RN Satisfaction Survey, differences in RN workgroup job satisfaction were examined among 10 unit types—medical-surgical, step-down, critical care, pediatric, maternal-newborn, psychiatric, emergency department, rehabilitation, surgical services, and outpatient clinics and labs. The national sample included RN workgroups in 2,900 patient care units (55,516 RNs; 206 hospitals in 44 states). Workgroup satisfaction across all unit types was moderate. RN workgroups in pediatric units were the most satisfied, whereas those in surgical services and emergency department unit types were least satisfied. A consistent finding across all unit types was high satisfaction with the specific domains of nurse-to-nurse interaction, professional status, and professional development versus much lower satisfaction with task, decision making, and pay. Findings can be used to inform and develop investigations that examine specific aspects of the work environment for RN workgroups in various unit types.

Reliability Testing of the National Database of Nursing Quality Indicators Pressure Ulcer Indicator

A criterion-referenced Web-based test was designed and administered to 256 individuals at 48 randomly sampled National Database of Nursing Quality Indicators (NDNQI) member hospitals to determine the reliability of the NDNQI pressure ulcer indicator. Overall κ values for pressure ulcer identification, staging, and sourcing indicate moderate to near perfect reliability. Findings suggest that nurses can accurately differentiate pressure ulcers from other ulcerous wounds in Web-based photographs, reliably stage pressure ulcers, and reliably identify community versus nosocomial pressure ulcers.

Lower-Extremity Strength Differences Predict Activity Limitations in People With Chronic Stroke

Background: Body system impairments following stroke have a complex relationship with functional activities. Although gait and balance deficits are well-documented in people after stroke, the overlapping influence of body impairments makes it difficult to prioritize interventions. Objective: This study examined the relationship between prospectively selected measures of body function and structure (body mass index, muscle strength, sensation, and cognition) and activity (gait speed, gait endurance, and functional balance) in people with chronic stroke. Design: This was a cross-sectional, observational study. Methods: Twenty-six individuals with mean (SD) age of 57.6 (11) years and time after stroke of 45.4 (43) months participated. Four variables (body mass index, muscle strength difference between the lower extremities, sensation difference between the lower extremities, and Mini-Mental Status Exam score) were entered into linear regression models for gait speed, Six-Minute Walk Test distance, and Berg Balance Scale score. Results: Lower-extremity strength difference was a significant individual predictor for gait speed, gait endurance, and functional balance. Cognition significantly predicted only gait speed. Limitations: The authors did not include all possible factors in the model that may have influenced gait and balance in these individuals. Conclusions: Strength deficits in the hemiparetic lower extremity should be an important target for clinical interventions to improve function in people with chronic stroke.

Exertion Fatigue and Chronic Fatigue Are Two Distinct Constructs in People Post-Stroke

Background and Purpose— Post-stroke fatigue is a common and neglected issue despite the fact that it impacts daily functions, quality of life, and has been linked with a higher mortality rate because of its association with a sedentary lifestyle. The purpose of this study was to identify the contributing factors of exertion fatigue and chronic fatigue in people post-stroke. Methods— Twenty-one post-stroke people (12 males, 9 females; 59.5±10.3 years of age; time after stroke 4.1±3.5 years) participated in the study. The response variables included exertion fatigue and chronic fatigue. Participants underwent a standardized fatigue-inducing exercise on a recumbent stepper. Exertion fatigue level was assessed at rest and immediately after exercise using the Visual Analog Fatigue Scale. Chronic fatigue was measured by the Fatigue Severity Scale. The explanatory variables included aerobic fitness, motor control, and depressive symptoms measured by peak oxygen uptake, Fugl-Meyer motor score, and the Geriatric Depression Scale, respectively. Results— Using forward stepwise regression, we found that peak oxygen uptake was an independent predictor of exertion fatigue (P=0.006), whereas depression was an independent predictor of chronic fatigue (P=0.002). Conclusion— Exertion fatigue and chronic fatigue are 2 distinct fatigue constructs, as identified by 2 different contributing factors.

Technology dependence in home care: impact on patients and their family caregivers.

BACKGROUND The purpose of this review is to explore how home technology care affects patients, family caregivers, and quality of life (QOL). METHODS A literature search was conducted to identify studies of home parenteral nutrition (HPN) and other technology prescribed home care. RESULTS Technology dependence influences health-related QOL. Patients and their family caregivers must balance the positive aspects of being in the home environment with the challenges of administering complex therapies at home. Patients and caregivers need additional support to reduce the physical, emotional, social, and financial burdens they experience. CONCLUSIONS More research is needed to address effective interventions to reduce patient and caregiver burdens and to improve outcomes for technology-dependent individuals. A greater level of preparedness for managing home technology and technology-related problems may improve quality of life.

Recent and Past Musical Activity Predicts Cognitive Aging Variability: Direct Comparison with General Lifestyle Activities

Studies evaluating the impact of modifiable lifestyle factors on cognition offer potential insights into sources of cognitive aging variability. Recently, we reported an association between extent of musical instrumental practice throughout the life span (greater than 10 years) on preserved cognitive functioning in advanced age. These findings raise the question of whether there are training-induced brain changes in musicians that can transfer to non-musical cognitive abilities to allow for compensation of age-related cognitive declines. However, because of the relationship between engagement in general lifestyle activities and preserved cognition, it remains unclear whether these findings are specifically driven by musical training or the types of individuals likely to engage in greater activities in general. The current study controlled for general activity level in evaluating cognition between musicians and nomusicians. Also, the timing of engagement (age of acquisition, past versus recent) was assessed in predictive models of successful cognitive aging. Seventy age and education matched older musicians (>10 years) and non-musicians (ages 59–80) were evaluated on neuropsychological tests and general lifestyle activities. Musicians scored higher on tests of phonemic fluency, verbal working memory, verbal immediate recall, visuospatial judgment, and motor dexterity, but did not differ in other general leisure activities. Partition analyses were conducted on significant cognitive measures to determine aspects of musical training predictive of enhanced cognition. The first partition analysis revealed education best predicted visuospatial functions in musicians, followed by recent musical engagement which offset low education. In the second partition analysis, early age of musical acquisition (<9 years) predicted enhanced verbal working memory in musicians, while analyses for other measures were not predictive. Recent and past musical activity, but not general lifestyle activities, predicted variability across both verbal and visuospatial domains in aging. These findings are suggestive of different use-dependent adaptation periods depending on cognitive domain. Furthermore, they imply that early age of musical acquisition, sustained and maintained during advanced age, may enhance cognitive functions and buffer age and education influences.

Aerobic Exercise Alters Analgesia and Neurotrophin-3 Synthesis in an Animal Model of Chronic Widespread Pain

Background Present literature and clinical practice provide strong support for the use of aerobic exercise in reducing pain and improving function for individuals with chronic musculoskeletal pain syndromes. However, the molecular basis for the positive actions of exercise remains poorly understood. Recent studies suggest that neurotrophin-3 (NT-3) may act in an analgesic fashion in various pain states. Objective The purpose of the present study was to examine the effects of moderate-intensity aerobic exercise on pain-like behavior and NT-3 in an animal model of widespread pain. Design This was a repeated-measures, observational cross-sectional study. Methods Forty female mice were injected with either normal (pH 7.2; n=20) or acidic (pH 4.0; n=20) saline in the gastrocnemius muscle to induce widespread hyperalgesia and exercised for 3 weeks. Cutaneous (von Frey monofilament) and muscular (forceps compression) mechanical sensitivity were assessed. Neurotrophin-3 was quantified in 2 hind-limb skeletal muscles for both messenger RNA (mRNA) and protein levels after exercise training. Data were analyzed with 2-factor analysis of variance for repeated measures (group × time). Results Moderate-intensity aerobic exercise reduced cutaneous and deep tissue hyperalgesia induced by acidic saline and stimulated NT-3 synthesis in skeletal muscle. The increase in NT-3 was more pronounced at the protein level compared with mRNA expression. In addition, the increase in NT-3 protein was significant in the gastrocnemius muscle but not in the soleus muscle, suggesting that exercise can preferentially target NT-3 synthesis in specific muscle types. Limitations Results are limited to animal models and cannot be generalized to chronic pain syndromes in humans. Conclusions This is the first study demonstrating the effect of exercise on deep tissue mechanical hyperalgesia in a rodent model of pain and providing a possible molecular basis for exercise training in reducing muscular pain.