Frits G. J. Oosterveld

Delirium After Cardiac Surgery and Predictive Validity of a Risk Checklist

BACKGROUNDnDelirium or acute confusion is a temporary mental disorder that occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of delirium, which is associated with many negative consequences. Therefore, prevention or early recognition of delirium is essential.nnnMETHODSnIn this observational study, a risk checklist for delirium was used during the preoperative outpatient screening in 112 patients who underwent elective cardiac surgery. The Delirium Observation Screening (DOS) scale was used before and after surgery to assess whether delirium had developed in patients. The psychiatrist was consulted to confirm or refute the diagnosis delirium.nnnRESULTSnThe incidence of delirium after cardiac surgery was 21%, and the mean duration of delirium was 2.5 days. The time to discharge was 11 days longer for patients with delirium. The delirium risk checklist could accurately predict postoperative delirium in patients who underwent elective cardiac surgery based on a disturbance in the electrolytes sodium and potassium and on EuroSCORE (European System for Cardiac Operative Risk Evaluation). When using a probability of delirium of 50%, the sensitivity of the risk checklist was 25.0% and specificity was 95.5%. The predictive value of a positive test was 60.0%, and the predictive value of a negative test was 82.4%. The area under the receiver-operating characteristic curve was 0.75.nnnCONCLUSIONSnWith the risk checklist for delirium, patients at an increased risk of delirium after elective cardiac surgery can be identified.

The Delirium Observation Screening Scale Recognizes Delirium Early after Cardiac Surgery

Background: Ddelirium or acute confusion is a temporary mental disorder which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Prevention or early recognition of delirium is essential. The Delirium Observation Screening (DOS) scale was developed to facilitate early recognition of delirium by nurses observations during routine clinical care. Aim: The aim of this study was to validate the DOS scale in accordance with the diagnosis of the psychiatrist, using the DSM-IV criteria as the gold standard. Methods: In this observational study, the DOS scale was used to assess whether 112 patients who underwent elective cardiac surgery had developed a postoperative delirium. The psychiatrist was consulted to confirm or refute the diagnosis delirium. Wilcoxons Rank Sum Test was utilized to compare patients with and without delirium on duration of hospital stay. A Receiver Operating Characteristic Curve of the DOS scale was constructed with accompanying Area Under the Curve (AUC). Results: Based on the diagnosis of the psychiatrist, the incidence of delirium following cardiac surgery was 21.4% and the mean duration of delirium was two and a half days. The time to discharge was 11 days longer in patients with delirium. In 27 of the 112 patients a DOS score of > = 3 was found, that indicates delirium. The sensitivity and specificity of the DOS scale was 100% and 96.6% respectively. The AUC was 0.98. Conclusion: The DOS scale is a very good instrument to facilitate early recognition of delirium by nurses observation of patients who undergo cardiac surgery. Early recognition will expedite good postoperative management such as implementation of appropriate interventions, and may decrease negative consequences caused by postoperative delirium.

The Effect of Osteoarthritis of the Hip or Knee on Work Participation

In our systematic literature search, we included studies involving patients with hip or knee osteoarthritis (OA) and outcome measures of work participation. Methodological quality was assessed using 11 criteria; a qualitative data analysis was performed. Fifty-three full-text articles were selected out of 1861 abstracts; finally, data were extracted from 14 articles. Design, populations, definitions, and measurements in the studies showed large variations; work outcomes were often only secondary objectives. The outcomes were summarized as showing a mild negative effect of OA on work participation. Many patients had paid work and managed to stay at work despite limitations. However, research on the effect of OA on work participation is scarce and the methodological quality is often insufficient. The longitudinal course of work participation in individuals with OA has not been described completely.

Work Participation and Health Status in Early Osteoarthritis of the Hip and/or Knee: A Comparison Between the Cohort Hip and Cohort Knee and the Osteoarthritis Initiative

To examine the work participation of Dutch people with early osteoarthritis (OA) in hips or knees and compare this with data from the American Osteoarthritis Initiative (OAI) cohort. The influence of health status and personal factors on work participation was analyzed.

Does an Eye-Hand Coordination Test Have Added Value as Part of Talent Identification in Table Tennis? A Validity and Reproducibility Study

This study investigated the added value, i.e. discriminative and concurrent validity and reproducibility, of an eye-hand coordination test relevant to table tennis as part of talent identification. Forty-three table tennis players (7–12 years) from national (nu200a=u200a13), regional (nu200a=u200a11) and local training centres (nu200a=u200a19) participated. During the eye-hand coordination test, children needed to throw a ball against a vertical positioned table tennis table with one hand and to catch the ball correctly with the other hand as frequently as possible in 30 seconds. Four different test versions were assessed varying the distance to the table (1 or 2 meter) and using a tennis or table tennis ball. ‘Within session’ reproducibility was estimated for the two attempts of the initial tests and ten youngsters were retested after 4 weeks to estimate ‘between sessions’ reproducibility. Validity analyses using age as covariate showed that players from the national and regional centres scored significantly higher than players from the local centre in all test versions (p<0.05). The tests at 1 meter demonstrated better discriminative ability than those at 2 meter. While all tests but one had a positive significant association with competition outcome, which were corrected for age influences, the version with a table tennis ball at 1 meter showed the highest association (ru200a=u200a0.54; pu200a=u200a0.001). Differences between the first and second attempts were comparable for all test versions (between −8 and +7 repetitions) with ICCs ranging from 0.72 to 0.87. The smallest differences were found for the test with a table tennis ball at 1 meter (between −3 and +3 repetitions). Best test version as part of talent identification appears to be the version with a table tennis ball at 1 meter regarding the psychometric characteristics evaluated. Longitudinal studies are necessary to evaluate the predictive value of this test.

Self-Reported Functional Status as Predictor of Observed Functional Capacity in Subjects with Early Osteoarthritis of the Hip and Knee: A Diagnostic Study in the CHECK Cohort

Objectives Patients with hip or knee osteoarthritis (OA) may experience functional limitations in work settings. In the Cohort Hip and Cohort Knee study (CHECK) physical function was both self-reported and measured performance-based, using Functional Capacity Evaluation (FCE). Relations between self-reported scores on SF-36 and WOMAC (Western Ontario and McMaster Arthritis Index, function scales) and FCE performance were studied, and their diagnostic value for clinicians in predicting observed physical work limitations was assessed. Methods Ninety-two subjects scored physical function on SF-36 (scale 0–100, 100 indicating the best health level) and WOMAC (scale 0–68, 68 indicates maximum restriction) and performed the FCE. Correlations were calculated between all scores. Cross-tables were constructed using both questionnaires as diagnostic tests to identify work limitations. Subjects lifting <22.5xa0kg on the FCE-test ‘lifting-low’ were labeled as having physical work limitations. Diagnostic aspects at different cut-off scores for both questionnaires were analysed. Results Statistically significant correlations (Spearman’s ρ 0.34–0.49) were found between questionnaire scores and lifting and carrying tests. Results of a diagnostic cross-table with cut-off point <60 on SF-36 ‘physical functioning’ were: sensitivity 0.34, specificity 0.97 and positive predictive value (PV+) 0.95. Cut-off point ≥21 on WOMAC ‘function’ resulted in sensitivity 0.51, specificity 0.88 and PV+ 0.88. Conclusion Low self-reported function scores on SF-36 and WOMAC diagnosed subjects with limitations on the FCE. However, high scores did not guarantee performance without physical work limitations. These results are specific to the tested persons with early OA, in populations with a different prevalence of limitations, different diagnostic values will be found. FCE may be indicated to help clinicians to assess actual work capacity.

Assessing personal talent determinants in young racquet sport players: a systematic review

Abstract Since junior performances have little predictive value for future success, other solutions are sought to assess a young player’s potential. The objectives of this systematic review are (1) to provide an overview of instruments measuring personal talent determinants of young players in racquet sports, and (2) to evaluate these instruments regarding their validity for talent development. Electronic searches were conducted in PubMed, PsychINFO, Web of Knowledge, ScienceDirect and SPORTDiscus (1990 to 31 March 2014). Search terms represented tennis, table tennis, badminton and squash, the concept of talent, methods of testing and children. Thirty articles with information regarding over 100 instruments were included. Validity evaluation showed that instruments focusing on intellectual and perceptual abilities, and coordinative skills discriminate elite from non-elite players and/or are related to current performance, but their predictive validity is not confirmed. There is moderate evidence that the assessments of mental and goal management skills predict future performance. Data on instruments measuring physical characteristics prohibit a conclusion due to conflicting findings. This systematic review yielded an ambiguous end point. The lack of longitudinal studies precludes verification of the instrument’s capacity to forecast future performance. Future research should focus on instruments assessing multidimensional talent determinants and their predictive value in longitudinal designs.

Arm Crank Ergometer is Reliable and Valid for Measuring Aerobic Capacity During Submaximal Exercise

Bulthuis, Y, Drossaers-Bakker, W, Oosterveld, F, van der Palen, J, and van de Laar, M. Arm crank ergometer is reliable and valid for measuring aerobic capacity during submaximal exercise. J Strength Cond Res 24(10): 2809-2815, 2010-Measuring physical fitness becomes more important. Yet most instruments depend upon the function of the lower extremities. Hence, we investigated whether an adapted submaximal arm crank test on an ergometer for the upper body is reliable to use, and if the submaximal test for the arm crank ergometer is valid compared to the test on the bicycle ergometer. Different types of reliability measures of the adapted submaximal test on an arm crank ergometer were assessed in healthy volunteers, such as test-retest, interobserver, interergometer, and between arm crank and bicycle ergometer. A crossover design was used. The measurements were proportionally distributed over 30 volunteers. Based on the intraclass correlation coefficient (ICC) and the magnitude of within-person differences, we revealed a good reliability of the submaximal test. For the test-retest reliability, the ICC was 0.76, the interobserver reliability was 0.82, and the interergometer reliability 0.63. In addition, the criterion validity was also tested by comparing the calculated &OV0312;o2max during the submaximal test on the arm crank ergometer and on the bicycle ergometer. Between &OV0312;o2max on the arm crank and bicycle ergometer, an ICC of 0.64 was found. The results of the submaximal test on the arm crank ergometer are reliable and valid as compared with those on the bicycle crank ergometer. We showed that the submaximal test on the arm crank ergometer is suitable for measuring physical fitness in healthy people. We expect that disabled people can use this submaximal test on the arm crank ergometer for measuring their physical fitness, also.

Functional capacity of people with early osteoarthritis: a comparison between subjects from the cohort hip and cohort knee (CHECK) and healthy ageing workers

ObjectiveThe prevalence of osteoarthritis (OA) increases, but the impact of the disorder on peoples’ functional capacity is not known. Therefore, the objective of this study was to compare self-reported health status and functional capacity of subjects with early OA of hip and/or knee to reference data of healthy working subjects and to assess whether this capacity is sufficient to meet physical job demands.MethodsSelf-reported health status and functional capacity of 93 subjects from the Cohort Hip and Cohort Knee (CHECK) were measured using the Short-Form 36 Health Survey and 6 tests of the Work Well Systems Functional Capacity Evaluation. Results were compared with reference data from 275 healthy workers, using t-tests. To compare the functional capacity with job demands, the proportions of subjects with OA performing lower than the p5 of reference data were calculated.ResultsCompared to healthy workers, the subjects (mean age 56) from CHECK at baseline reported a significantly worse physical health status, whereas the women (nxa0=xa078) also reported a worse mental health status. On the FCE female OA subjects performed significantly lower than their healthy working counterparts on all 6 tests. Male OA subjects performed lower than male workers on 3 tests. A substantial proportion of women demonstrated functional capacities that could be considered insufficient to perform jobs with low physical demands.ConclusionsFunctional capacity and self-reported health of subjects with early OA of the hips and knees were worse compared to healthy ageing workers. A substantial proportion of female subjects did not meet physical job demands.

The Dutch motor skills assessment as tool for talent development in table tennis: a reproducibility and validity study

Abstract A motor skills assessment could be helpful in talent development by estimating essential perceptuo-motor skills of young players, which are considered requisite to develop excellent technical and tactical qualities. The Netherlands Table Tennis Association uses a motor skills assessment in their talent development programme consisting of eight items measuring perceptuo-motor skills specific to table tennis under varying conditions. This study aimed to investigate this assessment regarding its reproducibility, internal consistency, underlying dimensions and concurrent validity in 113 young table tennis players (6–10 years). Intraclass correlation coefficients of six test items met the criteria of 0.7 with coefficients of variation between 3% and 8%. Cronbach’s alpha valued 0.853 for internal consistency. The principal components analysis distinguished two conceptually meaningful factors: “ball control” and “gross motor function.” Concurrent validity analyses demonstrated moderate associations between the motor skills assessment’s results and national ranking; boys r = −0.53 (P < 0.001) and girls r = −0.45 (P = 0.015). In conclusion, this evaluation demonstrated six test items with acceptable reproducibility, good internal consistency and good prospects for validity. Two test items need revision to upgrade reproducibility. Since the motor skills assessment seems to be a reproducible, objective part of a talent development programme, more longitudinal studies are required to investigate its predictive validity.