Iratxe Lafuente

Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population.

BACKGROUND Relatively little is known about the prevalence of knee and hip osteoarthritis in the general population. METHODS To estimate the prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in a general population of older individuals, the validated Knee and Hip OsteoArthritis Screening Questionnaire (KHOA-SQ) was sent to a random sample of individuals aged 60 to 90 years, stratified by age and sex, living in a single province in Spain. Respondents positive for knee or hip osteoarthritis on the KHOA-SQ were invited to be examined by an orthopedic surgeon. Diagnosis of knee or hip osteoarthritis was based on clinical and radiographic data. For respondents judged as having osteoarthritis, the appropriateness of knee or hip replacement was evaluated using published explicit criteria. RESULTS Of 11 002 individuals contacted, 7577 completed the KHOA-SQ. The derived prevalence of hip osteoarthritis was approximately 7.4%. It was slightly higher in women (8.0%) than in men (6.7%) and tended to increase with age. The estimated appropriateness rate for hip replacement was 37.7% in men and 52.7% in women with osteoarthritis. The derived prevalence of knee osteoarthritis was 12.2%; it was significantly higher in women (14.9%) than in men (8.7%) and tended to increase with age. The estimated appropriateness rate for knee replacement was 11.8% in men and 17.9% in women with osteoarthritis. CONCLUSIONS Knee and hip osteoarthritis are highly prevalent diseases in the older population. The estimation of appropriateness for hip replacement seems to be significantly higher than that for knee replacement.

The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort

BackgroundPatients with chronic obstructive pulmonary disease (COPD) often experience exacerbations of the disease that require hospitalization. Current guidelines offer little guidance for identifying patients whose clinical situation is appropriate for admission to the hospital, and properly developed and validated severity scores for COPD exacerbations are lacking. To address these important gaps in clinical care, we created the IRYSS-COPD Appropriateness Study.Methods/DesignThe RAND/UCLA Appropriateness Methodology was used to identify appropriate and inappropriate scenarios for hospital admission for patients experiencing COPD exacerbations. These scenarios were then applied to a prospective cohort of patients attending the emergency departments (ED) of 16 participating hospitals. Information was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up after admission or discharge home. While complete data were generally available at the time of ED admission, data were often missing at the time of decision making. Predefined assumptions were used to impute much of the missing data.DiscussionThe IRYSS-COPD Appropriateness Study will validate the appropriateness criteria developed by the RAND/UCLA Appropriateness Methodology and thus better delineate the requirements for admission or discharge of patients experiencing exacerbations of COPD. The study will also provide a better understanding of the determinants of outcomes of COPD exacerbations, and evaluate the equity and variability in access and outcomes in these patients.

A Comparison of Standard Scoring versus Rasch Scoring of the Visual Function Index-14 in Patients with Cataracts

PURPOSE To compare the discriminatory ability and sensitivity to change of the standard summative score of the Visual Function Index (VF)-14 with two alternative Rasch-based scoring systems. METHODS A total of 4335 prospective patients with cataracts completed the VF-14 before surgery and 3 months after surgery. Rasch analysis was applied to the VF-14 patient responses before surgery and the VF-14 joint patient responses before and after surgery. To study the discriminatory ability, the VF-14 patient responses were grouped according to the preoperative visual acuity (VA) and the presence of ocular morbidities besides cataracts. For analysis of the sensitivity to change, the overall mean change in VF-14 scores was calculated after surgery, and the patients were grouped according to the presence of other ocular morbidities, postoperative VA gain, and satisfaction with the surgical outcome. The relative precision (RP) index and the effect size were used to compare the different scoring systems. RESULTS Rasch analysis confirmed the unidimensional structure of the VF-14. All items and scales adjusted well to the model (fit indices range, 0.71-1.34). The RP index for discrimination by ocular morbidity was 0.82 and by preoperative VA level, 1.02. Regarding sensitivity to change, the RP was 2.68 based on ocular morbidity and 1.78 with samples grouped by postoperative VA gain. CONCLUSIONS For longitudinal studies in which change is the relevant outcome, Rasch scores should be used, rather than the traditional score. However, for cross-sectional studies, both scoring systems were similarly precise.

Prevalence of symptoms of knee or hip joints in older adults from the general population

Background and aims: The prevalence of knee and hip symptoms varies from study to study, or is unknown. The goals of this study were to determine the prevalence of these symptoms, of diagnosed osteoarthritis and the use of prostheses, by age and gender, in a sample of the general older population. Methods: We mailed a questionnaire to 11,002 people aged 60 to 90 years who were selected by stratified random sampling. The questionnaire included questions on pain, functional limitations, diagnosed osteoarthritis, previous operations on either or both joints, and sociodemographic data. Descriptive statistics were performed. Results: From 10,150 people who fulfilled the selection criteria, 74.6% answered the questionnaire. Up to 49.2% of the subjects reported pain in either knee or hip or both, with pain in the knee reported more frequently (38.3%) than the hip (23.8%). Functional limitations were present in 51.6% of respondents, with 42.5% having limitations in the knees and 27.7% in the hips. The symptoms increased with age and were more prevalent in women. About 6.6% of respondents reported that they had already had prosthesis implant (hip 3.9%; knee 2.6%). The presence of a hip prosthesis was slightly lower in women than in men and more women had a knee prosthesis. Physicians had already diagnosed osteoarthritis in 38.5% of the sample, 19.4% of the hip and 31% of the knee. Conclusions: The prevalence of pain symptoms is relatively high among older people, more often in the knee and, in both pints, more often in women, but the rate of prosthetic surgeries was low, which means that additional studies are necessary to gain insight into the healthcare needs of the population.

Validation of a screening questionnaire for hip and knee osteoarthritis in old people

BackgroundTo develop a sensitive and specific screening tool for knee and hip osteoarthritis in the general population of elderly people.MethodsThe Knee and Hip OsteoArthritis Screening Questionnaire (KHOA-SQ) was developed based on previous studies and observed data and sent to 11,002 people aged 60 to 90 years, stratified by age and gender, who were selected by random sampling. Algorithms of the KHOA-SQ were created. Respondents positive for knee or hip OA on the KHOA-SQ were invited to be evaluated by an orthopedic surgeon. A sample of 300 individuals negative for knee or hip OA on the KHOA-SQ were also invited for evaluation. Sensitivity and specificity were determined for the KHOA-SQ, as well as for KHOA-SQ questions. Classification and Regression Tree analysis was used to find alternative screening algorithms from the questionnaire.ResultsOf 11,002 individuals contacted, 7,577 completed the KHOA-SQ. Of 1,115 positive for knee OA, on the KHOA-SQ, 710 (63.6%) were diagnosed with it. For hip OA, 339 of the 772 who screened positive (43.9%) were diagnosed it. Sensitivity for the hip algorithm was 87.4% and specificity 59.8%; for the knee, sensitivity was 94.5% and specificity 43.8%. Two alternative algorithms provided lower specificity.ConclusionThe KHOA-SQ offers high sensitivity and moderate specificity. Although this tool correctly identifies individuals with knee or hip OA, the high false positive rate could pose problems. Based on our questions, no better algorithm was found.

Predictors of Hospital Admission Two Months after Emergency Department Evaluation of COPD Exacerbation

Background: Limited information is available regarding the factors related to short-term hospital admission following an exacerbation of chronic obstructive pulmonary disease (eCOPD). Objectives: The aim of this study was to identify variables related to short-term admission in patients with an eCOPD. Methods: This was a prospective cohort study of patients with an eCOPD who attended an emergency department (ED) at 1 of 16 hospitals. Information on possible predictor variables was recorded during the ED stay, 24 h after admission to the hospital or after ED discharge home, and at hospital discharge or 1 week later if discharged home from the ED. An admission after an eCOPD within 2 months was the outcome of interest. Multivariate models were employed for patients admitted to the hospital or discharged home from the ED. Results: For patients discharged home from the ED, eCOPD-related hospital admissions in the previous year [odds ratio (OR) 1.98 and 2.33], pCO2 at ED admission (ORs 2.02 and 2.90), the number of ED visits within 1 week of the index ED visit (OR 5.14) and dyspnea level 1 week after the index ED visit (ORs 2.66 and 1.40) were predictors of short-term admission [area under the curve (AUC) 0.82]. For patients admitted to the hospital during the index ED visit, baseline FEV1% (ORs 1.32 and 1.88), eCOPD-related hospital admissions in the previous year (ORs 1.28 and 2.51), severe baseline dyspnea (OR 2.57) and dyspnea level 1 week after the index ED visit (ORs 2.15 and 1.74) were predictors of short-term readmission (AUC 0.73). Conclusions: Just a few easily recorded parameters may allow clinicians to identify patients at a higher risk of short-term readmission and establish preventive strategies.

Evaluation of the psychometric characteristics of the Spanish version of the Anorectic Behaviour Observation Scale

The Anorectic Behaviour Observation Scale (ABOS) was designed to obtain information from relatives about behaviours and attitudes of patients with eating disorders (ED). The aim of this study was to validate the ABOS into Spanish.

Appropriateness of diagnostic effort in hospital emergency room attention for episodes of COPD exacerbation

RATIONALE, AIMS AND OBJECTIVES To assess the adequacy of diagnostic effort in the emergency departments of Spanish hospitals with respect to episodes of exacerbation of chronic obstructive pulmonary disease (COPD). METHODS A descriptive cross-sectional study, conducted between 2007 and 2010 in 15 hospitals in Andalusia, Catalonia, Madrid and the Basque Country. The study population included cases of COPD exacerbation attended at the emergency departments of the participating hospitals. Diagnostic efforts were considered sufficient and appropriate when the emergency room conducted a clinical evaluation including electrocardiogram, chest X-ray, arterial blood gas analysis and spirometry. RESULTS 2852 episodes of COPD exacerbation attended in hospital emergency departments were assessed. 91.4% of the patients were male, with a mean age of 72.8 (SD 9.5) years, and 45.6% had had a previous emergency admission. The diagnostic effort was considered adequate in 60.1% of the episodes (95% CI: 58.3-61.9). The inter-hospital range of variation(25-75) was 1.67 and the coefficient of variation was 28.3%. In multivariate analysis, adjusting for hospital, date of admission and previous hospitalization, among the male patients, the OR for adequate diagnostic effort was 1.38 (95% CI: 1.04-1.84) CONCLUSION: With respect to diagnostic effort, inequities were observed in our assessment of episodes of COPD exacerbation attended in the emergency departments of Spanish public hospitals. In a high percentage of cases (40%), proper assessment was not conducted. Moreover, inter-individual and inter-hospital differences were observed.

Prognostic severity scores for patients with COPD exacerbations attending emergency departments.

SETTING Reported predictors of the adverse evolution of patients with chronic obstructive pulmonary disease exacerbations (eCOPD) are various and inconsistent in the bibliography. OBJECTIVE To develop clinical prediction rules for short-term outcomes in eCOPD patients attending an emergency department (ED). DESIGN Prospective cohort study of patients with an eCOPD. Short-term outcomes were admission to an intensive care unit (ICU), admission to an intermediate respiratory care unit (IRCU) and death in these groups. Multivariate logistic regression models were developed for each of the outcomes. RESULTS Predictors of ICU or IRCU admission were use of long-term home oxygen therapy (LT-HOT) or non-invasive mechanical ventilation (NIMV), elevated PCO2 and decreased pH upon ED arrival (area under the curve [AUC] 0.87 in the derivation sample; 0.89 in the validation sample). Among those admitted to an ICU or IRCU, predictors of death were increased age, use at home of LT-HOT or NIMV, use of inspiratory accessory muscles upon ED arrival and altered Glasgow Coma Scale (<15 points) (AUC 0.78). CONCLUSIONS Three clinical predictors available in the ED can be used to create a simple score to predict the need for intensive treatment among eCOPD patients. Such a score can be a tool for clinical practice.

Visual acuity level, ocular morbidity, and the better seeing eye affect sensitivity and responsiveness of the visual function index.

PURPOSE To examine the relation between Visual Function Index-14 (VF-14) scores and VA by accounting for concurrent ocular comorbidities, effect of the better seeing eye (BSE), and VA before and after cataract surgery. DESIGN Prospective cohort study. PARTICIPANTS A total of 4335 patients with cataract who completed the VF-14 before and after cataract surgery. METHODS Collaborating clinicians provided demographic and clinical data before and after cataract surgery. Lowess curves, general linear models, and Spearman correlation coefficients were used to study the relation between the VF-14 and the VA. MAIN OUTCOME MEASURES Scores in the VF-14 preintervention, change in VF-14 after surgery, VA before surgery, and VA change after surgery. RESULTS General linear models and Spearman correlation coefficients showed a significant (P < 0.0001) association between VF-14 score and VA (measured in decimal fraction) when the preoperative VA was ≤0.5 (20/40) and no association (P > 0.4020) when the VA was >0.5 (20/40). Small VA gains (≤0.5) after surgery only led to significant gains (P < 0.0001) in functionality in patients with other ocular pathologies and whose BSE was the surgical eye. Gains in VA >0.5 had a significant (P < 0.02) effect on VF-14 change scores in most patients. CONCLUSIONS The VF-14 seems to be more sensitive when the preoperative VA is <0.5 (20/40), especially in patients whose BSE is the surgical eye. The VF-14 seems responsive to increases in VA if the gains exceed 0.5. For gains <0.5, the VF-14 seems unresponsive, except for patients with other ocular pathologies in whom the BSE before and after surgery is the surgical eye.