Wim Peersman

Are Sore Throat Patients Who Hope for Antibiotics Actually Asking for Pain Relief

PURPOSE Antibiotics are still overprescribed for self-limiting upper respiratory tract infections such as acute sore throat, and physicians mention patient’s desire for antibiotics as a driving force. We studied patients’ concerns when visiting their family physician for acute sore throat, more specifically the importance they attach to antibiotic treatment and pain relief. METHODS Family physicians in 6 peer groups in Belgium participated in an observational postvisit questionnaire survey. Patients aged 12 years and older making an office visit for acute sore throat were invited to indicate the importance of different reasons for the visit. RESULTS Sixty-eight family physicians provided data from 298 patients. The 3 most frequently endorsed reasons for visiting the physician were examination to establish the cause of the symptoms, pain relief, and information on the course of the disease. Hopes for an antibiotic ranked 11th of 13 items. Patients who considered antibiotics very/rather important valued pain relief significantly more than patients who considered them little/not important (P <.001). Patients who hoped for antibiotics felt more unwell (P <.001), had more faith in antibiotics to speed recovery (P <.001), and were less convinced that sore throat was a self-limiting disease (P <.012). A multivariate model, adjusted for age, sex, and educational status, showed that the desire for pain relief is a strong predictor of the hope to receive a prescription for antibiotics. CONCLUSION Our study suggests that patients with acute sore throat and who hope for antibiotics may in fact want treatment for pain. Trials are needed to test whether exploring patients’ expectations about pain management and offering adequate analgesia can assist physicians in managing sore throats without prescribing antibiotics.

The reliability of the Movement Assessment Battery for Children for preschool children with mild to moderate motor impairment

Objectives : To provide further evidence of the test—retest reliability and agreement of the Movement Assessment Battery for Children (M-ABC), a standardized motor test used for identification and evaluation of children with mild to moderate motor impairment. Both the stability of total test scores and classification according to specified cut-off points were examined. Design and setting : Children were tested on the M-ABC, three times with an interval of three weeks between each assessment. Participants : Thirty-three 4- and 5-year-old children with poor motor performance, 24 boys and 9 girls. Results : A systematic practice effect between three consecutive testing sessions was shown. This was significant for the total score and two of the three subscores. Test—retest reliability of the total test score yielded an intraclass correlation coefficient (ICC) of 0.88. The total impairment score ranged between 0 and 40. The standard error of measurement (SEM) of this score was 2.4, resulting in a least detectable difference of 6.6 (with alpha set at 5%). The agreement over three testing sessions (κ) was 0.72. Conclusions : The total impairment score of the M-ABC is a reliable measure for identification of mild to moderate motor impairment in young children. Repeated testing on the M-ABC at intervals of three weeks results in a systematic measurement error and is not recommended. The SEM is substantial. Follow-up of preschool children with the M-ABC as a single outcome measure is not appropriate.

A prospective study on gait-related intrinsic risk factors for lower leg overuse injuries

Objective: To determine prospectively gait-related risk factors for lower leg overuse injury (LLOI). Design: A prospective cohort study. Setting: Male and female recruits from a start-to-run (STR) programme during a 10-week training period. Participants: 131 healthy subjects (20 men and 111 women), without a history of any lower leg complaint, participated in the study. Interventions: Before the start of the 10-week STR programme, plantar force measurements during running were performed. During STR, lower leg injuries were diagnosed and registered by a sports physician. Main Outcome Measures: Plantar force measurements during running were performed using a footscan pressure plate. Results: During the STR, 27 subjects (five men and 22 women) developed a LLOI. Logistic regression analysis revealed that subjects who developed a LLOI had a significantly more laterally directed force distribution at first metatarsal contact and forefoot flat, a more laterally directed force displacement in the forefoot contact phase, foot flat phase and at heel-off. These subjects also had a delayed change of the centre of force (COF) at forefoot flat, a higher force and loading underneath the lateral border of the foot, and a significantly higher directed force displacement of the COF at forefoot flat. Conclusions: These findings suggest that a less pronated heel strike and a more laterally directed roll-off can be considered as risk factors for LLOI. Clinically, the results of this study can be considered important in identifying individuals at risk of LLOI.

Construct Validity of the Assessment of Balance in Children Who Are Developing Typically and in Children With Hearing Impairments

Background Children with hearing impairments have a higher risk for deficits in balance and gross motor skills compared with children who are developing typically. As balance is a fundamental ability for the motor development of children, a valid and reliable assessment to identify weaknesses in balance is crucial. Objective The purpose of this study was to investigate the construct validity of posturography and clinical balance tests in children with hearing impairments and in children who are developing typically. Methods The study involved 53 children with typical development and 23 children with hearing impairments who were between 6 and 12 years of age and without neuromotor or orthopedic disorders. All participants completed 3 posturography tests (modified Clinical Test of Sensory Interaction of Balance [mCTSIB], unilateral stance, and tandem stance) and 4 clinical balance tests (one-leg stance with eyes open and with eyes closed, balance beam walking, and one-leg hopping). Results Three conditions of the mCTSIB, unilateral stance, and 2 clinical balance tests were able to distinguish significantly between the 2 groups. Children with hearing impairments showed more difficulties in balance tasks compared with children who were developing typically when 1 or 2 types of sensory information were eliminated or disturbed. The study showed only low to moderate correlations among the different methods of evaluating balance. Conclusions Clinical balance tests and posturography offer different but complementary information. An assessment protocol for balance consisting of posturography and clinical balance tasks is proposed. Static and dynamic balance abilities could not be differentiated and seem not to be a valid dichotomy.

Autonomic symptom burden in the hypermobility type of Ehlers–Danlos syndrome: A comparative study with two other EDS types, fibromyalgia, and healthy controls

AIM This study provides insight into the profile and importance of autonomic symptoms in the hypermobility type (HT) of Ehlers-Danlos syndrome (EDS). The impact of these symptoms is put into perspective by comparing with fibromyalgia (FM) and two other EDS types. METHODS Overall, 80 patients with EDS-HT participated, as well as 11 with classical EDS (cEDS), seven with vascular EDS (vEDS), 38 with FM, and 43 healthy controls. All participants filled out the autonomic symptom profile (ASP). Furthermore, they were inquired about quality of life (QOL, SF-36) and factors contributing to the EDS disease burden, e.g., hypermobility (5-point questionnaire, GHQ), fatigue (checklist individual strength, CIS), pain (pain detect questionnaire, PDQ), affective distress (hospital anxiety and depression scale, HADS), and physical activity (Baecke). RESULTS The total autonomic symptom burden was higher in EDS-HT (57.9 ± 21.57) than in controls (11.3 ± 19.22), cEDS (32.3 ± 19.47), and vEDS (29.1 ± 19.18), but comparable to FM (53.8 ± 19.85). Especially orthostatic and gastrointestinal complaints were prevalent. The importance of autonomic symptoms in EDS-HT was emphasized by the correlation with lowered QOL (r = -0.402), fatigue (r = 0.304), and pain severity (r = 0.370). Although affective distress and decreased physical activity are often suggested as possible causes for dysautonomia, the ASP did not correlate with the HADS and Baecke score. By contrast, the correlation of the GHQ (r = 0.298) and PDQ (r = 0.413) with the ASP supports the hypothesis that joint hypermobility and neuropathy may play a role in the development of autonomic symptoms. CONCLUSION Autonomic symptoms, especially orthostatic and gastrointestinal complaints, are frequent extraarticular manifestations of EDS-HT and contribute to the disease burden.

SOS : a screening instrument to identify children with handwriting impairments

ABSTRACT Poor handwriting has been shown to be associated with developmental disorders such as Developmental Coordination Disorder, Attention Deficit Hyperactivity Disorder, autism, and learning disorders. Handwriting difficulties could lead to academic underachievement and poor self-esteem. Therapeutic intervention has been shown to be effective in treating children with poor handwriting, making early identification critical. The SOS test (Systematic Screening for Handwriting Difficulties) has been developed for this purpose. A child copies a sample of writing within 5 min. Handwriting quality is evaluated using six criteria and writing speed is measured. The Dutch SOS test was administered to 860 Flemish children (7–12 years). Inter- and intrarater reliability was excellent. Test–retest reliability was moderate. A correlation coefficient of 0.70 between SOS and “Concise Assessment Methods of Children Handwriting” test (Dutch version) confirmed convergent validity. The SOS allowed discrimination between typically developing children and children in special education, males and females, and different age groups.

Intratest reliability and test–retest reproducibility of the oxygen uptake efficiency slope in healthy participants:

Background The oxygen uptake efficiency slope (OUES) is a newer ventilatory exercise parameter, used in the evaluation of healthy participants and patients with cardiovascular disease. However, few data about the reliability and reproducibility of OUES are available. Our study assessed intratest reliability and test-retest reproducibility of OUES in healthy participants. Design and methods Eighteen participants (age 28 ± 6 years, BMI 22.1 ± 1.9 kg/m2, 10 men) performed two identical maximal exercise tests on a bicycle ergometer. To assess test-retest reproducibility, we performed Bland-Altman analysis and calculated the coefficient of repeatability of the main ventilatory variables. Results OUES remained stable during the second part of the exercise test. Mean values varied 2.4 ± 4.0% between OUES calculated at 70% (OUES70) and at 100% of exercise duration. Mean variation decreased to 1.4 ± 2.3% when OUES was calculated at 90% of exercise duration (OUES90). The Bland-Altman 95% limits of agreement for OUES90 were +3 and –6%, those for OUES70 were +11 and –8%. The coefficient of repeatability for OUES was 597 ml/min or 18.7% of the average value of repeated OUES measurements. These results were similar to those of peak oxygen uptake and minute ventilation/carbon dioxide output. However, the test-retest reproducibility for submaximal-derived values of OUES was lower, as we noted higher coefficients of repeatability for OUES90 and OUES70, increasing up to 27% of the average of repeated values. Conclusion OUES shows excellent intratest reliability and has a test-retest reproducibility that is similar to that of peak oxygen uptake and minute ventilation/carbon dioxide output slope. However, its reproducibility becomes higher when it is calculated from increasing levels of achieved exercise intensity.

Validity of self-reported utilization of physician services: a population study

BACKGROUND Health care utilization is of central interest in epidemiology, and most of the studies rely on self-report. The objectives of this study were to assess the validity of self-reported utilization of general practitioner and specialist physician by correlating self-reported utilization with registered services utilization, and to determine the factors related to that validity. METHODS The 1997 Belgian National Health Interview Survey (BNHIS) was linked with registered medical utilization data provided by the Belgian Health Insurance Funds. Valid information on general practitioner and specialist physician utilization during the past 2 months was found for 5869 participants at the BNHIS who were aged ≥25 years. Intra-class correlation coefficients were used to determine the rate of agreement, and multinomial logistic regression to model factors influencing under- and over-reporting. RESULTS The results demonstrated a substantial agreement between the self-reported and registered general practitioner contacts, and only a minor bias was found towards under-reporting. There was no significant difference between mean self-reported and registered specialist physician utilization, but the agreement was rather moderate. Gender, age, country of birth, self-rated health, number of chronic illnesses, having functional limitations and having mental health problems, were associated with under- and/or over-reporting. CONCLUSION Studies that aim to compare the utilization of different socio-demographic groups have to take into account that the reporting errors vary by respondents characteristics.

The movement assessment battery for children: similarities and differences between 4- and 5-year-old children from Flanders and the United States.

Purpose: To explore the possibility that 4- and 5-year-old Flemish children would perform differently from children of the same age in the US standardization sample of the Movement Assessment Battery for Children (M-ABC). Participants: Two hundred sixty-seven 4-year-old and 239 5-year-old Flemish children without known impairments, from regular schools, took part in the study (260 boys, 246 girls). Methods: All children were individually assessed using the M-ABC. Results: The total M-ABC score of the 4-year-old children was similar to that of their peers in the United States. The 5-year-old Flemish children performed significantly better, although the effect size of the difference was very small. Of the 5-year-old children, one scored at the 5th percentile (0.4%) and 5.0% of the children scored below the 15th percentile. Conclusions: United States norms are appropriate for 4-year-old Flemish children but require adjustment if they are to identify 5-year-old Flemish children with mild motor impairment.

Retraining basic life support skills using video, voice feedback or both: A randomised controlled trial

INTRODUCTION The optimal strategy to retrain basic life support (BLS) skills on a manikin is unknown. We analysed the differential impact of a video (video group, VG), voice feedback (VFG), or a serial combination of both (combined group, CG) on BLS skills in a self-learning (SL) environment. METHODS Two hundred and thirteen medicine students were randomly assigned to a VG, a VFG and a CG. The VG refreshed the skills with a practice-while-watching video (abbreviated Mini Anne™ video, Laerdal, Norway) and a manikin, the VFG with a computer-guided manikin (Resusci Anne Skills Station™, Laerdal, Norway) and the CG with a serial combination of both. Each student performed two sequences of 60 compressions, 12 ventilations and three complete cycles of BLS (30:2). The proportions of students achieving adequate skills were analysed using generalised estimating equations analysis, taking into account pre-test results and training strategy. RESULTS Complete datasets were obtained from 192 students (60 VG, 69 VFG and 63 CG). Before and after training, ≥70% of compressions with depth ≥50 mm were achieved by 14/60 (23%) vs. 16/60 (27%) VG, 24/69 (35%) vs. 50/69 (73%) VFG and 19/63 (30%) vs. 41/63 (65%) CG (P<0.001). Compression rate 100-120/min was present in 27/60 (45%) vs. 52/60 (87%) VG, 28/69 (41%) vs. 44/69 (64%) VFG and 27/63 (43%) vs. 42/63 (67%) CG (P=0.05). Achievement of ≥70% ventilations with a volume 400-1000 ml was present in 29/60 (49%) vs. 32/60 (53%) VG, 32/69 (46%) vs. 52/69 (75%) VFG and 25/63 (40%) vs. 51/63 (81%) CG (P=0.001). There was no between-groups difference for complete release. CONCLUSIONS Voice feedback and a sequential combination of video and voice feedback are both effective strategies to refresh BLS skills in a SL station. Video training alone only improved compression rate. None of the three strategies resulted in an improvement of complete release.