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Background: The use of instruments in clinical practice with measurement properties tested is highly recommended, in order to provide adequate assessment and measurement of outcomes. Objective: To calculate the minimum clinically important difference (MCID) and responsiveness of the Perme Intensive Care Unit Mobility Score (Perme Score). Methods: This retrospective, multicentric study investigated the clinimetric properties of MCID, estimated by constructing the Receiver Operating Characteristic (ROC). Maximizing sensitivity and specificity by Youden's, the ROC curve calibration was performed by the Hosmer and Lemeshow goodness-of-fit test. Additionally, we established the responsiveness, floor and ceiling effects, internal consistency, and predictive validity of the Perme Score. Results: A total of 1.200 adult patients records from four mixed general intensive care units (ICUs) were included. To analyze which difference clinically reflects a relevant evolution we calculated the area under the curve (AUC) of 0.96 (95% CI: 0.95-0.98), and the optimal cut-off value of 7.0 points was established. No substantial floor (8.8%) or ceiling effects (4.9%) were observed at ICU discharge. However, a moderate floor effect was observed at ICU admission (19.3%), in contrast to a very low incidence of ceiling effect (0.6%). The Perme Score at ICU admission was associated with hospital mortality, OR 0.86 (95% CI: 0.82-0.91), and the predictive validity for ICU stay presented a mean ratio of 0.97 (95% CI: 0.96-0.98). Conclusion: Our findings support the establishment of the minimum clinically important difference and responsiveness of the Perme Score as a measure of mobility status in the ICU.
Antecedentes: Se recomienda encarecidamente el uso de instrumentos en la práctica clínica con propiedades de medición probadas, con el fin de proporcionar una evaluación y medición adecuada de los resultados. Objetivo: Calcular la diferencia mínima clínicamente importante (MCID) y la capacidad de respuesta de la puntuación de movilidad de la unidad de cuidados intensivos de Perme (Perme Score). Métodos: Este estudio multicéntrico retrospectivo investigó las propiedades clinimétricas de MCID, estimadas mediante la construcción de la característica operativa del receptor (ROC). Maximizando la sensibilidad y especificidad mediante la prueba de Youden, la calibración de la curva ROC se realizó mediante la prueba de bondad de ajuste de Hosmer y Lemeshow. Además, establecimos la capacidad de respuesta, los efectos suelo y techo, la consistencia interna y la validez predictiva del Perme Score. Resultados: Se incluyeron un total de 1,200 registros de pacientes adultos de cuatro unidades de cuidados intensivos (UCI) generales mixtas. Para analizar qué diferencia refleja clínicamente una evolución relevante calculamos el área bajo la curva (AUC) de 0.96 (95% CI: 0.95-0.98); y se estableció el valor de corte óptimo de 7.0 puntos. No se observaron efectos suelo (8.8%) o techo (4.9%) sustanciales al alta de la UCI. Sin embargo, se observó un efecto suelo moderado al ingreso en la UCI (19.3%), en contraste con una incidencia muy baja del efecto techo (0.6%). El Perme Score al ingreso en UCI se asoció con la mortalidad hospitalaria, OR 0.86 (95% CI: 0.82-0.91), y la validez predictiva de estancia en UCI presentó una relación media de 0.97 (95% CI: 0.96-0.98). Conclusiones: Nuestros hallazgos respaldan el establecimiento de la diferencia mínima clínicamente importante y la capacidad de respuesta de el Perme Score como medida del estado de movilidad en la UCI.
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Objective@#To investigate the quality of life(QoL) and emotion symptoms(anxiety symptom and depressive symptom), and its influencing factors in patients with permanent peripheral facial paralysis(PPFP).@*Methods@#A case-control trial was conducted to evaluate the QoL status and emotion symptoms of 79 PPFP patients(PPFP group, disease course >12 months) between January 2017 and January 2018 from the Affiliated Hospital of Yangzhou University, and 42 healthy individuals were selected as control group.The generic questionnaire medical outcomes study short-form 36 items health survey(SF-36), Chinese version of facial clinimetric evaluation(FaCE) scale, self-rating depression scale(SDS) and self-rating anxiety scale(SAS) were evaluated.The correlation among SF-36, SDS, SAS and FaCE was evaluated.SPSS 21.0 software was used to analyze the data.@*Results@#By the assessment of SF-36, the score of vitality[(73.23±15.04)points], social function[(72.41±15.46)points], role-emotion[(72.53±15.27)points] and mental health[(73.35±14.54)points] in four dimensions of the PPFP group were lower than those of the control group [(97.56±3.76)points, (96.51±3.32)points, (97.09±2.49)points and (96.63±2.37)points](t=-10.506, -10.144, -10.505, -10.403, all P<0.001), but the scores of physical function, role-physica, bodily pain and general health in four domains of the PPFP group were similar with those of the control group (all P>0.05). By the assessment of FaCE, the total score of the PPFP group was lower than those of the control group [(48.63±17.44)points vs.(100.00±0.00)points, t=-19.281, P<0.05]. The score of SDS in the PPFP group was higher than those of the control group[(48.43±11.57)points vs.(40.63±5.39)points](t=4.174, P<0.001), but the score of SAS had no statistically significant difference between the two groups (P>0.05). According to the assessment of the correlation among SF-36, SDS, SAS and FaCE, the total scores of FaCE in the PPFP group was related only to SF-36 related mental health dimensions and SDS(r=-0.848~0.908, all P<0.001). Multiple linear regression analysis showed that marital status(t=-2.442, P=0.017), occupation(t=-2.377, P=0.020), and age(t=-5.501, P=0.000) were negatively correlated with the SDS scores; with/without synkinesis(t=3.604, P= 0.042), disease course(t=4.152, P=0.000), and the level of House-Brackmann grading system(HBGS)(t=2.116, P=0.038) were positively associated with the SDS of the PPFP group.However, disease course (t=-2.616, P=0.011), HBGS(t=-6.523, P=0.000) were negatively correlated with the total scores of FaCE, and with/without synkinesis(t= 2.767, P=0.000) was positively associated with the total scores of FaCE.@*Conclusion@#The patients with PFPP have a poorer quality of life and experienced greater psychological distress than healthy individuals.The present study suggested that age, gender, occupation, marital status, disease course, with/without synkinesis, the sources of PPFP and the level of HBGS are associated with depression increasing and quality of life decreasing in PPFP patients.
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To investigate the quality of life (QoL) and emotion symptoms (anxiety symptom and depressive symptom), and its influencing factors in patients with permanent peripheral facial paralysis ( PPFP). Methods A case-control trial was conducted to evaluate the QoL status and emotion symptoms of 79 PPFP patients (PPFP group,disease course ＞12 months) between January 2017 and January 2018 from the Affiliated Hospital of Yangzhou University,and 42 healthy individuals were selected as control group.The generic questionnaire medical outcomes study short -form 36 items health survey(SF-36),Chinese version of facial clinimetric evaluation (FaCE) scale,self-rating depression scale(SDS) and self-rating anxiety scale (SAS) were evaluated.The correlation among SF-36,SDS,SAS and FaCE was evaluated.SPSS 21.0 software was used to analyze the data.Results By the assessment of SF-36,the score of vitality[(73.23 ±15.04)points],social function[(72.41 ±15.46)points],role-emotion[(72.53 ±15.27) points] and mental health [(73.35 ±14.54) points] in four dimensions of the PPFP group were lower than those of the control group [( 97.56 ±3.76 ) points, (96.51 ±3.32 ) points, (97.09 ± 2.49)points and (96.63 ±2.37) points] (t＝-10.506,-10.144,-10.505,-10.403,all P＜0.001),but the scores of physical function ,role-physica,bodily pain and general health in four domains of the PPFP group were similar with those of the control group (all P＞0.05).By the assessment of FaCE,the total score of the PPFP group was lower than those of the control group [(48.63 ±17.44) points vs.(100.00 ±0.00) points,t＝-19.281,P＜0.05].The score of SDS in the PPFP group was higher than those of the control group [(48.43 ±11.57)points vs. (40.63 ±5.39) points] ( t ＝4.174, P ＜0.001), but the score of SAS had no statistically significant difference between the two groups (P＞0.05).According to the assessment of the correlation among SF -36,SDS,SAS and FaCE,the total scores of FaCE in the PPFP group was related only to SF -36 related mental health dimensions and SDS(r＝-0.848 ～0.908, all P ＜0.001).Multiple linear regression analysis showed that marital status ( t ＝-2.442,P＝0.017),occupation ( t＝-2.377,P＝0.020),and age ( t ＝-5.501,P＝0.000) were negatively correlated with the SDS scores;with／without synkinesis ( t ＝3.604, P ＝0.042), disease course ( t ＝4.152,P ＝0.000),and the level of House-Brackmann grading system(HBGS)(t＝2.116,P＝0.038) were positively associated with the SDS of the PPFP group.However,disease course (t＝-2.616,P＝0.011),HBGS(t＝-6.523,P＝0.000) were negatively correlated with the total scores of FaCE ,and with／without synkinesis (t＝2.767,P＝0.000) was positively associated with the total scores of FaCE.Conclusion The patients with PFPP have a poorer quality of life and experienced greater psychological distress than healthy individuals .The present study suggested that age ,gender, occupation,marital status,disease course,with／without synkinesis ,the sources of PPFP and the level of HBGS are associated with depression increasing and quality of life decreasing in PPFP patients.
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Introducción. Mahieu y colaboradores desarrollaron una escala denominada NOSEP-1, basada en datos clínicos y de laboratorio, con el objetivo de encontrar parámetros para el diagnóstico de sepsis nosocomial neonatal. En este estudio se evaluó la eficacia de la escala en recién nacidos prematuros menores de 1 500 g. Material y métodos. Se utilizó la escala NOSEP-1, la cual cuenta con 5 ítems: proteína C reactiva, neutrófilos, plaquetas, nutrición parenteral y fiebre. Se incluyó recién nacidos pretérmino menores de 1 500 g al nacimiento, en quienes se sospechó sepsis neonatal nosocomial. La validez se evaluó mediante curvas ROC, área bajo la curva, sensibilidad, especificidad y valores predictivos; el estándar de oro fue el hemocultivo. Se formaron 2 grupos: el grupo 1 se integró por pacientes con sospecha de sepsis nosocomial pero con hemocultivo negativo, y el grupo 2 formado por pacientes con sepsis confirmada. Resultados. En el grupo 1 se incluyeron a 50 pacientes y en el grupo 2 a 51 pacientes. Mediante curvas ROC se estableció que el punto de corte de 8 presentó sensibilidad de 62.7%, especificidad de 70%,VPP de 53.8% y VPN de 50%. Conclusiones. Comparados con el trabajo original, la sensibilidad, especificidad y valores predictivos son bajos en recién nacidos menores de 1 500 g; la modificación de variables puede ser evaluada para mejorar la sensibilidad.
Introduction. NOSEP-1 score was developed by Mahieu et al, to predict nosocomial sepsis in neonatal intensive care unit patients based on 3 laboratory, 1 clinical, and 1 historical variables potentially related with nosocomial infections. Material and methods. NOSEP-1 score had 5 items including: C reactive protein, neutrophil fraction, thrombocytopenia, fever and parenteral nutrition. We evaluated the NOSEP score in premature patients lower than 1 500 g to predict nosocomial sepsis in the Neonatal Intensive Care Unit of Instituto Nacional de Perinatologia. Validity was evaluated using receiver operating characteristic curve (ROC), sensitivity, specificity, positive predictive value and negative predictive value. Gold standard was the blood culture and 2 or more features of systemic inflammatory response syndrome.We analyzed 2 groups of patients. Group 1:50 new-borns with negative blood culture, and group 2: 52 with positive blood culture, respectively. Results.The point score was 8, with sensitivity of 62.7%, specificity of 70%, positive predictive value of 53.8%, and negative predictive value of 50%. Conclusions. NOSEP-1 score is a simple indicator for detecting nosocomial infections in premature patients; however in the present study analyzing infants < 1 500 g, the sensitivity, specificity, positive predictive value, negative predictive value were lower than original report. We propose that if some of the variables are modified, the specificity may be improved.