P981Lvot area measurement using gated ct data reclassifies aortic stenosis severity as graded by echocardiography.

BACKGROUND: Measurement of left ventricular outflow tract (LVOT) diameter and area for estimation of aortic valve area (AVA) using transthoracic echocardiography (TTE) and the continuity equation assumes circular LVOT. The use of direct planimetric measurement of LVOT area by gated-CT can theoretically improve accuracy of AVA calculation. PURPOSE: We aim to assess reproducibility of LVOT echo measurement and its correlation and agreement with Gated CT measurements. In the subgroup with aortic stenosis (AS) we secondarily assessed the potential change in AS severity using LVOT area by CT instead of TTE in the continuity equation. METHODS: We retrospectively studied 93 patients, 43 of whom with severe AS. LVOT Area was measured with 2D TTE by 2 expert echocardiographers and gated-CT by 2 expert radiologists; inter-reader agreement and inter-method (Echo vs gated CT) agreement and correlation were measured. Finally we used the measurement of CT scan in the continuity equation instead of TTE measurement to assess potential reclassification of AS severity. RESULTS: Mean age was 78±11. Table shows inter-reader and inter-method agreement and correlation.The correlation between 2 echocardiophers for LVOT measurements was good (rho = 0,77) although not perfect. Out of 43 severe AS, defined as AVA<1 cm2 using TTE in the continuity equation, 18 were reclassified by gated-CT LVOT measurements into moderate AS. This was due to gated-CT LVOT area resulting on average 1.4 cm2 larger than LVOT area by TTE. CONCLUSION: LVOT is elliptical and TTE tends to underestimate LVOT area and AVA due to the measurement of the shorter diameter of this ellipse. CT scan can provide more geometrically accurate measurement and requires different cut-offs compared with traditional TTE AVA measurement. By the way, in the current study the LVOT area by CT was on average 38% larger of the LVOT area measured by TTE. Such correcting factor (increase TTE LVOT area by 38%) should apparently be used to assess anatomical true planimetric area to be compared with gated-CT LVOT.summary tableTTE Inter-reader correlation LVOT area (Spearman rho)0.77TTE reader A vs CT 3-chamber equivalent correlation (Spearman rho)0.49TTE reader B vs CT 3-chamber equivalent correlation (Spearman rho)0.38TTE reader A area vs CT planimetric area correlation (Spearman rho)0.41TTE reader B area vs CT planimetric area correlation (Spearman rho)0.31Mean LVOT Area by TTE reader A3,60SD 0,6038%Mean LVOT Area by CT scan4,99SD 0,98 Abstract P981 Figure.summary table.Abstract P981 Figure.

[The use of occupational therapy in upper limb amputees]. / L'applicazione della TO nell'amputato di arto superiore.

Since pre-history until modern times, the ever more refined use of the hand has been fundamental to the progress of mankind. The list of functions of this incredible part of the body would fill several pages and show its fundamental importance in all our actions; in fact, there is very little that humans do that does not involve the use of the hands. The hand offers points for unlimited dissertation and is the executive organ par excellence, carrying out directly or participating in almost all our actions; it is an organ for communication and an instrument of well-being as well as being the main site of one of the five senses: touch. On this background, attention will be focused on the importance that the hand plays in daily life and, particularly, on the difficulties inevitably faced by people who are forced to live without a hand, even if replaced by an orthopaedic prosthesis. This is the sense of occupational therapy in the context of upper limb amputees.

[Sincerity of effort: isokinetic evaluation of knee extension]. / Sincerità dello sforzo: valutazione isocinetica nell'estensione del ginocchio.

The aim of this study was to find a reliable method to evaluate the sincerity of the muscular maximal effort performed in a dynamometric isokinetic test of knee flexion-extension. The coefficient of variation of the peak torque (CV) and 3 new indices were analysed: (1) the average coefficient of variation calculated on the complete peak torque curve (CVM); (2) the slope of the regression line in an endurance test (PRR); (3) the correlation coefficient of the peak torques in the same endurance test (CCR). Twenty healthy subjects underwent assessment in two different trials, maximal (MX) and 50% submaximal (SMX), with 20 minutes of rest between trials. Each trial consisted of 4 tests, each of 3 repetitions, at angular speed of 30, 180, 30, and 180 degrees/s, respectively, and 1 test of 15 repetitions at 240 degrees/s. Our findings confirmed the ability of CV to detect a high percentage of sincere efforts: at 30 degrees/s Sensibility (Sns)=100% and Specificity (Spc)=70%; at 180 degrees/s Sns=75%, Spc=95%. The 3 new indices here proposed showed high characteristics of Sns and Spc, generally better than those of CV. CVM showed at 180 degrees/s Sns=90% and Spc=100%, while at 30 degrees/s Sns=90%, Spc=75%. PRR was the best index identifying all the efforts, except one (Sns=100%, Spc=95%). The CCR coefficient showed Sns and Spc values both of 90%.

[Tests of hand functionality in upper limb amputation with prosthesis]. / I test di funzionalità della mano in amputati di arto superiore con protesi.

The need for standardized instruments for clinical measurements has become pressing in the fields of occupational rehabilitation and ergonomics. This is particularly the case for instruments that allow a quantitative evaluation of upper limb function, and especially hand function in patients who have undergone an amputation and then application of an upper limb prosthesis. This study presents a review of the main tests used to evaluate hand function, with a critical analysis of their use in subjects with an upper limb prosthesis. The tests are divided into: tests to evaluate strength, tests to evaluate co-ordination and dexterity, tests of global or overall function, and tests proposed specifically for subjects with an upper limb prosthesis. Of the various tests presented, the authors give their preference to the Bimanual Functional Assessment, Abilhand and/or the ADL Questionnaire, because of the practical usefulness, clinimetric features, simplicity and ease of administration of these tests.

Measuring long-term outcome in people with lower limb amputation: cross-validation of the Italian versions of the Prosthetic Profile of the Amputee and Prosthesis Evaluation Questionnaire.

AIM: Recently 2 questionnaires have been developed for people with lower limb amputation to determine, in follow-up studies, the level of function and extent of prosthetic use, to measure major life domains connected with prosthesis function, and to study the factors potentially related to prosthetic use the Prosthetic Profile of the Amputee (PPA) and the Prosthesis Evaluation Questionnaire (PEQ). The purpose of the present study was: a) to produce Italian versions of both PPA (PPA-it) and PEQ (PEQ-it), using a validated procedure of cross-cultural translation; b) to analyse and discuss the internal consistency and construct validity of the main sections of the 2 questionnaires, in an Italian population. METHODS: The PPA questionnaire consists of 44 questions arranged in 6 sections. The PEQ is composed of 82 questions subdivided into 9 scales related to 4 sectors. In order to produce the Italian versions of the PPA and PEQ the forward/backward translation method was used. The final versions of the questionnaires were mailed to 110 patients and 95 of them returned the questionarries. RESULTS: The Cronbach's alpha of Locomotor Capabilities Index (LCI/5), part of the PPA, was 0.97, and those of the 9 PEQ-it scales ranged from 0.64 (appearance) to 0.95 (mobility, MO). The LCI/5 and MO correlated highly with each other (rs=0.81) and with the variables related to prosthesis use. There was a significant correlation among the PEQ-it domains concerning MO, prosthesis function, psycho-social aspects and well-being. CONCLUSION: Unfortunately, the acceptability and feasibility of both questionnaires (rather low completion rate, visual analogue scale format of PEQ, demanding scoring procedures) were sub-optimal, and their structure (item selection, response format, scaling properties, etc.) would need some refinement and simplification in order to facilitate a broader clinical use. On the other hand, findings for the LCI/5 (PPA) and MO (PEQ) are encouraging (particularly regarding the first scale) and confirm their sound practical and psychometric features.

Evaluation of a structured alcohol education course in a secondary school system in north Italy.

The authors describe the results of an alcohol education course given to 2166 high school students in the area of Padua, Italy. An evaluation was performed, utilizing a before and after technique: it was shown that baseline knowledge of relevant information on alcohology was similar among younger and older teenagers; also, baseline information and course gain varied according to question content.