Reliability of the Modified Ashworth Scale After Stroke for 13 Muscle Groups.

OBJECTIVE: To evaluate the reliability of the protocol for administration of the Modified Ashworth Scale (MAS) for all commonly affected muscle groups after stroke. DESIGN: A repeated-measures design was used in administration of MAS for 13 muscle groups on 2 assessment days. Intrarater reliability and interrater reliability (between 3 raters) was assessed. SETTING: Inpatient rehabilitation. PARTICIPANTS: 30 patients, 1-19 months after stroke (age 55.1±13.5 years; N=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Intra- and interrater reliability of the muscle tone assessment protocol with MAS for 7 upper and 6 lower limb muscle groups compiled from previous studies; 1 modified and 4 originally described. The weighted kappa was calculated. RESULTS: The most and the least frequently assigned MAS grades were 0 and 4, respectively. Agreement was the highest for grade 0 (49% within raters, 32% between raters). Intrarater reliability was good to excellent for upper limb (κ=0.71-0.94) and moderate to excellent for lower limb (κ=0.55-0.97) muscles. Interrater reliability was poor to good for upper limb (κ=0.25-0.66) and moderate for lower limb (κ=0.41-0.54) muscles. CONCLUSIONS: The intrarater reliability of MAS was moderate for the hip flexors. The reliability results for the other 4 muscles studied anew after stroke were similar to the predetermined ones. The better intrarater reliability results confirmed previous findings. Because of the low interrater reliability, caution is needed in interpreting the results when reassessment is not possible by the same examiner. A well-described protocol for administering the MAS may lead to its standardization.

Impact of Outpatient Neuraminidase Inhibitor Treatment in Patients Infected With Influenza A(H1N1)pdm09 at High Risk of Hospitalization: An Individual Participant Data Metaanalysis.

BACKGROUND: While evidence exists to support the effectiveness of neuraminidase inhibitors (NAIs) in reducing mortality when given to hospitalized patients with A(H1N1)pdm09 virus infection, the impact of outpatient treatment on hospitalization has not been clearly established. We investigated the impact of outpatient NAI treatment on subsequent hospitalization in patients with A(H1N1)pdm09 virus infection. METHODS: We assembled general community and outpatient data from 9 clinical centers in different countries collected between January 2009 and December 2010. We standardized data from each study center to create a pooled dataset and then used mixed-effects logistic regression modeling to determine the effect of NAI treatment on hospitalization. We adjusted for NAI treatment propensity and preadmission antibiotic use, including "study center" as a random intercept to account for differences in baseline hospitalization rate between centers. RESULTS: We included 3376 patients with influenza A(H1N1)pdm09, of whom 3085 (91.4%) had laboratory-confirmed infection. Eight hundred seventy-three patients (25.8%) received outpatient or community-based NAI treatment, 928 of 2395 (38.8%) with available data had dyspnea or respiratory distress, and hospitalizations occurred in 1705 (50.5%). After adjustment for preadmission antibiotics and NAI treatment propensity, preadmission NAI treatment was associated with decreased odds of hospital admission compared to no NAI treatment (adjusted odds ratio, 0.24; 95% confidence interval, 0.20-0.30). CONCLUSIONS: In a population with confirmed or suspected A(H1N1)pdm09 and at high risk of hospitalization, outpatient or community-based NAI treatment significantly reduced the likelihood of requiring hospital admission. These data suggest that community patients with severe influenza should receive NAI treatment.

Pancreatic exocrine insufficiency, diabetes mellitus and serum nutritional markers after acute pancreatitis.

AIM: To investigate impairment and clinical significance of exocrine and endocrine pancreatic function in patients after acute pancreatitis (AP). METHODS: Patients with AP were invited to participate in the study. Severity of AP was determined by the Atlanta classification and definitions revised in 2012. Pancreatic exocrine insufficiency (PEI) was diagnosed by the concentration of fecal elastase-1. An additional work-up, including laboratory testing of serum nutritional markers for determination of malnutrition, was offered to all patients with low levels of fecal elastase-1 FE. Hemoglobin A1c or oral glucose tolerance tests were also performed in patients without prior diabetes mellitus, and type 3c diabetes mellitus (T3cDM) was diagnosed according to American Diabetes Association criteria. RESULTS: One hundred patients were included in the study: 75% (75/100) of patients had one attack of AP and 25% (25/100) had two or more attacks. The most common etiology was alcohol. Mild, moderately severe and severe AP were present in 67, 15 and 18% of patients, respectively. The mean time from attack of AP to inclusion in the study was 2.7 years. PEI was diagnosed in 21% (21/100) of patients and T3cDM in 14% (14/100) of patients. In all patients with PEI, at least one serologic nutritional marker was below the lower limit of normal. T3cDM was more frequently present in patients with severe AP (P = 0.031), but was also present in some patients with mild and moderately severe AP. PEI was present in all degrees of severity of AP. There were no statistically significantly differences according to gender, etiology and number of AP attacks. CONCLUSION: As exocrine and endocrine pancreatic insufficiency can develop after AP, routine follow-up of patients is necessary, for which serum nutritional panel measurements can be useful.