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The assessment of somatosensory function is a cornerstone of research and clinical practice in neurology. Recent initiatives have developed novel protocols for quantitative sensory testing (QST). Application of these methods led to intriguing findings, such as the presence lower pain-thresholds in healthy children compared to healthy adolescents. In this article, we (re-) introduce the basic concepts of signal detection theory (SDT) as a method to investigate such differences in somatosensory function in detail. SDT describes participants’ responses according to two parameters, sensitivity and response-bias. Sensitivity refers to individuals’ ability to discriminate between painful and non-painful stimulations. Response-bias refers to individuals’ criterion for giving a “painful” response. We describe how multilevel models can be used to estimate these parameters and to overcome central critiques of these methods. To provide an example we apply these methods to data from the mechanical pain sensitivity test of the QST protocol. The results show that adolescents are more sensitive to mechanical pain and contradict the idea that younger children simply use more lenient criteria to report pain. Overall, we hope that the wider use of multilevel modeling to describe somatosensory functioning may advance neurology research and practice.
Mind the gap
(2015)
The following article deals with equivalence as a specific quality criterion concerning cross cultural research in psychology and provides an overview for this topic. The comparability of constructs as well as of data is analyzed. For this, the different levels of equivalence are regarded, e.g., translation equivalence and others. Classical as well as modern methods for the testing and guarantee of equivalence are analyzed. Critical approaches and methodical problems of cross cultural research are described.
This review aimed to synthesize the current evidence on the effectiveness of invasive treatments for complex regional pain syndrome in children and adolescents. Studies on children and adolescents with complex regional pain syndrome that evaluated the effects of invasive treatment were identified in PubMed (search March 2013). Thirty-six studies met the inclusion criteria. Articles reported on a total of 173 children and adolescents with complex regional pain syndrome. Generally, many studies lack methodological quality. The invasive treatments applied most often were singular sympathetic blocks, followed by epidural catheters and continuous sympathetic blocks. Rarely, spinal cord stimulation and pain-directed surgeries were reported. An individual patient frequently received more than one invasive procedure. Concerning outcome, for approximately all patients, an improvement in pain and functional disability was reported. However, these outcomes were seldom assessed with validated tools. In conclusion, the evidence level for invasive therapies in the treatment of complex regional pain syndrome in children and adolescents is weak.
Incidence of Tube Feeding in 7174 Newly Admitted Nursing Home Residents With and Without Dementias
(2015)
Background:
Tube feeding is a common form of long-term nutritional support, especially for nursing home residents, of whom many have dementia.
Objective:
Estimating the incidence of feeding tube placement in nursing home residents with and without dementia.
Methods:
Using claims data, we studied a cohort of newly admitted nursing home residents aged 65 years and older between 2004 and 2009. Analyses were stratified by dementia. We estimated incidence rates and performed multivariate Cox regression analyses.
Results:
The study cohort included 7174 nursing home residents. Over a mean follow-up of 1.3 years, 273 people received a feeding tube. The incidence per 1000 person-years was 28.4, with higher estimates for patients with dementia. When adjusting for age, sex, and level of care as a time-dependent covariate, influence of dementia decreased to a nonsignificant hazard ratio.
Conclusion:
It seems that not dementia itself but the overall clinical condition might be a predictor of tube feeding placement.
Objectives: to identify the errors in daily intensive nursing care and analyze them according to the theory of human error. Method: quantitative, descriptive and exploratory study, undertaken at the Intensive Care Center of a hospital in the Brazilian Sentinel Hospital Network. The participants were 36 professionals from the nursing team. The data were collected through semistructured interviews, observation and lexical analysis in the software ALCESTE®. Results: human error in nursing care can be related to the approach of the system, through active faults and latent conditions. The active faults are represented by the errors in medication administration and not raising the bedside rails. The latent conditions can be related to the communication difficulties in the multiprofessional team, lack of standards and institutional routines and absence of material resources. Conclusion: the errors identified interfere in nursing care and the clients’ recovery and can cause damage. Nevertheless, they are treated as common events inherent in daily practice. The need to acknowledge these events is emphasized, stimulating the safety culture at the institution.
The demand for evidence-based health informatics and benchmarking of 'good' information systems in health care gives an opportunity to continue reporting on recent papers in the German journal GMS Medical Informatics, Biometry and Epidemiology (MIBE) here. The publications in focus deal with a comparison of benchmarking initiatives in German-speaking countries, use of communication standards in telemonitoring scenarios, the estimation of national cancer incidence rates and modifications of parametric tests. Furthermore papers in this issue of MIM are introduced which originally have been presented at the Annual Conference of the German Society of Medical Informatics, Biometry and Epidemiology. They deal as well with evidence and evaluation of 'good' information systems but also with data harmonization, surveillance in obstetrics, adaptive designs and parametrical testing in statistical analysis, patient registries and signal processing.
Gender disparities in German home-care arrangements
An ageing population correlates with rising needs for
long-term care (LTC). Support programmes should con-
sider the specific needs of the various subgroups of care
dependents and family caregivers. The objective of this
study was to analyse the gender-specific disparities in
home-care arrangements in Germany, and for this pur-
pose, survey and insurance claims data were used. A sur-
vey of 2545 insured care recipients with high-level care
needs was conducted in 2012 with the Barmer GEK, a
major German statutory healthcare insurance. Insurance
claims data were provided for a follow-up, focussing on
the group aged 60 years and older. For statistical compar-
ison, chi-squared test and t-tests were used, and a p-
value < 0.05 was considered statistically significant. Most
care recipients are female, and they are on average
2 years older than males. Men receive family care mostly
from their wives, whereas widows frequently live alone
and receive care from daughters, sons, other relatives,
neighbours and friends, as well as from professional
nursing services. Furthermore, women more often antici-
pate the need for (further) professional assistance and
move in with a relative or to an assisted living facility or
a nursing home in good time. The desired rate for reloca-
tion to a nursing home was higher than the anticipated,
and during the 6-month follow-up, the actual rate of
relocations was in between both. In summary, the caring
situation of men and women is different. Care-receiving
men are most often cared for by their wives. Widowed
women need a social network and their children in order
to remain in their own home. To provide better home-
care arrangements for women in this situation, the fam-
ily and social networks need a stronger focus in politics
and research. To stabilise the home-care situation of men
with high-level care needs, their wives need more
support.
Usability is a core construct of website evaluation and inherently defined as interactive. Yet, when analysing first impressions of websites, expected usability, i.e., before use, is of interest. Here we investigate to what extend ratings of expected usability are related to (a) experienced usability, i.e., ratings after use, and (b) objective usability measures, i.e., task performance. Furthermore, we try to elucidate how ratings of expected usability are correlated to aesthetic judgments. In an experiment, 57 participants submitted expected usability ratings after the presentation of website screenshots in three viewing-time conditions (50, 500, and 10,000 ms) and after an interactive task (experienced usability). Additionally, objective usability measures (task completion and duration) and subjective aesthetics evaluations were recorded for each website. The results at both the group and individual level show that expected usability ratings are not significantly related either to experienced usability or objective usability measures. Instead, they are highly correlated with aesthetics ratings. Taken together, our results highlight the need for interaction in empirical website usability testing, even when exploring very early usability impressions. In our study, user ratings of expected usability were no valid proxy neither for objective usability nor for experienced website usability.