Forty-two women with thumb base osteoarthritis referred to a joint protection programme (JP) were distributed into groups: one with only JP (Control group) and one with addition of splints day/night, hot pack/home exercise (SE group). Assessments of pain, stiffness, grip force, disabilities of daily activities were performed before treatment, 1 week and 1 year after treatment. The SE group had a significant decrease in pain, stiffness and an improvement in daily activities directly after the intervention and at 1-year follow-up compared to the Control group. In the SE group pain at night, pain on motion, and stiffness decreased. Grip force increased and daily activities improved. The Control group decreased in pain on motion and showed improvement in daily activities just after the intervention but not at 1-year follow up. This comparative study shows that when splinting and exercise regimen are added to a JP programme it gives a greater improvement of pain, stiffness, grip force and daily activities than the JP programme alone.
The current study has shown that the FIMTM Motor Scale, as applied to a stroke rehabilitation sample, satisfies Rasch model expectations and the unidimensionality assumptions, having accommodated local dependency issues, and by using the partial credit parameterization with re-scored categories. Other analytical pathways gave less ideal solutions, and are consistent with the wide range of solutions found for the scale over the years. Consequently, the development of the Rasch approach in health outcomes can be traced in the history of analysis of the FIMTM, and that development continues to this day.
Background
COVID-19 prediction models based on clinical characteristics, routine biochemistry and imaging, have been developed, but little is known on proteomic markers reflecting the molecular pathophysiology of disease progression.
Methods
he multicentre (six European study sites) Prospective Validation of a Proteomic Urine Test for Early and Accurate Prognosis of Critical Course Complications in Patients with SARS-CoV-2 Infection Study (Crit-COV-U) is recruiting consecutive patients (≥ 18 years) with PCR-confirmed SARS-CoV-2 infection. A urinary proteomic biomarker (COV50) developed by capillary-electrophoresis-mass spectrometry (CE-MS) technology, comprising 50 sequenced peptides and identifying the parental proteins, was evaluated in 228 patients (derivation cohort) with replication in 99 patients (validation cohort). Death and progression along the World Health Organization (WHO) Clinical Progression Scale were assessed up to 21 days after the initial PCR test. Statistical methods included logistic regression, receiver operating curve (ROC) analysis and comparison of the area under the curve (AUC).
Findings
in the derivation cohort, 23 patients died, and 48 developed worse WHO scores. The odds ratios (OR) for death per 1 standard deviation (SD) increment in COV50 were 3·52 (95% CI, 2·02–6·13,
p
<0·0001) unadjusted and 2·73 (1·25–5·95,
p =
0·012) adjusted for sex, age, baseline WHO score, body mass index (BMI) and comorbidities. For WHO scale progression, the corresponding OR were 2·63 (1·80–3·85,
p<
0·0001) and 3·38 (1·85–6·17,
p<
0·0001), respectively. The area under the curve (AUC) for COV50 as a continuously distributed variable was 0·80 (0·72–0·88) for mortality and 0·74 (0·66–0·81) for worsening WHO score. The optimised COV50 thresholds for mortality and worsening WHO score were 0·47 and 0·04 with sensitivity/specificity of 87·0 (74·6%) and 77·1 (63·9%), respectively. On top of covariates, COV50 improved the AUC, albeit borderline for death, from 0·78 to 0·82 (
p =
0·11) and 0·84 (
p =
0·052) for mortality and from 0·68 to 0·78 (
p =
0·0097) and 0·75 (
p =
0·021) for worsening WHO score. The validation cohort findings were confirmatory.
Interpretation
this first CRIT-COV-U report proves the concept that urinary proteomic profiling generates biomarkers indicating adverse COVID-19 outcomes, even at an early disease stage, including WHO stages 1–3. These findings need to be consolidated in an upcoming final dataset.
Aim: The purpose of the thesis was to describe and evaluate different aspects of rehabilitation after discharge for persons of working age after stroke. Aims were to compare an approach of support, information and training in the home setting with ordinary outpatient rehabilitation at the clinic and to describe the costs and factors influencing the costs.
There is no clinical difference between covered and uncovered biliary Hanaro SEMS. Both types are easily inserted with low complication rate and have long-term patency.
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