scholarly journals Value of Patient Self-Assessment in the Diagnosis and Monitoring of Post-Thrombotic Syndrome

2012 ◽  
Vol 18 (4) ◽  
pp. 345-350 ◽  
Author(s):  
Russell Hull ◽  
Penny Butcher
Keyword(s):  
Self Assessment ◽  
Post Thrombotic Syndrome ◽  
Patient Self Assessment

Development and validation of a tool for patient reporting of symptoms and signs of the post-thrombotic syndrome

2016 ◽  
Vol 115 (02) ◽  
pp. 361-367 ◽  
Author(s):  
Kristin Kornelia Utne ◽  
Waleed Ghanima ◽  
Siv Foyn ◽  
Susan Kahn ◽  
Per Morten Sandset ◽  
...  
Keyword(s):  
Reference Method ◽  
Patient Reporting ◽  
Self Assessment ◽  
Post Thrombotic Syndrome ◽  
Supplementary Material ◽  
Development And Validation ◽  
Kappa Agreement ◽  
Symptoms And Signs ◽  
Patient Self Assessment

SummaryPost-thrombotic syndrome (PTS) is a long-term complication of deepvein thrombosis (DVT). The Villalta scale is the recommended tool for diagnosing PTS, but requires a clinician’s assessment in addition to patient self-assessment. In the present study, we validated a self-administered tool for patient reporting of leg symptoms and signs as a mean to assess PTS. We first validated a form for patient self-reported Villalta (PRV1), then developed and validated a visually assisted form (PRV2). The validity of PRV1 and PRV2 was assessed in patients diagnosed with DVT between 2004 and 2012. Median time from DVT to inclusion was 5.1 and 3.5 years for PRV1 (n=162) and PRV2 (n=94), respectively. Patients were requested to complete the PRV form before a scheduled visit. PTS diagnosed by the original Villalta scale during the visit served as the reference method. PRV1 showed only moderate agreement for diagnosing PTS compared with the original Villalta scale (kappa agreement 0.60, 95 % CI 0.48–0.72), whereas PRV2 showed very good agreement (0.82, 95 % CI 0.71–0.94). In the validation of PRV2, PTS was diagnosed in 54 (57 %) patients according to the original Villalta scale and in 60 (64 %) by PRV2. The sensitivity of PRV2 to detect PTS was 98 % and the specificity was 83 %. We conclude that the visually assisted form for PRV is a valid and sensitive tool for diagnosing PTS. Such a tool could be applied in further clinical studies of PTS, making studies less resource demanding by reducing the need for in-person clinic visits.Supplementary Material to this article is available online at www.thrombosis-online.com.

Patient Self-Assessed Passive Range of Motion of the Knee Cannot Replace Health Professional Measurements

2017 ◽  
Vol 30 (08) ◽  
pp. 829-834
Author(s):  
Frank Madsen ◽  
Anders Odgaard ◽  
Jens Borgbjerg
Keyword(s):  
Range Of Motion ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Patient Assessment ◽  
Limits Of Agreement ◽  
Self Assessment ◽  
Knee Motion ◽  
Bland Altman Method ◽  
Flexion And Extension ◽  
Patient Self Assessment

AbstractThe purpose of this study was to investigate whether patients can accurately self-assess their knee passive range of motion (PROM). A picture-based questionnaire for patient self-assessment of knee PROM was developed and posted to patients. The self-assessed PROM from 58 patients was compared with surgeon-assessed PROM using a short-arm goniometer. Agreement between the measurement methods was calculated with the Bland-Altman method. We calculated the sensitivity and specificity of patient-assessed PROM in dichotomously detecting knee motion impairment in both flexion (≤ 100 degrees) and extension (≥ 10-degree flexion contracture). Surgeon- and patient-assessed knee PROM showed a mean difference (95% limits of agreement) of −2.1 degrees (−42.5 to 38.3 degrees) for flexion and −8.1 degrees (−28.8 to 12.7 degrees) for extension. The sensitivity of patient self-assessed PROM in identifying knee flexion and extension impairments was 86 and 100%, respectively, whereas its specificity was 84 and 43%, respectively. Although wide limits of agreement were observed between surgeon- and patient-assessed knee PROM, the picture-based questionnaire for patient assessment of knee ROM was found to be a valid tool for dichotomously detecting knee motion impairment in flexion (≤ 100 degrees). However, the specificity of the questionnaire for detection of knee extension impairments (≥ 10-degree flexion contracture) was low, which limits is practical utility for this purpose.

Voice disorders after total thyroidectomy: Prospective patient self-assessment in comparison with traditional and alternative methods of examining the vocal folds

2020 ◽  
Author(s):  
Alexander Shulutko ◽  
Vasiliy Semikov ◽  
Andrey Moiseev ◽  
Elkhan Osmanov ◽  
Yulia Boblak ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Vocal Folds ◽  
Indirect Laryngoscopy ◽  
Alternative Methods ◽  
Original Form ◽  
Self Assessment ◽  
The Third ◽  
The Mean ◽  
The Voice ◽  
Patient Self Assessment

Abstract Background Voice alterations after thyroidectomy with mobile vocal folds are common. Ultrasonography has been used to assess the mobility of the vocal folds after thyroidectomy. Methods 54 patients underwent thyroidectomy. Indirect laryngoscopy, ultrasonography and GRBAS scoring were performed preoperatively,3 days, 2 and 6 months postoperatively. Results On the third postoperative day, the mobility of the vocal folds was preserved in 52 patients and paresis were recorded in 2 patients. All patients after total thyroidectomy noted the presence of voice alteration in the absence of the postoperative paresis of the vocal folds. On the third postoperative day, the voice was impaired by all criteria of the GRBAS scale, but mainly due to roughness (85%). Sixth month postoperatively 62% of the subjects considered the voice to be altered. Asthenia was observed in 39%. On the third postoperative day indirect laryngoscopy revealed the unchanged vocal folds, the symmetrical edema and the shortening of one of the vocal folds in 56%,42% and 1.9%. Six months postoperatively, the vocal folds returned to their original form. Ultrasonography was well correlated to the results of indirect laryngoscopy. Patients with edema of the vocal folds had a significantly higher mean GRBAS grade than patients without edema. The mean GRBAS score decreased from 3.36 to 0.90, 3 days and 6 months postoperatively. Conclusion Voice alteration after total thyroidectomy is always present. Postoperative edema represents a likely main cause of voice alteration and resolves within 6 months. Ultrasonography is recommended as alternative to indirect laryngoscopy in assessing of the vocal folds in thyroid surgery patients.

Treatment of Osteoarthrosis with Piroxicam in General Practice: Long-Term Follow-Up in a Multicentre Study

1980 ◽  
Vol 8 (6) ◽  
pp. 375-381 ◽  
Author(s):  
A J Gordon ◽  
T F Estabrooks ◽  
P Dessain
Keyword(s):  
Final Visit ◽  
Global Evaluation ◽  
Short Term ◽  
Self Assessment ◽  
Prior Therapy ◽  
Moderate Improvement ◽  
Long Term Follow Up ◽  
Patient Self Assessment

Thirty-eight investigators in Belgium, Finland, Germany, Italy and The Netherlands participated in a long-term follow-up of 154 patients who had shown adequate response without toleration problems in a short-term multicentre trial in osteoarthrosis. Patients were from 37 to 85 years of age (mean 63) and 68% were female. They received piroxicam from 92 to 344 days (mean 182). The starting dose of 20 mg once daily was maintained throughout for 69% of patients; for 12% the final dose was 30 mg, for 16% it was 10 mg, and for 3% it was 40 mg. Forty-seven per cent of patients reported they were taking concurrent anti-inflammatory/analgesic medication at baseline but by the end of therapy only 18% were. Most patients had moderate or severe involvement in one or more of the knee, hip, spine, shoulder, and finger joints. By the final visit, between 84% and 94% showed marked or moderate improvement in the physician's assessment of joint tenderness and limitation of motion. These results were in good agreement with patient self assessment: 83% to 90% reported marked or moderate improvement in ability to move and use joints and in their general overall feeling (‘quality of life’ measurement). Furthermore, steady improvement was observed throughout therapy in patient self-assessment of pain and stiffness relative to baseline. The 50% to 60% pain reduction recorded over the short-term (6 to 12 weeks) reached 70% at the end of therapy. The figures for stiffness were 50% to 55% short-term and 61% long-term. Onset of morning pain which occurred on the average within 1 hour of waking at baseline had risen to 8.4 hours (740% increase) by the end of therapy. The drug was well tolerated with sixteen patients (10%) reporting side-effects attributed to piroxicam. Nearly all were mild or moderate and occurred without disruption of therapy during the first 1 or 2 months of treatment. Most adverse reactions were upper gastro-intestinal but there were no reports of ulceration. One patient, with gastro-intestinal pain after 99 days on drug, was discontinued. In their global evaluation, physicians judged the efficacy of piroxicam as marked in 71%, moderate in 24%, slight in 4%, and not effective in 1% of patients. Toleration was considered excellent in 83%, good in 14 %, fair in 2%, and poor in only 1%. Compared to prior therapy, piroxicam was rated by the investigators as better in 90% of the 114 assessable cases. The results suggest that patients with osteoarthrosis who respond well to piroxicam during a short course of treatment are likely to continue their good response and possibly obtain increased relief of symptoms during longer treatment periods.

Validation of the LET classification

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 14-19 ◽  
Author(s):  
RHW Strijkers ◽  
CWKP Arnoldussen ◽  
CHA Wittens
Keyword(s):  
Quality Of Life ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Odds Ratio ◽  
Original Data ◽  
Self Assessment ◽  
Post Thrombotic Syndrome ◽  
Thrombus Removal ◽  
Disease Specific

Introduction Acute thrombus removal therapies may reduce post-thrombotic syndrome in certain deep venous thrombosis patients. The LET classification is designed to identify patients at high risk for developing post-thrombotic syndrome in the acute phase using thrombus location and extent. This study evaluates the use of the LET classification to predict post-thrombotic syndrome in a cohort of patients after deep venous thrombosis. Methods A cohort of 660 deep venous thrombosis patients was invited to participate and fill out a questionnaire with Quality of life questionnaires, basic information, a modified self-assessment version of the Villalta scale for post-thrombotic syndrome and potential confounders. Original data on thrombus extension was available, and the LET classes were determined. Obtained information was analysed using ANOVA and in a multiple logistic regression model to correct for confounders. All different LET classes were compared to post-thrombotic syndrome occurrence, post-thrombotic syndrome prediction and disease specific quality of life scores (VEINES-Sym/Qol). Results Three hundred and fifteen patients responded, and in 309 a post-thrombotic syndrome score was distilled. LET I,II,III ( n = 63) had an odds ratio of 3.4(1.2–9.2) for predicting severe post-thrombotic syndrome, and LET II ( n = 17) had an odds ratio of 5.1(1.3–20.8) compared to LET class I ( n = 97). Both the VEINES-Sym and VEINES-Qol score were significantly lower for LET I,II,III compared to LET I, and LET II compared to LET I. Conclusion The LET classification can be used to classify patients according to acute thrombus location and extent. Extensive and centrally located (LET I,II,III) deep venous thrombosis showed the highest probability in developing severe post-thrombotic syndrome and lower disease specific quality of life.

scholarly journals Acceptability of older patients’ self-assessment in the Emergency Department (ACCEPTED)—a randomised cross-over pilot trial

2019 ◽  
Vol 48 (6) ◽  
pp. 875-880
Author(s):  
Valérie Boucher ◽  
Marie-Eve Lamontagne ◽  
Jacques Lee ◽  
Pierre-Hugues Carmichael ◽  
Julien Déry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Qualitative Data ◽  
Pilot Trial ◽  
Research Assistant ◽  
Self Assessment ◽  
Clinical Frailty Scale ◽  
Use Of Technology ◽  
Standard Assessment ◽  
Patient Self Assessment

Abstract Background patient self-assessment using electronic tablet could improve the quality of assessment of older Emergency Department(ED) patients. However, the acceptability of this practice remains unknown. Objective to compare the acceptability of self-assessment using a tablet in the ED to a standard assessment by a research assistant (RA), according to seniors and their caregivers. Design randomised crossover pilot study. Setting The Hôpital de l’Enfant-Jésus (CHU de Québec–Université Laval) (2018/05–2018/07). Subjects (1) ED patients aged ≥65, (2) their caregiver, if present. Methods participants’ frailty, cognitive and functional status were assessed with the Clinical Frailty scale, Montreal Cognitive Assessment, and Older American Resources and Services scale and patients self-assessed using a tablet. Test administration order was randomised. The primary outcome, acceptability, was measured using the Treatment Acceptability and Preferences (TAP) scale. Descriptive analyses were performed for sociodemographic variables. TAP scores were adjusted using multivariate linear regression. Thematic content analysis was performed for qualitative data. Results sixty-seven patients were included. Mean age was 75.5 ± 8.0 and 55.2% were women. Adjusted TAP scores for RA evaluation and patient self-assessment were 2.36 and 2.20, respectively (P = 0.08). Patients aged ≥85 showed a difference between the TAP scores (P < 0.05). Qualitative data indicates that this might be attributed to the use of technology. Data from nine caregivers showed a 2.42 mean TAP score for RA evaluation and 2.44 for self-assessment. Conclusions our results show that older patients believe self-assessment in the ED using an electronic tablet as acceptable as a standard evaluation by a research assistant. Patients aged ≥85 find this practice less acceptable.

Initial Treatment Assignment as a Function of Patient Self-Assessment And/Or Family Assessment of Patient

1974 ◽  
Vol 35 (1) ◽  
pp. 495-498 ◽  
Author(s):  
Bernard Lubin ◽  
Robijn J. Hornstra ◽  
Allene Love
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Initial Treatment ◽  
Community Mental Health Center ◽  
Mental Health Center ◽  
Family Assessment ◽  
Self Assessment ◽  
Initial Assignment ◽  
Standardized Interview ◽  
Patient Self Assessment

A standardized interview administered at intake to a cohort of 611 applicants to a community mental health center and to 433 of their family members showed that patients who received hospitalization as their initial assignment were assessed as significantly more ill by their families than those who received other initial outpatient assignments. Patients who were hospitalized did not see themselves as being more ill, however. Patients assigned to Medicine Clinic saw themselves as significantly less psychologically ill.

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