Preoperative Factors Associated with Press Ganey Patient Satisfaction Scores after Anterior Cruciate Ligament Reconstruction

Patient satisfaction is increasingly used as a metric to evaluate the quality of healthcare services and to determine hospital and physician compensation. The aim of this study was to identify preoperative factors associated with Press Ganey Ambulatory Surgery (PGAS) satisfaction scores, and to evaluate the effect of each PGAS domain score on the total PGAS score variability in patients undergoing anterior cruciate ligament reconstruction (ACLR). A review of a Press Ganey (PG) database at a single center was performed for patients undergoing ACLR between 2015 and 2019. Ninety-nine patients completed the PGAS survey and 54 also completed preoperative demographic and patient-reported outcome measures (PROMs) for an orthopaedic registry. PGAS scores were calculated and bivariate analysis was performed. Multivariable linear regression determined the effect of each of the six PGAS domains on the total PGAS score variability. In the total cohort of 99 patients, no factors were significantly associated with the total PGAS score or any domain scores. For the 54 patients who also participated in the orthopaedic registry, none of the preoperative PROMs were significantly correlated with total PGAS score. However, having a college degree (89 vs. 95 or 97 points; p = 0.02) and continuous femoral nerve catheter (92 vs. 100 points; p = 0.04) was associated with lower personal issue domain scores, while patients with a greater number of prior surgeries had worse registration domain scores (ρ = -0.27; p = 0.049). For the entire cohort, the registration and facility domains contributed the most variability to the total PGAS score, while the physician domain contributed the least. Few preoperative factors are associated with PGAS scores, and total PGAS scores do not significantly correlate with baseline PROMs. Surgeons may have limited ability to improve their PGAS scores given most of the variability in total scores stems from systemic aspects of the patient experience.

Examining the validity of chiropractic grade point averages for predicting National Board of Chiropractic Examiners Part I exam scores

ABSTRACT Objective The main objective of this study was to evaluate the validity of grade point average (GPA) for predicting the National Board of Chiropractic Examiners (NBCE) Part I exam scores using chiropractic GPA. Methods Data were collected during the January 2019 computer-based testing administration of the NBCE's Part I exam. The sample size was n = 2278 of test takers from 18 domestic and 4 international chiropractic educational institutions. Six regression models were developed and tested to predict the Part I domain scores from chiropractic GPA while controlling for self-reported demographic variables. Residuals from the models were disaggregated by pre–chiropractic GPA. Results Chiropractic GPA revealed a positive, statistically significant correlation with sex. The chiropractic GPA was found to be a significant predictor of the Part I domain scores. A different perspective was obtained when residuals (observed minus predicted) were collected and split by the pre–chiropractic GPA. Very good students tended to be underpredicted, while other students were overpredicted. Conclusion This study builds on the cascading evidence from educational literature by providing additional results suggesting that undergraduate (prechiropractic) GPA as well as the GPA obtained in doctor of chiropractic programs are related to the future performance on the NBCE Part I exam. The results provide a first glance at the connection between the standardized test scores, which are often used for instructors' and institutional evaluation and the GPA obtained in a doctor of chiropractic program.

Female Sexual Dysfunction before and after Diagnosis of Infertility

This study determined the prevalence, domain, and predictors of sexual dysfunction among 222 infertile women before and after Diagnosis of infertility in Ife East Senatorial district, Nigeria. They were interviewed using interviewer-administered questionnaire and Female Sexual Function Index assessment tool. Information about their sexual functions after marriage and before the couple started having difficulty in getting pregnant were obtained and compared with sexual functions after Diagnosis of infertility. Data management was done using SPSS Version22 and STATA 12. The Chi-square test was used to test associations. P-value of was set <0.05. Before infertility diagnosis, the prevalence of sexual dysfunction was 23.9%. After infertility diagnosis, this increased to 57.2%, P<0.001. The mean scores of female sexual function index for infertile patients were 29.57 ±5.10 before the infertility diagnosis but reduced to 24.42 ± 5.86 after infertility diagnosis P <0.001. The domain scores reduced after Diagnosis of infertility, and it shows statistical significance at P<0.001. Significant predictors at multivariate analysis include increasing maternal age, increasing duration of infertility, Hausa /Fulani tribe, and female genital mutilation. Infertility increases the prevalence of female sexual dysfunction and reduces the domain scores of sexual functions.

Social and Nonsocial Autism Symptom Domains in Children and Adolescents with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder: Insights into Their Symptomatological Interplay

<b><i>Introduction:</i></b> Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) share overlapping symptomatology, particularly with regard to social impairments (including peer relationship difficulties), and they frequently co-occur. However, the nature of their co-occurrence remains unclear. Therefore, the current study aimed to examine the nature of the transdiagnostic link between ASD and ADHD from a symptomatological point of view measured with the Autism Diagnostic Observation Schedule (ADOS Module 3) and the Autism Diagnostic Interview-Revised (ADI-R). <b><i>Methods:</i></b> We analyzed the social and nonsocial ASD symptom domain scores from both diagnostic instruments in 4 clinically referred groups (i.e., ASD, ADHD, ASD + ADHD, and no psychiatric diagnosis) without other co-occurring mental disorders using a two-by-two full-factorial MANOVA design with the factors ASD (yes/no) and ADHD (yes/no). <b><i>Results:</i></b> We found no ASD by ADHD interaction effects across all symptom domain scores of ADOS and ADI-R, except for ADOS <i>imagination/creativity</i>. There were only main effects of the factor ASD but no main effects of ADHD. Follow-up contrasts showed that exclusively, ASD had an impact on the measured symptomatology in case of co-occurring ASD + ADHD. <b><i>Conclusion:</i></b> Overall, the results support an additive model of the symptomatology across areas of communication, social interaction, and stereotyped behaviors and restricted interests in case of the co-occurrence of ASD and ADHD when assessed with ADOS/ADI-R. Thus, one can assume that the phenotypic overlap of ASD + ADHD may be less complicated than suspected – at least with regard to ASD symptomatology – and that in the presence of ADHD, ASD symptomatology is generally well measurable with best-practice diagnostic instruments.

Development of the Near Vision Presbyopia Task-based Questionnaire for use in evaluating the impact of presbyopia

Background Presbyopia is a progressive condition that reduces the eye’s ability to focus on near objects with increasing age. After a systematic literature review identified no existing presbyopia-specific patient-reported outcome (PRO) instruments meeting regulatory guidance, a new PRO instrument, the Near Vision Presbyopia Task-based Questionnaire (NVPTQ), was developed. Results To explore the patient experience with presbyopia, concept elicitation interviews were conducted with 20 presbyopic participants. The most frequently reported impacts were difficulty with reading menus/books/newspapers/magazines, reading on a cell phone/caller ID, and reading small print. Based on these results, a task-based PRO instrument (the NVPTQ) was developed instructing participants to complete four near-vision, paper-based reading tasks (book, newspaper, nutrition label, menu) under standardized settings, and subsequently assess their vision-related reading ability and associated satisfaction. The draft NVPTQ was cognitively debriefed with a sample of 20 presbyopes, which demonstrated that most participants interpreted the items as intended and endorsed the relevance of the concepts being assessed. After the qualitative research, the draft instrument was psychometrically tested using data from a Phase 2 study. Based on item-level analyses, all items in the NVPTQ demonstrated expected response option patterns and lacked substantial floor or ceiling effects. The reliability, validity, and responsiveness of the NVPTQ Performance and Satisfaction domain scores were assessed. All domains scores had large Cronbach’s coefficient α values and good test–retest statistics, indicating that the scores are internally consistent and produce stable values over time. The pattern of correlations with a concurrent measure of visual functioning (National Eye Institute Visual Function Questionnaire 25) demonstrated that the NVPTQ domain scores were related to an alternative assessment of near-vision activities. The NVPTQ domain scores were able to distinguish between groups that were known to differ on the clinical outcome of uncorrected near visual acuity, supporting the construct validity of these scores. The NVPTQ domain scores showed evidence of responsiveness to change by being able to distinguish between groups defined as improved and not improved based on patient-reported and clinical outcomes. Conclusions This research has resulted in a content-valid and psychometrically sound instrument designed to evaluate vision-related reading ability and satisfaction with vision-related reading ability. Trial registration: ClinicalTrials.gov NCT02780115. Registered 23 May 2016, https://www.clinicaltrials.gov/ct2/show/NCT02780115?term=NCT02780115&draw=2&rank=1.

Moderators of Dual Task Gait Effects in Mild Cognitive Impairment and Dementia

Spatiotemporal gait parameters may provide indication about the cognitive status of individuals. Dysfunction in specific gait features has been associated with increased risk of cognitive decline. Here we use spatiotemporal gait patterns to determine whether specific cognitive domain scores moderate the effects during dual-tasking on individuals with mild cognitive impairment (MCI) and dementia. Participants (n=46; mean age: 77.0±8.9 years) with a diagnosis of cognitive impairment (n=16), or dementia (n=30) were included. They performed validated computerized cognitive assessment battery (CAB, NeuroTrax BrainCare) to obtain cognitive domain measures of executive function (EF), attention, memory, visual-spatial processing (VSP), information processing speed (IPS), and a global cognitive score (GCS) measure. Using the Zeno Walkway Gait Analysis System (Protokinetics), measures of velocity, stride width (SW), stride time (ST), stride length, cadence, double support (DS), and gait variability were obtained for both single-task and DT gait. Data analysis was conducted using SPSS 26 and PROCESS 3.5. As expected, the dementia group had lower cognitive domain scores and slower walking speed than MCI group. Results also indicated that visual-spatial processing skills was the only cognitive domain that did have a moderation effect on gait velocity (F=4.2, p&lt;0.05, R-square change 10%). Our results indicate that differences between walking speed in MCI and dementia groups are moderated by visual spatial skills. Improvement in visual spatial skills could improve the dual task effects of individual gait measures.

Comparing the Emotion Status of Individuals With MCI to Their Cognitively Normal Counterparts: I-CONECT Project

Socially isolated older adults with MCI are at greater risk of developing ADRD. This study compares the emotional status of older adults with MCI to their cognitively normal counterparts within a socially isolated sample. We used baseline data from the Internet-based Conversational Engagement Clinical Trial (NCT02871921). MCI status was determined according to clinical diagnosis. Three emotion domain scores were calculated: negative affect, social satisfaction, and psychological wellbeing. Linear regressions were conducted for all 17 Emotion Battery measures and 3 domain scores. The 127 participants' mean age was 81.1 (SD=4.6). About 54% were diagnosed with MCI. Older adults with MCI had more negative affect, yet no difference was observed in social satisfaction and psychological wellbeing. Individuals with MCI had higher levels of fear, perceived hostility, perceived stress, sadness, and lower self-efficacy. Better understanding the emotional status could inform the development of behavioral health interventions and early detection of MCI.

Knowledge, attitude, and practice toward COVID-19 in Trinidad and Tobago

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) has affected over 250 million people globally and resulted in over 5 million deaths since it was first reported in November 2019. Methods: A cross-sectional study was conducted online from July to September 2020 among nationals and permanent residents of Trinidad and Tobago (N = 812). The related questionnaire consisted of demographic characteristics, 11 items on knowledge, 11 items on attitude and 7 items on practice and experience. Domain scores were derived for each component (K, A and P) and independent t-tests and one-way ANOVA were used to compare differences in scores within demographic categories. Results: The population possessed a high level of knowledge about COVID-19(0.85 ± 0.09). Attitude scores (0.54 ± 0.07) were influenced by factors such as sex, age, occupation, level of education and area of residence. Significant relationships (P<0.05) were found between demographic categories of sex, age, profession, education, geographical region and the mean domain scores. Conclusion: There was overall high level of knowledge and good practices in response to COVID-19 which suggests that the government's management approach was effective in providing information about COVID-19 and the safe practice needed to reduce spread of the virus.

Comprehensive Assessment of Cognitive Function in Patients with Sickle Cell Disease Reveals Deficits in Memory and Processing Speed

Cognitive impairment (CI) is a serious complication of sickle cell disease (SCD) and can cause significant functional and social limitations. To date, there are only a few studies characterizing CI in adults with SCD. In this study, we comprehensively assessed cognitive function in a cross-sectional sample of patients with SCD compared to healthy controls across ten memory and processing speed domains. Patients with SCD (HbSS, HbSC and HbS/beta thalassemia) ages 18 years and older were recruited from the University of Pittsburgh Medical Center Adult Sickle Cell Program, and sex- and age-matched controls were recruited from the community and by SCD patient referral. Unlike previous studies, we did not restrict participation to patients with HbSS only and we included all SCD comorbidities. All participants underwent neurocognitive assessments using measures that are validated and accurate in discriminating CI from dementia and normal cognition. We conducted linear regression analyses to estimate the difference in each cognitive domain score between patients and controls. We also contrasted pairwise comparisons between controls and patients with and without stroke, with and without chronic blood transfusions, and classified by disease severity based on genotype. Among 86 SCD patients and 66 controls, 43% were male and the average age was 36.2 years. SCD patients had fewer years of education on average (13.3 vs. 14.2) and a higher percent had a history of smoking (46% vs. 29%). Additionally, 45% of patients had milder disease (HbSC or HbSb +-thalassemia) with the rest having severe disease (HbSS or HbSb 0-thalassemia)), 14% had a history of stroke, and 20% were receiving chronic exchange transfusions. Patients with SCD had significantly lower scores on five out of ten cognitive domains: language (b=-5.88, P=0.014), attention/processing (b=-14.47, P&lt;0.001), RBANS total score (b=-7.55, P&lt;0.001), executive function (b=-1.60, P&lt;0.001), and DSST scaled score (b=-2.08, P&lt;0.001). Adjusting for pre-morbid verbal IQ (VIQ), hemoglobin level, and smoking history, attention/processing (b=-10.70, P=0.001), RBANS total (b=-7.27, P=0.003), and DSST scaled scores (b=-1.54, P=0.019) were significantly lower among patients compared to controls. In adjusted models, there were no significant differences in cognitive domain scores between patients with mild disease compared to patients with severe disease; both mild and severe disease subgroups had lower attention/processing scores compared to controls (both P&lt;0.05). Patients with SCD and a history of stroke had significantly lower attention/processing, executive function, RBANS total, and DSST scaled scores (all P&lt;0.01) compared to controls, and SCD patients who did not have a history of stroke had lower attention/processing and RBANS total scores than controls (both P&lt;0.05). Patients with a history of stroke had significantly lower executive function (b=-1.65, P=0.012), RBANS total (b=-8.64, P=0.020), and DSST scaled scores (b=-2.43, P=0.015) than patients without a history of stroke. There were no significant differences in cognitive domain scores between patients receiving chronic transfusions and those not receiving transfusions. To our knowledge, this is the most inclusive real-life study of adult patients with SCD to investigate cognition to date, further characterizing CI among this patient population. Many of the disparities in cognitive function between patients and controls are not explained by pre-morbid VIQ, hemoglobin levels or smoking, indicating further research is needed to understand the pathogenesis of CI in SCD. Figure 1 Figure 1. Disclosures Novelli: Novartis Pharmaceuticals: Consultancy.