Hyperbaric oxygen therapy in necrotising soft tissue infections: a study of patients in the United States Nationwide Inpatient Sample.

PURPOSE: Necrotising soft tissue infection (NSTI) is a deadly disease associated with a significant risk of mortality and long-term disability from limb and tissue loss. The aim of this study was to determine the effect of hyperbaric oxygen (HBO(2)) therapy on mortality, complication rate, discharge status/location, hospital length of stay and inflation-adjusted hospitalisation cost in patients with NSTI. METHODS: This was a retrospective study of 45,913 patients in the Nationwide Inpatient Sample (NIS) from 1988 to 2009. RESULTS: A total of 405 patients received HBO(2) therapy. The patients with NSTI who received HBO(2) therapy had a lower mortality (4.5 vs. 9.4 %, p = 0.001). After adjusting for predictors and confounders, patients who received HBO(2) therapy had a statistically significantly lower risk of dying (odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.29-0.83), higher hospitalisation cost (US$52,205 vs. US$45,464, p = 0.02) and longer length of stay (LOS) (14.3 days vs. 10.7 days, p < 0.001). CONCLUSIONS: This retrospective analysis of HBO(2) therapy in NSTI showed that despite the higher hospitalisation cost and longer length of stay, the statistically significant reduction in mortality supports the use of HBO(2) therapy in NSTI.

Patterns of herbal combination for the treatment of insomnia commonly employed by highly experienced Chinese medicine physicians.

OBJECTIVE: To explore the most effective herbal combinations commonly used by highly experienced Chinese medicine (CM) physicians for the treatment of insomnia. METHODS: We collected and analyzed data related to insomnia treatment from the clinics of 7 highly experienced CM physicians in Beijing. The sample included 162 patients and 460 consultations in total. Patient outcomes, such as sleep quality and sleep time per day, were manually collected from the medical records by trained CM clinicians. Three data mining methods, support vector machine (SVM), logistic regression and decision tree, and multifactor dimensionality reduction (MDR), were used to determine and confirm the herbal combinations that resulted in positive outcomes in patients suffering from insomnia. RESULTS: Results show that MDR is the most efficient method to predict the effective herbal combinations. Using the MDR model, we identified several combinations of herbs with 100% positive outcomes, such as stir-fried spine date seed, Szechwan lovage rhizome, and prepared thinleaf milkwort root; white peony root, golden thread, and stir-fried spine date seed; and Asiatic cornelian cherry fruit with fresh rehmannia. CONCLUSIONS: Results indicate that herbal combinations are effective treatments for patients with insomnia compared with individual herbs. It is also shown that MDR is a potent data mining method to identify the herbal combination with high rates of positive outcome.

Development of a Quality Checklist Using Delphi Methods for Prescriptive Clinical Prediction Rules: the QUADCPR.

OBJECTIVE: Clinical prediction rules (CPRs) are clinician decision-making aids designed to improve the accuracy of a variety of decisions made during patient care. To our knowledge, there are no formally developed consensus-based guidelines designed to provide standards for the creation of CPRs. METHODS: The study used a 3-round Delphi method for consensus of a quality checklist initially developed based on recommendations derived from the literature. The 9 Delphi participants were randomly selected from the authors of peer-reviewed publications of prescriptive CPRs. RESULTS: During the 3 rounds, the Delphi participants modified the originally derived checklist and, based on a consensus standard, agreed upon a final 23-item checklist, which involved 4 constructs: (1) sample and participants, (2) outcome measures, (3) quality of tests and measures, and (4) statistical assumptions. CONCLUSIONS: Use of the checklist has potential for improving the design and reporting of future prescriptive CPRs.

Observer agreement of spine stenosis on magnetic resonance imaging analysis of patients with cervical spine myelopathy.

OBJECTIVES: The purpose of this study was to measure the intraobserver and interobserver reliability of magnetic resonance detection of cervical spondylotic myelopathy with and without operational guidelines. METHODS: Seven radiologists examined images from 10 patients with cord signal abnormalities and clinical signs of myelopathy. Radiologist examined films twice, with and without operational guidelines designed to define stenotic changes, while blinded to the clinical findings of the patients. Analyses included a Fleiss kappa assessment of intraobserver and interobserver reliability. RESULTS: Results demonstrated high percentage of agreement and strong intraobserver reliability and variable Fleiss kappa values for interobserver assessment. Operational guidelines did not improve the intraobserver or interobserver agreement. CONCLUSION: Although the percentage of agreement was high in some cases, the kappa agreement was low-most likely a result of the base rate problem of a kappa analysis. Sample bias toward severe degenerative changes resulted in highly prevalent selections and kappa adjusted values. Nonetheless, the results do suggest that substantial intraobserver kappa agreement and a wide range of interobserver kappa agreement exists among trained radiologists during detection of stenotic changes associated with cervical spondylotic myelopathy.

A survey of orthopaedic traumatologists concerning the use of bone growth stimulators.

The purpose of the study was to determine the attitudes of members of the Orthopaedic Trauma Association (OTA) concerning the use and efficacy of bone growth stimulators. A questionnaire regarding bone growth stimulators was sent to the active members of the OTA. Descriptive statistics was performed using frequencies and percentages. All analyses were performed using Stata for Linux, version 8.0 (Intercooled Stata, Stata Corporation; College Station, TX). A response rate of 43% was obtained. Respondents indicated that they only occasionally used bone stimulators for the treatment of acute fractures and stress fractures. A majority of respondents have utilized stimulators for the treatment of delayed unions and nonunions. It was concluded that many members of the OTA utilize bone stimulators for delayed unions and nonunions, but not routinely for the treatment of acute fractures or stress fractures.

Dimensionality, internal consistency, and item analysis of the National Health and Nutrition Examination Surveys activities of daily living instrument among patients with report of low back pain.

OBJECTIVE: To measure selected psychometric properties of individual item responses from the National Health and Nutrition Examination Surveys (NHANES) activities of daily living (ADL) instrument among a population of patients with low back pain (LBP). METHODS: The study group consisted of 926 individual attendees of a traditional medical appointment. All subjects had self-reported LBP and completed questions within the NHANES ADL instrument, a 16-item questionnaire designed to represent the internal latent construct of ADL. Data analyses included exploratory factor analysis, internal consistency measures, and polytomous (graded) item response theory. RESULTS: The NHANES ADL instrument is a unidimensional and internally consistent measure of ADL. Graded item response theory analyses indicated that although some variability exists, all 16 single items were sensitive measures of the latent construct of ADL. Most item responses demonstrated high discrimination. CONCLUSION: Individual use of selected items of the NHANES ADL instrument may further improve the capacity of the health care provider in measuring and recording dysfunction associated with LBP.