Faculty Bibliography

BACKGROUND/UNASSIGNED:Children's oral health-related quality of life (COHQoL) measures are well known and widely used. However, rigorous systematic reviews of these measures and analyses of their quality are in absence. OBJECTIVES/UNASSIGNED:To systematically review and quantitatively assess the quality of COHQoL measures through a scoping review. DATA SOURCES/UNASSIGNED:Systematic literature search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE (Excerpta Medica database), HaPI (Health and Psychosocial Instruments), and DOSS (Dentistry and Oral Sciences Source). STUDY ELIGIBILITY/UNASSIGNED:The measure's focus was COHQoL; the child age ranged from 5 to 14 years; the publication was either a research article or a systematic review and related to caries; and it was written in English or had an English abstract. Two authors independently selected the studies. Disagreements were reconciled by group discussions with a third author. APPRAISAL/UNASSIGNED:The International Society for Quality of Life Research minimum standards for patient-reported outcome measures were used for quality appraisal. SYNTHESIS/UNASSIGNED:Descriptive analysis. RESULTS/UNASSIGNED:We identified 18 measures. Their quality scores ranged from 9.5 to 15.0 on a scale of 16. The quality appeared to bear no relationship to the citation and use of these measures. However, elements of these measures might be more useful than others, depending on the age-specific use and primary quality concerns. LIMITATIONS/UNASSIGNED:Some of the information on the minimum standards of the 18 measures cannot be found in the existing literature. Measures published without English abstract were not searched. CONCLUSIONS/UNASSIGNED:The quality of these measures is suboptimal. Researchers and practitioners in this field should exercise caution when choosing and using these measures. Efforts at improving the quality of the COHQoL measures, such as refining existing ones or developing new measures, are warranted. KNOWLEDGE TRANSFER STATEMENT/UNASSIGNED:Researchers, clinician scientists, and clinicians can use the results of this study when deciding which oral health-related quality of life measure they wish to use in children.

BACKGROUND:Home blood pressure monitoring (HBPM) is cited as an effective approach for improving blood pressure control. The objective of this study was to determine the effectiveness of HBPM combined with a health education session in reducing blood pressure and improving medication adherence among adults with hypertension. METHODS:Two hundred and thirteen participants were enrolled in a 3-month study and randomized to receive home blood pressure monitoring or usual care. Participants were also randomized to receive an educational session delivered using a pamphlet or a computer-based program. Topics of the educational session included preventing hypertension, weight management, staying active, and cutting down on salt and fat. RESULTS:At the 3 month follow-up there was a reduction in ambulatory blood pressure among the HBPM group. However, the differences found within the HBPM group were no greater than those found among the control group. We did not detect a statistically significant difference in adherence to medication when comparing the HBPM to the usual care group. CONCLUSIONS:HBPM and educational session did not lower blood pressure or improve medication adherence in our sample. A greater effect may have been seen if coupled with an enhanced educational intervention and if blood pressure measures were shared with the provided. The findings of this study provides useful insights for future HBPM studies.

Objective: To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression. Methods: In this study, we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology, Tongji Medical College, Huazhong University of Science and Technology from May to September, 2018. The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n = 150), and those who were not to the control group (n = 150). Labor duration and delivery outcomes were analyzed by Student's t test, Mann-Whitney U test, Chi-square test, and Fisher's exact test. Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration. Results: The median durations of first- and second-stage labor in the epidural group were 600 (400 - 840) and 66 (45 - 98) min, respectively, which were significantly longer than those of the control group [420 (320 - 610) and 52 (33 - 87) min] (z = -4.273, p < 0.001; z = -3.210, p = 0.001). Quantile regression analysis showed that, for the first stage of labor, epidural analgesia was associated with labor prolongation, and had significant effects on all the percentiles (all p < 0.05). The regression coefficients increased (95.630 - 285.000) correspondingly as the percentiles of the labor duration (from 10th to 90th percentiles) increased. For the second stage of labor, epidural analgesia showed a significant impact on prolongation only between the 25th and 75th percentiles (coefficients: 10.000 - 18.143; all p < 0.05). Although the epidural group had a significant higher episiotomy rate [46.8ï¼… (65/139) vs. 33.3ï¼… (48/144), Chi-square = 5.318, p = 0.02l], more times of urine catheterization during labor [1(0-1) vs. 0 (0-1), z = -0.974, p = 0.001] and higher rate of oxytocin administration during labor [48.7ï¼… (73/150) vs. 30.0ï¼… (45/150), Chi-square = 10.952, p = 0.001] when compared with the control group, there was no significant difference in cesarean section rate, assisted vaginal delivery rate, and neonatal outcomes between the two groups (all p > 0.05). Conclusion: Epidural analgesia may be associated with the prolongation of the first and second stage of labor, especially with the first stage of labor, but has no adverse effects on maternal and neonatal outcomes

OBJECTIVE: To evaluate 2 strategies for preparing family members for surrogate decision-making. DESIGN: A 2 x 2 factorial, randomized controlled trial testing whether: (1) comprehensive online advance care planning (ACP) is superior to basic ACP, and (2) having patients engage in ACP together with family members is superior to ACP done by patients alone. SETTING: Tertiary care centers in Hershey, Pennsylvania, and Boston, Massachusetts. PARTICIPANTS: Dyads of patients with advanced, severe illness (mean age 64; 46% female; 72% white) and family members who would be their surrogate decision-makers (mean age 56; 75% female; 75% white). INTERVENTIONS: Basic ACP: state-approved online advance directive plus brochure. Making Your Wishes Known (MYWK): Comprehensive ACP decision aid including education and values clarification. MEASUREMENTS: Pre-post changes in family member self-efficacy (100-point scale) and postintervention concordance between patients and family members using clinical vignettes. RESULTS: A total 285 dyads enrolled; 267 patients and 267 family members completed measures. Baseline self-efficacy in both MYWK and basic ACP groups was high (90.2 and 90.1, respectively), and increased postintervention to 92.1 for MYWK ( P = .13) and 93.3 for basic ACP ( P = .004), with no between-group difference. Baseline self-efficacy in alone and together groups was also high (90.2 and 90.1, respectively), and increased to 92.6 for alone ( P = .03) and 92.8 for together ( P = .03), with no between-group difference. Overall adjusted concordance was higher in MYWK compared to basic ACP (85.2% vs 79.7%; P = .032), with no between-group difference. CONCLUSION: The disconnect between confidence and performance raises questions about how to prepare family members to be surrogate decision-makers.

Background: Psychometric instruments such as the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) are commonly used under conditions for which they were not developed or validated. They may then generate troublesome data that could conceal potential findings. Methods: Based on a previously published refinement of the RBANS, we reanalyzed the data on 303 patients from two National Institutes of Health (NIH) trails in Parkinson’s disease and contrasted the results using the original versus refined scores. Results: Findings from the original RBANS scores were inconsistent; however, use of the refined scores produced potential findings that were in agreement with independent reports. Conclusion: This study demonstrates that, for negative trials using instrument scores as primary outcomes, it is possible to rescue potential findings. The key to this new strategy is to validate and refine the instrument for the specific disease and conditions under study and then to reanalyze the data. This study offers a demonstration of this new strategy for general approaches