Examining the effectiveness of promotional nudges increasing plant-based food choices in a post-secondary education dining hall: a pilot study.

Objective: To evaluate nudge strategies that increase the consumption of plant-based foods, defined as vegetarian or vegan food items, compared with meat-based options in post-secondary dining hall settings.

Design: A pilot study.

Setting: This study took place in the University of British Columbia Vancouver Campus's Gather Dining Hall (GDH) over a 6-week intervention period and two control periods.

Colposcopy referral rates post-introduction of primary screening with human papillomavirus testing: evidence from a large British Columbia cohort study.

Background: Shifting from cytology to human papillomavirus (HPV)-based cervical cancer screening will initially increase colposcopy referrals. The anticipated impact on health systems has been raised as a concern for implementation. It is unclear if the higher rate of colposcopy referrals is sustained after initial HPV-based screens or reverts to new lower baselines due to earlier detection and treatment of precancer.

Analysis of an intervention to reduce parental anxiety prior to voiding cystourethrogram.

Purpose: The voiding cystourethrogram (VCUG) is a common imaging test in pediatric urology that can be associated with anxiety in the child and parent. We hypothesized that education by mailed brochure would decrease pre-procedure parental anxiety.

Methods: Families of children scheduled for VCUG were randomized into an experimental group that was mailed an educational brochure about the VCUG and a control group.

Mean changes versus dichotomous definitions of improvement.

In recent years, when reporting the results of clinical trials for chronic disease, including rheumatologic conditions, use has been made of dichotomous definitions of improvement, but it is to be expected that continuous definitions would offer improved discrimination between treatment groups. Nevertheless, a well-constructed dichotomous outcome (usually a composite) has advantages of clinical sense and specificity and may, under a variety of realistic conditions, have power that closely approximates that of standard continuous outcome measures. This has been seen for established dichotomous outcome definitions for two rheumatologic conditions, rheumatoid arthritis (RA) and ankylosing spondylitis (AS).

Successful treatment of AL amyloidosis with high-dose melphalan and autologous stem cell transplantation in patients over age 65.

Recently, protocols using high-dose melphalan chemotherapy and autologous peripheral blood stem cell transplantation (HDM/SCT) have been developed for the treatment of patients with immunoglobulin light chain (AL) amyloidosis. Although peritransplantation mortality is greater than for other hematologic diseases, treatment leads to durable hematologic complete responses, improvements in organ function and quality of life, and extended survival in a substantial proportion of patients. To determine whether this treatment can be applied to older patients, we have analyzed HDM/SCT treatment outcomes for 65 patients (aged 65 years or older) with AL amyloidosis compared with outcomes for 280 younger patients.

Durometry for the assessment of skin disease in systemic sclerosis.

Objective: To examine the validity of a durometer to objectively measure skin hardness in systemic sclerosis (SSc), and to compare digital durometry with the modified Rodnan skin score (MRSS) and ultrasonography.

Methods: Patients with SSc and healthy controls underwent durometry measurements in 3 assessments: a Latin square experiment to establish durometry's intra- and interobserver reliability compared with skin scoring (5 SSc, 1 control); a longitudinal cohort to assess sensitivity to change in skin hardness (13 SSc, 5 controls); and an ultrasound cohort to evaluate correlation between durometry, ultrasound-measured skin thickness, and clinical skin scoring (30 SSc, 12 controls).

Results: Intraobserver reproducibility was higher for durometry than for clinical skin scoring (intraclass correlation coefficient [ICC] 0.

Minimal disease activity for rheumatoid arthritis: a preliminary definition.

Agreement on response criteria in rheumatoid arthritis (RA) has allowed better standardization and interpretation of clinical trial reports. With recent advances in therapy, the proportion of patients achieving a satisfactory state of minimal disease activity (MDA) is becoming a more important measure with which to compare different treatment strategies. The threshold for MDA is between high disease activity and remission and, by definition, anyone in remission will also be in MDA.

Improvement in quality of life of patients with AL amyloidosis treated with high-dose melphalan and autologous stem cell transplantation.

Treatment of AL amyloidosis patients with high-dose melphalan chemotherapy followed by autologous peripheral blood stem cell transplantation (HDM/SCT) can produce hematologic complete responses (CRs) and improvement in organ function. To determine whether these responses are accompanied by improvement in quality of life (QOL), we employed the Medical Outcomes Study (MOS) 36-item Short Form General Health Survey (SF-36) questionnaire for 544 patients evaluated between 1994 and 2002. At baseline, the scores were significantly lower on all 8 SF-36 scales compared with age-matched population norms: the composite physical component summary (PCS) for the AL patients was 34.

Proactive and reactive aggression in referred children and adolescents.

Investigating different types of aggression is important to facilitate a better understanding of excessive maladaptive aggression in referred youth. Using regression analysis, the authors investigated demographic, historical, diagnostic, and treatment correlates of proactive aggression and reactive aggression in a heterogeneous population (N = 323) of psychiatrically referred youths. Ratings of proactive and reactive aggression significantly correlated with more established measures of aggression.

High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8-year study.

Background: AL amyloidosis is a fatal disease resulting from tissue deposition of amyloid fibrils derived from monoclonal immunoglobulin light chains. Treatment with oral chemotherapy is minimally effective.

Objective: To test survival and organ response in a large sample of patients treated with high-dose intravenous melphalan (100 to 200 mg/m2) and autologous blood stem-cell transplantation.

Comparison of rheumatoid arthritis clinical trial outcome measures: a simulation study.

Objective: Isolated studies have suggested that continuous measures of response may be better than predefined, dichotomous definitions (e.g., the American College of Rheumatology 20% improvement criteria [ACR20]) for discriminating between rheumatoid arthritis (RA) treatments.

Outcome variables for osteoarthritis clinical trials: The OMERACT-OARSI set of responder criteria.

Improvement in analysis and reporting results of osteoarthritis (OA) clinical trials has been recently obtained because of harmonization and standardization of the selection of outcome variables (OMERACT 3 and OARSI). Moreover, OARSI has recently proposed the OARSI responder criteria. This composite index permits presentation of results of symptom modifying clinical trials in OA based on individual patient responses (responder yes/no).

Applying diagnostic cost groups to examine the disease burden of VA facilities: comparing the six "Evaluating VA Costs" study sites with other VA sites and Medicare.

Objectives: To compare the disease burden of Veterans Health Administration (VA) patients at six study sites with all other VA patients and the Medicare population.

Design: A 60% random sample of all VA veteran patients during federal fiscal year 1997 was obtained from administrative databases. A split-sample technique provided a 40% sample (n = 1,046,803) for development and a 20% sample (n = 524,461) for validation.

Deriving an operational definition of low disease activity state in rheumatoid arthritis.

This article summarizes the process proposed to come to a definition of low disease activity in rheumatoid arthritis (RA). The purpose of this definition is to aid the interpretation of trial and longitudinal study results. A conceptual proposal is "a disease activity state that is deemed a useful treatment target by both physicians and patients.

Gender differences in reactive and proactive aggression.

The purpose of our investigation was to study gender differences in proactive and reactive aggression in a sample of 323 clinically referred children and adolescents (68 females and 255 males). Proactive aggression and reactive aggression were assessed using the Proactive/Reactive Aggression Scale. Demographic, historical, family, diagnostic, and treatment variables were entered into stepwise regression analyses to determine correlates of proactive and reactive aggression in males and females.

Quality improvement implementation in the nursing home.

Objective: To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and its effects on pressure ulcer care.

Data Sources/study Setting: Primary data were collected from staff at 35 nursing homes maintained by the Department of Veterans Affairs (VA) on measures related to QI implementation and organizational culture. These data were combined with information obtained from abstractions of medical records and analyses of an existing database.

Beta 2 microglobulin serum levels and prediction of survival in AL amyloidosis.

To study the relation between beta 2 microglobulin (beta 2M) and survival in AL amyloidosis, we measured the serum level of beta 2M in 80 patients with AL amyloidosis diagnosed within 1 year of evaluation, who had received no therapy. Patients had a median age of 61 years and 52% were male. Major clinical manifestations were renal disease in 25 patients (31%), cardiomyopathy in 23 patients (29%), and neuropathy or other organ involvement in 32 patients (41%).

Profiling resource use: do different outcomes affect assessments of provider efficiency?

Objectives: To examine whether 2 outcome measures result in different assessments of efficiency across 22 service networks within the Department of Veterans Affairs (VA).

Study Design: A retrospective analysis using VA inpatient and outpatient administrative databases.

Methods: A 60% random sample of veterans who used healthcare services during fiscal year 1997 was split into a 40% sample (n = 1,046,803) for development and a 20% sample (n = 524,461) for validation.

Measuring disease activity and functional status in patients with scleroderma and Raynaud's phenomenon.

Objective: To document disease activity and functional status in patients with scleroderma (systemic sclerosis [SSc]) and Raynaud's phenomenon (RP) and to determine the sensitivity to change, reliability, ease of use, and validity of various outcome measures in these patients.

Methods: Patients with SSc and moderate-to-severe RP participating in a multicenter RP treatment trial completed daily diaries documenting the frequency and duration of RP attacks and recorded a daily Raynaud's Condition Score (RCS). Mean scores for the 2-week periods prior to baseline (week 0), end of trial (week 6), and posttrial followup (week 12) were calculated.

Diagnostic cost groups (DCGs) and concurrent utilization among patients with substance abuse disorders.

Objective: To assess the performance of Diagnostic Cost Groups (DCGs) in explaining variation in concurrent utilization for a defined subgroup, patients with substance abuse (SA) disorders, within the Department of Veterans Affairs (VA).

Data Sources: A 60 percent random sample of veterans who used health care services during Fiscal Year (FY) 1997 was obtained from VA administrative databases. Patients with SA disorders (13.

Barriers, facilitators, and access for wheelchair users: substantive and methodologic lessons from a pilot study of environmental effects.

We undertook a month-long intensive pilot study of a sample of adult wheelchair-users in Boston, Massachusetts and Durham, North Carolina, USA. The study had four objectives; to: (1) measure experiences of reaching and failing to reach specific destinations; (2) measure encounters with environmental facilitators and barriers, including both those overcome and not overcome; (3) determine the frequencies of destinations, facilitators, and barriers, and (4) test for consistency between daily reports and retrospective reports. Full participation entailed baseline and exit telephone interviews, and 28 daily telephone contacts.

Relative costs and effectiveness of specialist and general internist ambulatory care for patients with 2 chronic musculoskeletal conditions.

Objective: To evaluate costs and effectiveness of ambulatory care provided by specialists, nonspecialists (general internists), and both specialists and nonspecialists (co-care) to patients with knee osteoarthritis (OA) and/or chronic low back pain (LBP).

Methods: We studied Veterans Health Administration (VHA) outpatients from the Veterans Health Study with LBP and/or OA followed for at least 6 months between August 1993 and December 1995, who completed the Medical Outcomes Study Short Form 36-item (SF-36) functional status questionnaires at both baseline and followup. We obtained costs of VHA outpatient utilization and medications for these patients during the followup period.