Indiana University-Purdue University Indianapolis (IUPUI) / Stroke is the main cause of disability in the United States. Individuals with stroke commonly report sensory impairment affects their recovery. Motor recovery and sensory impairment are related and impact individuals’ ability to perform valued occupations. Despite the prevalence of sensation impairment after stroke, many occupational therapists fail to include sensation assessment and intervention in treatment planning. The exclusion of sensation in occupational therapy interventions during stroke rehabilitation may be due to the lack of literature supporting the association between sensation and occupational performance. The current study aimed to determine the relationship between touch sensation of the affected hand and occupational performance and satisfaction in individuals with chronic stroke. Using a cross-sectional study design, this study associated factors related to hand sensation and function in individuals with chronic stroke. Fifty individuals with chronic stroke participated in a one-time testing session in which assessments related to sensation, movement of the hand and engagement in daily activities were administered. Correlation analyses were utilized to determine relationships between touch sensation of the affected hand with individuals’ abilities to engage in valued daily activities, arm and hand disability, and manual abilities. The main finding of the study was that individuals with intact sensation reported greater ability to perform valued occupations and satisfaction with their performance, as compared with individuals with touch sensation impairment. For individuals with impaired touch sensation of the affected hand, impairment of touch sensation of the hand did not correlate with individuals’ performance or satisfaction with valued occupations, arm or hand movement, or manual abilities. Collectively, the results of this study reflect the complex interaction between touch sensation, occupational performance, motor functioning, and manual abilities of the affected hand for individuals’ who have experienced a stroke. This study informs therapists, rehabilitation scientists, and other healthcare professionals that client-centered, individualized approaches, including a wide array of clinical assessments and intervention, including assessment of occupational performance and sensation, remain important components in stroke rehabilitation.

To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke. DESIGN: Cohort study. SETTING: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom. PARTICIPANTS: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy-based start-and-stop rules was checked in a second group of patients (n=237; mean age +/- SD, 60.0+/-11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules. RESULTS: The RMI had good fit of the double monotonicity model (coefficient H(T)=.87). The interpretation of the total score improved. Item hierarchy-based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules. CONCLUSIONS: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI.

A osteomielite possui elevada prevalência e morbidade. O tratamento depende de apropriada terapia antimicrobiana por tempo prolongado e frequentemente requer cirurgia para remoção de tecidos necróticos. A aderência dos pacientes com osteomielite à prescrição do antibiótico, embora fundamental para o sucesso terapêutico, tem sido pouco estudada. O objetivo deste estudo foi mensurar a aderência à terapia antimicrobiana oral em pacientes adultos com osteomielite; identificar se alguns fatores relacionados na literatura estavam associados com a não aderência; estabelecer o valor preditivo dos fatores associados a não aderência ao tratamento em pacientes com osteomielite. Foi realizado um estudo transversal, fundamentado na avaliação por meio de métodos indiretos da aderência para 83 pacientes. Foram considerados pelo menos 30 dias de uso do antimicrobiano à entrevista e os pacientes foram classificados como aderentes de acordo com o questionário de Morisky, que é constituído por 4 questões com respostas dicotômicas para avaliar a aderência. Os pacientes com < 2 pontos foram considerados de baixa aderência e os que obtiverem > 3 pontos, de alta aderência. O presente estudo identificou uma prevalência de alta aderência de 83,1% (n=63). O ajuste dos modelos de regressão logística múltipla não resultou em variáveis conjuntas influenciando a aderência ao tratamento, porém pacientes do gênero masculino sugeriram apresentar maior frequência de baixa aderência ao tratamento em relação aos pacientes do gênero feminino (p = 0,053). Com relação à idade, a análise dos dados mostrou que os pacientes com idade entre 31 e 59 anos possuíam probabilidade de baixa aderência 68% menor que pacientes com idade entre 18 e 30 anos. A aderência observada foi semelhante à encontrada na literatura. Os fatores sociodemográficos podem interferir na aderência de pacientes em uso de antibióticos orais para tratamento de osteomielite / Osteomyelitis is a highly prevalent disease and a major cause of morbidity. Clinical treatment is based on appropriate antimicrobial therapy. Adherence of patients with osteomyelitis to the prescribed treatment, although critical for successful treatment, has been little studied. The aim of the study was: to measure the adherence to oral antimicrobial therapy in adult patients with osteomyelitis; to identify whether some of the factors listed in health literature were associated with non-adherence; to establish the predictive values associated with non-adherence to antimicrobial therapy in patients with osteomyelitis. We conducted a cross-sectional study, based on evaluation through indirect methods of adherence for 83 patients. We included patients receiving at least 30 days of antimicrobial use. Patients were interviewed and classified as adherent according to the Morisky questionnaire, that consists of 4 questions with dichotomous responses to assess adherence. Patients with 3 points, with high adherence. This study identified a prevalence of high adherence of 83.1% (n = 63). The multivariate logistic regression analysis did not result in multiple variables influencing adherence to treatment. Gender was the only variable with an suggested association with low adherence, male gender was more associated with low adherence than female (p = 0,053). Regarding age, data analysis showed that patients aged between 31 and 59 years had low adherence probability 68% lower than patients aged between 18 and 30 years. The high adherence observed in this study was similar than previous reported in the literature. Social and demographic factors may interfere in the adherence with patients using oral antibiotics for the treatment of osteomyelitis

A osteomielite possui elevada prevalência e morbidade. O tratamento depende de apropriada terapia antimicrobiana por tempo prolongado e frequentemente requer cirurgia para remoção de tecidos necróticos. A aderência dos pacientes com osteomielite à prescrição do antibiótico, embora fundamental para o sucesso terapêutico, tem sido pouco estudada. O objetivo deste estudo foi mensurar a aderência à terapia antimicrobiana oral em pacientes adultos com osteomielite; identificar se alguns fatores relacionados na literatura estavam associados com a não aderência; estabelecer o valor preditivo dos fatores associados a não aderência ao tratamento em pacientes com osteomielite. Foi realizado um estudo transversal, fundamentado na avaliação por meio de métodos indiretos da aderência para 83 pacientes. Foram considerados pelo menos 30 dias de uso do antimicrobiano à entrevista e os pacientes foram classificados como aderentes de acordo com o questionário de Morisky, que é constituído por 4 questões com respostas dicotômicas para avaliar a aderência. Os pacientes com < 2 pontos foram considerados de baixa aderência e os que obtiverem > 3 pontos, de alta aderência. O presente estudo identificou uma prevalência de alta aderência de 83,1% (n=63). O ajuste dos modelos de regressão logística múltipla não resultou em variáveis conjuntas influenciando a aderência ao tratamento, porém pacientes do gênero masculino sugeriram apresentar maior frequência de baixa aderência ao tratamento em relação aos pacientes do gênero feminino (p = 0,053). Com relação à idade, a análise dos dados mostrou que os pacientes com idade entre 31 e 59 anos possuíam probabilidade de baixa aderência 68% menor que pacientes com idade entre 18 e 30 anos. A aderência observada foi semelhante à encontrada na literatura. Os fatores sociodemográficos podem interferir na aderência de pacientes em uso de antibióticos orais para tratamento de osteomielite / Osteomyelitis is a highly prevalent disease and a major cause of morbidity. Clinical treatment is based on appropriate antimicrobial therapy. Adherence of patients with osteomyelitis to the prescribed treatment, although critical for successful treatment, has been little studied. The aim of the study was: to measure the adherence to oral antimicrobial therapy in adult patients with osteomyelitis; to identify whether some of the factors listed in health literature were associated with non-adherence; to establish the predictive values associated with non-adherence to antimicrobial therapy in patients with osteomyelitis. We conducted a cross-sectional study, based on evaluation through indirect methods of adherence for 83 patients. We included patients receiving at least 30 days of antimicrobial use. Patients were interviewed and classified as adherent according to the Morisky questionnaire, that consists of 4 questions with dichotomous responses to assess adherence. Patients with 3 points, with high adherence. This study identified a prevalence of high adherence of 83.1% (n = 63). The multivariate logistic regression analysis did not result in multiple variables influencing adherence to treatment. Gender was the only variable with an suggested association with low adherence, male gender was more associated with low adherence than female (p = 0,053). Regarding age, data analysis showed that patients aged between 31 and 59 years had low adherence probability 68% lower than patients aged between 18 and 30 years. The high adherence observed in this study was similar than previous reported in the literature. Social and demographic factors may interfere in the adherence with patients using oral antibiotics for the treatment of osteomyelitis

<p>Трауматско оштећење мозга (ТОМ) настаје услед дејства спољашње мехничке силе на кранијум и ендокранијални садржај, које се карактерише привременим или трајним неуролошким оштећењем, функционалном онеспособљеношћу или психосоцијалном неприлагођеношћу. Најчешће коришћени предиктори исхода су године повређеног, иницијални Гласгов кома скор (ГКС), статус зеница на пријему, време протекло од момента повређивања до неурохируршког збрињавања, удружене повреде, хипоксија, хипертензија и налаз компјутерско-томографског снимања. Основни циљ истраживања је израда алгоритма ургентног лечења трауматског можданог оштећења и дизајн скале за рану предикцију исхода ТОМ уз додатну анализу појединих фактора на пријему (ГКС, неуролошки налаз, радиолошки налаз, клинички симптоми). Спроведено је ретроспективно и проспективно истраживање којим је обухваћено 568 испитаника који су у периоду од 1.6.2018. до 31.05.2019. лечени унутар Клиничког центра Војводине у Новом Саду због трауматске озледе мозга. Узорак је чинило 34,3% жена и 65,7 % мушкараца. Старосна структура узорка је од 18-96 године (М=56,56; SD=20,17). Свим пацијентима је по пријему начињена радиолошка дијагностика компјутеризованом томографијом (ЦТ), начињен је детаљан физикални и неуролошки преглед, те је детаљно узета анамнеза. Нотирани су следећи подаци: витални параметри (артеријски крвни притисак, сатурација крви кисеоником), статус и повреде других система органа, знаци повређивања главе и врата. За неуролошки преглед је коришћена ГКС скала. За ЦТ преглед је нотирано присуство интракранијалних трауматских лезија и прелома лобање. Резултати овог истраживања указали су на неопходност пажљивог разматрања бројних фактора (радиолошких и клиничких) који се могу испољити већ на самом пријему. Иако ЦТ има висок појединачни допринос предвиђању исхода у моделу са више варијабли није се издвојио као значајан. Пацијенти који су имали дужи период између времена протеклог од момента повређивања до неурохируршког збрињавања имали су бољи исход лечења. Предпоставља се да су пацијенти који су стизали раније у здравствену установу имали тежа трауматска оштећења мозга и самим тим исход је био лошији, док су пацијенти са благим оштећењима долазили касније управо из разлога што манифестације проблема нису биле хитне. Ротердам скала се издвојила добром дискриминативном способношћу када се користи као изолован инструмент. Као најјачи предиктори издвојили су се следећи предиктори: нису показане цистерне на ЦТ-у, присутан САХ, померање више од 5 mm, присутан мали субдурални хематом, присутна велика контузија, примена антиагрегациона тераpија. Успешност предвиђања на основу новог модела је 96%. Резултати студије се могу искористити за боље разумевање ТОМ у смислу лакшег решавања дијагностичких дилема и терапијских, креирање ефикаснијих дијагностичких протокола и прецизније процене исхода након повређивања. Предикција исхода лечења је од великог значаја како би се благовермено направио алгоритам лечења и праћења ових пацијената.</p> / <p>Traumatsko oštećenje mozga (TOM) nastaje usled dejstva spoljašnje mehničke sile na kranijum i endokranijalni sadržaj, koje se karakteriše privremenim ili trajnim neurološkim oštećenjem, funkcionalnom onesposobljenošću ili psihosocijalnom neprilagođenošću. Najčešće korišćeni prediktori ishoda su godine povređenog, inicijalni Glasgov koma skor (GKS), status zenica na prijemu, vreme proteklo od momenta povređivanja do neurohirurškog zbrinjavanja, udružene povrede, hipoksija, hipertenzija i nalaz kompjutersko-tomografskog snimanja. Osnovni cilj istraživanja je izrada algoritma urgentnog lečenja traumatskog moždanog oštećenja i dizajn skale za ranu predikciju ishoda TOM uz dodatnu analizu pojedinih faktora na prijemu (GKS, neurološki nalaz, radiološki nalaz, klinički simptomi). Sprovedeno je retrospektivno i prospektivno istraživanje kojim je obuhvaćeno 568 ispitanika koji su u periodu od 1.6.2018. do 31.05.2019. lečeni unutar Kliničkog centra Vojvodine u Novom Sadu zbog traumatske ozlede mozga. Uzorak je činilo 34,3% žena i 65,7 % muškaraca. Starosna struktura uzorka je od 18-96 godine (M=56,56; SD=20,17). Svim pacijentima je po prijemu načinjena radiološka dijagnostika kompjuterizovanom tomografijom (CT), načinjen je detaljan fizikalni i neurološki pregled, te je detaljno uzeta anamneza. Notirani su sledeći podaci: vitalni parametri (arterijski krvni pritisak, saturacija krvi kiseonikom), status i povrede drugih sistema organa, znaci povređivanja glave i vrata. Za neurološki pregled je korišćena GKS skala. Za CT pregled je notirano prisustvo intrakranijalnih traumatskih lezija i preloma lobanje. Rezultati ovog istraživanja ukazali su na neophodnost pažljivog razmatranja brojnih faktora (radioloških i kliničkih) koji se mogu ispoljiti već na samom prijemu. Iako CT ima visok pojedinačni doprinos predviđanju ishoda u modelu sa više varijabli nije se izdvojio kao značajan. Pacijenti koji su imali duži period između vremena proteklog od momenta povređivanja do neurohirurškog zbrinjavanja imali su bolji ishod lečenja. Predpostavlja se da su pacijenti koji su stizali ranije u zdravstvenu ustanovu imali teža traumatska oštećenja mozga i samim tim ishod je bio lošiji, dok su pacijenti sa blagim oštećenjima dolazili kasnije upravo iz razloga što manifestacije problema nisu bile hitne. Roterdam skala se izdvojila dobrom diskriminativnom sposobnošću kada se koristi kao izolovan instrument. Kao najjači prediktori izdvojili su se sledeći prediktori: nisu pokazane cisterne na CT-u, prisutan SAH, pomeranje više od 5 mm, prisutan mali subduralni hematom, prisutna velika kontuzija, primena antiagregaciona terapija. Uspešnost predviđanja na osnovu novog modela je 96%. Rezultati studije se mogu iskoristiti za bolje razumevanje TOM u smislu lakšeg rešavanja dijagnostičkih dilema i terapijskih, kreiranje efikasnijih dijagnostičkih protokola i preciznije procene ishoda nakon povređivanja. Predikcija ishoda lečenja je od velikog značaja kako bi se blagovermeno napravio algoritam lečenja i praćenja ovih pacijenata.</p> / <p>Traumatic brain injury (TBI) Is defined as temporary or permanent neurological damage, functional disability or psychosocial inadaptability occurring due to effects of external mechanical force to brain and cranium. Mostly used predictors are age, Glasgow coma scale score, pupillary reactivity, time from injury to neurosurgical intervention, combined injuries, hypoxia, hypertension and computed tomography (CT) findings. Basic goal of this research was to analyse TBI and design early outcome prediction scale together with the analysis of individual factors on admission (GCS, neurological status, radiological findings). This research was both retro and prospective and included 568 patients treated for TBI at Clinical centre of Vojvodina in Novi Sad from 01.06.2018. to 31.05.2019. Sample was made out of 34,3% females and 65,7 % males aged from 18 to 96 years ( M=56,56; SD=20,17). All patients had CT diagnostics preformed upon admission, had undergone detailed general and neurological examination and patient&rsquo;s history was taken. Physical examination included: vitals (arterial blood pressure, blood oxygenation), status and injuries of other organs, signs of injury to head and neck. GCS scale was used for neurological examination Computed tomography (CT) included presence of intracranial lesions and skull fractures. Results of this research showed importance of careful observation of multiple factors (radiological and clinical) that can be present at the time of admission. Despite CT having high individual predictive power for outcome, in multiple variable model it was not significant. Patients with longer time elapsed to treatment had better outcome. It is assumed that patients who arrived shortly after injury had severe TBI thus having worse outcome, while patients suffering from mild TBI arrived later and thus had better outcome right because their symptoms of TBI were not very symptomatic. Rotterdam scale showed good disciminative power. The strongest predictors were: CT absence of cisterns, present subarachnoid haemorrhage, midline shift over 5mm, presence of small subdural haematoma, presence of large contusion, presence of antiaggregational therapy. Predictive power based on primary model was 96%. Results of this study can be used for better understanding of TBI in order to solve some diagnostic dilemma, create more efficient diagnostic protocols and facilitate more precise outcome assessment after TBI. Prediction of treatment outcome is very important in order to timely design treatment algorithm of treatment and follow up of TBI patients.</p>

Indiana University-Purdue University Indianapolis (IUPUI) / In medical research, data analysis often requires complex statistical methods where no closed-form solutions are available. Under such circumstances, Monte Carlo (MC) methods have found many applications. In this dissertation, we proposed several novel statistical models where MC methods are utilized. For the first part, we focused on semicompeting risks data in which a non-terminal event was subject to dependent censoring by a terminal event. Based on an illness-death multistate survival model, we proposed flexible random effects models. Further, we extended our model to the setting of joint modeling where both semicompeting risks data and repeated marker data are simultaneously analyzed. Since the proposed methods involve high-dimensional integrations, Bayesian Monte Carlo Markov Chain (MCMC) methods were utilized for estimation. The use of Bayesian methods also facilitates the prediction of individual patient outcomes. The proposed methods were demonstrated in both simulation and case studies. For the second part, we focused on re-randomization test, which is a nonparametric method that makes inferences solely based on the randomization procedure used in clinical trials. With this type of inference, Monte Carlo method is often used for generating null distributions on the treatment difference. However, an issue was recently discovered when subjects in a clinical trial were randomized with unbalanced treatment allocation to two treatments according to the minimization algorithm, a randomization procedure frequently used in practice. The null distribution of the re-randomization test statistics was found not to be centered at zero, which comprised power of the test. In this dissertation, we investigated the property of the re-randomization test and proposed a weighted re-randomization method to overcome this issue. The proposed method was demonstrated through extensive simulation studies.