BACKGROUND:We prospectively compared the proxy reporting of health-related quality of life (HRQL) by parents and nurses of children with Hodgkin disease to see how well they correlated with the children's report. METHODS: Children with all stages of Hodgkin disease, their parents, and the clinic nurse were all asked to complete 4 different HRQL measures at 4 time points: 2 weeks after the first course of chemotherapy, on the third day of the second course of chemotherapy, during the third week of radiation, and 1 year after diagnosis. RESULTS: Fifty-one patients from 12 centers across Canada were enrolled in the study between May 1, 2002 and March 31, 2005. Two patients were excluded. The children's Pediatric Quality of Life Inventory (PedsQL) generic scores increased from 64 at base line to 81 at the end of the study. There was substantial agreement (intraclass correlation coefficient >0.6) among the participants' scores at most time points except when the child was actively receiving inpatient chemotherapy. At that time, there was only fair to moderate agreement between the child and parent, with the parents on average rating the PedsQL generic score 5 points lower than the child. The nurses still had substantial agreement at that time point with the PedsQL generic and cancer module as well as the EuroQol EQ-5D visual analogue scale visual analogue scale. CONCLUSIONS: Over the course of treatment for Hodgkin disease, there was substantial agreement among the parent's, nurse's, and children's reported HRQL scores. Nurses contribute valuable additional information as proxy respondents.
BACKGROUND:We evaluated 4 different health‐related quality of life (HRQL) measures prospectively to determine their ability to detect change over time: the Health Utilities Index Mark 2 and Mark 3, the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core and Cancer Module, the EuroQol EQ‐5D visual analogue scale (EuroQol), and the Lansky Play‐Performance Scale.METHODS:Children with all stages of Hodgkin disease from 12 centers across Canada were asked to complete the 4 measures at 4 time points: 2 weeks after the first course of chemotherapy, on the third day of the second course of chemotherapy, during the third week of radiation, and 1 year after diagnosis.RESULTS:Fifty‐one patients were enrolled in the study between May 1, 2002 and March 31, 2005. Two patients were excluded: 1 patient died shortly after the first time point and the other patient failed to complete any of the questionnaires. All measures showed a significant change between Time 1 and Time 4 (<0.05). When the change in child scores was analyzed between the time points using the child's self‐reported change in HRQL, the PedsQL and the EuroQol showed significant change at all time points.CONCLUSIONS:All of the measures were able to detect change in a diverse group of children with Hodgkin disease. The PedsQL and the EuroQol appeared to be the most sensitive to change. Cancer 2010. © 2010 American Cancer Society.
Purpose Our aim is to retrospectively review and evaluate the patterns of affection of Charcot arthropathy of foot and ankle. Methods Two hundred twenty-eight patients (235 feet) with post-acute Charcot were reviewed and classified anatomically through plain radiographs into type I and type II based on single or multiple regions affected, respectively. Type I included ankle, Lisfranc (tarsometatarsal), naviculocuneiform, forefoot, and hindfoot which includes one of the following: talonavicular joint, calcaneocuboid joint, or calcaneus. Type II included peritalar, perinavicular, mid-tarsal Charcot, or any other combination. Both types were further classified into four stages (A, stable with no deformity; B, stable with deformity; C, unstable; and D, deformity/instability with associated mechanical ulcers). ResultsThe most common type was type IIC (27.2%) followed by type IID (18.3%), while types IA and IIA represented the least common types (3.4% and 3.8%, respectively). Types IA and IIA were managed conservatively. All patients in types IC, ID, IIB, IIC, and IID and the majority of type IB received fusion surgery to achieve stability and correction of deformity. Type II D had the highest complication rate (30%). Five patients ended up with amputation, and all were stage IID. Conclusion Affection of single region has better prognosis than affection of two or more regions. Stage A has the best prognosis and can be managed conservatively provided good diabetes control. Surgery is indicated in all cases of types IC, ID, IIB, IIC, and IID to achieve stability and correction of deformity and prevent complications. Mechanical ulcer (stage D) carries the worst prognosis and highest complication rate.
Background Recently, a new prognostic classification for foot and ankle Charcot arthropathy (Mansoura Classification) was published. The aim of this study was to evaluate both interobserver and intraobserver reliability of Mansoura classification for foot and ankle Charcot arthropathy. Methods Mansoura classification for foot and ankle Charcot arthropathy was presented to participants at an international foot and ankle course, then participants were given colored printed copy of the classification table and diagrams. Thereafter, twenty cases of foot and ankle Charcot were presented to participants and they were asked to rate each case according to the classification. Furthermore, six raters who were specialized in foot and ankle surgery were asked to repeat the classification of the cases after three weeks from the initial evaluation. Kappa statistics was used to evaluate both interobserver and intraobserver reliability using STATA 14.2 program. Results Sixty-one participants with different level of experience completed the evaluation of the twenty cases of foot and ankle Charcot. The interobserver reliability for all participants was moderate (Kappa = 0.5). Further analysis according to the level of experience based on the years of practice of orthopedic surgery showed similar moderate reliability (range, 0.4–0.57). Intraobserver reliability was excellent for all six participants (range, 0.81–0.93). Further analysis of the interobserver reliability of the former six raters who were specialized in foot and ankle surgery showed substantial reliability; Kappa = 0.67. Conclusion Mansoura classification for Charcot arthropathy of foot and ankle has an excellent intraobserver reliability. The overall interobserver reliability among orthopedic surgeons was moderate and comparable to other classifications, and the interobserver reliability for orthopedic surgeons who were specialized in foot and ankle surgery was substantial. Therefore, Mansoura classification for foot and ankle Charcot has an acceptable reliability and could be promising in the evaluation and guiding the management of such cases. LEVEL OF EVIDENCE: Level IV case series
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