We present a clinimetric assessment of the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The MDS-UDPRS Task Force revised and expanded the UPDRS using recommendations from a published critique. The MDS-UPDRS has four parts, namely, I: Non-motor Experiences of Daily Living; II: Motor Experiences of Daily Living; III: Motor Examination; IV: Motor Complications. Twenty questions are completed by the patient/caregiver. Item-specific instructions and an appendix of complementary additional scales are provided. Movement disorder specialists and study coordinators administered the UPDRS (55 items) and MDS-UPDRS (65 items) to 877 English speaking (78% non-Latino Caucasian) patients with Parkinson's disease from 39 sites. We compared the two scales using correlative techniques and factor analysis. The MDS-UPDRS showed high internal consistency (Cronbach's alpha 5 0.79-0.93 across parts) and correlated with the original UPDRS (q 5 0.96). MDS-UPDRS acrosspart correlations ranged from 0.22 to 0.66. Reliable factor structures for each part were obtained (comparative fit index > 0.90 for each part), which support the use of sum scores for each part in preference to a total score of all parts. The combined clinimetric results of this study support the validity of the MDS-UPDRS for rating PD.2008 Movement Disorder Society

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Initial antihypertensive therapy with single-pill combinations produced more rapid blood pressure control than initial monotherapy in clinical trials. Other studies reported better cardiovascular outcomes in patients achieving lower blood pressure during the first treatment year. We assessed the effectiveness of initial antihypertensive monotherapy, free combinations, and single-pill combinations in controlling untreated, uncontrolled hypertensives during their first treatment year. Electronic record data were obtained from 180 practice sites; 106,621 hypertensive patients seen from 01/2004–06/2009 had uncontrolled blood pressure, were untreated for ≥6 months before therapy, and had ≥1 one-year follow-up blood pressure data. Control was determined by the first follow-up visit with blood pressure <140/<90 mm Hg for patients without diabetes mellitus or chronic kidney disease and <130/<80 for patients with either or both conditions. Multivariable hazards regression ratios (HR) and 95% confidence intervals (95%CI) for time-to-control were calculated adjusting for age, sex, baseline blood pressure, body mass index, diabetes, chronic kidney disease, cardiovascular disease, initial therapy, final blood pressure medication number, and therapeutic inertia. Patients on initial single-pill combinations (N=9,194) were more likely to have Stage 2 hypertension than those on free combinations (N=18,328) or monotherapy (N=79,099 [all p<0.001]). Initial therapy with single-pill combinations (HR 1.53, 95%CI 1.47–1.58) provided better hypertension control in the first year than free combinations (HR 1.34, 95%CI 1.31–1.37) or monotherapy (reference) with benefits in black and white patients. Greater use of single-pill combinations as initial therapy may improve hypertension control and cardiovascular outcomes in the first treatment year.

The traditional method of evaluating student tooth preparations in preclinical courses has relied on the judgment of experienced clinicians primarily utilizing visual inspection. At times, certain aids such as reduction matrices or reduction instruments of known dimension are used to assist the evaluator in determining the grade. Despite the skill and experience of the evaluator, there is still a signiicant element of uncertainty and inconsistency in these methods. Students may perceive this inconsistency as a form of subjective, arbitrary, and empirical evaluation, which often results in students' focusing more on the grade than the actual learning or developing skills necessary to accomplish the preparation properly. Perceptions of favoritism, discrimination, and unfairness (whether verbalized or not) may interfere with the learning process. This study reports the use of a new experimental scanning and evaluation software program (E4D Compare) that can consistently and reliably scan a student's tooth preparation and compare it to a known (faculty-determined) standardized preparation. An actual numerical evaluation is generated by the E4D Compare software, thereby making subjective judgments by the faculty unnecessary. In this study, the computer-generated result was found to be more precise than the hand-graded method.