179,201 research outputs found
Exploring the reliability of the modified Rankin Scale
No full text<p><b>Background and Purpose:</b> The modified Rankin Scale (mRS) is the most prevalent outcome measure in stroke trials. Use of the mRS may be hampered by variability in grading. Previous estimates of the properties of the mRS have used diverse methodologies and may not apply to contemporary trial populations. We used a mock clinical trial design to explore inter- and intraobserver variability of the mRS.</p>
<p><b>Methods:</b> Consenting patients with stroke attending for outpatient review had the mRS performed by 2 independent assessors with pairs of assessors selected from a team of 3 research nurses and 4 stroke physicians. Before formal assessment, interviewers estimated disability based only on initial patient observation. Each patient was then randomized to undergo the mRS using standard assessment or a prespecified structured interview. The second interviewer in the pair reassessed the patient using the same method blinded to the colleague’s score. For each patient assessed, one rater was randomly assigned to video record their interview. After 3 months, this interviewer reviewed and regraded their original video assessment.</p>
<p><b>Results:</b> Across 100 paired assessments, interobserver agreement was moderate (k=0.57). Intraobserver variability was good (k=0.72) but less than would be expected from previous literature. Forty-nine assessments were performed using the structured interview approach with no significant difference between structured and standard mRS. Researchers were unable to reliably predict mRS from initial limited patient assessment (k=0.16).</p>
<p><b>Conclusions:</b> Despite availability of training and structured interview, there remains substantial interobserver variability in mRS grades awarded even by experienced researchers. Additional methods to improve mRS reliability are required.</p>
Deriving modified rankin scores from medical records
No full text<p><b>Background and Purpose:</b> Modified Rankin score (mRS) is traditionally graded using a face-to-face or telephone interview. Certain stroke assessment scales can be derived from a review of a patient’s case-record alone. We hypothesized that mRS could be successfully derived from the narrative within patient case-records.</p>
<p><b>Methods:</b> Sequential patients attending our cerebrovascular outpatient clinic were included. Two independent, blinded clinicians, trained in mRS, assessed case-records to derive mRS. They scored “certainty” of their grading on a 5-point Likert scale. Agreement between derived and traditional face-to-face mRS was calculated using attribute agreement analysis.</p>
<p><b>Results:</b> Fifty patients with a range of disabilities were included. Case-record appraisers were poor at deriving mRS (k=0.34 against standard). Derived mRS grades showed poor agreement between observers (k=0.33). There was no relationship between certainty of derived mRS and proportion of correct grades (P=0.727).</p>
<p><b>Conclusion:</b> Accurate mRS cannot be derived from standard hospital records. Direct mRS interview is still required for clinical trials.</p>
Rankin, S C, VX34763
No full textThis record was harvested from a previous catalogue system and will be withdrawn in 2025. Information in this record may be superseded or incomplete. Visit this record in UMA's new catalogue at: https://archives.library.unimelb.edu.au/nodes/view/412352Surname: RANKIN. Given Name(s) or Initials: S C. Military Service Number or Last Known Location: VX34763. Missing, Wounded and Prisoner of War Enquiry Card Index Number: 8945.229062
Item: [2016.0049.44614] "Rankin, S C, VX34763
Rankin, C W, NX47925
No full textThis record was harvested from a previous catalogue system and will be withdrawn in 2025. Information in this record may be superseded or incomplete. Visit this record in UMA's new catalogue at: https://archives.library.unimelb.edu.au/nodes/view/412345Surname: RANKIN. Given Name(s) or Initials: C W. Military Service Number or Last Known Location: NX47925. Missing, Wounded and Prisoner of War Enquiry Card Index Number: 39636.229055
Item: [2016.0049.44607] "Rankin, C W, NX47925
Rankin, C (Charles), VX47157
No full textThis record was harvested from a previous catalogue system and will be withdrawn in 2025. Information in this record may be superseded or incomplete. Visit this record in UMA's new catalogue at: https://archives.library.unimelb.edu.au/nodes/view/412353Surname: RANKIN. Given Name(s) or Initials: C (CHARLES). Military Service Number or Last Known Location: VX47157. Missing, Wounded and Prisoner of War Enquiry Card Index Number: 19570.229063
Item: [2016.0049.44615] "Rankin, C (Charles), VX47157
Rankin, C F, NX38426
No full textThis record was harvested from a previous catalogue system and will be withdrawn in 2025. Information in this record may be superseded or incomplete. Visit this record in UMA's new catalogue at: https://archives.library.unimelb.edu.au/nodes/view/412343Surname: RANKIN. Given Name(s) or Initials: C F. Military Service Number or Last Known Location: NX38426. Missing, Wounded and Prisoner of War Enquiry Card Index Number: 39635.229053
Item: [2016.0049.44605] "Rankin, C F, NX38426
Rankin, D C, NX2613
No full textThis record was harvested from a previous catalogue system and will be withdrawn in 2025. Information in this record may be superseded or incomplete. Visit this record in UMA's new catalogue at: https://archives.library.unimelb.edu.au/nodes/view/412341Surname: RANKIN. Given Name(s) or Initials: D C. Military Service Number or Last Known Location: NX2613. Missing, Wounded and Prisoner of War Enquiry Card Index Number: 9335.229051
Item: [2016.0049.44603] "Rankin, D C, NX2613
Rankin, C, VX13409
No full textThis record was harvested from a previous catalogue system and will be withdrawn in 2025. Information in this record may be superseded or incomplete. Visit this record in UMA's new catalogue at: https://archives.library.unimelb.edu.au/nodes/view/412351Surname: RANKIN. Given Name(s) or Initials: C. Military Service Number or Last Known Location: VX13409. Missing, Wounded and Prisoner of War Enquiry Card Index Number: 8944.229061
Item: [2016.0049.44613] "Rankin, C, VX13409
Initial experience of a digital training resource for modified Rankin scale assessment in clinical trials
No full text<p><b>Background and Purpose:</b> The modified Rankin Scale (mRS) is the preferred measure of disability in cerebrovascular clinical trials, but its value is restricted by interobserver variability. Poor reliability reduces the statistical power of clinical trials and leads to underestimation of effect size. Strategies to improve mRS grading are required. Video training has previously improved application of the National Institutes of Health Stroke Scale in clinical research. We developed an mRS training resource in an attempt to minimize interobserver variability.</p>
<p><b>Methods:</b> We produced a complete training resource comprising an instructional DVD with accompanying written materials and assessment recordings of patient interviews. Formal assessment of training involved grading of real-life cases. Results of initial training and recertification were collected centrally and scored.</p>
<p><b>Results:</b> Data from 1564 assessments are presented. The majority of assessors were participating in 2 large prospective clinical stroke trials. Assessors represented a mixed group of disciplines and nationalities. After training, most trainees (90%) achieved certification in mRS assessment. The majority (85%) of investigators who did not reach an acceptable score on initial testing achieved certification after further exposure to the package.</p>
<p><b>Conclusions:</b> Mass training in mRS assessment for clinical trials is possible. We outline the development of a video-based training package, including technical issues, patient selection procedures, and methods of scoring and assessment. Certification results suggest that use of the resource can improve mRS grading. Acceptability of the training has been demonstrated by its successful use in 2 international acute stroke trials, SAINT 1 and CHANT.</p>
The ‘pathway of opportunity’ - the role of the librarian in supporting the development of communication, language and literacy in young children and their families.
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