1
|
Fiol-deRoque MA, Valderas JM, Arias de la Torre J, Serrano-Ripoll MJ, Gens-Barberà M, Sánchez-Freire E, Martín-Luján FM, Olry de Labry A, Ricci-Cabello I. Evaluation of the psychometric performance of the Spanish and Catalan versions of the patient reported experiences and Outcomes of Safety in Primary Care (PREOS-PC)-Compact questionnaire. Eur J Gen Pract 2024; 30:2296573. [PMID: 38197321 PMCID: PMC10783822 DOI: 10.1080/13814788.2023.2296573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Patients provide a unique, irreplaceable, and essential perspective in evaluating patient safety. The suite of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) tools are a notable exception to the scarcity of patient-reported patient safety measures. Full evaluation of their performance has only been attempted for the English version, thereby limiting its international applicability. OBJECTIVES To assess the psychometric performance of the Spanish and Catalan versions of the PREOS-PC-Compact. METHODS Cross-sectional validation study. We used Classical Test Theory methods to examine scale score distribution, internal consistency, and construct validity; and Item Response Theory (IRT) methods to further explore construct validity. RESULTS 3287 patients completed the Spanish version, and 1007 the Catalan version. Similar results were obtained for both versions. Confirmatory Factor Analysis supported a single construct for each scale. The correlations between PREOS-PC-Compact scales and known group analysis suggested adequate construct validity (inconclusive for known groups at the provider level). All four multi-item scales demonstrated adequate internal consistency reliability (α > 0.7), which was only confirmed for test-retest reliability for 'Practice activation.' A sample between 60-90 patients per practice was estimated sufficient to produce scores with reliability > 0.7 for all scales except for harm scales. IRT models showed disordered thresholds for 'Practice activation' and 'Harm burden' but showed excellent fit after reducing the response categories. CONCLUSION The Spanish and Catalan versions of the PREOS-PC-Compact are broadly valid and reliable tools to measure patient safety in Spanish primary care centres; confirmation of lower-than-expected test-rest reliability merits further examination .
Collapse
Affiliation(s)
- Maria A. Fiol-deRoque
- Research Group in Primary Care and Promotion – Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - José M. Valderas
- Centre for Research in Health Systems Performance, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Jorge Arias de la Torre
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- CIBER Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain
- Institute of Biomedicine, University of Leon, Leon, Spain
| | - Maria J. Serrano-Ripoll
- Research Group in Primary Care and Promotion – Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Montserrat Gens-Barberà
- Quality and Patient Safety Central Functional Unit, Gerència d‘Atenció Primària Camp de Tarragona, Catalan Institute of Health (ICS), Tarragona, Spain
- Research Group in Quality and Patient Safety, Institut Universitari d’Investigació en l’Atenció Primària-IDIAP Jordi Gol, Catalan Institute of Health (ICS), Tarragona, Spain
| | - Encarna Sánchez-Freire
- Quality and Patient Safety Unit, Gerència d‘Atenció Primària Catalunya Central, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Francisco M. Martín-Luján
- Primary Healthcare Research Support Unit-Camp de Tarragona, Institut Universitari d’Investigació en l’Atenció Primària-IDIAP Jordi Gol, Catalan Institute of Health (ICS), Tarragona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Antonio Olry de Labry
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Research Group in Health and Gender, Andalusian School of Public Health, Granada, Spain
| | - Ignacio Ricci-Cabello
- Research Group in Primary Care and Promotion – Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| |
Collapse
|
2
|
Farwati M, Braghieri L, Abdulhai FA, Dabbagh M, Alkhalaileh FA, Younis A, Tabaja C, Farwati A, Amin M, Santangeli P, Nakagawa H, Saliba WI, Kanj M, Callahan TD, Bhargava M, Baranowski B, Rickard J, Sroubek J, Lee J, Tchou PJ, Wazni OM, Hussein AA. Cryoballoon pulmonary vein isolation versus radiofrequency ablation of the pulmonary veins and left atrial posterior wall: Patient-reported outcomes. Pacing Clin Electrophysiol 2024; 47:595-602. [PMID: 38523591 DOI: 10.1111/pace.14943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Data are lacking on patient-reported outcomes (PRO) following cryoballoon ablation (CBA) versus radiofrequency ablation (RFA). We sought to evaluate QoL and clinical outcomes of cryoballoon pulmonary vein isolation only (CRYO-PVI-ONLY) versus RFA with PVI and posterior wall isolation (RF-PVI+PWI) in a large prospective PRO registry. METHODS Patients who underwent AF ablation (2013-2016) at our institution were enrolled in an automated, prospectively maintained PRO registry. CRYO-PVI-ONLY patients were matched (1:1) with RF-PVI+PWI patients based on age, gender, and type of AF (paroxysmal vs. persistent). QoL and clinical outcomes were assessed using PRO surveys at baseline and at 1-year. The atrial fibrillation symptom severity scale (AFSSS) was the measure for QoL. Additionally, we assessed patient-reported clinical improvement, arrhythmia recurrence, and AF burden (as indicated by AF frequency and duration scores). RESULTS A total of 296 patients were included (148 in each group, 72% paroxysmal). By PRO, a significant improvement in QoL was observed in the overall study population and was comparable between CRYO-PVI-ONLY and RF-PVI+PWI (baseline median AFSSS of 11.5 and 11; reduced to 2 and 4 at 1 year, respectively; p = 0.44). Similarly, the proportion of patients who reported improvement in their overall QoL and AF related symptoms was high and similar between the study groups [92% (CRYO-PVI-ONLY) vs. 92.8% (RF-PVI+PWI); p = 0.88]. Arrhythmia recurrence was significantly more common in the CRYO-PVI-ONLY group (39.7%) compared to RF-PVI+PWI (27.7 %); p = 0.03. Comparable results were observed in paroxysmal and persistent AF. CONCLUSION CRYO-PVI-ONLY and RF-PVI+PWI resulted in comparable improvements in patient reported outcomes including QoL and AF burden; with RF-PVI+PWI being more effective at reducing recurrences.
Collapse
Affiliation(s)
- Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Farah A Abdulhai
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marwan Dabbagh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Firas A Alkhalaileh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amr Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mustapha Amin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Justin Lee
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick J Tchou
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Polgreen LE, Villa-Lopez E, Chen L, Liu Z, Katz A, Parks-Schenck C, Hart M, Imel EA, Econs MJ. Patient-Reported Outcomes in Autosomal Dominant Osteopetrosis: Findings from the Osteopetrosis Registry Study. J Clin Endocrinol Metab 2024:dgae285. [PMID: 38661205 DOI: 10.1210/clinem/dgae285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Abstract
CONTEXT Autosomal dominant osteopetrosis (ADO) is a rare sclerotic bone disease characterized by impaired osteoclast activity, resulting in high bone mineral density and skeletal fragility. The full phenotype and disease burden on patients' daily lives has not been systematically measured. OBJECTIVE We developed an online registry to ascertain population-based data on the spectrum and rate of progression of disease and to identify relevant patient centered outcomes that could be used to measure treatment effects and guide the design of future clinical trials. DESIGN Cross-sectional data from participants with osteopetrosis were collected using an online REDCap-based database. PARTICIPANTS Thirty-four participants with a confirmed diagnosis of ADO, aged 4-84 years. MAIN OUTCOME MEASURES Participants aged 18 years and older completed the PROMIS 57, participants aged 8 to 17 years completed the PROMIS Pediatric 49, and parents of participants aged <18 years completed the PROMIS Parent Proxy 49. RESULTS Based on the PROMIS 57, relative to the general population, adults with ADO reported low physical function and low ability to participate in social roles and activities, and high levels of anxiety, fatigue, sleep problems, and pain interference. Daily pain medications were reported by 24% of the adult population. In contrast, neither pediatric participants, nor their parent proxy reported a negative impact on health-related quality of life. CONCLUSIONS Data from this registry demonstrate the broad spectrum of ADO disease severity and high impact on health-related quality of life in adults with ADO.
Collapse
Affiliation(s)
- Lynda E Polgreen
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Eva Villa-Lopez
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Liz Chen
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ziyue Liu
- Department of Biostatistics and Data Science, Indiana University School of Medicine, Indianapolis, IA, USA
| | - Amy Katz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IA, USA
| | - Corinne Parks-Schenck
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IA, USA
| | - Marian Hart
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IA, USA
| | - Erik A Imel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IA, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IA, USA
| | - Michael J Econs
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IA, USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IA, USA
| |
Collapse
|
4
|
Alghafri M, Fadhul I, Shah M, Hakam A, Tawse-Smith A, Alsabeeha NHM, Atieh MA. Diode laser as an adjunctive treatment for periodontitis: Arandomized controlled trial. Int J Dent Hyg 2024. [PMID: 38659231 DOI: 10.1111/idh.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/16/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The aim of this randomized controlled trial was to assess clinical and patient reported outcomes of subgingival instrumentation (SI) with adjunctive use of diode laser (DL) versus SI alone in the treatment of periodontitis. METHODS Participants requiring non-surgical periodontal treatment were randomly allocated into two treatment groups: SI with DL or SI alone. Clinical parameters [full mouth bleeding and plaque scores (FMBS and FMPS), probing pocket depth and clinical attachment level] were recorded at baseline, three and 6 months post-treatment. Visual analogue scale was used to evaluate postoperative participants' perception of pain, swelling, bleeding, bruising and root sensitivity. The impact of periodontal treatment on quality of life was assessed using the General Oral Health Assessment Index (GOHAI) at 6 months. RESULTS A total of 22 participants with stage III/IV periodontitis completed the 6-month follow-up. SI with or without DL resulted in statistically significant reduction in FMBS, FMPS, PPDs, and percentage of PPDs of ≥5 mm at 3- and 6-month follow-up visits (p = 0.001 to <0.001). The participants in SI/DL group had a greater reduction in the percentage of deep PPDs (≥5 mm) compared to those receiving SI alone, but statistically significant differences between the two groups were not observed (16.40 ± 9.57 vs. 32.50 ± 38.76 at 3 months and 7.20 ± 6.86 vs. 19.50 ± 35.06 at 6 months). The difference in the mean total GOHAI scores was not statistically significant at 6 months with total GOHAI scores of 7.25 ± 2.45 and 5.40 ± 3.06 for SI and SI/DL groups, respectively. CONCLUSION Within the limitations of this study, the use of DL as an adjunct to SI in the treatment of stage III/IV periodontitis did not produce significant additional improvement in clinical parameters or patient reported outcomes in the 6-month observation period.
Collapse
Affiliation(s)
- Meera Alghafri
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Israa Fadhul
- Department of Health, Abu Dhabi, United Arab Emirates
| | - Maanas Shah
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Abeer Hakam
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Andrew Tawse-Smith
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Nabeel H M Alsabeeha
- Department of Dental Services, Emirates Health Services, Dubai, United Arab Emirates
| | - Momen A Atieh
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
- School of Dentistry, University of Jordan, Amman, Jordan
| |
Collapse
|
5
|
Younossi ZM, Kremer AE, Swain MG, Jones D, Bowlus C, Trauner M, Henry L, Gerber L. Assessment of fatigue and its impact in chronic liver disease. J Hepatol 2024:S0168-8278(24)00276-9. [PMID: 38670320 DOI: 10.1016/j.jhep.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Patient reported outcomes (PROs) such as health related quality of life (HRQL) are important outcome measures for patients with chronic liver diseases (CLDs). Presence of cirrhosis and advanced liver disease have been associated with worsened HRQL and fatigue. On the other hand, some patients with earlier stages of CLD such as primary biliary cholangitis (PBC), chronic hepatitis C viral infection (HCV) and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), also experience fatigue causing PRO impairment. Treatment for some CLDs may improve HRQL and, sometimes, levels of fatigue. We aimed to provide an in-depth expert review of concepts related to fatigue and HRQL in patients with PBC, HCV and MASLD. As such, a panel of experts in fatigue and CLD reviewed and discussed the literature and collaborated to provide this expert review of fatigue in CLD. Herein, we review and report on the complexity of fatigue highlighting that fatigue is comprised of peripheral (neuromuscular failure, often in conjunction with sub-maximal cardiorespiratory function) and central (central nervous system dysfunction) causes. Fatigue and HRQL are measured using validated self-report instruments. Additionally, fatigue can be measured through objective tests (e.g. grip strength). Fatigue has deleterious effects on HRQL and one's ability to be physically active and socially engaged but does not always correlate with CLD severity. Treatments for HCV and MASLD can improve levels of fatigue and HRQL, but current treatments for PBC do not seem to affect levels of fatigue. We conclude that obtaining PRO data to include HRQL and fatigue are essential for determining the comprehensive burden of CLD and its potential treatments. IMPACT AND IMPLICATIONS: Fatigue is a complex phenomenon associated with both a peripheral cause (neuromuscular failure and sub-maximal cardiorespiratory function) and a central cause (central nervous system dysfunction). Although fatigue is common among patients with CLD, it does not always correlate with the severity of the liver disease, but fatigue is related with significant decreases in patients' health related quality of life (HRQL). Appreciating the impact of fatigue using validated self-report measurements is important to better understand the burden of CLD and the effectiveness of treatment.
Collapse
Affiliation(s)
- Zobair M Younossi
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA; The Global Liver Council, Washington DC, USA
| | - Andreas E Kremer
- Department of Gastroenterology and Hepatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Mark G Swain
- Professor of Medicine, Cal Wenzel Family Foundation Chair in Hepatology, University of Calgary Liver Unit, Calgary, Canada
| | - David Jones
- Professor of Liver Immunology, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Bowlus
- Lena Valente Professor and Chief, Division of Gastroenterology and Hepatology, University of California Davis
| | - Michael Trauner
- Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, MedUni Wien, Medical University of Vienna
| | - Linda Henry
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA; The Global Liver Council, Washington DC, USA; Center for Outcomes Research in Liver Diseases, Washington DC, USA
| | - Lynn Gerber
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA; The Global Liver Council, Washington DC, USA
| |
Collapse
|
6
|
Kim M, Ali B, Graziano FD, Colvin K, Boe LA, Allen RJ, Nelson JA, Disa J. Analyzing mastectomy and reconstruction weight in immediate autologous breast reconstruction: A preliminary study. J Surg Oncol 2024. [PMID: 38637992 DOI: 10.1002/jso.27647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND This study aims to explore the ideal breast size by assessing the relationship between mastectomy to free flap weight ratio and complications as well as patient-reported outcomes in autologous breast reconstruction (ABR). METHOD A retrospective review of patients undergoing bilateral immediate ABR with mastectomy and flap weights available was completed. Patients were divided into three groups based on the ratio of mastectomy to flap weights. The patients were grouped as "maintained" if the flap weight was within 10% of the mastectomy weight. Patients with a weight difference greater than 10% were used to declare "downsized" or "upsized." Outcomes included complications and four domains of the BREAST-Q at 1-year postoperatively. RESULTS Three hundred and fifty-nine patients were included in the analysis, of which 112 were downsized, 91 maintained, and 156 upsized, respectively. Presence of complications did not significantly differ among the groups. At 1-year postoperatively, Sexual Well-being significantly differed (p = 0.033). Between preoperative and 1 year, patients who upsized experienced an improvement in Satisfaction with Breasts by 16 points (p < 0.001), while patients who downsized experienced a decline in Physical Well-being of the Chest by 7 points (p = 0.016). Multivariable linear regression model showed that Sexual Well-being was 13 points lower in the downsized cohort than in the maintained cohort (β = -13, 95% confidence interval: -21 to -5.4; p = 0.001). CONCLUSION Although complication rates do not significantly differ between the three cohorts, patients who downsize may have lower Sexual Well-being postoperatively. Surgeons should consider our preliminary findings to counsel patients preoperatively about the predicted breast size and the impact of downsizing on sexual health.
Collapse
Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barkat Ali
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Francis D Graziano
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kate Colvin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lillian A Boe
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
7
|
Gibian JT, Bartosiak KA, Riegler V, King J, Lucey BP, Barrack RL. The CCJR® Charles A. Engh, Sr. Excellence in Knee Research Award: Remote Monitoring of Sleep Disturbance Following Total Knee Arthroplasty: A Cautionary Note. J Arthroplasty 2024:S0883-5403(24)00307-3. [PMID: 38599526 DOI: 10.1016/j.arth.2024.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Sleep disturbances are common after total knee arthroplasty (TKA). Despite the rising popularity of wearables to track sleep, little evidence exists in the arthroplasty literature regarding their efficacy. We aimed to correlate validated wearable sleep metrics with patient-reported sleep quality following TKA. METHODS Patients undergoing primary TKA were consecutively enrolled. Patients used a wearable device preoperatively and 90 days postoperatively to track five previously-validated measures of sleep. Each month, they rated their sleep quality. Wearable sleep data was correlated with patient-reported sleep quality using a point biserial correlation test. Categorical data were compared using Chi-square tests. A total of 110 patients were included. RESULTS Preoperatively, 20.8% of patients reported "fairly bad" or "very bad" sleep; this increased to 44.4% 30 days postoperatively, then decreased to 26.5% 60 days postoperatively, and to 20.2% 90 days postoperatively. At 30 days postoperatively, time in bed, time asleep, and minutes of rapid eye movement (REM) sleep weakly correlated with patient-reported sleep quality (correlations 0.356, 0.345, and 0.345, respectively; P < 0.001). Sleep quality did not correlate with any wearable metric collected 60 or 90 days postoperatively. CONCLUSION Patient-reported sleep quality following TKA initially worsened postoperatively, then improved to preoperative levels by 90 days. Time in bed, time asleep, and REM sleep minutes only weakly correlated with patient-reported sleep quality at 30 days; no other correlations were detected. Surgeons that utilize remote monitoring following TKA should be aware that surrogate measures generated from these devices may correlate weakly, if at all, with the patient-reported outcome of the parameter being studied.
Collapse
Affiliation(s)
- Joseph T Gibian
- Washington University School of Medicine Department of Orthopaedics, 660 S. Euclid Ave., St. Louis, MO, 63110.
| | - Kimberly A Bartosiak
- Washington University School of Medicine Department of Orthopaedics, 660 S. Euclid Ave., St. Louis, MO, 63110
| | - Venessa Riegler
- Washington University School of Medicine Department of Orthopaedics, 660 S. Euclid Ave., St. Louis, MO, 63110
| | - Jackie King
- Washington University School of Medicine Department of Orthopaedics, 660 S. Euclid Ave., St. Louis, MO, 63110
| | - Brendan P Lucey
- Washington University School of Medicine Department of Neurology, 660 S. Euclid Ave., St. Louis, MO, 63110
| | - Robert L Barrack
- Washington University School of Medicine Department of Orthopaedics, 660 S. Euclid Ave., St. Louis, MO, 63110
| |
Collapse
|
8
|
Looijen AEM, van Mulligen E, Vonkeman HE, van der Helm-van Mil AHM, de Jong PHP. Responsiveness and sensitivity of PROMs to change in disease activity status in early and established rheumatoid arthritis. Rheumatology (Oxford) 2024:keae213. [PMID: 38574380 DOI: 10.1093/rheumatology/keae213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES To determine whether patient reported outcome measures (PROMs) capturing activity limitations, health impact, pain, fatigue and work ability are responsive and sensitive to changes in disease activity status in patients with early and established rheumatoid arthritis (RA). METHODS All early RA patients (n = 557) from the tREACH-trial and established RA patients (n = 188) from the TARA-trial were included. Both studies were multicentre, single-blinded trials with a treat-to-target management approach. The following PROMs were studied: Health Assessment Questionnaire Disability Index(HAQ-DI), morning stiffness severity, EQ-5D, general health, 36-item short form(SF-36), joint pain, fatigue and productivity loss. Mean changes in PROMs between two consecutive visits were compared with changes in disease activity status(remission, low disease activity and active disease) using linear mixed models and standardised response means. Additionally, the proportion of individual observations that showed an expected PROM response to disease activity status alterations was calculated. RESULTS HAQ-DI, morning stiffness severity, general health, EQ-5D and joint pain demonstrated responsiveness to improvement or worsening of disease activity status in both early and established RA. SF-36 physical and mental component scale, fatigue and productivity loss did not show this effect in both groups. Across nearly all PROMs, the magnitude of change and the proportion of individual observations that reflect a shift from and to active disease remained low. CONCLUSION HAQ-DI, morning stiffness severity, EQ-5D, general health and joint pain are responsive to disease activity status alterations on a group level in both early and established RA. For the individual patient the responsiveness of these PROMs is poor. CLINICAL TRIAL REGISTRATION tREACH trial (www.isrctn.com, ISRCTN26791028) and TARA trial (www.onderzoekmetmensen.nl, NTR2754).
Collapse
Affiliation(s)
| | - Elise van Mulligen
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
- Department of Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
- Department of Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands
| | | |
Collapse
|
9
|
Rowin EJ, Wadid M, Maron MS, White M, Hook BG, Harnish P, Silver JS, Reynolds MR, Maron BJ. Assessing the impact of atrial fibrillation on symptoms and quality of life in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2024; 35:654-663. [PMID: 38288888 DOI: 10.1111/jce.16192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION In hypertrophic cardiomyopathy (HCM), atrial fibrillation (AF) has historically been regarded to have a deleterious impact on clinical course, strongly associated with progressive heart failure (HF) symptoms. However, there is a paucity of information regarding the impact of AF on HCM employing validated quality of life (QoL) surveys. Therefore, we evaluated the impact of AF on QoL utilizing patient reported outcome measures (PROMs). METHODS 218 consecutive HCM patients with or without AF at the Lahey HCM center in 2022 completed PROMs at their most recent visit evaluating HF (Kansas City Cardiomyopathy Questionnaire [KCCQ]) and AF symptoms (AF Effect on QoL [AFEQT]). RESULTS Among the 218 patients, 50 (23%) had a history of AF and comprise the primary study cohort. AF was diagnosed at 55 ± 10 years of age, median of 5.5 years before PROM, with 66% of patients treated with a rhythm control strategy with antiarrhythmic drug and/or AF ablation. AFEQT indicated that 52% of patients experienced no or minimal AF-related disability, mild to moderate in 22%, and severe in 26%. There was no substantial difference in HCM phenotype in patients with no or minimal AF disability compared to those with severe disability. HF symptoms for most HCM patients with prior AF history was consistent with no or minimal (59%) or only mild (27%) disability as measured by KCCQ overall summary scores. In addition, with multivariate analysis, AF history was associated with less HF symptoms and improved QoL (OR 0.4, p = 0.02). CONCLUSION In contrast to prior perceptions, HCM patients with prior AF history were less likely to incur HF symptoms impairing QoL compared to HCM patients without AF. After treatment, prior history of AF did not substantially impact current QoL. These data provide a realistic appraisal for the impact that AF has on HCM patients and also offers a measure of reassurance for this patient subgroup.
Collapse
Affiliation(s)
- Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Mark Wadid
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Maggie White
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Bruce G Hook
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Paul Harnish
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Jonathan S Silver
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Matthew R Reynolds
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| |
Collapse
|
10
|
Manduchi B, Fitch MI, Ringash JG, Howell D, Martino R. A core outcome set for patient-reported dysphagia for use in head and neck cancer clinical trials: An international multistakeholder Delphi study. Head Neck 2024; 46:831-848. [PMID: 38204219 DOI: 10.1002/hed.27626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Measuring dysphagia-related patient-reported outcomes (PROs) in Head and Neck Cancer (HNC) patients is challenging due to dysphagia's multidimensional impact, causing inconsistency in outcome reporting. To address this issue, this study derived a consensus-based core outcome set (COS) for patient-reported dysphagia in HNC clinical trials where swallowing is a primary or secondary endpoint. METHODS A sample of HNC clinicians, researchers, patients, and caregivers participated in a 2-Round Delphi technique. A Delphi survey, containing a comprehensive list of dysphagia-related PROs, was developed. In Round 1, participants rated item importance on a 5-point scale. Items rated ≥4 by >70% advanced to Round 2, where a consensus meeting addressed items with varied opinions, and the Delphi survey with remaining items was completed. Items rated ≥4 by >70% formed the final COS. RESULTS Forty-five participants from nine countries were recruited. After Round 1, 40 items were excluded and 64 advanced to Round 2. After Round 2, a 7-outcome COS was established, comprising the domains of dysphagia symptoms, health status and quality of life. CONCLUSION This study achieved consensus among HNC stakeholders on essential dysphagia PROs for HNC clinical trials. It is advisable to include these 7-core concepts in clinical trials involving people with HNC to facilitate treatment comparisons and data synthesis.
Collapse
Affiliation(s)
- Beatrice Manduchi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Bier J, Klingner A, Stadlhofer R, Betz CS, Böttcher A. The "fascia taco" for nasal septum perforation closure-A retrospective Cohort study on success rates and patient reported outcomes. Laryngoscope Investig Otolaryngol 2024; 9:e1248. [PMID: 38651076 PMCID: PMC11034486 DOI: 10.1002/lio2.1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/24/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
Objective Nasal septum perforation (NSP) is a common condition affecting ~1.2% of the general population and is still considered challenging to treat. Therapeutic strategies range from conservative local treatments and septal button closures to over 40 different surgical approaches. This study aimed to present a novel secure approach. Methods We describe our novel and unique NSP closure approach using a "fascia taco," in which conchal cartilage is enveloped by temporalis fascia like a taco and splints are left in place for 6-8 weeks. A review of patient charts was conducted and questionnaires including the German-SNOT-22 and D-NOSE were sent by mail to all eligible patients who received a fascia taco between 2016 and 2021. Results Thirty-three patients were identified. The questionnaire response rate was 54.5%. The mean operative time (cut to sew) for all patients who only underwent NSP closure was 90.4 min. The overall success rate in terms of postoperative NSP closure was 81.8%. We found an apparent but nonsignificant association between closure failure and smoking (failure rate 66.6% in smokers vs. 15.4% in nonsmokers; X 2 = 3.4188, p = .064). Questionnaire analysis showed a significant postoperative reduction of mean values in D-NOSE from 60.8 to 33.1 (p = .009) and in German-SNOT-22 from 38.6 to 21.2 (p = .005). Conclusion The fascia taco technique is an easy-to-apply, safe procedure for NSP closure that is short in duration and associated with a low morbidity, resulting in excellent patient satisfaction. Level of Evidence 4.
Collapse
Affiliation(s)
- Johannes Bier
- Department of OtorhinolaryngologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Alexandra Klingner
- Department of OtorhinolaryngologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Rupert Stadlhofer
- Department of OtorhinolaryngologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christian S. Betz
- Department of OtorhinolaryngologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Arne Böttcher
- Department of OtorhinolaryngologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| |
Collapse
|
12
|
Yeung YL, Lee KL, Lau ESH, Yung TF, Yang A, Wu H, Wong KTC, Kong APS, Chow EYK, Ma RCW, Yeung T, Loo KM, Ozaki R, Luk AOY, Lui JNM, Chan JCN. Associations of comorbid depression with cardiovascular-renal events and all-cause mortality accounting for patient reported outcomes in individuals with type 2 diabetes: a 6-year prospective analysis of the Hong Kong Diabetes Register. Front Endocrinol (Lausanne) 2024; 15:1284799. [PMID: 38586459 PMCID: PMC10999250 DOI: 10.3389/fendo.2024.1284799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background Psychosocial status and patient reported outcomes (PRO) [depression and health-related quality-of-life (HRQoL)] are major health determinants. We investigated the association between depression and clinical outcomes in Chinese patients with type 2 diabetes (T2D), adjusted for PRO. Methods Using prospective data from Hong Kong Diabetes Register (2013-2019), we estimated the hazard-ratio (HR, 95%CI) of depression (validated Patient Health Questionnaire 9 (PHQ-9) score≥7) with incident cardiovascular disease (CVD), ischemic heart disease (IHD), chronic kidney disease (CKD: eGFR<60 ml/min/1.73m2) and all-cause mortality in 4525 Chinese patients with T2D adjusted for patient characteristics, renal function, medications, self-care and HRQoL domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression measured by EQ-5D-3L) in linear-regression models. Results In this cohort without prior events [mean ± SD age:55.7 ± 10.6, 43.7% women, median (IQR) disease duration of 7.0 (2.0-13.0) years, HbA1c, 7.2% (6.6%-8.20%), 26.4% insulin-treated], 537(11.9%) patients had depressive symptoms and 1923 (42.5%) patients had some problems with HRQoL at baseline. After 5.6(IQR: 4.4-6.2) years, 141 patients (3.1%) died, 533(11.8%) developed CKD and 164(3.6%) developed CVD. In a fully-adjusted model (model 4) including self-care and HRQoL, the aHR of depression was 1.99 (95% confidence interval CI):1.25-3.18) for CVD, 2.29 (1.25-4.21) for IHD. Depression was associated with all-cause mortality in models 1-3 adjusted for demographics, clinical characteristics and self-care, but was attenuated after adjusting for HRQoL (model 4- 1.54; 95%CI: 0.91-2.60), though HR still indicated same direction with important magnitude. Patients who reported having regular exercise (3-4 times per week) had reduced aHR of CKD [0.61 (0.41-0.89)]. Item 4 of PHQ-9 (feeling tired, little energy) was independently associated with all-cause mortality with aHR of 1.66 (1.30-2.12). Conclusion Depression exhibits significant association with CVD, IHD, and all-cause mortality in patients with diabetes, adjusting for their HRQoL and health behaviors. Despite the association between depression and all-cause mortality attenuated after adjusting for HRQoL, the effect size remains substantial. The feeling of tiredness or having little energy, as assessed by item Q4 of the PHQ-9 questionnaire, was found to be significantly associated with an increased risk of all-cause mortality after covariate adjustments. Our findings emphasize the importance of incorporating psychiatric evaluations into holistic diabetes management.
Collapse
Affiliation(s)
- Yiu-Lam Yeung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Ka-Long Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Eric SH. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Tsun-Fung Yung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Kelly TC. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Alice PS. Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Elaine YK. Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Ronald CW. Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Theresa Yeung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Kit-man Loo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Andrea OY. Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Juliana NM. Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Juliana CN. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| |
Collapse
|
13
|
Plechschmidt J, Fietkau K, Hepp T, Dietrich P, Fischer S, Krebs S, Neurath MF, Dörje F, Atreya R. Clinical Pharmacist Counselling Improves Long-term Medication Safety and Patient-reported Outcomes in Anti-TNF-treated Patients With Inflammatory Bowel Diseases: The Prospective, Randomized AdPhaNCED Trial. Inflamm Bowel Dis 2024:izae040. [PMID: 38507608 DOI: 10.1093/ibd/izae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Antitumor necrosis factor (anti-TNF) antibody treatment has led to marked improvements in the management of patients with inflammatory bowel diseases (IBDs). Nevertheless, anti-TNF therapy is associated with potential adverse drug reactions (ADRs). Our prospective, randomized trial investigated the effect of intensified clinical pharmacist counselling in a multidisciplinary team on medication safety in anti-TNF-treated IBD patients. METHODS Patients with IBD with ongoing anti-TNF treatment were enrolled in our tertiary center AdPhaNCED trial and randomized to either receive conventional standard of care (control group) or additional clinical pharmacist counselling (intervention group) over 12 months. The primary end point consisted of the number and severity of ADRs associated with anti-TNF therapy. Secondary end points included patient satisfaction with medication information and medication safety. RESULTS One hundred twenty-seven IBD patients were included in this study. Anti-TNF-related ADRs were significantly lower in the intervention compared with the control group (0.20 vs 0.32 [mean] ADR/patient/month, P = .006) after 12 months. The risk of more severe ADRs (Common Terminology Criteria for Adverse Events [CTCAE] grade ≥2) was significantly higher in the control compared with the intervention group (hazard ratio, 0.34; P = .001). The probability of ADR resolution (hazard ratio, 2.02; P < .001) and patient satisfaction with medication information (14.82 vs 11.60; P < .001) were significantly higher in the intervention group compared with the control group. CONCLUSIONS Our study results demonstrate that intensified pharmacist counselling significantly reduces the occurrence and severity of therapy-related ADRs and improves patient satisfaction. Clinical pharmacists should therefore be part of a holistic approach to IBD care delivered by a multidisciplinary team.
Collapse
Affiliation(s)
- Johannes Plechschmidt
- Pharmacy Department, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Konstantin Fietkau
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Tobias Hepp
- Institute of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstraße 6, 91054 Erlangen, Germany
| | - Peter Dietrich
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Sarah Fischer
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Sabine Krebs
- Pharmacy Department, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F Neurath
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Frank Dörje
- Pharmacy Department, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Raja Atreya
- First Department of Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| |
Collapse
|
14
|
Scheipner L, Jankovic D, Jasarevic S, Seidl M, Altziebler JV, Pemberger K, Pohl KC, Primus G, Tian Z, Leitsmann M, Ahyai S. Patient reported outcomes of intermittent self-dilatation after direct vision internal urethrotomy. Neurourol Urodyn 2024; 43:664-671. [PMID: 38221870 DOI: 10.1002/nau.25390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE Long-term results on quality of life (QoL) as well as clinical outcomes of intermittent self-dilatation (ISD) of the urethra after direct visual internal urethrotomy (DVIU) are scarce. The aim of this study was to prospectively evaluate patient reported outcomes (PROs) on voiding symptoms and QoL in a large cohort of urethral stricture patients performing ISD. METHODS We identified a total of 121 patients who performed ISD following DVIU between 2008 and 2013. Baseline assessment was conducted for each patient before ISD was started. Follow-up visits were scheduled in 6-month intervals. Each assessment included the following questionnaires: International prostate symptom score (IPSS), IPSS quality of life index (IPSS-QoL), patient global impression of severity (PGI-S), and patient global impression of improvement (PGI-I). Additional parameters were maximum urinary flow rate (Qmax ), postvoid residual urine, rate of complications, and stricture recurrence. Linear mixed models were used to examine the change over the course of the follow-up visits to the baseline. RESULTS The median age of the patients was 58 years (interquartile range [IQR]: 43-70). The median follow-up was 17 months (IQR: 7-30). Mean change from baseline IPSS was -6.1, -5.9, -4.2, and -4.8 points at 6, 24, 36, and 48 months. Mean change from baseline IPSS-QoL was -1.3, -1.4, -1.6, and -1.8 points, respectively. Mean PGI-I was 1.7 points at 6, 1.9 points at 24, 1.9 points at 36, and 2.2 points at 48 months after ISD initiation. Mean change of Qmax ranged from 1.7 at 6 to 2.2 mL/s at 48 months. The median complication rate was 3.3% per 6-month ISD interval. Overall, 11 patients developed stricture recurrence (9%). CONCLUSION ISD after DVIU had no negative impact on patients' QoL (IPSS-QoL, PGI-I, PGI-S). Urodynamic parameters remained stable for up to 48 months with low complications and an acceptable stricture recurrence rate.
Collapse
Affiliation(s)
- Lukas Scheipner
- Department of Urology, Medical University of Graz, Graz, Austria
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | | | - Samra Jasarevic
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Matthias Seidl
- Department of Urology, Medical University of Graz, Graz, Austria
| | | | - Karl Pemberger
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Klara C Pohl
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Günter Primus
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | | | - Sascha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| |
Collapse
|
15
|
Lambrechts MJ, D’Antonio ND, Heard JC, Toci GR, Karamian BA, Sherman M, Canseco JA, Kepler CK, Vaccaro AR, Hilibrand AS, Schroeder GD. Opioid Use Increases the Rate of Pseudarthrosis and Revision Surgery in Patients Undergoing Anterior Cervical Discectomy and Fusion. Global Spine J 2024; 14:620-630. [PMID: 35959950 PMCID: PMC10802537 DOI: 10.1177/21925682221119132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVES To (1) quantify the risk opioids impart on pseudarthrosis development, (2) analyze the effect of pseudarthrosis on clinical outcomes, and (3) identify if the amount of opioids prescribed are predictive of pseudarthrosis revision. METHODS Patients who underwent ACDF at a single institution between 2017-2019 were retrospectively identified. Postoperative dynamic cervical spine radiographs were reviewed to assess fusion status. Logistic regression models measured the effect of morphine milligram equivalents (MME) prescribed on the likelihood of pseudarthrosis development. Receiver operating characteristic (ROC) curves were generated to predict the probability of surgical revision based on MME prescribed. RESULTS Of 298 included patients, an average of 2.01 ± 0.82 levels were included in the construct and 121 (40.9%) patients were diagnosed with a pseudarthrosis. However, only 14 (4.7%) required a pseudarthrosis revision. Patients requiring pseudarthrosis revision had worse one-year postoperative Δ PCS-12 (-1.70 vs. 7.58, P = 0.004), Δ NDI (3.33 vs. -15.26, P = 0.002), and Δ VAS Arm (2.33 vs. -2.48, P = .047). Multivariate logistic regression analyses found the three-month postoperative (OR=1.00, P = .010), one-year postoperative (OR=1.001, P = 0.025), and combined pre- and postoperative MME (OR=1.000, P = .035) increased the risk of pseudarthrosis. ROC analysis identified cutoff values to predict pseudarthrosis revision at 90.00 (area under the curve (AUC): 0.693, confidence interval (CI): 0.554-0.832), 132.86 (0.710, CI: 0.589-0.840), 224.76 (0.687, CI: 0.558-0.817) and 285.00 (0.711, CI: 0.585-0.837) MME in the preoperative, three-month postoperative, one-year postoperative, and combined pre-and postoperative period. CONCLUSION Increased prescription of opioid medications following ACDF procedures may increase the risk of pseudarthrosis development and revision surgery. LEVEL OF EVIDENCE Therapeutic Level III.
Collapse
Affiliation(s)
- Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicholas D. D’Antonio
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeremy C. Heard
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory R. Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Sherman
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
16
|
Cohen Z, Zhang KK, Kim M, Haglich K, Woods J, Monge J, Matros E, Boyle JO, McCarthy C, Cracchiolo JR, Cohen MA, Shahzad F, Nelson JA, Allen RJ. A preliminary analysis of patient reported outcomes following posterolateral mandible reconstruction: The role of flap type. J Surg Oncol 2024; 129:617-628. [PMID: 37985365 DOI: 10.1002/jso.27520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The choice of tissue type for free flap reconstruction of posterolateral mandible resections is dependent on patient and defect characteristics. We compared clinical and patient-reported outcomes following reconstruction of these defects with a soft tissue or bony free flap. METHODS A retrospective review was performed on patients who underwent posterolateral segmental mandibulectomy with immediate free flap reconstruction at MSKCC from 2006 to 2021. Outcomes of interest were patient-reported outcome measures (PROMs) assessed by FACE-Q surveys and complications at the flap recipient site. RESULTS Ninety patients received a bony flap and 24 patients received a soft tissue flap. Patients reconstructed with soft tissue flaps had greater rates of composite soft tissue defects (p < 0.0001), condyle resection (p = 0.001), and peripheral vascular disease (p = 0.035). Complication rates were similar between the cohorts (p > 0.05). Bony flaps scored higher on multiple FACE-Q scales: Facial Appearance (p = 0.023) Eating/Drinking (p = 0.029), Smiling (p = 0.012), Speaking (p < 0.001), Swallowing (p = 0.012), Smiling Distress (p = 0.037), and Speaking Distress (p = 0.001). CONCLUSION Reconstruction of posterolateral mandibular defects has a similar complication profile when utilizing a bony or soft tissue free flap. Bony flaps may perform better with respect to PROMs. Reconstructive surgeons should consider using bony flap reconstruction to achieve higher patient satisfaction and quality of life.
Collapse
Affiliation(s)
- Zack Cohen
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kevin K Zhang
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Minji Kim
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kathryn Haglich
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jack Woods
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jasmine Monge
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan Matros
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jay O Boyle
- Department of Surgery, Head and Neck Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Colleen McCarthy
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer R Cracchiolo
- Department of Surgery, Head and Neck Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc A Cohen
- Department of Surgery, Head and Neck Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Farooq Shahzad
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Allen
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
17
|
Lukez A, Handorf E, Mendenhall NP, Henderson RH, Stish BJ, Davis BJ, Hallman M, Horwitz EM, Vapiwala N, Wong JK. A pooled patient-reported outcomes analysis of moderately hypofractionated proton beam therapy and photon-based intensity modulated radiation therapy for low- or intermediate-risk prostate cancer. Prostate 2024; 84:395-402. [PMID: 38108113 DOI: 10.1002/pros.24660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND We sought to characterize and compare late patient-reported outcomes (PROs) after moderately hypofractionated intensity modulated radiation therapy (IMRT) and proton beam therapy (PBT) for localized prostate cancer (PC). METHODS This multi-institutional analysis included low- or intermediate-risk group PC patients treated with moderately hypofractionated radiation to an intact prostate stratified by treatment modality: IMRT or PBT. The primary outcomes were prospectively collected patient-reported late gastrointestinal (GI) and genitourinary (GU) toxicity assessed by International Prostate Symptom Score (IPSS) and Expanded PC Index Composite (EPIC). Multivariable regression analysis (MVA) controlling for age, race, and risk group tested the effect of time, treatment, and their interaction. RESULTS 287 IMRT and 485 PBT patients were included. Intermediate risk group (81.2 vs. 68.2%; p < 0.001) and median age at diagnosis (70 vs. 67 years; p < 0.001) were higher in the IMRT group. On MVA, there was no significant difference between modalities. PBT IPSS did not differ from IMRT IPSS at 12 months (odds ratio [OR], 1.19; p = 0.08) or 24 months (OR, 0.99; p = 0.94). PBT EPIC overall GI function at 12 months (OR, 3.68; p = 0.085) and 24 months (OR 2.78; p = 0.26) did not differ from IMRT EPIC overall GI function. At 24 months, urinary frequency was no different between PBT and IMRT groups (OR 0.35; p = 0.096). CONCLUSIONS This multi-institutional analysis of low- or intermediate-risk PC treated with moderately hypofractionated PBT and IMRT demonstrated low rates of late patient-reported GI and GU toxicities. After covariate adjustment, late GI and GU PROs were not significantly different between PBT or IMRT cohorts.
Collapse
Affiliation(s)
- Alexander Lukez
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Nancy P Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
| | - Randal H Henderson
- Department of Radiation Oncology, UF Health Proton Therapy Institute, Jacksonville, Florida, USA
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica Karen Wong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| |
Collapse
|
18
|
Sears SF, Harrell R, Crozier I, Murgatroyd F, Boersma LVA, Manlucu J, Knight BP, Leclercq C, Birgersdotter-Green UM, Wiggenhorn C, Hilleren G, Friedman P. "Piece by Piece" understanding of patient reported QOL and EV-ICD: Response to letter from Vicentini and Rodorf. J Cardiovasc Electrophysiol 2024; 35:518-519. [PMID: 38178366 DOI: 10.1111/jce.16178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Samuel F Sears
- East Carolina Heart Institute, East Carolina University, Greenville, North Carolina, USA
| | - Rebecca Harrell
- East Carolina Heart Institute, East Carolina University, Greenville, North Carolina, USA
| | - Ian Crozier
- Christchurch Hospital, Christchurch, New Zealand
| | | | - Lucas V A Boersma
- Cardiology Department, St. Antonius Hospital, Nieuwegein, Netherlands
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Eberhard A, Bergman S, Mandl T, Olofsson T, Sharma A, Turesson C. Joint tenderness at 3 months follow-up better predicts long-term pain than baseline characteristics in early rheumatoid arthritis patients. Rheumatology (Oxford) 2024; 63:734-741. [PMID: 37314957 PMCID: PMC10907811 DOI: 10.1093/rheumatology/kead278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/15/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To investigate pain course over time and to identify baseline and 3-month predictors of unacceptable pain with or without low inflammation in early RA. METHODS A cohort of 275 patients with early RA, recruited in 2012-2016, was investigated and followed for 2 years. Pain was assessed using a visual analogue scale (VAS; 0-100 mm). Unacceptable pain was defined as VAS pain >40, and low inflammation as CRP <10 mg/l. Baseline and 3-month predictors of unacceptable pain were evaluated using logistic regression analysis. RESULTS After 2 years, 32% of patients reported unacceptable pain. Among those, 81% had low inflammation. Unacceptable pain, and unacceptable pain with low inflammation, at 1 and 2 years was significantly associated with several factors at 3 months, but not at baseline. Three-month predictors of these pain states at 1 and 2 years were higher scores for pain, patient global assessment, and the health assessment questionnaire, and more extensive joint tenderness compared with the number of swollen joints. No significant associations were found for objective inflammatory measures. CONCLUSION A substantial proportion of patients had unacceptable pain with low inflammation after 2 years. Three months after diagnosis seems to be a good time-point for assessing the risk of long-term pain. The associations between patient reported outcomes and pain, and the lack of association with objective inflammatory measures, supports the uncoupling between pain and inflammation in RA. Having many tender joints, but more limited synovitis, may be predictive of long-term pain despite low inflammation in early RA.
Collapse
Affiliation(s)
- Anna Eberhard
- Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Helsingborg Hospital, Helsingborg, Sweden
| | - Stefan Bergman
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Mandl
- Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Tor Olofsson
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Ankita Sharma
- Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
20
|
Hermanns N, Kulzer B, Ehrmann D. Person-reported outcomes in diabetes care: What are they and why are they so important? Diabetes Obes Metab 2024; 26 Suppl 1:30-45. [PMID: 38311448 DOI: 10.1111/dom.15471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/06/2024]
Abstract
In this review, we aim to show how person-reported outcomes (PROs) and person-reported experiences (PREs) can significantly contribute to the way diabetes care is delivered, the involvement of people with diabetes in diabetes care, and the collaboration between health care professionals and people with diabetes. This review focuses on the definition and measurement of PROs and PREs, the importance of PROs and PREs for person-centred diabetes care, and integrating the perspectives of people with diabetes in the evaluation of medical, psychological and technological interventions. PROs have been increasingly accepted by Health Technology Assessment bodies and are therefore valued in the context of reimbursement decisions and consequently by regulators and other health care stakeholders for the allocation of health care resources. Furthermore, the review identified current challenges to the assessment and use of PROs and PREs in clinical care and research. These challenges relate to the combination of questionnaires and ecological momentary assessment for measuring PROs and PREs, lack of consensus on a core outcome set, limited sensitivity to change within many measures and insufficient standardization of what can be considered a minimal clinically important difference. Another issue that has not been sufficiently addressed is the involvement of people with diabetes in the design and development of measures to assess PROs and PREs.
Collapse
Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| |
Collapse
|
21
|
Chong AXJ, Alvarado R, Rimmer J, Campbell RG, Kalish L, Png LH, Harvey RJ. Comparison of Allergen Immunotherapy Alone and in Conjunction With Turbinate Surgery for Nasal Obstruction in Perennial Allergic Rhinitis Patients. Ann Otol Rhinol Laryngol 2024:34894241234593. [PMID: 38414187 DOI: 10.1177/00034894241234593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Nasal obstruction, triggered by allergic rhinitis, often does not resolve with allergen-specific immunotherapy (AIT) alone, thus inferior turbinate reduction surgery (ITR) may be required. This study aims to investigate the impact of combined treatment on nasal obstruction, as evidence is currently limited. METHODOLOGY/PRINCIPAL A retrospective cohort study of perennial allergic rhinitis patients experiencing nasal obstruction and undergoing ≥12 months AIT was conducted. Two groups were derived, those undergoing AIT-with or without an ITR. Patient reported nasal obstruction (evaluated with questionnaires) and nasal airway function (Nasal Peak Inspiratory Flow [NPIF] and Nasal Airflow Resistance [NAR]) were monitored. The change from baseline to 12 months post-treatment in each group were compared. RESULTS A total of 118 patients (33.71 ± 14.43 years, 41.5% female) were recruited, 72% had AIT and 28% AIT&ITR. At baseline, the AIT&ITR group had a higher level of nasal obstruction (>moderate%; 63.6% vs 52.9%, P = .048). Post treatment, AIT&ITR group reported greater reduction in nasal obstruction (>1 category change: 75.8% vs 48.2%, P = .002). Similarly, the AIT&ITR group had greater improvement in nasal function by NPIF (-13.9 ± 110.3 L/minute vs -3.4 ± 78.1 L/minute, P = .049) and NAR (-0.120 ± 0.342 Pa/cm³/second vs -0.093 ± 0.224 Pa/cm³/second, P = .050). CONCLUSIONS Allergic rhinitis patients, with moderate to severe nasal obstruction, who undergo combined AIT&ITR have greater relief of nasal obstruction and improved airflow analysis compared to AIT alone.
Collapse
Affiliation(s)
- Amaris Xin Jie Chong
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Woolcock Institute, University of Sydney, Sydney, Australia
- Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - Raewyn G Campbell
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Otolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Otolaryngology, Head and Neck Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Lu Hui Png
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- Singapore General Hospital, Singapore, Singapore
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
22
|
Klonizakis P, Roy N, Papatsouma I, Mainou M, Christodoulou I, Pantelidou D, Kokkota S, Diamantidis M, Kourakli A, Lazaris V, Andriopoulos D, Tsapas A, Klaassen RJ, Vlachaki E. A Cross-Sectional, Multicentric, Disease-Specific, Health-Related Quality of Life Study in Greek Transfusion Dependent Thalassemia Patients. Healthcare (Basel) 2024; 12:524. [PMID: 38470634 PMCID: PMC10931193 DOI: 10.3390/healthcare12050524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The assessment of health-related quality of life (HRQoL) in thalassemia offers a holistic approach to the disease and facilitates better communication between physicians and patients. This study aimed to evaluate the HRQoL of transfusion-dependent thalassemia (TDT) patients in Greece. This was a multicentric, cross-sectional study conducted in 2017 involving 283 adult TDT patients. All participants completed a set of two QoL questionnaires, the generic SF-36v2 and the disease-specific TranQol. Demographic and clinical characteristics were used to predefine patient subgroups. Significant factors identified in the univariate analysis were entered into a multivariate analysis to assess their effect on HRQoL. The SF-36 scores of TDT patients were consistently lower compared to the general population in Greece. The mean summary score of TranQol was relatively high (71 ± 14%), exceeding levels observed in national surveys in other countries. Employment emerged as the most significant independent factor associated with better HRQoL, whereas age had the most significant negative effect. This study represents the first comprehensive QoL assessment of a representative sample of the TDT population in Greece. The implementation of TranQol allowed for the quantification of HRQoL in Greece, establishing a baseline for future follow-up, and identifying more vulnerable patient subgroups.
Collapse
Affiliation(s)
- Philippos Klonizakis
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Noémi Roy
- Department of Haematology, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 0AG, UK;
| | - Ioanna Papatsouma
- Department of Mathematics, Imperial College London, London SW7 2BP, UK;
| | - Maria Mainou
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Ioanna Christodoulou
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| | - Despina Pantelidou
- Thalassemia Unit, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.K.)
| | - Smaro Kokkota
- Thalassemia Unit, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (S.K.)
| | - Michael Diamantidis
- Thalassemia and Sickle Cell Disease Unit, General Hospital of Larissa, 41110 Larissa, Greece;
| | - Alexandra Kourakli
- Thalassemia and Hemoglobinopathies Center, University Hospital of Patras, 26504 Patras, Greece; (A.K.); (V.L.)
| | - Vasileios Lazaris
- Thalassemia and Hemoglobinopathies Center, University Hospital of Patras, 26504 Patras, Greece; (A.K.); (V.L.)
| | - Dimitrios Andriopoulos
- Haemato-Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK;
| | - Apostolos Tsapas
- 2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Robert J. Klaassen
- Department of Pediatrics, Division of Hematology/Oncology, University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada;
| | - Efthymia Vlachaki
- Adults Thalassemia Unit-2nd Department of Internal Medicine, Aristotle University, Hippokration General Hospital Thessaloniki, 54642 Thessaloniki, Greece; (M.M.); (I.C.); (E.V.)
| |
Collapse
|
23
|
Künzel SH, Broadbent E, Möller PT, Lindner M, Goerdt L, Czauderna J, Schmitz-Valckenberg S, Holz FG, Pfau M, Fleckenstein M. Association of lesion location and functional parameters on vision-related quality of life in geographic atrophy secondary to AMD. Ophthalmol Retina 2024:S2468-6530(24)00057-5. [PMID: 38311207 DOI: 10.1016/j.oret.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The primary goal of this study was to determine how structural and functional parameters influence the vision-related quality of life (VRQoL) in patients suffering from geographic atrophy (GA) secondary to age-related macular degeneration. DESIGN This study was designed as a prospective, non-interventional, natural-history study (Directional Spread in Geographic-Atrophy study, NCT02051998). SUBJECTS The research involved 82 patients with bilateral GA. METHODS The study examined parameters including GA location as assessed by the Early Treatment Diabetic Retinopathy Study grid, best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), reading acuity, and speed. These parameters were then correlated with VRQoL, which was gauged using the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25). The analysis method employed was the least absolute shrinkage and selection operator with linear mixed-effects models. MAIN OUTCOME MEASURES The central parameters measured in this study encompassed GA area, VRQoL scores associated with different GA subfields, and the significance of LLVA for foveal-sparing patients. RESULTS On average, patients showed a total GA area of 2.9 ± 1.2 mm2 in the better eye and 3.1 ± 1.3 mm2 in the worse eye. The most significant associations with VRQoL scores for distance and near activities were observed in the inner lower and inner left subfields of the better eye, respectively. For patients with foveal-sparing GA, the LLVA of the better eye stood out as the most influential variable across all VRQoL scales. CONCLUSIONS The study's findings point towards the pivotal role of GA location, especially the inner lower and inner left subfields of the better eye, in relation to VRQoL in GA patients. The LLVA's importance becomes even more pronounced for foveal-sparing patients. These observations highlight the need for healthcare professionals to better understand the association between lesion location and patient-reported outcomes. This is critical for informing treatment decisions and refining the planning of interventional trials.
Collapse
Affiliation(s)
| | - Eliza Broadbent
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, 84312, UT, United States
| | | | - Moritz Lindner
- Institute of Physiology and Pathophysiology, Department of Neurophysiology, Philipps University, Deutschhausstr. 1-2, Marburg 35037, Germany; Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, South Parks Road, Oxford OX1 3QU, UK
| | - Lukas Goerdt
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, 84312, UT, United States
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Maximilian Pfau
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Monika Fleckenstein
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, 84312, UT, United States
| |
Collapse
|
24
|
Bregagnol RB, Coltro MPDL, Villarinho EA, Triches DF, Alonso FR, Mezzomo LAM, de Macedo BB, Teixeira ER, Vigo A, Shinkai RSA. Long-term clinical performance of short 6-mm implants supporting single crowns in the posterior region: A 10-year cohort study. Clin Implant Dent Relat Res 2024; 26:158-169. [PMID: 37882144 DOI: 10.1111/cid.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/10/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Long-term clinical success of non-splinted, posterior, and short implants still is unclear. This prospective cohort study reports the 10-year follow-up of 6-mm implants supporting single crowns in the posterior region, and patient-reported outcomes. METHODS Baseline sample comprised 20 patients treated with 46 screw-retained crowns supported by 6-mm implants with moderately rough implant surface. Participants were recalled for a 10-year clinical follow-up to assess survival rates, biologic and mechanic conditions, quality of life (OHIP-14), and treatment satisfaction. Data were collected with clinical-radiographic exams and analyzed using descriptive and inferential statistics. RESULTS Fourteen patients with 35 implant-crown units were examined after 127.6 ± 11.8 months. For the entire cohort period, 7/46 implants were lost (survival estimate: 77.7% at 133 months), and mechanic complications occurred in 14/46 units (survival estimate: 66.4% at 116 months). In the Cox models, "maximum occlusal force" had a significant effect for implant loss (p = 0.038) and for prosthetic screw loosening (p = 0.038); "arch" and "bruxism" were not significant. Peri-implant bone loss was 0.4 ± 0.6 mm at 10 years. For peri-implant bone level, "crown-to-implant ratio" (p < 0.001) and "time" (p = 0.001) were significant. Bone levels differed from baseline to 12, 48, and 120 months. Satisfaction VAS was 94.0 ± 7.9 mm and OHIP-14 was 2.3 ± 2.2. CONCLUSION Single screw-retained crowns supported by 6-mm implants have an acceptable long-term clinical performance, with stable peri-implant bone levels after 10 years of function.
Collapse
Affiliation(s)
- Raphaela Brambilla Bregagnol
- School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Private Practice, Porto Alegre, Brazil
| | | | | | - Diego Fernandes Triches
- School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Private Practice, Porto Alegre, Brazil
| | - Fernando Rizzo Alonso
- School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Private Practice, Jaú, Brazil
| | - Luís André Mendonça Mezzomo
- School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- School of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Eduardo Rolim Teixeira
- School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alvaro Vigo
- Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rosemary Sadami Arai Shinkai
- School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- School of Dentistry, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
25
|
Blazeby JM, Murkin C, Rooshenas L, Elliott D, Avery K, Chalmers K, Cousins S, Pinkney T, Blencowe N, Reeves BC, Smart N. Development and pilot testing of a patient-reported outcome measure to assess symptoms of parastomal hernia. Colorectal Dis 2024; 26:364-370. [PMID: 38177087 DOI: 10.1111/codi.16850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
AIM The aim was to develop and pilot a patient-reported outcome measure (PROM) to assess symptoms of parastomal hernia (PSH). METHODS Standard questionnaire development was undertaken (phases 1-3). An initial list of questionnaire domains was identified from validated colorectal cancer PROMs and from semi-structured interviews with patients with a PSH and health professionals (phase 1). Domains were operationalized into items in a provisional questionnaire, and 'think-aloud' patient interviews explored face validity and acceptability (phase 2). The updated questionnaire was piloted in patients with a stoma who had undergone colorectal surgery and had a computed tomography scan available for review. Patient-reported symptoms were examined in relation to PSH (phase 3). Three sources determined PSH presence: (i) data about PSH presence recorded in hospital notes, (ii) independent expert review of the computed tomography scan and (iii) patient report of being informed of a PSH by a health professional. RESULTS For phase 1, 169 and 127 domains were identified from 70 PROMs and 29 interviews respectively. In phase 2, 14 domains specific to PSH were identified and operationalized into questionnaire items. Think-aloud interviews led to three minor modifications. In phase 3, 44 completed questionnaires were obtained. Missing data were few: 5/660 items. PSH symptom scores associated with PSH presence varied between different data sources. The scale with the most consistent differences between PSH presence and absence and all data sources was the stoma appearance scale. CONCLUSION A PROM to examine the symptoms of PSH has been developed from the literature and views of key informants. Although preliminary testing shows it to be understandable and acceptable it is uncertain if it is sensitive to PSH-specific symptoms and further psychometric testing is needed.
Collapse
Affiliation(s)
- Jane M Blazeby
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Charlotte Murkin
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Leila Rooshenas
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Kerry Avery
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Katy Chalmers
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Sian Cousins
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Thomas Pinkney
- Birmingham University Hospitals NHS Trust, Birmingham, UK
| | - Natalie Blencowe
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Barnaby C Reeves
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Neil Smart
- Royal Devon and Exeter Hospital, Exeter, UK
| |
Collapse
|
26
|
Sears SF, Harrell R, Crozier I, Murgatroyd F, Boersma LVA, Manlucu J, Knight BP, Leclercq C, Birgersdotter-Green UM, Wiggenhorn C, Hilleren G, Friedman P. Patient-reported quality of life and acceptance of the extravascular implantable cardioverter-defibrillator: Results from pivotal study. J Cardiovasc Electrophysiol 2024; 35:240-246. [PMID: 38047465 DOI: 10.1111/jce.16151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION The pivotal study of the extravascular implantable cardioverter-defibrillator (EV ICD) recently demonstrated primary efficacy and safety endpoints comparable to previous ICD systems. Patient experience with this novel device has not been reported. The current study examined the standardized patient-reported outcome (PRO) metrics of quality of life (QOL) and patient acceptance of the device. METHODS The EV ICD Pivotal Study was a prospective, single-arm, nonrandomized, global, premarket approval trial. Patients completed the 12-Item Short Form Survey (SF-12) QOL surveys at baseline and at 6 months following implant. Additionally, patients completed the Florida Patient Acceptance Survey (FPAS) QOL survey at 6 months. RESULTS From baseline to 6 months, patients within the EV ICD Pivotal Study (n = 247) reported statistically significant SF-12 improvements in physical QOL (45.4 ± 9.4 vs. 46.8 ± 9.1 respectively, p = .020) and no changes in mental QOL (49.3 ± 10.4 vs. 50.5 ± 9.7, p = .061). No differences were noted by sex, atrial fibrillation, or the experience of ICD shock. EV ICD patients reported better total FPAS patient acceptance of their ICD than TV-ICD or S-ICD patients using historical norms comparisons (80.4 ± 15.7 vs. 70.2 ± 17.8, p < .0001 for S-ICD and 73.0 ± 17.4, p = .004 for TV-ICD). CONCLUSION The initial PROs for EV ICD patients indicated that patients had improvements in physical QOL from baseline to 6-month follow-up and markedly better overall acceptance of their ICD compared to a previous study with S-ICD and TV-ICD data. These initial results suggest that the EV ICD is evaluated positively by patients.
Collapse
Affiliation(s)
- Samuel F Sears
- Department of Psychology, Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Rebecca Harrell
- Department of Psychology, Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Ian Crozier
- Christchurch Hospital, Christchurch, New Zealand
| | | | - Lucas V A Boersma
- Cardiology Department of St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
- Amsterdam University Medical Centers Amsterdam, Amsterdam, The Netherlands
| | | | - Bradley P Knight
- Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Northwestern University, Evanston, Illinois, USA
| | | | - Ulrika Maria Birgersdotter-Green
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California, USA
| | | | | | | |
Collapse
|
27
|
Rosenberg JM, Bellucci CC, Edwards TC, Heike CL, Leroux BG, Jones SM, Stueckle LP, Patrick DL, Albert M, Aspinall CL, Kapp-Simon KA. Caregiver Observations of Infant Well-Being Before and After Cleft Lip Surgery. Cleft Palate Craniofac J 2024; 61:271-283. [PMID: 36112919 PMCID: PMC11037889 DOI: 10.1177/10556656221125371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate the sensitivity to change of daily ratings of the comfort (COMF) and behavioral/emotional health (BEH) domains of the Infants with Clefts Observation Outcomes Instrument (iCOO) at 3 time points, and to assess the association of post-surgical interventions on iCOO ratings. DESIGN The COMF and BEH domains were completed by caregivers before (T0), immediately after (T1), and 2-months after (T2) cleft lip (CL) surgery. Analyses included descriptive statistics, correlations, t-tests, and generalized estimating equations. PARTICIPANTS Caregivers (N = 140) of infants with CL with/without cleft palate. MAIN OUTCOME MEASURES The COMF and BEH domain scores of the iCOO: Scale (SCALE), a summary of observable signs; and Global Impression (IMPR), a single item measuring caregivers' overall impression. RESULTS Daily COMF and BEH SCALE and IMPR scores changed significantly during T1 (P's < 0.001) but not T0 or T2. Day 1 and 7 T0 scores were significantly higher than Day 1 and 7 T1 scores (P's <0.001 to <0.012) but similar at T2 (P's > 0.05). After CL surgery, the combined use of immobilizers and nasal stents and the use of multiple feeding methods with treatment for gastroesophageal reflux were associated with lower daily scores in COMF and BEH SCALE and IMPR (P's: 0.040 to <0.001). CONCLUSIONS COMF and BEH iCOO scores were sensitive to daily changes in infant well-being following CL surgery. Future studies should further investigate impact of post-surgical treatments on infant well-being.
Collapse
Affiliation(s)
- Janine M Rosenberg
- Craniofacial Center, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | | | - Todd C Edwards
- Health Services, University of Washington, Seattle, Washington, USA
| | - Carrie L Heike
- Seattle Children's Hospital, Craniofacial Center, Seattle, Washington, USA
| | | | - Salene M Jones
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laura P Stueckle
- Seattle Children's Hospital, Craniofacial Center, Seattle, Washington, USA
| | - Donald L Patrick
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Meredith Albert
- Shriners Hospitals for Children, Chicago Cleft/Craniofacial, Chicago, Illinois, USA
| | | | - Kathleen A Kapp-Simon
- Shriners Hospitals for Children, Cleft/Craniofacial Chicago, Illinois and University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
28
|
Purnell J, Shaffrey I, Ellis S, Deland J, Henry J, Demetracopoulos C. Early Survivorship, Clinical and Radiographic Outcomes of a Modular Augmented Revision Total Ankle Arthroplasty System. Foot Ankle Int 2024; 45:124-129. [PMID: 37994670 DOI: 10.1177/10711007231209938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND As the number of total ankle arthroplasties (TAAs) performed annually increases, there is increased demand for modular revision implants. There is limited early survivorship and clinical outcome data for the INVISION Total Ankle Arthroplasty System (Wright Medical Technology/Stryker). This study aims to determine early implant survivorship, complications, and radiographic and patient-reported outcomes (PROs) of the INVISION implant in the revision setting. METHODS This is a single-institution retrospective review of adult patients who underwent revision TAA with the INVISION implant with minimum 2-year follow-up. Demographics, complications, radiographic data, and PROs (PROMIS) were collected. The primary outcome was implant survivorship. Secondary outcomes were reoperation, radiographic complications, and PROs. RESULTS Nineteen patients underwent revision INVISION TAA with mean follow-up of 3.5 years. INVISION revision TAA was used for tibial (n = 6) or talar (n = 7) component subsidence, recurrent tibiotalar malalignment (valgus = 1, varus = 3), and postinfection bone loss (n = 2). Two-year implant survivorship was 100%. There were no reoperations. One patient had lucency of the talar component at 6 months post TAA revision with INVISION. One patient had talar subsidence at final follow-up. Two-year postoperative follow-up PROMIS domains improved significantly (P < .05). CONCLUSION There was excellent short-term survivorship of the INVISION TAA implant, with no failures. There were significant improvements in PROs and low rates of subsidence and lucencies. The results of this study support using the INVISION implant in the revision TAA setting. LEVEL OF EVIDENCE Level III, retrospective cohort.
Collapse
Affiliation(s)
- Jennifer Purnell
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Isabelle Shaffrey
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Scott Ellis
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Deland
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Jensen Henry
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | | |
Collapse
|
29
|
Panagiotopoulos A, Thomas K, Argyriou E, Chalkia A, Kapsala N, Koutsianas C, Mavrea E, Petras D, Boumpas DT, Vassilopoulos D. Health-related quality of life in patients with ANCA vasculitides compared to rheumatoid arthritis: a cross-sectional comparative study. Rheumatology (Oxford) 2024; 63:399-406. [PMID: 37171857 PMCID: PMC10836997 DOI: 10.1093/rheumatology/kead214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES There are limited data regarding health-related quality of life (HRQoL) in patients with ANCA-associated vasculitides (AAVs). We aimed to evaluate the HRQoL in patients with AAVs and compare it to another chronic inflammatory disease like RA and to healthy controls (HC). METHODS This was a multicentre, cross-sectional study of patients with AAVs and RA recruited from three tertiary rheumatology clinics. HRQoL was assessed with the Short Form 36 Health Survey, which included the physical and mental component summary scores (PCS and MCS). Data from 1007 HC served as historical controls. RESULTS Sixty-six patients with AAVs and 71 with RA were included. Both AAV and RA patients had significantly lower PCS and MCS scores compared with HC (P < 0.05). HRQoL in AAV patients was worse in patients with microscopic polyangiitis compared with granulomatosis with polyangiitis (physical components) and those with high (VDI ≥ 3) vs low (VDI < 3) damage scores while it did not differ between those with active (BVASv3 ≥ 1) vs. inactive (BVASv3 < 1) disease. In contrast, in RA patients, HRQoL correlated both with disease activity (assessed by the DAS28-ESR) and functional impairment/damage (assessed by the HAQ). Although overall patients with RA had similar HRQoL compared with those with AAVs, those with active RA had worse HRQoL compared with those with active AAV. CONCLUSIONS In patients with AAVs, HRQoL correlated more with organ damage and less with disease activity whereas in RA patients, it correlated with both. These data emphasize the need for AAV therapies aiming at preventing organ damage and thus improving HRQoL.
Collapse
Affiliation(s)
- Alexandros Panagiotopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| | - Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 4th Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon General Hospital, Athens, Greece
| | | | - Aglaia Chalkia
- Nephrology Department, General Hospital of Athens Hippokration, Athens, Greece
| | - Noemin Kapsala
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 4th Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon General Hospital, Athens, Greece
| | - Christos Koutsianas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| | - Evgenia Mavrea
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios Petras
- Nephrology Department, General Hospital of Athens Hippokration, Athens, Greece
| | - Dimitrios T Boumpas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 4th Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon General Hospital, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, General Hospital of Athens Hippokration, Athens, Greece
| |
Collapse
|
30
|
Turcotte JJ, Brennan JC, Rana P, Johnson AH, Patton C. Outcomes in Lumbar Fusion Patients Stratified by the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) Classification System. Cureus 2024; 16:e54177. [PMID: 38496088 PMCID: PMC10941802 DOI: 10.7759/cureus.54177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objective The Meyerding classification system remains the most common classification system for spondylolisthesis based on the percentages of vertebral translation. However, the majority of patients with degenerative disease fall into Grade 1, limiting its utility in this subset of patients. The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system provides a simple radiographic framework for classifying degenerative lumbar spondylolisthesis (DLS) patients by incorporating disc height, kyphosis, and anterior translation. The purpose of this study was to evaluate how clinical characteristics, treatments, and outcomes vary across different CARDS groups in patients undergoing one- or two-level lumbar fusion for DLS. Methods The patients were classified into one of the following four CARDS groups - Type A: advanced disc space collapse with no evidence of kyphosis; Type B: partially preserved disc space with less than 5.0 mm of translation; Type C: partially preserved disc space with greater than 5.0 mm of translation; and Type D: kyphotic alignment. Univariate analyses were performed to compare demographics, symptoms, clinical outcomes, and Patient-Reported Outcomes Measurement Information System (PROMIS) physical (PH) and mental health (MH) scores across groups. Results Ninety-one patients were included in the study. Based on the CARDS classification, there were three (3%) Type A patients, 25 (28%) Type B, 58 (64%) Type C, and five (5%) Type D. No significant differences in baseline demographics, symptom duration, or PROMIS scores were observed across groups. Interbody utilization varied, ranging from 19% in CARDS C (n=11) to 60% in CARDS B (n=15) and D (n=3) patients (p=0.005). Thirty-day clinical outcomes were similar across groups. At an average follow-up of 8.9 months, improvements in PROMIS PH and MH scores and rates of clinically significant improvement were similar across groups. Conclusions Based on our findings, patients undergoing lumbar fusion for DLS present with similar demographic and clinical characteristics and experience similar clinical and patient-reported outcomes when stratified using the CARDS classification system. Posterolateral fusion (PLF) can be effective for various radiographic presentations of DLS. Further research is warranted to assess the utility of CARDS in preoperative planning.
Collapse
Affiliation(s)
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Parimal Rana
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | | | - Chad Patton
- Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA
| |
Collapse
|
31
|
Bond M, Bicknell M, Crump T, Penner M, Veljkovic A, Wing K, Younger A, Liu G, Sutherland JM. Shared Decision Making in Hallux Valgus Surgery: A Prospective Observational Study. J Patient Exp 2024; 11:23743735241229376. [PMID: 38313865 PMCID: PMC10836134 DOI: 10.1177/23743735241229376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Patient-physician communication has the potential to improve outcomes and satisfaction through the shared decision-making process (SDM). This study aims to assess the relationship between perception of SDM and demographic, clinical, and patient-reported outcomes in patients undergoing Hallux Valgus (HV) correction. A prospective analysis of 306 patients scheduled for HV surgery was completed. The CollaboRATE score was used to measure SDM. Multivariable linear regression model was used to assess whether SDM scores were associated with preoperative characteristics or postoperative outcome scores. The mean CollaboRATE score was 2.9 (SD 0.9) and did not differ by age, socioeconomic status, or sex. Lower CollaboRATE scores were associated with more symptoms of depression, lower socioeconomic status, and lower general health scores (p-value < 0.05). There was no association between SDM scores and postoperative outcome scores. In this study, patients with depressive symptoms and lower socioeconomic status had worse perceptions of SDM. There was no difference in postoperative outcomes among participants based on SDM scores. Level of Evidence: Level III, prospective observational study.
Collapse
Affiliation(s)
- Michael Bond
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Mattheus Bicknell
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Trafford Crump
- Faculty of Medicine, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Murray Penner
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Wing
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| |
Collapse
|
32
|
Valente AM, Baraona Reyes F. Addressing Psychologic Distress in Adults With Congenital Heart Disease: Replacing Anxiety With Hope. J Am Coll Cardiol 2024; 83:442-443. [PMID: 38233018 DOI: 10.1016/j.jacc.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Anne M Valente
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Fernando Baraona Reyes
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
33
|
Lo Monaco M, Mallaci Bocchio R, Natoli G, Giardina A, Cangemi I, Scibetta S, Argano C, Corrao S. Critical importance of patient-reported outcomes for a comprehensive assessment of psoriatic arthritis patients. Front Med (Lausanne) 2024; 10:1332432. [PMID: 38293304 PMCID: PMC10826607 DOI: 10.3389/fmed.2023.1332432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Psoriatic arthritis (PsA) is a heterogeneous, chronic inflammatory disease that negatively impacts patients' quality of life. Patient-reported outcome measures (PROMs) are used to capture patient perspectives in disease assessment, and physicians use the Disease Activity Index for Psoriatic Arthritis (DAPSA) to evaluate disease activity in PsA. The study aimed to assess the relationship between PROMs and the DAPSA score in consecutive outpatients affected by PsA. Materials and methods A cross-sectional study was conducted from March 2018 to October 2020 at the PsA clinic of the ARNAS Civico in Palermo (Italy), enrolling outpatients with PsA. Patients were assessed for their disease activity according to the DAPSA score, and PROMs, such as PHQ-9, HAQ, FACIT-F, and PsAID, were evaluated. Linear regression analysis evaluated the relationship between the DAPSA Score and the included PROMs. Results 158 PsA consecutive peripheral subset psoriatic arthritis outpatients were recruited. The median years of illness was 10.6 (9.3-11.9), and the median DAPSA score was 19.02 (9-33.1). The regression analysis highlighted a strong relationship between the DAPSA score and the PsAID (adjR2 26%, p < 0.0001), the FACIT-F (adjR2 25.4%, p < 0.0001), the HAQ (adjR2 23.7%, p < 0.0001), and PHQ-9 (adjR2 15%, p < 0.0001). Conclusion PROMs are strongly associated with the DAPSA score, but it allows in-depth evaluation of the impact of the disease on different domains of PsA patients' life.
Collapse
Affiliation(s)
- Marika Lo Monaco
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties [PROMISE], University of Palermo, Palermo, Italy
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Raffaella Mallaci Bocchio
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Giuseppe Natoli
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Annarita Giardina
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Ignazio Cangemi
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Salvatore Scibetta
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Christiano Argano
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Salvatore Corrao
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties [PROMISE], University of Palermo, Palermo, Italy
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| |
Collapse
|
34
|
Wedel N, Zinger N, Singh AK, Kaur S, Njeze O, Cosar E, Mowrey W, Green S, Reznik M, Feldman J, Su Z, Ansari A, Elrington C, Mathur M, Zheng K, Jariwala SP. ASTHMAXcel PRO patient satisfaction and usability field testing. J Asthma 2024:1-10. [PMID: 38226774 DOI: 10.1080/02770903.2024.2304615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
Background: ASTHMAXcel PRO, an enhanced version of the ASTHMAXcel mobile application, has been developed to deliver comprehensive, guideline-based asthma education while also facilitating the collection of patient-reported outcomes (PROs) and enhancing user experience.Objective: To perform field testing and conduct formative and summative evaluation of the ASTHMAXcel PRO application to assess its impact on patient satisfaction, usability, and usage.Methods: Twenty-eight adult patients completed a baseline visit during which ASTHMAXcel PRO was introduced, health literacy was assessed, and demographic data were collected. They were instructed to use the app for 4 weeks. The Questionnaire for User Interface Satisfaction (QUIS) and the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire were administered at baseline and 4 weeks to assess user satisfaction and technology acceptance, respectively. Semi-structured interviews were conducted to gather feedback regarding the application from patients.Results: The baseline total scores were high for both UTAUT and QUIS (mean (SD): 64.2 (10.1), 6.8 (2.2) respectively) indicating that user satisfaction and acceptance began at high levels. UTAUT total score, as well as all domain scores, improved significantly from baseline to 4 weeks (p < 0.02). QUIS total score along with several domain scores (screen, system capabilities, usability) also increased from baseline to 4-weeks (p = 0.03, 0.01, 0.03, 0.01, respectively). These improvements remained significant when adjusting for age, gender, education, and health literacy. Patients reported that the application was helpful, informative, and easy to understand and use.Conclusion: The significant increases in satisfaction and technology adoption observed among ASTHMAXcel PRO users demonstrate that the application is viable and has the potential to improve upon usability challenges faced by existing mobile health applications.
Collapse
Affiliation(s)
- Nicole Wedel
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Nicole Zinger
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Anjani K Singh
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Savneet Kaur
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Obumneme Njeze
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Emine Cosar
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Wenzhu Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Samuel Green
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marina Reznik
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Jonathan Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Montefiore Medical Group, Montefiore Medical Center, Bronx, NY, USA
| | - Zhaoyuan Su
- Department of Informatics, University of CA Irvine, Irvine, CA, USA
| | - Asif Ansari
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carol Elrington
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Manuja Mathur
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kai Zheng
- Department of Informatics, University of CA Irvine, Irvine, CA, USA
| | - Sunit P Jariwala
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
35
|
Gunsilius CZ, Heffner J, Bruinsma S, Corinha M, Cortinez M, Dalton H, Duong E, Lu J, Omar A, Owen LLW, Roarr BN, Tang K, Petzschner FH. SOMAScience: A Novel Platform for Multidimensional, Longitudinal Pain Assessment. JMIR Mhealth Uhealth 2024; 12:e47177. [PMID: 38214952 PMCID: PMC10818247 DOI: 10.2196/47177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/03/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
Chronic pain is one of the most significant health issues in the United States, affecting more than 20% of the population. Despite its contribution to the increasing health crisis, reliable predictors of disease development, progression, or treatment outcomes are lacking. Self-report remains the most effective way to assess pain, but measures are often acquired in sparse settings over short time windows, limiting their predictive ability. In this paper, we present a new mobile health platform called SOMAScience. SOMAScience serves as an easy-to-use research tool for scientists and clinicians, enabling the collection of large-scale pain datasets in single- and multicenter studies by facilitating the acquisition, transfer, and analysis of longitudinal, multidimensional, self-report pain data. Data acquisition for SOMAScience is done through a user-friendly smartphone app, SOMA, that uses experience sampling methodology to capture momentary and daily assessments of pain intensity, unpleasantness, interference, location, mood, activities, and predictions about the next day that provide personal insights into daily pain dynamics. The visualization of data and its trends over time is meant to empower individual users' self-management of their pain. This paper outlines the scientific, clinical, technological, and user considerations involved in the development of SOMAScience and how it can be used in clinical studies or for pain self-management purposes. Our goal is for SOMAScience to provide a much-needed platform for individual users to gain insight into the multidimensional features of their pain while lowering the barrier for researchers and clinicians to obtain the type of pain data that will ultimately lead to improved prevention, diagnosis, and treatment of chronic pain.
Collapse
Affiliation(s)
- Chloe Zimmerman Gunsilius
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Neuroscience Graduate Program, Department of Neuroscience, Brown University, Providence, RI, United States
- Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Joseph Heffner
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, United States
| | - Sienna Bruinsma
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Department of Neuroscience, Brown University, Providence, RI, United States
| | - Madison Corinha
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
| | - Maria Cortinez
- Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Hadley Dalton
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Ellen Duong
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Joshua Lu
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Aisulu Omar
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Lucy Long Whittington Owen
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
| | - Bradford Nazario Roarr
- Center for Computation and Visualization, Brown University, Providence, RI, United States
| | - Kevin Tang
- Industrial Design, Rhode Island School of Design, Providence, RI, United States
| | - Frederike H Petzschner
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
- Center for Digital Health, Brown University, Lifespan, Providence, RI, United States
| |
Collapse
|
36
|
Bray N, Tudor Edwards R, Schneider P. Development of a value-based scoring system for the MobQoL-7D: a novel tool for measuring quality-adjusted life years in the context of mobility impairment. Disabil Rehabil 2024:1-10. [PMID: 38206178 DOI: 10.1080/09638288.2023.2297929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/16/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To create a preference-based value set scoring system for the MobQoL-7D outcome measure, and to examine differences in the health state preferences of the general population and individuals with impaired mobility. METHODS AND MATERIALS A preference elicitation study was undertaken to ascribe utility weights to all health states (i.e., all unique combination of answers) described by the MobQoL-7D. The elicitation exercise was developed using the Online Elicitation of Personal Utility Functions (OPUF) tool. Two UK sample groups were recruited; firstly a representative general population sample (N = 504), secondly a balanced sample of individuals with impaired mobility (N = 368). Distinct preference-based value sets were developed for each sample. Differences in dimension ranking, weighting, and overall utility values were assessed. RESULTS The general population sample considered most health states, especially the more severe states, to be worse than the mobility impaired sample comparatively. Statistically significant differences between the samples were observed in four of the seven MobQoL-7D dimensions. CONCLUSIONS This study is the first to provide preference-based value sets for the MobQoL-7D, ready for use in economic evaluations, QALY calculation, and other clinical or research applications. The study demonstrates how the general public and individuals with impaired mobility value health states differently.
Collapse
Affiliation(s)
- Nathan Bray
- Academy for Health Equity, Prevention and Wellbeing (AHEPW), School of Health Sciences, Bangor University, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, Bangor University, Bangor, UK
| | - Paul Schneider
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
37
|
McNiff MM, Hawkins S, Haase B, Bullivant J, McIver T, Mitelman O, Emery N, Tasca G, Voermans N, Diaz-Manera J. Facioscapulohumeral Muscular Dystrophy European Patient Survey: Assessing Patient Reported Disease Burden and Preferences in Clinical Trial Participation. J Neuromuscul Dis 2024; 11:459-472. [PMID: 38277300 DOI: 10.3233/jnd-230171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Background Facioscapulohumeral muscular dystrophy (FSHD) is a genetic disorder characterized by progressive muscle weakness leading to permanent disability. There are no curative treatments, however, there are several upcoming clinical trials testing new therapies in FSHD. Objective This study aimed to explore the disease burden and patient preferences of people with FSHD to ensure that clinical trials can be designed to include outcome measures that are relevant and important to patients. Methods A survey was developed with a steering committee clinicians and physiotherapists with relevant experience in the disease, patient representatives, a registry expert and industry consultants. Themes of the survey included; participant demographics, disease progression and impact on function, factors encouraging or discouraging clinical trial participation, and positive outcomes of a clinical trial. Results 1147 participants responded to the online survey, representing 26 countries across Europe and a range of disease severities. The study highlighted the key symptoms causing concern for FSHD patients - muscle weakness and mobility issues - reflecting what participants want targeted for future therapies. The need for clear information and communication throughout clinical trials was emphasised. Factors most encouraging trial participation included access to new investigational therapies, access to trial results and benefits for the FSHD community. Factors most discouraging trial participation included travel related issues and fear of side effects. Conclusions The results from this study identify the patient reported burden of FSHD and should provide researchers and industry with areas of therapeutic research that would be meaningful to patients, as well as supporting the development of patient centric outcome measures in clinical trials.
Collapse
Affiliation(s)
- Megan M McNiff
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sheila Hawkins
- FSHD Europe, Radboud University Medical Centre, Department of Neurology, HB Nijmegen, TheNetherlands
| | - Bine Haase
- FSHD Europe, Radboud University Medical Centre, Department of Neurology, HB Nijmegen, TheNetherlands
| | - Joanne Bullivant
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Tammy McIver
- F. Hoffmann-La Roche Ltd, PD Data Sciences, Welwyn Garden City, UK
| | | | - Nicholas Emery
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Giorgio Tasca
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicol Voermans
- FSHD Europe, Radboud University Medical Centre, Department of Neurology, HB Nijmegen, TheNetherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jordi Diaz-Manera
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
38
|
Morgantini LA, Alzein A, Bharadwaj A, del Pino MS, Egan E, Ganesh A, Smith J, Crivellaro S. A prospective study on single-port versus multiport patient-reported surgical outcomes. BJUI Compass 2024; 5:84-89. [PMID: 38179033 PMCID: PMC10764165 DOI: 10.1002/bco2.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/14/2023] [Accepted: 08/26/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction We sought to determine potential patient reported advantages of the da Vinci single-port (SP) robotic system for urological procedures compared with the previous model, the da Vinci multiport (MP) system. The SP model utilizes a single 30 to 40 mm incision rather than multiple 5 to 22 mm incisions. This project aims to prospectively investigate the impact of the novel SP system on patient reported cosmetic and psychometric surgical outcomes. Methods We conducted a prospective study of patients who underwent uro-oncologic surgery by three urologists at the University of Illinois Chicago from April to November 2021. Study participants completed a Patient Scar Assessment Questionnaire 20 and 90 days post-procedure. The Patient Scar Assessment Questionnaire is a reliable measure of surgical scars that includes five subscales: Appearance, Symptoms, Consciousness, Satisfaction with Appearance, and Satisfaction with Symptoms. Higher scores represented worse reported outcomes. Results On Postoperative Day 20, there were 77 responses (53 SP and 24 MP). Patients receiving SP procedures reported more favourable outcomes in terms of appearance, symptoms, consciousness, and pain medication. On Day 90, there were 37 responses (24 SP and 13 MP). Patients receiving SP procedures reported more favourable outcomes in terms of appearance. No significant differences were seen on Day 90 in terms of pain, medication, symptoms, consciousness, or satisfaction. Conclusions This study demonstrates the superiority of the SP in patient reported cosmetic and pain outcomes on short- and long-term follow-up after uro-oncological surgical procedures. Symptomatic and cosmetic advantages are present at the 20 day follow-up, with better scar appearance being significant 90 days after surgery.
Collapse
Affiliation(s)
- Luca A. Morgantini
- Department of UrologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Ahmad Alzein
- Department of UrologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Arthi Bharadwaj
- Department of UrologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | | | - Erin Egan
- Department of UrologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Ashwin Ganesh
- Department of UrologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - John Smith
- Department of UrologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Simone Crivellaro
- Department of UrologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| |
Collapse
|
39
|
Pagedar NA, Hoffman HT. Anatomic Variability of the Accessory Nerve: Implications for Dissection of Level IIB. Laryngoscope 2024; 134:154-159. [PMID: 37289066 PMCID: PMC10703995 DOI: 10.1002/lary.30758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES During neck dissection, level IIB lymphadenectomy necessitates manipulation of the spinal accessory nerve that might be avoided and might cause postoperative disability. Current literature does not describe the effect of variation in the spinal accessory nerve in the upper neck. We sought to measure the effect of the dimensions of level IIB on nodal yield in level IIB and on patient reported neck symptoms. METHODS We measured the boundaries of level IIB of 150 patients undergoing neck dissection. Level II was dissected and separated into levels IIA and IIB intraoperatively. Patient-reported symptoms were assessed in 50 patients using the Neck Dissection Impairment Inventory. We computed descriptive statistics, and sought to identify correlation with the number and proportion of level IIB nodes and the number of metastatic nodes. Level IIB dimensions were analyzed as predictors of postoperative symptoms. RESULTS We measured 184 sides, with 37.7% of level II nodes found in level IIB. Mean accessory nerve length across level II was 2.5 cm. Every additional 1 cm in accessory nerve length was associated with two more level IIB nodes. At all accessory nerve lengths, meaningful numbers of nodes were present in level IIB. Accessory nerve length and other factors did not correlate with NDII scores. CONCLUSIONS Longer lengths of accessory nerve across level IIB correlated with greater nodal yield. However, data did not point to an accessory nerve length cutoff below which level IIB dissection could be avoided. In addition, the dimensions of level IIB did not correlate with postoperative neck symptoms. LEVEL OF EVIDENCE 2 Laryngoscope, 134:154-159, 2024.
Collapse
Affiliation(s)
- Nitin A Pagedar
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
| | - Henry T Hoffman
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
| |
Collapse
|
40
|
Schroeder HS, Israeli A, Liebergall M(I, Or O, Abu Ahmed W, Paltiel O, Justo D, Zimlichman E. Home Versus Hospital Rehabilitation of Older Adults Following Hip Fracture Yields Similar Patient-Reported Outcome Measures. Inquiry 2024; 61:469580241230293. [PMID: 38491840 PMCID: PMC10943717 DOI: 10.1177/00469580241230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/18/2024]
Abstract
The increase in hip fractures (HF) due to aging of the population and the rise in attractiveness of services provided at home following the COVID-19 pandemic, emphasize the need to compare outcomes of home versus hospital HF rehabilitation. To date, studies comparing the 2 services have focused primarily on clinical outcomes rather than patient-reported outcomes (PROs). This longitudinal observational study evaluated PROs of older adults with HF in the 2 settings. The SF36 questionnaire was used to measure PROs 3 times after surgery. The first PRO was retrospective and reflected pre-fracture health status. Descriptive statistics and mixed-effect logistic regression were used. Of 86 patients participating in the study, 41 had home rehabilitation and 45 had hospital rehabilitation. In both groups, the mental and physical scores plummeted 2 weeks after the HF, compared to pre-fracture status. The difference in improvement from pre-fracture status to recovery in both groups, were not significantly (P < .05) different, except for the pain domain. PROs of home versus hospital rehabilitation were similar, suggesting that rehabilitation at home can be as effective as hospital rehabilitation for suitable patients. This knowledge can improve quality of care in an aging global population.
Collapse
Affiliation(s)
- Hanna S. Schroeder
- Hebrew University of Jerusalem, Jerusalem, Israel
- Israeli Ministry of Health, Israel
| | - Avi Israeli
- Israeli Ministry of Health, Israel
- Dr. Julien Rozan Professor of Healthcare, Hebrew University – Hadassah Medical School
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Omer Or
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Ora Paltiel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
41
|
Dangle P, Tasian GE, Chu DI, Shannon R, Spiardi R, Xiang AH, Jadcherla A, Arenas J, Ellison JS. A Systematic Scoping Review of Comparative Effectiveness Studies in Kidney Stone Disease. Urology 2024; 183:3-10. [PMID: 37806455 PMCID: PMC10841623 DOI: 10.1016/j.urology.2023.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/10/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To review the status of comparative effectiveness studies for kidney stone disease with focus on study outcome, type, population, time trends, and patient-centered approaches. METHODS A systematic scoping review was performed for articles published between January 1, 2005, and March 30, 2021, using keywords relevant to kidney stone disease. Studies published in English that compared two or more alternative methods for prevention, diagnosis, treatment, monitoring, or care delivery were included. Two reviewers independently reviewed abstracts and an arbitrator resolved discrepancies. Nine reviewers abstracted information from full-length studies. Descriptive statistics were summarized, and linear regression was performed to evaluate temporal trends of study characteristics. RESULTS We reviewed 1773 abstracts and 707 full-length manuscripts focused on surgical intervention (440); medical expulsive therapy (MET) (152); analgesic control (80); and homeopathic, diagnostics, and/or prophylaxis (84). Randomized controlled trials were common across all outcome categories, including surgery (41.6%), MET (60.2%), analgesic control (81.3%), homeopathic (41.2%), diagnostic (47.6%), and prophylaxis (49.1%). Patient-reported outcomes were utilized in 71.7% and 95% of MET and analgesic control studies, respectively, but in the minority of all other study themes. Over time, meta-analyses and multicenter studies increased [P < .001]. CONCLUSION Surgical and MET themes dominate published comparative literature in kidney stone disease. There is substantial variation in use of patient-reported outcomes across surgical themes. Multicentered studies and those generating higher level evidence have increased over time but opportunities exist to improve collaborative, high-quality, and patient-centered research in kidney stone disease.
Collapse
Affiliation(s)
- Pankaj Dangle
- Division of Pediatric Urology, Riley Hopsital for Children at IU Health, Indianapolis, IN
| | - Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David I Chu
- Division of Urology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Rachel Shannon
- Division of Urology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ryan Spiardi
- Renal-Electrolyte & Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alice H Xiang
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Aditya Jadcherla
- Division of Pediatric Urology & Department of Urology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI
| | | | - Jonathan S Ellison
- Division of Pediatric Urology & Department of Urology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI.
| |
Collapse
|
42
|
Bakas JM, van Montfrans C, Moelker A, Bos RRVD, Malskat WSJ, Verhagen HJM, van Rijn MJE. Quality of Life after Venous Stenting for Post-thrombotic Syndrome and the Effect of Inflow Disease. Vasc Endovascular Surg 2023:15385744231225802. [PMID: 38156525 DOI: 10.1177/15385744231225802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Patients with PTS experience an impaired quality of life (QoL). We aimed to study QoL in patients stented for post thrombotic syndrome (PTS) and analyze the influence of different parameters. METHODS Patients stented for PTS after iliofemoral deep vein thrombosis were asked to complete the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20) and the Short Form Health Survey (SF-36) in this cross-sectional study. All other data were collected retrospectively. Primary endpoints were median CIVIQ-20 and physical (PCS) and mental (MCS) component summary SF-36 scores. The influence of age, sex, and years between the procedure and completion of questionnaire were investigated using a multivariate linear regression model. Wilcoxon signed rank test compared the PCS and MCS with the normative. Effects of inflow from the deep femoral vein (DFV) and/or the femoral vein (FV) on QoL was analyzed in patients with patent stents. RESULTS The response rate was 70.3% (n = 45/64). Time period (median) from stenting to questionnaire completion was 6.6 years (IQR: 8.0). Most stents were placed unilateral left-sided (73.3%). For patients with patent stents (n = 42) median CIVIQ-20 was 35.5 (IQR: 17.3), higher than the minimum of 20.0 (P < .001). Median PCS of 44.7 (IQR: 14.2) was lower (P < .001), and MCS of 55.9 (IQR: 7.1) higher (P = .001) than the normative (50.0). Time since stenting and sex were not associated with QoL. Age was a significant predictor [standardized coefficient ß = .36, P = .04] for QoL using the CIVIQ-20, but not for the SF-36. Inflow disease did not impact QoL, but patients with occluded stents (n = 3) had poor functioning levels. CONCLUSION Quality of life is impaired after venous stenting for PTS, particularly physical functioning, among patients with an open stent, but was similar between patients with good and impaired inflow. Patients with a permanent stent occlusion had the lowest QoL.
Collapse
Affiliation(s)
- Jay M Bakas
- Department of Vascular and Endovascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Wendy S J Malskat
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hence J M Verhagen
- Department of Vascular and Endovascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marie Josee E van Rijn
- Department of Vascular and Endovascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
43
|
Faulks CR, Biddau DT, Munday NR, McKenzie DP, Malham GM. Patient-specific spinal rods in adult spinal deformity surgery reduce proximal junctional failure: a review of patient outcomes and surgical technique in a prospective observational cohort. J Spine Surg 2023; 9:409-421. [PMID: 38196735 PMCID: PMC10772658 DOI: 10.21037/jss-23-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/22/2023] [Indexed: 01/11/2024]
Abstract
Background Spinal rods used for adult spinal deformity (ASD) correction are usually manufactured straight and bent manually during surgery. Pre-bent patient-specific spinal rods (PSSR) developed with software provide the surgeon with an intraoperative deformity correction consistent with the surgical plan. Our aim was to report clinical and radiological outcomes using PSSR. We investigated rates of junctional complications both proximally [kyphosis (PJK) and failure (PJF)] and distally [failure (DJF)]. Methods Prospective case series of 20 consecutive patients who underwent ≥4 level ASD surgery with PSSR at a single institution between January 2019 and December 2022. Preoperative, 6-week, 6-month, 12-month, 24-month, and final follow-ups assessed patient satisfaction (Ottawa decision regret questionnaire) and patient reported outcome measures (PROMs) [visual analogue scale (VAS; Back/Leg), Oswestry disability index (ODI), and 12-Item Short Form Survey (SF-12)]. Sagittal spinopelvic parameters [sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence and lumbar lordosis mismatch (PI-LL)] measured by serial EOS scans were performed preoperatively then compared to planned correction and postoperative measures. Interoperative cages (narrow/wide) were placed for interbody support. PJK risk score assessed likelihood of developing kyphosis. Serial computed tomography (CT) imaging assessed complication (fusion/subsidence). Results The mean age of the patients (75% female) was 71.9±6.9 years, and the mean follow-up was 25.2±8.6 [7-40] months. Preoperative mean PROMs showed statistically significant overall improvement (P<0.001) postoperatively to final follow-up. Four patients without wide footprint cages at L4/5 or L5/S1, suffered DJF and reported regret undergoing surgery. Statistically significant difference (P<0.001) between preoperative and surgical plan in SVA and PI-LL but not in PT (P=0.058). No statistically significant difference in surgical plan versus the postoperative SVA, PI-LL, and PT (due to difficulty achieving the surgical plan, and also to maintaining the correction). One patient suffered PJF. There was a mean proximal kyphotic angle (PKA) of 17.8±13.0 degrees and PJK risk score of 3.7±1.0 with 40% who experienced PJK. No rod breakages were observed. Conclusions In this series, PSSR improved PROMs and treated ASD. Sagittal parameters planned preoperatively correlated with postoperative correction. PJF was reduced, compared to the literature (35%), but PJK was observed over time. DJF occurred and was related to the absence of interbody cages at the lumbosacral junction and decisional regret.
Collapse
Affiliation(s)
- Charlie R. Faulks
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
| | - Dean T. Biddau
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
| | - Nigel R. Munday
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
| | - Dean P. McKenzie
- Research Development & Governance, Epworth HealthCare, Melbourne, VIC, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
| | - Gregory M. Malham
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
44
|
Colombel JF, Schreiber S, D'Haens G, Rizzo J, Kligys K, Griffith J, Zambrano J, Zhou Q, Zhang Y, Kalabic J, Rieder F, Dubinsky M, Panaccione R. Risankizumab Induction Therapy Achieves Early Symptom Improvements That Are Associated With Future Clinical and Endoscopic Outcomes in Crohn's Disease: Post Hoc Analysis of the ADVANCE, MOTIVATE, and FORTIFY Phase 3 Studies. J Crohns Colitis 2023:jjad206. [PMID: 38069472 DOI: 10.1093/ecco-jcc/jjad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND AIMS Crohn's disease (CD) symptoms are a main driver for impaired quality of life and fast relief is important for patient care. Stool frequency (SF) and abdominal pain score (APS) are patient reported outcomes (PROs) measuring symptom severity, which are supported as treatment targets by the STRIDE-II consensus. This post hoc analysis examined the efficacy of risankizumab (RZB), a humanised monoclonal antibody with high specificity for interleukin-23 p19, for providing early symptom relief, along with the prognostic value of early symptom relief for achieving future clinical and endoscopic endpoints. METHODS Individual and combined measures of SF and AP at weeks 1, 2, and 3 were assessed in patients with moderate to severe CD who received 600 mg intravenous RZB or placebo (PBO) in the ADVANCE or MOTIVATE induction studies. Multivariate logistic regression was used to examine the predictiveness of early symptom improvement for clinical and endoscopic outcomes following RZB induction and maintenance. RESULTS Higher rates of SF/APS clinical remission and enhanced clinical response were observed as early as week 1 with RZB versus PBO. A larger proportion of patients achieved clinical endpoints with RZB versus PBO, irrespective of prior bio-failure status. Early PRO improvement was associated with a greater likelihood of achieving clinical and endoscopic improvement following 12-weeks induction and 52-weeks maintenance RZB dosing. CONCLUSIONS After the first intravenous RZB induction dose, significantly greater rates of symptom improvement versus PBO were achieved. Improvements could be observed as early as week 1 and were predictive of week 12 and 52 clinical and endoscopic improvement.
Collapse
Affiliation(s)
| | - Stefan Schreiber
- University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Geert D'Haens
- Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Joanne Rizzo
- AbbVie Inc, North Chicago, Illinois, United States
| | | | | | | | - Qian Zhou
- AbbVie Inc, North Chicago, Illinois, United States
| | - Yafei Zhang
- AbbVie Inc, North Chicago, Illinois, United States
| | | | | | - Marla Dubinsky
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | |
Collapse
|
45
|
Tapper EB, Lai JC. Time to embrace PROMIS-29 as the standard health-related quality of life instrument for patients with cirrhosis. Hepatology 2023; 78:1688-1691. [PMID: 37278246 PMCID: PMC10700645 DOI: 10.1097/hep.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Elliot B. Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, San Francisco
| | - Jennifer C. Lai
- Division of Gastroenterology and Hepatology, University of California, San Francisco
| |
Collapse
|
46
|
Hammond A, Tennant A, Ching A, Parker J, Prior Y, Gignac MAM, Verstappen SMM, O'Brien R. Psychometric testing of the British-English Long-Term Conditions Job Strain Scale, Long-Term Conditions Work Spillover Scale and Work-Health-Personal Life Perceptions Scale in four rheumatic and musculoskeletal conditions. Musculoskeletal Care 2023; 21:1020-1035. [PMID: 37165513 DOI: 10.1002/msc.1774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The aims were to validate linguistically British-English versions of the Long-Term Conditions Job Strain Scale (LTCJSS), Long-Term Conditions Work Spillover Scale (LTCWSS) and Work-Health-Personal Life Perceptions Scale (WHPLPS) in rheumatoid arthritis, axial spondyloarthritis, osteoarthritis and fibromyalgia (FM). METHODS The three scales were forward translated and reviewed by an expert panel prior to cognitive debriefing interviews. Participants completed a postal questionnaire. Construct validity was assessed using Rasch analysis. Concurrent validity included testing between the three scales and work (e.g., Workplace Activity Limitations Scale [WALS]) and condition-specific health scales. Two weeks later, participants were mailed a second questionnaire to measure test-retest reliability. RESULTS The questionnaire was completed by 831 employed participants: 68% women, 53.5 (SD 8.9) years of age, with condition duration 7.7 (SD 8.0) years. The LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 satisfied Rasch model requirements, but Part 3 did not. A Rasch transformation scale and Reference Metric equating scales with the WALS were created. Concurrent validity was generally good (rs = 0.41-0.85) for the three scales, except the WHPLPS Part 3. Internal consistency (Person Separation Index values) was consistent with group use in all conditions, and individual use except for the LTCWSS and WHPLSP Parts 1 and 2 in FM. Test-retest reliability was excellent, with intraclass coefficients (2,1) of 0.80-0.96 for the three scales in the four conditions. DISCUSSION Reliable, valid versions of the British-English LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 are now available for use in the UK.
Collapse
Affiliation(s)
- Alison Hammond
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, West Yorkshire, UK
| | - Angela Ching
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, Greater Manchester, UK
- King's Clinical Trials Unit, Institute of Psychiatry, King's College London, London, UK
| | - Jennifer Parker
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Yeliz Prior
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Monique A M Gignac
- Institute of Work and Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rachel O'Brien
- College of Health, Well Being and Life Sciences, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
47
|
Hammond A, Tennant A, Brown T, Prior Y, Ching A, Parker J. Psychometric testing of the Rheumatoid Arthritis Work Instability Scale in employed people with fibromyalgia. Musculoskeletal Care 2023; 21:1434-1446. [PMID: 37768007 DOI: 10.1002/msc.1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE The aim of the study was to establish whether the Rheumatoid Arthritis Work Instability Scale (RA-WIS), in its current form, is applicable for use with employed people with fibromyalgia (FM) to identify the risk of work disability and need for work rehabilitation. METHODS Content validity was first investigated using cognitive debriefing interviews. Participants completed a postal questionnaire. Construct validity was assessed using Rasch analysis. Concurrent validity included testing between the RA-WIS and work (e.g., Workplace Activity Limitations Scale) and health (FM Impact Questionnaire-Revised (FIQ-R) scales. Two weeks later, participants were mailed a second questionnaire to measure test-retest reliability. RESULTS Interviews were conducted with 13 participants with FM. All RA-WIS items were considered very or extremely relevant by almost all participants, with only one suggesting other items (anxiety and brain fog). Questionnaire responses were analysed from 156 employed participants: 94% women; 45.71 (SD 10.05) years of age; with time since FM diagnosis 2.99 (4.17) years (symptom duration 8.36 (SD 7.16) years). The RA-WIS mostly satisfied Rasch model requirements and a Rasch transformation scale was created. Concurrent validity was generally good (rs = 0.55-0.66) with work scales and the FIQ-R. Internal consistency (Person Separation Index values) was consistent with group use in FM, not individual level use. Test-retest reliability was excellent, with intraclass coefficient (2, 1) = 0.90. DISCUSSION The RA-WIS is valid and reliable for group use in employed people with FM. However, further work is needed to develop a WIS for individual use in FM.
Collapse
Affiliation(s)
- Alison Hammond
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Tamara Brown
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | - Yeliz Prior
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | - Angela Ching
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- King's Clinical Trials Unit, Institute of Psychiatry, King's College London, London, UK
| | - Jennifer Parker
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| |
Collapse
|
48
|
Rizzo EA, Phillips RD, Brown JT, Leary EV, Keeney JA. Obesity Severity Predicts Patient Dissatisfaction After Total Knee Arthroplasty. J Arthroplasty 2023; 38:2492-2496. [PMID: 37276951 DOI: 10.1016/j.arth.2023.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Patient dissatisfaction has been reported in 15 to 20% of traditional total knee arthroplasty (TKA) procedures. While contemporary improvements may have positive effects on patient satisfaction, these may be offset by increasing obesity prevalence among patients who have knee osteoarthritis. We performed this study to determine whether obesity severity impacts patient-reported TKA satisfaction. METHODS We compared patient demographic characteristics, preoperative expectations, preoperative and minimum 1-year postoperative patient-reported outcome measures as well as postoperative satisfaction level among 229 patients (243 TKAs) who had World Health Organization (WHO) Class II or III obesity (group A), and 287 patients (328 TKAs) who had WHO classifications of normal weight, overweight, or Class I obesity (group B). RESULTS Group A patients were younger and had more severe preoperative back and contralateral knee pain, more frequent preoperative opioid medication use, and lower preoperative and postoperative patient-reported outcome measures (P < .01). A similar proportion of patients in both groups expected at least 75% improvement (68.5 versus 73.2%, P = .27). While satisfaction was higher than traditional reporting for both groups (89.4 versus 92.6%, P = .19), group A patients were less likely to be highly satisfied (68.1 versus 78.5%, P = .04) and were more likely to be highly dissatisfied (5.1 versus 0.9%, P < .01). CONCLUSIONS Patients who have Class II and III obesity report greater TKA dissatisfaction. Additional studies should help determine whether specific implant designs or surgical techniques may improve patient satisfaction or whether preoperative counseling should incorporate lower satisfaction expectations for patients who have WHO Class II or III obesity.
Collapse
Affiliation(s)
- Ennio A Rizzo
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Rachel D Phillips
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - J Turner Brown
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Emily V Leary
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James A Keeney
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| |
Collapse
|
49
|
De Lott LB, Ehrlich JR. Patient-Reported Outcomes for Ocular Myasthenia Gravis: Response. J Neuroophthalmol 2023; 43:e357. [PMID: 35421027 PMCID: PMC9500114 DOI: 10.1097/wno.0000000000001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, Michigan
Medicine, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan
Medicine, Ann Arbor, Michigan, USA
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, Michigan
Medicine, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan
Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
50
|
Duey AH, Dieterich JD, Patel AV, White CA, Cirino CM, Li T, Galatz LM, Parsons BO, Flatow EL, Cagle PJ. Superior migration of the humeral head does not significantly affect outcomes at an average of 11 years after total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:2493-2500. [PMID: 37276920 DOI: 10.1016/j.jse.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Superior migration of the humeral head has been linked with rotator cuff dysfunction and glenoid loosening after total shoulder arthroplasty (TSA). We aimed to determine if superior migration was associated with poor shoulder function following anatomic TSA at long-term follow-up. METHODS In this retrospective cohort study, we reviewed patients undergoing TSA by a single surgeon at an urban, academic institution. To study the effect of superior migration on TSA outcomes, we stratified the cohort by ≥ and <7 mm of acromiohumeral interval (AHI) and compared range of motion and patient reported outcomes (PROs). Clinical variables included preoperative and postoperative forward elevation (FE), internal rotation, external rotation, visual analog scale, American Shoulder and Elbow Surgeons shoulder score, and Simple Shoulder Text score. Radiographic variables included immediate postoperative and long-term follow-up AHI, lateral humeral offset, and glenoid loosening scores. RESULTS After applying exclusion criteria, 121 TSAs were included. The mean age was 63.9 ± 9.5 years, and 66 surgeries (55%) were in male patients. The mean follow-up for our cohort was 11.2 years (range, 5-26 years). Nine shoulders underwent revision surgery. All range of motion and PROs improved significantly from preoperative to the most recent postoperative follow-up. The mean AHI immediately following surgery was 10.9 ± 4.1 mm, while the mean AHI at most recent follow-up was 8.4 ± 3.5 mm. Glenoid loosening was observed in 29 (23.8%) shoulders at the most recent follow-up appointment. Although AHI correlated weakly with FE (r = 0.252; P = .006), we did not observe a clear threshold of migration which led to degraded function. Importantly, glenoid loosening was not related to AHI at long-term follow-up (P = .631). None of FE, internal rotation, external rotation, visual analog scale, American Shoulder and Elbow Surgeons shoulder score, Simple Shoulder Text, or revisions were significantly different between patients with ≥ and <7 mm of AHI. CONCLUSION Our results suggest that anatomic TSA provides durable improvements to pain, function, and PROs despite changes to the AHI.
Collapse
Affiliation(s)
- Akiro H Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James D Dieterich
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl M Cirino
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Troy Li
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L Flatow
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|