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Vassy JL, Brunette CA, Yi T, Harrison A, Cardellino MP, Assimes TL, Christensen KD, Devineni P, Gaziano JM, Gong X, Hui Q, Knowles JW, Muralidhar S, Natarajan P, Pyarajan S, Sears MG, Shi Y, Sturm AC, Whitbourne SB, Sun YV, Danowski ME. Design and pilot results from the Million Veteran Program Return Of Actionable Results (MVP-ROAR) Study. Am Heart J 2024; 276:99-109. [PMID: 38762090 DOI: 10.1016/j.ahj.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND As a mega-biobank linked to a national healthcare system, the Million Veteran Program (MVP) can directly improve the health care of participants. To determine the feasibility and outcomes of returning medically actionable genetic results to MVP participants, the program launched the MVP Return of Actionable Results (MVP-ROAR) Study, with familial hypercholesterolemia (FH) as an exemplar actionable condition. METHODS The MVP-ROAR Study consists of a completed single-arm pilot phase and an ongoing randomized clinical trial (RCT), in which MVP participants are recontacted and invited to receive clinical confirmatory gene sequencing testing and a telegenetic counseling intervention. The primary outcome of the RCT is 6-month change in low-density lipoprotein cholesterol (LDL-C) between participants receiving results at baseline and those receiving results after 6 months. RESULTS The pilot developed processes to identify and recontact participants nationally with probable pathogenic variants in low-density lipoprotein receptor (LDLR) on the MVP genotype array, invite them to clinical confirmatory gene sequencing, and deliver a telegenetic counseling intervention. Among participants in the pilot phase, 8 (100%) had active statin prescriptions after 6 months. Results were shared with 16 first-degree family members. Six-month ΔLDL-C (low-density lipoprotein cholesterol) after the genetic counseling intervention was -37 mg/dL (95% CI: -12 to -61; P = .03). The ongoing RCT will determine between-arm differences in this primary outcome. CONCLUSION While underscoring the importance of clinical confirmation of research results, the pilot phase of the MVP-ROAR Study marks a turning point in MVP and demonstrates the feasibility of returning genetic results to participants and their providers. The ongoing RCT will contribute to understanding how such a program might improve patient health care and outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID NCT04178122.
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Affiliation(s)
- Jason L Vassy
- VA Boston Healthcare System, Boston, MA; Departments of Medicine and Population Medicine, Harvard Medical School, Boston, MA.
| | - Charles A Brunette
- VA Boston Healthcare System, Boston, MA; Departments of Medicine and Population Medicine, Harvard Medical School, Boston, MA
| | - Thomas Yi
- VA Boston Healthcare System, Boston, MA
| | | | | | - Themistocles L Assimes
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; VA Palo Alto Health Care System, Palo Alto, CA
| | - Kurt D Christensen
- Departments of Medicine and Population Medicine, Harvard Medical School, Boston, MA; PRecisiOn Medicine Translational Research Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
| | | | - J Michael Gaziano
- VA Boston Healthcare System, Boston, MA; Departments of Medicine and Population Medicine, Harvard Medical School, Boston, MA
| | - Xin Gong
- VA Boston Healthcare System, Boston, MA
| | - Qin Hui
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA; VA Atlanta Healthcare System, Decatur, GA
| | - Joshua W Knowles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Sumitra Muralidhar
- Veterans Health Administration, Office of Research and Development, Washington, DC
| | - Pradeep Natarajan
- Departments of Medicine and Population Medicine, Harvard Medical School, Boston, MA; Division of Cardiology, Massachusetts General Hospital, Boston, MA; Broad Institute of Harvard and MIT, Cambridge, MA
| | | | | | | | | | | | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA; VA Atlanta Healthcare System, Decatur, GA
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Masurkar PP, Goswami S. Marginal health care expenditures and health-related quality of life burden in patients with migraine. J Manag Care Spec Pharm 2024; 30:1149-1159. [PMID: 39321120 DOI: 10.18553/jmcp.2024.30.10.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
BACKGROUND Migraine, characterized by recurrent, severe headaches, presents a considerable challenge for patients, health care systems, and employers in the United States. However, there is a lack of recent estimates of the economic and humanistic burden in this population. OBJECTIVE To assess the incremental burden of migraine on the total all-cause health care costs and health-related quality of life (HRQoL) in the United States, using data from the Medical Expenditure Panel Survey (MEPS). METHOD This retrospective cross-sectional study included adults (≥18 years) with and without migraine on the 2019-2021 full-year consolidated MEPS Household Component and Medical Provider Component data files. Descriptive analyses were conducted to compare health care expenditures and HRQoL among patients with and without migraine. To estimate the marginal effect of migraine on total health care spending, a two-part model generalized linear models was employed. HRQoL was evaluated using physical component summary (PCS) and mental component summary (MCS) scores based on the items in the Veterans Rand 12 Health Survey. A multivariate linear regression with log-link was conducted to understanding the factors associated with PCS and MCS scores. All analyses accounted for complex survey design of MEPS. RESULTS The study included approximately 1.14 million patients with migraine and approximately 184 million patients without migraine. The patients with migraine were majorly female (82.81%), aged 18-45 years (50.24%), and residing in the southern region of the United States (41.45%). A two-part model revealed that marginal total health care expenditures among patients with migraine were $6,078.56 (95% CI = $4,618.45-$8,141.34) higher compared with those without migraine. In terms of HRQoL, average PCS scores in migraine and nonmigraine groups were 39.79 and 42.15, respectively. The average MCS scores were 46.63 and 49.95 for migraine and nonmigraine groups, respectively. After adjusting for sociodemographic characteristics, multivariable linear regression models revealed that the PCS score was 2.14 (95% CI = 1.17-4.55) units lower, and the MCS score was 3.19 (95% CI = 2.51-6.07) units lower among patients with migraine compared with those without. CONCLUSIONS Migraine imposes a substantial economic burden on both health care payers and patients in the United States. Notably, prescription drugs make up nearly half of the overall cost. Additionally, patients with migraine experience lower levels of physical and mental HRQoL compared with those without migraine.
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Affiliation(s)
- Prajakta P Masurkar
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, now with Amgen, Thousand Oaks, CA
| | - Swarnali Goswami
- Department of Pharmacy Administration, University of Mississippi, University, now with Complete HEOR Solutions LLC, Chalfont, PA
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Young AS, Skela J, Siddarth P. The Characteristics of People with Serious Mental Illness Who are at High Risk for Hospitalization or Death. Community Ment Health J 2024; 60:1243-1246. [PMID: 38653869 DOI: 10.1007/s10597-024-01281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
Many individuals with serious mental illness are at high risk for hospitalization or death due to inadequate treatment of medical conditions or unhealthy behaviors. The authors describe demographic and clinical characteristics associated with increased risk in this population. Electronic data were obtained for individuals in treatment at a large Veterans' healthcare system who were at high risk according to a validated model. A random sample of these individuals was assessed in person. Multivariable regressions estimated the effect of numerous demographic, health, and clinical characteristics on risk. Emergency visits and hospitalizations were common. Greater risk was associated with being male, not married, and having more diagnoses. While risk varied by race, this effect was no longer significant after controlling for other factors. Health-related quality of life worsened with increasing risk. Routine data identify a large population of high-risk individuals who may benefit from outreach to provide healthcare services.
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Affiliation(s)
- Alexander S Young
- Desert Pacific Mental Illness Research Education and Clinical Center, Greater Los Angeles Veterans Healthcare System, 11301 Wilshire Blvd., 210A, Los Angeles, CA, USA.
- Department of Psychiatry, School of Medicine, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, USA.
| | - Jessica Skela
- Department of Psychiatry, School of Medicine, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, USA
| | - Prabha Siddarth
- Desert Pacific Mental Illness Research Education and Clinical Center, Greater Los Angeles Veterans Healthcare System, 11301 Wilshire Blvd., 210A, Los Angeles, CA, USA
- Department of Psychiatry, School of Medicine, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, USA
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Dieter V, Janssen P, Krauss I. Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e54356. [PMID: 39250181 PMCID: PMC11420596 DOI: 10.2196/54356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/16/2024] [Accepted: 06/12/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply. OBJECTIVE This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis. METHODS This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately. RESULTS A total of 61 participants were included (IG: n=30, 49%; CG: n=31, 51%; male: n=31, 51%; female: n=30, 49%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5% (899/972) of all scheduled exercise sessions. CONCLUSIONS Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269.
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Affiliation(s)
- Valerie Dieter
- Department of Sports Medicine, Medical Clinic, University Hospital Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tübingen, Germany
| | - Pia Janssen
- Department of Sports Medicine, Medical Clinic, University Hospital Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tübingen, Germany
| | - Inga Krauss
- Department of Sports Medicine, Medical Clinic, University Hospital Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tübingen, Germany
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Anwar FN, Roca AM, Wolf JC, Loya AC, Medakkar SS, Federico VP, Singh K. The influence of preoperative 12-item veterans rand physical component scores on outcomes following cervical disc replacement. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08392-6. [PMID: 39223431 DOI: 10.1007/s00586-024-08392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 06/14/2024] [Accepted: 06/30/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To evaluate the influence of preoperative VR-12 physical component scores (PCS) on outcomes following cervical disc replacement (CDR). METHODS Patients undergoing elective CDR were retrospectively identified. Patient-reported outcomes (PROs) of interest included VR-12 PCS/VR-12 Mental Component Score (MCS)/9-Item Patient Health Questionnaire (PHQ-9)/Short Form-12 (SF-12) PCS and MCS/Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF)/Visual Analog Scale-Neck Pain (VAS-NP)/VAS-Arm Pain (VAS-AP)/Neck Disability Index (NDI). Baseline up to two-year postoperative scores were obtained (average follow-up: 9.2 ± 6.8months). Two cohorts were created: VR-12 PCS < 35 or VR-12 PCS ≥ 35. Improvements in scores from baseline to six weeks postoperatively and to final follow-up were calculated. Changes in scores were compared to previously reported thresholds to determine rates of minimum clinically important difference (MCID). RESULTS Of 127 patients, 64 were in the worse VR-12 PCS group. Patients with better VR-12 PCS were more likely to have private insurance (p = 0.034). When accounting for insurance differences, the worse VR-12 PCS group reported inferior NDI/VAS-NP/PHQ-9/PROMIS-PF/VR-12 PCS/SF-12 PCS at six weeks and final follow-up (p ≤ 0.015, all). The worse VR-12 PCS group reported greater improvements in VAS-AP and VR-12 PCS by six weeks and in NDI/VR-12 MCS/VR-12 PCS/SF-12 PCS by final follow-up (p ≤ 0.026, all). Patients with worse VR-12 PCS reported greater MCID achievement for VR-12 MCS and SF-12 PCS (p ≤ 0.034, both). CONCLUSION Following surgery, patients with worse VR-12 PCS report greater improvements in PROs, highlighting the increased relative impact of surgery for patients with worse baseline physical function. These findings can be used to optimize patient experience perioperatively and inform postoperative expectations.
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Affiliation(s)
- Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Jacob C Wolf
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, 3333 N. Green Bay Rd., North, Chicago, IL, 60064, USA
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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Vu K, Deng H, Kelter B, Shepler L, Stewart B, Wolf S, Mandell S, Bamer A, Mehta A, Kazis L, Ryan C, Schneider J. Chronic Use of Prescription Pain Medication and Outcomes in Patients With Burn Injury: A Burn Model System National Database Study. Am J Phys Med Rehabil 2024; 103:805-810. [PMID: 38363714 PMCID: PMC11317539 DOI: 10.1097/phm.0000000000002448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE This study attempts to examine long-term pain medication usage after burn injury and its association with functional and psychosocial outcomes. DESIGN This is a multicenter retrospective cohort study utilizing the Burn Model System National Longitudinal Database. Participants injured from 2015 to 2021 were divided into two groups, those taking and not taking prescription pain medication at 12 mos after injury. Regression analyses examined associations between pain medication use and outcomes at 12 mos, adjusting for demographics, burn size, length of hospital stay, and preinjury pain medication use and employment status. Outcomes included VR-12 Physical and Mental Component Summary scores Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores, Satisfaction with Life Scale, and employment status. RESULTS Of 358 participants analyzed, prescription pain medication use was associated with worse outcomes at 12 mos: Physical Component Summary (β = -7.11, P < 0.001), Mental Component Summary (β = -6.01, P < 0.001), and Patient-Reported Outcomes Measurement Information System Depression (β = 4.88, P < 0.001) and Anxiety (β = 6.16, P < 0.001). Satisfaction with Life Scale was not significantly associated with pain medication use ( P = 0.069) and those taking pain medication were 52% less likely to be employed at 12 mos ( P = 0.035). CONCLUSIONS There is a significant association between prescription pain medication use and worse physical, mental, and employment outcomes at 12 mos after burn injury.
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Affiliation(s)
- Kevin Vu
- From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts (KV, HD, LS, LK, JS); Mass General Cancer Center, Massachusetts General Hospital, Boston, Massachusetts (BK); Division of Trauma, Burn and Critical Care Surgery, University of Washington, Seattle, Washington (BS); Harborview Injury Prevention and Research Center, Seattle, Washington (BS); Department of Surgery, University of Texas Medical Branch, Galveston, Texas (SW); Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (SM); Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (AB); Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts (AM); Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts (LK); Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation Network, Charlestown, Massachusetts (LK, JS); Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (CR); Shriners Hospitals for Children-Boston, Boston, Massachusetts (CR); and Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (JS)
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Cheng R, Blevins J, Debbi EM, Chiu YF, Gonzalez Della Valle A, Lee GC. Contemporary Isolated Bearing Exchange for the Management of Hip Instability Following Primary Total Hip Arthroplasty. J Arthroplasty 2024; 39:S173-S177. [PMID: 38522800 DOI: 10.1016/j.arth.2024.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Isolated ball and liner exchanges (IBLEs) can be performed to increase hip joint stability, but historical results have been mixed due to a lack of head size options or dual mobility articulations. The purpose of this study was to evaluate the contemporary results of IBLEs in patients who have instability following primary total hip arthroplasty (THA). METHODS We retrospectively reviewed 65 primary THAs from 2016 to 2020 with hip instability undergoing IBLE or conversion to dual mobility articulation. There were 31 men and 34 women who had an average age of 70 years (range, 26 to 92). The mean time to revision from primary was 40.1 months (range, 1 to 120). In 52 cases, IBLE was performed using conventional bearings, while 13 hips were converted to dual mobility. Radiographic factors, including acetabular component orientation, reproduction of hip joint offset, leg lengths, and outcomes such as recurrent instability requiring subsequent revision and patient-reported outcome measure, were recorded and compared. RESULTS There were 12 (18.4%) hips that experienced subsequent instability and required another revision (17.3% ball and liner exchange versus 23.1% dual mobility articulation, P = .615). The mean time to rerevision for instability was 17.1 months. There were no significant differences in either acetabular component anteversion (P = .25) or restoration of hip joint offset (P = .87) in patients who required another revision for instability compared to those who did not, respectively. At 1 year, patients undergoing conventional bearing exchange reported higher Hip Dysfunction Osteoarthritis Outcome Score for Joint Replacements (P = .002) and Veterans Rand physical component (P = .023) scores compared to those who underwent a conversion to dual mobility articulation. Only age > 75 years at the time of surgery was associated with increased risk for dislocation (odds ratio 7.2, confidence interval 1.2 to 43.7, P = .032). CONCLUSIONS Isolated bearing exchanges for instability following THA remained at high risk for subsequent instability. Conversion to dual mobility articulations did not reduce the risk of reoperation.
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Affiliation(s)
- Ryan Cheng
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jason Blevins
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | | | - Gwo-Chin Lee
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Vederhus JK, Timko C, Birkeland B, Haugland SH, Gabrielsen KB. Validation of an ultra-short global quality of life scale in a large population-based health survey. PLoS One 2024; 19:e0307539. [PMID: 39208302 PMCID: PMC11361658 DOI: 10.1371/journal.pone.0307539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/05/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Quality of life (QoL) assessment is essential in health-related research and clinical settings, offering insights into individuals' well-being and functioning. This study validated the Essential QoL-3 (EQoL-3), an ultra-short scale assessing essential dimensions of QoL, for use in epidemiological research and clinical settings. METHODS Data from a 2021 national survey in Norway (N = 17,487) were used. Three items on the EQoL-3 assess life satisfaction, happiness, and meaningfulness on a 0-10 scale. Discriminant validity was assessed by comparing the EQoL-3 with the Satisfaction with Life Scale (SWLS) and by examining latent mean differences between individuals with adverse life experiences (ALE+) and those without such experiences (ALE-). Convergent validity was evaluated through latent regression analyses comparing the EQoL-3 with a perceived mastery scale and a mental distress scale. RESULTS The discriminant validity of the EQoL-3 was less than optimal when compared with the SWLS. Nonetheless, a multigroup confirmatory factor analysis revealed that the EQoL-3 score was 1.42 (95% CI = 1.33-1.50, p < 0.001) lower in the ALE+ group compared to the ALE- group, providing support for discriminant validity. Convergent validity was established with a positive association between EQoL-3 and mastery (β = 1.75, 95% CI = 1.70-1.80, p < 0.001) and a negative association between the EQoL-3 and mental distress (β = -2.64, 95% CI = -2.71/-2.59, p < 0.001). CONCLUSIONS The EQoL-3 is a reliable measure of QoL. Its streamlined nature facilitates quick administration, making it a valuable tool for clinicians and researchers in diverse settings. Its inclusion of the eudaimonic dimension, as well as its exclusion of health items in the measure itself, distinguishes it from traditional HQoL measures, making it suitable for mental health and substance use disorder research.
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Affiliation(s)
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs Health Care System and Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Bente Birkeland
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
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Luger M, Holzbauer M, Klotz MC, Fellner F, Gotterbarm T. Cementless short stem total hip arthroplasty in patients older than 75 years: is it feasible? Arch Orthop Trauma Surg 2024; 144:3715-3727. [PMID: 38967777 PMCID: PMC11417050 DOI: 10.1007/s00402-024-05425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND In recent years, the indication for cementless short stem total hip arthroplasty (THA) has been widened to elderly patients as they might profit by the advantages of the short-curved implant design as well. Therefore, this study was conducted to evaluate the clinical and radiological outcome of a cementless short stem in elderly patients (≥ 75 years) compared to a young control group (≤ 60 years). METHODS A retrospective cohort of 316 THAs performed between 2014 and 2017 was prospectively examined. In all patients a cementless, curved short stem and press-fit cup (Fitmore® stem; Allofit®/-S cup; both ZimmerBiomet, Warsaw, IN, USA) were implanted via a minimally-invasive anterolateral approach. Clinical and radiological outcome as well as rate of complications and revision were assessed. RESULTS In total, 292 patients have been included for analysis of complications and revisions (Øfollow-up: 4.5 years) and 208 patients for clinical and radiological outcome (Øfollow-up: 4.4 years). Complication rate was significantly increased in elderly patients (13.7% vs. 5.8%, p = 0.023), while the revision rate was increased without statistical significance (5.2% vs. 2.2%, p = 0.169). Periprosthetic fractures occurred significantly higher in the elderly patients (5.2% vs. 0.7%; p = 0.026). Both groups showed a comparable clinical outcome in the Harris Hip Score (93.7 vs. 91.9; p = 0.224), Oxford Hip Score (44.5 vs. 43.7; p = 0.350), Forgotten Joint Score (81.7 vs. 81.5; p = 0.952) and WOMAC (7.4 vs. 9.3; p = 0.334). CONCLUSION Cementless short stem total hip arthroplasty shows a comparable clinical and radiological outcome in patients over 75 years of age compared to younger patients under 60 years of age. However, cementless shorts stem THA shows an increased rate of overall complications and periprosthetic fractures in elderly patients over 75 years of age. Cemented fixation of the femoral component should be considered in patients over 75 years of age. LEVEL OF EVIDENCE III Case-controlled study. TRIAL REGISTRATION Observational study without need for trial registration due to ICMJE criteria.
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
| | - Matthias Holzbauer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Matthias C Klotz
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- Marienkrankenhaus Soest, Orthopedics and Trauma Surgery, Widumgasse 5, 59494, Soest, Germany
| | - Franz Fellner
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- Central Radiology Institute, Kepler University Hospital, 4020, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
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Cheng R, Debbi EM, Chalmers BP, Chiu YF, Rodriguez JA, Lee GC. Clinical Outcomes of Isolated Polyethylene Exchange Versus Full Component Revision for the Management of Instability Following Total Knee Arthroplasty. J Arthroplasty 2024; 39:S270-S274. [PMID: 38631514 DOI: 10.1016/j.arth.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Instability following total knee arthroplasty (TKA) is a common cause for revision. Isolated polyethylene exchange (IPE) can be performed to increase knee joint stability, but results have been mixed. The purpose of this study was to compare the survivorship and patient-reported outcomes of patients undergoing revision TKA for instability with IPE versus full component revision. METHODS We reviewed 280 primary TKAs undergoing revision TKA for instability. There were 181 knees that underwent revision with IPE, compared to 99 knees treated with full component revision. The mean follow-up was 32.8 months (range, 24.8 to 82.5). Patient demographics, radiographic parameters, prosthesis constraints, reoperations for instability, and patient-reported outcomes were compared. RESULTS The survivorship for instability was significantly higher at 2 years (99 versus 92%, P = .024) and 5 years (94 versus 84%, P = .024) for patients undergoing full component revision. Although there was no difference in Knee Injury and Osteoarthritis Outcome Score for Joint Replacements and Veterans RAND 12 physical component scores between the 2 groups at 6 weeks, 1 year, and 2 years after surgery, full revision patients reported greater pain relief (P = .006) and greater improvements in Veterans RAND 12 physical component scores (P = .027) at 1 year and Knee Injury and Osteoarthritis Outcome Score for Joint Replacements scores at 2 years (P = .017) compared to IPE patients. Men were associated with an increased risk for recurrent instability following IPE (hazard ratio 3.3, 95% confidence interval: [1.0 to 10.6]). CONCLUSIONS Isolated polyethylene exchange was not as reliable or durable compared to full component revision for the management of postoperative instability. These procedures should only be reserved in cases with competent collaterals and when component position, offset, and rotation are optimized.
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Affiliation(s)
- Ryan Cheng
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jose A Rodriguez
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Gwo-Chin Lee
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Hoffer AJ, McConkey MO, Lodhia P, Leith JM. Not all patient-reported outcome measures are equivalent at two years compared to one year after anterior cruciate ligament reconstruction based on a retrospective analysis. J ISAKOS 2024; 9:510-518. [PMID: 38492849 DOI: 10.1016/j.jisako.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE This article aims to assess for clinically important differences in patient-reported outcome measures (PROMs) at one and two years post anterior cruciate ligament reconstruction (ACLR). METHODS A retrospective comparison of prospectively collected PROMs for a single cohort who underwent a primary ACLR with or without associated meniscal surgery from 2016 to 2020 was assessed. Six externally validated PROMs were collected preoperatively and at standardized times postoperatively. Descriptive statistics and paired equivalence testing of PROMs at one and two years after surgery was completed using previously published or calculated minimal clinically important differences as upper and lower equivalence limits. A repeated measures analysis of PROMs that were not clinically equivalent at one and two years after surgery was completed to assess for a clinically significant difference. Subgroup analyses based on sex, age and associated meniscal injury were completed. RESULTS One-hundred and forty-five participants with a mean age of 28.7 years (standard deviation: 9.9 years) were included in the final analysis. All PROMs were clinically equivalent at two years compared to one year after ACLR except the quality of life and sport and recreation domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The quality of life (mean difference (MD):12.3, P < 0.01, effect size (η2): 0.65) and sport and recreation (MD: 8.78, P < 0.01, η2: 0.50) domains of the KOOS were clinically different at two years compared to one year postoperatively. No major differences were found in the subgroup analyses compared to the entire included sample. CONCLUSION While most PROMs were equivalent at two years compared to one year after ACLR, the quality of life and sport and recreation domains of the KOOS, which reflect knee performance during higher demand activities, exhibited a clinically significant difference. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alexander J Hoffer
- Department of Surgery, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
| | - Mark O McConkey
- Department of Orthopaedics, Gordon and Leslie Diamond Health Care Centre 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Parth Lodhia
- Department of Orthopaedics, Gordon and Leslie Diamond Health Care Centre 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jordan M Leith
- Department of Orthopaedics, Gordon and Leslie Diamond Health Care Centre 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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12
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Moore BP, Forrister DZ, Somerson JS. A threshold of lower preoperative mental health is associated with decreased achievement of comfort and capability benchmarks following rotator cuff repair: a retrospective cohort study. J Shoulder Elbow Surg 2024; 33:e403-e414. [PMID: 38325556 DOI: 10.1016/j.jse.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Preoperative biomedical patient characteristics are known to affect the time to achievement of clinically significant outcomes (CSOs) following arthroscopic rotator cuff repair (RCR). However, less is known about the association between preoperative mental status and the time to achievement of CSOs. We hypothesize that higher preoperative mental status is associated with faster achievement of CSOs following arthroscopic RCR. METHODS Patient-reported outcome measures (PROMs) were collected preoperatively and at postoperative intervals up to 2 years. PROMs included pain visual analog scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), and Veterans RAND 12-Item Health Survey (VR-12) scores. Threshold values for CSOs were obtained from previous literature. Mean time to achievement of CSOs was calculated using a Kaplan-Meier analysis. A Cox proportional hazards regression analysis was performed to identify preoperative variables associated with earlier achievement of CSOs. RESULTS Sixty-nine patients with an average age of 59 ± 8 years were included. Patients with higher preoperative mental status, as measured by VR-12 mental component summary (MCS), experienced significantly earlier substantial pain improvement postoperatively (P = .0471). Patients with higher preoperative mental status also achieved CSOs for physical health at earlier time points (P = .0187). Preoperative VR-12 MCS scores ≥ 40 were associated with earlier achievement of CSOs for pain (P = .0005) and physical health (P = .0015). Ninety-eight percent of patients with preoperative MCS scores ≥40 achieved acceptable pain relief at 4.5 months vs. 56% of all other patients at 12.3 months (P = .0001). Patients with preoperative MCS scores ≥40 experienced significantly faster improvement in physical health compared to patients with preoperative MCS scores <40 (P = .0006). CONCLUSIONS Higher preoperative mental status, especially a preoperative MCS score ≥40, is associated with significantly faster improvement in pain and physical function following arthroscopic RCR. Nearly all patients (98%) with preoperative MCS score ≥40 achieved an acceptable state of pain relief compared with only 56% of patients with preoperative MCS score <40. These findings indicate that a holistic approach with equal consideration of preoperative mental health and rotator cuff pathophysiology is vital to the successful management of rotator cuff tendinopathy.
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Affiliation(s)
- Brady P Moore
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - David Z Forrister
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
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Park FS, Pang JC, Yang CD, Breziner D, Manzanarez-Felix KO, Hoyos JP, Ruiz AM, Alvarez CA, Swentek LY, Chin TL. Surgical Care Through a Community Free Clinic-Ambulatory Surgical Center Partnership. Am Surg 2024:31348241262433. [PMID: 39028113 DOI: 10.1177/00031348241262433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Disparities secondary to underinsurance present throughout the surgical care continuum. Community free clinics are uniquely capable to provide health care services to the medically underserved, but surgery often falls outside their scope of care. METHODS Retrospective chart review was conducted on consecutive community free clinic patients receiving free surgical services via referral to a partnering ambulatory surgery center between March 2016 and September 2021. Those with documented contact information were recruited 1-3 years post-procedure for long-term quality-of-life (LTQOL) outcomes assessment via modified Veterans RAND 12-item health survey. RESULTS Of 142 included patients, 95.7% identified as Hispanic/Latino and 75.6% were uninsured. Twelve patients had cancerous or precancerous lesions detected and/or removed through diagnostic or definitive procedures. 3.5% experienced postoperative complication including bacterial (n = 2) or fungal (n = 1) surgical site infection and wound dehiscence (n = 2). With a 48.9% response rate, no significant differences in sociodemographic or clinical characteristics were found between surveyed vs non-surveyed patients. Of surveyed patients, 59.7% and 52.2% reported pre-/post-operative improvement in physical health and emotional health, respectively. DISCUSSION Free diagnostic screening procedures provided timely diagnoses while free definitive surgeries safely and positively impacted long-term patient-reported physical health. Longitudinal, multidisciplinary follow-up and social support may be warranted to concurrently improve emotional and mental health in similarly underinsured populations.
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Affiliation(s)
- Flora S Park
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Jonathan C Pang
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Irvine School of Medicine, University of California, Orange, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Christopher D Yang
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Dalia Breziner
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Karlos O Manzanarez-Felix
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Juan Pablo Hoyos
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Andres M Ruiz
- Department of General Surgery, Huntington Health, Pasadena, CA, USA
| | - Claudia A Alvarez
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Lourdes Y Swentek
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Theresa L Chin
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Irvine School of Medicine, University of California, Orange, CA, USA
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Archer KR. Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury: The Results of a Randomized Controlled Trial. J Bone Joint Surg Am 2024; 106:1300-1308. [PMID: 38781313 DOI: 10.2106/jbjs.23.01234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Lower-extremity injuries can result in severe impairment and substantial years lived with a disability. Persistent pain and psychological distress are risk factors for poor long-term outcomes and negatively influence the recovery process following a traumatic injury. Cognitive-behavioral therapy (CBT) interventions have the potential to address these risk factors and subsequently improve outcomes. This study aimed to evaluate the effect of a telephone-delivered cognitive-behavioral-based physical therapy (CBPT) program on physical function, pain, and general health at 12 months after hospital discharge following lower-extremity trauma. The CBPT program was hypothesized to improve outcomes compared with an education program. METHODS A multicenter, randomized controlled trial was conducted involving 325 patients who were 18 to 60 years of age and had at least 1 acute orthopaedic injury to the lower extremity or to the pelvis or acetabulum requiring operative fixation. Patients were recruited from 6 Level-I trauma centers and were screened and randomized to the CBPT program or the education program early after hospital discharge. The primary outcome was the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scale. The secondary outcomes were objective physical function tests (4-square step test, timed stair ascent test, sit-to-stand test, and self-selected walking speed test), PROMIS Pain Intensity and Pain Interference, and the Veterans RAND 12-Item Health Survey. Treatment effects were calculated using targeted maximum likelihood estimation, a robust analytical approach appropriate for causal inference with longitudinal data. RESULTS The mean treatment effect on the 12-month baseline change in PROMIS PF was 0.94 (95% confidence interval, -0.68 to 2.64; p = 0.23). There were also no observed differences in secondary outcomes between the intervention group and the control group. CONCLUSIONS The telephone-delivered CBPT did not appear to yield any benefits for patients with traumatic lower-extremity injuries in terms of physical function, pain intensity, pain interference, or general health. Improvements were observed in both groups, which questions the utility of telephone-delivered cognitive-behavioral strategies over educational programs. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Shah KP, Khan SS, Baldridge AS, Grady KL, Cella D, Goyal P, Allen LA, Smith JD, Lagu TC, Ahmad FS. Health Status in Heart Failure and Cancer: Analysis of the Medicare Health Outcomes Survey 2016-2020. JACC. HEART FAILURE 2024; 12:1166-1178. [PMID: 37930290 DOI: 10.1016/j.jchf.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND People with heart failure (HF) and cancer experience impaired physical and mental health status. However, health-related quality of life (HRQOL) has not been directly compared between these conditions in a contemporary population of older people. OBJECTIVES The authors sought to compare HRQOL in people with HF vs those with lung, colorectal, breast, and prostate cancers. METHODS The authors performed a pooled analysis of Medicare Health Outcomes Survey data from 2016 to 2020 in participants ≥65 years of age with a self-reported history of HF or active treatment for lung, colon, breast, or prostate cancer. They used the Veterans RAND-12 physical component score (PCS) and mental component score (MCS), which range from 0-100 with a mean score of 50 (based on the U.S. general population) and an SD of 10. The authors used pairwise Student's t-tests to evaluate for differences in PCS and MCS between groups. RESULTS Among participants with HF (n = 71,025; 54% female, 16% Black), mean PCS was 29.5 and mean MCS 47.9. Mean PCS was lower in people with HF compared with lung (31.2; n = 4,165), colorectal (35.6; n = 4,270), breast (37.7; n = 14,542), and prostate (39.6; n = 17,670) cancer (all P < 0.001). Participants with HF had a significantly lower mean MCS than those with lung (31.2), colon (50.0), breast (52.0), and prostate (53.0) cancer (all P < 0.001). CONCLUSIONS People with HF experience worse HRQOL than those with cancer actively receiving treatment. The pervasiveness of low HRQOL in HF underscores the need to implement evidence-based interventions that target physical and mental health status and scale multidisciplinary clinics.
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Affiliation(s)
- Kriti P Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail S Baldridge
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Kathleen L Grady
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Patient-Centered Outcomes, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Parag Goyal
- Program for the Care and the Study of the Aging Heart, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tara C Lagu
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Health Information Partnerships, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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16
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Hander NR, Krohn J, Kohl F, Heming M, Erim Y, Herold R, Kröger C, Hansmann M, Köllner V, Chrysanthou S, Wegewitz U, Schröder UB, Feißt M, Herrmann K, Rothermund E. [Psychotherapeutic consultation at work: associations between company size and psychosomatic health]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:772-782. [PMID: 38896152 PMCID: PMC11230955 DOI: 10.1007/s00103-024-03904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The utilization of psychotherapeutic consultation at work (PT-A) has so far been investigated in large enterprises (LEs). These differ structurally from small(est) and medium-sized enterprises (SMEs). Differences in the user profiles of a PT‑A with regard to psychosomatic health, work-related self-efficacy, and work ability depending on company size have hardly been investigated. This study also examined differences in the employees' perception of the psychosocial safety climate (PSC) in the company, which represents management's efforts to promote mental health. METHODS As part of the Early Intervention in the Workplace intervention study called "friaa", employees from LEs and SMEs interested in a PT‑A were surveyed throughout Germany from September 2021 to January 2023. Using t‑ and χ2-tests, differences between employees in LEs (n = 439) and SMEs (n = 109) were examined with regard to the ICD-10 F diagnostic code ("International Statistical Classification of Diseases and Related Health Problems"; mental and behavioral disorders), depression (PHQ-9), anxiety (GAD-2), level of functioning (GAF), somatic symptom burden (SSS-8), health (VR-12), ability to work (WAI), self-efficacy (SOSES), and psychosocial safety climate (PSC-4). The association between these variables and especially the PSC‑4 were investigated using correlation analysis. RESULTS Both groups showed similar levels of stress. From the employees' perspective, psychosocial issues were addressed significantly more frequently in LEs than in SMEs with a medium effect size. The study provided initial indications that in LEs there were positive correlations of the PSC‑4 with SOSES and WAI and negative ones with PHQ‑9 and SSS‑8. DISCUSSION The comparable psychological strain on employees in LEs and SMEs points to the need for behavioral and structural preventive measures regardless of the company size. Mainly in SMEs, organizational communication of psychosocial health should be given greater priority.
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Affiliation(s)
- Nicole R Hander
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Albert-Einstein-Alle 23, 89081, Ulm, Baden-Württemberg, Deutschland.
| | - Julia Krohn
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Albert-Einstein-Alle 23, 89081, Ulm, Baden-Württemberg, Deutschland
| | - Fiona Kohl
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heinrich-Universität Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Deutschland
| | - Meike Heming
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heinrich-Universität Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Deutschland
| | - Yesim Erim
- Psychosomatische und Psychotherapeutische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bayern, Deutschland
| | - Regina Herold
- Psychosomatische und Psychotherapeutische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bayern, Deutschland
| | - Christoph Kröger
- Abteilung Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim, Hildesheim, Niedersachsen, Deutschland
| | - Marieke Hansmann
- Abteilung Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim, Hildesheim, Niedersachsen, Deutschland
| | - Volker Köllner
- Medizinische Klinik mit Schwerpunkt Psychosomatik, Forschungsgruppe Psychosomatische Rehabilitation, Charité Universitätsmedizin Berlin, Berlin, Berlin, Deutschland
| | - Sophia Chrysanthou
- Medizinische Klinik mit Schwerpunkt Psychosomatik, Forschungsgruppe Psychosomatische Rehabilitation, Charité Universitätsmedizin Berlin, Berlin, Berlin, Deutschland
| | - Uta Wegewitz
- FG 3.5 Evidenzbasierte Arbeitsmedizin, Betriebliches Gesundheitsmanagement, b a u a: Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin, Berlin, Deutschland
| | - Ute B Schröder
- FG 3.5 Evidenzbasierte Arbeitsmedizin, Betriebliches Gesundheitsmanagement, b a u a: Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin, Berlin, Deutschland
| | - Manuel Feißt
- Institut für Medizinische Biometrie, Universitätsklinikum Heidelberg, Heidelberg, Baden-Württemberg, Deutschland
| | - Kristin Herrmann
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Albert-Einstein-Alle 23, 89081, Ulm, Baden-Württemberg, Deutschland
| | - Eva Rothermund
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Albert-Einstein-Alle 23, 89081, Ulm, Baden-Württemberg, Deutschland
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17
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Cheng R, Mantena Y, Chiu YF, Kahlenberg CA, Figgie MP, Driscoll DA. To Stage or Not to Stage? Comparison of Patient-Reported Outcomes, Complications, and Discharge Disposition After Staged and Simultaneous Bilateral Posterior Total Hip Arthroplasty. J Arthroplasty 2024; 39:1752-1757. [PMID: 38216001 DOI: 10.1016/j.arth.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 12/23/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Patients who have bilateral hip arthritis can be treated with bilateral total hip arthroplasty (bTHA) in either a staged or simultaneous fashion. The goal of this study was to determine whether staged and simultaneous posterior bTHA patients differ in regard to (1) patient-reported outcome measures, (2) 90-day complication rates, and (3) discharge dispositions and cumulative lengths of stay. METHODS Patients who (1) underwent simultaneous bTHA or staged bTHA (within 12 months) using the posterior approach, and (2) completed preoperative and 1-year postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement surveys were included in the study. A total of 266 patients (87 simultaneous bTHA and 179 staged bTHA) were included. Chart review was performed to collect patient-level variables, postoperative complications, discharge dispositions, and lengths of stay. RESULTS Staged bTHA patients had higher Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Lower Extremity Activity Scale, and Veterans RAND 12-Item Health Survey physical component scores compared to simultaneous bTHA patients at 6 weeks after surgery (P = .019, .006, and .008, respectively), but these differences did not meet the minimal clinically important difference threshold for any questionnaire. Simultaneous bTHA was associated with higher rate of periprosthetic fractures (P = .034) and discharge to a location other than home (P < .001). CONCLUSIONS There were statistically significant, but likely not clinically meaningful differences in patient-reported outcomes for staged and simultaneous bTHA patients at 6 weeks after surgery. Surgeons should be aware of the higher periprosthetic fracture risk and greater likelihood of discharge to a rehabilitation facility associated with simultaneous bTHA. Further research should aim to understand which patients may benefit most from simultaneous bTHA.
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Affiliation(s)
- Ryan Cheng
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yasoda Mantena
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Cynthia A Kahlenberg
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Mark P Figgie
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Daniel A Driscoll
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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18
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Guild GN, Najafi F, DeCook CA, Levit C, McConnell MJ, Bradbury TL, Naylor BH. Evaluating Knee Recovery Beyond Patient Reports: A Comparative Study of Smart Implantable Device-Derived Gait Metrics Versus Patient-Reported Outcome Measures in Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00578-3. [PMID: 38852690 DOI: 10.1016/j.arth.2024.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Total Knee Arthroplasty (TKA) is frequently performed for advanced osteoarthritis, with patient-reported outcome measures (PROMs) traditionally reporting on efficacy. These subjective evaluations, although useful, may inaccurately reflect post-TKA activity levels. With technological advancements, smart implantable devices (SIDs) offer objective, real-time gait metrics, potentially providing a more accurate postoperative recovery assessment. This study compares these objective metrics with PROMs to evaluate TKA success more effectively. METHODS We conducted a retrospective cohort study with 88 participants undergoing TKA using a SID. Eligible patients were aged 18 years or older and had advanced osteoarthritis. We excluded those who had bilateral TKAs, joint infections, or neuromuscular disease. The SID system collected daily gait metrics, including step count, distance traveled, walking speed, stride length, cadence, and functional knee range of motion. The PROMs, including Knee Injury and Osteoarthritis Outcome Score-Joint Replacement, Veterans Rand 12 Physical Component Summary, and Veterans Rand 12 Mental Component Summary, were analyzed against SID gait metrics. Among the 88 patients, 80 provided continuous data over 12 weeks. RESULTS All gait metrics, except stride length, significantly increased at the 12-week point (P < .05). The PROMs also significantly improved postoperatively (P < .05). Initial low positive correlations between 12-week PROMs and SID metrics decreased after adjusting for demographic variables, leaving only weak correlations between the Veterans Rand 12 Physical Component Summary and Knee Injury and Osteoarthritis Outcome Score-Joint Replacement with functional knee range of motion (r = 0.389, P = .002; r = 0.311, P = .014, respectively), and Veterans Rand 12 Mental Component Summary with step count (r = 0.406, P = .001) and distance traveled (r = 0.376, P = .003). CONCLUSIONS This study indicates that both PROMs and SID gait metrics show significant improvements post-TKA, though they correlate weakly with each other, suggesting a possible discrepancy between perceived recovery and actual functional improvement. The SID gait metrics might provide a valuable addition to traditional PROMs by offering an objective representation of physical capabilities unaffected by patient compliance or subjective perceptions of recovery. Further research is needed to validate these findings in larger populations and to explore whether integrating SID metrics can enhance long-term functional outcomes.
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Affiliation(s)
- George N Guild
- Arthritis and Total Joint Specialists, Northside Hospital Forsyth, Cumming, Georgia
| | - Farideh Najafi
- Arthritis and Total Joint Specialists, Northside Hospital Forsyth, Cumming, Georgia
| | - Charles A DeCook
- Arthritis and Total Joint Specialists, Northside Hospital Forsyth, Cumming, Georgia
| | - Courtney Levit
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Mary Jane McConnell
- Arthritis and Total Joint Specialists, Northside Hospital Forsyth, Cumming, Georgia
| | - Thomas L Bradbury
- Arthritis and Total Joint Specialists, Northside Hospital Forsyth, Cumming, Georgia
| | - Brandon H Naylor
- Arthritis and Total Joint Specialists, Northside Hospital Forsyth, Cumming, Georgia
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Leighton SC, Rodriguez KE, Jensen CL, MacLean EL, Davis LW, Ashbeck EL, Bedrick EJ, O’Haire ME. Service Dogs for Veterans and Military Members With Posttraumatic Stress Disorder: A Nonrandomized Controlled Trial. JAMA Netw Open 2024; 7:e2414686. [PMID: 38833250 PMCID: PMC11151141 DOI: 10.1001/jamanetworkopen.2024.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/01/2024] [Indexed: 06/06/2024] Open
Abstract
Importance Military members and veterans (hereafter, veterans) with posttraumatic stress disorder (PTSD) increasingly seek psychiatric service dogs as a complementary intervention, yet the effectiveness of service dogs is understudied. Objective To estimate the associations between psychiatric service dog partnership and self-reported and clinician-rated PTSD symptom severity, depression, anxiety, and psychosocial functioning after 3 months of intervention among veterans. Design, Setting, and Participants This nonrandomized controlled trial used standardized and validated assessment instruments completed by participants and administered by blinded clinicians. Recruitment, eligibility screening, and enrollment were conducted between August 2017 and December 2019. Veterans were recruited using the database of an accredited nonprofit service dog organization with constituents throughout the US. Participants were veterans with a PTSD diagnosis; they were allocated to either the intervention group (n = 81) or control group (n = 75). Outcome assessments were performed at baseline and at the 3-month follow-up. Data analyses were completed in October 2023. Interventions Participants allocated to the intervention group received a psychiatric service dog for PTSD, whereas those allocated to the control group remained on the waiting list based on the date of application submitted to the service dog organization. Both groups had unrestricted access to usual care. Main Outcomes and Measures The primary outcomes were PTSD symptom severity, depression, and anxiety after 3 months, and the secondary outcomes were psychosocial functioning, such as quality of life and social health. The self-reported PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was used to measure symptom severity, and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) was used to assess PTSD diagnosis (score range for both instruments: 0-80, with higher scores indicating greater PTSD symptoms). Results The 156 participants included in the trial had a mean (SD) age of 37.6 (8.3) years and included 117 males (75%), 17 Black or African American individuals (11%), 30 Hispanic individuals (19%), and 117 White individuals (76%). Compared with the control group, the intervention group had significantly lower PTSD symptom severity based on the PTSD Checklist for DSM-5 mean (SD) score (41.9 [16.9] vs 51.7 [16.1]; difference in means, -11.5 [95% CI, -16.2 to -6.6]; P < .001) and the CAPS-5 mean (SD) score (30.2 [10.2] vs 36.9 [10.2]; difference in means, -7.0 [95% CI, -10.8 to -4.5]; P < .001) at 3 months. The intervention group also had significantly lower depression scores (odds ratio [OR], 0.45 [95% CI, 0.23-0.86]; difference in means, -3.3 [95% CI, -6.8 to -0.6]), anxiety (OR, 0.25 [95% CI, 0.13-0.50]; difference in means, -4.4 [95% CI, -6.9 to -2.1]), and most areas of psychosocial functioning (eg, social isolation: OR, 0.34 [95% CI, 0.18-0.64]). Conclusions and Relevance This nonrandomized controlled trial found that compared with usual care alone, partnership with a trained psychiatric service dog was associated with lower PTSD symptom severity and higher psychosocial functioning in veterans. Psychiatric service dogs may be an effective complementary intervention for military service-related PTSD. Trial Registration ClinicalTrials.gov ID: NCT03245814.
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Affiliation(s)
| | | | - Clare L. Jensen
- College of Veterinary Medicine, University of Arizona, Oro Valley
| | - Evan L. MacLean
- College of Veterinary Medicine, University of Arizona, Oro Valley
| | - Louanne W. Davis
- Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
- Indiana University School of Medicine, Indianapolis
| | - Erin L. Ashbeck
- Statistics Consulting Lab, The BIO5 Institute, University of Arizona, Tucson
| | - Edward J. Bedrick
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson
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Miller KA, Baier Manwell LM, Bartels CM, Yu TY, Vundamati D, Foertsch M, Brown RL. Implementing an osteoarthritis management program to deliver guideline-driven care for knee and hip osteoarthritis in a U.S. academic health system. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100452. [PMID: 38495347 PMCID: PMC10940781 DOI: 10.1016/j.ocarto.2024.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
Objective Assess implementation feasibility and outcomes for an Osteoarthritis Management Program (OAMP) at an academic center. Design This open study assessed an OAMP designed to deliver care in 1-5 individual or group visits across ≤12 months. Eligibility included adults with knee or hip osteoarthritis with ≥1 visit from 7/1/2017-1/15/2021. A multidisciplinary care team provided: education on osteoarthritis, self-management, exercise, weight loss; pharmacologic management; assessments of mood, sleep, quality of life, and diet. Clinic utilization and growth are reported through 2022. Patient outcomes of body mass index (BMI), pain, and function were analyzed using multivariable general linear models. OAMP outcomes were feasibility and sustainability. Results Most patients were locally referred by primary care. 953 patients attended 2531 visits (average visits 2.16, treatment duration 187.9 days). Most were female (72.6%), older (62.1), white (91.1%), and had medical insurance (95.4%). Obesity was prevalent (84.7% BMI ≥30, average BMI 40.9), mean Charlson Comorbidity Index was 1.89, and functional testing was below average. Longitudinal modeling revealed statistically but not clinically significant pain reduction (4.4-3.9 on 0-10 scale, p = 0.002). BMI did not significantly change (p = 0.87). Higher baseline pain and BMI correlated with greater reductions in each posttreatment. Uninsured patients had shorter treatment duration. Increasing clinic hours (4-24 h weekly) and serving 953 patients over four years demonstrated OAMP sustainability. Conclusions OAMP implementation was feasible and sustainable. Patients with high baseline pain and BMI were more likely to improve. Noninsurance was a barrier. These results contribute to understanding OAMP outcomes in U.S. healthcare.
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Affiliation(s)
- Kathryn A. Miller
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- UW Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Linda M. Baier Manwell
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christie M. Bartels
- Division of Rheumatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tommy Yue Yu
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Divya Vundamati
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Marley Foertsch
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Roger L. Brown
- Research Design and Statistics Unit, Schools of Nursing, Medicine, and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Yue Z, Xue X, Qian J. The association between polypharmacy and health-related quality of life among older adults with prostate cancer. J Geriatr Oncol 2024; 15:101772. [PMID: 38676976 DOI: 10.1016/j.jgo.2024.101772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Older adults with prostate cancer (PC) are at risk of polypharmacy, which further complicates disease management and health-related quality of life (HRQoL). This study evaluated the association between polypharmacy and HRQoL among Medicare beneficiaries with PC. MATERIALS AND METHODS This observational, retrospective study analyzed data from the Surveillance, Epidemiology, and End Results (SEER) Medicare Health Outcomes Survey (MHOS) data resource. Beneficiaries aged ≥65 and enrolled in Medicare Advantage Organizations were included if they had a PC diagnosis and continuously enrolled in Part D for 12 months prior to the completion of MHOS. Polypharmacy was determined based on the unique number of concurrent Part D prescriptions during 12 months before survey: no polypharmacy (NP, n = 0-4), polypharmacy (PP, n = 5-9), and excessive polypharmacy (EPP, n ≥ 10). HRQoL was assessed using the Physical and Mental Component Summary T-scores (PCS and MCS, respectively) in MHOS. ANOVA and Pearson's Chi-Square tests were performed to assess variances between polypharmacy and continuous/categorical variables. Multivariate linear regression models with generalized estimating equations were used to assess the association between polypharmacy and HRQoL. The severely impaired HRQoL cohort was identified based on normalized z-scores of PCS and MCS. Odds ratios were calculated to prioritize drug-drug and class-class pairs associated with patients with severely impaired HRQoL. RESULTS Data from 16,573 beneficiaries (24,126 records) showed that 44.4% had PP and 10.1% had EPP. Beneficiaries with PP and EPP had significantly lower mean PCS and MCS scores compared to those without polypharmacy (p < 0.001). After adjusting for covariates, beneficiaries with EPP had clinically significantly lower PCS (adjusted marginal difference: -8.47 [-9.00, -7.94]) and MCS (adjusted marginal difference: -4.32 [-4.89, -3.75]) compared to the NP group. Top-ranked drug-drug pairs like tiotropium bromide and oxycodone/acetaminophen exhibited significant associations with HRQoL decline. Analysis of class-class pairs highlighted (1) corticosteroid hormone receptor agonists and opioid agonists and (2) benzodiazepines and adrenergic beta2-agonists as having significant associations with HRQoL decline. DISCUSSION Polypharmacy exhibits a significant association with HRQoL declines among older adults with PC.
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Affiliation(s)
- Zongliang Yue
- Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | - Xiangzhong Xue
- Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | - Jingjing Qian
- Auburn University Harrison College of Pharmacy, Auburn, AL, USA.
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22
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Young AS, Skela J, Chang ET, Oberman R, Siddarth P. Variation in benefit among patients with serious mental illness who receive integrated psychiatric and primary care. PLoS One 2024; 19:e0304312. [PMID: 38781176 PMCID: PMC11115296 DOI: 10.1371/journal.pone.0304312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE The population with serious mental illness has high risk for hospitalization or death due to unhealthy behaviors and inadequate medical care, though the level of risk varies substantially. Programs that integrate medical and psychiatric services improve outcomes but are challenging to implement and access is limited. It would be useful to know whether benefits are confined to patients with specific levels of risk. METHODS In a population with serious mental illness and increased risk for hospitalization or death, a specialized medical home integrated services and improved treatment and outcomes. Treatment quality, chronic illness care, care experience, symptoms, and quality of life were assessed for a median of 385 days. Analyses examine whether improvements varied by baseline level of patient risk. RESULTS Patients with greater risk were more likely to be older, more cognitively impaired, and have worse mental health. Integrated services increased appropriate screening for body mass index, lipids, and glucose, but increases did not differ significantly by level of risk. Integrated services also improved chronic illness care, care experience, mental health-related quality of life, and psychotic symptoms. There were also no significant differences by risk level. CONCLUSIONS There were benefits from integration of primary care and psychiatric care at all levels of increased risk, including those with extremely high risk above the 95th percentile. When developing integrated care programs, patients should be considered at all levels of risk, not only those who are the healthiest.
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Affiliation(s)
- Alexander S. Young
- Desert Pacific Mental Illness Research Education and Clinical Center, Greater Los Angeles Veterans Healthcare System, Los Angeles, California, United States of America
- Department of Psychiatry, School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles Veterans Healthcare System, Los Angeles, California, United States of America
| | - Jessica Skela
- Department of Psychiatry, School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Evelyn T. Chang
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles Veterans Healthcare System, Los Angeles, California, United States of America
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Rebecca Oberman
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles Veterans Healthcare System, Los Angeles, California, United States of America
| | - Prabha Siddarth
- Department of Psychiatry, School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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Neitzke CC, LaValva SM, Chandi SK, Chiu YF, McLawhorn AS, Gausden EB. Should We Wait for Bone-on-Bone Arthritis? Equivalent Clinical Outcomes in Patients Requiring Advanced Imaging Prior to Primary Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00515-1. [PMID: 38776991 DOI: 10.1016/j.arth.2024.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Plain radiographs remain the standard for diagnosing osteoarthritis (OA). Total hip arthroplasty (THA) is generally offered only for advanced OA by plain radiographs. Advanced imaging is used as an adjunct to assess OA severity in cases of progressive symptoms with less advanced OA by plain radiographs. The objective of this study was to compare outcomes following THA in patients who have advanced OA visualized by plain radiographs to patients who have less severe OA visualized by plain radiographs. METHODS From February 2016 to February 2020, 93 patients who had Kellgren-Lawrence (KL) grade 0 to 2 OA and underwent THA were identified. The median age was 65 years, and 55% were women. They were matched 1:3 to patients who underwent THA for KL 4 OA based on age, sex, BMI, and Charlson Comorbidity Index. The primary outcome was achievement of the Hip Injury and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) at 1 year postoperatively. RESULTS There was no difference between the KL 0 to 2 and KL 4 cohorts in the achievement of HOOS JR MCID (86 versus 85.6%, P = 0.922), SCB (81.7 versus 80.2%, P = 0.751), or PASS (89.2 versus 85.6%, P = 0.374). The KL 0 to 2 cohort had a similar improvement in their 2-year HOOS JR (42.5 versus 38.6, P = 0.019). CONCLUSION In this series, there was no difference in outcomes following primary THA between patients who have severe OA on plain radiographs (KL 4) compared to those who have less severe OA (KL 0 to 2). In the setting of severe symptoms and the absence of advanced OA on radiographs, advanced imaging can be used to guide treatment and select patients who could benefit from THA.
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Affiliation(s)
- Colin C Neitzke
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott M LaValva
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sonia K Chandi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Yu-Fen Chiu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Kaur M, Chmielewski TL, Saliba S, Hart J. How Does Physical and Psychological Recovery Vary Among Competitive and Recreational Athletes After Anterior Cruciate Ligament Reconstruction? Sports Health 2024:19417381241249413. [PMID: 38736252 DOI: 10.1177/19417381241249413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND The recovery and rehabilitation journey after anterior cruciate ligament reconstruction (ACLR) surgery can be different for competitive and recreational athletes as their motivation and goals toward sports are different. HYPOTHESIS Competitive athletes would present with better patient-reported outcomes and higher muscle strength compared with recreational athletes postsurgery. Second, competitive athletes would recover better (patient-reported outcome [PRO] measures and muscle strength) compared with recreational athletes at later stages. STUDY DESIGN Cross-sectional laboratory-based study. LEVEL OF EVIDENCE Level 2. METHODS A total of 245 patients with unilateral ACLR were categorized as competitive or recreational athletes and grouped into early (4-6.9 months) or late (7-10 months) stages of recovery. PRO were collected for psychological response (Tampa Scale Kinesiophobia; Anterior Cruciate Ligament-Return to Sport after Injury), perceived knee function (International Knee Documentation Committee subjective form [IKDC]), and quality of life (Knee injury and Osteoarthritis Outcome Score; Veteran Rand-12). Isokinetic, concentric knee extension strength was measured bilaterally with a multimodal dynamometer (System 4, Biodex Medical Systems) at a speed of 90° and 180°/s. RESULTS Competitive athletes had significantly higher scores for IKDC (P = 0.03), and quadriceps peak torque at 90°/s (P = 0.01) and 180°/s (P < 0.01) compared with recreational athletes. Competitive athletes had higher quadriceps strength at 90°/s (P < 0.01) and 180°/s (P = 0.02) in the late group. Recreational athletes displayed higher sports participation in the late group. CONCLUSION Outcomes of ACLR may differ based on preinjury athletic level. Whereas competitive athletes had higher knee and muscle function than recreational athletes, psychological measures were not different among groups. CLINICAL RELEVANCE There is a need for more individualized care for patients with ACLR since there is variability among patient goals postsurgery. This information might help set realistic expectations for competitive and recreational athletes after surgery.
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Affiliation(s)
- Mandeep Kaur
- School of Health Professions, Department of Physical Therapy and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | | | - Susan Saliba
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Joe Hart
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina
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Narcisse MR, McElfish PA, Schootman M, Selig JP, Kirkland T, McFarlane SI, Felix HC, Seixas A, Jean-Louis G. Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep. Sleep Med 2024; 117:209-215. [PMID: 38593616 PMCID: PMC11081429 DOI: 10.1016/j.sleep.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To examine mediating effects of sleep quality and duration on the association between T2D and QoL among Medicare beneficiaries 65+. METHODS Data from the Medicare Health Outcome Survey (2015-2020) were used. The outcome was QoL (physical and mental health component-summary scores [PCS and MCS]) measured by the Veterans-Rand-12. The main predictor was diagnosed T2D. Mediators were sleep duration and sleep quality. The effect modifier was race/ethnicity. Structural Equation Modeling was used to estimate moderated-mediating effects of sleep quality and duration across race/ethnicity. RESULTS Of the 746,400 Medicare beneficiaries, 26.7% had T2D, and mean age was 76 years (SD ± 6.9). Mean PCS score was 40 (SD ± 12.2), and mean MCS score was 54.0 (SD ± 10.2). Associations of T2D with PCS and MCS were negative and significant. For all racial/ethnic groups, those with T2D reported lower PCS. For White, Black, Asian, and Hispanic beneficiaries only, those with T2D reported lower MCS. The negative impact of T2D on PCS and MCS was mediated through sleep quality, especially very bad sleep quality. CONCLUSION Improving sleep may lead to improvement in QoL in elderly adults with T2D.
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Affiliation(s)
- Marie-Rachelle Narcisse
- Department of Psychiatry and Human Behavior, Brown University, 222 Richmond St., Providence, RI, 02903, USA.
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Mario Schootman
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Tracie Kirkland
- Department of Nursing, University of Southern California, Los Angeles, CA, 90033, USA
| | - Samy I McFarlane
- Department of Medicine, State University of New York-Downstate Health Sciences University, 450 Clarkson Avenue, MSC 50, Brooklyn, NY, 11203, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Azizi Seixas
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
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Timko C, Macia K, Lewis M, Lor MC, Blonigen D, Jannausch M, Ilgen M. Medical-surgical patients with untreated hazardous drinking: Randomized controlled trial of the DO-MoST intervention to improve health outcomes over 12-month follow-up. Drug Alcohol Depend 2024; 258:111259. [PMID: 38503244 DOI: 10.1016/j.drugalcdep.2024.111259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION High prevalence and harmful consequences of hazardous drinking among medical-surgical patients underscore the importance of intervening with drinking to improve patients' health. This study evaluated a novel intervention, "Drinking Options - Motivate, Shared Decisions, Telemonitor" (DO-MoST). METHODS In a randomized design, 155 medical-surgical patients with untreated hazardous drinking were assigned to enhanced usual care or DO-MoST, and followed 3, 6, and 12 months later. We conducted intent-to-treat and per-protocol analyses. RESULTS For the primary outcome, percent days of alcohol abstinence in the past 30 days, intent-to-treat analyses did not find superior effectiveness of DO-MoST. However, per-protocol analyses found abstinence increased between 3 and 12 months among participants assigned to DO-MoST who engaged with the intervention (n=46). Among DO-MoST-assigned participants who did not engage (n=27), abstinence stayed stable during follow-up. Group comparisons showed an advantage on abstinence for Engaged compared to Non-Engaged participants on change over time. Intent-to-treat analyses found that DO-MoST was superior to usual care on the secondary outcome of physical health at 12 months; per-protocol analyses found that Engaged DO-MoST-assignees had better physical health at 12 months than Non-Engaged DO-MoST-assignees. DO-MoST-assignees had lower odds of receiving substance use care during follow-up than usual care-assignees. DISCUSSION Patients engaged in DO-MoST showed a greater degree of abstinence and better physical health relative to the non-engaged or usual care group. DO-MoST may be a source of alcohol help in itself rather than only a linkage intervention. Work is needed to increase DO-MoST engagement among medical-surgical patients with untreated hazardous drinking.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Kathryn Macia
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, CA 94304, USA
| | - Mandy Lewis
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Mai Chee Lor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA
| | - Daniel Blonigen
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Mary Jannausch
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Mark Ilgen
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
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Allaire BT, Horvath ML, Lines LM, Davidoff AJ, Smith AW, Jensen RE. Do Contemporary Cancer Survivors Experience Better Quality of Life? Evaluating a Decade of SEER Medicare Health Outcomes Survey Data. Cancer Epidemiol Biomarkers Prev 2024; 33:593-599. [PMID: 38284816 DOI: 10.1158/1055-9965.epi-23-1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/29/2023] [Accepted: 01/25/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND A cancer diagnosis may have deleterious effects on health-related quality of life (HRQOL) as adults age. This study examined differences in HRQOL between cancer and matched noncancer Medicare beneficiaries over 65, within and across two time periods. METHODS We used novel matching methods on data from the Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) data resource. We matched SEER-MHOS respondents with cancer from a recent period (2015-2019) to respondents with cancer from an earlier period (2008-2012). We then matched these two cohorts, without replacement, to contemporary cohorts without cancer diagnoses. We estimated Veteran's RAND 12-Item Short Form Survey Physical Component Summary (PCS) and Mental Component Summary (MCS) scores for all cohorts. RESULTS Our analysis found significantly higher mean MCS scores in the recent period for those with cancer relative to the recent noncancer control group. Breast and lung cancer presented positive and statistically significant trends. We found statistically insignificant differences in PCS scores between the two time periods. No cancer sites had different PCS scores over time compared with the comparison group. CONCLUSIONS Mental health for those with cancer improved more between 2008 and 2019 than a matched noncancer comparison group. Physical health remained stable across time. These findings highlight the importance of including a matched noncancer group when evaluating HRQOL outcomes. IMPACT SEER-MHOS respondents with cancer report stable PCS scores across 15 years of data and higher MCS scores relative to noncancer controls.
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Affiliation(s)
| | - Marc L Horvath
- RTI International, Research Triangle Park, North Carolina
| | - Lisa M Lines
- RTI International, Research Triangle Park, North Carolina
| | - Amy J Davidoff
- Outcomes Research Branch, Healthcare Delivery Research Program, DCCPS, National Cancer Institute, Bethesda, Maryland
| | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, DCCPS, National Cancer Institute, Bethesda, Maryland
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, DCCPS, National Cancer Institute, Bethesda, Maryland
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Brusalis CM, Huddleston HP, Lavalva SM, Gottlieb D, Fletcher C, Hinkley P, Gomoll AH, Strickland SM. Short-Term Outcomes of Concomitant Patellofemoral Arthroplasty and Medial Patellofemoral Ligament Reconstruction to Treat Concurrent Patellofemoral Arthritis and Patellar Instability. J Knee Surg 2024; 37:350-355. [PMID: 37339670 DOI: 10.1055/s-0043-1770156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
The purpose of this study was to evaluate the efficacy of combined patellofemoral arthroplasty (PFA) and medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral arthritis in the setting of concomitant patellar instability. Patients who underwent single-stage, combined PFA and MPFL reconstruction by a single surgeon at a tertiary-care orthopaedic center between 2016 and 2021 were identified. Postoperative radiographic and clinical outcomes at a minimum of 6 months were recorded using patient-reported outcome measures, including International Knee Documentation Committee (IKDC), Kujala, and VR-12. Early complications and rates of recurrent instability were also recorded. Of the 16 patients who met inclusion and exclusion criteria, 13 patients were available for final follow-up (81%; 51.7 ± 7.2 years, 11 females, 2 males) with a mean clinical follow-up of 1.3 ± 0.5 years (range: 0.5-2.3 years). Patients experienced significant improvements in patellar tilt and multiple patient-reported outcome metrics postoperatively, including IKDC, Kujala, VR-12 Mental Health, and VR-12 Physical Health. At the time of the most recent follow-up, no patient had experienced a postoperative dislocation or subluxation event. The findings suggest that concurrent PFA and MPFL reconstruction are associated with significant improvements in multiple patient-reported outcomes. Further studies are needed to evaluate the duration of clinical benefits achieved with this combined intervention.
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Affiliation(s)
- Christopher M Brusalis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Hailey P Huddleston
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Scott M Lavalva
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Dana Gottlieb
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Connor Fletcher
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Paige Hinkley
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Andreas H Gomoll
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Sabrina M Strickland
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
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Ahmad CS, Hellwinkel JE, Ahmed R, Alexander FJ, Reynolds AW, Piasecki DP, Bottiglieri TS, Lynch TS, Popkin CA, Saltzman BM, Trofa DP. Impacts of the Early COVID-19 Pandemic on Depressive Symptoms and Mental Health Among Student-Athletes. Open Access J Sports Med 2024; 15:19-28. [PMID: 38523629 PMCID: PMC10959820 DOI: 10.2147/oajsm.s392977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/06/2023] [Indexed: 03/26/2024] Open
Abstract
Objective Social distancing protocols due to the COVID-19 pandemic resulted in premature ending of athletic seasons and cancellation of upcoming seasons, placing significant stress on young athletes. Inability to play or forced early retirement has significant consequences on athlete's mental health, as demonstrated by an extensive body of injury literature. We hypothesize that premature suspension and cancellation of athletic events due to the COVID-19 pandemic leads to higher incidence of depressive symptoms among high-school and collegiate athletes. Further, athletes who strongly derive their sense of self-worth centered around athletics would have higher rates of depressive symptoms. Methods High school and collegiate athletes were evaluated for depressive symptoms, emotional health and athletic identity measures through validated assessment instruments from May 2020 through July 2020. The Patient-Reported Outcomes Measurement Information System Depression Computer Adaptive Test (PROMIS-10 Depression CAT), Veterans RAND-12 (VR-12), which comprises both a physical and mental health component, and Athletic Identity Measurement Scale (AIMS) were utilized. Results Mental health assessments were completed by 515 athletes (52.4% male, 47.6% female; .84.5% collegiate, 15.5% high school). Female athletes scored significantly worse than males on VR-12 mental health assessments, as well as PROMIS-10 Depression scores; however, males scored significantly lower than females on VR-12 physical health assessments, irrespective of education level. Athletes who had strong associations with athletics as central to their personal identity exhibited worse psychologic impact on VR-12 mental health and PROMIS-10 Depression measures and female athletes in this cohort reported greater depressive symptoms than males. Conclusion Social distancing protocols due to the COVID-19 pandemic have limited athlete's ability to participate in sports at the training and competition level. Higher rates of depressive symptoms in high school and college athletes have resulted among female athletes and those who identify strongly as an athlete.
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Affiliation(s)
- Christopher S Ahmad
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Justin E Hellwinkel
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Rifat Ahmed
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Frank J Alexander
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Alan W Reynolds
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Dana P Piasecki
- Sports Medicine Center, OrthoCarolina, Charlotte, NC, 28207, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, NC, 28207, USA
| | - Thomas S Bottiglieri
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - T Sean Lynch
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Charles A Popkin
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Bryan M Saltzman
- Sports Medicine Center, OrthoCarolina, Charlotte, NC, 28207, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, NC, 28207, USA
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
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Retzky JS, Thacher RR, Palhares GH, Gomoll AH, Strickland SM. Impact of Wiberg Patellar Type on Outcomes and Survival Following Cell-Based Cartilage Repair for Patellar Chondral Lesions at Midterm Follow-up. Am J Sports Med 2024; 52:705-709. [PMID: 38243799 DOI: 10.1177/03635465231220028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
BACKGROUND Cell-based cartilage repair procedures of the patellofemoral joint have less reliable outcomes than those of the tibiofemoral joint. No previous studies have evaluated the influence of patellar shape on cell-based cartilage repair outcomes. Patellar dysplasia may predispose patients to worse outcomes after cell-based cartilage repair. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the relationship between Wiberg patellar type and outcomes after cell-based cartilage repair (autologous chondrocyte implantation or particulated juvenile allograft cartilage transplantation) for the treatment of patellar chondral lesions at a minimum 2-year follow-up. It was hypothesized that Wiberg classification of patellar shape would have no effect on patient-reported outcome measures (PROMs) or graft survival. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients undergoing autologous chondrocyte implantation or particulated juvenile allograft cartilage transplantation for full-thickness patellar chondral defects between 2016 and 2020 were retrospectively reviewed after institutional review board approval. The change in PROMs, including International Knee Documentation Committee (IKDC), Kujala, and Veterans RAND 12-item Health Survey Mental and Physical scores, from pre- to postoperatively and the percentage of patients who achieved the minimal clinically important difference (MCID) for IKDC and Kujala scores were compared for the Wiberg type A versus Wiberg type B versus Wiberg type C groups. The log-rank test was used to evaluate for differences in survival between subgroups. RESULTS A total of 59 patients (63 knees) were included, with a mean age of 33.3 ± 8.6 years, median body mass index of 26.0 (IQR, 21.8-30.2), and median follow-up time of 3.5 years (IQR, 2.6-4.2 years). In total, 26 (41%) patellae were Wiberg type A, 29 (46%) were Wiberg type B, and 8 (13%) were Wiberg type C. There were no differences between Wiberg type A versus Wiberg type B versus Wiberg type C groups with respect to change in PROMs from pre- to postoperatively or the percentage of patients who achieved the MCID for IKDC or Kujala scores (P > .05 for all). There were no differences in survival between groups (P = .45). CONCLUSION Wiberg patellar type has no effect on patient-reported outcomes or graft survival at midterm follow-up. Patellar dysplasia should not be seen as a contraindication for cell-based cartilage repair procedures.
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Affiliation(s)
- Julia S Retzky
- Hospital for Special Surgery, Sports Medicine Institute, New York, New York, USA
| | - Ryan R Thacher
- Hospital for Special Surgery, Sports Medicine Institute, New York, New York, USA
| | - Guilherme H Palhares
- Hospital for Special Surgery, Sports Medicine Institute, New York, New York, USA
| | - Andreas H Gomoll
- Hospital for Special Surgery, Sports Medicine Institute, New York, New York, USA
| | - Sabrina M Strickland
- Hospital for Special Surgery, Sports Medicine Institute, New York, New York, USA
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Broekman MM, Brinkman N, Swanson D, Ring D, van den Bekerom M, Jawa A. Variations in 1-year Trajectories of Levels of Pain and Capability After Shoulder Arthroplasty Are Associated With Baseline Mental Health. Clin Orthop Relat Res 2024; 482:514-522. [PMID: 37678387 PMCID: PMC10871746 DOI: 10.1097/corr.0000000000002821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/20/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND There is variability in the trajectories of pain intensity and magnitude of incapability after shoulder arthroplasty. A better understanding of the degree to which variation in recovery trajectories relates to aspects of mental health can inform the development of comprehensive biopsychosocial care strategies. QUESTIONS/PURPOSES (1) Do pain intensities at baseline and the trajectories during recovery differ between groups when stratified by mental health composite summary score, arthroplasty type, and revision surgery? (2) Do magnitudes of capability at baseline and the trajectories during recovery differ between these groups? METHODS We used a registry of 755 patients who underwent shoulder arthroplasty by a single surgeon at a specialized urban orthopaedic hospital that recorded the mental component summary (MCS) score of the Veterans RAND 12, a measure of shoulder-specific comfort and capability (American Shoulder and Elbow Surgeons [ASES] score, which ranges from 0 to 100 points, with a score of 0 indicating worse capability and pain and 100 indicating better capability and pain and a minimum clinically important difference of 6.4), and the VAS for pain intensity (range 0 [representing no pain] to 10 [representing the worst pain possible], with a minimum clinically important difference of 1.4) preoperatively, 2 weeks postoperatively, and 6 weeks, 3 months, 6 months, and 1 year after surgery. Forty-nine percent (368 of 755) of the patients were men, with a mean age of 68 ± 8 years, and 77% (585) were treated with reverse total shoulder arthroplasty (rTSA). Unconditional linear and quadratic growth models were generated to identify the general shape of recovery for both outcomes (linear versus quadratic). We then constructed conditional growth models and curves for pain intensity and the magnitude of capability showing mean baseline scores and the rates of recovery that determine the trajectory, accounting for mental health (MCS) quartiles, primary or revision arthroplasty, and TSA or reverse TSA in separate models. Because pain intensity and capability showed quadratic trends, we created trajectories using the square of time. RESULTS Patients in the worst two MCS quartiles had greater pain intensity at baseline than patients in the best quartile (difference in baseline for bottom quartile: 0.93 [95% CI 0.72 to 1.1]; p < 0.01; difference in baseline for next-worst quartile: 0.36 [95% CI 0.16 to 0.57]; p < 0.01). The rates of change in recovery from pain intensity were not different among groups (p > 0.10). Patients with revision surgery had greater baseline pain (difference: 1.1 [95% CI 0.7 to 1.5]; p < 0.01) but no difference in rates of recovery (difference: 0.031 [95% CI 0.035 to 0.097]; p = 0.36). There were no differences in baseline pain intensity and rates of recovery between patients with reverse TSA and those with TSA (baseline pain difference: -0.20 [95% CI -0.38 to -0.03]; p = 0.18; difference in rate of recovery: -0.005 [95% CI -0.035 to 0.025]; p = 0.74). Patients in the worst two MCS quartiles had worse baseline capability than patients in the best quartile (difference in baseline for bottom quartile: -8.9 [95% CI -10 to -7.4]; p < 0.001; difference in baseline for the next-worst quartile: -4.9 [95% CI -6.4 to -3.4]; p < 0.01), with no differences in rates of recovery (p > 0.10). Patients with revision surgery had lower baseline capability (difference in baseline: -13 [95% CI -15 to -9.7]; p < 0.01), with a slower rate of recovery (difference in rate of recovery: -0.56 [95% CI -1.0 to -0.079]; p = 0.021). There were no differences in baseline capability or rates of recovery between TSA and reverse TSA. CONCLUSION The observation that preoperative and 1-year comfort and capability are associated with mental health factors and with similar recovery trajectories reminds us that assessment and treatment of mental health is best considered an integral aspect of musculoskeletal care. Future studies can address how prioritization of mental health in musculoskeletal care strategies might reduce variation in the 1-year outcomes of discretionary surgeries such as shoulder arthroplasty. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Melle Martijn Broekman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit van Amsterdam, Amsterdam, the Netherlands
| | - Niels Brinkman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Daniel Swanson
- Shoulder Surgery, Boston Sports & Shoulder Center, Boston, MA, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Michel van den Bekerom
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit van Amsterdam, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Amsterdam, the Netherlands
| | - Andrew Jawa
- Shoulder Surgery, Boston Sports & Shoulder Center, Boston, MA, USA
- Division of Shoulder Arthroplasty, New England Baptist Hospital, Boston, MA, USA
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Meredith LS, Wong EC, Marx BP, Han B, Korn AR, Tobin JN, Cassells A, Williamson S, Franco M, Overa CC, Holder T, Lin TJ, Sloan DM. Design of a hybrid implementation effectiveness cluster randomized controlled trial of delivering written exposure therapy for PTSD in underserved primary care settings. Contemp Clin Trials 2024; 138:107435. [PMID: 38211725 PMCID: PMC11146292 DOI: 10.1016/j.cct.2024.107435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) results in substantial costs to society. Prevalence of PTSD among adults is high, especially among those presenting to primary care settings. Evidence-based psychotherapies (EBPs) for PTSD are available but dissemination and implementation within primary care settings is challenging. Building Experience for Treating Trauma and Enhancing Resilience (BETTER) examines the effectiveness of integrating Written Exposure Therapy (WET) within primary care collaborative care management (CoCM). WET is a brief exposure-based treatment that has the potential to address many challenges of delivering PTSD EBPs within primary care settings. METHODS The study is a hybrid implementation effectiveness cluster-randomized controlled trial in which 12 Federally Qualified Health Centers (FQHCs) will be randomized to either CoCM plus WET (CoCM+WET) or CoCM only with 60 patients within each FQHC. The primary aim is to evaluate the effectiveness of CoCM+WET to improve PTSD and depression symptom severity. Secondary treatment outcomes are mental and physical health functioning. The second study aim is to examine implementation of WET within FQHCs using FQHC process data and staff interviews pre- and post-intervention. Exploratory aims are to examine potential moderators and mediators of the intervention. Assessments occur at baseline, and 3- and 12-month follow-up. CONCLUSION The study has the potential to impact practice and improve clinical and public health outcomes. By establishing the effectiveness and feasibility of delivering a brief trauma-focused EBP embedded within CoCM in primary care, the study aims to improve PTSD outcomes for underserved patients. TRIAL REGISTRATION (Clinicaltrials.govNCT05330442).
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Affiliation(s)
- Lisa S Meredith
- RAND Corporation, Santa Monica, CA, United States of America; VA HSR&D Center for Healthcare Innovation, Implementation & Policy, Sepulveda, CA, United States of America.
| | - Eunice C Wong
- RAND Corporation, Santa Monica, CA, United States of America
| | - Brian P Marx
- National Center for PTSD, Behavioral Science Division at VA Boston Healthcare, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Bing Han
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States of America
| | - Ariella R Korn
- RAND Corporation, Boston, MA 02116, United States of America
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY, United States of America; The Rockefeller University Center for Clinical and Translational Science, New York, NY, United States of America
| | - Andrea Cassells
- Clinical Directors Network (CDN), New York, NY, United States of America
| | | | - Meghan Franco
- Pardee RAND Graduate School, Santa Monica, CA, United States of America
| | - Cleo Clarize Overa
- Clinical Directors Network (CDN), New York, NY, United States of America
| | - Tameir Holder
- Clinical Directors Network (CDN), New York, NY, United States of America
| | - T J Lin
- Clinical Directors Network (CDN), New York, NY, United States of America
| | - Denise M Sloan
- National Center for PTSD, Behavioral Science Division at VA Boston Healthcare, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
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Wu TC, Farrell MJ, Karimi-Mostowfi N, Chaballout BH, Akingbemi WO, Grogan TR, Raldow AC. Evaluating the Impact of Race and Ethnicity on Health-Related Quality of Life Disparities in Patients with Esophageal Cancer: A SEER-MHOS National Database Study. Cancer Epidemiol Biomarkers Prev 2024; 33:254-260. [PMID: 38015776 DOI: 10.1158/1055-9965.epi-23-0789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/15/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND It is unclear whether health-related quality of life (HRQOL) disparities exist between racial/ethnic groups in older patients with esophageal cancer, pre- and post-diagnosis. METHODS Using the SEER-MHOS (Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey) national database, we included patients ages 65-years-old or greater with esophageal cancer diagnosed from 1996 to 2017. HRQOL data within 36 months before and after diagnosis were measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36 and VR-12 instruments. Total combined score (TCS) was reflected by both PCS and MCS. RESULTS We identified 1,312 patients, with evaluable data on 873 patients pre-diagnosis and 439 post-diagnosis. On pre-diagnosis cohort MVA, the MCS was better for White over Hispanic patients (54.1 vs. 48.6, P = 0.012). On post-diagnosis cohort MVA, PCS was better for Hispanic compared with White (39.8 vs. 34.5, P = 0.036) patients, MCS was better for Asian compared with White (48.9 vs. 40.9, P = 0.034) patients, and TCS better for Asian compared with White (92.6 vs. 76.7, P = 0.003) patients. CONCLUSIONS In older patients with esophageal cancer, White patients had better mental HRQOL as compared with Hispanic patients pre-diagnosis. However, post-diagnosis, White patients had worse mental and physical HRQOL compared with Asian and Hispanic patients, respectively, suggesting a greater negative impact on self-reported HRQOL in White patients with esophageal cancer. IMPACT To our knowledge, this study is the first to explore HRQOL differences in patients with esophageal cancer of various racial and ethnic groups and warrants further validation in future studies.
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Affiliation(s)
- Trudy C Wu
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Matthew J Farrell
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | | | - Basil H Chaballout
- University of South Carolina, School of Medicine Greenville, Greenville, South Carolina
| | | | - Tristan R Grogan
- Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, California
| | - Ann C Raldow
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
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Magnan E, Weyrich M, Miller M, Melnikow J, Moulin A, Servis M, Chadha P, Spivack S, Henry SG. Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:221-231. [PMID: 37801599 DOI: 10.1097/acm.0000000000005467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
PURPOSE In this systematic review, the authors examine the prevalence and extent of stigmatizing attitudes among health care professionals (HCPs) and trainees against patients with substance use disorders (SUDs), including research on interventions to reduce stigma. METHOD The authors searched 7 databases for articles published from January 1, 2011, through February 15, 2023, that quantified SUD stigma among HCPs or trainees. Inclusion criteria allowed both observational and intervention studies from the United States or Canada to be included in this review. Quality assessment was applied to all included studies; studies were not excluded based on quality. RESULTS A total of 1,992 unique articles were identified of which 32 articles (17 observational studies and 15 intervention studies), all conducted in the United States, met the inclusion criteria. Half of the included studies (16 of 32) were published in 2020 or later. Most of the intervention studies (13 of 15) used a single-group pre-post design; interventions involved didactics and/or interactions with persons with SUDs. The 32 included studies used a total of 19 different measures of stigma. All 17 observational studies showed some degree of HCP or trainee stigma against patients with SUDs. Most intervention studies (12 of 15) found small but statistically significant reductions in stigma after intervention. CONCLUSIONS SUD stigma exists among HCPs and trainees. Some interventions to reduce this stigma had positive impacts, but future studies with larger, diverse participants and comparison groups are needed. Heterogeneity among studies and stigma measures limits the ability to interpret results across studies. Future rigorous research is needed to determine validated, consensus measures of SUD stigma among HCPs and trainees, identify stigma scores that are associated with clinical outcomes, and develop effective antistigma interventions for HCPs and trainees.
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Abraham J, Holzer KJ, Lenard EM, Meng A, Pennington BRT, Wolfe RC, Haroutounian S, Calfee R, Hammil CW, Kozower BD, Cordner TA, Schweiger J, McKinnon S, Yingling M, Baumann AA, Politi MC, Kannampallil T, Miller JP, Avidan MS, Lenze EJ. A Perioperative Mental Health Intervention for Depressed and Anxious Older Surgical Patients: Results From a Feasibility Study. Am J Geriatr Psychiatry 2024; 32:205-219. [PMID: 37798223 PMCID: PMC10852892 DOI: 10.1016/j.jagp.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES The perioperative period is challenging and stressful for older adults. Those with depression and/or anxiety have an increased risk of adverse surgical outcomes. We assessed the feasibility of a perioperative mental health intervention composed of medication optimization and a wellness program following principles of behavioral activation and care coordination for older surgical patients. METHODS We included orthopedic, oncologic, and cardiac surgical patients aged 60 and older. Feasibility outcomes included study reach, the number of patients who agreed to participate out of the total eligible; and intervention reach, the number of patients who completed the intervention out of patients who agreed to participate. Intervention efficacy was assessed using the Patient Health Questionnaire for Anxiety and Depression (PHQ-ADS). Implementation potential and experiences were collected using patient surveys and qualitative interviews. Complementary caregiver feedback was also collected. RESULTS Twenty-three out of 28 eligible older adults participated in this study (mean age 68.0 years, 65% women), achieving study reach of 82% and intervention reach of 83%. In qualitative interviews, patients (n = 15) and caregivers (complementary data, n = 5) described overwhelmingly positive experiences with both the intervention components and the interventionist, and reported improvement in managing depression and/or anxiety. Preliminary efficacy analysis indicated improvement in PHQ-ADS scores (F = 12.13, p <0.001). CONCLUSIONS The study procedures were reported by participants as feasible and the perioperative mental health intervention to reduce anxiety and depression in older surgical patients showed strong implementation potential. Preliminary data suggest its efficacy for improving depression and/or anxiety symptoms. A randomized controlled trial assessing the intervention and implementation effectiveness is currently ongoing.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO.
| | - Katherine J Holzer
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Emily M Lenard
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
| | - Alicia Meng
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Bethany R Tellor Pennington
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Rachel C Wolfe
- Department of Pharmacy (RCW), Barnes-Jewish Hospital, St. Louis, MO
| | - Simon Haroutounian
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Ryan Calfee
- Department of Orthopaedic Surgery (RC), Washington University School of Medicine, St. Louis, MO
| | - Chet W Hammil
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Theresa A Cordner
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Julia Schweiger
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
| | - Sherry McKinnon
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Michael Yingling
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
| | - Ana A Baumann
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Mary C Politi
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Thomas Kannampallil
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - J Philip Miller
- Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Michael S Avidan
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
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Trenaman L, Guh D, Bansback N, Sawatzky R, Sun H, Cuthbertson L, Whitehurst DGT. Quality of life of the Canadian population using the VR-12: population norms for health utility values, summary component scores and domain scores. Qual Life Res 2024; 33:453-465. [PMID: 37938404 PMCID: PMC10850034 DOI: 10.1007/s11136-023-03536-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To estimate Canadian population norms (health utility values, summary component scores and domain scores) for the VR-12. METHODS English and French speaking Canadians aged 18 and older completed an online survey that included sociodemographic questions and standardized health status instruments, including the VR-12. Responses to the VR-12 were summarized as: (i) a health utility value; (ii) mental and physical component summary scores (MCS and PCS, respectively), and (iii) eight domain scores. Norms were calculated for the full sample and by gender, age group, and province/territory (univariate), and for several multivariate stratifications (e.g., age group and gender). Results were summarized using descriptive statistics, including number of respondents, mean and standard deviation (SD), median and percentiles (25th and 75th), and minimum and maximum. RESULTS A total of 6761 people who clicked on the survey link completed the survey (83.4% completion rate), of whom 6741 (99.7%) were included in the analysis. The mean health utility score was 0.698 (SD = 0.216). Mean health utility scores tended to be higher in older age groups, ranging from 0.661 (SD = 0.214) in those aged 18-29 to 0.728 (SD = 0.310) in those aged 80+. Average MCS scores were higher in older age groups, while PCS scores were lower. Females consistently reported lower mean health utility values, summary component scores and domain scores compared with males. CONCLUSIONS This is the first study to present Canadian norms for the VR-12. Health utility norms can serve as a valuable input for Canadian economic models, while summary component and domain norms can help interpret routinely-collected data.
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Affiliation(s)
- Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, Box 351621, Seattle, WA, 98195, USA.
| | - Daphne Guh
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Nick Bansback
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Richard Sawatzky
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Nursing, Trinity Western University, Vancouver, BC, Canada
| | - Huiying Sun
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Lena Cuthbertson
- British Columbia Office of Patient-Centred Measurement, Ministry of Health/Providence Health Care, Vancouver, BC, Canada
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Surette KE, Abouzeid C, Shepler LJ, McMullen KA, Cancio JM, Cancio LC, Hickey SA, Mandell SP, Stewart BT, Wolf SE, Kazis LE, Ryan CM, Schneider JC. Examining the association between military service history and outcomes after burn injury. Burns 2024; 50:59-65. [PMID: 37709564 PMCID: PMC10872572 DOI: 10.1016/j.burns.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/30/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The association between military service history and long-term outcomes after burn injury is unknown. This study uses data from the Burn Model System National Database to compare outcomes of individuals with and without self-reported military service history. METHODS Outcome measures were assessed at 12 months after injury including the Veterans Rand-12 Item Health Survey/Short Form-12, Satisfaction With Life Scale, Patient Reported Outcomes Measure Information System 29, 4-D Itch scale, Post Traumatic Stress Disorder Check List - Civilian Version, self-reported Post Traumatic Stress Disorder, and employment status. This study included 675 people with burns of whom 108 reported a history of military service. RESULTS The military service history group was more likely to be older, and male. Those with military service were most likely to be on Medicare insurance and those without military service history were most likely to be on Private Insurance/HMP/PPO. No significant differences were found between those with and without military service history in the outcome measures. CONCLUSIONS Further research should examine differences in outcomes between civilians and those with military service history, including elements of resilience and post traumatic growth.
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Affiliation(s)
- Kate E Surette
- Shriners Children's Hospital-Boston, 51 Blossom St., Boston, MA 02114, United States
| | - Cailin Abouzeid
- Spaulding Rehabilitation Hospital, 300 1st Ave., Charlestown, MA 02129, United States
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, 300 1st Ave., Charlestown, MA 02129, United States
| | - Kara A McMullen
- Harborview Medical Center, University of Washington, 325 9th Ave., Seattle, WA 98104, United States
| | - Jill M Cancio
- US Army Institute of Surgical Research, Fort Sam Houston, 3698 Chambers Rd., San Antonio, TX 78234, United States
| | - Leopoldo C Cancio
- US Army Institute of Surgical Research, Fort Sam Houston, 3698 Chambers Rd., San Antonio, TX 78234, United States
| | - Sean A Hickey
- Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States
| | - Samuel P Mandell
- University of Texas Southwestern, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Barclay T Stewart
- Harborview Medical Center, University of Washington, 325 9th Ave., Seattle, WA 98104, United States
| | - Steven E Wolf
- University of Texas Medical Branch, 1302 Mechanic St., Galveston, TX 77550, United States
| | - Lewis E Kazis
- Boston University School of Public Health, 715 Albany St., Boston, MA 02218, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States; Spaulding Rehabilitation Outcomes Center, 300 1st Ave., Charlestown, MA 02129, United States
| | - Colleen M Ryan
- Shriners Children's Hospital-Boston, 51 Blossom St., Boston, MA 02114, United States; Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, 300 1st Ave., Charlestown, MA 02129, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States; Spaulding Rehabilitation Outcomes Center, 300 1st Ave., Charlestown, MA 02129, United States.
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Davis KR, Soti V. Effectiveness of Kinematic Alignment-Total Knee Arthroplasty in Treating Preoperative Varus and Valgus Deformities in Patients With Knee Osteoarthritis. Cureus 2024; 16:e53230. [PMID: 38293678 PMCID: PMC10826793 DOI: 10.7759/cureus.53230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/01/2024] Open
Abstract
Knee osteoarthritis (OA) is surgically treated with total knee arthroplasty (TKA). Traditionally, TKA has been performed using a mechanical alignment (MA) philosophy. However, due to significant patient dissatisfaction with surgical outcomes, an alternate alignment approach, kinematic alignment (KA), has gained popularity. KA-TKAs have improved functional patient outcomes by restoring the patient's native joint line orientation and minimizing soft tissue releases compared to neutral alignment in MA-TKAs. This review explores the postoperative effectiveness of utilizing KA-TKA to treat knee OA in patients with preoperative varus and valgus deformities. A comprehensive literature search was conducted on PubMed and Biomed Central databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search focused on studies analyzing the postoperative TKA outcomes in knee OA patients with preoperative varus or valgus deformities whose surgeries followed a KA philosophy and those comparing KA-TKA with MA-TKA. The available clinical evidence indicates that KA-TKA can be a viable treatment option for individuals with knee OA. The alignment of phenotypes has little clinical significance concerning functional outcomes and implant survival rates following KA-TKA. Furthermore, surgery outcomes in patients with preoperative deformities who underwent KA-TKA were similar to those who underwent MA-TKA. KA-TKA produced significantly better functional outcomes than MA-TKA in certain aspects. However, studies with larger sample sizes and more extended follow-up periods that directly compare KA-TKA with MA-TKA in treating knee OA patients are needed to fully demonstrate the efficacy of each technique. Furthermore, further research into the effects of KA-TKA on implant survival rates will provide a better understanding of the benefits of this technique and ultimately lead to improved patient outcomes.
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Affiliation(s)
- Kyle R Davis
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Varun Soti
- Pharmacology and Therapeutics, Lake Erie College of Osteopathic Medicine, Elmira, USA
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Maguen S, Batten A, Siegel SE, Huggins J, Snow JL, Fenn LM, Dick AM, Zenteno C, West AC, Masheb RM. Validation of the EDDS-5 self-report survey against the SCID-5 diagnostic interview in US veterans. Eat Behav 2024; 52:101846. [PMID: 38335645 DOI: 10.1016/j.eatbeh.2024.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
The aim of our study was to validate the Eating Disorder Diagnostic Scale (EDDS-5) updated for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with a diverse veteran population against a clinician-administered interview based on the Structured Clinical Interview for DSM-5 (SCID-5). Our sample included 343 veterans, 18-75 years, recruited April 2019 to December 2022 who completed the EDDS-5 as well as other eating disorder and mental health measures. A subsample of these veterans received clinical interviews (n = 166), which were used to validate the EDDS-5. We found that despite multiple proposed modifications, the EDDS-5 performed poorly at correctly identifying diverse veterans who were diagnosed as having eating disorders through clinician-administered interviews. The sensitivity was very low, indicating that using the EDDS-5 did not identify many true positives and may also over diagnose those without true eating disorders. The EDDS-5 may not be the best for screening or diagnostic purposes among diverse samples like veterans.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA.
| | - Adam Batten
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA
| | - Sarah E Siegel
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA
| | - Joy Huggins
- San Francisco VA Health Care System, USA; University of California San Francisco School of Medicine, USA
| | | | | | | | | | | | - Robin M Masheb
- VA Connecticut Healthcare System, USA; Yale School of Medicine, New Haven, CT, USA
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Hindmarch G, Meredith LS, McCullough CM, Griffin BA, Watkins KE. Interpersonal Violence and Mental Health, Drug use, and Treatment Utilization among Patients with Co-Occurring Opioid use and Mental Health Disorders. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2024; 8:24705470241279335. [PMID: 39246736 PMCID: PMC11378169 DOI: 10.1177/24705470241279335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/15/2024] [Indexed: 09/10/2024]
Abstract
Interpersonal violence is a common type of trauma experienced by people with opioid use disorder (OUD), especially for people with co-occurring OUD and mental illness (COD). However, little is known about demographic and clinical characteristics of individuals with COD who have experienced an interpersonal violence traumatic event compared to those who have experienced a non-violent trauma, and how experiences of interpersonal violence are associated with treatment utilization. Data presented are from a randomized clinical trial testing collaborative care for COD in primary care. Of the 797 patients enrolled in the larger study, 733 (92%) were included in this analysis because they reported a traumatic event. In this sample, 301 (41%) participants experienced a traumatic event involving interpersonal violence. Participants who experienced interpersonal violence were more likely to be younger and female. Among the 301 people who experienced interpersonal violence, 30% experienced child sexual abuse, 23% experienced physical violence, 19% experienced domestic violence, and 28% experienced sexual assault. Those who experienced physical violence were significantly less likely to be female (28.6% vs 74.2% to 88.2% in other groups). Those who reported domestic violence had significantly fewer days of drug use (4.1 days vs 9.0 to 11.5 in the other groups) and lower opioid use severity scores (mean = 13.0 vs 16.6 to 19.5 in the other groups). Multivariable regression results examining the associations between interpersonal violence experiences on treatment utilization revealed no statistically significant differences. Rates of receipt were high for medication for opioid use disorder (∼80%) in this sample while rates of mental health counseling were around 35% and rates of receiving mental health medication around 48%. These findings make an important contribution to understanding the associations between patient characteristics and traumatic experiences, and receipt of treatment for OUD and mental health problems among a sample of patients with COD. Clinical trial registration clinicalTrials.gov ID: NCT04559893.
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Zheng Z, Shi KS, Kamal A, Howard DH, Horný M, Richards TB, Ekwueme DU, Yabroff KR. Health-related quality of life among prostate cancer survivors with metastatic disease and non-metastatic disease and men without a cancer history in the USA. J Cancer Surviv 2023:10.1007/s11764-023-01509-8. [PMID: 38102521 PMCID: PMC11180215 DOI: 10.1007/s11764-023-01509-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Few studies have comprehensively compared health-related quality of life (HRQoL) between metastatic prostate cancer survivors, survivors with non-metastatic disease, and men without a cancer history. METHODS We used the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) data linkage to identify men aged ≥ 65 years enrolled in Medicare Advantage (MA) plans. Prostate cancer survivors were diagnosed between 1988 and 2017 and completed MHOS surveys between 1998 and 2019. We analyzed data from 752 metastatic prostate cancer survivors (1040 survey records), 19,583 localized or regional prostate cancer survivors (non-metastatic; 30,121 survey records), and 784,305 men aged ≥ 65 years without a cancer history in the same SEER regions (1.15 million survey records). We used clustered linear regressions to compare HRQoL measures at the person-level using the Veterans RAND 12 Item Health Survey (VR-12) T-scores for general health and physical and mental component summaries. RESULTS Compared to men without a cancer history, prostate cancer survivors were older, more likely to be married, and had higher socioeconomic status. Compared to men without a cancer history, metastatic prostate cancer survivors reported lower general health (T-score differences [95% confidence interval]: - 6.26, [- 7.14, - 5.38], p < .001), physical health (- 4.33, [- 5.18, - 3.48], p < .001), and mental health (- 2.64, [- 3.40, - 1.88], p < .001) component summaries. Results were similar for other VR-12 T-scores. In contrast, non-metastatic prostate cancer survivors reported similar VR-12 T-scores as men without a cancer history. Further analyses comparing metastatic and non-metastatic prostate cancer survivors support these findings. CONCLUSION Interventions to improve health-related quality of life for men diagnosed with metastatic prostate cancer merit additional investigation. IMPLICATIONS FOR CANCER SURVIVORS Interventions to improve health-related quality of life for metastatic prostate cancer survivors merit additional investigation.
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Affiliation(s)
| | | | - Arif Kamal
- American Cancer Society, Atlanta, GA, USA
| | - David H Howard
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Michal Horný
- Emory University Rollins School of Public Health, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
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Zhou Y, Shadbolt C, Thuraisingam S, Schilling C, Choong P, Dowsey M. Differences in Outcomes Between Initial Responders and Subsequent Responders to Health Questionnaires for Total Hip and Knee Arthroplasty: An Australian Tertiary Institutional Registry Study. J Arthroplasty 2023; 38:2561-2567. [PMID: 37286051 DOI: 10.1016/j.arth.2023.05.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Patient-reported outcome measure (PROM) questionnaires in national arthroplasty registries often have low response rates leading to questions about data reliability. In Australia, the SMART (St. Vincent's Melbourne Arthroplasty Outcomes) registry captures all elective total hip (THA) and total knee (TKA) arthroplasty patients with an approximate 98% response rate for preoperative and 12-month PROM scores. This high response rate is due to dedicated registry staff following up patients who do not initially respond (subsequent responders). This study compared initial responders to subsequent responders to find differences in 12-month PROM outcomes for THA and TKA. METHODS All elective THA and TKA patients for osteoarthritis from 2012 to 2021 captured by the SMART registry were included. In total, 1,333 THA and 1,340 TKA patients were included. The PROM scores were assessed using the Veterans-RAND 12 (VR12) and Western Ontario and McMasters Universities Arthritis Index (WOMAC) questionnaires. The primary outcome was differences in mean 12-month PROM scores between initial and subsequent responders. RESULTS Baseline characteristics and PROM scores were similar between initial and subsequent responders. However, 12-month PROM scores varied significantly. The adjusted mean difference showed that for the WOMAC pain score, subsequent responders scored 3.4 points higher in the THA cohort and 7.4 points higher in the TKA cohort compared to initial responders. Significant differences were also found in other WOMAC and VR12 scores for both THA and TKA cohorts at the 12-month timepoint. CONCLUSION This study found that significant differences in PROM outcomes postsurgery occurred in THA and TKA patients based on response to PROM questionnaires, suggesting that loss to follow-up in PROM outcomes should not be treated as missing completely at random (MCAR).
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
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Held P, Patton E, Pridgen SA, Smith DL, Kaysen DL, Klassen BJ. Using the Personalized Advantage Index to determine which veterans may benefit from more vs. less comprehensive intensive PTSD treatment programs. Eur J Psychotraumatol 2023; 14:2281757. [PMID: 38010280 PMCID: PMC10990437 DOI: 10.1080/20008066.2023.2281757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Intensive PTSD treatment programs (ITPs) are highly effective but tend to differ greatly in length and the number of adjunctive services that are provided in conjunction with evidence-based PTSD treatments. Individuals' treatment response to more or less comprehensive ITPs is poorly understood.Objective: To apply a machine learning-based decision-making model (the Personalized Advantage Index (PAI)), using clinical and demographic factors to predict response to more or less comprehensive ITPs.Methods: The PAI was developed and tested on a sample of 747 veterans with PTSD who completed a 3-week (more comprehensive; n = 360) or 2-week (less comprehensive; n = 387) ITP.Results: Approximately 12.32% of the sample had a PAI value that suggests that individuals would have experienced greater PTSD symptom change (5 points) on the PTSD Checklist for DSM-5 in either a more- or less comprehensive ITP. For individuals with the highest 25% of PAI values, effect sizes for the amount of PTSD symptom change between those in their optimal vs. non-optimal programs was d = 0.35.Conclusions: Although a minority was predicted to have benefited more from a program, there generally was not a substantial difference in predicted outcomes. Less comprehensive and thus more financially sustainable ITPs appear to work well for most individuals with PTSD.
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Affiliation(s)
- Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Emily Patton
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sarah A. Pridgen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Dale L. Smith
- Department of Psychiatry, University of Illinois – Chicago, Chicago, IL, USA
| | - Debra L. Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Brian J. Klassen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Sheckter CC, Holan C, Carrougher G, Orton C, Gibran N, Stewart BT. Higher Out-of-pocket Expenses are Associated with Worse Health-related Quality of Life in Burn Survivors: A Northwest Regional Burn Model System Investigation. J Burn Care Res 2023; 44:1349-1354. [PMID: 37094279 DOI: 10.1093/jbcr/irad058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Indexed: 04/26/2023]
Abstract
The care required to recover serious burn injuries is costly. In the United States, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors. Financial data from a regional burn center were merged with data in the Burn Model System (BMS) National Database. HRQL outcomes included VA-Rand 12 (VR-12) physical component summary (PCS) and mental component summary (MCS) scores. Participant surveys were conducted at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, sex, insurance/payer, self-identified race/ethnicity, measures of burn injury severity). 644 participants were included, of which 13% (84) had OOP costs. The percentage of participants with OOP costs was 34% for commercial/private, 22% for Medicare, 8% for other, 4% for self-pay, and 0% for workers' compensation and Medicaid. For participants with OOP expenses, median payments were $875 with an IQR of $368-1728. In addition to markers of burn injury severity, OOP costs were negatively associated with PCS scores at 6-months (coefficient -0.002, P < .001) and 12-months post-injury (coefficient -0.001, P = .004). There were no significant associations with PCS scores at 24 months post-injury or MCS scores at any interval. Participants with commercial/private or Medicare payer had higher financial liability than other payers. Higher OOP expenses were negatively associated with physical HRQL for at least 12 months after injury. Financial toxicity occurs after burn injury and providers should target resources accordingly.
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Affiliation(s)
- Clifford C Sheckter
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, USA
- Regional Burn Center at Santa Clara Valley Medical Center, Department of Surgery, USA
| | - Cole Holan
- Dell Medical School, The University of Texas, Austin, USA
| | - Gretchen Carrougher
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Caitlin Orton
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, USA
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Swisher EM, Rayes N, Bowen D, Peterson CB, Norquist BM, Coffin T, Gavin K, Polinsky D, Crase J, Bakkum-Gamez JN, Blank SV, Munsell MF, Nebgen D, Fleming GF, Olopade OI, Law S, Zhou A, Levine DA, D'Andrea A, Lu KH. Remotely Delivered Cancer Genetic Testing in the Making Genetic Testing Accessible (MAGENTA) Trial: A Randomized Clinical Trial. JAMA Oncol 2023; 9:1547-1555. [PMID: 37707822 PMCID: PMC10502696 DOI: 10.1001/jamaoncol.2023.3748] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/29/2023] [Indexed: 09/15/2023]
Abstract
Importance Requiring personalized genetic counseling may introduce barriers to cancer risk assessment, but it is unknown whether omitting counseling could increase distress. Objective To assess whether omitting pretest and/or posttest genetic counseling would increase distress during remote testing. Design, Setting, and Participants Making Genetic Testing Accessible (MAGENTA) was a 4-arm, randomized noninferiority trial testing the effects of individualized pretest and/or posttest genetic counseling on participant distress 3 and 12 months posttest. Participants were recruited via social and traditional media, and enrollment occurred between April 27, 2017, and September 29, 2020. Participants were women aged 30 years or older, English-speaking, US residents, and had access to the internet and a health care professional. Previous cancer genetic testing or counseling was exclusionary. In the family history cohort, participants had a personal or family history of breast or ovarian cancer. In the familial pathogenic variant (PV) cohort, participants reported 1 biological relative with a PV in an actionable cancer susceptibility gene. Data analysis was performed between December 13, 2020, and May 31, 2023. Intervention Participants completed baseline questionnaires, watched an educational video, and were randomized to 1 of 4 arms: the control arm with pretest and/or posttest genetic counseling, or 1 of 3 study arms without pretest and posttest counseling. Genetic counseling was provided by phone appointments and testing was done using home-delivered saliva kits. Main Outcomes and Measures The primary outcome was participant distress measured by the Impact of Event Scale 3 months after receiving the results. Secondary outcomes included completion of testing, anxiety, depression, and decisional regret. Results A total of 3839 women (median age, 44 years [range 22-91 years]), most of whom were non-Hispanic White and college educated, were randomized, 3125 in the family history and 714 in the familial PV cohorts. In the primary analysis in the family history cohort, all experimental arms were noninferior for distress at 3 months. There were no statistically significant differences in anxiety, depression, or decisional regret at 3 months. The highest completion rates were seen in the 2 arms without pretest counseling. Conclusions and Relevance In the MAGENTA clinical trial, omitting individualized pretest counseling for all participants and posttest counseling for those without PV during remote genetic testing was not inferior with regard to posttest distress, providing an alternative care model for genetic risk assessment. Trial Registration ClinicalTrials.gov Identifier: NCT02993068.
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Affiliation(s)
| | - Nadine Rayes
- Department of Obstetrics & Gynecology, University of Texas MD Anderson Cancer Center, Houston
| | - Deborah Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Christine B Peterson
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston
| | - Barbara M Norquist
- Department of Obstetrics & Gynecology, University of Washington, Seattle
| | - Tara Coffin
- Department of Bioethics and Humanities, University of Washington, Seattle
| | | | | | - Jamie Crase
- Department of Obstetrics & Gynecology, University of Washington, Seattle
| | | | - Stephanie V Blank
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark F Munsell
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston
| | - Denise Nebgen
- Department of Obstetrics & Gynecology, University of Texas MD Anderson Cancer Center, Houston
| | - Gini F Fleming
- Section of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois
| | | | | | | | - Douglas A Levine
- Perlmutter Cancer Center, NYU Langone Health, New York, New York
- Now with Merck Research Laboratories, Rahway, New Jersey
| | | | - Karen H Lu
- Department of Obstetrics & Gynecology, University of Texas MD Anderson Cancer Center, Houston
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Albelooshi A, Hamie M, Bollars P, Althani S, Salameh R, Almasri M, Schotanus MGM, Meshram P. Image-free handheld robotic-assisted technology improved the accuracy of implant positioning compared to conventional instrumentation in patients undergoing simultaneous bilateral total knee arthroplasty, without additional benefits in improvement of clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2023; 31:4833-4841. [PMID: 37558748 PMCID: PMC10598071 DOI: 10.1007/s00167-023-07523-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical and radiological outcomes in patients who underwent simultaneous bilateral total knee arthroplasty (SB-TKA) using either robotic-assisted TKA (RA-TKA) or conventional TKA (C-TKA). METHODS Included were the patients who underwent SB-TKA between January 2018 and January 2020 and had a minimum follow-up of 2 years. Of 151 patients included, 117 patients were operated using an image-free handheld robotic sculpting system (RA-TKA group) and 34 patients operated using conventional instrumentation (C-TKA group). The key outcomes noted were multiple patient-reported outcomes (PROs), adverse events, and radiological outcomes. Two investigators independently measured the radiological outcomes on pre- and post-operative radiographs in coronal plane (medial proximal tibial angle [MPTA] and anatomic lateral distal femoral angle [aLDFA]) and sagittal plane (posterior tibial slope [PTS] and posterior condylar offset [PCO]). The chi-square test was used to examine categorical variables. Student's t test was used to analyze the continuous variables. RESULTS Patients in both groups were similar in baseline characteristics (gender, body mass index, incidence of comorbidities, and length of hospital stay) except that RA-TKA group patients younger (66.7 ± 8.9 vs 70.4 ± 10.5, P = 0.037) than C-TKA group. The operative time was longer in RA-TKA group as compared to C-TKA (189.3 ± 37.1 vs 175.0 ± 28.2, P = 0.040). The final PROs at each were similar between the two groups (P > 0.05). The values of PROs at final follow-up in RA-TKA compared to C-TKA were VAS pain (0.4 ± 0.9 vs 0.4 ± 0.5), KOOS-JR (89.3 ± 5.8 vs 87.1 ± 5.3), and physical (55.9 ± 2.8 vs 55.4 ± 3.2), mental (61.1 ± 4.4 vs 60.2 ± 4.7) component of VR-12 scores, and KSS satisfaction (37.5 ± 1.1 vs 37.1 ± 2.2) (all P > 0.50 or non-significant [n.s.]). While one patient in RA-TKA required revision of femoral component for peri-prosthetic fracture, none of the patient in conventional group were revised (0.85% vs 0%, P = n.s.). The proportion of patients with outliers in RA-TKA group was lower for aLDFA (2.6% vs 22.1%, P < 0.01) and PTS (0% vs 35%, P < 0.01). CONCLUSION This comparative study in patients undergoing SB-TKA found reduction of outliers in femoral and tibial implant positioning with RA-TKA as compared to C-TKA. There were no differences in both groups for pain, function, and satisfaction at a minimum of 2 years of follow-up. LEVEL OF EVIDENCE III Therapeutic Study.
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Affiliation(s)
- Ali Albelooshi
- Department of Orthopaedic Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
- Orthocure Medical Center, Dubai, United Arab Emirates
| | - Muhieddine Hamie
- Department of Orthopaedic Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
- Orthocure Medical Center, Dubai, United Arab Emirates
| | - Peter Bollars
- Department of Orthopedic Surgery, St. Trudo Hospital, Sint Truiden, Belgium
| | - Saeed Althani
- Department of Orthopaedic Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
- Orthocure Medical Center, Dubai, United Arab Emirates
| | - Rami Salameh
- Orthocure Medical Center, Dubai, United Arab Emirates
| | - Malak Almasri
- Orthocure Medical Center, Dubai, United Arab Emirates
| | - Martijn G M Schotanus
- Department of Orthopedic Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Prashant Meshram
- Department of Orthopaedic Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
- Orthocure Medical Center, Dubai, United Arab Emirates.
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Morlock R, Morlock A. Think Before You Ink: Perception, Prevalence, and Correlates of Tattooing and Tattoo Regret in US Adults. Cureus 2023; 15:e48167. [PMID: 38046700 PMCID: PMC10693284 DOI: 10.7759/cureus.48167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Few population-based studies have examined the perception and prevalence of tattoos and tattoo regret in the general United States (US) adult population. Our objective was to report the perception of people with tattoos and describe the prevalence, socio-demographics, health-related quality of life, and the extent of tattoo regret in US adults. Methods Data were assessed from a cross-sectional study of US adults. Participants were recruited using a random stratified sampling framework similar to the US Census. Data collected for all participants included socio-demographic and clinical characteristics, general health-related quality of life (Veterans RAND 12-item), depression (Patient Health Questionnaire 9-item), anxiety (Generalized Anxiety Disorder 7-item), and perceptions of those with tattoos. Those with tattoos also answered questions about their tattoo(s), including age when first tattooed, reasons for getting a tattoo, and tattoo regret. Categorical data were described by percentages, and continuous data by mean and standard deviation. Proportions were compared with Chi-squared tests and the means with ANOVA. A logistic regression controlling for confounding variables was carried out to assess factors predictive of tattoo regret. Results Of the 3033 participants, 35.3% (1,072) reported having a tattoo. Those more likely to have a tattoo were female (58% vs. 45%), younger (38 vs. 46 years), smoked cigarettes (38% vs. 19% non-smoker), and/or reported an alcohol or drug problem (10% vs. 5%). Those without tattoos were more likely to perceive those with tattoos as less attractive, intelligent, professional, and more rebellious. More time (in years) with a tattoo, having a tattoo on the face, neck, hands, wrist, or fingers, getting a tattoo because of peer pressure, being impaired when getting a tattoo, and experiencing an adverse event related to a tattoo were predictive of tattoo regret. Older age and remembrance as the reason for a tattoo were predictive of not having tattoo regret. Conclusion More than one-third of the study sample comprised of adults in the US reported having at least one tattoo. While most people, regardless of their tattoo status, perceived tattooed and non-tattooed individuals equally, tattooed individuals were more likely to be perceived negatively than positively by those without tattoos. Whether tattooed or not, being aware of varying perceptions of tattoo status may be helpful in facilitating positive outcomes.
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Affiliation(s)
- Robert Morlock
- Health Services Research, Acumen Health Research Institute, Ann Arbor, USA
| | - Amy Morlock
- Health Services Research, Acumen Health Research Institute, Ann Arbor, USA
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Anderson S, Haraldsdottir K, Sanfilippo J, McGehee C, Watson A. Mindfulness training is associated with improved quality of life in female collegiate athletes. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-6. [PMID: 37856360 DOI: 10.1080/07448481.2023.2252512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 08/20/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To examine the effects of a mindfulness intervention on health-related quality of life in female Division I collegiate athletes. PARTICIPANTS 135 female collegiate athletes, ages 18 - 23 years. METHODS Health related quality of life (HRQoL) was reported twice/year in approximately January and July from January 2017 to 2020 with the 12-question Veterans Rand survey (VR-12). Twenty-three of the participants received a 6-week, in-person, group mindfulness training in spring 2019, while 112 did not. RESULTS A significant interaction between time and mindfulness was identified with respect to the mental component score of the VR-12 of the VR-12 (MCS; β = 3.86 ± 1 .56, p = 0.012) but no significant relationships were identified with respect to time (pre-mindfulness: β = -2.36 ± 1.38, p = 0.074), mindfulness (yes: β = -2.26 ± 1.54, p = 0.14) or season (winter: β = -0.84 ± 0.57, p = 0.14). With respect to the physical component score (PCS), no significant relationships were identified with respect to time (pre-mindfulness: β = -1.09 ± 1.21, p = 0.37), mindfulness (yes: β = 1.30 ± 1.31, p = 0.32), season (winter: β = 0.50 ± 0.50, p = 0.32), or the interaction between time and mindfulness (β = 0.35 ± 1 .36, p = 0.80). CONCLUSIONS Among female collegiate athletes, mindfulness training is associated with significant improvements in mental HRQoL, but not physical HRQoL.
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Affiliation(s)
- S Anderson
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, USA
- Center for Healthy Minds, University of Wisconsin, Madison, Wisconsin, USA
| | - K Haraldsdottir
- Watson Human Performance Laboratory, University of Wisconsin, Madison, Wisconsin, USA
| | - J Sanfilippo
- Division of Intercollegiate Athletics, University of Wisconsin, Madison, Wisconsin, USA
| | - C McGehee
- Division of Intercollegiate Athletics, University of Wisconsin, Madison, Wisconsin, USA
| | - A Watson
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, USA
- Watson Human Performance Laboratory, University of Wisconsin, Madison, Wisconsin, USA
- Department of Orthopedics and Rehabilitation, Division of Sports Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Wilson R, Cuthbertson L, Sasaki A, Russell L, Kazis LE, Sawatzky R. Validation of an Adapted Version of the Veterans RAND 12-Item Health Survey for Older Adults Living in Long-Term Care Homes. THE GERONTOLOGIST 2023; 63:1467-1477. [PMID: 36866495 PMCID: PMC10581377 DOI: 10.1093/geront/gnad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Veterans RAND 12-Item Health Survey (VR-12) is a generic patient-reported outcome measure of physical and mental health status. An adapted version of the VR-12 was developed for use with older adults living in long-term residential care (LTRC) homes in Canada: VR-12 (LTRC-C). This study aimed to evaluate the psychometric validity of the VR-12 (LTRC-C). RESEARCH DESIGN AND METHODS Data for this validation study were collected via in-person interviews for a province-wide survey of adults living in LTRC homes across British Columbia (N = 8,657). Three analyses were conducted to evaluate validity and reliability: (1) confirmatory factor analyses were conducted to validate the measurement structure; (2) correlations with measures of depression, social engagement, and daily activities were examined to evaluate convergent and discriminant validity; and (3) Cronbach's alpha (r) statistics were obtained to evaluate internal consistency reliability. RESULTS A measurement model with 2 correlated latent factors (representing physical health and mental health), 4 cross-loadings, and 4 correlated items resulted in an acceptable fit (root-mean-square error of approximation = 0.07; comparative fit index = 0.98). Physical and mental health were correlated in expected directions with measures of depression, social engagement, and daily activities, though the magnitudes of the correlations were quite small. Internal consistency reliability was acceptable for physical and mental health (r > 0.70). DISCUSSION AND IMPLICATIONS This study supports the use of the VR-12 (LTRC-C) to measure perceived physical and mental health among older adults living in LTRC homes.
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Affiliation(s)
- Rozanne Wilson
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lena Cuthbertson
- British Columbia Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver, British Columbia, Canada
| | - Ayumi Sasaki
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lara Russell
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lewis E Kazis
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, Massachusetts, USA
- Department of Pulmonary Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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50
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Eliacin J, Burgess D, Rollins AL, Patterson S, Damush T, Bair MJ, Salyers MP, Spoont M, Chinman M, Slaven JE, Matthias MS. Outcomes of a peer-led navigation program, PARTNER-MH, for racially minoritized Veterans receiving mental health services: a pilot randomized controlled trial to assess feasibility and acceptability. Transl Behav Med 2023; 13:710-721. [PMID: 37130337 DOI: 10.1093/tbm/ibad027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
This pilot study explored the feasibility and acceptability of PARTNER-MH, which aimed to engage racially diverse Veterans in mental health services, facilitate their active participation in care, and improve their communication with providers. Fifty participants were randomized to the intervention or a waitlist control group. For primary outcomes, we assessed the feasibility of the study design and PARTNER-MH's feasibility and acceptability. For secondary outcomes, we explored preliminary effects on patient engagement, patient activation, shared decision-making, and health-related outcomes. The study had a recruitment rate of 68%, enrollment rate of 91%, and a follow-up retention rate of 72%. For intervention feasibility and acceptability, fidelity scores were satisfactory and improved over time, session attendance was modest with 33% of participants completing ≥6 sessions, and 89% of participants were satisfied with the intervention. For secondary outcomes, patients in the intervention arm showed significant improvement on self-reported mental health and depression, compared with those in the control group at both 6- and 9-month follow-ups. However, there were no significant differences between study arms on the other measures. Pilot results provide support for future testing of PARTNER-MH in a larger trial, although modifications are needed to increase session attendance and follow-up retention rate. CLINICAL TRIAL INFORMATION The study was preregistered at Clinical Trials.gov. The study Trial registration number is ClinicalTrials.gov NCT04515771.
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Affiliation(s)
- Johanne Eliacin
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Diana Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Angela L Rollins
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Scott Patterson
- Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Teresa Damush
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew J Bair
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, Pittsburg VA, Pittsburg, PA, USA
- RAND, Pittsburgh, PA, USA
| | - James E Slaven
- Deparmtent of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marianne S Matthias
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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