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Nie S, Li J, Liu X, Liu J, Wu X, Tang P, Zhao Y, Li M, Zhang L. The clinical efficacy of Medial Sustain Nail(MSN) and Proximal femoral nail anti-rotation(PFNA) for fixation of medial comminuted trochanteric fractures: a prospective randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2024; 48:2189-2200. [PMID: 38772935 DOI: 10.1007/s00264-024-06220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
PURPOS To evaluate the clinical efficacy of the Medial Sustain Nail (MSN) for medial comminuted trochanteric fractures fixation in comparison to Proximal Femoral Nail Antirotation (PFNA) through a clinical study. METHODS A non-inferiority randomized controlled trial was conducted at a single centre between July 2019 and July 2020. Fifty patients diagnosed comminuted trochanteric fractures were randomly assigned to either the MSN group (n = 25) or the PFNA group (n = 25). A total of forty-three patients were included in the final study analysis. The primary outcome measure was Short Form 36 health surgery physical component summary (SF-36 PCS) score. Secondary outcomes included the Oxford Hip Scores (OHS), weight bearing, complication relate to implant and so on. This study was not blined to surgeons, but to patients and data analysts. RESULTS The MSN demonstrated significantly better functional outcomes as measured by SF-36 PCS and OHS at six months postoperative compared to PFNA (p < 0.05). Union of fractures in the MSN group reached 90.9% at three months after surgery, whereas the PFNA group achieved a union rate of 57.1% (p < 0.05). Furthermore, weight-bearing time of MSN group was earlier than PFNA group (p < 0.05). Additionally, complications related to implant usage were more prevalent in the PFNA group (33.3%) compared to the MSN group (4.5%) (p < 0.05). CONCLUSION MSN exhibited superior quality of life outcomes compared to PFNA at six months postoperative. This indicates that MSN effectively reconstructs medial femoral support in patients with comminuted trochanteric fractures, which facilitates early weight-bearing and accelerates the recovery process. TRIAL REGISTRATION Trial registration number: NCT01437176, Date of the trial registration:2011-9-1, Date of commencement of the study:2011-9, Date of enrolment/recruitment of the study subjects:2019-7.
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Affiliation(s)
- Shaobo Nie
- Department of Orthopaedics, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Jiantao Li
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Xiao Liu
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Jianheng Liu
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Xiaoyong Wu
- Department of Orthopaedics, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Peifu Tang
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Yanpeng Zhao
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
| | - Ming Li
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
| | - Licheng Zhang
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
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Latham S, Leach MJ, White VM, Webber K, Jefford M, Lisy K, Davis N, Millar JL, Evans S, Emery JD, IJzerman M, Ristevski E. Health-related quality of life in rural cancer survivors compared with their urban counterparts: a systematic review. Support Care Cancer 2024; 32:424. [PMID: 38864894 PMCID: PMC11168981 DOI: 10.1007/s00520-024-08618-9] [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: 03/04/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE We conducted a systematic review to describe health-related quality of life (HRQOL) in rural cancer survivors (RCS), and compare HRQOL between RCS and urban cancer survivors (UCS). METHOD We searched Medline, Embase, CINAHL Plus, and PsycINFO for studies with HRQOL in adult cancer survivors living in rural, regional, remote, and urban areas, who had completed definitive primary cancer treatment, without evidence of residual disease. Where available, we used normative and clinically important values to ascribe meaning to HRQOL data. FINDINGS Fifteen studies (16 papers) were included. Most were from the US (n = 8) and reported on breast cancer survivors (n = 9). Six HRQOL instruments, collecting data across 16 domains, were used. Three instruments were specific to the survivorship phase. Normative and clinical data were available for 12 studies. Compared with normative populations, RCS had clinically worse physical HRQOL (6/12 studies), better social/family (5/7), and functional (3/6) HRQOL, and there were no differences in emotional or/mental HRQOL (9/12). In six studies with rural-urban comparator groups and normative and clinically important data, RCS and UCS had clinically worse physical (3/6 and 2/6, respectively) and better social/family (3/4 and 2/4 studies, respectively) HRQOL than normative populations. Functional HRQOL was better in RCS (2/4 studies) than UCS and normative populations. In 3/6 studies, there were no clinical differences in emotional or/mental HRQOL between RCS, UCS, and normative populations. CONCLUSION Overall, HRQOL is not clearly better or worse in RCS than UCS. Future research should include different tumor types, rural residents, and survivorship-specific HRQOL instruments.
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Affiliation(s)
- S Latham
- Department of Oncology, Monash Health, Clayton, Victoria, Australia
- Department of Oncology, Eastern Health, Box Hill, Victoria, Australia
- Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - M J Leach
- School of Rural Health, Monash University, Bendigo, VIC, Australia
| | - V M White
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - K Webber
- Department of Oncology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - M Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, , Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - K Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, , Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - N Davis
- Cancer Survivor, Melbourne, Australia
| | - J L Millar
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - S Evans
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J D Emery
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Cancer Research, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - M IJzerman
- Centre for Health Policy, Cancer Health Services Research, Melbourne School of Population and Global/Total Health, The University of Melbourne, Carlton, Victoria, Australia
| | - E Ristevski
- School of Rural Health, Monash University, 15 Sargeant Street, Warragul, VIC, 3820, Australia.
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Gikandi A, Hallet J, Koerkamp BG, Clark CJ, Lillemoe KD, Narayan RR, Mamon HJ, Zenati MA, Wasif N, Safran DG, Besselink MG, Chang DC, Traeger LN, Weissman JS, Fong ZV. Distinguishing Clinical From Statistical Significances in Contemporary Comparative Effectiveness Research. Ann Surg 2024; 279:907-912. [PMID: 38390761 PMCID: PMC11087199 DOI: 10.1097/sla.0000000000006250] [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] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To determine the prevalence of clinical significance reporting in contemporary comparative effectiveness research (CER). BACKGROUND In CER, a statistically significant difference between study groups may or may not be clinically significant. Misinterpreting statistically significant results could lead to inappropriate recommendations that increase health care costs and treatment toxicity. METHODS CER studies from 2022 issues of the Annals of Surgery , Journal of the American Medical Association , Journal of Clinical Oncology , Journal of Surgical Research , and Journal of the American College of Surgeons were systematically reviewed by 2 different investigators. The primary outcome of interest was whether the authors specified what they considered to be a clinically significant difference in the "Methods." RESULTS Of 307 reviewed studies, 162 were clinical trials and 145 were observational studies. Authors specified what they considered to be a clinically significant difference in 26 studies (8.5%). Clinical significance was defined using clinically validated standards in 25 studies and subjectively in 1 study. Seven studies (2.3%) recommended a change in clinical decision-making, all with primary outcomes achieving statistical significance. Five (71.4%) of these studies did not have clinical significance defined in their methods. In randomized controlled trials with statistically significant results, sample size was inversely correlated with effect size ( r = -0.30, P = 0.038). CONCLUSIONS In contemporary CER, most authors do not specify what they consider to be a clinically significant difference in study outcome. Most studies recommending a change in clinical decision-making did so based on statistical significance alone, and clinical significance was usually defined with clinically validated standards.
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Affiliation(s)
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Clancy J Clark
- Department of Surgical Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Raja R Narayan
- Department of Surgical Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - Harvey J Mamon
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - Marco A Zenati
- Department of Cardiac Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nabil Wasif
- Department of Surgical Oncology and Endocrine Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Dana Gelb Safran
- Department of Medicine, National Quality Forum, Washington, DC; School of Medicine, Tufts University, Boston, MA
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Lara N Traeger
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Joel S Weissman
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Zhi Ven Fong
- Department of Surgical Oncology and Endocrine Surgery, Mayo Clinic Arizona, Phoenix, AZ
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Grönkvist R, Vixner L, Äng B, Grimby-Ekman A. Measurement Error, Minimal Detectable Change, and Minimal Clinically Important Difference of the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale, and Pain Numeric Rating Scale in Patients With Chronic Pain. THE JOURNAL OF PAIN 2024:104559. [PMID: 38734041 DOI: 10.1016/j.jpain.2024.104559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
In both pain research and clinical practice, patient-reported outcome measures are used to assess dimensions of health. Interpreting these instruments requires understanding their measurement error and what magnitude of change has subjective importance for patients. This study estimated the standard error of measurement, 1-year minimal detectable change, and 1-year minimal clinically important difference (MCID) for the Short Form-36 Health Survey physical component summary and mental component summary, the Hospital Anxiety and Depression Scale subscales for anxiety symptoms and depression symptoms, and the numeric rating scale for past-week average pain intensity. MCIDs for these instruments have not previously been estimated in a large sample of chronic pain patients participating in interdisciplinary pain rehabilitation. Data were drawn from the Swedish Quality Registry for Pain Rehabilitation (n = 8,854 patients). MCID was estimated as average change and change difference based on 3 different anchors. MCID estimates were 2.62 to 4.69 for Short Form-36 Health Survey physical component summary, 4.46 to 6.79 for Short Form-36 Health Survey mental component summary, .895 to 1.48 for numeric rating scale, 1.17 to 2.13 for anxiety symptoms in the Hospital Anxiety and Depression Scale, and 1.48 to 2.54 for depression symptoms in the Hospital Anxiety and Depression Scale. The common assumption of an identical standard error of measurement for pre- and post-treatment measurements was not always applicable. When estimating MCID, researchers should select an estimation method and anchor aligned with the study's context and objectives. PERSPECTIVE: This article presents estimates of MCID and minimal detectable change for several commonly used patient-reported outcome measures among patients with chronic pain. These estimates can help clinicians and researchers to determine when a measured health improvement is subjectively important to the patient and greater than measurement error.
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Affiliation(s)
- Rode Grönkvist
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Björn Äng
- School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Research and Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anna Grimby-Ekman
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Broderick J, Haberlin C, O Donnell DM. Feasibility and preliminary efficacy of a physiotherapy-led remotely delivered physical activity intervention in cancer survivors using wearable technology. The IMPETUS trial. Physiother Theory Pract 2024; 40:929-940. [PMID: 36424873 DOI: 10.1080/09593985.2022.2147408] [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: 12/23/2020] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physical activity levels are low in cancer survivors. Remotely delivered programs which harness wearable technology may potentially be beneficial. OBJECTIVE To evaluate the feasibility and preliminary efficacy of a remotely delivered, physical activity intervention which harnessed wearable technology. METHODS This single arm pre-post longitudinal study included cancer survivors who had completed treatment in the preceding 3 years. Participants were supplied with a Fitbit One® or Flex® for 12 weeks. Physical activity goals were discussed during support phone calls. Outcome measures, assessed at baseline (T1), 12 weeks (T2), and 24 weeks (T3), included feasibility (recruitment, adherence, safety, acceptability) and efficacy [physical activity (Godin leisure time Index, ActiGraph GT3X+), quality of life (functional assessment of cancer therapy - general, short form 36 physical functioning component), functional capacity (six-minute walk test)]. RESULTS Forty-five participants completed T1 assessments (10 males, 35 females). Thirty-nine (86.6%) of those underwent assessment at T2 and 31 (68.8%) at T3. The intervention was perceived positively with no adverse effects. There were increases in functional capacity (six-minute walk test, p = .002) between T1-T3, an increase in quality of life [short form 36 physical functioning measure (p = .0035), functional assessment of cancer total score (p = .02)] and self-report physical activity levels (p = .000123) between T1-T2, although effect sizes were generally low (d = 0.180 to d = 0.418). Objectively measured physical activity did not change. CONCLUSION A physical activity intervention including wearable technology was safe, feasible, and well received by cancer survivors. An intervention based on this proof of concept should be followed up in further studies.
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Affiliation(s)
- Julie Broderick
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - Ciarán Haberlin
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
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Diab MM, Patel S, Young C, Allen IE, Harris HW. Quality of life measures and cost analysis of biologic versus synthetic mesh for ventral hernia repair: The Preventing Recurrence in Clean and Contaminated Hernias randomized clinical trial. Surgery 2024; 175:1063-1070. [PMID: 38135553 DOI: 10.1016/j.surg.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Although the most durable method for ventral hernia repairs involves using mesh, whether to use biologic mesh versus synthetic mesh remains controversial. This study aimed to compare synthetic and biologic meshes with respect to patient-reported quality of life scores and costs after ventral hernia repair surgeries. METHODS This study is part of the Preventing Recurrence in Clean and Contaminated Hernias (PRICE) pragmatic randomized control trial conducted from March 2014 through October 2018. Patients were randomized 1:1 to undergo ventral hernia repair using either a biologic or synthetic mesh. The coprimary outcomes were 2-year changes in Visual Analog Scale, Activities Assessment Scale, Hernia-Related Quality-of-Life Survey, and Short-Form 36 Health Survey (SF-36) quality-of-life scores from repair. The secondary outcome was the overall cost per patient. RESULTS Among the 165 patients included in the study, 82 were randomized to biologic meshes and 83 to synthetic meshes. There were no significant differences in the performance between the 2 mesh types with regard to quality-of-life measures using a mixed model approach. This result was consistent even when performing subgroup analysis based on wound contamination. However, nonparametric tests comparing the differences in quality-of-life measures from preoperative to 24-month postoperative timepoints revealed that the synthetic mesh group showed a greater reduction in disability than biologic mesh for the SF-36 (median [interquartile range] of 20 [5-30] vs 6 [1-20], P = .025). This difference was due to reductions in the physical role limitations (62 [0-100] vs 0 [0-50], P = .018) and the pain (38 [12-50] vs 12 [0-25], P = .012) domains of the SF-36. Overall cost per patient was greater for biologic meshes (mean [95% confidence interval] of $80,420 [$66,485-$94,355] vs $61,036 [$48,946-$73,125], P = .038), regardless of insurance type. CONCLUSION In this randomized clinical trial, there were no differences in changes in quality-of-life scores at the 2-year timepoint except for the SF-36, where the synthetic mesh may be associated with less pain and physical role limitations than the biologic mesh. Overall costs per patient were less for synthetic than biologic mesh.
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Affiliation(s)
- Mohamed Mustafa Diab
- Department of Surgery, University of California, San Francisco, CA; Department of Surgery, Duke University, Durham, NC
| | - Sohil Patel
- Department of Surgery, University of California, San Francisco, CA
| | - Charlotte Young
- Department of Surgery, University of California, San Francisco, CA
| | - Isabel Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
| | - Hobart W Harris
- Department of Surgery, University of California, San Francisco, CA.
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Gerstein E, Bierbrier J, Whitmore GA, Vandemheen KL, Bergeron C, Boulet LP, Cote A, Field SK, Penz E, McIvor RA, Lemière C, Gupta S, Hernandez P, Mayers I, Bhutani M, Lougheed MD, Licskai CJ, Azher T, Ezer N, Ainslie M, Alvarez GG, Mulpuru S, Aaron SD. Impact of Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma on Symptoms, Quality of Life, Healthcare Use, and Work Productivity. Am J Respir Crit Care Med 2023; 208:1271-1282. [PMID: 37792953 DOI: 10.1164/rccm.202307-1264oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/04/2023] [Indexed: 10/06/2023] Open
Abstract
Rationale: A significant proportion of individuals with chronic obstructive pulmonary disease (COPD) and asthma remain undiagnosed. Objectives: The objective of this study was to evaluate symptoms, quality of life, healthcare use, and work productivity in subjects with undiagnosed COPD or asthma compared with those previously diagnosed, as well as healthy control subjects. Methods: This multicenter population-based case-finding study randomly recruited adults with respiratory symptoms who had no previous history of diagnosed lung disease from 17 Canadian centers using random digit dialing. Participants who exceeded symptom thresholds on the Asthma Screening Questionnaire or the COPD Diagnostic Questionnaire underwent pre- and post-bronchodilator spirometry to determine if they met diagnostic criteria for COPD or asthma. Two control groups, a healthy group without respiratory symptoms and a symptomatic group with previously diagnosed COPD or asthma, were similarly recruited. Measurements and Main Results: A total of 26,905 symptomatic individuals were interviewed, and 4,272 subjects were eligible. Of these, 2,857 completed pre- and post-bronchodilator spirometry, and 595 (21%) met diagnostic criteria for COPD or asthma. Individuals with undiagnosed COPD or asthma reported greater impact of symptoms on health status and daily activities, worse disease-specific and general quality of life, greater healthcare use, and poorer work productivity than healthy control subjects. Individuals with undiagnosed asthma had symptoms, quality of life, and healthcare use burden similar to those of individuals with previously diagnosed asthma, whereas subjects with undiagnosed COPD were less disabled than those with previously diagnosed COPD. Conclusions: Undiagnosed COPD or asthma imposes important, unmeasured burdens on the healthcare system and is associated with poor health status and negative effects on work productivity.
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Affiliation(s)
- Emily Gerstein
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jared Bierbrier
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Celine Bergeron
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia
| | | | - Andreanne Cote
- Centre de recherche, Hôpital Laval, Université Laval, Quebec, Quebec, Canada
| | - Stephen K Field
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - R Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Lemière
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Samir Gupta
- Department of Medicine and Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Irvin Mayers
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - M Diane Lougheed
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Tanweer Azher
- Department of Medicine, Memorial University, St. John's, Newfoundland, Canada; and
| | - Nicole Ezer
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Martha Ainslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Kaundinya T, Kye Y, El-Behaedi SE, Choi JN. Protocol for a feasibility trial (EXPRESS-C-GVHD) for an expressive helping intervention within a support group for cutaneous graft-versus-host-disease. Arch Dermatol Res 2023; 315:2905-2912. [PMID: 37698591 DOI: 10.1007/s00403-023-02718-y] [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: 07/20/2023] [Revised: 07/20/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Cutaneous graft-versus-host disease (cuGVHD) is a complication of allogeneic hematopoietic stem cell transplantation that presents with varying severity and can significantly affect one's quality of life (QOL). No trials have yet tested nonpharmacologic interventions to improve the QOL of patients with cuGVHD. The primary objective of the Expressive Helping in Support Groups for Cutaneous GVHD (EXPRESS-C-GVHD) Trial is to evaluate the effect of a support group that employs expressive writing on cutaneous and systemic GVHD symptoms, general distress, and QOL immediately after the intervention. Secondary objectives include evaluating the impact of the intervention on QOL at 1 month post intervention, as well as willingness to participate, compliance, feasibility, and satisfaction. METHODS The EXPRESS-C-GVHD Trial will include patients with chronic cuGVHD who are at least 18 years old and able to use a writing utensil, have access to Zoom, an online video conference platform, and attend all four live support group sessions. Subjects will be recruited from the Department of Dermatology, Northwestern University, Chicago, IL and will participate in a 4 week program via Zoom. Program activities will be 1 h long and consist of 40 min of participant-led verbal reflection and discussion in a group setting in response to prompts, and 20 min of expressive writing. Participants will fill out a baseline willingness survey, follow-up surveys after every session, and post-intervention surveys at 2 weeks and 1 month after intervention. DISCUSSION The EXPRESS-C-GVHD Trial is a pilot trial and will assess whether a Zoom-based expressive writing intervention within the framework of a support group is feasible and can improve QOL outcomes among individuals with cuGVHD. TRIAL REGISTRATION The trial is registered under number NCT05694832.
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Affiliation(s)
- Trisha Kaundinya
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Suite 1600, Chicago, IL, 60611, USA
| | - Yae Kye
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Suite 1600, Chicago, IL, 60611, USA
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Salma E El-Behaedi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Suite 1600, Chicago, IL, 60611, USA
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jennifer N Choi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Suite 1600, Chicago, IL, 60611, USA.
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9
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Meneses-Echavez JF, Loaiza-Betancur AF, Díaz-López V, Echavarría-Rodríguez AM, Triana-Reina HR. Prehabilitation programs for individuals with cancer: a systematic review of randomized-controlled trials. Syst Rev 2023; 12:219. [PMID: 37978411 PMCID: PMC10655304 DOI: 10.1186/s13643-023-02373-4] [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: 07/06/2021] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Prehabilitation programs focusing on exercise training as the main component are known as a promising alternative for improving patients' outcomes before cancer surgery. This systematic review determined the benefits and harms of prehabilitation programs compared with usual care for individuals with cancer. METHODS We searched CENTRAL, MEDLINE, and EMBASE from inception to June 2022, and hand searched clinical trial registries. We included randomized-controlled trials (RCTs) in adults, survivors of any type of cancer, that compared prehabilitation programs that had exercise training as the major component with usual care or other active interventions. Outcome measures were health-related quality of life (HRQL), muscular strength, postoperative complications, average length of stay (ALOS), handgrip strength, and physical activity levels. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias and the certainty of the evidence. RESULTS Twenty-five RCTs (2682 participants) published between 2010 and 2022 met our inclusion criteria. Colorectal and lung cancers were the most common diagnoses. The studies had methodological concerns regarding outcome measurement, selective reporting, and attrition. Five prehabilitation programs were compared to usual care (rehabilitation): combined training, aerobic training, respiratory muscle training plus aerobic training, respiratory muscle training plus resistance training, and pelvic floor training. The studies provided no clear evidence of an effect between groups. We assessed the overall certainty of the evidence as very low, downgraded due to serious study limitations and imprecision. CONCLUSION Prehabilitation programs focusing on exercise training may have an effect on adults with cancer, but the evidence is very uncertain. We have very little confidence in the results and the true effect is likely to be substantially different from these. Further research is needed before we can draw a more certain conclusion. SYSTEMATIC REVIEW REGISTRATION CRD42019125658.
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Affiliation(s)
- Jose F Meneses-Echavez
- Division for Health Services, Norwegian Institute of Public Health, Sandakerveien 24C, Building D11, Oslo, Norway.
- Facultad de Cultura Física, Deporte y Recreación. GICAEDS, Universidad Santo Tomás, Bogotá, Colombia.
| | - Andrés F Loaiza-Betancur
- Universidad de Antioquia. Instituto Universitario de Educación Física, Medellín, Colombia
- Grupo de Investigación en Entrenamiento Deportivo y Actividad Física Para La Salud (GIEDAF), Universidad Santo Tomás, Tunja, Colombia
| | - Víctor Díaz-López
- Universidad de Antioquia. Instituto Universitario de Educación Física, Medellín, Colombia
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10
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Nakanishi N, Liu K, Kawauchi A, Okamura M, Tanaka K, Katayama S, Mitani Y, Ota K, Taito S, Fudeyasu K, Masuka Y, Yoshihiro S, Utsumi S, Nishikimi M, Masuda M, Iida Y, Kawai Y, Hatakeyama J, Hifumi T, Unoki T, Kawakami D, Obata K, Katsukawa H, Sumita H, Morisawa T, Takahashi M, Tsuboi N, Kozu R, Takaki S, Haruna J, Fujinami Y, Nosaka N, Miyamoto K, Nakamura K, Kondo Y, Inoue S, Nishida O. Instruments to assess post-intensive care syndrome assessment: a scoping review and modified Delphi method study. Crit Care 2023; 27:430. [PMID: 37936249 PMCID: PMC10629074 DOI: 10.1186/s13054-023-04681-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The assessment of post-intensive care syndrome (PICS) is challenging due to the numerous types of instruments. We herein attempted to identify and propose recommendations for instruments to assess PICS in intensive care unit (ICU) survivors. METHODS We conducted a scoping review to identify PICS follow-up studies at and after hospital discharge between 2014 and 2022. Assessment instruments used more than two times were included in the modified Delphi consensus process. A modified Delphi meeting was conducted three times by the PICS committee of the Japanese Society of Intensive Care Medicine, and each score was rated as not important (score: 1-3), important, but not critical (4-6), and critical (7-9). We included instruments with ≥ 70% of respondents rating critical and ≤ 15% of respondents rating not important. RESULTS In total, 6972 records were identified in this scoping review, and 754 studies were included in the analysis. After data extraction, 107 PICS assessment instruments were identified. The modified Delphi meeting reached 20 PICS assessment instrument recommendations: (1) in the physical domain: the 6-min walk test, MRC score, and grip strength, (2) in cognition: MoCA, MMSE, and SMQ, (3) in mental health: HADS, IES-R, and PHQ-9, (4) in the activities of daily living: the Barthel Index, IADL, and FIM, (5) in quality of life: SF-36, SF-12, EQ-5D-5L, 3L, and VAS (6), in sleep and pain: PSQI and Brief Pain Inventory, respectively, and (7) in the PICS-family domain: SF-36, HADS, and IES-R. CONCLUSION Based on a scoping review and the modified Delphi method, 20 PICS assessment instruments are recommended to assess physical, cognitive, mental health, activities of daily living, quality of life, sleep, and pain in ICU survivors and their families.
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Affiliation(s)
- Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4067, Australia
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, 113-0033, Japan
| | - Akira Kawauchi
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-Machi, Maebashi-shi, Gunma, 371-0811, Japan
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kohei Tanaka
- Department of Rehabilitation Medicine, Osaka Police Hospital, 10-31 Kitayama, Tennouji, Osaka, 543-0035, Japan
| | - Sho Katayama
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1 Shikata, Kitaku, Okayama, 700-8558, Japan
| | - Yuki Mitani
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Kenichi Fudeyasu
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Yuki Masuka
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shodai Yoshihiro
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Shu Utsumi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mamoru Masuda
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-Machi, Maebashi-shi, Gunma, 371-0811, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, 20-1, Matsushita, Ushikawa, Toyohashi, 440-8511, Japan
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Kita 11 Nishi 13, Chuo-ku, Sapporo, 060-0011, Japan
| | - Daisuke Kawakami
- Department of Intensive Care Medicine, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Kengo Obata
- Department of Rehabilitation, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ward, Okayama, 700-8607, Japan
| | - Hajime Katsukawa
- Department of Scientific Research, Japanese Society for Early Mobilization, 1-2-12, Kudan-kita, Chiyoda-ku, Tokyo, 102-0073, Japan
| | - Hidenori Sumita
- Clinic Sumita, 305-12, Minamiyamashinden, Ina-cho, Toyokawa, Aichi, 441-0105, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masahiro Takahashi
- Department of Rehabilitation, Sapporo General Hospital, Kita11-Nishi13, Chuou-ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Norihiko Tsuboi
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Shunsuke Takaki
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junpei Haruna
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Central City Hospital, 439 Kakogawacho Honmachi, Kakogawa-city, Hyogo, 675-8611, Japan
| | - Nobuyuki Nosaka
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, 279-0021, Japan
| | - Shigeaki Inoue
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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11
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Lattimore P, Harrison F. Pilot study of an online-delivered mindfulness meditation in Ehlers-Danlos syndrome (hEDS): effect on quality-of-life and participant lived experience. Disabil Rehabil 2023; 45:3833-3840. [PMID: 36326346 DOI: 10.1080/09638288.2022.2140843] [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: 02/10/2022] [Revised: 10/18/2022] [Accepted: 10/23/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Ehlers-Danlos syndromes (EDS) are connective tissue disorders with multi-systemic symptoms. Management of chronic pain and other symptoms of EDS is a challenge for patients and clinicians. Mindfulness-based approaches for chronic pain produce improvement in pain symptoms. Mindfulness meditation could be an acceptable and readily accessible therapy for pain in EDS. This study evaluated the effect of daily practice of mindfulness meditation on pain experience and quality-of-life in EDS. MATERIALS AND METHODS A pre-post design enabled assessment of change in quality-of-life (SF-36) after practicing internet-delivered mindful meditation for two weeks. Thematic analysis of interviews (n = 10) documented lived experience of meditation practice for pain symptoms. One hundred fifty-seven were recruited from UK EDS charities mailing lists. Seventy six completed the two-week intervention. RESULTS There was a statistically significant improvement in the SF-36 mental component summary score of medium effect size; the change was clinically important. Thematic analysis revealed three key themes of lived experience relating to increased body awareness, reduction in pain intensity, and barriers to practicing meditation. CONCLUSIONS This study provides novel evidence about the effect and experience of meditation for symptoms in people with EDS. The outcomes warrant further research with appropriate control groups to determine efficacy.Implications for rehabilitationMindfulness-based interventions are effective for chronic pain relief.Hypermobile Ehlers-Danlos syndrome (hEDS) patients experience chronic pain that affects quality-of-life.Online-delivered mindfulness meditation was clinically significant in reducing pain intensity and improving quality-of-life outcomes.hEDS patients found the online-delivered intervention acceptable and recommended development to make it flexible to meet their specific needs by varying types and duration of meditations offered.
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Affiliation(s)
- Paul Lattimore
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Fay Harrison
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
- The Ehlers-Danlos Support, Devonshire House, Borehamwood, UK
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12
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Arifin FA, Matsuda Y, Kanno T. Development and Validation of Oral Health-Related Quality of Life Scale for Patients Undergoing Endodontic Treatment (OHQE) for Irreversible Pulpitis. Healthcare (Basel) 2023; 11:2859. [PMID: 37958003 PMCID: PMC10648889 DOI: 10.3390/healthcare11212859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
An oral health-related quality of life measure specific to patients undergoing endodontic treatment has not been developed. This study aimed to validate the oral health-related quality of life scale for patients undergoing endodontic treatment (OHQE) for irreversible pulpitis, comprised of 42 questions. Sixty-two patients with irreversible pulpitis, comprising 23 (37.1%) males and 39 (62.9%) females, were enrolled between August 2022 and February 2023. Data were collected at three time points: pretreatment, post-treatment, and at the second week post-treatment. Factor analysis revealed physical, psychological, and expectations as subscales of OHQE. Cronbach's alpha coefficients ranged from 0.87 to 0.95 for each subscale. Each subscale of the General Oral Health Assessment Index (GOHAI) was moderately correlated with the OHQE subscales. Good-poor analysis revealed a significant difference between the high-scoring and low-scoring groups for each OHQE subscale. The intraclass correlation coefficients of the OHQE subscales ranged from 0.89 to 0.95. Multivariate linear regression analysis revealed a significant correlation between the pretreatment and post-treatment psychological factors (p < 0.05). Thus, OHQE will help researchers and policymakers understand the impact of oral health on the quality of life of patients with irreversible pulpitis undergoing endodontic treatment. OHQE could contribute to the appropriate planning, treatment decisions, and management of dental treatment.
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Affiliation(s)
- Fadil Abdillah Arifin
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (F.A.A.); (Y.M.)
- Department of Conservative Dentistry, Faculty of Dentistry, Universitas Muslim Indonesia, Makassar 90132, Indonesia
| | - Yuhei Matsuda
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (F.A.A.); (Y.M.)
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (F.A.A.); (Y.M.)
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13
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El Jurdi N, Martens MJ, Brunstein CG, O'Donnell P, Lee SJ, D'Souza A, Logan B, Hong S, Singh AK, Sandhu K, Shapiro RM, Horowitz MM, Hamilton BK. Health-Related Quality of Life in Double Umbilical Cord Blood versus Haploidentical Marrow Transplantation: A Quality of Life Analysis Report of BMT CTN 1101. Transplant Cell Ther 2023; 29:467.e1-467.e5. [PMID: 37088401 PMCID: PMC10330136 DOI: 10.1016/j.jtct.2023.04.009] [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: 02/06/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
The Blood and Marrow Transplant Clinical Trials Network study 1101 (BMT CTN 1101; ClinicaTrials.gov identifier NCT01597778) was a multicenter phase III randomized trial comparing the clinical outcomes and quality of life (QoL) of patients with hematologic malignancies undergoing double umbilical cord blood transplantation (dUCBT) or HLA-haploidentical bone marrow transplantation (haplo-BMT) after reduced-intensity conditioning. At a 5-year follow-up, there were no significant differences in progression- free survival (PFS) or overall survival (OS) between the 2 cohorts. The impact of alternative donor source on QoL is unknown, however. English- and Spanish-speaking patients completed the Functional Assessment of Cancer Therapy-General (FACT-G), Short Form 36 (SF-36), EuroQoL-5 Dimensions EQ-5D, and Global QoL patient-reported outcome (PRO) assessments pretransplantation and at 12 and 24 months post-transplantation. We compared longitudinal QoL measures between the dUCBT and haplo-BMT cohorts and investigated the association of QoL and clinical outcomes using an inverse probability weighted-independent estimating equations method, accounting for missingness and baseline variables. We found no significant differences between the 2 cohorts in any of the QoL scores pretransplantation and at 12 and 24 months post-transplantation. Pretransplantation scores were the only significant predictors of post-transplantation QoL scores. Relapse and grade III-IV acute graft-versus-host disease (GVHD) were associated with significant declines in mean FACT-BMT and SF-36 Physical Component scores, and chronic GVHD was associated with a decline in mean EQ-5D utility scores. There were no significant associations between pretransplantation QoL scores and OS or PFS. Donor type did not impact post-transplantation QoL. Pretransplantation QoL scores and clinical events of GVHD and relapse were the only predictors of post-transplantation QoL. QoL was not associated with survival in either treatment arm. PROs may be valuable tools in pretransplantation risk assessment strategies to improve QoL outcomes.
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Affiliation(s)
- Najla El Jurdi
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Michael J Martens
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Claudio G Brunstein
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Paul O'Donnell
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brent Logan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sanghee Hong
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Anurag K Singh
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, Kansas
| | - Karamjeet Sandhu
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Roman M Shapiro
- Stem Cell Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mary M Horowitz
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
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14
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Schmitz KH, Kanski B, Gordon B, Caru M, Vasakar M, Truica CI, Wang M, Doerksen S, Lorenzo A, Winkels R, Qiu L, Abdullah S. Technology-based supportive care for metastatic breast cancer patients. Support Care Cancer 2023; 31:401. [PMID: 37338627 DOI: 10.1007/s00520-023-07884-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Metastatic breast cancer (MBC) patients are living longer. However, symptom burden remains a significant issue. Technology-based interventions may assist. The purpose of this study was to test a virtual assistant for addressing symptoms in MBC using the Amazon Echo Show with Alexa. METHODS In this partial crossover randomized trial, the immediate treatment group was exposed to the intervention, called Nurse AMIE (Addressing Metastatic Individuals Everyday) for 6 months. The comparison group was unexposed for the first 3 months and then exposed for 3 months. The randomized controlled trial (RCT) during the first 3 months allowed for the evaluation of intervention effects on symptoms and function. The partial crossover maximized exposure to the intervention for evaluation of feasibility, usability, and satisfaction. RCT outcome data were collected at baseline and 3 months. Feasibility, usability, and satisfaction data were collected throughout the first 3 months of intervention exposure. RESULTS Forty-two MBC patients were randomized (1:1). Participants were 53 ± 11 years old and 4 ± 7 years from diagnosis with metastatic disease. No significant effects on psychosocial distress, pain, sleep disturbance, fatigue (vitality), quality of life, or chair stands were noted, despite high levels of acceptability (51%), feasibility (65%), and satisfaction (70%). CONCLUSION A high level of participant acceptability, feasibility, usability, and satisfaction all suggest further research on this platform is warranted. The lack of statistically significant effects on symptoms, quality of life, and function may be the result of small sample size. CLINICALTRIALS GOV REGISTRATION NUMBER NCT04673019 (registration date: December 17, 2020).
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Affiliation(s)
- Kathryn H Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Beth Kanski
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Brett Gordon
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Maxime Caru
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Monali Vasakar
- Division of Hematology and Oncology, Penn State College of Medicine, Hershey, PA, USA
| | - Cristina I Truica
- Division of Hematology and Oncology, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Division of Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Shawna Doerksen
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abby Lorenzo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Renata Winkels
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Ling Qiu
- College of Information Sciences and Technology, Penn State University, State College, PA, USA
| | - Saeed Abdullah
- College of Information Sciences and Technology, Penn State University, State College, PA, USA
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15
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Rashid N, Arora M, Jurdi NE, Onstad L, Pidala JA, Flowers ME, Lee SJ. Frailty in Patients with Chronic Graft-versus-Host Disease. Transplant Cell Ther 2023; 29:367-374. [PMID: 36921916 PMCID: PMC10239364 DOI: 10.1016/j.jtct.2023.03.010] [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: 12/02/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
Frailty is an increasingly recognized clinical diagnosis associated with high risk of disability and mortality. Frailty in patients after hematopoietic cell transplantation (HCT) is associated with increased nonrelapse mortality (NRM) and decreased overall survival (OS). Frailty has not been studied extensively in patients with chronic graft-versus-host disease (cGVHD). The objectives of the present study were to assess the prevalence and clinical correlates of frailty and the association of frailty with NRM and OS in patients enrolled in the Chronic GVHD Consortium. Patients were characterized as frail if they met the Fried definition of ≥3 of the following criteria at enrollment: unintentional weight loss, exhaustion, slow walking speed, low physical activity, and weakness. Frailty was assessed retrospectively using surrogate measures for the 5 domains of frailty. Frailty, cGVHD organ scores, and patient-reported outcomes were measured at the time of enrollment. The study included 399 patients from 9 centers in the United States, with 32% characterized as frail and 68% as not frail. The median duration of follow-up from enrollment was 9 years (interquartile range, 7 to 11 years). Frail patients were more likely to be older (P = .004), to have a lower Karnofsky Performance Status (P < .001), to have severe cGVHD (P < .001), and to have gastrointestinal (P < .001), liver (P = .04), or lung cGVHD (P = .002). In a multivariable analysis, older age, increased cGVHD global severity, and thrombocytopenia were statistically significantly associated with frailty when cGVHD organ involvement was excluded. A separate analysis excluding cGVHD severity and including organ involvement showed that lung and liver cGVHD and older age were associated with frailty. Neither corticosteroid use at the time of enrollment nor the maximum recorded dose of corticosteroids before enrollment was associated with frailty. Frail patients had higher NRM than nonfrail patients (P < .001), with a 10-year cumulative incidence of 41% (95% confidence interval [CI], 32% to 49%) versus 22% (95% CI, 17% to 28%). Reciprocally, frailty also was associated with a significantly lower OS (P < .001), with a 10-year OS of 43% (95% CI, 35% to 53%) in frail patients versus 63% (95% CI, 57% to 69%) in nonfrail patients. In multivariable analysis that included the individual domains of frailty, weakness, low physical activity, and slow walking speed were associated with survival. Frail patients also had worse scores on various measures of patient-reported outcomes, including the Short Form (SF)-36, the Lee Symptom Scale, and the trial outcome of the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) index score. Frail patients with cGVHD have significantly worse outcomes than nonfrail patients. Such clinical features as older age and lung and liver cGVHD are associated with frailty. Earlier clinical recognition of frailty in patients with cGVHD may prompt interventions to counteract frailty that could be beneficial for this population.
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Affiliation(s)
- Nahid Rashid
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
| | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Najla El Jurdi
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Lynn Onstad
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Joseph A Pidala
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
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Cusatis R, Martens MJ, Nakamura R, Cutler CS, Saber W, Lee SJ, Logan BR, Shaw BE, Gregory A, D’Souza A, Hamilton BK, Horowitz MM, Flynn KE. Health-related quality of life in reduced-intensity hematopoietic cell transplantation based on donor availability in patients aged 50-75 with advanced myelodysplastic syndrome: BMT CTN 1102. Am J Hematol 2023; 98:229-250. [PMID: 36251401 PMCID: PMC9839494 DOI: 10.1002/ajh.26768] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 01/17/2023]
Abstract
For myelodysplastic syndrome (MDS), allogeneic hematopoietic cell transplantation (alloHCT) is the only available curative therapy. The Blood and Marrow Transplant Clinical Trials Network study 1102 (BMT CTN 1102, NCT02016781) was a multicenter, biologic assignment trial based on matched donor availability in adults aged 50-75 with higher risk de novo MDS who were candidates for reduced-intensity conditioning (RIC) alloHCT. The primary analysis showed that those who received alloHCT had a survival benefit, but whether this is at the cost of worse quality of life (QOL) has not been described in detail. English- and Spanish-speaking trial participants completed the Functional Assessment of Cancer Therapy-General (FACT-G), the SF-36, and the EQ-5D, at enrollment, every 6 months until 24 months, and 36 months. We compared patient-reported outcome (PRO) scores between study arms using an inverse probability weighted-independent estimating equation (IPW-IEE) model. Between January 2014 and November 2018, 384 subjects (median age 66.7 years, range: 50.1-75.3) enrolled at 34 centers. PRO completion rates were generally high at 65%-78%. The PRO trajectories for both arms were similar, with most decreasing or stable from baseline to 6 months and improving thereafter. Baseline PRO scores were the most consistent independent predictors of subsequent QOL outcomes and survival, even after controlling for clinical and patient-level factors. For older adults with MDS, the survival advantage associated with donor availability and alloHCT did not come at the cost of worse QOL. These results should reassure older patients and clinicians who prefer a curative approach to treating MDS.
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Affiliation(s)
- Rachel Cusatis
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Michael J. Martens
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Corey S. Cutler
- Stem Cell Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA
| | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Stephanie J. Lee
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Brent R. Logan
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Bronwen E. Shaw
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Anita D’Souza
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Betty K. Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Mary M. Horowitz
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Kathryn E. Flynn
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Berger S, Andersen R, Smaastuen MC, Rosseland LA, Dorenberg E. Long-term changes of health-related quality of life in patients with peripheral vascular malformations - a prospective observational study. J Plast Reconstr Aesthet Surg 2023; 77:46-53. [PMID: 36549122 DOI: 10.1016/j.bjps.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this observational study was to assess health-related quality of life (HRQOL) changes in patients with vascular malformations, over a period of almost eight years, and to assess clinical and demographic characteristics possibly associated with HRQOL changes. METHODS Eighty out of 111 patients who were included in a previously published comparative HRQOL study accepted inclusion in this follow-up study. HRQOL at baseline and follow-up was assessed with the Short-Form 36-item questionnaire (SF-36). Median observation time was 7.9 years. Linear mixed models and linear regression models were applied to assess HRQOL change and possible associations with demographic and clinical variables. RESULTS The median age of the patient cohort at baseline evaluation (n = 111) was 27.0 years. Ninety-six out of 111 (86.5%) patients were diagnosed with venous malformations. Significantly higher SF-36 scores at follow-up were found for the physical domains Role limitations due to (RLDT) physical problems (difference=13.5; 95% CI [1.6, 25.3]) and Bodily pain (difference=11.3; 95% CI [3.8, 18.8]). No deterioration of HRQOL was found in any domain. In multivariate analyses, female gender, muscle/bone involvement, and higher age were associated with a positive relative change in SF-36 in the domains Physical functioning, RLDT physical problems, and RLDT emotional problems, respectively. Invasive treatment was not associated with long-term HRQOL change. CONCLUSIONS Over a period of almost eight years, significant improvement of SF-36 scores was observed in the physical domains RLDT physical problems and bodily pain. Female gender, muscle/bone involvement, and higher age were associated with HRQOL improvement in certain domains.
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Affiliation(s)
- Sigurd Berger
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Rune Andersen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Milada Cvancarova Smaastuen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Leiv Arne Rosseland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Eric Dorenberg
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
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Ippolito M, Spurio G, Compagno V, Rizzo A, Di Simone M, Corsale AM, Mazzola G, Giarratano A, Meraviglia S, Cortegiani A, Alongi A. Autologous conditioned serum for chronic pain in patients with osteoarthritis: A feasibility observational study. Br J Pain 2023; 17:103-111. [PMID: 36815072 PMCID: PMC9940252 DOI: 10.1177/20494637221134169] [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: 11/17/2022] Open
Abstract
Background Autologous conditioned serum is a product of blood origin, with fragmented evidence of therapeutic properties in osteoarthritis chronic pain. This pilot observational prospective study aimed to evaluate the feasibility of a treatment with conditional autologous serum (ACS) in patients with severe chronic pain and grade I-III osteoarthritis and to describe its cytokine content. Methods We prospectively collected data on consecutive patients affected by osteoarthritis grade I to III and treated with four weekly injections of ACS at our outpatient pain service. The primary outcome was pain intensity, measured with the visual analogic scale (VAS). Additional outcomes were symptoms evaluated using joint district-specific scales. The study also evaluated concentrations of 48 cytokines and chemokines involved in the balance pro-inflammation/anti-inflammation and tissue repair in the ACS. Results We included 26 patients, mostly female (65.4%), with a median age of 63.5 years [IQR 58.25-73]. A median reduction of VAS of -3 cm [-5; -1.25] was observed 6 months after the first injection of ACS. The analysis showed a statistically significant difference between the values of VAS (p < .01; X2 = 69.6; df = 6, N = 26) at the different time points. No adverse events were observed or reported by patients during the entire study period. Conclusions Conditional autologous serum may be a feasible option for patients with chronic pain due to grade I-III osteoarthritis refractory to other treatments. These preliminary findings should be confirmed in studies with adequate design.
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Affiliation(s)
- Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Giulia Spurio
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Viviana Compagno
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Alessandra Rizzo
- Department of Anaesthesia, Intensive Care and Emergency, Ospedale Paolo Borsellino, Marsala, Italy
| | - Marta Di Simone
- Central Laboratory of Advanced Diagnosis and Biomedical Research, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Anna Maria Corsale
- Central Laboratory of Advanced Diagnosis and Biomedical Research, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Giuseppina Mazzola
- Unit of Transfusion Medicine, University Hospital “Paolo Giaccone,” Palermo, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Serena Meraviglia
- Central Laboratory of Advanced Diagnosis and Biomedical Research, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Antonietta Alongi
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
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BERGET AM, MOEN VP, HUSTOFT M, EIDE GE, SKOUEN JS, STRAND LI, HETLEVIK Ø. Long-Term Change and Predictors of Change in Physical and Mental Function after Rehabilitation: A Multi-Centre Study. J Rehabil Med 2023; 55:jrm00358. [PMID: 36601734 PMCID: PMC9837623 DOI: 10.2340/jrm.v55.2809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/03/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate changes and predictors of change in physical and mental function over a 3-year period after rehabilitation. DESIGN Prospective cohort. PARTICIPANTS Patients, across diseases, living in western Norway, accepted for somatic specialized interprofessional rehabilitation (n = 984). METHODS Physical and mental function were assessed at admittance (baseline), and after 1 and 3 years using the Medical Outcome Study Short Form 36 (SF-36). Associations between changes in SF-36 component summary scores and sense of coherence, pain, disease group (musculoskeletal, neoplasm, cardiovascular, neurological, other), exercise habits and demographic variables were analysed using linear mixed modelling. RESULTS In the total group, mean (standard deviation) physical component summary scores improved by 2.9 (8.4) and 3.4 (9.3) points at 1 and 3 years, respectively. Mental component summary scores improved by 2.1 (9.7) and 1.6 (10.8) points. Improvement in physical component summary was significantly greater for patients with higher sense of coherence (b = 0.09, p = 0.001) and for the neoplasm disease group (b = 2.13, p = 0.046). Improvement in mental component summary was significantly greater for patients with low sense of coherence (b = -0.13, p = < 0.001) and higher level of education (b = 3.02, p = 0.0302). Interaction with age (physical component summary: b = 0.22, p = 0.039/mental component summary b = 0.51, p = 0.006) indicated larger effect at 1 year than at 3 years. CONCLUSION Physical and mental function improved in the total study group over the 3-year period. Sense of coherence at baseline was associated with improved physical and mental function, suggesting that coping resources are important in rehabilitation.
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Affiliation(s)
- Anne Mette BERGET
- Centre of Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital,Department of Global Public Health and Primary Care, University of Bergen
| | - Vegard Pihl MOEN
- Centre of Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital,Department of Health and Functioning, Western Norway University of Applied Sciences
| | - Merethe HUSTOFT
- Centre of Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital,Department of Health and Functioning, Western Norway University of Applied Sciences
| | - Geir Egil EIDE
- Department of Global Public Health and Primary Care, University of Bergen,Centre for Clinical Research
| | - Jan Sture SKOUEN
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Liv Inger STRAND
- Department of Global Public Health and Primary Care, University of Bergen
| | - Øystein HETLEVIK
- Department of Global Public Health and Primary Care, University of Bergen
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Does the Low Anterior Resection Syndrome Score Accurately Represent the Impact of Bowel Dysfunction on Health-Related Quality of Life? J Gastrointest Surg 2023; 27:114-121. [PMID: 36253504 PMCID: PMC9576127 DOI: 10.1007/s11605-022-05481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bowel dysfunction after rectal cancer surgery is common, but its effect on health-related quality of life (HRQOL) is complex. Objective measures of bowel function may not be a good representation on the actual impact on HRQOL. Therefore, the objective of this study is to determine whether there are differences between patient-reported bowel-related impairment versus a standardized measure of bowel dysfunction on HRQOL. METHODS A prospective database starting in September 2018 of adult patients who had undergone sphincter preserving rectal cancer surgery up to October 2021 was queried. Patients were excluded if they had local recurrence, metastasis, persistent stoma, or had less than 1-year follow-up. Patients were administered the study instruments at their standard surveillance visit: patient-reported bowel-related quality of life(BQOL) impairment, HRQOL using the Short Form-36 (SF-36), and bowel dysfunction using the low anterior resection syndrome(LARS) score. RESULTS Overall, 136 patients were included. There were 43% with no LARS, 22% with minor LARS, and 35% with major LARS. For the BQOL, 26% of subjects reported no impairment, 57% minor impairment, and 17% major impairment. There was a high proportion of discordance between BQOL and LARS, with 23% minor or major LARS in patients with no BQOL impairment, and 32% with no or minor LARS with major BQOL impairment. The BQOL was associated with more changes in SF-36 scores compared to the LARS score. CONCLUSIONS The patient-reported BQOL is likely to be a more relevant outcome of interest to patients than the objective LARS score. This has important implications for shared decision-making for rectal cancer treatments.
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21
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Messier SP, Beavers DP, Queen K, Mihalko SL, Miller GD, Losina E, Katz JN, Loeser RF, DeVita P, Hunter DJ, Newman JJ, Quandt SA, Lyles MF, Jordan JM, Callahan LF. Effect of Diet and Exercise on Knee Pain in Patients With Osteoarthritis and Overweight or Obesity: A Randomized Clinical Trial. JAMA 2022; 328:2242-2251. [PMID: 36511925 PMCID: PMC9856237 DOI: 10.1001/jama.2022.21893] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Some weight loss and exercise programs that have been successful in academic center-based trials have not been evaluated in community settings. OBJECTIVE To determine whether adaptation of a diet and exercise intervention to community settings resulted in a statistically significant reduction in pain, compared with an attention control group, at 18-month follow-up. DESIGN, SETTING, AND PARTICIPANTS Assessor-blinded randomized clinical trial conducted in community settings in urban and rural counties in North Carolina. Patients were men and women aged 50 years or older with knee osteoarthritis and overweight or obesity (body mass index ≥27). Enrollment (N = 823) occurred between May 2016 and August 2019, with follow-up ending in April 2021. INTERVENTIONS Patients were randomly assigned to either a diet and exercise intervention (n = 414) or an attention control (n = 409) group for 18 months. MAIN OUTCOMES AND MEASURES The primary outcome was the between-group difference in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain score (range, 0 [none] to 20 [severe]; minimum clinically important difference, 1.6) over 18 months, tested using a repeated-measures mixed linear model with adjustments for covariates. There were 7 secondary outcomes including body weight. RESULTS Among the 823 randomized patients (mean age, 64.6 years; 637 [77%] women), 658 (80%) completed the trial. At 18-month follow-up, the adjusted mean WOMAC pain score was 5.0 in the diet and exercise group (n = 329) compared with 5.5 in the attention control group (n = 316) (adjusted difference, -0.6; 95% CI, -1.0 to -0.1; P = .02). Of 7 secondary outcomes, 5 were significantly better in the intervention group compared with control. The mean change in unadjusted 18-month body weight for patients with available data was -7.7 kg (8%) in the diet and exercise group (n = 289) and -1.7 kg (2%) in the attention control group (n = 273) (mean difference, -6.0 kg; 95% CI, -7.3 kg to -4.7 kg). There were 169 serious adverse events; none were definitely related to the study. There were 729 adverse events; 32 (4%) were definitely related to the study, including 10 body injuries (9 in diet and exercise; 1 in attention control), 7 muscle strains (6 in diet and exercise; 1 in attention control), and 6 trip/fall events (all 6 in diet and exercise). CONCLUSIONS AND RELEVANCE Among patients with knee osteoarthritis and overweight or obesity, diet and exercise compared with an attention control led to a statistically significant but small difference in knee pain over 18 months. The magnitude of the difference in pain between groups is of uncertain clinical importance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02577549.
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Affiliation(s)
- Stephen P. Messier
- J. B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Rheumatology and Immunology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kate Queen
- Haywood Regional Medical Center, Clyde, North Carolina
| | - Shannon L. Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Gary D. Miller
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard F. Loeser
- Division of Rheumatology, Allergy, and Immunology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, North Carolina
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jovita J. Newman
- J. B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mary F. Lyles
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Joanne M. Jordan
- Division of Rheumatology, Allergy, and Immunology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | - Leigh F. Callahan
- Division of Rheumatology, Allergy, and Immunology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
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Effects of a microprocessor-controlled ankle-foot unit on energy expenditure, quality of life, and postural stability in persons with transtibial amputation: An unblinded, randomized, controlled, cross-over study. Prosthet Orthot Int 2022; 46:541-548. [PMID: 36515900 DOI: 10.1097/pxr.0000000000000187] [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] [Received: 03/24/2021] [Accepted: 08/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Microprocessor-controlled prostheses are designed to improve mobility and quality of life through better balance and energy restoration in persons with transtibial amputation. Quasi-active microprocessor-controlled ankles (MPA) adapt to variable terrain by ankle angle adjustment. OBJECTIVES To compare energy expenditure, balance, quality of life, and satisfaction of Proprio-foot® (a quasi-active MPA model) with standard prescribed ankle prosthesis (prescribed ankle-foot units [PA]) (standard energy storage and return prosthesis). STUDY DESIGN Multicenter, unblinded, randomized, controlled, cross-over study. METHODS Energy expenditure (primary outcome) was assessed by oxygen uptake (VO2) measured at the maximum level reached with the 2 prostheses during treadmill walking at progressively increasing incline and speed. Balance was assessed by stabilometry in different static positions. Quality of life and satisfaction were assessed by "Short Form 36" questionnaire (0-100) and by Evaluation de la Satisfaction envers une Aide Technique (0-5) questionnaires after wearing each of the 2 prostheses for 34 days. RESULTS Forty-five patients tested the 2 prostheses. No statistical difference in VO2 was observed. Significant improvement of balance was observed both during standing on an incline or decline with MPA and PA (p < 0.01). Short Form 36 questionnaire physical scores and Short Form 36 questionnaire mental scores were 68.5 ± 19.5 vs. 62.1 ± 19.6 (p < 0.01) and 72.0 ± 20.8 vs. 66.2 ± 20.9 (p < 0.01) in MPA and PA, respectively. Evaluation de la Satisfaction envers une Aide Technique score on the device was not statistically significant between the 2 groups (MPA 4.4 ± 0.5 vs. PA 4.3 ± 0.5, p = 0.360). CONCLUSION Proprio-foot® improved balance, quality of life, and patient satisfaction despite no reduction or increase in energy expenditure in comparison with standard energy storage and return prosthesis.
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Long-term efficacy and safety of inotersen for hereditary transthyretin amyloidosis: NEURO-TTR open-label extension 3-year update. J Neurol 2022; 269:6416-6427. [PMID: 35908242 PMCID: PMC9618524 DOI: 10.1007/s00415-022-11276-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/25/2022]
Abstract
Background Hereditary transthyretin amyloidosis (hATTR/ATTRv) results from the deposition of misfolded transthyretin (TTR) throughout the body, including peripheral nerves. Inotersen, an antisense oligonucleotide inhibitor of hepatic TTR production, demonstrated a favorable efficacy and safety profile in patients with the polyneuropathy associated with hATTR in the NEURO-TTR (NCT01737398) study. We report longer-term efficacy and safety data for inotersen, with a median treatment exposure of 3 years. Methods Patients who satisfactorily completed NEURO-TTR were enrolled in its open-label extension (OLE) study. Efficacy assessments included the modified Neuropathy Impairment Score + 7 (mNIS + 7), Norfolk Quality of Life–Diabetic Neuropathy (Norfolk QoL-DN) questionnaire total score, and the Short Form 36 (SF-36v2) Health Survey Physical Component Summary score. Safety and tolerability were also assessed. Efficacy is reported for patients living in Europe and North America (this cohort completed the study approximately 9 months before the remaining group of patients outside these regions); safety is reported for the full safety dataset, comprising patients living in Europe, North America, and Latin America/Australasia. This study is registered with ClinicalTrials.gov, identifier NCT02175004. Results In the Europe and North America cohort of the NEURO-TTR study, 113/141 patients (80.1%) completed the study, and 109 patients participated in the OLE study. A total of 70 patients continued to receive inotersen (inotersen–inotersen) and 39 switched from placebo to inotersen (placebo–inotersen). The placebo–inotersen group demonstrated sustained improvement in neurological disease progression as measured by mNIS + 7, compared with predicted worsening based on projection of the NEURO-TTR placebo data (estimated natural history). The inotersen–inotersen group demonstrated sustained benefit, as measured by mNIS + 7, Norfolk QoL-DN, and SF-36v2, compared with estimated natural history as well as compared with the placebo–inotersen group. With a maximum exposure of 6.2 years, inotersen was not associated with any additional safety concerns or increased toxicity in the OLE study. Platelet and renal monitoring were effective in reducing the risk of severe adverse events in the OLE study. Conclusion Inotersen treatment for > 3 years slowed progression of the polyneuropathy associated with hATTR, and no new safety signals were observed.
Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11276-8.
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Mogensen N, Saaranen E, Olsson E, Klug Albertsen B, Lähteenmäki P, Kreicbergs U, Heyman M, Harila‐Saari A. Quality of life in mothers and fathers of children treated for acute lymphoblastic leukaemia in Sweden, Finland and Denmark. Br J Haematol 2022; 198:1032-1040. [PMID: 35852790 PMCID: PMC9543076 DOI: 10.1111/bjh.18350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
Acute lymphoblastic leukaemia (ALL) has a high survival rate, but treatment is lengthy with risk of severe side‐effects, which may also impact parents' health‐related quality of life (HRQOL). We present data on 526 parents of 310 children treated for ALL according to the NOPHO ALL2008‐protocol, in Sweden, Finland and Denmark. Parents were asked to complete the 36‐Item Short Form Survey (SF‐36) at least 6 months after end of treatment and data were compared with Norwegian reference data. Parental background factors were collected via a study‐specific questionnaire. Participating parents scored significantly lower than the reference population on both physical and mental summary indexes, but only surpassed a minimal clinically important difference for the mental summary index (Mental Component Summary [MCS]). Mothers scored lower than fathers in the MCS and stopped working and took care of the affected child more often than the fathers. Higher mental HRQOL was associated with male gender and living in Finland or Denmark (compared to Sweden). Correlations within spouses in physical and mental scores were weak to moderate. In conclusion, ALL negatively affects parental HRQOL, especially the mental domains, even after treatment. Findings suggest that mothers are more affected than fathers and may require extra support.
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Affiliation(s)
- Nina Mogensen
- Department of Pediatric Oncology Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
| | - Ella Saaranen
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Erik Olsson
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine, Faculty of Medicine University of Aarhus Aarhus Denmark
| | - Päivi M. Lähteenmäki
- Department of Women's and Children's Health, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
- Department of Pediatrics and Adolescent Medicine Turku University Hospital, and Turku University Turku Finland
| | - Ulrika Kreicbergs
- Department of Women's and Children's Health, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
- Department of Health Care Sciences, Palliative Research Centre Marie Cederschiöld University Stockholm Sweden
| | - Mats Heyman
- Department of Pediatric Oncology Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
| | - Arja Harila‐Saari
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
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van der Willik EM, Lengton R, Hemmelder MH, Hoogeveen EK, Bart HAJ, van Ittersum FJ, ten Dam MAGJ, Bos WJW, Dekker FW, Meuleman Y. Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms – results from the RENINE/PROMs registry. Nephrol Dial Transplant 2022; 37:1731-1741. [PMID: 35098998 PMCID: PMC9395377 DOI: 10.1093/ndt/gfac022] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background Itching (pruritus) is common in dialysis patients, but little is known about its impact on health-related quality of life (HRQOL), sleep problems and psychological symptoms. This study investigates the impact of itching in dialysis patients by looking into the persistence of itching, the effect of itching on the course of HRQOL and the combined effect of itching with sleep problems and with psychological symptoms on HRQOL. Methods Data were obtained from the RENINE/PROMs registry and included 2978 dialysis patients who completed patient-reported outcome measures between 2018 and 2020. Itching, sleep problems and psychological symptoms were assessed with the Dialysis Symptom Index (DSI) and HRQOL with the 12-item Short Form Health Survey. Effects of itching on HRQOL and interactions with sleep problems and psychological symptoms were investigated cross-sectionally and longitudinally using linear regression and linear mixed models. Results Half of the patients experienced itching and in 70% of them, itching was persistent. Itching was associated with a lower physical and mental HRQOL {−3.35 [95% confidence interval (CI) −4.12 to −2.59) and −3.79 [95% CI −4.56 to −3.03]}. HRQOL remained stable during 2 years and trajectories did not differ between patients with or without itching. Sleep problems (70% versus 52%) and psychological symptoms (36% versus 19%) were more common in patients with itching. These symptoms had an additional negative effect on HRQOL but did not interact with itching. Conclusions The persistence of itching, its impact on HRQOL over time and the additional effect on HRQOL of sleep problems and psychological symptoms emphasize the need for recognition and effective treatment of itching to reduce symptom burden and improve HRQOL.
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Affiliation(s)
- Esmee M van der Willik
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robin Lengton
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Maastricht University Medical Center and CARIM school for cardiovascular diseases, Maastricht University, Maastricht, The Netherlands
| | - Ellen K Hoogeveen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Hans A J Bart
- Dutch Kidney Patients Association (NVN), Bussum, The Netherlands
| | - Frans J van Ittersum
- Department of Nephrology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marc A G J ten Dam
- Nefrovisie Foundation, Utrecht, The Netherlands
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Willem Jan W Bos
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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27
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Fekete C, Tough H, Arora M, Hasnan N, Joseph C, Popa D, Strom V, Middleton J. Are Social Relationships an Underestimated Resource for Mental Health in Persons Experiencing Physical Disability? Observational Evidence From 22 Countries. Int J Public Health 2021; 66:619823. [PMID: 34744581 PMCID: PMC8565297 DOI: 10.3389/ijph.2021.619823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: As advancing evidence on modifiable resources to support mental health in persons experiencing physical disabilities is of particular importance, we investigate whether structural and functional social relationships relate to mental health in people with spinal cord injury (SCI). Methods: Data from 12,330 participants of the International SCI community survey (InSCI) from 22 countries were analyzed. Structural (partnership status, living situation) and functional aspects of social relationships (belongingness, relationship satisfaction, problems with social interactions) were regressed on the SF-36 mental health index (MHI-5), stratified by countries and for the total sample using multilevel models. Results: Functional aspects of social relationships were consistently related to clinically relevant higher MHI-5 scores and lower risk of mental health disorders (MHI-5 >56). Structural social relationships were inconsistently associated with mental health in our sample. Conclusion: This study provides evidence that functional aspects of social relationships are important resources for mental health. Interventions to establish and maintain high quality relationships should be considered in public health interventions and rehabilitation programs to reduce long-term mental health problems in persons experiencing physical disabilities.
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Affiliation(s)
- Christine Fekete
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Hannah Tough
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Sydney Medical School - Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya and UM Medical Centre, Kuala Lumpur, Malaysia
| | - Conran Joseph
- Faculty of Medicine and Health Science, Department of Health and Rehabilitation Sciences, Physiotherapy Division, Stellenbosch University, Cape Town, South Africa
| | - Daiana Popa
- Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania
| | - Vegard Strom
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Sydney Medical School - Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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28
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Skalitzky MK, Gulbrandsen TR, Groot OQ, Karhade AV, Verlaan JJ, Schwab JH, Miller BJ. The preoperative machine learning algorithm for extremity metastatic disease can predict 90-day and 1-year survival: An external validation study. J Surg Oncol 2021; 125:282-289. [PMID: 34608991 DOI: 10.1002/jso.26708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/12/2021] [Accepted: 09/25/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prediction of survival is valuable to optimize treatment of metastatic long-bone disease. The Skeletal Oncology Research Group (SORG) machine-learning (ML) algorithm has been previously developed and internally validated. The purpose of this study was to determine if the SORG ML algorithm accurately predicts 90-day and 1-year survival in an external metastatic long-bone disease patient cohort. METHODS A retrospective review of 264 patients who underwent surgery for long-bone metastases between 2003 and 2019 was performed. Variables used in the stochastic gradient boosting SORG algorithm were age, sex, primary tumor type, visceral/brain metastases, systemic therapy, and 10 preoperative laboratory values. Model performance was calculated by discrimination, calibration, and overall performance. RESULTS The SORG ML algorithms retained good discriminative ability (area under the cure [AUC]: 0.83; 95% confidence interval [CI]: 0.76-0.88 for 90-day mortality and AUC: 0.84; 95% CI: 0.79-0.88 for 1-year mortality), calibration, overall performance, and decision curve analysis. CONCLUSION The previously developed ML algorithms demonstrated good performance in the current study, thereby providing external validation. The models were incorporated into an accessible application (https://sorg-apps.shinyapps.io/extremitymetssurvival/) that may be freely utilized by clinicians in helping predict survival for individual patients and assist in informative decision-making discussion before operative management of long bone metastatic lesions.
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Affiliation(s)
- Mary Kate Skalitzky
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Trevor R Gulbrandsen
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Olivier Q Groot
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aditya V Karhade
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jorrit-Jan Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Benjamin J Miller
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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The Surgical Management of Proximal Femoral Metastases: A Narrative Review. ACTA ACUST UNITED AC 2021; 28:3748-3757. [PMID: 34677238 PMCID: PMC8534449 DOI: 10.3390/curroncol28050320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022]
Abstract
The proximal femur is a common location for the development of bony metastatic disease. Metastatic bone disease in this location can cause debilitating pain, pathologic fractures, reduced quality of life, anemia or hypercalcemia. A thorough history, physical examination and preoperative investigations are required to ensure accurate diagnosis and prognosis. The goals of surgical management is to provide pain relief and return to function with a construct that provides stability to allow for immediate weightbearing. Current surgical treatment options include intramedullary nailing, hemiarthroplasty or total hip arthroplasty and endoprosthetic reconstructions. Oligometastatic renal cell carcinoma must be given special consideration as tumor resection and reconstruction has survival benefit. Both tumor and patient characteristics must be taken into account before deciding on the appropriate surgical intervention.
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Yokokawa D, Ohira Y, Ikegami A, Shikino K, Tsukamoto T, Noda K, Uehara T, Ikusaka M. Relationship between the presence of primary care physicians and health‐related quality of life. J Gen Fam Med 2021; 23:87-93. [PMID: 35261855 PMCID: PMC8888798 DOI: 10.1002/jgf2.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/06/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Daiki Yokokawa
- Department of General Medicine Chiba University Hospital Chiba City Japan
| | - Yoshiyuki Ohira
- Department of General Medicine Chiba University Hospital Chiba City Japan
- Department of General Medicine School of Medicine International University of Health and Welfare Chiba Japan
| | - Akiko Ikegami
- Department of General Medicine Chiba University Hospital Chiba City Japan
| | - Kiyoshi Shikino
- Department of General Medicine Chiba University Hospital Chiba City Japan
| | - Tomoko Tsukamoto
- Department of General Medicine Chiba University Hospital Chiba City Japan
| | - Kazutaka Noda
- Department of General Medicine Chiba University Hospital Chiba City Japan
| | - Takanori Uehara
- Department of General Medicine Chiba University Hospital Chiba City Japan
| | - Masatomi Ikusaka
- Department of General Medicine Chiba University Hospital Chiba City Japan
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31
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Jørgensen CU, Homøe P, Dahl M, Hitz MF. Postoperative Chronic Hypoparathyroidism and Quality of Life After Total Thyroidectomy. JBMR Plus 2021; 5:e10479. [PMID: 33869995 PMCID: PMC8046100 DOI: 10.1002/jbm4.10479] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/02/2021] [Accepted: 02/13/2021] [Indexed: 12/31/2022] Open
Abstract
Chronic hypoparathyroidism (HypoPT) is a common complication after total thyroidectomy and it impacts affected patients' quality of life (QoL). This study aimed to assess the QoL in patients with chronic HypoPT independently from their concurrent hypothyroidism and other comorbidities. For this purpose a follow‐up study was performed, including 14 patients who developed chronic HypoPT after total thyroidectomy and 28 age‐ and sex‐matched patients who had intact parathyroid function after total thyroidectomy. We used the RAND Short Form 36 Health Survey (SF‐36) to compare the QoL between patients with or without chronic HypoPT. Chronic HypoPT patients had lower QoL scores in all domains of the RAND‐SF‐36 questionnaire and significant impairment in six of eight domains after adjustment for relevant confounders. They were more often operated because of a toxic diagnosis (p = .01), often being Graves disease. Additionally adjusting for surgical indications resulted in three of eight domains being significant affected. Chronic HypoPT is associated with significantly impairment of QoL, independently of the concurrent disease of hypothyroidism, comorbidities, and prospective values of TSH and serum (se)‐ionized‐Ca++. There is a need for more focus and better treatment of patients experiencing chronic HypoPT after surgery. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Camilla Uhre Jørgensen
- Department of Otorhinolaryngology and Maxillofacial Surgery Zealand University Hospital (ZUH) Køge Denmark.,Department of Medical Endocrinology Zealand University Hospital (ZUH) Køge Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery Zealand University Hospital (ZUH) Køge Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Morten Dahl
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,Department of Clinical Biochemistry Zealand University Hospital (ZUH) Køge Denmark
| | - Mette Friberg Hitz
- Department of Medical Endocrinology Zealand University Hospital (ZUH) Køge Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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Zhang Z, Li X, Zhang F, Wu Y. 100-day Lung Function Follow-up of a Critical COVID-19 Patient Treated with Mechanical Ventilation and Extracorporeal Membrane Oxygenation. JOURNAL OF TRANSLATIONAL CRITICAL CARE MEDICINE 2021. [PMCID: PMC9070590 DOI: 10.4103/jtccm.jtccm_10_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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