Minimal Clinically Important Difference of the Standardized Cosmesis and Health Nasal Outcomes Survey

2019 ◽  
Vol 39 (8) ◽  
pp. 837-840 ◽  
Author(s):  
Cherian K Kandathil ◽  
Mikhail Saltychev ◽  
Mohamed Abdelwahab ◽  
Emily A Spataro ◽  
Sami P Moubayed ◽  
...  
Keyword(s):  
Nasal Obstruction ◽  
Minimal Clinically Important Difference ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Clinically Important Difference ◽  
Symptom Evaluation ◽  
The Mean ◽  
O 18 ◽  
Preoperative Score

AbstractBackgroundThe minimal clinically important difference (MCID) for the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) has not been determined.ObjectivesThe authors sought to define the MCID for both domains of the SCHNOS questionnaire.MethodsThis prospective cohort study included patients who underwent functional, cosmetic, or combined rhinoplasty operation from June 2017 to June 2018 at a tertiary referral center. The average preoperative, postoperative, and change in scores were calculated for the nasal obstruction symptom evaluation scale (NOSE) and SCHNOS. Anchor-based MCIDs were estimated for both SCHNOS subscales to define change in obstruction and cosmesis perceived after the rhinoplasty.ResultsEighty-seven patients (69% women, 31% males) with a mean age (standard deviation [SD]) of 38 years (14.7) at the time of surgery were included. The mean postoperative follow-up period (SD) was 145 days (117). The mean preoperative score (SD) for the NOSE was 52 (32), SCHNOS for nasal obstruction (SCHNOS-O) score was 55 (33), and SCHNOS for nasal cosmesis (SCHNOS-C) score was 50 (26) points. Postoperatively, the NOSE score was 23 (22), SCHNOS-O score was 24 (23), and SCHNOS-C score was 13 (18) points. The mean change in scores (SD) for NOSE, SCHNOS-O, and SCHNOS-C was −29 (37), −31 (38), and −37 (28), respectively. The calculated MCID for SCHNOS-O was 26 (16) and for SCHNOS-C was 22 (15) points. The MCID for NOSE was 24 (13) points. A sensitivity test for the patients with a follow-up ≥3 months showed only slightly different MCID estimates: 28 (17) for SCHNOS-O, 18 (13) for SCHNOS-C, and 24 (15) points for NOSE.ConclusionsFor the obstruction domain SCHNOS-O, the MCID was 28 points. For the cosmetic domain SCHNOS-C, the MCID was 18 points.

scholarly journals Articular Cartilage Repair of the Pediatric and Adolescent Knee with Regard to Minimal Clinically Important Difference: A Systematic Review

Cartilage ◽  
2018 ◽  
Vol 11 (1) ◽  
pp. 9-18 ◽  
Author(s):  
Rosa S. Valtanen ◽  
Armin Arshi ◽  
Benjamin V. Kelley ◽  
Peter D. Fabricant ◽  
Kristofer J. Jones
Keyword(s):  
Systematic Review ◽  
Articular Cartilage ◽  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Minimal Clinically Important Difference ◽  
Cochrane Library ◽  
Clinically Important Difference ◽  
Outcome Score ◽  
The Mean

Objective To perform a systematic review of clinical outcomes following microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and osteochondral autograft transplantation system (OATS) to treat articular cartilage lesions in pediatric and adolescent patients. We sought to compare postoperative improvements for each cartilage repair method to minimal clinically important difference (MCID) thresholds. Design MEDLINE, Web of Science, Scopus, and Cochrane Library databases were searched for studies reporting MCID-validated outcome scores in a minimum of 5 patients ≤19 years treated for symptomatic knee chondral lesions with minimum 1-year follow-up. One-sample t tests were used to compare mean outcome score improvements to established MCID thresholds. Results Twelve studies reporting clinical outcomes on a total of 330 patients following cartilage repair were identified. The mean age of patients ranged from 13.7 to 16.7 years and the mean follow-up was 2.2 to 9.6 years. Six studies reported on ACI, 4 studies reported on MFX, 2 studies reported on OATS, and 1 study reported on OCA. ACI ( P < 0.001, P = 0.008) and OCA ( P < 0.001) showed significant improvement for International Knee Documentation Committee (IKDC) scores with regard to MCID while MFX ( P = 0.66) and OATS ( P = 0.11) did not. ACI ( P < 0.001) and OATS ( P = 0.010) both showed significant improvement above MCID thresholds for Lysholm scores. MFX ( P = 0.002) showed visual analog scale (VAS) pain score improvement above MCID threshold while ACI ( P = 0.037, P = 0.070) was equivocal. Conclusions Outcomes data on cartilage repair in the pediatric and adolescent knee are limited. This review demonstrates that all available procedures provide postoperative improvement above published MCID thresholds for at least one reported clinical pain or functional outcome score.

Long-term functional outcome of surgical treatment for degenerative cervical myelopathy

2021 ◽  
pp. 1-11
Author(s):  
Mark D. Dijkman ◽  
Martine W. T. van Bilsen ◽  
Michael G. Fehlings ◽  
Ronald H. M. A. Bartels
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Cervical Myelopathy ◽  
Minimal Clinically Important Difference ◽  
Clinically Important Difference ◽  
Surgical Data ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

OBJECTIVE Degenerative cervical myelopathy (DCM) is a major global cause of spinal cord dysfunction. Surgical treatment is considered a safe and effective way to improve functional outcome, although information about long-term functional outcome remains scarce despite increasing longevity. The objective of this study was to describe functional outcome 10 years after surgery for DCM. METHODS A prospective observational cohort study was undertaken in a university-affiliated neurosurgery department. All patients who underwent surgery for DCM between 2008 and 2010 as part of the multicenter Cervical Spondylotic Myelopathy International trial were included. Participants were approached for additional virtual assessment 10 years after surgery. Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA; scores 0–18) score at baseline and 1, 2, and 10 years after surgery. The minimal clinically important difference was defined as 1-, 2-, or 3-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilization or improvement after 2 years was maintained at 10 years. Self-evaluated effect of surgery was assessed using a 4-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models. RESULTS Of the 42 originally included patients, 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10–12 years). The mean mJOA score increased significantly from 13.1 (SD 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p = 0.01). A minimal clinically important difference was achieved in 54.1%, and stabilization of functional status was maintained in 75.0% in the long term. Patients who worsened were older (median 63 vs 52 years, p < 0.01) and had more comorbidities (70.0% vs 25.9%, p < 0.01). A beneficial effect of surgery was self-reported by 78.3% of patients. CONCLUSIONS Surgical treatment for DCM results in satisfactory improvement of functional outcome that is maintained at 10-year follow-up.

scholarly journals Radiofrequency Turbinoplasty in Imidazoline-induced Rhinitis Medicamentosa

2017 ◽  
Vol 10 (2) ◽  
pp. 53-57
Author(s):  
SV Manjunatha Rao
Keyword(s):  
Nasal Obstruction ◽  
Objective Assessment ◽  
Cost Effective ◽  
Objective Evaluation ◽  
Subjective Assessment ◽  
Controlled Study ◽  
Symptom Evaluation ◽  
The Mean ◽  
Rhinitis Medicamentosa

ABSTRACT Aim To evaluate the efficacy and results of radiofrequency turbinoplasty in patients with rhinitis medicamentosa due to imidazolines like oxymetazoline and xylometazoline. Study design This is a prospective, single-blinded, randomized controlled study. Materials and methods Study was conducted on 20 patients in a tertiary level center from January 2010 to February 2016. Patients with symptoms and signs of nasal obstruction due to rhinitis medicamentosa were selected. Patients were aged from 16 to 43 years (mean age is 24 years). Twelve were males and eight were females. The duration of use of nasal decongestant drops varied from 3 months to 5 years. The turbinoplasty was performed using the radiofrequency method. Nasal obstruction symptom evaluation (NOSE) questionnaires are used for subjective assessment and nasal endoscopy view score (NES) was used for objective assessment pre- and postoperatively. Follow-up was done at the end of 15 days and 3 months after surgery. The results were statistically analyzed by paired t-test. Results The mean NOSE score before procedure was 92. At the 15th postoperative day, mean NOSE score reduced to 1.3 and it further reduced at the 3rd month to 0.5 (p < 0.001), with 99.5% reduction in subjective symptoms. The mean NES before procedure was 3.95. On the 15th day, it was 0.35 and at the end of 3rd month, it was 0 with 91.1% reduction in objective evaluation (p < 0.001). Results were same on left and right side of nose. No major postoperative complication was observed in patients. Conclusion Radiofrequency turbinoplasty technique can be recommended as an effective method in imidazoline-induced rhinitis medicamentosa. It is simple, comfortable, fast relief giving, no repeated steroids, and cost-effective, single-session treatment. Good compliance and cooperation from patients can be obtained with no major complications of the treatment. It allows patients to be managed in the office environment. How to cite this article Rao SVM. Radiofrequency Turbinoplasty in Imidazoline-induced Rhinitis Medicamentosa. Clin Rhinol An Int J 2017;10(2):53-57.

Management of optic disc pit-associated maculopathy: A case series from a tertiary referral center

2021 ◽  
pp. 112067212110237
Author(s):  
Ilkay Kilic Muftuoglu ◽  
Ecem Onder Tokuc ◽  
V Levent Karabas
Keyword(s):  
Optic Disc ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Maximum Height ◽  
Optic Disc Pit ◽  
Tertiary Referral Center ◽  
Number Of Patients ◽  
The Mean ◽  
Foveal Center

Purpose: To report outcomes of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) stuffing technique in patients with optic disc pit associated maculopathy (ODP-M). Methods: Data including best-corrected visual acuity (BCVA), central macular thickness (CMT), foveal center point thickness (FCP), and maximum height of fluid (max_fluid) (intraretinal or subretinal) were collected from the medical records of the patients. Results: Six eyes of six patients with a mean age of 28.0 ± 17.68 years (range: 9–53 year) underwent PPV + ILM plug surgery. The mean follow-up duration was 25.62 ± 26.11 months (range: 11.80–78.00 month) duration. The mean BCVA increased from 1.25 ± 1.04 logMAR (20/355, Snellen equivalent) to 0.86 ± 1.09 logMAR (20/144, Snellen equivalent) at last follow-up ( p = 0.043). Compared to baseline, CMT, FCP, and max_fluid significantly decreased at all visits after the surgery ( p < 0.05 for all visits). At last follow-up, 66.6% of the eyes (four eyes) showed complete resolution of fluid at a mean of 5.25 ± 4.99 months (range: 1–12 months) after the surgery. Conclusion: PPV with ILM plug seemed to be an effective surgical technique in ODP-M. Studies with longer follow-up and higher number of patients are needed to confirm our results.

scholarly journals The King’s Brief Interstitial Lung Disease (KBILD) questionnaire: an updated minimal clinically important difference

2019 ◽  
Vol 6 (1) ◽  
pp. e000363 ◽  
Author(s):  
Aish Sinha ◽  
Amit Suresh Patel ◽  
Richard J Siegert ◽  
Sabrina Bajwah ◽  
Toby M Maher ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Minimal Clinically Important Difference ◽  
Scale Transformation ◽  
Global Rating ◽  
Longitudinal Assessment ◽  
Hrqol Questionnaire ◽  
Clinically Important Difference ◽  
The Mean ◽  
Small Change

IntroductionThe King’s Brief Interstitial Lung Disease (KBILD) is a 15-item validated health-related quality of life (HRQOL) questionnaire. The method of scoring the KBILD has recently changed to incorporate a logit-scale transformation from one that used raw item responses, as this is potentially a more linear scale. The aim of this study was to re-evaluate the KBILD minimal clinically important difference (MCID) using the new logit -transformed scoring.Methods57 patients with interstitial lung disease (17 idiopathic pulmonary fibrosis, IPF) were asked to complete the KBILD questionnaire on two occasions in outpatient clinics. At the second visit, patients also completed a 15-item global rating of change of health status questionnaire (GRCQ). The MCID was calculated as the mean of four different methods: the change in KBILD for patients indicating a small change in GRCQ, patients with a 7%–12% change in FVC, 1 SE of measurement of baseline KBILD and effect size (ES) of 0.3.ResultsThe mean (SD) KBILD total score for all patients was 55.3 (15.6). 16 patients underwent a therapeutic intervention. 36 patients reported a change in their condition on the GRCQ; 22 deteriorated, 14 improved and 21 were unchanged. There was a significant change in KBILD total score in patients reporting a change in GRCQ; mean (SD) 57.0 (13.6) versus 50.0 (9.7); mean difference 7.0; 95% CI of difference 3.0 to 11.0; p<0.01. The change in KBILD total score correlated with the GRCQ scale; r=−0.49, p<0.01. The mean KBILD total score MCID was 5. The MCID of KBILD domains were 6 for Psychological, 7 for Breathlessness and Activities, and 11 for Chest Symptoms.ConclusionThe KBILD is a responsive tool for longitudinal assessment of HRQOL in patients with ILD. The MCID of the KBILD total score is a 5-unit change.

scholarly journals Assessment of Septoplasty Outcome using Nasal Obstruction Symptom Evaluation Scale

2019 ◽  
Vol 21 (2) ◽  
pp. 142-146
Author(s):  
Kundan Kumar Shrestha ◽  
R.R. Joshi ◽  
A.S. Rijal ◽  
A. Dhungana ◽  
S. Maharjan
Keyword(s):  
Quality Of Life ◽  
Nasal Obstruction ◽  
Septal Deviation ◽  
Definitive Treatment ◽  
Nose Scale ◽  
Outcome Instrument ◽  
Symptom Evaluation ◽  
The Mean ◽  
Nasal Septoplasty

 Nasal obstruction, the most common presenting symptom in nasal and sinus disease, is defined as patient discomfort manifested as a sensation of insufficient airflow through the nose. Nasal septal deviation is the most common anatomical cause of nasal obstruction. Surgical correction of a deviated septum, nasal septoplasty, is the definitive treatment for septal deviation. Many studies have discussed about outcomes of septoplasty. However, there is limited published literature on nasal septoplasty and its outcome in Nepal. The aim of this study is to evaluate the outcome of septoplasty using Nasal Obstruction Symptom Evaluation (NOSE) scale, a validated outcome instrument assessing quality of life (QoL) related to nasal obstruction. A total of 52 patients aged 18 years and above, with nasal obstruction at least for 3 months, undergoing septoplasty alone were included in the study. Baseline NOSE score was calculated a week before surgery. The patients were followed up after 3 months to record postoperative NOSE score. On statistical analysis, the mean NOSE scores before and 3 months after septoplasty were 45.58±21.38 and 8.46±8.37 respectively. The mean difference was 37.11± 21.22 and p value on paired t test was less than 0.001(highly significant). The mean differences of each component of the NOSE scale questionnaire were also found to be highly significant statistically with p values less than 0.001. Gender and age did not seem to affect the outcomes. In conclusion, NOSE scale is a valid, reliable and responsive instrument that is brief and easy to complete and has potential use for outcome studies in adults with nasal obstruction. This instrument showed that septoplasty, if done in properly selected patients, results in significant improvement in nasal obstruction and disease specific quality of life with high patient satisfaction.

Amniotic Band Syndrome: A Single-Institutional Experience

2014 ◽  
Vol 37 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Corey W. Iqbal ◽  
S. Christopher Derderian ◽  
Yvonne Cheng ◽  
Hanmin Lee ◽  
Shinjiro Hirose
Keyword(s):  
Body Wall ◽  
Membrane Disruption ◽  
Common Site ◽  
Tertiary Referral ◽  
Fetal Intervention ◽  
Amniotic Band ◽  
Tertiary Referral Center ◽  
Amniotic Band Syndrome ◽  
Institutional Experience ◽  
The Mean

Introduction: Amniotic band syndrome (ABS) is uncommon. We review our single-institutional experience to define its natural history and outcomes. Materials andMethods: We conducted a retrospective analysis from a single, tertiary referral center of patients evaluated for and confirmed to have ABS from 1997 to 2012. Results: Twenty-eight patients had confirmed ABS. The mean ± SD maternal age was 27.9 ± 5.9 years, and the mean gestational age at diagnosis was 20.7 ± 3.8 months. Oligohydramnios was reported in 4 patients. Eleven patients had membrane disruption, of whom 4 had undergone a prior percutaneous intervention. Extremities were the most common site affected (n = 20), followed by the umbilical cord (n = 7), abdomen (n = 5), limb-body wall complex (n = 5), head (n = 1), and chest (n = 1). Nine patients were felt to be candidates for fetal intervention; 5 underwent fetoscopic amniotic band lysis with 4 survivors. Overall survival, excluding 3 terminations, was 74%. There were 5 fetal demises and one neonatal death. Cord involvement was higher in nonsurvivors (67%) compared to survivors (19%, p = 0.05). Discussion: ABS most commonly involves the extremities. Membrane disruption is not always present. Fetoscopic lysis is appropriate for select patients, and special consideration should be given for cord involvement, which is associated with a worse outcome.

Primary focal cryosurgery of the prostate: Long-term clinical and biochemical outcomes in a large cohort at a tertiary referral center.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 114-114
Author(s):  
Jamie Sungmin Pak ◽  
Philippa J. Cheetham ◽  
Aaron Katz ◽  
Sven Wenske
Keyword(s):  
Cancer Control ◽  
Median Number ◽  
Primary Treatment ◽  
Consecutive Series ◽  
Primary Therapy ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Psa Nadir

114 Background: Modern primary focal cryosurgery (PFC) has emerged as a primary therapy option for localized and minimal low-risk prostate cancer (PCa), achieving good local cancer control and survival outcome. The aim of this analysis was to report on the experience of PFC in our tertiary referral center in the management of localized PCa. Methods: We identified a consecutive series of patients that underwent PFC for localized PCa at our institution between 8/2000 and 1/2014. Demographics, PSA levels and Gleason scores before primary treatment and at time of recurrence were assessed; BDFS, OS, and DSS were assessed. BCR was defined by the Phoenix (PD) and Stuttgart Definitions (SD). Results: A total of 126 patients were included in the analysis, with a median follow-up of 40.3 (0.8-116, IQR 41) months. Median age was 73.5 (range 45-92, IQR 9) years. Median initial serum PSA level was 6.0 (1-44.5, IQR 3) ng/ml. Median primary and secondary Gleason score on initial biopsy was 3 (3-5, IQR 1) with a median sum of 6 (6-10, 1), and 15% (2-95%, IQR 0) of biopsy tissue involved with cancer. Median number of biopsy cores was 12 (2-32), with a median of 1 (1-12, IQR 1) core affected by cancer. Median PSA nadir post-treatment was 1.3 (0.1-13.1, IQR 2) ng/ml. According to PD and SD, 24 and 37 patients had BCR after a median of 14.9 (3.4-91.3, IQR 17) and 13.0 (2.9-90.3, IQR 11) months. Overall 4-year-BDFS was 83% and 73% by PD and SD, respectively. 5-year OS and DSS was 95%, and 99.2%. Of patients that met BCR criteria, almost 25% were proven to be negative on biopsy, confirming over-estimation of failures. Patients that recurred had significantly higher initial median PSA levels (8.5 vs. 5.8 ng/ml; p<0.01) and PSA-nadir (2.1 vs. 1.0 ng/ml; p<0.05). Conclusions: Our analysis confirms PFC being a good option with low rate of morbidities for patients with localized PCa, with excellent BDFS and DSS at a long follow-up of 40 months. Controversy exists regarding criteria of BCR-definitions after focal therapies. More stringent definitions, such as the SD, especially in a focal cryosurgery setting, significantly over-estimate failure rates, and prostate biopsy seems to be the only reliable means to assess for recurrence at this point.

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