MO847PREVALENCE OF FATIGUE REPORTED BY PATIENTS ON HEMODIALYSIS THERAPY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Mauricio Sanabria ◽  
Cesar Mauricio Doria ◽  
Edward Martinez ◽  
Carlos Simon ◽  
Jasmin Vesga ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Chronic Hemodialysis ◽  
Multicenter Cohort Study ◽  
Care Services ◽  
Protein Energy ◽  
Confounding Variables ◽  
Patient Reported ◽  
High Prevalence ◽  
One Year

Abstract Background and Aims Fatigue is a symptom with a high prevalence in patients on hemodialysis therapy due to uremic toxins, anemia, associated comorbidity, and hemodialysis treatment per se. Our objective is to evaluate the prevalence of fatigue reported by patients and their association with the nutritional status. Method This was a prospective observational, multicenter cohort study. Prevalent patients on HD therapy for at least 90 days, older than 18, at the Baxter Renal Care Services were included between September 1, 2017, to November 30, 2017 with one-year follow-up. Socio-demographic and clinical characteristics of all patients were summarized descriptively, the nutritional status was evaluated by protein Energy waste (PEW). Patient reported fatigue was measured with high flux membrane and medium cut-off membrane (Theranova). A generalized linear binomial multivariable model was conducted to assess the effect of PEW on fatigue symptom controlling for some confounding variables. Results We found that the fatigue reported by the patients has a prevalence of 55% [95% CI: 52.2 to 57.7] in our population, there are no statistical differences due to the use of different types of membranes p= 0.911, and neither did we find that the nutritional status is an independent factor that explains this symptom. If we find that women and diabetics have a higher risk of fatigue; RR=1.17 [95% CI: 1.06 to 1.29] and RR= 1.19 [95% CI: 1.00 to 1.42] respectively. Conclusion The fatigue is a prevalent symptom in the chronic hemodialysis population; being a woman and the diagnosis of diabetes are risk factors associated with this outcome. PEW and the type of dialysis membrane used were not associated with this symptom. Studies evaluating the recovery time from post-dialysis symptoms and its relationship with the type of membrane are necessary.

scholarly journals AB0330 HIGH REMISSION RATES IN RA – REAL LIFE DATA FROM BARITICINIB

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1463.2-1464
Author(s):  
S. Bayat ◽  
K. Tascilar ◽  
V. Kaufmann ◽  
A. Kleyer ◽  
D. Simon ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Cox Regression ◽  
Real Life ◽  
Inadequate Response ◽  
Research Support ◽  
Das 28 ◽  
Patient Reported ◽  
One Year

Background:Recent developments of targeted treatments such as targeted synthetic DMARDs (tsDMARDs) increase the chances of a sustained low disease activity (LDA) or remission state for patients suffering rheumatoid arthritis (RA). tsDMARDs such as baricitinib, an oral inhibitor of the Janus Kinases (JAK1/JAK2) was recently approved for the treatment of RA with an inadequate response to conventional (cDMARD) and biological (bDMARD) therapy. (1, 2).Objectives:Aim of this study is to analyze the effect of baricitinb on disease activity (DAS28, LDA) in patients with RA in real life, to analyze drug persistance and associate these effects with various baseline characteristics.Methods:All RA patients were seen in our outpatient clinic. If a patient was switched to a baricitinib due to medical reasons, these patients were included in our prospective, observational study which started in April 2017. Clinical scores (SJC/TJC 76/78), composite scores (DAS28), PROs (HAQ-DI; RAID; FACIT), safety parameters (not reported in this abstract) as well as laboratory biomarkers were collected at each visit every three months. Linear mixed effects models for repeated measurements were used to analyze the time course of disease activity, patient reported outcomes and laboratory results. We estimated the probabilities of continued baricitinib treatment and the probabilities of LDA and remission by DAS-28 as well as Boolean remission up to one year using survival analysis and explored their association with disease characteristics using multivariable Cox regression. All patients gave informed consent. The study is approved by the local ethics.Results:95 patients were included and 85 analyzed with available follow-up data until November 2019. Demographics are shown in table 1. Mean follow-up duration after starting baricitinib was 49.3 (28.9) weeks. 51 patients (60%) were on monotherapy. Baricitinib survival (95%CI) was 82% (73% to 91%) at one year. Cumulative number (%probability, 95%CI) of patients that attained DAS-28 LDA at least once up to one year was 67 (92%, 80% to 97%) and the number of patients attaining DAS-28 and Boolean remission were 31 (50%, 34% to 61%) and 12(20%, 9% to 30%) respectively. Median time to DAS-28 LDA was 16 weeks (Figure 1). Cox regression analyses did not show any sufficiently precise association of remission or LDA with age, gender, seropositivity, disease duration, concomitant DMARD use and number of previous bDMARDs. Increasing number of previous bDMARDs was associated with poor baricitinib survival (HR=1.5, 95%CI 1.1 to 2.2) while this association was not robust to adjustment for baseline disease activity. Favorable changes were observed in tender and swollen joint counts, pain-VAS, patient and physician disease assessment scores, RAID, FACIT and the acute phase response.Conclusion:In this prospective observational study, we observed high rates of LDA and DAS-28 remission and significant improvements in disease activity and patient reported outcome measurements over time.References:[1]Keystone EC, Taylor PC, Drescher E, Schlichting DE, Beattie SD, Berclaz PY, et al. Safety and efficacy of baricitinib at 24 weeks in patients with rheumatoid arthritis who have had an inadequate response to methotrexate. Annals of the rheumatic diseases. 2015 Feb;74(2):333-40.[2]Genovese MC, Kremer J, Zamani O, Ludivico C, Krogulec M, Xie L, et al. Baricitinib in Patients with Refractory Rheumatoid Arthritis. The New England journal of medicine. 2016 Mar 31;374(13):1243-52.Figure 1.Cumulative probability of low disease activity or remission under treatment with baricitinib.Disclosure of Interests:Sara Bayat Speakers bureau: Novartis, Koray Tascilar: None declared, Veronica Kaufmann: None declared, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Johannes Knitza Grant/research support from: Research Grant: Novartis, Fabian Hartmann: None declared, Susanne Adam: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB

scholarly journals Novel Physical Therapy Protocol Targeting Insertional Achilles Tendinopathy Improves Patient Reported Outcomes that Persist For 1 Year

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0028
Author(s):  
Meghan Kelly ◽  
Ashlee MacDonald ◽  
Rachel Olson ◽  
Grace Weyand ◽  
Ruth Chimenti ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Achilles Tendon ◽  
Exercise Program ◽  
Achilles Tendinopathy ◽  
Home Exercise ◽  
Sf 36 ◽  
Patient Reported ◽  
One Year ◽  
Therapy Protocol

Category: Sports Introduction/Purpose: Insertional Achilles Tendinopathy (IAT) affects 5% of the general population and up to 20% of the athletic population. Despite trials of non-surgical management such as physical therapy and heels lifts, more than 50% of patients ultimately pursue surgery. One hypothesis regarding the development of IAT pain and stiffness is that ankle dorsiflexion and associated calcaneal impingement causes transverse compression of the tendon insertion, inducing metaplastic changes within the Achilles tendon, and bursa, contributing to inflammation. Thus the aim of the current study is to examine the effect of a home exercise program designed to minimize compression of insertional tissues for patients with IAT on patient reported outcomes (PRO) measures at 3 months and one year. Methods: Thirty-five patients with IAT were enrolled in the study from May 2014 until June 2015 as two separate cohorts (21 and 14 patients, respectively) of whom 26 completed the study (mean age: 56.7 + 10.1 years, BMI: 29.5 + 6.0 kg/m2, 58% women). One patient elected for surgery prior to completing the physical therapy protocol. Physical therapy exercises were progressive eccentric loading of the Achilles tendon and seated isometric plantar flexion that were performed 4 times a week for 3 months. The Victorian Institute of Sport Assessment – Achilles (VISA-A), the Foot and Ankle Ability Measure (FAAM) and the SF-36 questionnaires were completed at baseline and at the completion of the 3-month physical therapy protocol. Six of the 14 patients in the second cohort returned for a 1 year follow up visit; four patients were lost to follow up and 4 had undergone surgical intervention prior to 1-year follow up. Results: Completion of the 3 month protocol resulted in statistically significant improvements in VISA-A, FAAM ADL and sports scores as well as multiple subcategories of the SF-36 (physical function, role limiting physical function, energy/vitality, social functioning and general pain). Twenty-two of the 26 patients (~85%) that completed the study had clinically significant, greater than MCID, improvements in their VISA-A and/or FAAM scores. In the second cohort, all six patients that returned for a one year follow up assessment maintained their improved VISA-A and FAAM scores observed at the end of the initial physical therapy protocol. Of the four patients that underwent surgical intervention prior to follow up, two did not demonstrate improvement in any of their outcomes following the initial study period. Conclusion: The results of the present study suggest that a physical therapy home exercise program utilizing eccentric and isometric Achilles exercises may result in a greater improvement in functional outcomes compared to other exercise programs that do not progressively increase both ankle dorsiflexion and Achilles tendon loading. Furthermore, improvements in pain and function result in increased energy and social wellbeing. Finally, symptomatic improvement that occurs after 3 months is likely to persist for at least one year following initial treatment.

scholarly journals What are the Risk Factors for Worse Outcomes of Meniscus Surgery in 23-39-Year-Old Patients Ligamentously Stable Knees?

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
◽  
Megan Flynn ◽  
Anthony Egger ◽  
Yuxuan Jin ◽  
Elizabeth Sosic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adult ◽  
Patient Reported Outcomes ◽  
Meniscal Repair ◽  
Patient Specific ◽  
Lower Baseline ◽  
Patient Reported ◽  
Grade 3 ◽  
One Year

Objectives: Meniscus tears are a common and significant source of knee dysfunction in active young adult patients, and no high-quality prospective cohort or RCTs studies exist evaluating patient-reported outcomes in patients in this age group with ligamentously stable knees. Our objective was to identify patient-reported outcomes and patient-specific risk factors from a prospective cohort with a minimum of one-year follow-up following meniscal repair or excision in patients with ligamentously stable knees. We hypothesized that both groups would have significant improvement in outcomes; patients undergoing meniscal repair would have a higher reoperation rate; and articular cartilage injuries, subsequent knee surgery, and certain demographic characteristics would be significant risk factors to inferior outcomes at one year. Methods: Between February 2015 and December 2017, ligamentously stable meniscal procedures were enrolled and prospectively followed using the outcomes management evaluation system (OME) at Cleveland Clinic. Patients aged 23-39 preoperatively completed a series of validated outcome measurements including the Knee Injury and Osteoarthritis Outcome Score for both Pain (KOOS Pain) and Quality of Life (KOOS QoL). At the time of surgery, physicians documented all intra-articular findings, treatment, and surgical techniques utilized. Patients were followed at minimum of 1-year postoperatively through the OME platform and asked to complete the same outcome instruments done at baseline as well as a question designed to evaluate the Patient Acceptable Symptom State (PASS). The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of outcomes. Results: A total of 371 patients aged 23-39 underwent meniscus excision or repair during the study period. One hundred ninety-four met inclusion criteria, and one-year follow-up was obtained on 72% (n = 139) of the cohort (67% male; median age 32). Both KOOS Pain and KOOS QoL improved significantly at one-year for the entire cohort. Fourteen percent of the cohort (9% on the ipsilateral knee, 5% on the contralateral knee) underwent subsequent surgery at a minimum of one-year postoperatively. The patient-specific risk factors for worse one-year outcomes included preoperative baseline mental capacity score (VR-12 MCS), lower baseline KOOS QoL score, and the intraoperative finding of any grade 3 or 4 chondral changes. Conclusion: Young adult patients with ligamentously stable knees undergoing meniscal surgery have significantly improved patient-reported outcomes regardless of excision or repair; however, 14% of patients underwent additional knee surgery at a minimum of one-year postoperatively. The risk factors for worse outcomes include lower baseline mental health score, lower baseline KOOS QoL score, and any grade 3 or 4 chondromalacia scene.

Tibial nailing using a suprapatellar rather than an infrapatellar approach significantly reduces anterior knee pain postoperatively: a multicentre clinical trial

2019 ◽  
Vol 101-B (9) ◽  
pp. 1138-1143 ◽  
Author(s):  
D. R. W. MacDonald ◽  
P. Caba-Doussoux ◽  
C. A. Carnegie ◽  
I. Escriba ◽  
D. P. Forward ◽  
...  
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Tibial Fracture ◽  
Patient Reported Outcome ◽  
Surgical Approaches ◽  
Patient Reported ◽  
Suprapatellar Approach ◽  
One Year ◽  
Anterior Knee

Aims The aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approaches Patients and Methods A total of 95 patients with a tibial fracture requiring an intramedullary nail were randomized to treatment using a supra- or infrapatellar approach. Anterior knee pain was assessed at four and six months, and one year postoperatively, using the Aberdeen Weightbearing Test – Knee (AWT-K) score and a visual analogue scale (VAS) score for pain. The AWT-K is an objective patient-reported outcome measure that uses weight transmitted through the knee when kneeling as a surrogate for anterior knee pain. Results A total of 53 patients were randomized to a suprapatellar approach and 42 to an infrapatellar approach. AWT-K results showed a greater mean proportion of weight transmitted through the injured leg compared with the uninjured leg when kneeling in the suprapatellar group compared with the infrapatellar group at all timepoints at all follow-up visits. This reached significance at four months for all timepoints except 30 seconds. It also reached significance at six months at 0 seconds, and for one year at 60 seconds. Conclusion The suprapatellar surgical approach for antegrade tibial nailing is associated with less anterior knee pain postoperatively compared with the infrapatellar approach Cite this article: Bone Joint J 2019;101-B:1138–1143

scholarly journals Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties

2021 ◽  
Vol 103-B (7) ◽  
pp. 1270-1276
Author(s):  
David N. Townshend ◽  
Andrew J. F. Bing ◽  
Timothy M. Clough ◽  
Ian T. Sharpe ◽  
Andy Goldberg ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Early Experience ◽  
Outcome Data ◽  
Patient Specific ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean ◽  
One Year

Aims This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270–1276.

P1116IS DIALYSIS ADEQUACY AMELIORATED AFTER INCREASING DIALYSATE FLOW RATE IN CHRONIC HEMODIALYSIS? - ONE YEAR FOLLOW-UP

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Aggeliki Barbatsi ◽  
Eugenia Karakou ◽  
Theodoros Chiras ◽  
Jacob Skarakis ◽  
Nikolaos Trakas ◽  
...  
Keyword(s):  
Flow Rate ◽  
Reduction Rate ◽  
Flow Distribution ◽  
Chronic Hemodialysis ◽  
Serum Urea ◽  
Dialysis Adequacy ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
One Year

Abstract Background and Aims Hemodialysis (HD) adequacy, as measured by single pool (sp) Kt/V and urea reduction rate (URR), has been reported to be ameliorated after increasing dialysate flow rate (DFR). However, this is a matter of controversy as no benefit has been observed with dialyzers incorporating features to enhance dialysate flow distribution. We investigated the effect of increasing DFR on dialysis adequacy and on various laboratory parameters. Method Twenty-three patients, M/F=20/3, aged 65(44-89) years, dialyzed thrice weekly for 50(6-274) months, using polysulfone low flux dialyzers, participated in an annual randomized cross-over study. Patients were dialyzed with DFR of 500 ml/min and 700 ml/min for 6 consecutive months respectively, according to their usual dialysis prescription and with ultrafiltration volumes according to clinical need. Blood was sampled before and at the end of midweek sessions at the beginning of the first, 7th and 13rd month for urea, creatinine, potassium, sodium, albumin, total Ca and phosphate (sP). URR, spKt/V, corrected for albumin Ca(sCa) and sCa x sP product (CaxP) values were calculated. Results Under both 500 and 700 ml/min DFRs used, the expected post-dialysis alterations were found: decreased values in serum urea (respectively 161,5±38,0 to 49,9±20.1-p<0,001 and 140,3±30 to 56,0±20.4 mg/dl-p<0,001), creatinine (respectively 10,2±2 to 3.9±1,2-p<0,001 and 10,2±3,3 to 4,1±1,6 mg/dl-p<0,001), potassium (respectively 5,2±0,7 to 3,7±0,3 mM-p<0,001 and 5,3±0,6 to 3,9±0,3mM-p<0,001) and phosphate (respectively 5,4±1,7 to 2,9±0,6-p<0,001 and 5,7±1,6 to 2,6±0,6 mg/dl-p<0,001); increased values in serum albumin (respectively 4,3±0,4 to 4,7±0,4 g/dl-p=0,001 and 4,2±0,3 to 4,7±0,4 g/dl-p<0,001) and sCa (9,1±0,7 to 11,3±0,9 mg/dl-p<0,001 and 8,7±0,6 to 9,9±0,7 mg/dl-p<0,001). After increasing DFR from 500 to 700 ml/min we observed no reductions in pre-dialysis serum urea and creatinine levels or URR (68,6±8,1% to 69,9±7,9%-p=NS) and Kt/V (1,41±0,4 to 1,42±0,3-p=NS) values. However, under DFR of 700ml/min post-dialysis sCa, sP and sCa x sP product values were always lower compared with those under DFR of 500 ml/min (respectively 9,9±0.7 vs 10,8±0.8 mg/dl-p<0,001, 2,6±0,6 vs 2,9±0,6 mg/dl-p=0,02 and 25,6±6,2 vs 30,9±6,7 mg2/dl2-p<0,001). Conclusion DFR increase from 500 to 700 ml/min did not lead to favorable effects on dialysis adequacy but resulted in post-dialysis amelioration of serum calcium and phosphate levels and may be useful in cases of hypercalcemia, hyperphosphatemia and calcifications. DFR increase utility needs further investigation in patients with disorders of calcium-phosphate metabolism.

Incidence, mortality and hospital resource utilization in patients with gastrointestinal cancer and malnutrition: A nationwide analysis.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 466-466
Author(s):  
Vatsala Katiyar ◽  
Ishaan Vohra ◽  
Prasanth Lingamaneni ◽  
Binav Baral ◽  
Rohit Kumar
Keyword(s):  
Nutritional Status ◽  
Resource Utilization ◽  
Protein Energy Malnutrition ◽  
Temporal Trends ◽  
Failure To Thrive ◽  
Total Charge ◽  
Protein Energy ◽  
High Prevalence ◽  
Icd 10 ◽  
Comorbidity Index

466 Background: Malignancies are associated with a high prevalence of cachexia, protein energy malnutrition (PEM) and failure to thrive. We analyzed the National inpatient Sample database (NIS) to understand the temporal trends and differences between gastrointestinal cancers (GIC) patients with and without malnutrition. Methods: All adults admitted with GIC including esophageal, gastric, pancreatic, hepatic, gall bladder, small and large intestine and anal cancers from 2012-2016 were identified from the NIS using the ICD 9 and ICD 10 codes. We analyzed the temporal trends of mortality and resource utilization. Multivariable logistic regression was used to evaluate the risk factors for malnutrition in patients with GIC. Results: There were 2,645,285 GIC inpatient admissions between 2012-2016, out of which 6.1% patients died. 11.1% (±0.22) patients had PEM and three most common GIC associated with PEM were Esophageal (19.7±0.24%), gastric (16.5±0.22%) and small intestine (15.2±0.41%). On multivariate analysis, PEM was more common in male gender (OR: 1.07, 95% CI:1.05-1.08, P<0.01), African- American race (OR:1.14, 95% CI: 1.10-1.17, P<0.01) and Charlson comorbidity index >=2(OR:1.5, 95% 1.42-1.51, P<0.01). Malnourished patients were often terminally ill (48.8% vs 39.8%), in intensive care unit (7.89% vs 3.75%), were more likely to be seen by palliative care team (17.6 % vs 9.8%) and were more likely to die (9.6% vs 5.70%, OR-1.76; p <0.01). The incidence, mortality, and total charge of PEM in patients with GIC significantly increased from 2012 to 2016 as shown in the table below. Conclusions: Malnourished patients with GIC tend to have more advanced disease and have an increased mortality as compared to patients with adequate nutritional status. Optimization of their nutritional status can greatly improve outcomes and curb healthcare costs. [Table: see text]

Identification of Factors Predictive for Patient Reported Outcomes in the Prospective Australian Breast Device Registry

2021 ◽  
Author(s):  
Jessy Hansen ◽  
Susannah Ahern ◽  
Pragya Gartoulla ◽  
Ying Khu ◽  
Elisabeth Elder ◽  
...  
Keyword(s):  
Risk Adjustment ◽  
Breast Implants ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Logistic Regression Models ◽  
Multivariate Risk ◽  
Patient Reported ◽  
The Aesthetic ◽  
One Year

Abstract Background Patient-reported outcome measures (PROMs) are an important tool for evaluating outcomes following breast device procedures, and are used by breast device registries. PROMs can assist with device monitoring through benchmarked outcomes, but need to account for demographic and clinical factors which may affect PROMs responses. Objectives This study aimed to develop appropriate risk-adjustment models for the benchmarking of PROMs data to accurately track device outcomes and identify outliers in an equitable manner. Methods Data for this study were obtained from the Australian Breast Device Registry, which consists of a large prospective cohort of patients with primary breast implants. The five-question BREAST-Q implant surveillance module was used to assess PROMs at one-year following implant insertion. Logistic regression models were used to evaluate associations between demographic and clinical characteristics and PROMs separately by implant indication. Final multivariate risk-adjustment models were built sequentially assessing the independent significant association of these variables. Results 2,221 reconstructive and 12,045 aesthetic primary breast implants with complete one-year follow-up PROMs were included in the study. Indication for operation (post-cancer, risk-reduction, developmental deformity) was included in the final model for all reconstructive implant PROMs. Site type (private or public hospital) was included in the final breast reconstruction model for look, rippling and tightness. Age at operation was included in the reconstruction models for rippling and tightness and in the aesthetic models for look, rippling, pain and tightness. Conclusions These multivariate models will be useful for equitable benchmarking of breast devices by PROMs to help track device performance.

One-year follow-up of the nutritional status of celiac people on a gluten-free diet

2021 ◽  
Author(s):  
Gesala Perez-Junkera ◽  
Maialen Vazquez-Polo ◽  
Francisco Jose Eizagirre ◽  
Laura Benjumea ◽  
Carlos Tutau ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Dietary Habits ◽  
Clinical Investigation ◽  
Gastrointestinal Symptoms ◽  
Gluten Free Diet ◽  
Dietary Advice ◽  
Gluten Free ◽  
Dietary Counseling ◽  
One Year

Abstract Background The gluten-free diet (GFD), the only effective treatment for celiac disease, is usually nutritionally imbalanced. The present work aimed to analyze the evolution of the nutritional status, dietary profile, and symptoms present among celiac people over one year on a GFD while receiving individualized dietary advice. Methods Twenty-seven adults and thirty-one celiac children/adolescents participated in the cohort study. They were followed by 3 visits, at diagnosis (vt0) and after 3 and 12 months (vt3;vt12). Participants filled out dietary and gastrointestinal symptoms questionnaires and received a personalized form from dietitians containing dietary advice and anthropometric and biochemical data evolution. Results Most patients presented normal BMI, fat and muscle mass, and biochemical parameters at diagnosis and vt12. By contrast, all participants consumed protein and lipids in excess and carbohydrates in defect, in both vt0 and vt12. Low intakes of cereals, fruits and vegetables and high of meat were observed, these also remain-ing unchanged after dietary counseling. Symptoms present decreased after vt3 but rebounded in vt12. Conclusions Few changes in dietary pattern and symptom elimination suggested that the intervention was not effective enough. More research is necessary to evaluate whether closer follow up and face-to-face dietary advice improve dietary habits of celiac people. Trial registration: Code PI2016069, Ethical Comitee of the Clinical Investigation of the Basque Country. Registered on 15 July 2016.

Functional and Quality of Life Outcomes of Surgery for Degenerative Cervical Myelopathy: a Quality Improvement Study

2020 ◽  
Author(s):  
Babak Mirzashahi ◽  
Pejman Mansouri ◽  
Arvin Najafi ◽  
Saeed Besharati ◽  
Mohammad Taha Kouchakinejad ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cervical Myelopathy ◽  
Short Form ◽  
Sf 36 ◽  
Patient Reported ◽  
Vas Scores ◽  
One Year ◽  
Degenerative Cervical Myelopathy

Background: This study aimed to determine the outcome of surgical treatments in patients with degenerative cervical myelopathy (DCM). During one-year follow-up period, we evaluated patient-reported functional and quality of life (QOL) measures.   Methods: In a retrospective single-center study, we collected data of patients with DCM who underwent cervical fusion surgeries in Imam Khomeini Hospital, Tehran, Iran, from 2011 to 2015. Patients underwent single or multi-level anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), or posterior laminectomy and fusion. We utilized patient-reported assessments including Short Form 36 (SF-36), Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Nurick grade. Follow-up was performed at 6 weeks, 3 months, 6 months, and 12 months post-operatively to assess the outcome of surgery.   Results: Ninety patients (56 men, 34 women) with a mean age of 54.1 (27-87) years were included. Comparison of pre- and post-operative scores showed significant improvement in SF-36 parameters, VAS, NDI, and Nurick grade (P < 0.001). Also, women’s VAS scores improved more than men's VAS scores during the follow-up period (P < 0.050). Age and type of surgery did not significantly affect the SF-36 parameters, VAS, NDI, and Nurick grade (P > 0.05).   Conclusions: Cervical surgeries in patients with different severity of DCM can improve different aspects of QOL during one-year after surgery

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