The Impact of Disability Compensation on Long-term Treatment Outcomes of Patients With Sciatica Due to a Lumbar Disc Herniation

Object The authors comprehensively studied the recovery of individual patients undergoing treatment for lumbar disc herniation. The primary goal was to gain insight into the variability of individual patient utility scores within a treatment cohort. The secondary goal was to determine how the rates and variability of patient recovery over time, represented by improvement in utility scores, affected long-term patient outcomes. Methods EuroQol Group–5 Dimension (EQ-5D) scores were obtained at baseline and at 2, 4, 8, 12, 26, 38, and 52 weeks for 93 patients treated under a prolonged conservative care protocol for lumbar disc herniation. Gaussian kernel densities were used to estimate the distribution of utility scores at each time point. Logistic regression and multistate Markov models were used to characterize individual patient improvement over time. Fisher exact tests were used to compare the distribution of EQ-5D domain scores. Results The distribution of utility scores was bimodal at 1 year and effectively sorted patients into a “higher” utility group (EQ-5D = 1; 43% of cohort) and a “lower” utility group (EQ-5D ≤ 0.86; 57% of cohort). Fisher exact tests revealed that pain/discomfort, mobility, and usual activities significantly differed between the 2 utility groups (p ≪ 0.001). The utility groups emerged at 8 weeks and were stable for the remainder of the treatment period. Using utility scores from 8 weeks, regression models predicted 1-year outcomes with 62% accuracy. Conclusions This study is the first to comprehensively consider the utility recovery of individual patients within a treatment cohort for lumbar disc herniation. The results suggest that most utility is recovered during the early treatment period. Moreover, the findings suggest that initial improvement is critical to a patient's long-term outcome: patients who do not experience significant initial recovery appear unlikely to do so at a later time under the same treatment protocol.

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Long-term treatment outcomes from a patient’s perspective with Treacher Collins syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-241351 ◽

2021 ◽

Vol 14 (5) ◽

pp. e241351

Author(s):

Francis Smith ◽

Peter Fowler ◽

Pamela Ellis

Keyword(s):

Treatment Outcomes ◽

Current Knowledge ◽

Term Treatment ◽

Treacher Collins Syndrome ◽

Multidisciplinary Teams ◽

Treatment Pathway ◽

Long Term Treatment ◽

Heavy Burden ◽

The Impact

The management of patients with Treacher Collins Syndrome (TCS) is complex and involves many different specialists within multidisciplinary teams (MDT). The treatment pathway extends from birth well into adulthood and is associated with a heavy burden of care. Due to the extensive nature of the interaction with these patients, MDT members have opportunities to provide enhanced patient-centred care and support.This case report provides an overview of the current knowledge of the aetiology of TCS, the management of these patients and provides a unique perspective from one of the coauthors who has TCS and reports on his treatment experiences and long-term treatment outcomes. By having a better understanding of the impact of TCS and treatment provided, MDT members can not only provide improved clinical treatment but also offer improved patient experiences for those with craniofacial anomalies in particular an increased awareness of the psychosocial challenges they endure.

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Long-term treatment outcomes from the perspective of a patient with unilateral cleft lip and palate

BMJ Case Reports ◽

10.1136/bcr-2021-246582 ◽

2021 ◽

Vol 14 (12) ◽

pp. e246582

Author(s):

Peter Fowler ◽

Kenny Ardouin ◽

Jennifer Haworth ◽

Leslie Snape

Keyword(s):

Treatment Outcomes ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Current Knowledge ◽

Term Treatment ◽

Multidisciplinary Teams ◽

Treatment Pathway ◽

Long Term Treatment ◽

The Impact

The management of patients with orofacial cleft (OFC) often extends from diagnosis or birth well into adulthood and requires many different specialists within multidisciplinary teams (MDT). The aims of treatment are to restore form and function relating to hearing, speech, occlusion and facial aesthetics. People with OFCs that include the lip, alveolus and palate (cleft lip and palate (CLP)) require several different staged and coordinated surgical and non-surgical interventions, and the treatment pathway is associated with a heavy burden of care. Due to the extensive nature of the interaction with these patients, MDT members have opportunities to provide enhanced patient-centred care and support. This case report provides an overview of the current knowledge of the aetiology of OFC and the management of these patients. It provides a unique perspective from one of the coauthors who has a unilateral CLP (UCLP) and reports on his treatment experiences and long-term treatment outcomes. By having a better understanding of the impact of UCLP and treatment provided, MDT members can not only provide improved clinical treatment but also offer improved patient experiences for those with craniofacial anomalies, in particular, an increased awareness of the psychosocial challenges, they endure throughout their treatment pathway and beyond.

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Long-Term Treatment Outcomes for Heroin Dependence: The 11-Year Follow-Up of the ATOS Study

PsycEXTRA Dataset ◽

10.1037/e612192013-001 ◽

2013 ◽

Author(s):

Christina Marel ◽

Maree Teesson ◽

Shane Darke ◽

Katherine Mills ◽

Joanne Ross ◽

...

Keyword(s):

Treatment Outcomes ◽

Term Treatment ◽

Heroin Dependence ◽

Long Term Treatment

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Long-Term Outcome of Patients who Underwent Percutaneous Nucleotomy for Lumbar Disc Herniation: Results after a Mean Follow-up of 5 Years

Acta Neurochirurgica ◽

10.1007/s007010050070 ◽

1998 ◽

Vol 140 (2) ◽

pp. 108-113 ◽

Cited By ~ 16

Author(s):

E. Kotilainen ◽

S. Valtonen

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Term Outcome ◽

Long Term Outcome

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What Are Long-term Predictors of Outcomes for Lumbar Disc Herniation? A Randomized and Observational Study

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-014-3803-7 ◽

2014 ◽

Vol 473 (6) ◽

pp. 1920-1930 ◽

Cited By ~ 35

Author(s):

Dana Kerr ◽

Wenyan Zhao ◽

Jon D. Lurie

Keyword(s):

Observational Study ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Predictors Of Outcomes

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Sustained drug delivery optimizes long-term treatment of patients with schizophrenia

Acta Neuropsychiatrica ◽

10.1111/j.0924-2708.2004.00100.x ◽

2004 ◽

Vol 16 (6) ◽

pp. 319-325 ◽

Cited By ~ 2

Author(s):

Pierre S. Chue ◽

Peter D'Hoore ◽

J. Michael Ramstack

Keyword(s):

Antipsychotic Agents ◽

Term Treatment ◽

Treatment Programs ◽

Sustained Drug Delivery ◽

Partial Compliance ◽

Long Term Treatment ◽

Optimal Maintenance ◽

Long Acting ◽

The Impact

Chronic disorders such as schizophrenia require long-term treatment programs in order to maintain patients at the lowest level of symptomatology, reduce the likelihood of psychotic relapse, and support achievement of remission and recovery. Evidence suggests that treatment with long-acting injectable antipsychotics reduces the impact of partial compliance and provides predictable release of medication, assuring continuous therapeutic coverage. Until recently, only conventional antipsychotic agents were available in long-acting formulations, thereby foregoing the advantages of the atypical class. Atypical agents which are given orally have been shown to provide long-term efficacy and tolerability benefits compared with conventional agents, but are limited by the need for daily administration. The most recent pharmacological strategy to achieve optimal maintenance treatment has been to combine the benefits of an atypical antipsychotic with delivery in a water-based long-acting formulation. The first antipsychotic to achieve this combination – long-acting risperidone – may thus represent an important advance in the optimization of long-term treatment outcomes in patients with schizophrenia.

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