Patient-Reported Outcomes in Free-Flap Breast Reconstructive Surgery over Time (PRO-BREST)

Introduction: Patient-reported outcomes (PROMs) are increasingly relevant to assess surgical quality and guide decisions in breast reconstruction (BR). Satisfaction with outcomes may change as time progresses. We assessed satisfaction in patients who underwent free-flap BR in the last 12 years. Methods: All patients who underwent free-flap BR from 2006 to 2018 were invited to complete the validated BREAST-Q for reconstruction. The BREAST-Q comprises 6 domains covering various aspects of satisfaction. Unadjusted linear regression assessed the relationship between different domains of the BREAST-Q and time since BR. Two-sample t tests assessed differences in satisfaction between patients who underwent BR ≥5 years versus <5 years prior. Results: Forty-three women with primary or secondary free-flap BR between 2006 and 2018 were included in the study. Most patients (n = 33, 76.7%) underwent DIEP flap BR. Overall satisfaction with breasts and with outcomes improved as time since BR increased (p = 0.031 and p = 0.017, respectively). Overall satisfaction with outcomes scored higher in patients with BR ≥5 years prior (≥5 years vs. <5 years: breast score 88.6 (SD 12.5) versus 66.9 (SD 21.8); p = 0.005). Satisfaction with breasts and psychosocial well-being also scored higher in these patients. There was no difference in results between primary and secondary BR. Patients who underwent additional surgery (refinements) reported higher satisfaction with outcomes and abdominal well-being. Conclusions: PROMs concerning satisfaction with breast and with outcomes following BR improve as time since treatment progresses. This study demonstrates that time since diagnosis may be an important factor in satisfaction. It underlines the importance of long-term PROMs related to BR, to help provide patients and health care professionals in decision-making and in managing expectations related to BR.

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Preoperative Expectations of Patients Undergoing Knee Surgery

The Journal of Knee Surgery ◽

10.1055/s-0039-1698805 ◽

2019 ◽

Cited By ~ 1

Author(s):

Kali N. Stevens ◽

Vidushan Nadarajah ◽

Julio J. Jauregui ◽

Xuyang Song ◽

Shaun H. Medina ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Medical Center ◽

Academic Medical Center ◽

Well Being ◽

Knee Surgery ◽

Measurement Information ◽

Patient Reported ◽

Preoperative Expectations ◽

The Relationship ◽

Preoperative Patient

AbstractThere is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee surgery at an urban academic medical center. We utilized the Musculoskeletal Outcomes Data Evaluation and Management System to measure preoperative expectations. Multiple legacy PRO measures were recorded, as well as the new Patient-Reported Outcomes Measurement Information Systems (PROMIS) Computer Adaptive Testing. Nonparametric statistical analyses were performed to determine significance. Overall, patients undergoing knee surgery had high expectations, with a mean of 88.0 (95% confidence interval [CI], 86.7–89.3) and median of 91.7 (95% CI, 89.2–94.3). Greater preoperative expectations of knee surgery were associated with higher income, surgically naïve knee, lower Charlson Comorbidity Index, better PROMIS Depression and Anxiety scores, greater Marx knee activity scores, and lower total body pain (p < 0.05). Preoperative expectations of patients undergoing knee surgery are associated with a history of prior knee surgery, income, general and mental health, activity, and pain. Expectations were also found to be associated with PRO measures of function and psychological well-being. These findings may have implications for patient education and shared decision-making preoperatively. The Level of Evidence for the study is IV.

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Impact of Contralateral Symmetry Procedures on Long-Term Patient-Reported Outcomes following Unilateral Prosthetic Breast Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1667365 ◽

2018 ◽

Vol 35 (02) ◽

pp. 124-128 ◽

Cited By ~ 1

Author(s):

Shantanu Razdan ◽

Hina Panchal ◽

Claudia Albornoz ◽

Andrea Pusic ◽

Colleen McCarthy ◽

...

Keyword(s):

Breast Reconstruction ◽

Patient Reported Outcomes ◽

Statistical Significance ◽

Multivariable Analysis ◽

Well Being ◽

Contralateral Breast ◽

Prosthetic Reconstruction ◽

Patient Reported ◽

The Impact

Background One aim of unilateral postmastectomy breast reconstruction (BR) is to restore symmetry with the contralateral breast. As such, unilateral prosthetic reconstruction often requires a contralateral symmetry procedure (CSP). There is sparse literature on the impact of CSPs on long-term patient-reported outcomes (PROs) such as satisfaction and health-related quality of life (HRQoL). This study aims to describe PROs following CSPs, using a validated PRO tool, BREAST-Q. The hypothesis is that CSPs are associated with greater patient-reported satisfaction and HRQoL. Methods This study is a single institutional analysis of prospectively collected BREAST-Q scores of patients who underwent unilateral prosthetic BR during 2011 to 2015. Women 18 years and older with BREAST-Q scores measured ≥ 9months after BR with or without CSP(s) at the time of expander replacement were included. Patients were classified into four subcohorts: augmentation, mastopexy, reduction, and no symmetry procedure (controls). Sociodemographic, clinical characteristics, and BREAST-Q scores were analyzed. Multivariable linear regression was performed. Results Of 553 patients, 67 (12%) underwent contralateral augmentation, 68 (12%) mastopexy, 93(17%) reduction, and 325 (59%) were controls. Mean follow-up time was 52 months. Satisfaction with breast and outcomes were higher in the augmentation compared with the control groups (p = 0.01). On multivariable analysis, augmentation remained an independent predictor of satisfaction with breast (p = 0.04). Physical well-being scores were lower for contralateral mastopexy and reduction compared with the controls with a trend toward statistical significance on multivariable models. Psychological and sexual well-being was similar across groups. Conclusion Prosthetic reconstruction with contralateral breast augmentation was associated with greater satisfaction with breast and reconstructive outcome. In contrast, breast reduction and mastopexy procedures demonstrated equivalent satisfaction with breasts compared with controls but may be associated with lower physical well-being. Such information can be used to improve the shared decision-making process for women who choose unilateral prosthetic BR.

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Information support, illness perceptions, and distress in survivors of differentiated thyroid cancer

Journal of Health Psychology ◽

10.1177/1359105317692143 ◽

2017 ◽

Vol 24 (9) ◽

pp. 1201-1209 ◽

Cited By ~ 5

Author(s):

Chelsea H Wiener ◽

Jeffrey E Cassisi ◽

Daniel Paulson ◽

Olga Husson ◽

Rema A Gupta

Keyword(s):

Thyroid Cancer ◽

Patient Reported Outcomes ◽

Differentiated Thyroid Cancer ◽

Illness Perceptions ◽

Information Support ◽

Cancer Data ◽

Patient Reported ◽

Term Evaluation ◽

The Relationship

Survivors of differentiated thyroid cancer report significant distress. This study examines illness perceptions as mediating the relationship between information support and distress among survivors of differentiated thyroid cancer. Data were obtained from the Patient Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship registry. Model results revealed that greater information support was associated with better illness perceptions, and that better illness perceptions were associated with less distress. Information support and distress were indirectly related via illness perceptions. Results highlight the importance of addressing illness perceptions in this population and suggest that informational interventions may help serve this function.

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Long-Term Patient-Reported Outcomes of Radial Forearm Free Flap Donor Site in the Context of Head and Neck Cancer Reconstruction

Indian Journal of Surgical Oncology ◽

10.1007/s13193-019-01015-3 ◽

2019 ◽

Vol 11 (2) ◽

pp. 192-195

Author(s):

Khyati Jani ◽

Nirav Maharaja ◽

Nisha Rajrattansingh Akali ◽

Deepak Balasubramanian ◽

Janarthanan Ramu ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Patient Reported Outcomes ◽

Donor Site ◽

Radial Forearm Free Flap ◽

Patient Reported ◽

Radial Forearm

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End of Induction Patient Reported Outcomes Predict Clinical Remission but not Endoscopic Remission in Crohn’s Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa242 ◽

2020 ◽

Author(s):

Emily C L Wong ◽

Elisa Buffone ◽

So Jeong Lee ◽

Parambir S Dulai ◽

John K Marshall ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Remission ◽

Patient Reported Outcomes ◽

Post Induction ◽

Patient Reported ◽

Endoscopic Remission ◽

One Year ◽

The Relationship

Abstract Background and Aims It is unclear however whether early symptom improvement in Crohn’s disease (CD) provides any prognostic information for patients long-term. This paper aims to investigate the relationship between early patient reported outcomes (PROs) after completion of induction of infliximab and their relationship with long-term clinical remission (CR) and endoscopic remission (ER). Methods This post-hoc analysis (Clinicaltrials.gov: NCT02096861) used data from 220 CD patients to evaluate the relationship of week 6 and 14 PRO variables and week 54 clinical remission (CR) (CDAI < 150), PRO2 remission (mean score abdominal pain (AP) ≤ 1 and stool frequency (SF) ≤ 1.5), and endoscopic remission (SES-CD < 3). Multivariable logistic regression models adjusted for confounders were used to assess the relationships between post-induction PROs and outcomes of interest. Results Patients with moderate or severe AP after induction had reduced odds of achieving one-year CR and PRO2 remission compared to those with mild AP (aOR for CR 0.31, 95% CI 0.17-0.57, p=0.0002). Similarly, patients with moderate to severely elevated SF after induction had reduced odds of one-year CR and PRO2 remission compared to patients with less SF (aOR for CR 0.31, 95% CI 0.16-0.58, p=0.0003). No significant differences were found when comparing higher week 6 or 14 PRO scores of AP and/or SF to lower PRO scores in the odds of achieving one-year ER. Conclusions Post-induction PROs of AP and SF strongly predict likelihood of one-year CR but are not associated with one-year ER. Clinical symptoms alone should not be relied upon when assessing response to therapies for CD.

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Long-Term Patient-Reported Outcomes following Free Flap Lower Extremity Reconstruction for Traumatic Injuries

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000004124 ◽

2018 ◽

Vol 141 (3) ◽

pp. 773-783 ◽

Cited By ~ 6

Author(s):

Sabine A. Egeler ◽

Tim de Jong ◽

Antonius J. M. Luijsterburg ◽

Marc A. M. Mureau

Keyword(s):

Lower Extremity ◽

Free Flap ◽

Patient Reported Outcomes ◽

Traumatic Injuries ◽

Patient Reported ◽

Lower Extremity Reconstruction ◽

Extremity Reconstruction

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Pain Management Telementoring, Long-term Opioid Prescribing, and Patient-Reported Outcomes

Pain Medicine ◽

10.1093/pm/pnz338 ◽

2019 ◽

Vol 21 (2) ◽

pp. 266-273 ◽

Cited By ~ 1

Author(s):

Diane Flynn ◽

Ardith Z Doorenbos ◽

Alana Steffen ◽

Honor McQuinn ◽

Dale J Langford

Keyword(s):

Pain Management ◽

Patient Reported Outcomes ◽

Medical Center ◽

Intervention Group ◽

Control Group ◽

Significant Difference ◽

Patient Reported ◽

Intent To Treat ◽

The Relationship

Abstract Objective Benefits of primary care provider (PCP) participation in pain management telementoring have been reported; however, no studies have examined within-patient changes in dose or discontinuation of long-term opioid therapy (LOT). The objectives of this nonrandomized study were to evaluate the relationship between telementoring participation and 1) LOT dose reduction and 2) LOT discontinuation and to 3) explore the relationship between LOT dose changes and patient-reported outcomes. Methods PCPs were recruited from a US Army medical center. Intervention group PCPs (N = 12) attended telementoring sessions; control group providers (N = 13) did not. Morphine equivalent daily doses (MEDD) for patients of study providers (N = 396) were extracted from the study site’s opioid database. The intervention group was subdivided based on number of sessions attended (i.e., active and low participation). Intent-to-treat and as-treated analyses were conducted using generalized estimating equations. Separate analyses evaluated the association between within-patient changes in MEDD and pain impact, depression, and anxiety (N = 40). Results Intent-to-treat analysis revealed no significant difference in MEDD reduction; however, a higher proportion of patients of intervention PCPs discontinued LOT (25% ± 3.6%) compared with control PCPs (16% ± 3.6%, P < 0.05). As-treated analyses revealed differences in MEDD reduction between active (13.2 ± 3.0) and low-participating (2.6 ± 3.0) PCPs (P < 0.01). Further, a higher proportion of patients of actively participating PCPs discontinued LOT (29% ± 4.9%) compared with control PCPs (16% ± 3.6%, P = 0.01). We found no evidence that decreased MEDD was associated with poorer self-reported outcomes within patients. Conclusions Pain management telementoring supports PCPs’ efforts to reduce reliance on LOT for chronic pain management and highlights the need for actively engaged PCP pain champions.

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Long-Term Efficacy, Visual Performance and Patient Reported Outcomes with a Trifocal Intraocular Lens: A Six-Year Follow-up

Journal of Clinical Medicine ◽

10.3390/jcm10092009 ◽

2021 ◽

Vol 10 (9) ◽

pp. 2009

Author(s):

Joaquín Fernández ◽

Manuel Rodríguez-Vallejo ◽

Javier Martinez ◽

Noemi Burguera ◽

David P. Piñero

Keyword(s):

Intraocular Lens ◽

Patient Reported Outcomes ◽

Phone Call ◽

Distortion Analysis ◽

Patient Reported ◽

Visual Function Questionnaire ◽

Secondary Objective ◽

Defocus Curve ◽

The Mean

(1) Background: To evaluate the efficacy at 6 years postoperative after the implantation of a trifocal intraocular lens (IOL) AT Lisa Tri 839MP. The secondary objective was to evaluate the contrast sensitivity defocus curve (CSDC), light distortion analysis (LDA), and patient reported outcomes (PROs). (2) Methods: Sixty-two subjects participated in phone call interviews to collect data regarding a visual function questionnaire (VF-14), a patient reported spectacle independence questionnaire (PRSIQ), and questions related to satisfaction and decision to be implanted with the same IOL. Thirty-seven of these subjects were consecutively invited to a study visit for measurement of their visual acuity (VA), CSDC, and LDA. (3) Results: The mean monocular distance corrected VA was −0.05, 0.08, and 0.05 logMAR at far and distances of 67 cm and 40 cm, respectively. These VAs were significantly superior to those reported in previous literature (p < 0.05). The total area under the CSDC was 2.29 logCS/m−1 and the light distortion index 18.82%. The mean VF-14 score was 94.73, with 19.4% of subjects requiring spectacles occasionally for near distances, and 88.9% considering the decision of being operated again; (4) Conclusions: Long-term AT LISA Tri 839MP IOL efficacy results were equal or better than those reported 12 months postoperatively in previous studies. The spectacle independence and satisfaction rates were comparable to those reported in short-term studies.

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Objective and Subjective Outcomes in Patients with Hearing Aids: A Cross-Sectional, Comparative, Associational Study

Audiology and Neurotology ◽

10.1159/000516623 ◽

2021 ◽

pp. 1-9

Author(s):

Xunyi Wang ◽

Yun Zheng ◽

Gang Li ◽

Jingzhe Lu ◽

Yan Yin

Keyword(s):

Hearing Aids ◽

Patient Reported Outcomes ◽

Cross Sectional ◽

Patient Reported ◽

Objective Tests ◽

The Difference ◽

Potential Factors ◽

Positive Correlations ◽

The Relationship ◽

Subjective Outcomes

Introduction: Outcome assessment for hearing aids (HAs) is an essential part of HA fitting and validation. There is no consensus about the best or standard approach for evaluating HA outcomes. And, the relationship between objective and subjective measures is ambiguous. This study aimed to determine the outcomes after HA fitting, explore correlations between subjective benefit and acoustic gain improvement as well as objective audiologic tests, and investigate several variables that may improve patients’ perceived benefits. Methods: Eighty adults with bilateral symmetrical hearing loss using HAs for at least 1 month were included in this study. All subjects completed the pure tone average (PTA) threshold and word recognition score (WRS) tests in unaided and aided conditions. We also administered the Chinese version of International Outcome Inventory for Hearing Aids (IOI-HA), to measure participants’ subjective benefits. Objective HA benefit (acoustic gain improvement) was defined as the difference in thresholds or scores between aided and unaided conditions indicated with ΔPTA and ΔWRS. Thus, patients’ baseline hearing levels were taken into account. Correlations were assessed among objective audiologic tests (PTA and WRS), acoustic gain improvement (ΔPTA and ΔWRS), multiple potential factors, and IOI-HA overall scores. Results: PTA decreased significantly, but WRS did not increase when aided listening was compared to unaided listening. Negative correlations between PTAs and IOI-HA scores were significant but weak (r = −0.370 and r = −0.393, all p < 0.05). Significant weak positive correlations were found between WRSs and IOI-HA (r = 0.386 and r = 0.309, all p < 0.05). However, there was no correlation among ΔPTA, ΔWRS, and IOI-HA (r = 0.056 and r = −0.086, all p > 0.05). Moreover, 2 nonaudiological factors (age and daily use time) were significantly correlated with IOI-HA (r = −0.269 and r = 0.242, all p < 0.05). Conclusions: Correlations among objective audiologic tests, acoustic gain, and subjective patient-reported outcomes were weak or absent. Subjective questionnaires and objective tests do not reflect the same hearing capability. Therefore, it is advisable to evaluate both objective and subjective outcomes when analyzing HA benefits on a regular basis and pay equal attention to nonaudiological and audiological factors.

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