Speech and Safety in Tracheostomy Patients Receiving Mechanical Ventilation: A Systematic Review

Objective To synthesize evidence of the safety and effectiveness of phonation in patients with fenestrated tracheostomy tubes. Methods PubMed, CINAHL, Scopus, Cochrane, and Web of Science databases were searched. The research question was, “Are fenestrated tracheostomy tubes a safe and effective option to facilitate early phonation in patients undergoing tracheostomy?” Studies of fenestrated tracheostomy tubes were assessed for risk of bias and quality of evidence. Data were abstracted, cross-checked for accuracy, and synthesized. Results Of the 160 studies identified, 13 met inclusion criteria, including 6 clinical studies (104 patients), 6 case reports (13 patients), and 1 nationwide clinician survey. The primary indications for a tracheostomy were chronic ventilator dependence (83%) and airway protection (17%). Indications for fenestrated tracheostomy included inaudible phonation and poor voice intelligibility. Patients with fenestrated tubes achieved robust voice outcomes. Complications included granulation tissue (6 patients [5%]), malpositioning (1 patient [0.9%]), decreased oxygen saturation (3 patients [2.6%]), increased blood pressure (1 patient [0.9%]), increased peak pressures (2 patients [1.7%]), and air leakage (1 patient [0.9%]); subcutaneous emphysema also occurred frequently. Patient-reported symptoms included shortness of breath (4 patients [3.4%]), anxiety (3 patients [2.6%]), and chest discomfort (1 patient [0.9%]). Conclusions Fenestrated devices afford benefits for speech and decannulation but carry risks of granulation, aberrant airflow, and acclimation challenges. Findings highlight the need for continued innovation, education, and quality improvement around the use of fenestrated devices.

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Systematic review of the psychometric properties of patient-reported outcome measures for rheumatoid arthritis in the foot and ankle

Clinical Rehabilitation ◽

10.1177/0269215519862328 ◽

2019 ◽

Vol 33 (11) ◽

pp. 1788-1799 ◽

Cited By ~ 2

Author(s):

Ana Belen Ortega-Avila ◽

Laura Ramos-Petersen ◽

Pablo Cervera-Garvi ◽

Christopher J Nester ◽

José Miguel Morales-Asencio ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systematic Review ◽

Psychometric Properties ◽

Outcome Measures ◽

Methodological Quality ◽

Measurement Properties ◽

Foot And Ankle ◽

Inclusion Criteria ◽

Patient Reported

Objective: To identify self-reported outcome measures specific to the foot and ankle in patients with rheumatoid arthritis and to investigate the methodological quality and psychometric properties of these measures. Method: A systematic review focusing on patients with rheumatoid arthritis. Setting: The search was conducted in the PubMed, SCOPUS, CINAHL, PEDro and Google Scholar databases, based on the following inclusion criteria: population (with rheumatoid arthritis) > 18 years; psychometric or clinimetric validation studies of patient-reported outcomes specific to the foot and ankle, in different languages, with no time limit. Two of the present authors independently assessed the quality of the studies located and extracted the relevant data. Terwee’s criteria and the COSMIN checklist were employed to ensure adequate methodological quality. Results: Of the initial 431 studies considered, 14 met the inclusion criteria, representing 7,793 patients (56.8 years). These instruments were grouped into three dimensions (pain, perceived health status and quality of life and disability). The time to complete any of the PROMs varies around 15 minutes. PROMs criterias with the worst scores by COSMIN, 92.85% and 85.71% were criterion validity, measurement error, internal consistency and responsiveness. 28.57% of PROMs were compared with the measurement properties. Conclusion: the Self-Reported Foot and Ankle Score achieved the highest number of positive criteria (according to Terwee and COSMIN), and is currently the most appropriate for patients with Rheumatoid arthritis.

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Convalescent Plasma for Pregnant Women with COVID-19: A Systematic Literature Review

Viruses ◽

10.3390/v13071194 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1194

Author(s):

Massimo Franchini ◽

Federico Prefumo ◽

Gianpaolo Grisolia ◽

Valentino Bergamini ◽

Claudia Glingani ◽

...

Keyword(s):

Pregnant Women ◽

Web Of Science ◽

Case Reports ◽

Antiviral Agents ◽

Current Evidence ◽

Inclusion Criteria ◽

Clinical Trial Registries ◽

Advanced Search ◽

Immune Depression

The treatment of COVID-19 is particularly critical in pregnant women, considering the potential teratogenic effects of antiviral agents and the immune-depression related with pregnancy. The aim of this review is to systematically examine the current evidence on the clinical use of convalescent plasma during pregnancy. The electronic databases Medline PubMed Advanced Search Builder, Scopus, Web Of Science and Google Scholar were searched (until 1 January 2021). Inclusion criteria were pregnant women with COVID-19 (or SARS-CoV-2 infection), in whom convalescent plasma (or hyperimmune plasma) was used as treatment. We searched clinical trial registries (censored 5 January 2021) for eligible studies under way. After elimination of duplications, the initial search yielded 79 potentially relevant records, of which 67 were subsequently excluded. The 12 remaining records were case reports involving 12 pregnancies. Six of the mothers were reported to be well, two were reported to have preeclampsia, and in one case each the maternal outcome was described as survival, clinical improvement, discharged with oxygen and rehabilitation. With regard to the neonates, two were declared to be well, four had transient morbidity, two were critically ill and one died; normal ongoing pregnancies, but no post-delivery information, were reported for the remaining three cases. Clinical trials under way or planned to investigate the use of convalescent plasma for COVID-19 during pregnancy are lacking. This is the first systematic review of the literature regarding the treatment of COVID-19 in pregnancy. The published literature data seem to indicate that convalescent plasma administered to pregnant women with severe COVID-19 provides benefits for both the mother and the fetus. The quality of the available studies is, however, very limited since they are all case reports and thus suffer from relevant reporting bias.

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Systematic Review of the Use of Patient Reported Outcome Measures in Studies of Electively-Managed Hand Conditions

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500425 ◽

2019 ◽

Vol 24 (03) ◽

pp. 329-341

Author(s):

Hawys Lloyd-Hughes ◽

Luke Geoghegan ◽

Jeremy Rodrigues ◽

Michele Peters ◽

David Beard ◽

...

Keyword(s):

Quality Of Life ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Inclusion Criteria ◽

Site Specific ◽

Patient Reported ◽

Generic Quality ◽

Disease Specific

Background: Electively-managed conditions account for over 100 000 inpatient surgeries a year in the English National Health Service alone, with further procedures in other regions of the UK, or performed on an outpatient basis. To quality assure this care and to conduct research, effective outcome measurement is critical. Traditional surgeon-centric outcome measures correlate poorly with hand function and are seldom important to patients. There has been an advent in the use of patient reported outcome measures (PROMs) in hand surgery although consensus of PROM choice appears to be lacking. This systematic review aimed to describe the use of relevant PROMs in clinical research of electively-managed hand conditions. Methods: A PRISMA-compliant methodology was used. A bespoke search strategy was developed in conjunction with a search strategist, and applied to Medline, EMBASE, CINAHL and PSYCHINFO from 1992 to June 2017. Pre-specified stepwise inclusion criteria were used to identify studies describing adult patients undergoing treatment for electively-managed hand conditions distal to the distal radius, with clinical outcomes measured using one or more PROMs. Results: Of 4554 results, 834 met inclusion criteria. PROMs identified included 9 disease-specific, 8 site-specific and 4 generic quality of life measures. Across all, the Disabilities of the Arm, Shoulder and Hand (DASH) was the most commonly used (overall frequency 41.0%). The most commonly reported disease-specific measure was the Boston Carpal Tunnel Questionnaire (overall frequency 23.0%). The most commonly reported generic quality of life of measure was the SF-36 (overall frequency 4%). Time-analysis demonstrated predominance of site-specific PROMs since the year 2000. Conclusions: Various PROMs have been used to study electively-managed hand conditions, with site-specific PROMs most popular. However, there appears to be limited consensus on choices. A future systematic evaluation of the published psychometric properties of identified PROMs may inform standardisation of measurement.

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Quality of life in palliative care: principles and practice

10.1093/med/9780199656097.003.0197 ◽

2015 ◽

Author(s):

Stein Kaasa ◽

Jon Håvard Loge

Keyword(s):

Quality Of Life ◽

Health Care ◽

Palliative Care ◽

Health Care Providers ◽

Research Question ◽

Patient Reported Outcome ◽

Care Providers ◽

Sequential Approach ◽

Patient Reported

To improve or sustain patients’ health-related quality of life (HRQOL) is the main goal of palliative care. In health care, HRQOL encompasses a range of components that are measurable and related to health, disease, illness, and medical interventions. Another term, patient-reported outcome (PRO), is used and understood as any measure that collects responses directly from the patients and measures any aspect of patients’ health status that is reported by the patients without any interpretation by health-care providers or family members. The selection of PRO-instruments (questionnaires) is recommended to follow a sequential approach. Define overall aim(s), define the research question(s), agree upon the key outcome(s), and select the appropriate set of questions/questionnaires guided by the primary and secondary outcomes. In general, it is recommended to use a HRQOL measure of generic or disease-specific character and supplement it with domain-specific measure(s) (such as measurement of fatigue, pain, anxiety, depression, etc.) reflecting the purpose(s) of the data collection.

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Quality of life and patient-reported outcome measures

10.1093/med/9780198821328.003.0125 ◽

2021 ◽

pp. 1318-1327

Author(s):

Jon Håvard Loge ◽

Stein Kaasa

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Research Question ◽

Patient Reported Outcome ◽

Specific Questionnaire ◽

Patient Reported ◽

Related Quality ◽

Health Related ◽

Pro Instruments

To improve or sustain patients’ quality of life (QoL) is the main goal of palliative care. In palliative care as in healthcare in general, QoL is commonly conceptualized as health-related quality of life (HRQoL) which is the self-perceived health status of an individual and encompasses measurable components that are related to health, disease, illness, and medical interventions. Patient-reported outcome (PRO) measures is the term presently used for any measure that collects responses directly from the patients and includes measures on QoL, HRQoL, functions, and symptoms. In spite of substantial evidence on the positive outcomes of using PRO instruments (questionnaires) in the clinic, such use still faces barriers from the health system and the healthcare providers. The content and the measurement capabilities of present PRO instruments can also be a barrier. The selection of PRO instruments is recommended to follow a sequential approach. Define overall aim(s), define the research question(s), agree upon the key outcome(s), and select the appropriate set of questions/questionnaires guided by the primary and secondary outcomes. In general, it is recommended to use a generic or a disease-specific questionnaire and supplement with domain-specific questionnaire(s) for measurement of fatigue, pain, anxiety, depression, or other symptoms/functions reflecting the purpose(s) of the data collection.

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Topiramate: Safety and Efficacy of its Use in the Prevention and Treatment of Migraine

Journal of Central Nervous System Disease ◽

10.4137/jcnsd.s4365 ◽

2011 ◽

Vol 3 ◽

pp. JCNSD.S4365 ◽

Cited By ~ 9

Author(s):

Ginger C. Minton ◽

April D. Miller ◽

P. Brandon Bookstaver ◽

Bryan L. Love

Keyword(s):

Migraine Headache ◽

Case Reports ◽

Cost Effective ◽

Controlled Trials ◽

Therapeutic Area ◽

Migraine Prevention ◽

Randomized Controlled ◽

Migraine Headaches ◽

Effective Option

Migraine headaches are typically episodic in nature and may affect nearly 10% of the population. In addition to treatment, prevention of subsequent episodes or progression to a chronic migraine state is an important therapeutic area. Topiramate is a centrally acting medication approved for both the prevention of seizures and migraine headache. At this time, the exact mechanism of how topiramate assists in migraine prevention is unknown. Several large randomized, controlled trials have aided in establishing topiramate's role in migraine prevention. Despite a favorable pharmacokinetic and adverse effect profile established in clinical trials, several additional studies, case reports and toxicology reports have demonstrated topiramate as a cause of cognitive and behavioural changes. The use of topiramate in migraine prevention can improve a patient's quality of life and is a cost-effective option for migraine prevention.

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Association of Physical Morbidity and Health-Related Quality of Life in a Representative Sample of Older German People

European Journal of Health Psychology ◽

10.1027/2512-8442/a000019 ◽

2018 ◽

Vol 25 (4) ◽

pp. 140-151

Author(s):

Markus A. Wirtz ◽

Matthias Morfeld ◽

Elmar Brähler ◽

Andreas Hinz ◽

Heide Glaesmer

Keyword(s):

Quality Of Life ◽

Representative Sample ◽

Short Form ◽

Physical Symptoms ◽

German Population ◽

Health Related Quality ◽

Patient Reported ◽

Related Quality ◽

Health Related

Abstract. The association between health-related quality of life (HRQoL; Short-Form Health Survey-12; SF-12) and patient-reported morbidity-related symptoms measured by the Patient Health Questionnaire-15 (PHQ-15) is analyzed in a representative sample of older people in the general German population. Data from 1,659 people aged 60 to 85 years were obtained. Latent class analysis identified six classes of patients, which optimally categorize clusters of physical symptoms the participants reported: musculoskeletal impairments (39.8%), healthy (25.7%), musculoskeletal and respiratory/cardiac impairments (12.8%), musculoskeletal and respiratory impairments, along with bowel and digestion problems (12.9%), general impairments (4.9%), and general impairments with no bowel and digestion problems (4.8%). The participants’ SF-12 Physical Health Scores (η2 = .39) and their Mental Health Scores (η2 = .28) are highly associated with these latent classes. These associations remain virtually identical after controlling for age. The results provide evidence that profiles of patient-reported physical impairments correspond strongly with reduced HRQoL independently from aging processes.

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