The effect of COVID-19 restrictions on rehabilitation and functional outcome following total hip and knee arthroplasty during the first wave of the pandemic

Aims The primary aim was to assess the patient-perceived effect of restrictions imposed due to COVID-19 on rehabilitation following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Secondary aims were to assess perceived restrictions, influence on mental health, and functional outcome compared to patients undergoing surgery without restriction. Methods During February and March 2020, 105 patients underwent THA (n = 48) or TKA (n = 57) and completed preoperative and six-month postoperative assessments. A cohort of 415 patients undergoing surgery in 2019 were used as the control. Patient demographic data, BMI, comorbidities, Oxford Hip Score (OHS) or Knee Score (OKS), and EuroQoL five-domain (EQ-5D) score were collected preoperatively and at six months postoperatively. At six months postoperatively, the 2020 patients were also asked to complete a questionnaire relating to the effect of the social restrictions on their outcome and their mental health. Results Nearly half of the patients (47.6%, n = 50/105) felt that the restrictions imposed by COVID-19 had limited their rehabilitation and were associated with a significantly worse postoperative OKS (p < 0.001), EQ-5D score (p < 0.001), and lower satisfaction rate (p = 0.019). The reasons for the perceived limited rehabilitation were: being unable to exercise (n = 32, 64%), limited access to physiotherapy (n = 30, 60%), and no face-to-face follow-up (n = 30, 60%). A quarter (n = 26) felt that their mental health had deteriorated postoperatively; 17.1% (n = 18) felt depressed and 26.7% (n = 28) felt anxious. Joint-specific scores and satisfaction for the 2020 group were no different to the 2019 group, however patients undergoing THA in 2020 had a significantly worse postoperative EQ-5D compared to the 2019 cohort (difference 0.106; p = 0.001) which was not observed in patients undergoing TKA. Conclusion Half of the 2020 cohort felt that their rehabilitation had been limited and was associated with worse postoperative Oxford and EQ-5D scores, and lower rates of patient satisfaction, but relative to the 2019 cohort their overall outcomes were no different, with the exception of THA patients who had a worse general health score. Level of evidence: Prospective study, Level 2 Cite this article: Bone Jt Open 2021;2(6):380–387.

Hospital Epidemics Tracker (HEpiTracker): Description and pilot study of a mobile app to track COVID-19 in hospital workers

Background Hospital workers have been the most frequently and severely affected professional group during the COVID-19 pandemic, and have a big impact on transmission. In this context, innovative tools are required to measure the symptoms compatible with COVID-19, the spread of infection, and testing capabilities within hospitals in real time. Objective We aimed to develop and test an effective and user-friendly tool to identify and track symptoms compatible with COVID-19 in hospital workers. Methods We developed and pilot tested Hospital Epidemics Tracker (HEpiTracker), a newly designed app to track the spread of COVID-19 among hospital workers. Hospital staff in 9 hospital centers across 5 Spanish regions (Andalusia, Balearics, Catalonia, Galicia, and Madrid) were invited to download the app on their phones and to register their daily body temperature, COVID-19–compatible symptoms, and general health score, as well as any polymerase chain reaction and serological test results. Results A total of 477 hospital staff participated in the study between April 8 and June 2, 2020. Of note, both health-related (n=329) and non–health-related (n=148) professionals participated in the study; over two-thirds of participants (68.8%) were health workers (43.4% physicians and 25.4% nurses), while the proportion of non–health-related workers by center ranged from 40% to 85%. Most participants were female (n=323, 67.5%), with a mean age of 45.4 years (SD 10.6). Regarding smoking habits, 13.0% and 34.2% of participants were current or former smokers, respectively. The daily reporting of symptoms was highly variable across participating hospitals; although we observed a decline in adherence after an initial participation peak in some hospitals, other sites were characterized by low participation rates throughout the study period. Conclusions HEpiTracker is an already available tool to monitor COVID-19 and other infectious diseases in hospital workers. This tool has already been tested in real conditions. HEpiTracker is available in Spanish, Portuguese, and English. It has the potential to become a customized asset to be used in future COVID-19 pandemic waves and other environments. Trial Registration ClinicalTrials.gov NCT04326400; https://clinicaltrials.gov/ct2/show/NCT04326400

A Comparison of Random Forest and Decision Tree for Suicide Ideation Classification

Background: Suicide resulted from complex interaction factors. Most classical statistical methods were not efficiently enough to cover this complexity. With the new branch of statistics as statistical/machine learning, complex relationships between risk factors and responses can be modeled. Methods: We aimed to identify the high-risk groups for suicide using different classification methods including logistic regression(LR), decision tree(DT), and random forest(RF). Also, the prediction accuracy of the models is compared. This study used data obtained from a cross-sectional study conducted in in the Hamadan University of Medical Sciences from 2015-2016 to investigate the prevalence of suicidal ideation and related risk factors among university students. The LR, DT, and RF models were used to evaluate the high-risk group for suicide. Finally, the applied all three models were compared using sensitivity(SE), specificity(SP), and the area under receiver operating characteristics (ROC) curves. Results: In the training sample, the area under the ROC curve of the DT was greater than the LR and RF. But in the validation sample, the RF model has the best performance and the DT has the worst performance among these methods.Discussion: In this study, the risk factors for suicide were different for men and women. According to the results of the DT, substance abuse, average, general health score, faculty of education, depression were the risk factors on suicidal ideation in both genders. But despair about the future, residence (parents' house/dormitory) were among the factors contributing to the suicidal ideation of men. On the other hand, parents’ education, interested in the discipline and anxiety influence factors on suicidal ideation in women. The results of RF indicated that depression, general health score, average, anxiety and substance abuse were important risk factors for suicidal ideation in both genders. Also, the faculty of education and age are risk factors for suicide in women. Conclusions: In the training sample, the DT had better performance but in the validation sample, the RF model provided better results. The LR was the best model for diagnosis of the patient and the DT and RF are considered the best models to diagnosis a healthy individual.

Hospital Epidemics Tracker (HEpiTracker): Description and pilot study of a mobile app to track COVID-19 in hospital workers (Preprint)

BACKGROUND Hospital workers have been the most frequently and severely affected professional group during the COVID-19 pandemic, and have a big impact on transmission. In this context, innovative tools are required to measure the symptoms compatible with COVID-19, the spread of infection, and testing capabilities within hospitals in real time. OBJECTIVE We aimed to develop and test an effective and user-friendly tool to identify and track symptoms compatible with COVID-19 in hospital workers. METHODS We developed and pilot tested Hospital Epidemics Tracker (HEpiTracker), a newly designed app to track the spread of COVID-19 among hospital workers. Hospital staff in 9 hospital centers across 5 Spanish regions (Andalusia, Balearics, Catalonia, Galicia, and Madrid) were invited to download the app on their phones and to register their daily body temperature, COVID-19–compatible symptoms, and general health score, as well as any polymerase chain reaction and serological test results. RESULTS A total of 477 hospital staff participated in the study between April 8 and June 2, 2020. Of note, both health-related (n=329) and non–health-related (n=148) professionals participated in the study; over two-thirds of participants (68.8%) were health workers (43.4% physicians and 25.4% nurses), while the proportion of non–health-related workers by center ranged from 40% to 85%. Most participants were female (n=323, 67.5%), with a mean age of 45.4 years (SD 10.6). Regarding smoking habits, 13.0% and 34.2% of participants were current or former smokers, respectively. The daily reporting of symptoms was highly variable across participating hospitals; although we observed a decline in adherence after an initial participation peak in some hospitals, other sites were characterized by low participation rates throughout the study period. CONCLUSIONS HEpiTracker is an already available tool to monitor COVID-19 and other infectious diseases in hospital workers. This tool has already been tested in real conditions. HEpiTracker is available in Spanish, Portuguese, and English. It has the potential to become a customized asset to be used in future COVID-19 pandemic waves and other environments. CLINICALTRIAL ClinicalTrials.gov NCT04326400; https://clinicaltrials.gov/ct2/show/NCT04326400

Investigation of relationship between spiritual intelligence and quality of life in nurses of Birjand teaching hospitals

Spiritual intelligence is a set of abilities to take advantage of religious resources that can predict a person's quality of life and adjustment. The aim of this study was to investigate the relationship between spiritual intelligence and quality of life in nurses of Birjand teaching hospitals in a descriptive-analytical and cross-sectional study. Data were collected by using the Spiritual Intelligence Questionnaires (SISRI-24) and Quality of Life (SF36) and analyzed using the correlation and t-tests. In this study, 187 subjects were included in the study, of which 42.2% were male and 58.8% were female. The average score of spiritual intelligence of the subjects was 48, which is lower than average. Based on the results of correlation coefficient test, there was a significant relationship between spiritual intelligence and emotional health (r=0.77) and the individual's general health score (r=0.20). Based on the results, the spiritual intelligence score of the subjects was moderate and low. On the other hand, spiritual intelligence predicted some areas of quality of life in nurses, Therefore, the implementation of programs aimed at increasing the spiritual intelligence of individuals can increase the quality of life of nurses.

SAT-430 Quality of Life After Thyroidectomy for Patients with Hashimoto’s Disease and Persistent Symptoms

Objective: To determine whether thyroidectomy improves quality of life in patients with Hashimoto’s thyroiditis with persistent symptoms despite biochemical euthyroidism. Study Design: A retrospective cohort study of patients undergoing thyroidectomy for Hashimoto’s thyroiditis. Setting: Tertiary referral center. Subjects and Methods: Included patients underwent thyroidectomy for Hashimoto’s thyroiditis at our institution between 2014 and 2018. The following variables were collected: age, race, body mass index (BMI), pre-operative symptoms, pre-operative thyroid peroxidase antibody (TPO Ab), thyroglobulin antibody (Tg Ab) thyroid stimulating hormone (TSH), free T4, specimen weight, and presence of thyroiditis or malignancy on the pathology report. The primary outcome was general health score on the Short Form-36 Health Survey (SF-36) ranging from 3–35 months postoperatively. Secondary outcomes included an additional questionnaire specifically addressing disease management after surgery as well as any adverse outcomes. Results: 19 patients were included in the study. 18 of the 19 patients were female with a mean age of 48 years (SD 13.6 years). The majority of patients were Caucasian. There was no significant difference between the general health score of the Hashimoto’s thyroiditis patients post-operatively compared to a healthy control population. (66.9 vs. 74.1; 95% CI [-16.9 + 2.5], p = 0.16). There were also no significant differences between groups within the 7 SF-36 subscores. Elevation in pre-operative TPO Ab correlated with lower reported post-operative energy levels (r = -0.63, p = 0.016) and emotional well-being (r = -.55, p = 0.041). 87.5% (14/16) of respondents reported to be moderately or extremely happy with their decision to proceed with surgery. Conclusions: Quality of life in patients with Hashimoto’s thyroiditis who undergo thyroidectomy is equivalent to the general population, and the majority of patients are satisfied with the decision to have undergone surgery. Thyroidectomy is a consideration for patients with Hashimoto’s disease and persistent symptoms despite optimization on medical therapy.

Quality of Life after an Episode of Severe Maternal Morbidity: Evidence from a Cohort Study in Brazil

Objective. To assess quality of life (QOL) in women who experienced a severe maternal morbidity (SMM) event and associated factors, in comparison to those who did not. Study Design. Retrospective cohort study performed at the maternity of the University of Campinas in Brazil, including 801 women with or without SMM, within 6 months to 5 years after delivery. Women were interviewed by phone and data were electronically stored, using the Brazilian version of the SF36 to assess women’s self-perception of quality of life. To analyze a possible relationship between SMM and perceived impairment in quality of life, χ2 and Fisher’s Exact tests were used. Multiple analysis using Generalized Linear Models was applied to identify factors independently associated with the general health score. The main outcome measures were general and domain-specific SF36 scores on quality of life. Results. Maternal morbidity conditions were associated with lower scores of patient perceptions of quality of life in the following domains: physical functioning, role-limiting physical, pain, and general health status. A lower level of school education, not having a partner, caesarean section, and history of previous clinical conditions were associated with a worse perception of general health and quality of life. Conclusion. Health professionals should know the association between life conditions, previous chronic health conditions, and SMM for women during prenatal care to beyond 42 weeks postpartum. Longitudinal and interdisciplinary actions should be put into practice to provide healthcare for these women, with special emphasis on the effective reduction in health inequities.