Patient-acceptable symptom state for the Oxford Hip Score and Forgotten Joint Score at 3 months, 1 year,and 2 years following total hip arthroplasty: a registry-based study of 597 cases

Background and purpose — Patient-acceptable symptom states (PASS) represent the level on a patient-reported outcome measure (PROM) at which patients are satisfied with postoperative outcomes. We defined the PASS for the Oxford Hip Score (OHS) and Forgotten Joint Score (FJS-12) at 3-month, 1-year, and 2-year intervals after primary total hip arthroplasty (THA).Patients and methods — Between July 2018 and April 2019, primary THA patients in an academic medical center’s registry completed the OHS, FJS-12, and a satisfaction anchor question at 3-month (n = 230), 1-year (n = 180), or 2-year (n = 187) postoperative intervals. PASS thresholds were derived with receiver operating characteristic analysis using the 80% specificity method. 95% confidence intervals (CI) were calculated using 1,000 non-parametric bootstrap replications.Results — 74%, 85%, and 86% of patients reported having a satisfactory symptom state at 3 months, 1, and 2 years after surgery, respectively. At 3-month, 1-year, and 2-year intervals, PASS thresholds were 34 (CI 31–36), 40 (CI 36–44), and 39 (CI 35–42) points for the OHS and 59 (CI 54–64), 68 (CI 61–75), and 69 (CI 62–75) points for the FJS-12.Interpretation — PASS thresholds varied with time for both the OHS and the FJS-12, with lower 3-month compared with 1-year and 2-year thresholds. These PASS thresholds represent OHS and FJS-12 levels at which the average patient is satisfied with THA outcomes, helping to interpret PROMs and serving as clinically significant benchmarks and patient-centered outcomes for research.

Patient-reported outcome measures (PROMs) are commonly used to evaluate preoperative and postoperative symptom states of patients undergoing procedures such as total hip arthroplasty (THA) (Rolfson et al. 2016). Although measures such as revision or infection rates may reliably identify significant outliers in arthroplasty outcomes, the absence of such negative outcomes is not sufficient to determine whether the outcome of a procedure was satisfactory from a patient’s point of view (American Academy of Orthopedic Surgeons 2018). Within arthroplasty, there is a focus on joint-specific PROMs, but even between these PROMs there remains variation in the ways in which joint-related health is measured.The Oxford Hip Score (OHS) and the Forgotten Joint Score (FJS-12) are 2 such PROMs. The OHS assesses hip pain and function, and has been widely used in hip arthroplasty since its development in 1996 (Dawson et al. 1998). The FJS-12, designed in 2012, is a joint-specific questionnaire that focuses on the patient’s awareness of the affected joint (Behrend et al. 2012). 3 studies comparing these 2 PROMs found a smaller ceiling effect (proportion of respondents achieving the maximum score) in the FJS-12 compared with the OHS, suggesting that the FJS-12 may be better at distinguishing between patients with good postoperative outcomes in comparison with the OHS within their respective constructs (Hamilton et al. 2016, 2017, Larsson et al. 2019).The patient acceptable symptom state (PASS) is the threshold on a PROM most closely associated with patient satisfaction, which is assessed on a separate questionnaire (Tubach et al. 2005, Sayers et al. 2017). PASS values allow for the interpretation of PROMs within the context of a given treatment, and they may fulfil a variety of roles: as clinically significant benchmarks for procedures, as clinically relevant, patient-centered outcomes for research, and as guides for physicians to contextualize a patient’s postoperative symptom state.Although 2 studies have presented PASS values for the OHS following THA, they have not been externally validated (Judge et al. 2012, Keurentjes et al. 2014). Furthermore, these studies did not investigate the time-dependence of the PASS. The PASS may change within the first year of surgery in accordance with changes in patient expectations during rehabilitation. 1 study established the OHS PASS 6 months after arthroplasty, while the other derived the PASS on a cohort of patients ranging between 1.5 and 6 years following THA. Another study applied a composite questionnaire-based satisfaction anchor criterion to establish an OHS value associated with patient satisfaction 1 year following THA of 37.5 points (Hamilton et al. 2018). To our knowledge, while no THA PASS values have been established for the FJS-12, a composite anchor questionnaire-based “successful treatment” anchor was used by 1 study to establish a threshold value of 74 and 70 points at 1- and 2-year intervals following THA, respectively (Rosinsky et al. 2019).We defined PASS values for the OHS and FJS-12 at 3 months, 1 year, and 2 years following primary THA.     

Assessment of periprocedural hemodynamic changes in arteriovenous malformation vessels by endovascular dual-sensor guidewire

Endovascular embolization is an important modality in the treatment of brain AVMs. Nowadays staged embolization is the method of choice for the prevention of perioperative hemorrhagic complications.Current theory suggests that simultaneous occlusion of more than 60% of AVM volume induces significant redistribution local blood flow. That, in turn, may lead to hemorrhage due to AVM rupture. Aside from angiographic findings, there is still no method that predicts the degree of safe partial embolization. Intraluminal measurement of flow velocity and pressure in the vicinity of the AVM nidus might allow detecting the changes in local hemodynamics. That can provide a valuable data and shed the light on the origin of vascular catastrophes.Ten patients underwent 12 embolization sessions with intraluminal flow velocity and pressure monitoring. The measurements were performed by dual-sensor guidewire. The “Combomap” (Volcano) system with Combowire microguidewires was chosen for measurements, as there is a documented experience of safe use of said guidewires in the cerebral vasculature.The findings observed during the study matched empirical data as well as the current physiological hypothesis of AVM hemorrhage.In conjunction with DSA runs, intraluminal flow velocity and pressure monitoring has the potential to become a valuable tool in AVM treatment.     

Which Oxford Knee Score level represents a satisfactory symptom state after undergoing a total knee replacement?

Background and purpose — Meaningful interpretation of postoperative Oxford Knee Score (OKS) levels is challenging. We established Patient Acceptable Symptoms State (PASS) and Treatment Failure (TF) values for the OKS in patients undergoing primary total knee replacement (TKR) in Denmark.Patients and methods — Data from patients undergoing primary TKR between February 2015 and January 2019 was extracted from the arthroplasty registry at the Copenhagen University Hospital, Hvidovre in Denmark. Data included 3, 12, and 24 months postoperative responses to the OKS and 2 anchor questions asking whether they considered their symptom state to be satisfactory, and if not, whether they considered the treatment to have failed. PASS and TF threshold values were calculated using the adjusted predictive modeling method. Non-parametric bootstrapping was used to derive 95% confidence intervals (CI).Results — Complete 3, 12, and 24 months postoperative data was obtained for 187 of 209 (89%), 884 of 915 (97%), and 575 of 586 (98%) patients, with median ages from 68 to 70 years (59 to 64% female). 72%, 77%, and 79% considered as having satisfactory symptoms, while 6%, 11%, and 11% considered the treatment to have failed, at 3, 12, and 24 months postoperatively, respectively. OKS PASS values (CI) were 27 (26–28), 30 (29–31), and 30 (29–31) at 3, 12, and 24 months postoperatively. TF values were 27 (26–28) and 27 (26–29) at 12 and 24 months postoperatively.Interpretation — The OKS PASS values can be used to guide the interpretation of TKR outcome and support quality assessment in institutional and national registries.

The patient perspective on outcome of total knee replacement (TKR) is captured with patient-reported outcome measures (PROMs) (Price et al. 2018). The Oxford Knee Score (OKS) measures the degree of knee pain and functional status of the knee on a scale ranging from 0 to 48 (worst to best score) (Dawson et al. 1998). Registry-based data suggest that 6-months postoperative OKS results are on average 36 points (NHS 2020). However, judging whether the outcome of surgery was successful or not can be challenging, because it is not clear which symptom level patients consider to be satisfactory. The Patient Acceptable Symptom State (PASS) concept was defined by Tubach et al. (2005) as the score on a PROM above which patients consider themselves well. The contrary concept, Treatment Failure (TF), was introduced for patients undergoing ACL reconstruction, to define patients who consider their symptom levels unsatisfactory to a degree that they find the treatment has failed (Ingelsrud et al. 2015).Suggested satisfaction thresholds for the OKS range from 30 to 38 points after knee replacement (Judge et al. 2012, Keurentjes et al. 2014, Petersen et al. 2017). The time-points evaluated in these studies were either 6 months or shorter/longer than 3 years postoperatively. A dichotomized visual analogue scale (VAS) or a numeric rating scale (NRS) was used as anchor question to measure patients’ satisfaction. However, having the patients’ explicit judgements of whether they have reached a satisfactory symptom state or not after surgery is necessary to derive credible PASS values. Moreover, interpretation characteristics of PROMs are context dependent (Tubach et al. 2007), which highlights the relevance of evaluateing the time-dependency of PASS values for the OKS after TKR. We therefore defined PASS and TF values for the OKS at 3 months, and 1 and 2 years after a TKR.     

Electrical Excitation of the Acoustically Sensitive Auditory Nerve: Single-Fiber Responses to Electric Pulse Trains

Nearly all studies on auditory-nerve responses to electric stimuli have been conducted using chemically deafened animals so as to more realistically model the implanted human ear that has typically been profoundly deaf. However, clinical criteria for implantation have recently been relaxed. Ears with “residual” acoustic sensitivity are now being implanted, calling for the systematic evaluation of auditory-nerve responses to electric stimuli as well as combined electric and acoustic stimuli in acoustically sensitive ears. This article presents a systematic investigation of single-fiber responses to electric stimuli in acoustically sensitive ears. Responses to 250 pulse/s electric pulse trains were collected from 18 cats. Properties such as threshold, dynamic range, and jitter were found to differ from those of deaf ears. Other types of fiber activity observed in acoustically sensitive ears (i.e., spontaneous activity and electrophonic responses) were found to alter the temporal coding of electric stimuli. The electrophonic response, which was shown to greatly change the information encoded by spike intervals, also exhibited fast adaptation relative to that observed in the “direct” response to electric stimuli. More complex responses, such as “buildup” (increased responsiveness to successive pulses) and “bursting” (alternating periods of responsiveness and unresponsiveness) were observed. Our findings suggest that bursting is a response unique to sustained electric stimulation in ears with functional hair cells.     

Self-assessment of treatment compliance with antimuscarinic drugs and lower urinary tract condition among women with urinary incontinence

Aim

Our aim was to determine the efficiency of the Medication Compliance Self-Report Inventory (MASRI) in self-reporting antimuscarinic drug treatment compliance among women with urinary incontinence (UI).

Materials and methods

The study assessed 347 women aged 18–65 (averaging 49.7) years with more than one urinary incontinence (UI) episode per day. Treatment compliance was tested at the beginning and at weeks 4, 8, and 12 using the MASRI, the Brief Medication Questionnaire (BMQ), and visual pill counts. The MASRI’s constructive, concurrent, and discriminate validity was studied in comparison with an external standard that uses the chi-square and Spearman coefficient. Receiver operating characteristic (ROC) analysis was performed to identify optimum MASRI cutoffs that would predict noncompliance. Furthermore, the functional condition of the lower urinary tract was tested using voiding diaries, uroflowmetry, and cystometry.

Result

The correlation between the percentage of noncompliant women according to the MASRI, and individuals with a belief barrier with respect to the BMQ screen was r = 0.81 (p ≤0.05), r = 0.84 (p ≤0.05), and r = 0.79 (p ≤0.05). The correlation between the percentage of noncompliant women according to the MASRI and of women who missed >20% of their doses according to the Regimen Screen of the BMQ was r = 0.79, p ≤0.05, r = 0.82, p ≤0.01, r = 0.77, and p ≤0.05 at the control points. Finally, the percentage of noncompliant patients who self-reported correctly according to the MASRI data compared with the BMQ was 95.6%, 95.7%, and 96.6% at the control points.

Conclusion

The MASRI entails acceptable validity for accurately predicting treatment compliance with antimuscarinic drugs among women who have had UI for >3 months.

     

Genetic and biological characterization of avian influenza H5N1 viruses isolated from wild birds and poultry in Western Siberia

Three viruses included in the study were isolated from dead birds (A/duck/Omsk/1822/2006, A/chicken/Reshoty/02/2006, and A/duck/Tuva/01/2006), whereas the virus A/common gull/Chany/P/2006 was isolated from an apparently healthy gull during outbreaks of highly pathogenic avian influenza in Russia in 2006. The intravenous pathogenicity index (IVPI) of viruses A/duck/Omsk/1822/2006, A/chicken/Reshoty/02/2006, and A/duck/Tuva/01/2006 ranged from 2.7 to 3.0, while the virus A/common gull/Chany/P/2006 had a markedly lower IVPI of 1.7. The virus A/common gull/Chany/P/2006 had a unique pattern of six amino acid substitutions in the regions of viral proteins crucial for virulence of H5N1 viruses. We hypothesize that these substitutions may affect the pathogenicity of A/common gull/Chany/P/2006.     

Rapatar,a nanoformulation of rapamycin,decreases chemically-induced benign prostate hyperplasia in rats

Benign prostatic hyperplasia (BPH) is the most common age-related disease in men. Here we tested the efficacy of Rapatar, a micellar nanoformulation of rapamycin, in two rat models of BPH: testosterone-induced and sulpiride-induced hyperplasia in ventral lobes and lateral/dorsal lobes, respectively. We found that Rapatar prevented hypertrophic and hyperplastic abnormalities and degenerative alterations in both BPH models. Rapatar normalized weight of the lateral lobes in sulpiride-induced BPH, the most relevant animal model of human BPH. Unlike Finasteride, a standard therapy of BPH, Rapatar reduced inflammation caused by sulpiride. No obvious side effects of Rapatar were detected. Our data provide a rationale for clinical trials of Rapatar in patients suffering from BPH.