The effect of inlay butterfly cartilage tympanoplasty technique on compliance

Conclusion: IBCT technique should be preferred owing to its high graft survival rate and ABG gain. While no significant difference was found in middle ear pressures between ears that underwent IBCT and normal ears, compliance values were found to be decreased in patients undergoing IBCT. However, the lack of correlation between ABG gain and compliance values indicated that compliance increase had no effect on post-operative ABG results. Objective: The aim of the present study was to compare tympanometric and audiological parameters in patients undergoing inlay butterfly cartilage tympanoplasty (IBCT) with their normal ears and to determine their difference with normal ear tympanometric parameters. Methods: Overall, 25 patients that underwent an operation between August 2010–May 2014 were included in the present study. In 13 of these patients, the ear that did not undergo operation was normal. 0.5, 1, 2, 4?kHz pure sound average values, tympanometric measurements and compliance values of normal and operated ears were compared. Results: The graft survival rate in patients was found to be 92%. Mean pre-operative air–bone gap (ABG) was 16.4?±?5.4 in patients, while mean post-operative ABG was 10.9?±?5.8, with a statistically significant difference (p?=?0.001) While there was no significant difference between operated and normal ears of patients in terms of middle ear pressure (0.441), compliance values were significantly higher in normal ears than those in operated ears (0.032). When post-operative ABG gain was compared with compliance values, no significant correlation was found between ABG gain and compliance measurements (r?=??0.025 and p?=?0.936).     

行为干预联合针对性宣教对心肌梗死PCI术患者服药依从性、认知程度及再狭窄发生率的影响

目的：探讨行为干预联合针对性宣教对心肌梗死PCI术患者服药依从性、认知程度及再狭窄发生率的影响。方法选取我院2014年9月至2015年7月期间收治的经确诊为心肌梗死的患者92例,随机分为观察组和对照组,每组46例,对照组给予术前准备、PCI术后及急性心肌梗死的常规护理,观察组在对照组基础上进行行为干预联合针对性宣教护理,比较两组服药依从性、认知程度及再狭窄发生率。结果两组12个月随访成功率均为100%。出院后3个月服药依从性比较无明显差异（P＞0.05）;观察组出院后6个月、12个月服药依从性明显高于对照组(P＜0.05)。观察组病情认知程度评分显著高于对照组,再狭窄发生率4.35%明显低于对照组17.39%(P＜0.05)。结论行为干预联合针对性宣教护理可明显提高心肌梗死PCI术患者服药依从性、认知程度,降低再狭窄发生率。     

Social context, the struggle with uncertainty, and subjective risk as meaning-rich constructs for explaining HBP noncompliance

OBJECTIVE: To identify the reasons for which people fail to take blood-pressure-lowering medication regularly, a qualitative study was conducted. METHODS: Interviews lasting approximately 90 min were conducted with 27 patients (15 women, 12 men) aged 40-70. The verbatim of the 27 interviews was first read and divided into segments with explanatory value. This was followed by the production of a final text in vignette form for all interviews. An integrative, analytical phase consisted of identifying trends, significant central themes, regularities, and divergences in the vignettes. RESULTS: Analysis revealed the explanatory power that 3 broad groups of subjective meanings could hold for given medication noncompliance scenarios. These scenarios are expressing the role of: (1) stress and living conditions in the occasional skipping or deferral of medication-taking; (2) doubt as the motivating factor for transitory, irregular medication use; (3) subjective risk as the motivating factor for persistent irregular use. CONCLUSION: Life and social contexts, doubt and risk subsume extremely meaning-rich constructs that can help identify dilemmas facing people about medication-taking. PRACTICE IMPLICATIONS: By discussing these dimensions with their patients, health professionals will be better able to understand patient medication behaviors that sometimes run counter to their recommendations.     

Lymphedema in breast cancer survivors: assessment and information provision in a specialized breast unit

OBJECTIVE: Assessment and adequate treatment of lymphedema is required by the European Society of Mastology. The purpose of our study was the evaluation of self-reported incidences of lymphedema in breast cancer survivors and the effect of providing the patients with information about lymphedema on the extent to which lymph-drainage massage services and compression garments were used. METHODS: A total of 742 breast cancer survivors were analysed in this questionnaire-based survey. The associations between lymphedema and the patients' medical history; morbidity located in the breast, axilla, and arm; the amount of information the patients had received concerning lymphedema; and the extent to which lymph-drainage massage services and compression garments were analyzed. RESULTS: 31.67% of the patients stated to have lymphedema. Radiotherapy was identified as a significant risk factor. Pain, paresthesia, and functional limitations were associated with the occurrence of lymphedema. The only independent positive predictive factor found to be associated with the use of lymph-drainage massage services (OR 5.74) was the provision of information about the condition. CONCLUSIONS: Self-reported assessment of lymphedema is feasible. The observed lymphedema incidence of approximately 30% may be able to serve as a basis for benchmarking in quality-assurance procedures at breast centers. PRACTICE IMPLICATIONS: Control mechanisms are required to assess if the indication for lymphdrainage is adequate and the compliance to this subject is sufficient.     

Biomechanical analysis of cervical spine sagittal stiffness characteristics

The orientation of the loading, along which the minimum and maximum displacements occur, can be described as the principal axis. This work presents a model to determine extremums of the compliance of the cervical spine and corresponding principal axis, given the pose and flexibility of each functional cervical unit. As the cervical model of C(2)-C(7) section is flexed, it becomes tensionally stiffer and as the structure is extended, it becomes compressively stiffer. The opposite is true for the model including the atlanto-occipito-axial complex suggesting a compressively stiffer column as it is flexed and a tensionally stiffer structure as it is extended.     

Can lithium salts prevent depressive episodes in the real world?

To critically examine the effectiveness of lithium in preventing depressive symptoms (mixed and depressive episodes) in real life settings, taking into account adherence to drug treatment and its implications for the clinical costs of the disease. Overall, 72 patients with bipolar disorder initially treated with lithium carbonate were included and followed-up for 10 years. Patients were assessed every 8 weeks for morbidity and alcohol/drug consumption. Patients with good adherence to lithium had fewer episodes with depressive features than poor adherers (B?=?2.405, p?=?0.046) and also fewer manic and hypomanic episodes (B?=?2.572; p?<?0.001), after controlling for confounders. Time to relapse into a depressive or mixed episode and into a manic or hypomanic episode was shorter in patients with poor adherence. The costs of the 1.95?±?2.38 (mean?±?standard deviation) admissions of adherent patients through the 10 years of follow-up were €10,349, while the costs of the 6.25?±?4.92 admissions of non-adherent patients were €44,547. In clinical practice settings, long-term lithium salts seem to have a preventive effect on depressive symptoms.     

L’alliance thérapeutique est associée à l’adhésion au traitement chez les enfants atteints d’arthrite juvénile idiopathique

ObjectifsL’alliance thérapeutique (AT) se définit comme l’engagement mutuel entre le soignant et le patient au cours du processus thérapeutique. L’adhésion thérapeutique est un enjeu majeur dans la prise en charge de l’arthrite juvénile idiopathique (AJI) et repose sur la forte capacité de l’enfant à suivre les traitements. Cette étude avait pour objectif d’évaluer l’association entre l’AT et l’adhésion thérapeutique chez des patients atteints d’AJI.MéthodesÉtude observationnelle, transversale, multicentrique. Des enfants atteints d’AJI, âgés de 8 à 16 ans ont été inclus. Les enfants, leurs parents et les médecins ont complété le Helping Alliance Questionnaire (HAq-CP) pour mesurer l’AT. L’observance aux traitements a été mesurée à l’aide du Child/Parent Adherence Report Questionnaire (CARQ & PARQ). Les données démographiques, les caractéristiques de la maladie, les traitements en cours et l’environnement social ont été recueillis. La relation univariée entre l’AT et l’adhésion a été mesurée à l’aide du coefficient de corrélation de Pearson. L’analyse multivariée a utilisé un modèle de régression linéaire multiple.Résultats119 patients ont été inclus : 68,9 % de filles, l’âge moyen (ET) était de 12,4 (2,9) ans, avec une durée de la maladie de 73,1 (48,2) mois. L’AJI était en rémission (52 %), de faible activité (32 %) et active (16 %). Les scores de l’AT étaient élevés (≥ 80/100) chez les enfants, les parents et les médecins. Le HAQ-CP a montré une forte corrélation avec le CARQ (r = 0,31 ; p < 0,001) et le PARQ (r = 0,37 ; p < 0,001). Dans l’analyse univariée, l’activité de la maladie (p < 0,05), le lieu de résidence (p < 0,01) et le statut familial (p < 0,01) ont été associés à l’AT de l’enfant. Dans l’analyse multivariée, seuls le lieu de résidence (p < 0,001) et le statut familial (p < 0,05) restaient associés à l’AT.ConclusionL’AT exerce une forte influence sur l’adhésion thérapeutique et pourrait jouer un rôle majeur dans l’efficacité du traitement.     

疼痛教育项目提高癌症患者疼痛治疗效果的有效性评价

目的：确定疼痛教育项目对减轻患者对疼痛治疗的顾虑、提高遵医行为，从而提高疼痛缓解程度及对疼痛治疗的满意程度的有效性。方法：对112例癌症疼痛患者开展疼痛教育，对比干预前后患者对疼痛治疗的顾虑和遵医行为的变化，对比干预前后患者的疼痛缓解程度及对疼痛治疗的满意度的变化。结果：与疼痛教育前比较，教育后患者对疼痛治疗的总体顾虑水平明显减低（P〈0．01）；能够完全遵医嘱用止痛药的患者比例明显增加（P〈0．01）；疼痛中度及明显缓解的患者比例增加（P〈0．01）；患者对疼痛治疗的满意度明显提高（P〈0．01）。结论：在规范化治疗的前提下，开展疼痛教育项目，可明显减轻患者对疼痛治疗的顾虑，提高其治疗依从性，从而保证疼痛治疗的顺利进行，对临床癌症疼痛控制起积极的促进作用。     

The first knee prosthesis to go through beyond compliance: A new standard for the safe introduction of orthopaedic implants

IntroductionBeyond Compliance (BC) was introduced in 2012 to improve the monitoring and regulation of new medical devices and techniques, ensuring patient safety whilst promoting innovation through an evidence based appraisal of devices during their introduction. This study reports the 2 year outcomes of the first Total Knee Replacement (TKR) implant to be assessed through the BC process.Methods100 consecutive patients undergoing primary knee arthroplasty were enrolled. All patients received a single radius cruciate retaining TKA (Unity, Corin), and the patella was resurfaced in all cases. Patients were followed up at 6 weeks, 3, 6, 12 and 24 months post operatively. Pre-and post-operative range of movement (ROM) as well as outcome scores including OKS, KOOS, EQ5D index and EQ5D VAS were recorded.Results100 patients with a mean age 73.6 (SD = 8.7) were included. 2 patients died during the follow-up period due to unrelated reasons. Overall satisfaction rates were 96%. Complications included ongoing pain (5 patients), and a periprosthetic fracture (1 patient) nine months post-surgery (traumatic). No knees were revised during the follow-up period. Significant improvements were observed in all outcomes measures (OKS, KOOS, EQ5D, and EQ5D VAS). The mean added ROM was 13.2°.DiscussionThis knee prosthesis has been demonstrated to be safe and effective with excellent early outcomes. The careful regulated introduction of this device through BC has ensured patients safety while supporting innovation in knee arthroplasty. The success of BC requires surgeons to insist industry fully engage with the process for all new devices or techniques.     

门诊静脉血栓栓塞症患者抗凝手册的建立及有效性分析

目的评估门诊静脉血栓栓塞症(venous thromboembolism,VTE)患者抗凝手册的建立及其临床可行性、安全性和有效性。方法前瞻性分析上海交通大学医学院附属第九人民医院2018年10月至2019年3月采用门诊VTE抗凝手册的门诊VTE患者随访资料,主要研究终点为规范性抗凝的依从性,次要研究终点包括出血并发症发生率和症状性血栓复发率和失访率。结果门诊VTE患者规范性抗凝依从性为89.4%,其中口服利伐沙班和皮下注射低分子量肝素患者的依从性分别为92.9%和100%,口服华法林患者的依从性为77.8%。出血并发症发生率为5.3%,均为轻微出血。症状性血栓复发率为2.1%,均发生于口服华法林患者。患者总失访率为4.3%。结论建立门诊VTE患者抗凝手册可以有效提高患者治疗依从性,降低失访率,且具有较低的并发症发生率和血栓复发率。