Do patient-reported outcome measures capture functioning aspects and environmental factors important to individuals with injuries or disorders of the hand?

Study designQualitative study.IntroductionClinical outcome evaluation needs to consider the patient perspective for an in-depth understanding of functioning and disability.Purpose of the studyTo explore whether patient-reported outcome measures (PROMs) used in the field of hand injuries or hand disorders, capture functioning aspects and environmental factors important to the patients.MethodsWe performed a qualitative study and a systematic literature review. The focus group sessions were recorded, transcribed verbatim, and the identified concepts were linked to the ICF. We searched in MEDLINE for reviews, related to injuries or disorders of the hand, reporting on PROMs. We linked the items of the identified PROMs to the ICF and compared the qualitative data with the content of the PROMs.ResultsStatements from 45 individuals who participated in eight focus groups were linked to 97 categories of the ICF. From 15 reviews included, eight PROMs were selected. The selected PROMs capture 34 of the categories retrieved from the qualitative data.ConclusionsPROMs used in the context of hand injuries or hand disorders capture only in parts the functioning aspects important to the patients.Level of evidenceN.A.     

Which clinical anesthesia outcomes are important to avoid? The perspective of patients.

Healthcare quality can be improved by eliciting patient preferences and customizing care to meet the needs of the patient. The goal of this study was to quantify patients' preferences for postoperative anesthesia outcomes. One hundred one patients in the preoperative clinic completed a written survey. Patients were asked to rank (order) 10 possible postoperative outcomes from their most undesirable to their least undesirable outcome. Each outcome was described in simple language. Patients were also asked to distribute $100 among the 10 outcomes, proportionally more money being allocated to the more undesirable outcomes. The dollar allocations were used to determine the relative value of each outcome. Rankings and relative value scores correlated closely (r2 = 0.69). Patients rated from most undesirable to least undesirable (in order): vomiting, gagging on the tracheal tube, incisional pain, nausea, recall without pain, residual weakness, shivering, sore throat, and somnolence (F-test < 0.01). IMPLICATIONS: Although there is variability in how patients rated postoperative outcomes, avoiding nausea/vomiting, incisional pain, and gagging on the endotracheal tube was a high priority for most patients. Whether clinicians can improve the quality of anesthesia by designing anesthesia regimens that most closely meet each individual patient's preferences for clinical outcomes deserves further study.     

Quality of life in patients treated with hemodialysis or peritoneal dialysis: what are the important determinants?

BACKGROUND: Patients with end-stage renal disease (ESRD) have significant impairments in health-related quality of life (HRQOL). In part, this is due to the intrusiveness of the treatment (hemodialysis or peritoneal dialysis) that is required. It is unclear whether hemodialysis or peritoneal dialysis is associated with a higher HRQOL. METHODS: 192 prevalent patients who self-selected treatment with hemodialysis (either in-center, satellite or home/self-care hemodialysis) or peritoneal dialysis were studied to determine whether treatment with hemodialysis or peritoneal dialysis is associated with a higher HRQOL. Demographic, laboratory and clinical information (including the presence of comorbid conditions using the Charlson comorbidity index) was assessed at baseline. The outcome of interest was HRQOL, which was measured using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), the Short-Form 36 (SF-36) and the EuroQol EQ-5D at baseline and after 6 and 12 months of follow-up. RESULTS: There was no significant difference in HRQOL scores for the SF-36, the EQ-5D and for 9 of 11 KDQOL dimensions for patients treated with hemodialysis or peritoneal dialysis at baseline. As expected, HRQOL was significantly lower for patients who had more comorbid disease, required assistance with their daily care, and for patients with less than a grade 12 education. After controlling for the effect of other important variables, HRQOL (as measured by the EQ-5D visual analog or index scores) did not differ between hemodialysis and peritoneal dialysis patients. HRQOL was stable over time, both for patients who started on hemodialysis or peritoneal dialysis. CONCLUSIONS: There is no significant difference in HRQOL for prevalent ESRD patients treated with hemodialysis or peritoneal dialysis. It will be important to determine if this finding holds true for incident patients treated with hemodialysis or peritoneal dialysis.     

The roentgenmorphologic aspects of symptomatic calcifications in patients with calcifying tendinitis of the shoulder: determination of intra- and interobserver variabilities of Gärtner's classification

Aim of the study. The roentgenologic morphology of symptomatic calcified deposits of the rotator cuff can be classified according Gärtner.This classification influences therapeutic procedures and prognosis of clinical outcome in these patients. In the present study intraoberserver-reproducibility and interobserver-reliability of Gärtner's classification were tested. Methods. Plane radiographs of 100 patients with calcifications of the supraspinatus tendon were classified according the criteria of Gärtner by 6 independent observers twice within 4 months.Intraoberserver-reproducibility and interobserver-reliability were calculated by means of Cohen's κ-index. Results. κ-values of intraoberserverreproducibility had a mean of 0.4208 (SD 0.1299), κ-values of interobserver-reliability were 0.490 for the first and 0.474 for the second classification. Conclusions. Determination of intraoberserver-reproducibility gave insufficient to satisfactory results, interobserver-reliability was sufficient.The clinical use of Gärtner's classification to plan therapeutic procedures or to determine clinical prognosis in patients with calcifying tendinitis can be recommended only with limitations.     

Nerve injuries of the upper extremity associated with vascular trauma—surgical treatment and outcome

Peripheral nerve injuries are often associated with injuries of adjacent tissue. As a result of anatomic proximity between nerves and vascular structures, there is a high chance of combined injuries of these structures (23 %). The aim of our study is to describe and analyze associated nerve and vascular injuries of the upper extremity in patients treated at the Clinic of Neurosurgery in Belgrade over a 10-year period. This study included 83 patients that received surgical treatment at the Clinic of Neurosurgery in Belgrade after having been diagnosed with upper extremity nerve injury. The study included all patients that satisfied these criteria over a period of 10 years. The patients with associated vascular injuries, 36 of them, were considered our study group, while 47 patients without associated vascular injuries were considered our control group. Finally, we compared treatment outcome between these groups. The final outcome evaluation was performed 2 years after surgical treatment. In our study group, 84.8 % surgical nerve repair was successful (fair, good, and excellent outcome), while in the control group (patients without vascular injury), surgical nerve repair was successful in 87.9 %. The overall satisfactory neurological outcome (M3–M5) was present in 86.6 % of nerve repairs. Our study shows that there is no significant difference between the treatment outcome in patients with associated nerve and vascular injuries and patients with isolated nerve injuries if they are diagnosed in time and treated appropriately. Successful treatment can only be accomplished through a multidisciplinary approach undertaken by a highly qualified medical team.     

The vascular relaxing effects of sevoflurane and isoflurane are more important in hypertensive rats compared to normotensive rats

Purpose The vascular response to anesthetics in hypertensive patients are altered since the functional and structural integrity of vascular smooth muscle and endothelium are deranged in hypertension. Although angiotensin Ⅱ （Ang Ⅱ） plays a crucial role in developing hypertension, the effects of anesthetics on Ang Ⅱ-induced change in vascular tone has not been understood. The aim of the present study is to investigate the effects of sevoflurane and isoflurane on Ang Ⅱ-induced vasoconstriction in spontaneously hypertensive rats （SHR）. Methods The dose-dependent effects of sevoflurane and isoflurane on the Ang Ⅱ-induced contraction of aortic rings, in the presence and absence of an intact endothelium, from normotensive Wistar-Kyoto rats （WKY） and SHR were investigated and compared using isometric force transducers. Results Ang Ⅱ （10^-9-10^-6M） induced a similar transient phasic contraction of endothelium-intaet rings from the two rat strains in a dose-dependent manner. Removal of the endothelium augmented the Ang Ⅱ-elicited phasic contraction, to a greater extent in the SHR group than in the WKY group. Sevoflurane and isoflurane （1-3MAC） concentration-dependently inhibited the Ang Ⅱ-induced contraction of endothelium-intaet rings from WKY; an effect that was greatly enhanced following removal of the endothelium. A greater degree of attenuation of the Ang Ⅱ-induced contraction of both endothelium-intact and -denuded rings by the two anesthetics was observed in the SHR group. The inhibitory effects of isoflurane on the Ang Ⅱ-induced contraction of aortic rings from both strains appeared to he stronger than that of sevoflurane at the equipotent concentration. Conclusion The findings that the inhibitory effects of isoflurane and sevoflurane on the Ang Ⅱ-induced vasoconstriction were enhanced in SHR may, at least in part, account for the anesthesia-induced systemic hypotension frequently seen in hypertensive patients.     

Foot and ankle injuries related to the use of E-scooters — A case series and a review of literature

IntroductionAs E-scooter use is increasing with the introduction of urban rental schemes in the United Kingdom, associated foot and ankle injuries will become more prevalent. The aim of this study is to assess the injury pattern and injury severity of foot and ankle trauma associated with E-scooter use.MethodsA retrospective case analysis of all E-scooter foot and ankle injuries presenting to three London hospitals between 1st January and 31st December 2020 was conducted. Data including demographics, mechanism and location of injury sustained, management, duration of hospital stay and mortality were collected.Results20 patients were identified with a total of 27 foot and ankle fractures. Eight patients had fracture dislocations, four sustained open injuries and 45% (9/20) of patients required surgical treatment. Those travelling over 15.5 mph were significantly more likely to require operative intervention (70%) than those travelling below 15.5 mph (20%) (P < 0.033) and were more likely to have an open fracture (40% compared to 0%) (P < 0.0886), however the latter was not of statistical significance. 85% (17/20) of rider’s injuries involved the foot and/or ankle only. There were no mortalities at 30 days.ConclusionsE-scooter use can cause serious foot and ankle injuries. Robust guidelines and legislation restricting top speeds and enforcing the wearing of protective clothing could be implemented. This may protect the E-scooter user from significant foot and ankle injury.     

Which questionnaire is best? The reliability, validity and ease of use of the Patient Evaluation Measure, the Disabilities of the Arm, Shoulder and Hand and the Michigan Hand Outcome Measure

The Patient Evaluation Measure (PEM), The Michigan Hand Outcome Questionnaire (MHQ) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed independent of their originators for reliability, construct and criterion validity and acceptability, using an ease of use questionnaire. These were administered in random order to 100 patients with different hand and wrist disorders and with different impairments of movement, pain, sensation and strength. The internal consistency of all three questionnaires was very high suggesting redundancy in the questions. All questionnaires were reproducible and valid for finger and wrist disorders, but less for nerve disorders. All had poor construct validity. The PEM was the easiest to understand and complete, taking the least time. Correlation between the scales is high and conversion equations were calculated. All three are reliable and reproducible patient completed questionnaires, but the PEM is the easiest to use. The validity of all is suspected for nerve disorders.     

The analysis of injured and poisoned patients during the construction of urbanization and industrialization from 1998 to 2002

OurhospitallocatesintheeastofShenzhenCity.Duetotheconstructionofurbanizationandindustrializationamassofpeopleburstin,whichcausedachangeofthediseasepatternofinpatientsinourhospital.Herethedataofthepatientswithinjuries andpoisoningtreatedinourhospitalfrom1998to2002 wereanalyzed. METHODS Before1993ourhospitalwasacountyhospital. NowitisoneofcityhospitalsofShenzhen,theonly biggeneralhospitalinLonggangDistrictofShenzhen City.Itreceivespatientsfrom9affiliatedtown hospitalsand3districthospitals.…     

Analysis of monotherapy prostate brachytherapy in patients with prostate cancer. Initial PSA and Gleason are important for recurrence?

Purpose

To evaluate the clinical outcome of a cohort of localized prostate cancer patients treate with 125-I permanent brachytherapy at the São José Hospital – CHLC, Lisbon.

Materials and Methods

A retrospective analysis was carried out on 429 patients with low and intermediate-risk of prostate adenocarcinoma, according to the recommendations of the EORTC, who underwent 125I brachytherapies in intraoperative dosimetry “real-time” system between September 2003 and September 2013.

Results

The mean follow-up was 71.98 months. Biochemical relapse of disease by rising PSA (Phoenix criterion) was observed in 18 patients (4.2%). Through the application of Kaplan-Meier survival curves in this sample, the rate of survival at 6 years without biochemical relapse was higher than 95%. By Iog rank test comparing biochemical relapse with initial PSA (15-10 and <10) and Gleason values (7 and <7), there was no statistical difference (P=0.830) of the initial PSA in the probability of developing biochemical relapse. In relation to Gleason score, it was noted a statistical difference (P<0.05), demonstrating that patients with Gleason 7 are more likely to develop biochemical relapse.

Conclusions

Brachytherapy as monotherapy is at present an effective choice in the treatment of localized prostate adenocarcinoma. Biochemical relapses are minimal. The initial PSA showed no statistically difference in the rate of relapses, unlike the value Gleason, where it was demonstrated that patients with Gleason 7 have a higher probability of biochemical relapse. Cases with PSA bounce should be controlled before starting a salvage treatment.     

Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists.

Anesthesia groups may need to determine which clinical anesthesia outcomes to track as part of quality improvement efforts. The goal of this study was to poll a panel of expert anesthesiologists to determine which clinical anesthesia outcomes associated with routine outpatient surgery were judged to occur frequently and to be important to avoid. Outcomes scoring highly in both scales could then be prioritized for measurement and improvement in ambulatory clinical practice. A mailed survey instrument instructed panel members to rate 33 clinical anesthesia outcomes in two scales: how frequently they believe the outcomes occur and which outcomes they expect patients find important to avoid. A feedback process (Delphi process) was used to gain consensus rankings of the outcomes for each scale. Importance and frequency scores were then weighted equally to qualitatively rank order the outcomes. Of the 72 anesthesiologists, 56 (78%) completed the questionnaire. The five items with the highest combined score were (in order): incisional pain, nausea, vomiting, preoperative anxiety, and discomfort from IV insertion. To increase quality of care, reducing the incidence and severity of these outcomes should be prioritized. IMPLICATIONS: Expert anesthesiologists reached a consensus on which low-morbidity clinical outcomes are common and important to the patient. The outcomes identified may be reasonable choices to be monitored as part of ambulatory anesthesia clinical quality improvement efforts.     

Cancer of the stomach: are curative resections of any importance with respect to postoperative survival in patients with locoregional disease?

Ninety-seven patients operated on for cancer of the stomach with locoregional spread, i.e. invasion of adjacent tissue and/or lymph node metastases, have been studied in order to evaluate whether the surgeon's intraoperative assessment of "curative resection" was of any significance with respect to postoperative survival. Survival was not significantly different in patients who had undergone curative resection as compared with those who underwent palliative resection. Patients with unresectable disease had a significantly reduced survival rate compared with the other two groups. We conclude that resection should be performed if at all possible in patients with locoregional disease as resection seems to be effective in prolonging survival. On the other hand, whether the resection is though to be curative or palliative seems to be of less importance with respect to postoperative survival.     

The prospective study of the relationship between perimesencephalic cistern of CT scanning and the outcome of the patients with acute craniocerebral injury

Objective: To explore prospectively the relationship between the state of perimesencephalic cistern and the degree of deformation of the midbrain on CT scanning and the outcome of the patients with acute craniocerebral injury.Methods: The CT scan features including the states of perimesencephalic cisterns, the deformations of the midbrain and the ratios of the occipitofrontal diameter and the transverse diameter of the midbrain of 132 cases were measured. The GOS of the patients 3 months after trauma were regarded as outcome.Results: The rate of unfavorable outcome ( dead, vegetative status, severe disability ) was significantly correlated with perimesencephalic cistern narrower than 1mm (P < 0.05), especially narrower than 0.5 mm (P < 0.005), deformed midbrain (P< 0.005) or abnormal ratio ( < 0.9 or > 1.1) of the occipitofrontal diameter and transverse diameter of the midbrain (P < 0.01). But the patient's perimesencephalic cistern wider than 1mm and the patients without deformed midbrain got favorable