Health-related quality of life in hospital inpatients with pressure ulceration: Assessment using generic health-related quality of life measures

The objective of this study was to determine the impact of pressure ulceration on health-related quality of life (HRQoL) and to undertake a pilot study for a future larger study. The study comprised two parts. First, data from a large UK prospective cohort study were analyzed and the HRQoL of 218 people with pressure ulcers was compared with that of 2,289 people without ulcers using the Short Form-36 (SF-36) questionnaire. After adjusting for age, sex, and comorbidities, patients with pressure ulceration had significantly lower scores for both the physical (coefficient=−3.12, p <0.001) and mental (coefficient=−1.50, p =0.04) component summary scores of the SF-36. Second, a small pilot study was conducted to explore use of other tools. HRQoL was assessed in six patients with and 16 patients without pressure ulcers using the SF-36, the EQ-5D and a pain visual analog scale. SF-36 scores indicated that patients with pressure ulcers had significantly poorer physical functioning ( d =22.3, p =0.001), role limitations due to physical problems ( d =12.9, p =0.02), and vitality ( d =20.6, p =0.04) than those without. EQ-5D scores were also poorer for patients with pressure ulceration, for both the visual analog scale ( d =19.2, p =0.02) and the index ( d =0.29, p =0.08). Patients with pressure ulceration had more perceived pain than those without; however, this difference was of borderline significance ( d =−23.9, p =0.06). Pressure ulceration therefore has an impact on HRQoL that is measurable and persists after adjusting for potential confounding.     

Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy

Muscle strength changes following multi-level surgery in cerebral palsy and the impact of rehabilitation on functional recovery are largely unknown. The aim of this study was to quantify lower limb muscle strength changes in children with spastic diplegia after multi-level orthopaedic surgery and to compare the efficacy of progressive resistance strengthening (RS) versus active exercise (AE).

Twenty children with spastic diplegia (mean age 12.5 years) participated in this prospective randomised controlled trial. Participants underwent multi-level orthopaedic surgery. Routine physiotherapy commenced immediately after surgery. At 6 months post-operatively, children were randomly assigned to the resistance strengthening RS (n = 11) or active exercise AE (n = 9) group and received intensive physiotherapy for 6 weeks. Gait, motor function and maximum isometric muscle strength in five lower limb muscle groups were measured pre-operatively and at 6 months (before and after intensive physiotherapy) and 12 months. As part of the study, we developed and validated a myometry protocol.

Despite kinematic improvements, there was significant reduction of muscle strength (p < 0.05) in all muscle groups at 6 months post-operatively. Following 6 weeks of intensive physiotherapy, both groups showed significant improvement in muscle strength, GMFM scores and gait parameters. Resistance training showed some advantages over active exercise. At 1 year after surgery, strength did not reach pre-operative values in some muscle groups but the benefit from physiotherapy was maintained.

In conclusion, we quantified objectively the reduction in muscle strength 6 and 12 months following multi-level surgery. Furthermore, we demonstrated significant improvement in muscle strength, gait and function following post-operative strength training.     

When will I see you again? The fate of research findings from international wound care conferences*

Medical conferences provide a forum for the rapid dissemination of research directly to health professionals and academics. However, the published record of poster and oral presentations from these meetings is usually limited to abstracts. We aimed to assess how many wound studies presented as conference abstracts were eventually published in journals and to identify the factors that predicted publication. The study was a retrospective review. We identified abstracts relating to oral and poster presentation from two large wound conferences. Following data extraction from the abstracts, a systematic search was conducted to examine if the research was subsequently published as a journal article. A time-to-event analysis was conducted to assess predictive associations between features of the research reported in the conference abstracts and time to full publication. In total, 492 abstracts from two European wound care conferences were identified (467 after exclusions). Of the abstracts included, 60% (279) were for posters and 40% (188) were for oral presentations. Over half of the abstracts (53%) reported results from case studies or case series design. In total, only 57 (12%) of the abstracts included resulted in a related publication. Analysis suggested that those studies reporting positive findings were significantly more likely to be published (hazard ratio 1.79, P= 0.001, 95% CIs 1.26-2.55). Few studies presented as conference abstracts at these two wounds conferences were subsequently published. This may be because of the low methodological quality of studies accepted for poster or oral presentation.     

Cross-border reproductive care: a review of the literature

Cross-border reproductive care (CBRC) has attracted considerable attention in media and professional publications. The aim of this review is to present a critical narrative overview of the published evidence on CBRC. A systematic search of key academic databases was undertaken with no time restrictions set for publication. This was supplemented by additional searches of key websites, reference chaining and enquiries to people working in the field. A total of 54 items are included in the review, including both empirical research studies (18) and debate papers (36). The key themes discussed are: terminology and definitions; incidence; experiences; explanations; implications; and policy responses. Significant methodological limitations and gaps in the literature are identified. Evidence on incidence is scant, though it suggests that CBRC is increasing. The literature suggests legal, social and political drivers, which vary in importance geographically and between individuals. Limited findings on patient perceptions suggest a broadly positive patient experience. Suggested policy responses include prohibition, regulatory harmonization and harm minimization. There is a need for better international data collection tools and both quantitative and qualitative work which encompasses views of patients, donors, surrogates and professionals and which explores the implications for healthcare services in sending countries.     

Pulmonary thromboembolism secondary to left spermatic vein thrombosis: a case report

Spermatic vein thrombosis is a particularly rare entity which can be difficult to diagnose. Pulmonary embolism associated with spermatic vein thrombosis is rarely seen. We report the diagnosis and management of a case at our institution and recommend spermatic vein ligation as the definite treatment for thrombosed spermatic veins associated with pulmonary thromboembolism. We prefer laparoscopy as a minimally invasive approach because of its clear advantages over open surgery.