Are patient-reported outcome measures biased by method of follow-up? Evaluating paper-based and digital follow-up after lumbar fusion surgery

Background Context

Long-term follow-up of patient-reported outcome measures (PROM) is essential in both modern spinal care and research. Lack of time and staff are commonly reported barriers to implementing long-term follow-up of PROM. Automated and digital follow-up systems for PROM collection are seeing widespread use, yet their validity and comparative effectiveness have never been evaluated.

A Novel Approach to Management of Angular Pregnancies: A Case Series

Cornual, interstitial, and angular pregnancies are terms that are often used interchangeably in both the literature and clinical setting to describe various ectopic pregnancies. The diagnosis of these pregnancies can be difficult, and fear of disrupting an intrauterine pregnancy can cause hesitation during evaluation and management. In our 2 cases, a combination of transvaginal and 3-dimensional ultrasound images provided assistance in the accurate diagnosis of angular ectopic pregnancies. Traditional management of these pregnancies includes a wedge resection for pregnancy resolution. In this set of 2 cases, we describe a unique surgical approach to resolve these pregnancies using operative hysteroscopy.     

Characteristics of Adolescents with Differing Polycystic Ovary Syndrome Phenotypes

Study ObjectiveTo analyze clinical, metabolic, hormonal, and ultrasound characteristics of adolescents with polycystic ovary syndrome phenotypes.DesignWe performed a retrospective analysis of quality improvement data. We divided patients according to phenotype on the basis of clinical or biochemical diagnosis of hyperandrogenism (HA), irregular menstruation (IM), and presence or absence of polycystic ovarian morphology (PCOM) on pelvic ultrasound (PUS) images, if obtained. The 5 resulting groups were: (1) HA/IM/normal PUS, n = 28; (2) HA/PCOM, n = 10; (3) IM/PCOM, n = 18; (4) HA/IM/PCOM, n = 40; and (5) HA/IM/no PUS obtained, n = 80. We compared parameters between groups using the nonparametric Wilcoxon rank sum test.SettingBoston Children's Hospital, 2012-2016.ParticipantsOne hundred seventy-six girls and young women aged 11-25 years.InterventionsNone.Main Outcome Measures(1) Clinical, metabolic, and hormonal characteristics; and (2) PUS measurements.ResultsGroups with HA had significantly higher acne scores, Ferriman-Gallwey scores, and total and free testosterone concentrations than groups without HA. Significant differences in hemoglobin A1c were found between the IM/PCOM and HA/IM/PCOM groups (5.1% vs 5.3%; P = .01) and the IM/PCOM and HA/IM/no PUS groups (5.1% vs 5.3%; P < .01). In patients who had ultrasound performed, 49/94 (52.1%) met PCOM criteria on the basis of ovarian size, 37/94 (39.4%) on the basis of follicle number, and 27/94 (28.7%) on both; 10/94 (10.5)% had incidental findings on ultrasound, with 2 patients requiring further management.ConclusionLimited differences in clinical, metabolic, and hormonal characteristics exist between adolescents with different phenotypes of polycystic ovary syndrome, and are mostly related to the presence or absence of HA. Of patients with ultrasound examinations, only 2 had clinically actionable incidental findings.     

超声造影增强模式鉴别软组织肿块良恶性

Objective: To investigate the ability of contrast enhancement patterns of contrast-enhanced ultrasound in differentiating benign and malignant soft tissue tumours.     

Long-term health-related quality of life of breast cancer survivors remains impaired compared to the age-matched general population especially in young women. Results from the prospective controlled BREX exercise study

ObjectiveTo investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial.MethodsSurvivors (aged 35–68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age ≤ 50) and older (age >50) survivors’ HRQoL was compared to that of the age-matched general female population (n = 892). The analysis included 342 survivors.ResultsThe decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p = 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference −0.017, 95% CI: −0.031 to −0.004). The older survivors’ mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference −0.019, 95% CI: −0.031 to −0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up.ConclusionsHRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.     

肿胀法超声抽吸术治疗腋臭83例疗效观察

目的观察肿胀法超声抽吸术治疗液臭的效果,寻找一种治疗腋臭的新方法。方法在腋窝毛发区皮下注入肿胀液80~100ml,经5mm大小切口将超声探头在腋部皮下组织快速移动,直到皮肤发红发热为止,再用负压抽吸被乳化的皮下组织加压包扎。结果83例受术者,术后6~12个月随访,效果良好者76例(91.5%),有效5例(6.25%),无效2例(2.25%)。结论肿胀法超声抽吸术治疗腋臭,操作简单,不留瘢痕,安全有效,是目前治疗腋臭较为理想的方法。     

Ultrasound evaluation of female urinary incontinence

Thirty women, 25 with incontinence and five asymptomatic volunteer control subjects, were evaluated urodynamically by a variety of techniques, including ultrasound cystourethrography. The ultrasound evaluation was found to be a helpful adjunct in diagnosis. In comparison with radiologic techniques it offers more safety, more comfort, more privacy, more viewing time, and less cost. Bladder and urethral morphology during voiding activity and the amount and direction of urethrovesical mobility are easily determined by utilizing ultrasound techniques.     

针刺穴位后超声监测胆囊收缩功能诊断胆囊炎探讨

目的:超声监测胆囊在针刺穴位后的收缩功能,借此对胆囊炎进行诊断。方法:对临床上已经确诊的51例胆囊炎病例进行超声检查,并测量相关径线,然后运用针刺相关穴位,使胆囊收缩,在针刺后10 min2、0 min、30 min分别进行超声检查,测量相关径线,然后运用胆囊容积计算公式计算出收缩前后胆囊容积,计算胆囊收缩功能。随机抽取与病例组年龄范围相同的25例健康成年人,在针刺穴位胆囊收缩前后进行超声检查,计算胆囊收缩功能,以进行正常对照。将病例组与正常对照组作两样本均数比较的t检验。结果:病例组针刺穴位后的胆囊收缩功能明显低于正常组(t<0.01)。结论:超声监测胆囊在针刺穴位后的收缩功能,可以对胆囊炎进行诊断,并且具有无损伤、痛苦小、病人易接受、可重复等优点,是一种很有发展潜力的中西医结合诊断方法。     

Travel distance, age, and sex as factors in follow-up visit compliance in the post-gastric bypass population

BACKGROUND: There is no consensus regarding the optimal rate of follow-up in the post-bariatric surgery patient population. METHODS: The records of all patients who underwent laparoscopic Roux-en-Y gastric bypass from 2001 to 2003 were reviewed. Using patient zip codes, travel distances were calculated between the patients' places of residence and our clinic. Patients were then assigned to 1 of 3 cohorts according to the following distances: (1) < 50 miles, (2) 50 to 100 miles, and (3) > 100 miles. Patient compliance with follow-up appointments at 3 weeks, 3 months, 6 months, 9 months, and 12 months was analyzed. Linear trends were identified using the Mantel-Haenszel test. Age and sex were analyzed as possible predictors of compliance using the chi(2) test. P values < .05 were considered statistically significant. RESULTS: The study group comprised 150 patients (127 females and 23 males). The 3 cohorts contained 115, 21, and 14 patients, respectively. All patients in each cohort were compliant with the 3-week follow-up appointment. Although there were differences in compliance between cohorts at each of the remaining appointments, only the 9-month (70.3% vs 61.9% vs 35.7%) visit showed statistical significance (P = .035). The 6-month visit trended toward significance (85.2% vs 76.2% vs 64.3%; P = .088). Males were more likely to be compliant with the 12-month follow-up (P = .040). When controlling for sex, travel distance was also a predictor of compliance at this follow-up visit (P = .024). Age was not predictive of compliance (P = .827). CONCLUSION: Based on our findings, we conclude that travel distance from the clinic does not significantly affect compliance at the initial follow-up, 3-month, and 12-month appointments. However, distance does tend to affect compliance at the 6-month appointment and significantly affects compliance at the 9-month appointment. Males are more likely to be compliant at the 12 month follow-up visit. We must continue to strive for 100% follow-up in our post-bariatric surgery patients.