8 research outputs found

    Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

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    Introduction The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK. Methods A questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined. Results 81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50–80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0–3.0) and 2.0 plastic surgeons (IQR:1.0–3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures. Conclusions The iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored

    Psychometric Evaluation of a New Patient-Reported Outcome (PRO) Symptom Diary for Varicose Veins: VVSymQ(Âź) Instrument.

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    OBJECTIVE To evaluate the psychometric properties of the VVSymQ(Âź) instrument, a new 5-item patient-reported outcome (PRO) measure for symptoms of varicose veins. METHOD The VVSymQ(Âź) electronic daily diary was administered to outpatients who received routine treatment for varicose veins (N = 40). Compliance with diary administration and item score variability, reliability, construct validity, sensitivity to change, and clinically meaningful change were evaluated. RESULTS Patients completed >97 % of scheduled diary assessments (at screening, baseline, and week 8). The VVSymQ(Âź) instrument captured patients' pre-treatment symptoms (all VVSymQ(Âź) symptoms were endorsed by ≄75 % of patients at baseline), and the change post-treatment (mean change in score -6.1), with a large Cohen effect size (1.6). Test-retest reliability was high (intraclass correlation coefficient 0.96); internal consistency was good (Cronbach's alpha ≄0.76; baseline, week 8). VVSymQ(Âź) scores were more strongly associated with PRO scores that reflect symptoms and symptom impact (the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms [VEINES-QOL/Sym] instrument and the Chronic Venous Insufficiency Quality-of-Life Questionnaire [CIVIQ-20]) than with PRO scores that reflect appearance (the Patient Self-Assessment of Appearance of Visible Varicose Veins [PA-V(3)]) or clinician-reported outcome scores (the Clinical-Etiology-Anatomy-Pathophysiology [CEAP] Classification of Venous Disorders and Venous Clinical Severity Score [VCSS]), demonstrating construct validity. Patients reporting that symptoms were "moderately" or "much improved" on the Patient Global Impression of Change (PGIC) anchor (i.e., >97 % of patients) had mean improvements of -6.3 VVSymQ(Âź) points, while a cumulative distribution curve showed that 50 % of patients improved by ≄-5.8 points; thus, a score change of approximately -6 demonstrated a clinically meaningful change in this study. The clinically meaningful change in the VVSymQ(Âź) score was greater in patients with a greater baseline VVSymQ(Âź) symptom burden, and the VVSymQ(Âź) instrument captured clinically meaningful treatment benefit even in patients with a low baseline symptom burden. CONCLUSION The 5-item VVSymQ(Âź) instrument is a brief, psychometrically sound, useful tool for evaluating patient-reported varicose veins symptoms

    Combined Lower Limb Revascularisation and Supervised Exercise Training for Patients with Peripheral Arterial Disease: A Systematic Review of Randomised Controlled Trials

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    Background Both revascularisation and supervised exercise training improve functional outcomes and quality of life in patients with peripheral arterial disease (PAD).However, the value of combined therapy, where exercise therapy is delivered as an adjunct to revascularisation, is less clear. Objective To systematically review evidence on the effi- cacy of lower limb revascularisation combined with supervised exercise training in patients with PAD. Methods Parallel-group randomised controlled trials indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, CINAHL, SPORTDiscus and Web of Science were searched (up to Jan 2016). Outcome measures were pain-free and maximum walking distances, ankle-brachial index (ABI), leg blood flow and quality of life. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Result Eight trials were included that enrolled a total of 726 patients (mean age 66 ± 3 years, ABI 0.66 ± 0.05). Combined therapy led to greater improvements in pain-free (mean difference [MD] range 38–408 m) and maximal walking distances (MD range 82–321 m) compared with revascularisation or supervised training alone. Combined therapy had no added effect on resting ABI over revascularisation (MD range -0.05 to 0.13), and had a signifi- cantly greater effect than supervised exercise training alone (MD range 0.13–0.31). Limited evidence (one to three trials) also suggested that combined therapy led to greater improvements in leg blood flow and physical domains of quality of life than supervised exercise training alone, and that improvements in leg blood flow, as well as the physical and mental domains of quality of life were not different to that achieved with revascularisation alone. Conclusion Current evidence suggests that PAD patients treated with combined therapy achieve greater functional benefits than those treated with revascularisation or supervised exercise training alone. Limited evidence also suggests that the effect of combined therapy on leg haemodynamics and quality of life may be superior to supervised exercise training alone, and similar to revascularisation alone
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