170 research outputs found
Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty
BackgroundTotal knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA).MethodsA single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization.ResultsData from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes.ConclusionsPost-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications.Trial registrationThis trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879
Patients' and health professionals' understanding of and preferences for graphical presentation styles for individual-level EORTC QLQ-C30 scores
Purpose To investigate patients’ and health professionals’ understanding of and preferences for different graphical presentation styles for individual-level EORTC QLQC30 scores.
Methods We recruited cancer patients (any treatment and
diagnosis) in four European countries and health professionals in the Netherlands. Using a questionnaire, we
assessed objective and self-rated understanding of QLQ-C30
scores and preferences for five presentation styles (bar and
line charts, with or without color coding, and a heat map).
Results In total, 548 patients and 227 health professionals
participated. Eighty-three percent of patients and 85 % of
professionals self-rated the graphs as very or quite easy to
understand; this did not differ between graphical presentation styles. The mean percentage of correct answers to
questions objectively assessing understanding was 59 % in
patients, 78 % in medical specialists, and 74 % in other
health professionals. Objective understanding did not differ
between graphical formats in patients. For non-colored
charts, 49.8 % of patients did not have a preference.
Colored bar charts (39 %) were preferred over heat maps
(20 %) and colored line charts (12 %). Medical specialists
preferred heat maps (46 %) followed by non-colored bar
charts (19 %), whereas these charts were equally valued by
other health professionals (both 32 %).
Conclusion The substantial discrepancy between participants’ high self-rated and relatively low objective understanding of graphical presentation of PRO results
highlights the need to provide sufficient guidance when
presenting such results. It may be appropriate to adapt the
presentation of PRO results to individual preferences. This
could be facilitated when PROs are administered and presented to patients and health professionals electronically
Fatigue in Patients with Lung Cancer Is Related with Accelerated Tryptophan Breakdown
BACKGROUND: Patients with cancer often suffer from fatigue and decreased quality of life which might be related to the breakdown of essential amino acid tryptophan. METHODS: In 50 patients with lung cancer we examined fatigue and the deterioration of quality of life in patients using the Functional Assessment of Cancer Therapy Anemia (FACT-An) and -Fatigue (FACT-F) subscales of FACT-General and the Mental adjustment to Cancer (MAC) questionnaires. Results were compared with tryptophan breakdown as well as serum concentrations of immune activation markers. RESULTS: Scores of psychological tests correlated significantly with tryptophan breakdown and with circulatory markers of inflammation. However, immune activation and tryptophan breakdown were not related to MAC scores. CONCLUSIONS: Tryptophan breakdown relates with fatigue and impaired quality of life in patients with lung cancer, while declining tryptophan levels are not associated with patients'coping strategies
Responsiveness and ceiling effects of the Forgotten Joint Score-12 following total hip arthroplasty
ObjectivesTo assess the responsiveness and ceiling/floor effects of the Forgotten Joint Score -12 and to compare these with that of the more widely used Oxford Hip Score (OHS) in patients six and 12 months after primary total hip arthroplasty.MethodsWe prospectively collected data at six and 12 months following total hip arthroplasty from 193 patients undergoing surgery at a single centre. Ceiling effects are outlined with frequencies for patients obtaining the lowest or highest possible score. Change over time from six months to 12 months post-surgery is reported as effect size (Cohen’s d).ResultsThe mean OHS improved from 40.3 (sd 7.9) at six months to 41.9 (sd 7.2) at 12 months. The mean FJS-12 improved from 56.8 (sd 30.1) at six months to 62.1 (sd 29.0) at 12 months. At six months, 15.5% of patients reached the best possible score (48 points) on the OHS and 8.3% obtained the best score (100 points) on the FJS-12. At 12 months, this percentage increased to 20.8% for the OHS and to 10.4% for the FJS-12. In terms of the effect size (Cohen’s d), the change was d = 0.10 for the OHS and d = 0.17 for the FJS-12.ConclusionsThe FJS-12 is more responsive to change between six and 12 months following total hip arthroplasty than is the OHS, with the measured ceiling effect for the OHS twice that of the FJS-12. The difference in effect size of change results in substantial differences in required sample size if aiming to detect change between these two time points. This has important implications for powering clinical trials with patient-reported measures as the primary outcome
Cytokine imbalance in patients with herpesvirus infection and methods of its correction
A decrease in interleukin-2 (IL-2) in the serum of patients with a recurrent form of genital herpes was registered. To correct the revealed disorders, recombinant IL-2 was used. A comparative analysis of the efficacy of recombinant IL-2 in the complex therapy of recurrent genital herpes in 45 women aged 20 to 35 years, diagnosed on the basis of a set of clinical and laboratory indicators and the collection of anamnestic data. It was shown that the use of a complex therapy regimen including Valaciclovir 500 mg twice a day for 5 days Roncoleukin subcutaneously once a day for 3 days for 0.5 mg with an interval of 3 days resulted in the restoration of IL-2 content and contributed to a decrease in relapses of herpetic infection.Зарегистрировано снижение интерлейкина 2 (ИЛ-2) в сыворотке крови пациенток с рецидивирующей формой генитального герпеса. для коррекции выявленных нарушений использован рекомбинантный ИЛ-2. Проведен сравнительный анализ эффективности рекомбинантного ИЛ-2 в комплексной терапии рецидивирующего генитального герпеса у 45 женщин в возрасте от 20 до 35 лет, диагноз которым был выставлен на основании комплекса клинико-лабораторных показателей и сбора анамнестических данных. Показано, что применение комплексной схемы терапии, включающей Валацикловир по 500 мг 2 раза в сутки 5 дней Ронколейкин® подкожно 1 раз в сутки 3 дня по 0,5 мг с интервалом 3 дня приводило к восстановлению содержания ИЛ-2 и способствовало снижению рецидивов герпетической инфекции
Making the Oxford Hip and Knee Scores meaningful at the patient level through normative scoring and registry data
ObjectivesThe Oxford Hip and Knee Scores (OHS, OKS) have been demonstrated to vary according to age and gender, making it difficult to compare results in cohorts with different demographics. The aim of this paper was to calculate reference values for different patient groups and highlight the concept of normative reference data to contextualise an individual’s outcome.MethodsWe accessed prospectively collected OHS and OKS data for patients undergoing lower limb joint arthroplasty at a single orthopaedic teaching hospital during a five-year period. T-scores were calculated based on the OHS and OKS distributions.ResultsData were obtained from 3203 total hip arthroplasty (THA) patients and 2742 total knee arthroplasty (TKA) patients. The mean age of the patient was 68.0 years (sd 11.3, 58.4% women) in the THA group and in 70.2 (sd 9.4; 57.5% women) in the TKA group. T-scores were calculated for age and gender subgroups by operation. Different T-score thresholds are seen at different time points pre and post surgery. Values are further stratified by operation (THA/TKA) age and gender.ConclusionsNormative data interpretation requires a fundamental shift in the thinking as to the use of the Oxford Scores. Instead of reporting actual score points, the patient is rated by their relative position within the group of all patients undergoing the same procedure. It is proposed that this form of transformation is beneficial (a) for more appropriately comparing different patient cohorts and (b) informing an individual patient how they are progressing compared with others of their age and gender
Treatment Success Following Joint Arthroplasty: Defining Thresholds for the Oxford Hip and Knee Scores
BackgroundPatient-reported outcome scores are the mainstay method for quantifying success following arthroplasty. However, it is unclear when a “successful outcome” is achieved. We calculated threshold values for the Oxford Hip and Knee Score (OHS and OKS) representing achievement of a successful treatment at 12-month follow-up.MethodsQuestionnaires were administered to patients undergoing total hip (THA) or knee (TKA) arthroplasty before and 12 months after surgery alongside questions assessing key aspects of treatment success. A composite success criterion was used to perform receiver operator characteristic analysis. Thresholds providing maximum sensitivity and specificity were determined for the total sample and subgroups defined by presurgery scores.ResultsData were available for 3203 THA and 2742 TKA patients. Applying the composite treatment success criterion, 67.3% of the TKA and 77.6% of the THA sample reported treatment success. Accuracy for predicting treatment success was high for the OHS and OKS (both areas under the curve, 0.87). For the OHS, a threshold value of 37.5 points showed highest sensitivity and specificity in the total sample, while for the OKS the optimal threshold was 32.5 points. Depending on presurgery scores, optimal thresholds varied between 32.5 and 38.5 for the OHS and 28.5 and 36.5 for the OKS.ConclusionThis is the first study to apply a composite “success” anchor to the OHS and OKS to evaluate outcome following total joint arthroplasty. Notably fewer patients report a “successful outcome” using a composite outcome threshold than report being “satisfied.
Patient-reported outcome metrics following total knee arthroplasty are influenced differently by patients’ body mass index
PurposeThis study investigated the impact of body mass index (BMI) on improvement in patient outcomes (pain, function, joint awareness, general health and satisfaction) following total knee arthroplasty (TKA).MethodsData were obtained for primary TKAs performed at a single centre over a 12-month period. Data were collected pre-operatively and 12-month postoperatively with the Oxford Knee Score (OKS) measuring pain and function, the EQ-5D-3L measuring general health status, the Forgotten Joint Score-12 (FJS-12) measuring joint awareness and a single question on treatment satisfaction. Change in scores following surgery was compared across the BMI categories identified by the World Health Organization
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