Exploring the Role of Faith in Survival of Breast Cancer

In 2013, approximately 232,340 women were diagnosed with breast cancer, and an estimated 39,620 women would die as a result of breast cancer. Stage I breast cancer can often be treated, but Stage IV breast cancer presents more difficulties in treatment, as it spreads to the bones, liver, or other areas of the body. Consequently, women with Stage IV breast cancer have very low 18 month and 5-year survival rates. According to some statistics, 79.5% of the United States population claim to be Christian. Much of this segment of the population uses faith to guide most aspects of their lives, including issues pertaining to their health. The purpose of this study was to explore how women integrated faith into their lived experience of combating cancer. This mixed method phenomenological study examined the perceived attributions for survival among a group of 32 breast cancer survivors of various ages and cancer stages in the tristate area of Kentucky, Indiana, and Ohio. Faith related attributions for survival were more commonly reported among women who also reported affiliation to Christianity than women who did not express religious affiliation; however, faith related attributions often also incorporated the restorative effects of standard medical procedures. The implications for positive social change in this study includes the potential inclusion of faith in developing culturally appropriate strategies for treatment and recovery of many illnesses, including cancer

BUMC Annual Report

Annual report of the Boston University Medical Center

Differences in signal contrast and camouflage among different colour variations of a stomatopod crustacean, Neogonodactylus oerstedii

Animal colouration is often a trade-off between background matching for camouflage from predators, and conspicuousness for communication with con- or heterospecifics. Stomatopods are marine crustaceans known to use colour signals during courtship and contests, while their overall body colouration may provide camouflage. However, we have little understanding of how stomatopods perceive these signals in their environment or whether overall body coloration does provide camouflage from predators. Neogonodactylus oerstedii assess meral spot colour during contests, and meral spot colour varies depending on local habitat. By calculating quantum catch for N. oerstedii’s 12 photoreceptors associated with chromatic vision, we found that variation in meral spot total reflectance does not function to increase signal contrast in the local habitat. Neogonodactylus oerstedii also show between-habitat variation in dorsal body colouration. We used visual models to predict a trichromatic fish predator’s perception of these colour variations. Our results suggest that sandy and green stomatopods are camouflaged from a typical fish predator in rubble fields and seagrass beds, respectively. To our knowledge, this is the first study to investigate signal contrast and camouflage in a stomatopod. These results provide new insight into the function and evolution of colouration in a species with a complex visual system

Do Younger TKR and THR Patients Have Similar Disability at Time of Surgery as Older Adults? Lessons from FORCE-TJR

Introduction: The number of US patients under 65 year old who are undergoing total knee replacement (TKR) and total hip replacement (THR) has been rising, raising concerns that younger patients may receive surgery prematurely. Therefore, we examined demographics and clinical factors and compared the severity of operative knee pain and functional status in younger versus older TKR patients from a US national sample. Materials & methods: The FORCE-TJR registry gathers data from patients, surgeons and hospitals on sociodemographic factors (age, sex, race), BMI, comorbid conditions using the modified Charlson comorbidity scores, burden of musculoskeletal disease using the Knee/Hip injury and Osteoarthritis Outcome Score (KOOS/HOOS) in both knees and hips, emotional health based on the Short Form 36 (SF-36) Mental Component Score (MCS) and physical function based on the Physical Component Score (SF-36 PCS). Results: We analysed data from 2035 younger (\u3c65) and 3084 older (≥65) TKR patients and 1780 younger and 1831 older THR patients. Younger TKR and THR patients were more likely nonwhite (TKR: 13.1% vs. 6.6%; THR: 51.7% vs. 48.3%),), with greater body mass index (mean BMI TKR: 33.1 vs. 30.5; THR: 29.9 vs. 28.4), smokers, had fewer number of comorbid conditions. Younger TKR patients reported lower emotional health (MCS 49.1 vs. 52.6), greater joint pain, stiffness and functional impairment (based on estimated WOMAC) and global functional impairment (using PCS). Younger THR patients reported greater joint pain, stiffness and functional impairment (estimated WOMAC) but not global function. Conclusion: At the time of TKR and THR, younger patients have fewer medical illnesses, but higher rates of obesity and smoking as well as lower mental health scores. Younger have the same or greater joint specific and global functional impairment compared to older patients, suggesting surgeons use comparable standards for selecting TKR and THR candidates in younger and older adults

The Validity of Patient-Reported Short-Term Complications following Total Hip and Knee Arthroplasty

Introduction: Given the lack of national data on outcomes of on patients who undergo total joint arthroplasty (TJA) and the limitations of hospital databases to capture information on patients who seek post-TJA care elsewhere, there is growing interest in using patient self-report to identify possible complications following surgery. We examined the concordance between patients self-report of potential short-term complications with review of available medical records as well as the location of the reported post-operative care. Material & Methods: Patients undergoing primary hip or knee arthroplasty from 7/1/11 through 12/3/12 participating in a tertiary care center were identified. Patients completed a 6-month post-operative survey regarding needing evaluation at an emergency department, day surgery or hospitalization for possible medical or mechanical complications and the location of care. We reviewed available inpatient and outpatient medical records to identify the location of postoperative care as well as the validity of patient self-report (sensitivity, specificity, positive predictive values and negative predictive values). Results: There were 413 patients who had 431 surgeries and completed the 6-month questionnaire. Patients reported 40 medical encounters including emergency department, day surgery or inpatient care resulting in a 9% reported complication rate, of which 20% occurred at outside hospitals Overall patient self-report of emergency department, day surgery and inpatient care for possible complications was both sensitive (82%) and specific (100%). The positive predictive value was 100% and negative predictive value 98%. Conclusion: Given the prevalence of events requiring care at outlying hospitals and the accuracy of self-report, methods that directly engage patients can augment current surveillance procedures

Level of Pain and Disability at Time of TKR across the Past 10 Years: Results from Two National Cohorts

Introduction: A recent analysis reported a growing numbers of younger US adults with knee pain consistent with osteoarthritis (OA), although parallel analyses of knee x-rays found no increase in the classic radiographic signs of OA. The accompanying editorial evoked the need to understand if surgeons are performing surgery at an earlier stage in the condition.1 We compared pre-operative demographic and symptom profiles of a national US cohort of OA patients undergoing primary total knee replacement (TKR) in 2011-2012 with a national US cohort of patients from 2000-2004 to evaluate change, if any, in the timing of surgery as measured by patient pain and function. Methods: Following informed consent, the 2011-2012 national research study collected comprehensive data including demographic, comorbidity, and patient-reported pain and physical function, from a national sample of TKR patients. Comparable data from a national sample collected by one implant manufacturer between 2000-2004 were analyzed. Descriptive statistics compared the demographic and symptom profiles of the two cohorts. Results: There were fewer females in the 2011-2012 cohort (n=2363) compared to the 2000-2004 cohort (n=7144) (61.62%, vs. 66.72%). The 2011-2012 cohort was younger than the 2000-2004 cohort (66.7 years, vs. 68.12 years) and had a lower mean BMI (31.5 vs 32.3). Pre-operative physical function scores (SF36/PCS) were 3 points higher in 2011-2012 than 2000-2004 (33.2 vs. 30.41). When compared to the national PCS norm of 50 (SD=10), TKR patients from both time periods reported pre-operative function levels almost 2 standard deviations below the national norm. There was no significant difference in terms of emotional health (SF36/MCS scores: 51.85 for the 2011-2012 cohort vs. 51.83 for the 2000-2004 cohort). Conclusion: Despite the significant growth in the use of primary TKR in the last decade, especially among younger patients, TKR patients continue to report significant disability at the time of surgery

Predictors of Patient-reported Outcomes after TKR not Included in Risk Models Based on Administrative Data

Introduction: Because total knee replacement (TKR) surgery is performed to relieve pain and improve physical function in patients with advanced arthritis, patient-reported outcomes (PROs) are important to assess TKR effectiveness. The UK and others require PROs. Understanding pre-existing clinical factors that influence PROs after surgery is needed before comparing PROs across providers. We evaluated the roles of medical and musculoskeletal comorbidities in explaining variation in 6 month post-TKR pain relief and functional gain in a national cohort of TKR patients. Materials & methods: FORCE-TJR, funded by the Agency for Healthcare Research and Quality (AHRQ), is a national consortium in which 100% patients, surgeons and hospitals submit data: patients demographics (age, gender, BMI, race), complete medical and musculoskeletal comorbidities, PROs including SF-36 Physical Component Score (PCS), Knee injury and Osteoarthritis Outcome Score (KOOS), clinically refined adverse events and implant data. Predictors of change in pre-to-6 month post-TKR pain and function were examined using linear mixed models adjusting for clustering within site. Results: TKR patients had a mean age of 67 years, mean BMI of 31.2, were 63% female and 4.5% black, 9% with Charlson Comorbidity Index (CCI) of 2-5, 15% with CCI of 6, 7% moderate/severe pain in 2-3 knee/hip joints, 27% moderate/severe lumbar pain. After adjusting for socio-demographic factors, significant predictors of poorer 6 month post-TKR pain included poorer emotional health, higher CCI, 1-2 nonsurgical hip/knee joints with moderate/severe pain, any lumbar pain at time of TKR. These same factors also predicted poorer 6 month function. Conclusion: Before adopting PROs as a standard measure of TKR outcome, a complete understanding of pre-existing clinical factors associated with poorer pain relief and functional gain is needed. Greater musculoskeletal, and medical, comorbid conditions were associated with post-operative PROs and should be included in risk-adjustment models before cross-hospital comparisons can be made

Poor Pre-Operative Emotional Health Limits Gain in Function after Total Hip Replacement

Introduction: While total joint replacement surgery successfully reduce joint pain and is associated with a low complication rate, patients experience a wide variation in functional improvement. Pre-surgery emotional state correlates with post-surgical functional improvement in total knee replacement patients. We tested this concept against a national cohort of total hip replacement (THR) patients. Materials & methods: Patients undergoing primary THR from 7/1/11 through 12/6/13 with postoperative outcomes at 6 months were identified from FORCE-TJR, a US national research consortium. We obtained data on patient demographics, underlying type of arthritis, body mass index (BMI), Charlson Comorbidity Index, arthritic pain in contralateral hip and bilateral knees, back pain, Hip Disability and Osteoarthritis Outcome Score (HOOS), global function based on the Short Form 36 (SF-36) Physical Component Score (PCS) and emotional health using the SF-36 Mental Component Score (MCS). We performed descriptive statistics and multivariable linear regression models to identify factors associated with 6-month postoperative PCS global function scores. Results: The 1,426 THR patients identified were 60.7% female, 95.0% white, mean age 65.3 years, mean BMI of 29.0. Mean preoperative surgical joint pain, stiffness and function was 50.1 (± 19.2), 38.7 (± 21.9), 46.4 (±19.2) respectively. MCS was 51.56 (± 12.2) and PCS 31.6 (± 8.9). Pre-operative and post-operative functioning differed based on emotional health (MCS ≥50). In multivariable models, lower MCS levels were associated with worse PCS at 6 months (coefficient of 0.18. 95% CI 0.14-0.22) after controlling for demographics, medical comorbidity, baseline PCS and burden of musculoskeletal disease. Conclusion: Poorer emotional health is associated with poorer global function following surgery and a key factor in the recovery and rehabilitation following THR. Better emotional health screening for THR surgical candidates, and interventions to provide additional emotional support to those who need it, are necessary to ensure optimal functional gain

Differences Between Women and Men Undergoing TKR and THR in a National Research Consortium

Introduction: Prior studies reported higher prevalence of arthritis, greater disability, lower rate of utilization of total knee replacement (TKR) and total hip replacement (THR) in women as compared to men, as well as differences in outcomes after surgery. We examined sex differences in terms of demographic and clinical factors that influence surgical outcomes in a national sample of patients who underwent TKR or THR. Methods: Patients undergoing primary THR and TKR from 7/1/11 through 12/03/12 were identified from a national research consortium that gathers demographic data, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) estimated from the Knee injury and Osteoarthritis Outcome Score (KOOS) or the Hip injury and Osteoarthritis Outcome Score (HOOS), Short Form 36 Physical Component Score (PCS) and Mental Component Score (MCS) and musculoskeletal burden of illness. Descriptive statistics were performed. Results: Primary TKR patients included 2042 women and 1276 men. Women were more likely nonwhite (11.2% vs. 7.5%), unmarried (40.3% vs. 17.8%), lower income (p Conclusion: In this national sample, women undergoing primary THR and TKR have more severe arthritis, greater functional impairment and greater burden of musculoskeletal disease as compared to men. Understanding these differences will help tailor peri-operative care to the needs of the patients

Does Functional Gain and Pain Relief After TKR and THR Differ by Patient Obese Status?

Introduction: Obesity is an important predictor of functional status and pain after total knee (TKR) and total hip (THR) replacement. However, variations in pre-post TKR and THR changes in function and pain by obesity status remain to be examined. Material & Methods: Pre- and 6 month post surgery data were collected on 2,964 primary TKR and 2,040 primary THR patients between 5/2011 and 3/2013. Data included demographics, comorbidities, operative joint pain severity based on the Knee Injury or Hip Disability and Osteoarthritis Outcome Score (KOOS/HOOS), WOMAC pain (higher is better), physical function (SF-36 PCS, higher is better), mental health (SF-36 MCS), and musculoskeletal burden of illness. Pre-post changes in PCS and pain were analyzed using descriptive statistics. Results: TKR patients were average 67 years, 61% women, 93% whites, 13% under or normal weight, 33% overweight, 29% obese, 15% severely obese, 9% morbidly obese. Greater level of obesity was associated with lower PCS at baseline and 6 month, lower pain scores at baseline but larger improvement post-op. Pre to-6 month PCS did not differ by obesity status. At 6 months morbidly obese patients had slightly lower/worse pain score. THR patients were average 65 years, 62% women, 95% whites, 27% under/normal weight, 38% overweight, 23% obese, 9% severely obese, 4% morbidly obese. Greater level of obesity was associated with lower PCS at baseline and 6 month, poorer baseline pain score but larger improvement post-op. Mean changes in pre-to-6 month PCS did not differ by obesity status. Conclusion: At 6 months after TKR, severely obese patients (BMI\u3e35) reported improvements in both pain and function equal to or greater than patients with BMI35 had lower mean functional gain than those with BM