Preoperative PROMIS Scores Predict Postoperative PROMIS Score Improvement for Patients Undergoing Hand Surgery

Background: Patient-Reported Outcomes Measurement Information System (PROMIS) can be used alongside preoperative patient characteristics to set postsurgery expectations. This study aimed to analyze whether preoperative scores can predict significant postoperative PROMIS score improvement. Methods: Patients undergoing hand and wrist surgery with initial and greater than 6-month follow-up PROMIS scores were assigned to derivation or validation cohorts, separating trauma and nontrauma conditions. Receiver operating characteristic curves were calculated for the derivation cohort to determine whether preoperative PROMIS scores could predict postoperative PROMIS score improvement utilizing minimal clinically important difference principles. Results: In the nontrauma sample, patients with baseline Physical Function (PF) scores below 31.0 and Pain Interference (PI) and Depression scores above 68.2 and 62.2, respectively, improved their postoperative PROMIS scores with 95%, 96%, and 94% specificity. Patients with baseline PF scores above 52.1 and PI and Depression scores below 49.5 and 39.5, respectively, did not substantially improve their postoperative PROMIS scores with 94%, 93%, and 96% sensitivity. In the trauma sample, patients with baseline PF scores below 34.8 and PI and Depression scores above 69.2 and 62.2, respectively, each improved their postoperative PROMIS scores with 95% specificity. Patients with baseline PF scores above 52.1 and PI and Depression scores below 46.6 and 44.0, respectively, did not substantially improve their postoperative scores with 95%, 94%, and 95% sensitivity. Conclusions: Preoperative PROMIS PF, PI, and Depression scores can predict postoperative PROMIS score improvement for a select group of patients, which may help in setting expectations. Future work can help determine the level of true clinical improvement these findings represent

O processo de institucionalização da condicionalidade política na União Européia e sua eficácia como um instrumento de promoção da democracia

Promotion Political conditionality has been institutionalized in many international institutions since the end of the 1990s. These institutions have been making it more explicit the importance of the respect, on the part of its participants, of the Rule of Law, Human Rights and Democracy, and have been creating mechanisms of control and promotion of these principles. The form how these principles have been institutionalized, and the available instruments to guarantee their compliance, the effective compliance, and its effects upon Member-States varies with each institution. The present article analyses the case of the European Union. Despite the consensus about democratic values among its founding members, it was only in 1997, with the Treaty of Amsterdam, that they became a formal condition to participate in the process of integration. This article addresses firstly, how, and why political conditionality has been institutionalized in the European Union, exploring two factors in particular: the process of enlargement, and specific political crises. In addition, the article inquires whether political conditionality can be considered an effective instrument of democracy promotion. It analyses whether interventions in favor of democracy have a qualitative effect upon domestic governments, in other words, it explores the limits of the use of the political conditionality as an instrument of defense and promotion of democracy