Average Score Of Patients Research Articles

Comparison of Aesthetic Results of Mercedes-Y Versus Inverted-V Incision for Umbilical Reconstruction: A Randomized Clinical Trial.

The appearance and position of navel which are considered as a marker for overall abdominal aesthetics, are important for the final results of abdominal surgeries. However, reconstructing and improving its appearance have been a challenge in plastic surgery. In this study, we aimed to compare satisfaction of the patients and the plastic surgery professors with the aesthetic results of the two methods of umbilical reconstruction: Mercedes (Y) incision versus inverted-V incision. This is a randomized clinical trial performed on umbilicoplasty patients following abdominoplasty, breast reconstruction, or abdominal flap surgery whom referred to our center. They were divided into two equal groups of twenty patients with Mercedes (Y) incision and patients with inverted-V incision. The results of surgery were compared three months after the surgery by the opinions of patients, plastic surgery professors, and unbiased observers. The average scores of patients, professors, and observers showed that Mercedes (Y) had significantly higher scores compared to inverted-V incision in terms of position, size, shape, natural appearance, and the overall satisfaction. Surgical complications including stenosis, necrosis, and wound dehiscence were not statistically different in our small sample size. In this study, Mercedes (Y) incision was preferred by all of the groups in all five parameters that were assessed including size, shape, position, natural appearance, and overall satisfaction. The simplicity of the Y incision with less visible scar makes it a suitable method for further investigations with a larger sample size. Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

CONNECTION BETWEEN COMORBID PRIMARY HEADACHE, DEPRESSION AND ANXIETY IN PATIENTS WITH MULTIPLE SCLEROSIS

SUMMARY. Multiple sclerosis (MS) is a chronic autoimmune disorder of central nervous system that affects young people and progresses to physical disability. Among patient with MS risk of excessive anxiety and depression is quite common. One of the frequent comorbidities of MS is primary comorbid headache. Depression and anxiety might be more prominent on patients with pain comorbidity of MS. The aim – to show the prevalence and frequency of depression and anxiety in a population of patients with MS, with special attention to the group of patients with primary comorbid headache. Material and Methods. MS was confirmed according to the McDonald criteria 2017. Questionnaires Beck Depression Inventory (BDI) for assessment of depression and The Spielberger State-Trait Anxiety Inventory in Hanin`s interpretation (STAI), version for evaluation of reactive anxiety were used. Results. 130 patients with MS were examined with disease duration 8.63±7.49 years. 36.2 % of males (n=47) and 63.8 % of females (n=83) were included. Average score of patients with MS was 40.22±8.89 points that indicates moderate reactive anxiety. BDI score accounted for 14.15±7.58 points that interpretates as mild-to-moderate depression. Patients with MS and comorbid primary headache received the average points of the STAI in Hanin's interpretation – 42.41±7.49 (moderate anxiety); patients with MS without comorbid primary headache – 37.42±9.31 (low or moderate anxiety), but generally this difference did not show statistical significance (p=0.39). Among MS course scores of anxiety was similar between groups, depression score was the highest in group with primary progressive MS (PPMS). Conclusion. The average score of anxiety and depression showed moderate severity among patients with MS. There were not found significance between patients with primary headache comorbidity and without it, although scores between course disease subgroups showed higher points in patients with comorbid primary headache.

The management countermeasures of mass psychological anxiety in public health emergencies

BackgroundWith the improvement of people’s health awareness, they gradually pay attention to public health events. When public health incidents suddenly occur, people’s psychology is partially anxious. Conventional management measures only aim at patients’ health diseases and often ignore patients’ anxiety. To manage this kind of emotion, this study puts forward the management countermeasures of double-hearted nursing.Subjects and MethodsThe study divided 200 patients who met the inclusion criteria into two groups equally, and each group contained 50 cases of male and 50 cases of female. The patients in the control group were treated with traditional medical methods, while the patients in the control group were treated with the double-hearted nursing management countermeasures proposed in the study. After 12 weeks of treatment, the study used SPSS23.0 to count their psychological anxiety scores and compared the scores of patients before and after treatment.ResultsBefore the experiment, the average score of patients’ psychological anxiety was 90.1, and after the research of double-hearted nursing management countermeasures, the average score of patients’ psychological anxiety in the experimental group was 47.5, which was significantly lower than that in the control group (85.3).ConclusionsThe experimental results show that the double-hearted nursing management countermeasures proposed in this study can effectively address patients’ anxiety, thus keeping people away from public health emergencies. It can take good care of people’s mood and has the value of popularization and use.

Adaptation of the Serious Illness Care Program for Older Patients with Acute Myeloid Leukemia and Myelodysplastic Syndromes

Introduction: Compared to patients with solid tumors, patients with hematologic malignancies such as acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), experience more intense inpatient care at end of life. Older patients with AML and MDS are more likely to have rapid clinical decline and worse survival compared to younger patients. The Serious Illness Care Program (SICP) is a multicomponent, structured communication intervention developed to improve conversations about values for patients with serious illnesses. A previous randomized trial found that, compared to the control arm, patients who participated in the SICP were more likely to have a serious illness conversation (96% vs 79%) and these conversations occurred 2.4 months earlier and were more patient-centered. However, fewer than 10% of patients in this trial had a hematologic malignancy. The purpose of this study was to adapt the SICP to be delivered via telehealth for older patients with AML and MDS. Methods: We conducted a single center qualitative study of oncology and palliative care clinicians, patients with AML or MDS (age 60 years and older), and their caregivers (if available). Semi-structured interviews were audio recorded and transcribed. Interview questions focused on telehealth and feedback on the SICP. Two investigators independently coded all transcripts using MAXQDA and resolved discrepancies through iteration. Data were organized into feedback on telehealth and the components of the SICP. Results: There were 45 participants in this study: 16 oncology clinicians, 9 palliative care clinicians, 15 patients with AML or MDS, and 5 caregivers with mean ages of 46, 49, 70, and 69 years, respectively. Participants in this study had high health literacy with an average patient score of 5.7 (SD 0.6) and an average caregiver score of 6.0 (SD 0.0) on the 6-item cancer health literacy test (possible range 0-6). Four qualitative themes emerged: 1) Serious illness conversations can be conducted via telehealth, 2) Older patients have limited experience using technology but are willing to learn, 3) Patients want to understand their AML or MDS diagnosis better, and 4) Serious illness conversations should be good care, not special care (Table 1). Participants felt that telehealth-based serious illness conversations may provide patients with the comfort of being in a familiar environment but may make interpretation of body language challenging. Older patients were concerned that their lack of experience with technology may limit their ability to successfully use telehealth. Despite this, patients reported they would be willing to learn how to use telehealth, and that the SICP would be helpful and allow them to better understand their diagnosis. Patients shared that the serious illness conversation would be most effective if discussed with hope and positivity. Finally, palliative care clinicians emphasized that serious illness conversations should not fall solely on their specialty. Rather, the field of oncology would benefit from having these conversations regularly, since these patients are often facing diagnoses that have a poor prognosis. The SICP were adapted as follow: 1) Patient preparation letter: Oncology clinicians suggested providing patients with examples of questions for their clinician, and patients felt that the visual layout of the letter was overwhelming. We changed the visual layout from letter to pamphlet. 2) Serious Illness Conversation Guide (SICG): Oncology clinicians suggested simplifying the language of the conversation guide and offered alternative wording to better gauge the patient's understanding of their diagnosis. Oncology clinicians and patients suggested that the word "worried” be removed from the SICG. Patients also suggested removing the word "goals.” 3) Family guide: Oncology clinicians and patients liked the family guide and felt it would have a positive impact on the patient's ability to communicate with loved ones. Some patients felt that the language on the family guide accurately reflected conversations that they have had with their loved ones about their illness. No changes were made to the family guide. Conclusion: We adapted the SICP to meet the unique needs of older patients with AML and MDS. The adapted SICP is being tested in an ongoing single arm pilot study at the Wilmot Cancer Institute. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Posterior malleolus fracture fixation in ankle injuries

Introduction: Posterior Malleolar fractures are relatively rare and a part of complex ankle injuries. Trimalleolar fractures affect the stability of the weight-bearing ankle joint. Management of posterior malleolar fractures is a challenge. Aims: This study aimed to examine the radiological and clinical outcomes of the management of posterior malleolar fractures in adults. Settings and Design: This is an original research retrospective study Materials and Methods: Eleven patients underwent fixation of ankle fractures with fixation of posterior malleolus as needed using screws or plates. Surgical outcomes were examined in follow-up with an average follow-up of 21 months using the American Orthopedic Foot and Ankle Score (AOFAS) score and with radiological correlation at each follow-up. Results: In our series, 27% of patients had 44B type injury and 73% of patients had 44C type injury as per AO/OTA classification. The average AOFAS score was 90.45 for the series and the score for patients treated with direct reduction of the fragment was better than for those treated with indirect reduction. The average score for patients managed with screws was better than for those treated with plates in our series. 82% of patients showed excellent to good outcomes with one patient having an infection and one patient having moderate to severe pain. Conclusion: Anatomical reduction of posterior malleolar fragment leads to better long-term functional outcomes and a stable ankle joint with early mobilization.

Patient Experience Ratings: What Do Breast Surgery Patients Care About?

IntroductionPatient experience is essential in the overall care; physicians often receive patient reviews evaluating their consultation encounters. Patient experience surveys can be a helpful tool to identify areas to target for improvement. We sought to evaluate what factors influenced breast surgery patients' reviews of their clinic visits.MethodsProspective surveys from 2018-2020 were reviewed from a single institution. Surveys were sent to all patients within 48 hours after visiting one of our breast surgery clinics, and patients were asked their preferred mode of contact for the survey. Patients responded to surveys with scores of 0-10, with 0 as "not likely" and 10 "extremely likely" to recommend the provider's office. Scores 0-6 were considered negative, 7-8 neutral, and 9-10 positive. Positive/Negative comments from patients were reviewed and classified according to mention of surgeon, clinic staff/team, clinic processing, and facility amenities.Results744 out of 2205 patients contacted responded to the survey, resulting in a 33.7% response rate. Of this cohort, 47.6% (354/744) were new patients, and 52.4% (390/744) were established patients. Interactive voice response (IVR) and email, per patient indicated preferred mode of survey communication, had the highest responses. The average patient score was 9.5. Most ratings were positive (91.3%, 679/744), followed by neutral comments (5.2%, 39/744). There were 3.5% (26/744) which were negative ratings. Of those who responded, 47.7% (355/744) left a comment with their score. Surgeon-specific remarks were often noted in positive comments, followed by clinic staff/team comments. Negative comments most commonly referenced clinic processes.ConclusionPatient satisfaction surveys provide a window into creating the best patient experience. Further efforts to address these factors affecting patient experiences should be made to continue improving patient care.

Patients' trust and associated factors among primary care institutions in China: a cross-sectional study.

BackgroundEmpirical evidence on patients’ trust and the factors among primary care institutions (PCIs) in China is limited. This study aimed to investigate patients’ trust and explore some associated factors among PCIs in the central region of China.MethodsThe data was collected through a multistage stratified sampling method with a structured self-administered questionnaire, which was distributed from January to March 2021 among 2,287 Chinese patients ever involved in seeking healthcare among PCIs. Patients’ trust was measured with the Chinese version of the Wake Forest Physician Trust Scale (C-WFPTS). Differences in C-WFPTS scores among groups were estimated by t-tests or ANOVA analyses. Multiple linear regression analysis was used to analyze influencing factors for patients’ trust in primary care physicians.ResultsBased on the C-WFPTS with a full score of 50, the average score of patients’ trust was 34.19 (SD = 5.83). Multiple linear analyses indicated that the patients who were older aged, married, with education of higher level, living in urban regions, under better health status and with a family doctor contract reported a higher level of patients’ trust.ConclusionPatients’ trust in primary care physicians was at a medium but slightly improved level in the central region of China. Age, marital status, education, residential area, health status, and a family doctor contract were significant predictors of patients’ trust.

Impact of coronavirus disease 2019 on patients with chronic pain: multicenter study in Korea

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has caused significant changes. This study aimed to investigate the impact of COVID-19 on patients with chronic pain.MethodsPatients with chronic pain from 23 university hospitals in South Korea participated in this study. The anonymous survey questionnaire consisted of 25 questions regarding the following demographic data, diagnosis, hospital visit frequency, exercise duration, time outside, sleep duration, weight change, nervousness and anxiety, depression, interest or pleasure, fatigue, daily life difficulties, and self-harm thoughts. Depression severity was evaluated using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was used to investigate the relationship between increased pain and patient factors.ResultsA total of 914 patients completed the survey, 35.9% of whom had decreased their number of visits to the hospital, mostly due to COVID-19. The pain level of 200 patients has worsened since the COVID-19 outbreak, which was more prominent in complex regional pain syndrome (CRPS). Noticeable post-COVID-19 changes such as exercise duration, time spent outside, sleep patterns, mood, and weight affected patients with chronic pain. Depression severity was more significant in patients with CRPS. The total PHQ-9 average score of patients with CRPS was 15.5, corresponding to major depressive orders. The patients’ decreased exercise duration, decreased sleep duration, and increased depression were significantly associated with increased pain.ConclusionsCOVID-19 has caused several changes in patients with chronic pain. During the pandemic, decreased exercise and sleep duration and increased depression were associated with patients’ increasing pain.

Subcutaneous pedicled propeller flap for reconstructing the large eyelid defect due to excision of malignancies or trauma

Large eyelid defect after excision of malignancies or trauma is difficult to reconstruct due to special structure and function of the eyelid. In this study, we aimed to present the outcomes of subcutaneous pedicled propeller flap for reconstructing the large eyelid defect after excision of malignancies or trauma. A retrospective review of patients diagnosed with eyelid defect due to excision of malignancies or trauma, and undergoing subcutaneous pedicled propeller flap for reconstructing the large eyelid defect, was conducted at our hospital. The clinical data were collected and analyzed. A total of 15 patients were included in the cases series. Nine patients were diagnosed with basal cell carcinoma, 3 patients with epidermoid carcinoma, and 3 patients with trauma. All the defects were successfully covered with this designed flap. There was no flap necrosis in all the cases. No functional problems were observed in all of the cases. At long-term postoperative follow-up, the average score of patients’ satisfaction was good. This subcutaneous pedicled propeller flap is a feasible alternative technique for reconstructing the large eyelid defect after excision of malignancies or trauma. This flap option could avoid the use of free flaps for large defect.

Application of Nanotubes Combined with Ethnic Sports Rehabilitation Therapy in the Treatment of Patients with Knee Arthritis

National sports are traditional sports of ethnic minorities and sports with strong national characteristics. Sports performances generally include weightlifting, boxing or martial arts, gymnastics, skating, high jump, sprint, and hurdles. Such as knee joints that are particularly vulnerable to injury. Therefore, ordinary ethnic sports athletes are particularly vulnerable to injury. Ethnic sports rehabilitation therapy uses some exercises to enable patients to obtain full or partial exercise functions. Training methods for sensory function recovery were used. Ethnic sports rehabilitation therapy is a common rehabilitation therapy for ethnic sports athletes to resume sports training, such as table tennis, tennis, cycling, fishing, climbing, skating, weightlifting, and wrestling. However, with economic development and social progress, the treatment of knee arthritis is closely integrated with nanotubes combined with national sports rehabilitation therapy, and it has been increasingly used in competitive sports and national fitness. From 2003 to 2020, the medical research literature on nanotechnology increased from 20 to more than 20,000. This article presents a way for treating knee arthritis sufferers by combining nanotubes with ethnic sports rehabilitation therapy and discusses the clinical therapeutic effect of nanotubes combined with ethnic sports rehabilitation therapy in the treatment of knee arthritis patients. It provides a certain basis for the treatment of patients with knee arthritis. This article selected 100 knee patients, who, as research subjects, visited our facility for medical treatment between June 2016 and June 2020, and divided 100 patients into two groups, 50 patients in the experimental group and 50 patients in the control group. For patients, the experimental group used nanotubes combined with ethnic sports rehabilitation therapy to treat patients, and the control group used ethnic sports rehabilitation therapy to treat patients. The experimental results show that nanotubes combined with ethnic sports rehabilitation therapy can speed up the treatment process of patients with knee arthritis. When the experiment lasted only 5 days, patients in the control group scored an average of 3 points, and on the last day, they scored an average of 6.9 points. In the experimental group, the average score of patients on the fifth day of the experiment was 5 points, and the average score of patients on the last day was 9.7 points. The knee joint patients in the experimental group have higher walking ability, up‐and‐down ability, knee flexion, and knee swelling. In the control group, among them, the first to recover from knee arthritis is the ability to walk, and the slowest recovery is the flexion of the knee joint.

Evaluation of Medication Adherence and Associated Factors in Hypertensive Patients in Bangalore, India; A Cross-Sectional Study

Background: This survey aims to determine medication compliance among hypertension patients and discover factors influencing medication compliance. Methods: This study incorporated a cross-sectional study design. The Hill-Bone Compliance to High Blood Pressure Therapy Scale was used in this study to evaluate medication adherence in hypertensive individuals. Additionally, this scale aids in monitoring sodium intake control and appointment-keeping habits. Results: 69 (77%) of 90 hypertension patients comply with their antihypertensive therapy, whereas 21 (23%) are non-compliant. The average score of patients on the Hill-Bone Compliance to High Blood Pressure Therapy Scale is 20.21 ± 4.21. Subsequently, the medication-taking score is 11.97 ± 3.44, the sodium reduction score is 4.37 ± 1.4, and the appointment-keeping score is 3.88 ± 1.34. Simultaneously, studying the impact of patients’ socio-demographic characteristics and medical history on medication adherence. There was a considerable drop in the overall score of patients having more than five children by 5.59 (P-value < .05), thus improving medication adherence. In contrast, the total score of patients with hypertension from 6 to 10 years shot up by 2.4 (P-value < .05), whereas the total score of patients with comorbidities more than 5 have a sharp rise of 3.4 (P-value < .05). Therefore, reducing medication adherence. Conclusion: According to this survey, only 77% of patients are adherent to their antihypertensive medicines. Additionally, this study reveals that individuals with more than five children positively affect medication adherence. However, patients with long-term hypertension and many comorbidities have a detrimental effect.

Wells and Geneva decision rules to predict pulmonary embolism: can we use them in Covid-19 patients?

Funding AcknowledgementsType of funding sources: None.Introduction Pulmonary embolism (PE) is a recognized complication of SARS-COV2 infection due to hypercoagulability. Before the COVID era, the need for computed tomography pulmonary angiography (CTPA) to rule out PE was determined by clinical probability, based on Wells and Geneva scores, in association with D-dimer measurements. However, patients with SARS-COV2 infection have a pro-thrombotic and pro-inflammatory state which may compromise the usefulness of these algorithms to select patients for CTPA. Purpose To evaluate the accuracy of the Wells and Geneva scores to predict PE in patients with SARS-COV2 infection.Methods Retrospective study of consecutive outpatients with SARS-COV2 infection proved by positive PCR who underwent CTPA due to suspected PE. The Wells and Geneva scores were calculated and the area under the curve (AUC) of the receiver operating characteristic curve was measured.Results We enrolled 235 patients (61% males, mean age 69.10 ± 16.69 years) and the incidence of pulmonary embolism was 15% (35 patients). In patients with PE, emboli were located mainly in segmental arteries (60%) and bilaterally (46%). Patients with PE were older (mean age 75.06 ± 2.23 vs. 68.06 ± 1.21 years, p = 0.022), and did not differ in sex or risk factors for thromboembolic diseases from the non-PE group. Patients with PE had higher D-dimer levels (median 15.41 mg/dl, IQR 1.17 – 20.00) compared to patients without PE (median 5.99 mg/dl, IQR 0.47 – 2.82, p < 0.001). There was no statically significant difference between the average Wells score in patients with PE and without PE (1.04 and 0.89 respectively, p = 0.733) and the AUC demonstrated that the Wells score had no discriminatory power (AUC = 0.52). Within patients with PE, 19 patients had a Wells score of zero. Regarding the Geneva score, there was also no difference between the average score in patients with and without PE (4.20 vs 3.93 respectively, p = 0.420). AUC for Geneva score was 0.54.Clinical probability combined with D-dimer measurement had a 100% sensitivity for both Wells and Geneva scores, but a specificity of 10% and 11%, respectively. Conclusion PE diagnosis may be challenging in patients with SARS-COV2 infection since both conditions may have similar signs and symptoms and may be associated with increased D-dimers. According to our results, traditional clinical prediction scores have little discriminatory power in these patients and a higher D-dimer cut-off should be considered to better select patients for CTPA to minimize radiation exposure and contrast-related complications in COVID-19 patients.

Medication Adherence Improvement of Patients with Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus (DM) is a degenerative disease with long-term medication which needs home care service to enhance patients' obedience to medication compliance. The study aimed to investigate the effect of home care counseling on patients' medication adherence in prescribed medicine use. Methods: The research design was quasi-experimental using pre-test post-test without control group approach. A total of 43 patients with type 2 DM at the outpatient unit of Sari Mutiara General Hospital were selected through consecutive sampling techniques. The patients were given counseling in medicine using home care visits over 24 times in July 2017 and September 2017. Results: Patient adherence evaluation on disease medication was carried out through questionnaire administration before the patient received counseling (pre-test) and received counseling (post-test). Data from the Questionnaire were analyzed using the Wilcoxon test with a confidence level was 95%. Before counseling, the average score of patients was 3.26. However, after counseling was carried out to the patients, the average score was 0.72. In conclusion, there was an increase in patient adherence, i.e., 2.54. It was also obtained that there was a significant difference in patients' adherence to medication use before and after receiving counseling in-home care, with a significance value of 0.000 (p<0.05). It indicated that home care counseling was effective in enhancing their medication adherence. It is suggested that healthcare practitioners carry out monitoring, particularly during therapy, to prevent diabetic complications

Follow-Up Care of Distal Radius Buckle Fractures

Source: Colaco K, Willan A, Stimec J, et al. Home management versus primary care physician follow-up of patients with distal radius buckle fractures: a randomized controlled trial. Ann Emerg Med. 2021;77(2):163-173; doi:10.1016/j.annemergmed.2020.07.039Investigators from the University of Toronto conducted a randomized controlled trial to assess outcomes associated with home management versus physician follow-up in children with distal buckle fractures. Children were eligible if they were 5-17 years old and were diagnosed in the study ED within the previous 3 days with a distal radius buckle fracture during the 2018-2019 study period. The standard management for all patients diagnosed with a distal buckle fracture at the study ED is a removable splint. All participants completed a demographic survey at enrollment as well as a baseline modified Activities Scale for Kids-38 (ASKp38) scale that assessed wrist function the week before injury (with the average score for patients with no disabilities being 95%).Participants were randomized to either removal of the splint at home with physician follow-up as needed or to see their primary care physician 1-2 weeks after the ED visit. All participants were advised to wear the splint continuously (except for bathing) for the first week and then as needed to manage pain or swelling symptoms. All participants were advised to restrict activities that could lead to reinjury for 6 weeks.The primary outcome was ASKp38 scores at 3 weeks post-ED visit, assessed via telephone. A secondary outcome was health care resource use and parental expenses related to the child’s injury, assessed by parent report at 3 and 6 weeks post-ED visit and medical records. Total patient health care costs were estimated by multiplying health care resources data by corresponding unit prices. The investigators assessed outcomes by allocation arm using an intention-to-treat analysis.There were 149 participants enrolled, 73 in the home management group and 76 in the primary care physician follow-up group. Follow-up was completed for 90.4% of participants in the home management group and 88.2% of the physician follow-up group at 3 weeks, and 89% and 86.8%, respectively, at 6 weeks. There were no significant differences in baseline demographics or baseline ASKp38 scores. Mean ASKp38 scores at 3 weeks were similar between both groups (95.4% and 95.9% in the home management and physician follow-up groups, respectively). Total mean healthcare and parent costs in the physician follow-up group were greater than in the home management group ($149.10 vs $26.80, respectively).The investigators conclude that home removal of splints for distal buckle fractures is noninferior to physician follow-up and less costly.Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Buckle (torus) fractures of the distal radius are the most common fractures in children.1 There are many ways these fractures can be managed, as they are very stable and have an excellent prognosis. Primary care physicians are becoming the standard of care for follow-up of buckle fractures instead of orthopedic or fracture clinic follow-up. Primary care physician follow-up for distal forearm buckle fractures has demonstrated excellent recovery and management mainly based on patient symptoms rather than frequent radiographic follow-up common to orthopedists or fracture clinics.2 The current investigators sought to determine whether symptomatic home management versus primary care provider follow-up of torus fractures had equivalent functional outcomes in children managed with a removable splint.Indeed, the authors did find that home management was just as efficacious as primary care provider follow-up in terms of functional use scores at 3 weeks. Notably, children who were managed at home had even lower costs and fewer follow-up radiographs obtained than children who had follow-up with their primary care provider. There are, however, 2 significant limitations of the current study that should be noted. The first is that most of the population had post-secondary school education and telephone and electronic access and had a primary care provider. Thus, extrapolating the results to a different population (eg, lower parental education, lack of telephone access or a primary care provider) is not possible at this time. The second limitation is that the population was also primarily English-speaking, so it is likely not practical to expect similar results in a non-English speaking population of caregivers based on the current study.In English-speaking families with telephone and electronic access and a primary care physician, at-home management of children with torus fractures with a removable splint is less costly and just as efficacious as follow-up with a primary care physician.The benefits that accrue with home splint removal are potentially more than financial. Parental time away from employment or other priorities, as well as school absence by affected children, are obviated by home management of distal radius fractures.

Mutuality in Motor Neuron Disease: A Mixed-Method Study.

BACKGROUND: Mutuality, a positive relationship between caregiver and care receiver that affects patient's health and caregiver's burden, stress, and well-being, has never been investigated in motor neuron disease. METHOD: We conducted a mixed-method study with convergent parallel design. Quantitative data were collected with the Mutuality Scale, and qualitative data were collected using deep interviews. The sample was composed of 30 people with motor neuron diseases and 24 family caregivers. RESULTS: Deductive, qualitative content analysis of the interviews confirmed the presence of mutuality and its 4 dimensions. The average score of patients' Mutuality Scale was 3.07 (SD, 0.79; range, 1.3-4), and that of the caregivers was 3.16 (SD, 0.53; range, 2.2-3.9). The dimensions "love" and "shared values" had the highest scores, whereas the dimension "shared pleasurable activities" had the lowest score. Patients' and caregivers' answers correlated. CONCLUSION: Mutuality concept and its 4 dimensions had content validity in motor neuron disease people. Nurses should consider the level of mutuality and adopt strategies to increase and preserve it.

Examination of the attitudes of patients in preoperative period toward uncertainty and the factors affecting the uncertainty

Aim: To examine the attitudes of patients in preoperative period toward uncertainty and the factors affecting the uncertainty. Materials and Methods: The study had a relational descriptive design. It was conducted in the surgery clinics of a university hospital in the southeast of Turkey from November 2019 to February 2020. The study sample consisted of 200 patients in preoperative period. Results: The average score of patients in preoperative period from the attitudes toward uncertainty scale was 49.04±14.81. The average age of patients included in the study sample was 49.17±16.96. 59.5% of patients were female, 43.5% of them had an education below graduate level and 84.5% of them had someone to help with home care. A statistically significant difference was detected between the average uncertainty score and age, having someone to help with home care, total number of hospitalizations, American society of anesthesiologists preoperative risk status prior to surgical intervention and presence of any chronic diseases (p.05).Conclusion: Study findings indicate that patients in preoperative period had moderate levels of uncertainty. It was found that the patient’s age, having someone to help with home care, total number of hospitalizations, American society of anesthesiologists preoperative risk status and chronic disease variables affected the uncertainty levels. In the light of these results, it is thought that patients should be approached individually by taking these variables into consideration and the quality of patient support and their coping levels should be assessed.

SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE IN PATIENTS INFECTED WITH SARS COV-2

SESSION TITLE: Lessons from the ICU: What have We Learned about the Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Throughout the years, several scoring systems have been established to measure disease severity in efforts to predict patient mortality and help guide management. In patients with sepsis, organ failure has been proven to worsen outcome, therefore utility of scores such as Sequential Organ Failure Assessment (SOFA) has helped determine the severity of disease and predict mortality. Patients infected with SARS COV-2 were observed to have varying disease progression with multiorgan involvement. Through this study, we intend to investigate the use of the SOFA score in predicting mortality in critically ill patients who tested positive for SARS COV-2. The aim of this study is to determine if the SOFA score is a strong predictor of mortality in critical care patients admitted with SARS-COV2 infection. METHODS: A single centered, retrospective chart review of 54 patients admitted to the intensive care unit (ICU) for COVID-19 infection from March 15th to April 10th 2020 was conducted. A comprehensive review of laboratory values on the day of ICU admission was done to calculate SOFA score. Total length of stay and overall patient outcome was also recorded. The collected data was statistically analyzed using the statistical software Statistical Package for the Social Sciences (SPSS). RESULTS: The results reveal that the average SOFA score of patients who tested positive for SARS COV2 was 6.31 ± 2.73. The average score of patients who survived was 4.73 ± 1.88 and the average SOFA score of the patients who died during the hospital stay was 7.78 ± 2.58. Overall, the mortality rate of patients admitted to the ICU was 51.85%, 46% of them were male and 54% female. The average length of hospital stay was calculated to be 14.5 days for those who died and 16.4 for those who survived. Logistic regression analysis was done (OR=0.56, 95% CI 0.41-0.77, p < 0.05) which was indicative of an increase in mortality by 0.56 times with every 1 point increase in SOFA score. CONCLUSIONS: COVID-19 is a new disease process and has led to many questions regarding appropriate management and treatment plans which remain unanswered. This study focused on determining whether the SOFA score is a valuable tool in predicting mortality of critically ill patients who tested positive for SARS COV2. We found that there was an increase in mortality by 0.56 times for every 1 point increase in SOFA score. High variance in clinical presentation and rapid progression of the disease made risk stratification of these patients challenging. Labs as well as clinical presentation changed significantly within the span of a day, therefore daily assessment using the SOFA score would be a better indicator of disease progression. Limitations of this study include small sample size and the novelty of the disease and its clinical progression. CLINICAL IMPLICATIONS: SOFA score on admission was not a good predictor of mortality in patients with COVID-19. DISCLOSURES: No relevant relationships by Laith Al-janabi, source=Web Response No relevant relationships by Verisha Khanam, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by DANYAL TAHERI ABKOUH, source=Web Response No relevant relationships by vesna tegeltija, source=Web Response No relevant relationships by Jurgena Tusha, source=Web Response

Anxiety and Hair Restoration Surgery

The objective of this study is to compare the anxiety scores before and after hair transplant surgery in bald patients. This prospective, comparative study was conducted in a private setup after obtaining the informed consent. The Hamilton Anxiety Rating Scale (HAM-A) was used. Only those patients who filled the pro forma before surgery and underwent first hair transplant were included. All the details of the patients such as age, time elapsed since surgery, score before and after the surgery and so on were noted. All the data were analyzed using analysis of variance test. A total of 50 patients were included, with mean age of 30.9 years. The average HAM-A anxiety score was 33.16 before the surgery and 19.62 after the surgery. The average time interval (before and after surgery) was 12.7 months. The average anxiety score in patients less than 30 years of age was 33.46 before surgery and 18.5 after the surgery. Similarly, the average score in patients above 30 years of age was found to be 32.89 before surgery and 20.65 after the surgery ( P &lt; .01). The results indicated a significant improvement on the anxiety score after the surgery ( P &lt; .01). The hair transplant definitely improves the anxiety in the balding patients.

Cross-cultural adaptation, reliability and validity of the Persian version of the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A)

Purpose Achilles tendinopathy is a prevalent overuse injury among athletes and in those with a sedentary lifestyle. Current evidence indicates that the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a valid, reliable and disease-specific outcome measure for assessing the clinical symptoms in patients with Achilles tendinopathy. The objective of this study was to translate and cross-culturally adapt the VISA-A questionnaire into Persian (VISA-A-P) and evaluating its psychometric properties. Materials and methods Cultural adaptation of VISA-A-P was conducted according to Beaton’s guideline. The final version of VISA-A-P was handed to 61 patients for analysis of psychometric properties. Test–retest reliability, internal consistency, concurrent validity, item-total correlation, and floor/ceiling effect were evaluated in patients with Achilles tendinopathy. To assess test–retest reliability, 35 patients refilled the VISA-A-P twice within 5–7 days. Known-group validity was evaluated using 50 healthy individuals. Results VISA-A-P showed excellent test–retest reliability (ICC = 0.90), excellent internal consistency (Cronbach’s alpha = 0.95), strong correlation with FAAM, and moderate to strong correlation with FAOS questionnaires. There was a significant difference between the average score of patients (34.55 ± 18.24) and the healthy group (73.1 ± 20.10). VISA-A-P showed neither ceiling nor floor effect. Conclusions The VISA-A-P is a reliable and valid instrument for measuring the symptoms in Persian speaking populations with Achilles tendinopathy. Implications for rehabilitation Achilles tendinopathy is a debilitating overuse injury that insidiously affects tendoAchilles. VISA-A-P revealed acceptable validity and reliability and it could be used by Persian speaking clinicians and researchers to assess pain and function in people with Achilles tendinopathy.

AB0593 DOES REALLY EXIST MIXED CONNECTIVE TISSUE DISEASE?

Background:Currently, most authors accept that mixed connective tissue disease (MCTD) is an independent entity, although there are those who argue that it is actually an overlap syndrome or an undifferentiated early phase of another systemic autoimmune disease (SAD).Objectives:To analyze the long term evolution of a serie of patients with MCTD.Methods:Observational, retrospective and multicenter study in patients with MCTD (diagnostic criteria of Alarcón-Segovia et al),followed for a minimun of 2 years.Results:Fifty-five patients (49 women) with a median age at diagnosis of 38±14 years and with a follow up time (median) of 101 months (range, 24-237 months with a total of 501.2 pacients-year) were identified.At the end of the follow-up period, only 27% (15/55) of the patients kept on fulfilling MCTD criteria. In the remaining 73% (40), 40% (22) had been differentiated to systemic lupus erythematosus (SLE), 13% (7) to systemic sclerosis (SSc) and 20% (11) developed an overlap syndrome [SSc+SLE in 8 cases and SSc+rheumatoid arthritis (AR) in 3]. In 8% of these patients, a secondary Sjögren’s syndrome was diagnosed during the follow-up period. The average score in patients who met the EULAR/ACR 2013 criteria for SSc was 11 (minimum 9 - maximum 16) and the average time elapsed from the diagnosis of MCTD to meet SSc criteria was 64.4 months (interquartile range [IQR] 25-75%: 10-127 months).Applying the 2012 SLICC criteria, only 24 patients of those initially diagnosed as MCTD ended up meeting SLE criteria. The average score in these patients was 5.6 (4-9) and the average time elapsed from the diagnosis of MCTD unltil fulfilling the SLICC criteria was 39 months (IQR 25-75%: 6-28). When we apply the new ACR/EULAR 2019 criteria, the percentage of patients who meet SLE criteria increased to 30%, with an average score of 17.3 (10-38). The average time elapsed since the diagnosis of MCTD until meeting the new SLE criteria was reduced to 17 months (IQR 25-75: 0-10).In the multivariate study, the presence of sclerodactyly (OR: 2.91; IC 95% 1.90 - 4.1, p= 0.001) and esophageal involvement (OR: 2.05; IC 95% 1.14–3.66, p=0.016) were associated with the evolution to SSc. Any predictor of evolution to SLE was identified.Conclusion:Only slightly more than a quarter of patients initially diagnosed as MCTD maintain this diagnosis during the follow-up. The majority, ended up evolving towards to another SAD, fundamentally SLE and SSc. The new ACR/EULAR 2019 criteria seems to be more sensitive than the SLICC 2012 criteria for diagnose SLE in these patients.Disclosure of Interests:L Montolio-Chiva: None declared, J. Narváez: None declared, Maria Pascual: None declared, Hye Sang Park: None declared, Ana V Orenes Vera: None declared, Eduardo Flores: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis, Iván Castellví: None declared, Joan Miquel Nolla: None declared