Changes In Scores Research Articles

A Comparative Analysis of Mirabegron versus Tolterodine for the Management of Irritative Symptoms Caused by Ureteral Stents

Background: The use of ureteral stents is a common practice in the management of urinary tract obstruction. However, the presence of a stent often leads to irritative lower urinary tract symptoms (LUTS), significantly impacting the patient's quality of life. Traditional management with anticholinergics is limited by side effects, whereas beta 3 agonists like Mirabegron offer a potentially more tolerable alternative. Objective: To compare the efficacy and tolerability of Mirabegron versus Tolterodine in the management of irritative symptoms associated with ureteral stents. Methods: This prospective randomized controlled trial was conducted at the Department of Urology and Renal Transplant, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, from January 2019 to August 2020. A total of 104 patients who had undergone ureteral stent placement were randomized into two groups: Mirabegron (52 patients) and Tolterodine (52 patients). Inclusion criteria included individuals aged 18 years or older without prior LUTS history. The primary outcome measured was the change in the International Prostate Symptom Score (IPSS) Irritative score from baseline to post-treatment. Data analysis was conducted using SPSS version 25, with paired and unpaired t-tests for within and between-group comparisons, respectively. Results: The mean age in the Mirabegron group was 29.44 ± 6.25 years, and 28.23 ± 5.97 years in the Tolterodine group. Pre-treatment IPSS Irritative scores were 9.19 ± 3.72 for Mirabegron and 9.88 ± 3.5 for Tolterodine. Post-treatment, scores reduced to 3.27 ± 1.34 in the Mirabegron group and 4.13 ± 1.47 in the Tolterodine group. The change in IPSS Irritative score was 5.92 ± 2.46 for Mirabegron and 5.75 ± 2.10 for Tolterodine, with no significant difference between groups (p > 0.05). Conclusion: Mirabegron is as effective as Tolterodine in reducing irritative LUTS in patients with ureteral stents, with a comparable side effect profile. These findings support Mirabegron as a viable alternative for patients experiencing LUTS due to ureteral stents.

Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

Postpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant. To investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD. A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis. Patients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients. The primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42. A total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], -1.17 [0.44]; 95% CI, -2.04 to -0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03). These results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores. Chinese Clinical Trial Registry Identifier: ChiCTR2100054199.

Additive efficacy and safety of probiotics in the treatment of ulcerative colitis: a systematic review and meta-analysis.

We aim to report the latest pooled analyses to evaluate the additive efficacy and safety of probiotics in the treatment of ulcerative colitis (UC). We systematically searched the relevant literature investigating the efficacy and/or safety of probiotics in patients with UC from PubMed, Embase and Web of Science up to January 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies according to the inclusion and exclusion criteria. Any discrepancies throughout these processes were solved by consensus. All statistical analyses were performed by Review Manager version 5.4 and Stata version 15.0. A total of 13 articles were included in the pooled analyses, and the studies were all randomized controlled trials with a total of 930 patients. There were no significant differences between the probiotics and placebo groups concerning demographic and baseline characteristics. For patients with active UC, the probiotic group boosted the remission rate by 87% compared to the placebo group, but failed to reach a statistical difference (OR: 1.87; 95% CI 0.98, 3.57; P = 0.06, I2 = 67%); furthermore, there were no statistical differences in maintenance of clinical remission, clinical response, change in UCDAI scores, or mucosal healing outcomes in the probiotic group compared to the placebo group. For patients in clinical remission, the clinical relapse rates were significantly lower in the probiotic group than in the placebo group (OR: 0.34; 95% CI 0.14, 0.79; P = 0.01). Moreover, this study did not observe a significant difference between the two groups for general adverse events rate (OR: 1.98; 95% CI 0.69, 5.68; P = 0.20). Probiotic-assisted therapy may be effective in inhibiting UC recurrence in patients in clinical remission without increasing the risk of treatment-related adverse events; furthermore, probiotics may increase the rate of clinical remission in patients with active UC. However, caution is needed when interpreting the clinical efficacy of probiotics in improving the clinical outcome of patients with active UC.

Mandibular second molar extraction: A retrospective cohort study of spontaneous occlusal changes in adolescent patients.

Evaluate long-term spontaneous occlusal changes following L7 extraction in adolescent patients. Study models of 144 participants (63 males, 81 females) retrospectively assessed prior to L7 extraction (9-16 years old; T1) and following L8 eruption (14-25 years old; T2). All received upper fixed appliances. A sub-group (n = 86) received no lower fixed appliances and acted as controls. Occlusal changes were compared between treatment (lower fixed appliance) and control (no lower fixed appliance) groups using PAR index. At T2, L8 occlusal outcome was assessed using ABO grading system. Mean follow-up period 6 (SD 2) years. At T1, lower scores observed in control group for Lower Anterior (P < .001), Midline (P = .033) and Lateral Segments (P = .040) components. At T2, lower scores continued being observed in control group for Midline (P < .001) and Lateral segment (P = .019) components. Higher decrease in Lower Anterior PAR scores observed in treatment group (<.001) with comparable scores between groups at T2 (P = .057). Similar PAR score changes between groups for Lateral Segments, Overjet and Overbite components. At T2, no significant difference observed in Total PAR score reduction between control (83%) and treatment (82%) groups. Good-to-acceptable occlusal outcome of the L8 observed in 81.55% of cases at T2 with no difference between groups. In growing patients with mild mandibular crowding, extraction of L7 followed by upper fixed appliance therapy, leads to favourable occlusal changes over a 6-year follow-up period, with or without lower fixed appliance therapy, being an alternative extraction protocol where lower fixed appliance therapy is not recommended.

Focused Ultrasound Thalamotomy for Tremor Relief in Atypical Parkisnsonism.

Magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) VIM-thalamotomy has established efficacy and safety in tremor relief in patients with essential tremor and Parkinson's disease. The efficacy and safety in patients with atypical parkinsonism have not been reported. To report on the efficacy and safety of FUS VIM-thalamotomy in 8 patients with parkinsonism, multiple system atrophy-Parkinsonian type (MSA-P) (n = 5), and dementia with Lewy bodies (DLB) (n = 3). Tremor was assessed in the treated hemibody using the Clinical Rating Scale for Tremor (CRST). The motor Unified MSA Rating Scale (UMSAR) was used in the MSA-P and motor sections of the Unified Parkinson's Disease Rating Scale (UPDRS-III) in DLB patients. Cognition was measured using the Montreal Cognitive Assessment (MoCA). In MSA-P and DLB patients, there was immediate tremor relief. CRST scores measured on the treated side improved compared to baseline. During the follow-up of up to 1 year tremor reduction persisted. The change in CRST scores at different time points did not reach statistical significance, probably due to the small sample size. Adverse events were transient and resolved within a year. In our experience, FUS VIM-thalamotomy was effective in patients with MSA-P and DLB. Larger, controlled studies are needed to verify our preliminary observations.

The reliability, validity and clinical utility of the Clinical Outcomes in Routine Evaluation – ten-item version (CORE-10) in post-acute patients with stroke

Objective To explore the validity, reliability, and clinical utility of the Clinical Outcomes in Routine Evaluation – ten-item version (CORE-10: a ten-item questionnaire designed to measure psychological distress) in a stroke inpatient sample and calculate reliable and clinically significant change scores. Setting A post-acute stroke rehabilitation ward in the East of England. Participants A total of 53 patients with stroke, capable of completing the CORE-10 as part of their routine clinical assessment. Exclusion criteria included moderate to severe aphasia and/or alexia. Main measures Alongside the CORE-10, the Patient Health Questionnaire – 9, the Hospital Anxiety and Depression Scale, the Centre for Epidemiological Studies-Depression Scale, and the Beck Depression Inventory Second Edition were used as concurrent measures. Results To assess reliability, the internal consistency and test–retest reliability of the CORE-10 were calculated. The average number of days between CORE-10 test–retest administrations was 2.84 (SD = 3.12, Mdn = 1). Concurrent validity was assessed by examining correlations between the CORE-10 and comparable measures, and clinical utility was assessed using the criteria of Burton and Tyson (2015). The internal consistency (Cronbach’s alpha) for the CORE-10 was .80, and test–retest reliability interclass correlation coefficient was .81. Total score correlations between the CORE-10 and concurrent measures ranged from r = .49 to r = .89. The CORE-10 achieved the maximum score (i.e. 6/6) on criteria for clinical utility. Calculations demonstrated a reliable change index of nine points and a clinically significant change cut point of 12 on the CORE-10. Percentiles for CORE-10 total scores are reported. Conclusions This study provides preliminary support for the CORE-10 as a valid and reliable measure that has clinical utility for screening distress in inpatients with stroke.

Low Field MRI Surveillance 6-24 Months Post-acute COVID-19 Pneumonia: Factors Influencing Severity and Evolution of Lung Opacities

To determine factors influencing low-field MRI lung opacity severity 6-24 months after acute Covid-19 pneumonia. 104 post-acute Covid-19 patients with 167 MRI exams were included. 32 patients had more than one exam, and 63 exams were serial exams. Pulmonary findings were graded on a scale of 0-4 by quadrant, total score ranging from 0 (no opacity) to 16 (opacity > 75%), and score >8 considered moderate and >12 severe opacity. Kruskal-Wallis, Mann-Whitney, and Spearman rank correlation was used to assess the association of clinical and demographic factors with MR opacity severity at time intervals from acute infection. Random coefficients regression was used to assess whether opacity score changed over time. Severity of initial illness was associated with increased MR opacity score at timeframes up to 24 months (p<.05). Among the 167 exams, moderate to severe MR opacities (total opacity score >8) were identified in 33% of exams beyond 6 months: 37% at 6 - <12 months (n=23/63); 31% at 12- <18 months (n=13/42); 25% at 18- <24 months (n=6/24); and 50% at >24 months (n=3/6). No significant change in total opacity score over time was identified by random coefficients regression. Among the 32 patients with serial exams, 11 demonstrated no change in opacity score from initial to final exam, 10 decrease in score (mean 2.3, stdev 1.25, range 1-4), and 11 increase in score (average 2.8, stdev 1.48, range 1-7). Initial Covid-19 disease severity was associated with increased MRI total opacity score at time intervals up to 24 months, and moderate to severe opacities were commonly identified by low-field MRI beyond 6 months from acute illness.

(155) The Erectile Restoration Registry: It MATTERS

Abstract Introduction Treatment methodology for erectile dysfunction can vary from surgeon to surgeon. The It MATTERS registry has been developed to align prospective, long-term, real-world outcomes with current clinical practice. It MATTERS is an immediate avenue (following market approval of a product) to collect and monitor real-world data on existing and future innovation, with respect to Boston Scientific’s penile prostheses (2- and 3-piece inflatable, and malleable), Rear Tip Extenders, surgical tools (sterile and non-sterile), accessories, kits, and all included components. This includes, but is not limited to, the Furlow Insertion Tool, Disposable Dilators, Sizers, Insertion Package (tubing passers), Proximal Tool, Quick Connect Assembly Tool, AMS Closing Tool, and the Deactivation Package. Objective Description of a real-world registry that evaluates erectile function, post-penile prosthesis implantation, over time. Methods It MATTERS is a single-arm, prospective, multi-center registry with follow-up occurring post-surgery and at 6 months, 12 months, and annually, thereafter. Subjects will serve as their own control; follow-up assessments will be compared to values collected at baseline. The registry is designed to capture the wide array of immediate, post-surgery follow-up schedules without dictating a specific visit cadence. Following signature of an informed consent, eligible subjects are treated with a Boston Scientific penile prosthesis. The registry will enroll over the lifetime of each device, allowing for up to 150 active subjects in follow-up, per device. Results Registry endpoints include measuring change in erectile function from baseline using the Erectile Function domain of the International Index of Erectile Function (IIEF-EF), change in depressive symptoms using the Patient Health Questionnaire (PHQ)-9, overall sexual function using the IIEF Total Score, and change in work productivity using the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI:GH). Additional measures, amongst many, include patient-reported device satisfaction using a 5-point Likert scale and adverse events. For each penile prothesis group in the registry, a two-sided 95% confidence interval may be constructed for interpreting the change in IIEF-EF score over time compared to baseline. Descriptive statistics will summarize continuous and categorical variables. Currently, 51 penile prosthesis implants have been completed: Tactra™ Malleable Penile Prosthesis (n = 34), Spectra™ Concealable Penile Prosthesis (n = 9), and AMS Ambicor™ Inflatable Penile Prosthesis (2-piece; n = 8). Conclusions The It MATTERS registry builds on over 50 years of erectile dysfunction patient care and data. It will allow for the comparison of outcomes and clinical practice on legacy and new market-approved products, which will pave the way for future innovation and advancing patient care. Disclosure Yes, this is sponsored by industry/sponsor: Industry initiated, executed, and funded registry. All authors act as consultants, employees, or shareholders of Boston Scientific Corporation. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific Corporation.

Exploring Family Adjustment Among Parents of a Child With a Disability Attending Relationship Education

Objective: The current exploratory study examined dyadic changes in family adjustment (i.e., parental stress, positive coping, family-based support, social support) reported by parents of a child with a disability after 12-hours of relationship education (RE). Background: Parents of a child with a disability encounter social barriers that contribute to parental stress and inhibit family well-being. RE reduced psychological and relationship distress in community samples—yet, ability status and the influence on a family's presenting needs/resources are overlooked in previous research. Methods: We extracted a subset of data to examine pre- and post-reports of family adjustment among couples parenting a child with a disability who completed the PREP curriculum. We used structural equation modeling to examine an actor–partner interdependence model for the dyadic association of mean-centered baseline subscale measures of family adjustment and residual change scores for men and women in a relationship post-RE intervention. Results: Actor effects were significant and predicted the amount of residual change for men and women. Significant partner effects existed for male social support and male and female family-based support. Conclusion: Results expand our understanding of RE effectiveness with an understudied subset of parents, those raising a child with a disability. Parents reported improvements in family adjustment and partners influenced one another in terms of family adjustment changes. Implications: Supportive parent programming, such as RE, may be an important consideration for families that include a child with a disability to address the social barriers that tax existing parent and family resources.

Systemic Chemotherapy for Advanced Hepatocellular Carcinoma in Patients With Child-Pugh class B.

Numerous agents, including immune checkpoint inhibitors, are now available for hepatocellular carcinoma (HCC) treatment. Most trials involving systemic chemotherapy have included patients with Child-Pugh class A, while excluding or minimally enrolling those with Child-Pugh class B, due to liver dysfunction-related mortality. This study aimed to identify prognostic factors for survival in Child-Pugh class B patients receiving sorafenib (SOR), lenvatinib (LEN), atezolizumab plus bevacizumab (ATZ+BEV), or hepatic arterial infusion chemotherapy (HAIC). From December 2003 to June 2023, 137 patients with advanced HCC receiving systemic chemotherapies (SOR: n=43, LEN: n=16, ATZ+BEV: n=18, HAIC: n=60) were enrolled. Overall survival (OS) and response rates did not differ significantly across treatments (SOR: 8.3 months, LEN: 10.2 months, ATZ+BEV: 8.5 months, HAIC: 7.3 months). Patients on HAIC and LEN had a lower rate of discontinuing treatment within three months compared to those on ATZ+BEV and SOR. HAIC was associated with fewer changes in ALBI score and better preservation of liver function. Multivariate logistic regression identified serum α-fetoprotein >400 ng/ml [hazard ratio (HR)=1.94; p=0.001], tumor count >5 (HR=1.55; p=0.043), and Child-Pugh score (HR=2.53; p=0.002) as independent predictors of OS. OS and response rates were similar across systemic chemotherapies. Prognosis for HCC in Child-Pugh class B patients was associated with liver function, necessitating further research for optimal treatment.

Initial evaluation of the TALES (technology and literacy engagement after stroke) programme targeting functional literacy and social engagement in people with aphasia after stroke

ABSTRACT Background and aims Literacy skills are typically affected in people with stroke aphasia, leading to reduced engagement in functional everyday reading/writing tasks, such as email/messaging via social media. The aim of this study was to investigate the outcomes of the TALES (Technology And Literacy Engagement after Stroke) programme, a group-based online literacy-focused programme for people with aphasia after stroke. This first evaluation of this programme aimed to examine outcomes related to feasibility, changes in language, literacy and self-ratings of communication skills. Methods Five participants with aphasia were assessed on a range of outcome measures relating to language and self-perception of communication skills. These were: the Western Aphasia Battery-Revised (WAB-R; (Kertesz, 2007)), literacy subtests from the Psycholinguistic Assessment of Language Processing in Aphasia (PALPA; (Kay et al., 1996)) and the Communication Outcomes after Stroke (COAST; (Long et al., 2008)). TALES consisted of a weekly group online session, 1:1 supported telehealth reading/writing practice and regular messaging via email. Results and main contribution From a descriptive statistics perspective, the mean gains across the cohort were 7.94 (from 84.24 to 92.18) on the WAB AQ (aphasia quotient), 8.92 (from 81.18 to 90.10) on the WAB LQ (language quotient). Additionally, there was a change in the mean scores for PALPA subtests (31, 37 and 40) observed between the pre-treatment assessment and post-treatment assessment. Finally, the mean score increased by 8.8 (from 49.40 to 58.20) on the COAST (max score = 80). Results indicated gains in literacy and communication measures as well as changes to self-rating of communication reflecting changes in communication confidence. Conclusions Mindful of the threats to the internal validity inherent in the study design, the reported online therapy can overcome barriers such as distance and mobility limitations and may provide greater accessibility to therapy for individuals with aphasia. TALES was a low-therapist-input yet reasonably intensive treatment approach which embedded language practice immediately in functional use through the social group format and personally-relevant written communication. Implications The TALES programme meets many neuroscience principles of neurorehabilitation including “use it or lose it”, salience and transference. Future research may usefully investigate the contribution of the group format versus the functional literacy components towards these potentially promising early data.

Construct validity, responsiveness, minimal detectable change, and minimal clinically important difference of the stroke self-efficacy questionnaire in individuals receiving stroke rehabilitation

Purpose To assess the clinimetric properties of the Stroke Self-Efficacy Questionnaire (SSEQ) and estimate the minimal detectable change (MDC) and minimal clinically important difference (MCID) from the database of our randomized controlled trials (RCT) of individuals receiving stroke rehabilitation. Methods We retrieved the pre- and post-intervention scores of the SSEQ and Stroke Impact Scale (SIS) from 80 stroke survivors. The analysis of clinimetric properties was performed using: (1) confirmatory factor analysis and item response theory modeling (IRT) for construct validity; (2) standardized response mean and Glass’s delta for responsiveness; (3) MDC based on the standard deviation (SD) or standard error of measurement (SEM) of the SSEQ change scores; (4) MCID determined by the external anchor–SIS; (5) conditional MDC (cMDC) derived from the IRT analysis. Results There was a bi-factorial construct with excellent model-data fit and marked responsiveness. The MDC determined by the SD and SEM were 1.5 and 3.0, respectively, and the MCIDs were 3.3 and 3.7. Conclusions This study confirmed that SSEQ is a valid and reliable assessment tool for patients receiving stroke rehabilitation. We also provided practical threshold values, especially demonstrating the benefit of using individualized cMDC, to help clinicians better interpret the change in the SSEQ scores.

Comparison of Intensive Physical Therapy and Electrical Stimulation to Reduce Spasticity in Stroke

Background: Stroke is a leading cause of disability worldwide, often resulting in spasticity that significantly impairs the functional recovery of individuals. The comparative efficacy of intensive physical therapy and electrical stimulation in mitigating post-stroke spasticity remains a critical area of research. Understanding the impacts of these treatments can guide clinicians in optimizing rehabilitation strategies for stroke survivors. Objective: The study aimed to compare the effectiveness of intensive physical therapy and electrical stimulation in reducing spasticity among stroke patients, with an emphasis on how these interventions influence muscle tone and functional outcomes. Methods: This quasi-experimental trial was conducted at Nishtar Hospital, Multan, over six months, involving 30 participants aged 50-65 years who had experienced a stroke. Participants were randomly assigned to receive either intensive physical therapy or electrical stimulation. Baseline and post-treatment assessments of spasticity were conducted using the Modified Ashworth Scale (MAS). Data were analyzed using SPSS version 25, focusing on changes in MAS scores before and after the interventions. Results: Both interventions showed significant improvements in spasticity levels. The intensive physical therapy group exhibited notable reductions in MAS scores across various joints: shoulder flexors (from 3.13 ± 0.51 to 1.20 ± 0.41), shoulder extensors (from 3.00 ± 0.65 to 1.20 ± 0.67), and hip abduction (from 3.00 ± 0.65 to 1.33 ± 0.72). The electrical stimulation group also demonstrated significant improvements, with MAS scores in wrist flexion (from 2.73 ± 0.70 to 1.33 ± 0.61) and hip extension (from 2.80 ± 0.67 to 1.26 ± 0.45) showing notable reductions. However, no statistically significant differences were observed between the two groups in terms of overall effectiveness in reducing spasticity (p &gt; 0.05). Conclusion: Both intensive physical therapy and electrical stimulation are effective in reducing post-stroke spasticity, with no significant difference in their overall efficacy. This suggests that either treatment can be considered as part of a comprehensive rehabilitation strategy for stroke survivors, depending on individual patient needs, preferences, and specific functional goals.

The Effects of Nurse-Led Supportive Care Program on Quality of Life in Women with Breast Cancer Receiving Adjuvant Chemotherapy: A Randomized Controlled Pilot Study

This study was to evaluate the effects of nurse-led supportive care program on quality of life in women with breast cancer receiving adjuvant chemotherapy. The study was carried out a parallel group randomized controlled pilot study with repeated-measures design in general surgery unit of a training and research hospital. Forty-two women with newly diagnosed breast cancer were randomly assigned to the intervention and control groups. The intervention group received nurse-led supportive care program for 8 weeks, 4 weeks in face-to-face sessions and 4 weeks through phone sessions. The control group received only routine treatment. The women in both groups completed the EORTC-QLQ-C30 (version 3.0) Quality of Life questionnaires at baseline and ninth week. There was a significant increase in the mean global health status and functional status scores of the women with breast cancer in the intervention group compared to the women in the control group in the ninth week compared to the baseline. The women in the intervention group had a lower mean symptom status score in the ninth week than the women in the control group and there was a statistically significant difference in the change in the mean scores of the groups over time. Our nurse-led supportive care program is an effective, safe and acceptable method to support women with BC receiving adjuvant chemotherapy. The nurse-led supportive care program can be used as a reliable and effective nursing intervention to increase the quality of life of women breast cancer receiving adjuvant chemotherapy. NCT05399160.

Identifying Racial and Ethnic Disparities in Acute Inpatient Rehabilitation

ObjectiveTo investigate whether racial, ethnic, and linguistic disparities exist at discharge from an acute inpatient rehabilitation facility (IRF) by examining change in Functional Independence Measure (FIM) scores and discharge destination. DesignThis is a retrospective study using our IRF's data from the Uniform Data System for Medical Rehabilitation from 2013-2019. FIM scores and discharge destination were compared between race, language, and ethnic groups, with adjustment for patient characteristics. SettingAn urban hospital with a level 1 trauma center, comprehensive stroke center, and IRF with Commission on Accreditation of Rehabilitation Facilities (CARF) certification. Participants2518 patients admitted to the IRF from 2013-2019 (N=2518). InterventionsNot applicable. Main Outcome MeasuresChange in FIM score and discharge destination. ResultsAfter adjusting for covariates, non-White patients and patients with limited English proficiency had significantly lower functional recovery, as measured by smaller changes in FIM scores from IRF admission to discharge. Additionally, both groups were more likely to be discharged home with home health care than to a skilled nursing facility, compared with White and English-speaking patients. Disparities in discharge destination persisted within patients with noncommercial insurance (Medicaid or Medicare) and a stroke diagnosis but not within those who had commercial insurance or a nonstroke diagnosis. ConclusionsRacial and linguistic disparities were identified within our CARF certified IRF; however, the organization is committed to reducing health care disparities. Next steps will include investigating interventions to reduce disparities.

THE SIGNIFICANCE OF LAPAROSCOPY IN THE PROGNOSIS AND TREATMENT OF ACUTE PANCREATITIS

A study was conducted on 102 patients with acute destructive pancreatitis and enzymatic peritonitis, who underwent laparoscopy within the first 72 hours after the onset of the disease. The results of this study led to the development of a scoring system for assessing pathological changes in the abdominal cavity, which allows predicting the severity of the disease. It turned out that the results of laparoscopy with a scoring of changes in the abdominal cavity largely coincide with the assessment of the severity of acute pancreatitis performed using computed tomography using the Balthazar scale (the sensitivity of the method was 84.0% and 86.3%, respectively).

Rotation of a Part of the Composite Flap for Simultaneous Gonion Reduction and Malar Augmentation During Rhytidectomy in Asians.

The desired facial shape that Asians aim to achieve through plastic surgery differs from that of westerners. The author facilitates facial volume deflation by using the rotation of a part of the composite flap to the malar area resulting in volumetric augmentation during rhytidectomy; simultaneously, a volumetric reduction was implemented in the gonion. Extended deep plane rhytidectomy with the rotation of a part of the composite flap was performed in 49 patients, whereas extended deep plane rhytidectomy without the rotation of a part of the composite flap was performed in 20 patients. For the results, the satisfaction survey of the surgery was conducted in all patients and by 2 surgeons during a follow-up visit 12 months later. To assess the surgical outcome objectively, the author used the Allergan photometric midface volume deficit scale to measure the midface volume. The midface contour and degree of projection were analyzed using lateral view photographs of the patients. The measurement of segment CM (distance between the lateral canthus and mouth corner) and segment MA (distance from segment CM to the most protruding malar area) was performed. The patients who underwent extended deep plane rhytidectomy with the rotation of a part of the composite flap reported higher overall satisfaction and achieved more favorable results, as evaluated by the 2 aesthetic surgeons (P < 0.05). The scores on the Allergan photometric midface volume deficit scale showed a significant increase before and after the surgery in both groups (P < 0.05), also as evaluated by the 2 aesthetic surgeons. However, the change in scores was found to be higher in the extended deep plane rhytidectomy with the rotation of a part of the composite flap group. The midface contour and degree of projection showed an increase of 20.6% on the right face and 22.7% on the left face, respectively (P < 0.001). Using the rotation of a part of the composite flap during rhytidectomy resulted in overall satisfactory outcomes for all patients. Based on these findings, it can be concluded that the use of this surgical method is beneficial and effective.

Sex Differences in Hydration Biomarkers and Test-Retest Reliability Following Passive Dehydration.

This study investigated (a)differences between males and females for changes in serum, tear, and urine osmolality, hematocrit, and urine specific gravity following acute passive dehydration and (b)assessed the reliability of these biomarkers separately for each sex. Fifteen males (age: 26.3 ± 3.5years, body mass: 76 ± 7kg) and 15 females (age: 28.8 ± 6.4years, body mass: 63 ± 7kg) completed a sauna protocol twice (5-28days apart), aiming for 4% body mass loss (BML). Urine, blood, and tear markers were collected pre- and postdehydration, and change scores were calculated. Male BML was significantly greater than that of females in Trial 1 (3.53% ± 0.55% vs. 2.53% ± 0.43%, p < .001) and Trial 2 (3.36% ± 0.66% vs. 2.53% ± 0.44%, p = .01). Despite significant differences in BML, change in hematocrit was the only change marker that displayed a significant difference in Trial 1 (males: 3% ± 1%, females: 2% ± 1%, p = .004) and Trial 2 (males: 3% ± 1%, females: 1% ± 1%, p = .008). Regression analysis showed a significant effect for sex (male) predicting change in hematocrit (β = 0.8, p = .032) and change in serum osmolality (β = -3.3, p = .005) when controlling for BML but not for urinary or tear measures. The intraclass correlation coefficients for females (ICC 2, 1) were highest for change in urine specific gravity (ICC = .62, p = .006) and lowest for change in tear osmolarity (ICC = -.14, p = .689), whereas for males, it was posthematocrit (ICC = .65, p = .003) and post tear osmolarity (ICC = .18, p = .256). Generally, biomarkers showed lower test-retest reliability in males compared with females but, overall, were classified as poor-moderate in both sexes. These findings suggest that the response and reliability of hydration biomarkers are sex specific and highlight the importance of accounting for BML differences.

Changes in depression symptom profile with gender-affirming hormone use in transgender persons

BackgroundWomen show higher prevalence of depression and different symptomatology than men, possibly influenced by sex hormones. Many transgender persons, who face a high risk of depression, use Gender-Affirming Hormone Therapy (GAHT), but the impact of GAHT on depressive symptom profiles is unknown. MethodsThis study examined depressive symptoms in transgender persons before GAHT and after 3- and 12 months of GAHT. We used the Inventory of Depressive Symptomatology-Self Report to assess depressive symptoms, exploratory factor analysis (EFA) to assess symptom clusters, and linear mixed models to assess changes in symptom clusters. ResultsThis study included 110 transmasculine (TM) and 89 transfeminine (TF) participants. EFA revealed four symptom clusters: mood, anxiety, lethargy, and somatic symptoms. Changes in total depressive symptoms significantly differed between TM and TF groups. After 3 months of GAHT, TM participants reported improvement in lethargy (−16 %; 95%CI: −29 %; −2 %), and after 12 months TF participants reported worsening in low mood (24 %; 95%CI: 3 %; 51 %), but absolute score changes were modest. Neither group showed changes in anxiety or somatic symptoms. LimitationsThis study had limited sample sizes at 12 months follow-up and did not include relevant biological or psychosocial covariates. DiscussionChanges in depressive symptoms after GAHT use differ in TM and TF persons: TM persons report slight improvements in lethargy, whereas TF persons report a slight increase in low mood. Starting GAHT represents a significant life event with profound social and physical effects, and further research should assess social and biological effects of GAHT on mood-related symptoms.

Effect of family-centered care on the anxiety levels among family members of patients undergoing cardiac surgery: a randomized controlled trial.

The present study aims to determine the effect of family-centered care on anxiety levels among family members of patients undergoing cardiac surgery. This study was a randomized clinical trial study that was conducted on the families of Iranian cardiac surgery patients. In the intervention group, family-centered care was implemented, and the content of the intervention included providing informational and emotional support to the family member and the family member's participation in patient care according to the set framework. A total of 144 family members of patients undergoing cardiac surgery were included in this study. Among the 144 family members, 71 were in the intervention group, and 73 were in the control group. The changes in the state anxiety score before and after the intervention were significant between the two groups, and the changes were higher in the control group (P=0.043). Also, there was no significant difference in the changes in trait anxiety before and after the intervention between the two groups (P>0.05). In general, the high prevalence of anxiety in patients' families has negative functional consequences on both patients and their families. To reduce the level of anxiety, special attention should be paid to knowing the effective factors and appropriate coping methods. Nevertheless, it is important to note that additional research is warranted to delve deeper into this matter in future studies.