Changes In Functional Status Research Articles

Psychometric Validation of a Japanese Version of the emPHasis-10 Questionnaire, a Patient-Reported Outcome Measure for Pulmonary Hypertension - Multicenter Study in Japan.

Background: The emPHasis-10 questionnaire is a disease-specific patient-reported outcome assessment of quality of life (QOL) in pulmonary hypertension (PH). The aim of this study was to psychometrically validate a linguistically validated Japanese version of the emPHasis-10.Methods and Results: Japanese patients with PH (age ≥18 years) and no change in functional status, or initiation or change in PH-specific treatment during the past 3 months were recruited from 5 institutions from August 2018 to July 2019. A set of questionnaires was administered twice. The validity and reliability of the emPHasis-10 were assessed using the data of 76 patients. On concurrent validity analysis, a moderate-to-strong correlation was seen with the total score of all 5 external criteria (the Minnesota Living with Heart Failure modified for PH [MLHFQ-PH], Hospital Anxiety and Depression Scale, Dyspnea-12 questionnaire, European Quality of Life-5 Dimensions questionnaire [EQ-5D], and 6-min walk test), with a notably strong correlation with the MLHFQ-PH (0.77) and EQ-5D (–0.64). On known-group validity, a linear increasing trend of the emPHasis-10 score was observed across 4 World Health Organization functional status groups (Jonckheere-Terpstra test, 1-sided, P<0.001). Intraclass correlation coefficient for test-retest reliability was 0.86, and the Cronbach’s α for internal consistency was 0.89.Conclusions: The Japanese emPHasis-10 questionnaire is psychometrically valid to evaluate QOL in Japanese PH patients in a clinical setting.

Aquatic Therapy Interventions and Disability: A Recreational Therapy Perspective

Aquatic therapy interventions are critical for individuals with disabilities and the role of the therapist is just as critical for successful and effective interventions. The field of therapeutic recreation trains students to develop and implement evidence-based facilitation techniques including the use of aquatic therapy to assist in helping clients achieve a change in functional status. This review of the literature examined the impact of aquatic therapy interventions on a variety of disabilities including osteoarthritis, multiple sclerosis, Cerebral palsy, autism spectrum disorder, and mental health from a recreational therapy (RT) perspective. This review provides a variety of information on the positive benefits that may occur using aquatic therapy for diverse conditions. Examples include relaxation, stretching, and aerobic exercise and each has the ability to improve strength. It does appear that aquatic therapy interventions can provide a wide array of benefits that may reduce the burden associated with a variety of disabilities. These benefits may be useful in increasing the overall quality of life of a diverse group of disabilities. Likewise, due to the nature of RT, recreational therapists are in a unique position to provide plan and develop aquatic therapy interventions. However, it is the authors’ suggestion that those providing this service attend intensive training in order to provide aquatic therapy effectively. Additional research may be necessary to provide a more cohesive understanding of the impact of aquatic therapy on a variety of populations. Nonetheless, the information gleamed from this review, justify that aquatic therapy has benefits for a diverse clientele and thus may be useful in the implementation of RT programs.

Effectiveness of Early Rehabilitation Combined With Virtual Reality Training on Muscle Strength, Mood State, and Functional Status in Patients With Acute Stroke: A Randomized Controlled Trial.

Early rehabilitation has been shown to enhance functional outcomes. Whether the addition of virtual reality (VR) training could further improve muscle strength, mood state, and functional status for patients with acute stroke is unknown. To investigate the effectiveness of VR training on muscle strength, mood state (depression, anxiety), and functional status in patients following acute stroke. A randomized controlled trial was conducted. Patients with acute ischemic stroke (N=152) were selected and randomly assigned with a 1:3 randomization ratio to either experimental group (EG) or comparison group (CG). Both groups received early rehabilitation. The EG received an extra 5days of VR training (15min of time, two times a day), started 24hr to 3days poststroke. Muscle strength, mood state, and functional status were collected at admission and at the day of discharge. Generalized estimating equations were applied to examine the intervention effects. A total of 143 participants (94%) completed the study, and 145 were included in the intention-to-treat analysis. Participants in the EG reported increased muscle strength of upper and lower limbs in both affected and unaffected sides, decreased depression and anxiety, and increased functional status at discharge. When the group-time interaction was examined, the EG had greater increased upper limb muscle strength of the unaffected side (ß=0.34, p<.001) and decreased depression and anxiety scores (ß=-2.31, p=.011; ß=-1.63, p=.047) at discharge compared with the CG. However, there was no difference in the functional status change scores from baseline between EG and CG. A poststroke program that includes both early rehabilitation and VR training has greater benefit in relation to mood state and muscle strength at discharge than early rehabilitation alone. Therefore, an early physical rehabilitation program that includes VR training for acute stroke inpatients should be considered for implementation in clinical settings.

ACUTE CONFUSIONAL STATES IN OLDER ADULTS WITH MAJOR NEUROCOGNITIVE DISORDER AND BACTERIURIA: IS ANTIBIOTIC TREATMENT WARRANTED?

Introduction Uncomplicated urinary tract infection (UTI)/acute simple cystitis (ASC) is defined as an infection confined to the bladder/lower urinary tract with the absence of signs and symptoms that would suggest an upper tract or systemic infection (such as fever, chills, rigors, significant fatigue or malaise beyond baseline, flank pain, costovertebral angle tenderness, pelvic or perineal pain in men). Presence of systemic symptoms suggests a complicated UTI. Symptoms of ASC include dysuria, urinary frequency or urgency, and/or suprapubic pain. The term asymptomatic bacteriuria refers to isolation of bacteria in an appropriately collected urine specimen from an individual without symptoms of UTI. Asymptomatic bacteriuria generally is not treated unless the patient is pregnant, undergoing urological procedure or has a history of recent renal transplant. However, it is recommended that ASC be treated empirically with antibiotics. Minimum criteria for the initiation of antibiotics for urinary tract infection in long-term care residents without indwelling catheter include acute dysuria or fever and at least one of the following: new or worsening urgency, frequency, suprapubic pain, gross hematuria, CVA tenderness, urinary incontinence. Acute change in mental status is not considered as a criterion to diagnose and treat UTI. However, it is known that infection in older patients may be associated with nonspecific symptoms such as increased confusion, falling, and anorexia besides other classic symptoms of infection. Diagnosis of ASC is based solely on the subjective complaints of patients. Cognitive impairment with reduced capacity to specifically communicate symptoms makes it challenging to rule out the diagnosis of ASC in older patients with major neurocognitive disorder (MNCD). Such patients may communicate the pain and discomfort from ASC by having increased confusion and behavioral disturbances. Under these circumstances, is bacteriuria a clinically significant condition that warrants antibiotic therapy? Guidelines to relate urinalysis findings to the diagnosis of ASC in older adults with MNCD with behavioral disturbance are not currently available. Establishing the diagnosis in older patients is further complicated due to the higher prevalence in this group, of asymptomatic bacteriuria and chronic urinary symptoms (such as chronic urinary nocturia, incontinence, and general sense of lack of well-being). The Infectious Diseases Society of American (IDSA) Guidelines of 2019 recommend against antibiotic “trials” as these may cause drug toxicity, drug-drug interactions, and antimicrobial resistance. Recommendation is not to routinely test urine in elderly or debilitated patients with nonspecific changes in mental or functional status in the absence of focal urinary tract symptoms, and instead hydrate, carefully observe, and assess other potential contributing factors.However, as a part of work-up for delirium/acute change in mental status ruling out UTI with UA is still standard practice despite the recommendation not to do so in the absence of specific genitourinary symptoms. This is possibly due to the failure of current guidelines to convince clinicians of its adequacy to rule out possibility of UTI in cognitively impaired patients. This diagnostic challenge often leads to dilemma in the treatment approach of these patients. Methods Case series, systematic literature review Results Case identification: Six cases of elderly patients with MNCD who presented to the emergency department with acute change in mental status and behavioral disturbance were identified. Initial work-up included abnormal urinanalysis results. In the absence of patients reporting genitourinary symptoms, a diagnosis of UTI was not considered and they were admitted to a geriatric psychiatric unit for evaluation and behavioral management.. Variation in the treatment approach for each case was evaluated which included either considering the mental status change to be a result of UTI and treating with antibiotics or managing them with psychotherapeutic interventions and psychotropic medications for behavioral stabilization if safety and well-being were concerns. Discrepancies were noted in the recommendations made by the consulting internist and geriatric psychiatrist regarding whether or not antibiotic therapy vs. psychotropic medication treatment was most appropriate for older adults with MNCD and acute confusional states who had bacteriuria >100,000?CFU/?ml. While internists were concerned about adding load of antibiotic resistance to the community, psychiatrists were worried about the adverse effects of antipsychotics including thromboembolic events and sudden deaths in elderly patients. Conclusions The cases described here illustrate the need for concrete specialized diagnostic criteria for early and accurate identification of uncomplicated UTI/ ACS in elderly population with MNCD along with an appropriate management protocol. This research was funded by: Not applicable

Functional status, pain and return to work of injured motorcyclists involved in a motorcycle crash over one-year post-injury in Vietnam

ObjectiveThis study aimed to determine changes in functional status, pain, and return to work/study (RTW/study) over 12 months post-injury in motorcyclists admitted to a large hospital in Ho Chi Minh City (HCMC), Vietnam. MethodsA prospective study was undertaken with adult motorcyclists who were injured due to a crash and were admitted to hospital for more than 24 h. Pain and functional status data were collected at baseline (time of injury), and follow-up at 6 and 12 months post-injury. RTW/study was collected at 6 and 12 months post-injury. Multilevel mixed models and multiple logistic regression models were used to determine the changes in outcomes and predictors of outcomes including age, sex, education, Injury Severity Score, length of stay in the hospital and health-related quality of life. ResultsA total of 352 hospitalised motorcyclists were followed-up. The proportion of motorcyclist RTW/study was 60% (n = 165) at 6 months and 82% (n = 210) at 12 months post-injury. After adjusting for covariates, pain scores improved significantly at 6 months (β = -3.31, 95% CI: -3.61, -3.01) and 12 months post-injury (β = -3.62, 95% CI: -3.92, -3.32) compared to baseline. Functional status increased significantly by 2.89 points (95% CI: 2.64, 3.13) at 6 months and by 3.51 points (95% CI: 3.27, 3.75) at 12 months compared to baseline. ConclusionsThe study found improvements in outcomes over the study period, although there was ongoing disability at 12 months post-injury (18% had not RTW/study). This study provides further evidence on the burden of motorcycle injuries in Vietnam and priorities for research, and further informs treatment and rehabilitation service planning.

Effect of tart cherry juice on risk of gout attacks: protocol for a randomised controlled trial

IntroductionGout is a painful form of inflammatory arthritis associated with several comorbidities, particularly cardiovascular disease. Cherries, which are rich in anti-inflammatory and antioxidative bioactive compounds, are proposed to be efficacious...

Дослідження впливу занять оздоровчим плаванням на фізичний розвиток, функціональний стан і фізичну підготовленість жінок

Purpose: to study the influence of recreational swimming classes on physical development, functional state and physical preparedness of women aged 17–19. Material & Methods: data collection was carried out in the fitness groups of the Pioneer pool. A group of 15 women aged 17–19 years was formed. Classes were held for 21 weeks, 3 times a week. The duration of one lesson is 45 minutes. During the study, testing was conducted of the physical development, functional state and physical preparedness of the subjects. To analyze physical development, anthropometric data were measured; functional status was determined using the Harvard step test and heart rate measurement. Testing of physical preparedness was carried out in accordance with State tests and standards for assessing physical fitness of the population of Ukraine. The obtained quantitative data were processed by methods of mathematical statistics. Results: studies indicate that in women aged 17–19 years of health-improving swimming cause positive changes in physical development, physical preparedness and functional status. Changes in indicators are reliable. Conclusions: at the initial stage of the study, the anthropometric indicators of the respondents were age-appropriate; the physical preparedness of women aged 17–19 years on almost all indicators was at the level of unsatisfactory; Harvard step test indices were below the average. After lengthy swimming lessons, the majority of anthropometric indices of the studied contingent improved (P(t)<0,01–0,001). All indicators of physical fitness of young women improved (P(t)<0,01–0,001). Recovery processes after dosed muscular work (Harvard step test) and heart rate (P(t)<0,05–0,01) significantly improved.

Change of NLRP3 Inflammasome Expression Level, Symptoms, and Functional Status in HFpEF Patients Treated With ARNI

Change of NLRP3 Inflammasome Expression Level, Symptoms, and Functional Status in HFpEF Patients Treated With ARNI

Changes in Functional Status of Patients who Have Had a Stroke during Rehabilitation

The aim was to evaluate changes in functional status of patients who have had a stroke during rehabilitation. The sample consisted of 103 patients who have had a stroke and were treated in the section of rehabilitation; 62% of subjects were female, and 38% – male. Subjects ranged in age from 51 to 78 years, and mean age was 68 years. The methods of scientific research: problems in everyday activities were assessed using Barthel index test, cognitive disorders were assessed using the short mental status examination test. We carried out a retrospective analysis of clinical cases of rehabilitated patients, adjusted for age, gender, place of residence, and diagnosis of the disease. Investigations were carried out twice: upon arrival at upon leaving the section of rehabilitation. Because of rehabilitation, the functional status of patients who have had a stroke improved in the total group from 53.6 to 77.3 scores (p &lt; 0.001). Complications reported during in-patient rehabilitation aggravated and worsened the functional status both at the beginning of rehabilitation (42.4 scores) and later (56.9 scores), while the overall functional status improved during the course of rehabilitation. Integrated rehabilitation had an effect for recovery of cognitive functions: using rehabilitation measures a cognitive function improved in 4.8 points at the end of in-patient rehabilitation (p &lt; 0.001). The best improvement was in subject’s concentration, memory, and orientation in time and place.Keywords: stroke, functional status, rehabilitation.

Prompt Mental Health Care (PMHC): work participation and functional status at 12\u2009months post-treatment

BackgroundAnxiety and depression are associated with substantial functional impairment. Prompt Mental Health Care (PMHC), the Norwegian adaptation of IAPT is currently piloted across Norway, as a means to improve access to evidence-based care for adults with anxiety disorders (including subthreshold cases) and minor to moderate depression. The aims of the current paper were to examine the change in work status and functional status from pre- to post-treatment and 12 months post-treatment among clients at the first 12 PMHC pilot sites, and whether degree of change differed across sociodemographic characteristics.MethodsA prospective cohort design was used, including working age clients receiving treatment between October 2014 and December 2016 (n = 1446, participation rate = 61%). Work status and functional status were self-reported, the latter by the Work and Social Adjustment Scale (WSAS). Changes in work status and WSAS score were examined through multilevel models based on maximum likelihood estimation. Likelihood ratio tests were performed to determine whether the interaction between time and the respective background variables were statistically significant.ResultsA substantial increase in regular work participation was observed from pre- to post-treatment, which further had increased at 12 months post-treatment. The increase was driven by a corresponding reduction in proportion of clients working and receiving benefits (OR 0.38 [0.29–0.50] baseline to final treatment, OR = 0.19 [0.12–0.32] final treatment to 12-months post-treatment), while no statistically significant change was observed in proportion out of work. Large improvement (ES = − 0.89) in WSAS score was observed from pre- to post treatment. WSAS score at 12 months post-treatment remained at the post-treatment level.ConclusionsPrevious research has shown substantial symptom improvement among clients receiving treatment in PMHC. The current findings indicate that PMHC might also be able to aid adults struggling with mild to moderate anxiety and depression in returning to usual level of functioning. The degree to which the observed improvements are attributable to the treatment need nonetheless to be confirmed in a trial including a control group and with more complete follow-up data from registries.

DYNAMICS OF FUNCTIONAL CONDITION AND QUALITY OF LIFE IN PATIENTS WITH ASTHMA-COPD OVERLAP AND CONCOMITANT ARTERIAL HYPERTENSION AGAINST THE BACKGROUND OF COMPLEX THERAPY

Patients with ACO have significant poorer health-related quality of life and more severe functional limitations compared to asthma and COPD alone. Most commonly, chronic respiratory disease is associated with cardiovascular disease, such as arterial hypertension. However, the impact of concomitant cardiac diseases on the quality of life and functional status of patients with ACO remains poorly understood. The aim of the work was to study dynamics of functional condition and quality of life in with ACO and concomitant AH against the background of complex therapy. Materials and methods. We selected for participating in the study 100 patients with ACO and concomitant AH. Examination of the patients included: clinical methods, spirometry, and questinaries – mMRS, CAT, SGRQ, performing 6MWT. Results. After 16 weeks of treatment there were no changes in lung functional status in patients on standard treatment, at the same time, in group of patients who had an active rehabilitation program, there was a significant improvement in the bronchial response to the action of bronchodilators, although other indicators of the functional status of the lungs didn't show significant changes. Patients who additionally used an active rehabilitation program had a significant improvement in clinical symptoms, shortness of breath, and quality of life according to CAT, mMRC, and SGRQ scores, respectively. There was also a significant increase in distance during the 6MWT in this group of patients. Conclusions. Conducting an active rehabilitation program (physical rehabilitation in combination with an educational program and self-management) in group of patients with ACO and concomitant AH, who are on standard medical treatment, significantly improves the bronchial response to the action of bronchodilators, decreases clinical manifestations, shortness of breath and improve quality of life and exercise tolerance, according to CAT, mMRC, SGRQ and 6MWT questionnaires, respectively.

Medium-long-term mortality and change in functional status in elderly patients with pacemaker.

Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. We designed a prospective study to analyze the cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. An observational study including pacemaker implants in individual older than 70 years old in a single-center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long-term mortality, and functional status after implantation was undertaken. About 60% of patients were older than 80 years old. The third-degree atrioventricular blockage (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel Index and functional status in this subgroup of patients, 3 years after pacing. Long-term mortality in individuals older than 80 years old with pacemaker implantation was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.

Medium-long term mortality and change in functional status in elderly patients with pacemaker.

Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. We designed a prospective study to analyze cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. Observational study including pacemaker implants in individual older than 70 years old in a single center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long term mortality and functional status after implantation were undertaken. 60% of patients were older than 80 years old. Third-degree atrio-ventricular block (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001 respectively). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel index and functional status in this subgroup of patients, 3 years after pacing. Long-term mortality in individuals older than 80 years old with pacemaker implantation, was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.

Study of effectiveness of antibacterial therapy by the micro-spectral analysis method

The method of fluorescent spectral analysis using the metachromatic fluorescent «Stains all» dye allows finding out the ratio of nucleic acid and proteins in the epithelium of the mucous membrane ferruterous stomach in the control group and infected with Klebsiella pneumoniae. The dynamics of changes in these ratios reflects the special aspects of the functional state of the cells in this zone normally, with klebsiellez disease and in its treatment. In the control group, it stayed within the gradual increase in their functional activity respectively to the increase in the age of the chickens. The changes of functional status of these cells in the infected chickens were complicated, depending on both the impact of the agent and from the action of the “Enroflon” drug. These findings can be taken into account in the formation of a fundamentally new approach to the question of the creation of modern technologies of prevention and treatment of klebsiellez.

A multicenter randomized clinical trial to evaluate the efficacy of telemonitoring in patients with advanced heart and lung chronic failure. Study protocol for the ATLAN_TIC project

BackgroundUsing technologies of information and communication (TICs) is emerging in medical assistance. TICs application for medical assistance is promising. Its applicability in advanced heart and/or respiratory failure is still controversial because studies have shown methodological weakness which could put in danger their conclusions. Our objective is to evaluate efficacy of the application of home monitoring biological parameters in a multi-level model of coordinated clinical care for patients with chronic diseases with advanced heart (HF) and/or respiratory failure (RF) in comparison with conventional clinical care. Method/Design: Multicentric, phase III, randomized, parallel groups, controlled clinical trial. Patients with advanced HF and/or RF were eligible to participate. Patients received medical assistance by a multi-level model of coordinated clinical care with or without home monitoring. Follow up was performed until 180 days after inclusion. Primary efficacy outcome was defined as the percentage of patients with hospitalization/emergency room visits. Secondary efficacy outcomes were hospital admissions, admissions to hospital emergencies and Primary Care Emergencies, number of days of hospital stay, total cost per patient in euros, mortality, change in functional status, quality of life, assistance and technology devices. Intention to treat, as well as per protocol, and incremental cost-effectiveness analysis will be performed. The number of recruits patients per arm is set at 255, a total of 510 patients. DiscussionThis trial could provide some knowledge about the real impact of home monitoring for patients with advanced HF and/or RF within a multi-level model of integrated care.

Peer-Delivered Cognitive Behavioral Training to Improve Functioning in Patients With Diabetes: A Cluster-Randomized Trial.

Cognitive behavioral therapy (CBT)-based programs delivered by trained community members could improve functioning and pain in individuals who lack access to such programs. We tested the effectiveness of a peer-delivered diabetes self-management program integrating CBT principles in improving physical activity, functional status, pain, quality of life (QOL), and health outcomes in individuals with diabetes and chronic pain. In this community-based, cluster-randomized controlled trial, intervention participants received a 3-month, peer-delivered, telephone-administered program. Attention control participants received a peer-delivered general health advice program. Outcomes were changes in functional status and pain (Western Ontario and McMaster Universities Osteoarthritis Index), QOL (Short Form 12), and physiologic measures (hemoglobin A1c, systolic blood pressure, body mass index); physical activity was the explanatory outcome. Of 195 participants with follow-up data, 80% were women, 96% African Americans, 74% had annual income <$20,000, and 64% had high school education or less. At follow-up, compared with controls, intervention participants had greater improvement in functional status (-10 ± 13 vs -5 ± 18, P = .002), pain (-10.5 ± 19 vs -4.8 ± 21, P = .01), and QOL (4.8 ± 8.8 vs 3.8 ± 8.8, P = .001). Physiologic measures did not change significantly in either group. At 3 months, a greater proportion of intervention than control participants reported no pain or did other forms of exercise when pain prevented them from walking for exercise. This peer-delivered CBT-based intervention improved functioning, pain, QOL, and self-reported physical activity despite pain in individuals with diabetes and chronic pain. Trained community members can deliver effective CBT-based interventions in rural and under-resourced communities.

Patient, Caregiver, and Provider Perspectives on Challenges and Solutions to Individualization of Care in Hemodialysis: A Qualitative Study.

Background:Clinical settings often make it challenging for patients with kidney failure to receive individualized hemodialysis (HD) care. Individualization refers to care that reflects an individual’s specific circumstances, values, and preferences.Objective:This study aimed to describe patient, caregiver, and health care professional perspectives regarding challenges and solutions to individualization of care in people receiving in-center HD.Design:In this multicentre qualitative study, we conducted focus groups with individuals receiving in-center HD and their caregivers and semi-structured interviews with health care providers from May 2017 to August 2018.Setting:Hemodialysis programs in 5 cities: Calgary, Edmonton, Winnipeg, Ottawa, and Halifax.Participants:Individuals receiving in-center HD for more than 6 months, aged 18 years or older, and able to communicate in English were eligible to participate, as well as their caregivers. Health care providers with HD experience were recruited using a purposive approach and snowball sampling.Methods:Two sequential methods of qualitative data collection were undertaken: (1) focus groups and interviews with HD patients and caregivers, which informed (2) individual interviews with health care providers. A qualitative descriptive methodology guided focus groups and interviews. Data from all focus groups and interviews were analyzed using conventional content analysis.Results:Among 82 patients/caregivers and 31 health care providers, we identified 4 main themes: session set-up, transportation and parking, socioeconomic and emotional well-being, and HD treatment location and scheduling. Particular challenges faced were as follows: (1) session set-up: lack of preferred supplies, machine and HD access set-up, call buttons, bed/chair discomfort, needling options, privacy in the unit, and self-care; (2) transportation and parking: lack of reliable/punctual service, and high costs; (3) socioeconomic and emotional well-being: employment aid, finances, nutrition, lack of support programs, and individualization of treatment goals; and (4) HD treatment location and scheduling: patient displacement from their usual spot, short notice of changes to dialysis time and location, lack of flexibility, and shortages of HD spots.Limitations:Uncertain applicability to non-English speaking individuals, those receiving HD outside large urban centers, and those residing outside of Canada.Conclusions:Participants identified challenges to individualization of in-center HD care, primarily regarding patient comfort and safety during HD sessions, affordable and reliable transportation to and from HD sessions, increased financial burden as a result of changes in functional and employment status with HD, individualization of treatment goals, and flexibility in treatment schedule and self-care. These findings will inform future studies aimed at improving patient-centered HD care.

Lumbar microdiscectomy using intraoperative ultrasound

To analyze advisability of intraoperative ultrasound during lumbar microdiscectomy. We used intraoperative ultrasound to identify and localize various tissues and structures of the spinal canal, optimize surgical approach to the herniated disc and assess decompression of neural structures. The study was conducted in 48 patients with herniated discs of the lumbar spine who were operated for the period from 2014 to 2017. We used ultrasound devices BK Medical Pro Focus 2202 and BK Medical Flex Focus 400 with neurosurgical transducer Craniotomy 8862 and Burr-Hole 8863. Examinations were performed before and after flavotomy during neural decompression and after decompression. All patients underwent laboratory, clinical and instrumental survey. We analyzed changes of functional and neurological status and investigated various possibilities of intraoperative ultrasound and its impact on postoperative outcomes. Intraoperative ultrasound is valuable to verify various tissues and structures of the lumbar spine. On-line scanning gives a correct volumetric representation of the various anatomical structures and their spatial relationships that is essential for less traumatic and more radical surgery. Intraoperative ultrasound is easy, harmless, inexpensive and widely available method of intraoperative imaging. US data may be comparable with those of intraoperative CT and MRI. Intraoperative ultrasound during lumbar microdiscectomy results better postoperative outcomes.

The functional status, rehospitalization, and hospital cost reduction in geriatric patients after the implementation of the universal health coverage program in the national referral hospital Indonesia

BACKGROUND Universal health coverage program (UHCP) might implicate negatively toward geriatric care with its impact on higher cost. The evaluation had to be made, especially in functional status, rehospitalization, and cost-effectiveness.&#x0D; METHODS Retrospective cohort study with historical control was done. Seventy two geriatric inpatients in the pre-UHCP group and 86 in the UHCP group were recruited from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Subjects with geriatric syndromes admitted from July to December 2013 (pre-UHCP era) and January to June 2014 (UHCP era). Functional status changes, rehospitalization, and process indicators were observed. Cost reduction was calculated using the incremental cost-effectiveness ratio (ICER), whereby costs, functional status changes, and rehospitalization of both groups were used to identify the differences.&#x0D; RESULTS Proportions of functional status increase were 35.3% and 34.8% in the pre- UHCP and UHCP groups, respectively (p = 1.00) and the decrease were 5.9% and 4.5% in the pre-UHCP and UHCP group, respectively (p = 1.00). Rehospitalization rates were 21.7% and 18.1% (p = 0.603) in the pre-UHCP and UHCP groups, respectively. Mean hospital expenses were between 17.1 million IDR (1,221 USD; 1 USD = 14,000 IDR) for the pre-UHCP group and 20.8 million IDR (1,486 USD) for the UHCP group. ICER showed that hospitalization cost was 3.7 million IDR (264 USD) higher to increase 1 activity of daily living score in the UHCP era. As for rehospitalization, the cost was 600,000 IDR (43 USD) less, with 3.6% smaller in readmission.&#x0D; CONCLUSIONS There was no changes in patients’ functional status after the UHCP implementation. There was a reduction in rehospitalization with lower cost in the UHCP era.

Anterior gland focal cryoablation: proof-of-concept primary prostate cancer treatment in select men with localized anterior cancers detected by multi-parametric magnetic resonance imaging

BackgroundDue to their location away from the nerve bundles, anterior prostate cancers (APC) represent a rational target for image-guided cryoablation. This report describes the feasibility and short-term outcomes of anterior focal cryosurgery.MethodsA retrospective review between 2012 and 2016 of patients with clinically localized APC treated with anterior gland cryoablation was performed. Descriptive statistics were used to report: age, PSA, prostate volume, prostate cancer grade group (PGG), median time to follow-up, and changes in functional status measured with the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF-5) score.ResultsA total of 17 patients underwent anterior focal cryoablation with a median follow-up of 15 months. Median age and PSA at diagnosis were 67 years and 8.7 ng/mL. Pre-operative PGG1 was identified in 12 (71%) men and PGG2 in 5 (29%) men. Median (IQR) lesion volume was 2 mL(0.86, 3.1). Preoperative median IIEF-5 and IPSS scores were 19.5 and 5, and decreased to 19 and 4, post-operatively. All patients remained continent with no change in sexual function. All post-procedure targeted biopsies of the treated cancers were negative.ConclusionOur pilot study demonstrates the feasibility of treating APCs with image-guided targeted focal cryoablation as a good balance between short-term oncologic control and near complete preservation of genitourinary function. Further follow-up is necessary to examine the potential benefits long-term.