Change In Symptom Severity Score Research Articles

Comparison of the Effect of Out-of-plane and In-plane Injection Approaches on Injection Pain and Functionality in Patients with Carpal Tunnel Syndrome Undergoing Ultrasound-guided Injection: A Patient- and Assessor-blinded Randomized Study

ObjectivesThe aims were i) to compare the out-of-plane (OP) and in-plane (IP) approaches for carpal tunnel syndrome (CTS) in terms of pain during injection and post injection adverse effects, and ii) to investigate whether these approaches led to any difference in terms of pain/numbness, symptom severity, functionality, and median nerve cross-sectional area and to examine the relationship of these parameters with the pain during injection. DesignPatient/assessor blinded randomized study SettingHospital outpatient clinic. ParticipantsFifty patients with mild to moderate CTS. InterventionsThe participants were randomized into OP and IP (both n = 25) ultrasound-guided injection groups. Main outcome measuresEach patient reported the pain felt during the injection at 1 h thereafter, and also any adverse effects at 4 weeks after injection. Before and 4 weeks after injection, patients used a visual analog scale to indicate pain/numbness; symptom severity and functionality were assessed using the Boston Carpal Tunnel Syndrome Questionnaire. The cross-sectional area of the median nerve was also obtained. ResultsThe average pain during injection was 2.64±0.82 in the IP group and 1.96±0.86 in the OP group (p=0.017). Post-injection adverse effects were similar between the two groups (p<0.05). After injection, the percentage change in symptom severity was 49.8±11.8 in the IP group and 40.6±11.5 in the OP group (p=0.008). In the IP group, day pre-injection pain/numbness, night pain/numbness percentage change scores, and symptom severity percentage change scores were moderately correlated with the pain during injection (r=0.439, 0.469, and 0.429, respectively). ConclusionsIP injection caused greater pain during injection compared to OP injection and led to greater reduction in symptom severity at 1 month after injection. In that group, injection pain was associated with the baseline day pain score, change in night pain score, and change in symptom severity score.

Factors Influencing Time to Return to Learn Among NCAA Student-Athletes Enrolled in the Concussion Assessment, Research, and Education (CARE) Study.

The aim was to describe the demographic and post-injury factors that influence time to return to learn (RTL) among student-athletes enrolled in the Concussion Assessment, Research and Education (CARE) Consortium. A total of 47,860 student-athletes enrolled in the National Collegiate Athletic Association-Department of Defense (NCAA-DoD) CARE Consortium study from 2014 to 2020, with 1485 sport-related concussions (SRCs) analyzed in the present dataset. Demographic and post-injury characteristics were calculated using descriptive statistics, followed by Kaplan-Meier estimates to examine median time to return to normal academic performance (i.e., RTL) by sex (male, female), baseline psychiatric conditions (depression, anxiety) and/or learning disorder, NCAA division (I, II, III), SRC history (0, 1, 2, 3+), NCAA sport category (contact, limited contact, non-contact sport), and median difference in baseline/post-injury symptom severity scores (< 21, ≥ 21). Further, a multivariable zero-inflated negative binomial (ZINB) regression model was used to examine their association with RTL. Overall, time to RTL (mean = 4.96 ± 8.24days, median = 3.0 [interquartile range = 0.0, 6.0] days) was found to be influenced by several factors resulting in earlier trajectories. Notably, nearly 25% of the sample demonstrated immediate RTL (i.e., 0days). Among student-athletes who did not immediately RTL, males demonstrated a decreased rate in RTL (rate = 0.79; 95% CI 0.66-0.96) compared to females. Further, student-athletes with a ≥ 21 change in symptom severity score (post-injury baseline) demonstrated a higher rate of RTL (rate = 1.47; 95% CI 1.21-1.79) compared to student-athletes with a symptom severity change score < 21. Lastly, male student-athletes demonstrated two times higher odds (odds ratio = 1.95; 95% CI 1.02-3.73) of immediate RTL compared to female student-athletes. No other covariates were associated with time to RTL. Collectively, the present findings suggest a rapid return to the classroom following concussion. Specifically, males demonstrated higher odds of time to RTL, whereas those with greater differences in symptom severity resulted in a higher rate of time to RTL among those who did not immediately RTL. Ultimately, these findings support prior work emphasizing an individualized approach to SRC management.

Obinutuzumab Can Be Administered as a 90-minute Short Duration Infusion in Patients With Previously Untreated Follicular Lymphoma: GAZELLE End of Induction Analysis.

Obinutuzumab Can Be Administered as a 90-minute Short Duration Infusion in Patients With Previously Untreated Follicular Lymphoma: GAZELLE End of Induction Analysis.

Comparison of polyvinyl alcohol particles and tris-acryl gelatin microspheres embolic agents used in uterine artery embolization: A systematic review and meta-analysis.

To identify the preferred agent by comparing the therapeutic efficacy, degree of infarction, and side effects of polyvinyl alcohol particles (PVA) and tris-acryl gelatin embolization (TAGM) agents in uterine artery embolization. We included available articles comparing PVA with TAGM embolization agents in the management of fibroids. The primary outcomes included the decrease in uterine volume (%), decrease in dominant tumor volume (%), fibroid infarction rate, complete infarction fibroid, complications, pain score after 24 h, procedure time (minutes), duration of hospital stay, fluoroscopy time (minutes), and the change in symptom severity score. Eight articles that met our inclusion criteria were included in this study. Our analysis yielded an overall superiority of PVA compared to TAGM regarding complete fibroid infarction rate at the first 24 h. However, TAGM was better than PVA concerning <90% infarction rate outcome. While both embolization techniques showed similar effects regarding the change in symptom severity score, the percentage of decrease in uterine volume, percentage of decrease of dominant tumor volume, 90-99% infarction rate, complete infarction rate when assessed after the first 24 h, pain score after the first 24 h, procedure time, fluoroscopy time, minor, and major complications. Both PVA and TAGM embolization agents are effective and safe modalities in treating patients with fibroids, with no significant variation of both agents in most outcomes.

One year effectiveness of an app-based treatment for urinary incontinence in comparison to care as usual in Dutch general practice: A pragmatic randomised controlled trial over 12 months.

ObjectiveTo assess the long‐term effectiveness of app‐based treatment for female stress, urgency or mixed urinary incontinence (UI) compared with care‐as‐usual in primary care.DesignA pragmatic, randomised controlled, superiority trial.SettingPrimary care in the Netherlands from 2015 to 2018, follow up at 12 months.PopulationWomen with two or more UI episodes per week and access to mobile apps, wanting treatment. A total of 262 women were randomised equally to app or care‐as‐usual; 89 (68%) and 83 (63%) attended 1 year follow up.InterventionsThe standalone app included conservative management for UI with motivation aids (e.g. reminders). Care‐as‐usual was delivered according to the Dutch GP guideline for UI.Main outcome measuresEffectiveness assessed by the change in symptom severity score (ICIQ‐UI‐SF) and the change in quality of life (ICIQ‐LUTSqol) with linear regression on an intention‐to‐treat basis.ResultsClinically relevant improvement of UI severity for both app (−2.17 ± 2.81) and care‐as‐usual (−3.43 ± 3.6) groups, with a non‐significant mean difference of 0.903 (−0.66 to 1.871).ConclusionApp‐based treatment is a viable alternative to care‐as‐usual for UI in primary care in terms of effectiveness after 1 year.Tweetable abstractApp‐based treatment for female urinary incontinence is a viable alternative to care‐as‐usual after 12 months.

Extended Follow-up of Local Steroid Injection for Carpal Tunnel Syndrome

Local steroid injection is commonly used in treating patients with idiopathic carpal tunnel syndrome, but evidence regarding long-term efficacy is lacking. To assess the long-term treatment effects of local steroid injection for carpal tunnel syndrome. This exploratory 5-year extended follow-up of a double-blind, placebo-controlled randomized clinical trial was conducted from November 2008 to March 2012 at a university hospital orthopedic department. Participants included patients aged 22 to 69 years with primary idiopathic carpal tunnel syndrome and no prior treatment with local steroid injections. Data were analyzed from May 2018 to August 2018. Patients were randomized to injection of 80 mg methylprednisolone, 40 mg methylprednisolone, or saline. The coprimary outcomes were the symptom severity score and rate of subsequent carpal tunnel release surgery on the study hand at 5 years. Secondary outcomes were time from injection to surgical treatment, SF-36 bodily pain score, and score on the 11-item disabilities of the arm, shoulder, and hand scale. A total of 111 participants (mean [SD] age at follow-up, 52.9 [11.6] years; 81 [73.0%] women and 30 [27.0%] men) were randomized, with 37 in the 80 mg methylprednisolone group, 37 in the 40 mg methylprednisolone group, and 37 in the saline placebo group. Complete 5-year follow-up data were obtained from all 111 participants with no dropouts (100% follow-up). At baseline, mean (SD) symptom severity scores were 2.93 (0.85) in the 80 mg methylprednisolone group, 3.13 (0.70) in the 40 mg methylprednisolone group, and 3.18 (0.75) in the placebo group, and at the 5-year follow up, mean (SD) symptom severity scores were 1.51 (0.66) in the 80 mg methylprednisolone group, 1.59 (0.63) in the 40 mg methylprednisolone group, and 1.67 (0.74) in the placebo group. Compared with placebo, there was no significant difference in mean change in symptom severity score from baseline to 5 years for the 80 mg methylprednisolone group (0.14 [95%CI, -0.17 to 0.45]) or the 40 mg methylprednisolone group (0.12 [95%CI, -0.19 to 0.43]). After injection, subsequent surgical treatment on the study hand was performed in 31 participants (83.8%) in the 80 mg methylprednisolone group, 34 participants (91.9%) in the 40 mg methylprednisolone group, and 36 participants (97.3%) in the placebo group; the number of participants who underwent surgical treatment between the 1-year and 5-year follow-ups was 4 participants (10.8%) in the 80 mg methylprednisolone group, 4 participants (10.8%) in the 40 mg methylprednisolone group, and 2 participants (5.4%) in the placebo group. All surgical procedures were conducted while participants and investigators were blinded to type of injection received. The mean (SD) time from injection to surgery was 180 (121) days in the 80 mg methylprednisolone group, 185 (125) days in the 40 mg methylprednisolone group, and 121 (88) days in the placebo group. Kaplan-Meier survival curves showed statistically significant difference in time to surgical treatment (log-rank test: 80 mg methylprednisolone vs placebo, P = .002 ; 40 mg methylprednisolone vs placebo, P = .02; methylprednisolone 80 mg vs 40 mg, P = .37). These findings suggest that in idiopathic carpal tunnel syndrome, local methylprednisolone injection resulted in statistically significant reduction in surgery rates and delay in need for surgery. ClinicalTrials.gov Identifiers: NCT00806871 and NCT02652390.

App-Based Treatment in Primary Care for Urinary Incontinence: A Pragmatic, Randomized Controlled Trial.

Electronic application (app)-based treatment is promising for common diseases with good conservative management options, such as urinary incontinence (UI) in women, but its effectiveness compared with usual care is unclear. This study set out to determine if app-based treatment for women with stress, urgency, or mixed UI was noninferior to usual care in the primary care setting. The URinControl trial is a pragmatic, noninferiority randomized controlled trial in Dutch primary care including adult women with 2 episodes of UI per week. From July 2015 to July 2018, we screened 350 women for eligibility. A stand-alone app-based treatment with pelvic floor muscle and bladder training (URinControl) was compared with usual care according to the Dutch general practitioner guideline for UI treatment. Outcomes measured were change in symptom severity score from baseline to 4 months (primary outcome), impact on disease-specific quality of life, patient-perceived improvement, and number of UI episodes. Noninferiority (<1.5 points) was assessed with linear regression analysis. A total of 262 eligible women were randomized equally; 195 of them had follow-up through 4 months. The change in symptom severity with app-based treatment (-2.16 points; 95% CI, -2.67 to -1.65) was noninferior to that with usual care (-2.56 points; 95% CI, -3.28 to -1.84), with a mean difference of 0.058 points (95% CI, -0.776 to 0.891) between groups. Neither treatment was superior to the other, and both groups showed improvements in outcome measures after treatment. App-based treatment for women with UI was at least as effective as usual care in the primary care setting. As such, app-based treatments, with their potential advantages of privacy, accessibility, and lower cost, may provide women with a good alternative to consultation.

Genome-wide association study and polygenic risk score analysis of esketamine treatment response

To elucidate the genetic underpinnings of the antidepressant efficacy of S-ketamine (esketamine) nasal spray in major depressive disorder (MDD), we performed a genome-wide association study (GWAS) in cohorts of European ancestry (n = 527). This analysis was followed by a polygenic risk score approach to test for associations between genetic loading for psychiatric conditions, symptom profiles and esketamine efficacy. We identified a genome-wide significant locus in IRAK3 (p = 3.57 × 10–8, rs11465988, β = − 51.6, SE = 9.2) and a genome-wide significant gene-level association in NME7 (p = 1.73 × 10–6) for esketamine efficacy (i.e. percentage change in symptom severity score compared to baseline). Additionally, the strongest association with esketamine efficacy identified in the polygenic score analysis was from the genetic loading for depressive symptoms (p = 0.001, standardized coefficient β = − 3.1, SE = 0.9), which did not reach study-wide significance. Pathways relevant to neuronal and synaptic function, immune signaling, and glucocorticoid receptor/stress response showed enrichment among the suggestive GWAS signals.

Changes in Symptom Occurrence and Severity Before and After Lung Cancer Surgery

Patients need information about the course of recovery after surgery for lung cancer, but knowledge about symptoms in this period is limited. The purpose of this study was to assess for changes in symptom occurrence rates and severity scores from the preoperative period to 1 month after surgery. Patients (n = 228) completed questionnaires before and at 1 month after surgery. McNemar tests were used to evaluate for changes over time in symptom occurrence rates and paired t tests for changes in symptom severity scores. General linear model was used to determine if select demographic and clinical characteristics were associated with the number of symptoms after surgery. The total number of symptoms increased significantly from the preoperative (mean, 9.4) to the postoperative (mean, 13.1) assessment. Of the 11 symptoms that occurred in 50% or more of the patients 1 month after surgery, 8 increased significantly in both occurrence and severity. Four symptoms were experienced by more than 80% of the patients 1 month after surgery: shortness of breath (85.5%), lack of energy (83.8%), pain (83.8%), and feeling drowsy (82.5%). Patients experienced a high number of symptoms after lung cancer surgery. The only characteristic that was associated with a higher number of symptoms 1 month after surgery was the number of symptoms reported preoperatively. These findings can be used to educate patients about the normal course of postoperative recovery. Clinicians need to assess for these symptoms and develop effective interventions to improve symptom management for these patients.

Short-term and long-term response to pulmonary exacerbation treatment in cystic fibrosis

BackgroundTreatment of pulmonary exacerbations (PEx) in cystic fibrosis (CF) varies widely with no consensus on management practices or best indicators of therapeutic success. To design trials evaluating PEx treatment factors,...

A retrospective comparison of microwave ablation and high intensity focused ultrasound for treating symptomatic uterine fibroids

ObjectivesTo retrospectively compare the effectiveness and safety of percutaneous microwave ablation (PMWA) and ultrasound-guided high-intensity focused ultrasound (USgHIFU) for treating symptomatic uterine fibroids. MethodsSeventy-three women with symptomatic uterine fibroids who met the inclusion criteria were enrolled in our study from September 2012 to December 2013. Thirty-one patients with forty uterine fibroids underwent PMWA, and forty-two patients with fifty-one uterine fibroids underwent USgHIFU. A contrast-enhanced MRI was performed before and after treatment, and all patients were followed up for 6 months. Assessment endpoints included symptom severity scores (SSS), treatment time, ablation rate, fibroid regression rate and adverse events. ResultsThe mean age of the patients in our study was 35.4±6.2 years (range, 21–49 years), and the median volume of uterine fibroids was 95.7cm3 (60.3–131.5cm3). The ablation rate of uterine fibroids was 79.8±18.2% and 77.1±14.9% in the PMWA group and the USgHIFU group, respectively, and showed no significant difference between the groups. Changes in SSS after PMWA were similar in the PMWA group (47.7 pre-treatment vs. 29.9 post-treatment) and USgHIFU group (42.1 pre-treatment vs. 24.6 post-treatment). The regression rate of uterine fibroids also showed no marked difference between the two groups (PMWA, 50.3%; USgHIFU, 52.4%). The median treatment time of the PMWA group was 46.2min, which was demonstrably superior to USgHIFU. Finally, the occurrence rate of adverse events was the same in the two groups. ConclusionsThe safety and effectiveness of PMWA and USgHIFU in the treatment of uterine fibroids were similar; however, the median treatment time of PMWA was shorter than that of USgHIFU.

Midterm Results after Uterine Artery Embolization Versus MR-Guided High-Intensity Focused Ultrasound Treatment for Symptomatic Uterine Fibroids

To compare the rate of reintervention and midterm changes in symptom severity (SS) and Total health-related quality of life (HRQoL) scores after uterine artery embolization (UAE) and magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Eighty women (median age 38.3 years), equally eligible for MR-g HIFU and UAE who underwent one of both treatments between 2002 and 2009 at our institution, were included. The primary end point of the study was defined as the rate of reintervention after both therapies. The secondary outcome was defined as changes in SS and Total HRQoL scores after treatment. SS and Total HRQoL scores before treatment and at midterm follow-up (median 13.3 months) were assessed by the uterine fibroid symptom and quality-of-life questionnaire (UFS-QoL) and compared. The rate of reintervention was significantly lower after UAE than after MR-g HIFU (p = 0.002). After both treatments, SS and Total HRQoL scores improved significantly from baseline to follow-up (UAE: p < 0.001, p < 0.001; MR-g HIFU: p = 0.002, p < 0.001). Total HRQoL scores were significantly higher after UAE than after MR-g HIFU (p = 0.032). Changes in the SS scores did not differ significantly for both treatments (p = 0.061). UAE and MR-g HIFU significantly improved the health-related quality of life of women with symptomatic uterine fibroids. After UAE, the change in Total HRQoL score improvement was significantly better, and a significantly lower rate of reintervention was observed.

T1706 BMI is Superior to Symptom Characteristics or Esophageal pH Metry in Predicting Response to PPI Therapy in Patients With Normal Endoscopy

Background: Most patients with upper gastrointestinal symptoms are now H. pylori negative and no abnormalities are seen at endoscopy. Proton pump inhibitors (PPIs) are usually prescribed to these patients, though only a proportion benefit. Aim: To identify factors predicting response to PPI therapy in patients with upper GI symptoms and normal endoscopy. Methods: 105 patients with upper gastrointestinal symptoms of >3 months, normal endoscopy and HP-ve tests were prospectively recruited. Patients with hiatus hernia or taking NSAIDs were excluded. Character of symptoms and lifestyle factors were assessed by validated questionnaires and baseline severity over 7 days. The predominant symptom was retrosternal discomfort in 43, epigastric discomfort in 42, nausea/vomiting in 10, fullness/satiety in 1 and other symptoms in 6. Their median BMI was 26 (range 17.6-40.4) with 39% overweight and 20% obese. 24h esophageal pH monitoring and manometry of the lower esophageal sphincter (LES) by perfusion pull through technique (1cm every minute) was performed. Patients were then randomised in double-blind fashion to two weeks daily treatment with 2/3 receiving lansoprazole 30mg/day and 1/3 placebo. Symptomswere re-assessed throughout the second week of treatment, with the primary outcome being absolute change in symptom severity score (Glasgow Dyspepsia Score). Results: 102 individuals were treated (69 randomised to Lansoprazole, 33 to placebo). The mean pre-treatment symptom score in the active treatment group was 10.4 (SD 2.2) and in placebo 10.9 (SD2.7). The mean reduction in score following active treatment was 3.8 (SD 3.8) vs 0.6 (SD 2.1) following placebo (p<0.001). Within the PPI treated group, univariate analysis showed that BMI, LES pressure, LES abdominal length and % time esophageal pH<4 were statistically significant predictors of response. Multivariate regression modelling revealed that in the best model only BMI (p= 0.003) and LES abdominal length (p=0.013) were independent predictors of response (Rsquared = 19.4%). Neither predominant symptom nor any other symptom characteristic predicted response. Conclusion: This study indicates the lack of value of detailed symptom assessment in predicting response to PPI therapy. The strong predictive value of BMI is likely to be due to its association with gastroesophageal reflux which will respond to PPI therapy and highlights the important role of BMI in reflux disease.

PWE-081 Body mass index is superior to symptom characteristics or oesophageal pH-metry in predicting response to proton pump inhibitors therapy in patients with normal endoscopy

Introduction Most patients with upper gastrointestinal symptoms are now H pylori negative and no abnormalities are seen at endoscopy. Proton pump inhibitors (PPIs) are usually prescribed to these patients, though only a proportion benefit. Aim To identify factors predicting response to PPI therapy in patients with upper GI symptoms and normal endoscopy. Methods 105 patients with upper gastrointestinal symptoms of >3 months, normal endoscopy and HP-ve tests were prospectively recruited. Patients with hiatus hernia or taking NSAIDs were excluded. Character of symptoms and lifestyle factors were assessed by validated questionnaires and baseline severity over 7 days. The predominant symptom was retrosternal discomfort in 43, epigastric discomfort in 42, nausea/vomiting in 10, fullness/satiety in 1 and other symptoms in 6. Their median BMI was 26 (range 17.6–40.4) with 39% overweight and 20% obese. 24 h oesophageal pH monitoring and manometry of the lower oesophageal sphincter (LOS) by perfusion pull through technique (1 cm every minute) was performed. Patients were then randomised in double-blind fashion to 2 weeks daily treatment with 2/3 receiving lansoprazole 30 mg/day and 1/3 placebo. Symptoms were re-assessed throughout the second week of treatment, with the primary outcome being absolute change in symptom severity score (Glasgow Dyspepsia Score). Results 102 individuals were treated (69 randomised to Lansoprazole, 33 to placebo). The mean pre-treatment symptom score in the active treatment group was 10.4 (SD 2.2) and in placebo 10.9 (SD2.7). The mean reduction in score following active treatment was 3.8 (SD 3.8) vs 0.6 (SD 2.1) following placebo (p 2 =19.4%). Neither predominant symptom nor any other symptom characteristic predicted response. Conclusion This study indicates the lack of value of detailed symptom assessment in predicting response to PPI therapy. The strong predictive value of BMI is likely to be due to its association with gastro-oesophageal reflux which will respond to PPI therapy and highlights the important role of BMI in reflux disease.

Gonadotrophin-Releasing Hormone and Magnetic-Resonance–Guided Ultrasound Surgery for Uterine Leiomyomata

Magnetic-resonance-guided focused ultrasound is a novel, noninvasive technique of thermoablation for uterine leiomyomata. The hypothesis of this study was that pretreatment of leiomyomata with gonadotrophin-releasing hormone (GnRH) agonists would allow effective treatment of larger uterine leiomyomata, increasing the number of women who could benefit from this technique. We report a prospective study of women with leiomyomata in excess of 10 cm in diameter who received GnRH agonist before magnetic-resonance-guided focused ultrasound treatment. Eligible participants were recruited from the gynecology outpatient clinics. Entry criteria were a minimal leiomyoma symptom severity score and confirmation of uterine dimensions based on screening magnetic resonance imaging. These women received a 3-month course of GnRH agonists followed by magnetic-resonance-guided focused ultrasound treatment. The primary outcome measurement was reported change in symptom severity score as judged by the Uterine Fibroid Symptom and Quality of Life questionnaire. Comparison was made at enrollment, treatment, and at 3, 6, and 12 months posttreatment. A secondary outcome was the measured change in target leiomyoma volume. Forty-nine women were enrolled in the study. There was a 45% reduction in median symptom severity score at 6 months and 48% at 12 months posttreatment, with 83% of women achieving at least a 10-point reduction in symptom scoring at 6 months and 89% at 12 months (P < .001). There was an average reduction in target leiomyoma volume of 21% overall at 6 months (P < .001) and 37% at 12 months (P < .001). No serious infective complications or emergency operative interventions were recorded. The use of GnRH agonist therapy before magnetic-resonance-guided focused ultrasound improves the thermoablative treatment effect. II-3.