Distal Outcomes Research Articles

A systematic review of the association between interpretations and immediate, intermediate, and distal outcomes.

Interpretations are a hallmark of psychodynamic treatment and a method used in other theoretical orientations as well. Therapists use interpretations to increase patients' insight concerning unconscious and preconscious elements in their lives, with the ultimate aim to reduce mental pain and suffering and improve mental health. This systematic review focuses on the association between the therapists' use and accuracy of interpretation and immediate (within-session), intermediate (between-session), and distal (end-of-treatment) outcomes. This synthesis of the research literature is based on 18 independent samples of 1,011 total patients in individual psychotherapy. The results suggest that the use and accuracy of interpretations were associated, in half the studies, with patient disclosure of emotions and increased insight at the immediate, moment-to-moment enfolding of the session. At the intermediate postsession outcome, the use of interpretations was associated with a stronger alliance and greater depth, in half the studies. At the end of treatment, however, while there is some evidence for a positive effect of the use of interpretations on treatment success, there are also neutral effects and even evidence that interpretations have the potential to be harmful in some particular situations. The article concludes with training implications and therapeutic practices based on the integration of clinical experience and research evidence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Skills and methods that work in psychotherapy: Observations and conclusions from the special issue.

We draw recommendations and conclusions from the articles presented in this special issue and the companion special section in Psychotherapy Research on evidence-based therapist skills and methods. For distal (end-of-treatment) outcome, 10 skills/methods were judged to be demonstrably effective (affirmation/validation, paradoxical interventions, homework, routine outcome monitoring, strength-based methods, emotional regulation, imagery rehearsal therapy and exposure relaxation and rescripting therapy for nightmares, meditation/mindfulness/acceptance, behavioral activation, cognitive restructuring) and four were probably effective (rupture repair, role induction, collaborative assessment methods, chairwork). For intermediate (postsession or midtreatment) outcome, one method was judged to be demonstrably effective (cognitive-experiential dreamwork) and two methods probably effective (paradoxical interventions, homework). For immediate (in-session) outcomes, five skills/methods were judged to be probably effective (in-dialog silences, extended silences, role induction, strength-based methods, and emotion regulation). For the rest of the immediate, intermediate, or distal outcomes for skills/methods, there was either no or insufficient research available upon which to base judgments. Possible harmful effects, diversity considerations, and research limitations are summarized. The article ends with training implications, therapeutic practices, and the formal conclusions of the interorganizational Task Force on Psychotherapy Skills and Methods that Work. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A systematic research review of collaborative assessment methods.

Collaborative assessment methods (CAMs) involve working with clients during all phases of the assessment process, from goal definition to interpretation of the testing results to the recommendations and conclusions. In this article, we define CAMs, provide clinical examples, and then meta-analyze the published literature to assess their effectiveness on distal treatment outcomes. Our meta-analytic results indicate that CAMs have positive effects on three outcome domains: a moderate effect on treatment processes, a small-to-moderate effect on personal growth, and a small effect on symptom reduction. There is little research evidence on the immediate, in-session effects of CAMs. We include diversity considerations, training implications. and therapeutic practices grounded in this research evidence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Correction to Ryum et al. (2023).

Reports an error in "Integrating between-session homework in psychotherapy: A systematic review of immediate in-session and intermediate outcomes" by Truls Ryum, Mia Bennion and Nikolaos Kazantzis (Psychotherapy, Advanced Online Publication, Apr 27, 2023, np). In the article (https://doi.org/10.1037/ pst0000488), the number of included studies in Figure 2 omitted two studies that were added to the literature synthesis. Therefore, the following has been added to the Reports excluded box in Figure 2: A further two studies were added to the research synthesis by author knowledge. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2023-66181-001.) This article reviews the evidence for between-session homework (BSH) in individual psychotherapy. Whereas previous reviews have demonstrated a positive association between-client compliance with BSH and distal treatment outcomes; here, we pay particular attention to therapist behaviors that may promote client engagement with BSH assessed as immediate (in-session) and intermediate (session-to-session) outcomes, and moderators of these effects. For our systematic review, we identified 25 studies with 1,304 clients and 118 therapists, mostly on cognitive behavioral therapy such as exposure-based treatments with depression and anxiety disorders. A box score approach was utilized to summarize findings. Results for immediate outcomes were mixed but neutral. Results for intermediate outcomes were positive. Presenting a convincing rationale, being flexible in collaboratively designing, planning, and reviewing homework tasks in accordance with the clients' goals, aligning BSH with the clients' takeaways from the session and providing a written summary of homework and rationale, are some therapist behaviors that can promote client engagement with BSH. We conclude with research limitations, training implications, and therapeutic practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Working with dreams and nightmares: A review of the research evidence.

In this article, we describe methods for working with dreams and nightmares in individual psychotherapy, provide clinical examples, and review research evidence of immediate and distal outcomes of each method. An original meta-analysis of eight studies using the cognitive-experiential dream model with 514 clients showed moderate effect sizes for session depth and insight gains. In the nightmare treatment literature, a previous meta-analysis of 13 studies with 511 clients showed moderate to large effects in reducing nightmare frequency and small to moderate effects in decreasing sleep disturbance for imagery rehearsal therapy and exposure, relaxation, and rescripting therapy. Limitations of the current meta-analysis of cognitive-experiential dreamwork and of the reviewed research on nightmare methods are described. Training implications and therapeutic practice recommendations are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of a clinic-based reproductive empowerment intervention on proximal outcomes of contraceptive use, self-efficacy, attitudes, and awareness and use of survivor services: a cluster-controlled trial in Nairobi, Kenya

This study was undertaken to evaluate the effect of a reproductive empowerment contraceptive counselling intervention (ARCHES) adapted to private clinics in Nairobi, Kenya on proximal outcomes of contraceptive use and covert use, self-efficacy, awareness and use of intimate partner violence (IPV) survivor services, and attitudes justifying reproductive coercion (RC) and IPV. We conducted a cluster-controlled trial among female family planning patients (N = 659) in six private clinics non-randomly assigned to ARCHES or control in and around Nairobi, Kenya. Patients completed interviews immediately before (baseline) and after (exit) treatment and at three- and six-month follow-up. We use inverse probability by treatment weighting (IPTW) applied to difference-in-differences marginal structural models to estimate the treatment effect using a modified intent-to-treat approach. After IPTW, women receiving ARCHES contraceptive counselling, relative to controls, were more likely to receive a contraceptive method at exit (86% vs. 75%, p < 0.001) and had a significantly greater relative increase in awareness of IPV services at from baseline to three- (beta 0.84, 95% CI 0.13, 1.55) and six-month follow-up (beta 0.92, 95% CI 0, 1.84) and a relative decrease in attitudes justifying RC from baseline to six-month follow-up (beta −0.34, 95% CI −0.65, −0.04). In the first evaluation of a clinic-based approach to address both RC and IPV in a low- or middle-income country (LMIC) context, we found evidence that ARCHES contraceptive counselling improved proximal outcomes related to contraceptive use and coping with RC and IPV. We recommend further study and refinement of this approach in Kenya and other LMICs. Plain Language Summary Reproductive coercion (RC) and intimate partner violence (IPV) are two forms of gender-based violence that are known to harm women’s reproductive health. While one intervention, ARCHES – Addressing Reproductive Coercion in Health Settings, has shown promise to improve contraceptive use and help women cope with RC and IPV in the United States, no approach has been proven effective in a low- or middle-income country (LMIC) context. In the first evaluation of a reproductive empowerment contraceptive counselling intervention in an LMIC setting, we found that ARCHES contraceptive counselling, relative to standard contraceptive counselling, improved proximal outcomes on contraceptive uptake, covert contraceptive use, awareness of local violence survives, and reduced attitudes justifying RC among women seeking contraceptive services in Nairobi, Kenya. Distal outcomes will be reported separately. Findings from this study support the promise of addressing RC and IPV within routine contraceptive counselling in Kenya on women’s proximal outcomes related to contraceptive use and coping with violence and coercion and should be used to inform the further study of this approach in Kenya and other LMICs.

Implementing traumatic brain injury screening in behavioral health treatment settings: results of an explanatory sequential mixed-methods investigation

BackgroundTraumatic brain injury (TBI) is a complex condition common among individuals treated in behavioral healthcare, but TBI screening has not been adopted in these settings which can affect optimal clinical decision-making. Integrating evidence-based practices that address complex health comorbidities into behavioral healthcare settings remains understudied in implementation science, limited by few studies using theory-driven hypotheses to disentangle relationships between proximal and medial indicators on distal implementation outcomes. Grounded in the Theory of Planned Behavior, we examined providers’ attitudes, perceived behavioral control (PBC), subjective norms, and intentions to adopt The Ohio State University TBI Identification Method (OSU TBI-ID) in behavioral healthcare settings.MethodsWe used an explanatory sequential mixed-methods design. In Phase I, 215 providers from 25 organizations in the USA completed training introducing the OSU TBI-ID, followed by a survey assessing attitudes, PBC, norms, and intentions to screen for TBI. After 1 month, providers completed another survey assessing the number of TBI screens conducted. Data were analyzed using structural equation modeling (SEM) with logistic regressions. In Phase II, 20 providers were purposively selected for semi-structured interviews to expand on SEM results. Qualitative data were analyzed using thematic analysis, integrated with quantitative results, and combined into joint displays.ResultsOnly 25% (55/215) of providers adopted TBI screening, which was driven by motivations to trial the intervention. Providers who reported more favorable attitudes (OR: 0.67, p < .001) and greater subjective norms (OR: 0.12, p < .001) toward TBI screening demonstrated increased odds of intention to screen, which resulted in greater TBI screening adoption (OR: 0.30; p < .01). PBC did not affect intentions or adoption. Providers explained that although TBI screening can improve diagnostic and clinical decision-making, they discussed that additional training, leadership engagement, and state-level mandates are needed to increase the widespread, systematic uptake of TBI screening.ConclusionsThis study advances implementation science by using theory-driven hypothesis testing to disentangle proximal and medial indicators at the provider level on TBI screening adoption. Our mixed-methods approach added in-depth contextualization and illuminated additional multilevel determinants affecting intervention adoption, which guides a more precise selection of implementation strategies.

Help-seeking at work: an integrative review, organizing framework and agenda for future research

PurposeThe literature on help-seeking at work has experienced significant growth in the past decades. However, our knowledge about this research domain remains fragmented and lacks sufficient theoretical integration. Therefore, this paper aims to comprehensively integrate the extant literature on help-seeking behavior at work and propose an overarching, organized framework to propel this field forward.Design/methodology/approachA state-of-the-art review and theoretical development on help-seeking at work are conducted.FindingsFirst, the authors provide the conceptual clarity of its definitions, key characteristics, types and measurement techniques. Second, the authors develop a fine-grained and integrative process-based framework consisting of antecedents, proximal psychological mechanisms, subsequent influencing processes and distal outcomes to advance our understanding of seeking help in the workplace. Third, the authors offer a detailed agenda for future research to target opportunities within the field.Originality/valueThe current study is comprehensive in surveying the full body of knowledge on help-seeking at work. It uniquely provides a coherent overarching framework that organizes prior findings and channels future research. Additionally, this review paints a complete picture of what has been done and what needs to be done in the field. More research can be spurred based on our conceptual framework.

Relationship between survivorship care plans and unmet information needs, quality of life, satisfaction with care, and propensity to engage with, and attend, follow-up care.

The impact of survivorship care plans (SCPs) on the proximal and distal outcomes of adult and childhood cancer survivors, and parent proxies, is unclear. This study aimed to determine the relationship between SCP receipt and these outcomes. A cross-sectional survey of adult and childhood cancer survivors (and parent proxies for survivors aged younger than 16years) across Australia and New Zealand was conducted. Multivariate regression models were fitted to measure the impact of SCP receipt on proximal (unmet information needs and propensity to engage with, and attend, cancer-related follow-up care) and distal outcomes (quality of life and satisfaction with cancer-related follow-up care) with control for cancer history and sociodemographic factors. Of 1123 respondents, 499 were adult cancer survivors and 624 were childhood cancer survivors (including 222 parent proxies). We found that SCP receipt was predictive of greater attendance at, and awareness of, cancer-related follow-up care (adult: odds ratio [OR],2.46; 95% CI,1.18-5.12; OR,2.38; 95% CI,1.07-5.29; child/parent: OR,2.61; 95% CI,1.63-4.17; OR,1.63; 95% CI,1.06-2.50; respectively). SCP receipt also predicted fewer unmet information needs related to "follow-up care required" and "possible late effects" (adult: OR, 0.44; 95% CI,0.20-0.96; OR,0.29; 95% CI,0.13-0.64; child/parent: OR,0.46; 95% CI,0.30-0.72; OR,0.57; 95% CI, 0.38-0.85; respectively). In terms of distal outcomes, SCP receipt predicted a better global quality of life for adult cancer survivors (β,0.08; 95% CI,-0.01-7.93), proxy-reported health-related quality of life (β,0.15; 95% CI,0.44-7.12), and satisfaction with follow-up care for childhood cancer survivors (OR,2.93; 95% CI,1.64-5.23). Previous studies have shown little impact of SCPs on distal end points. Results suggest that SCPs may be beneficial to cancer survivors' proximal and distal outcomes.

Depth camera-based model for studying the effects of muscle loading on distal radius fracture healing

BackgroundDistal radius fractures (DRFs) treated with volar locking plates (VLPs) allows early rehabilitation exercises favourable to fracture recovery. However, the role of rehabilitation exercises induced muscle forces on the biomechanical microenvironment at the fracture site remains to be fully explored. The purpose of this study is to investigate the effects of muscle forces on DRF healing by developing a depth camera-based fracture healing model. MethodFirst, the rehabilitation-related hand motions were captured by a depth camera system. A macro-musculoskeletal model is then developed to analyse the data captured by the system for estimating hand muscle and joint reaction forces which are used as inputs for our previously developed DRF model to predict the tissue differentiation patterns at the fracture site. Finally, the effect of different wrist motions (e.g., from 60° of extension to 60° of flexion) on the DRF healing outcomes will be studied. ResultsMuscle and joint reaction forces in hands which are highly dependent on hand motions could significantly affect DRF healing through imposed compressive and bending forces at the fracture site. There is an optimal range of wrist motion (i.e., between 40° of extension and 40° of flexion) which could promote mechanical stimuli governed healing while mitigating the risk of bony non-union due to excessive movement at the fracture site. ConclusionThe developed depth camera-based fracture healing model can accurately predict the influence of muscle loading induced by rehabilitation exercises in distal radius fracture healing outcomes. The outcomes from this study could potentially assist osteopathic surgeons in designing effective post-operative rehabilitation strategies for DRF patients.

Areas of strength and opportunities for growth in translational science education and training: Results of a scoping review from the NCATS Education Branch.

Translational science education and training (E&T) aims to prepare the translational workforce to accelerate progress along the translational pipeline toward solutions that improve human health. In 2020-2021, the National Center for Advancing Translational Sciences (NCATS) Education Branch conducted a scoping review of the E&T literature with this focus. The review used the methodological framework proposed by Arksey and O'Malley. PubMed, Education Resources Information Center (ERIC), and Embase were searched, and forward citations conducted. Screening of titles, abstracts, and full text identified 44 included articles. Data extraction facilitated analysis of E&T content, audiences, modalities, evaluations, and recommendations. The NCATS Translational Science Principles were used to identity described or recommended E&T content. Twenty-nine articles described a translational science E&T opportunity or its evaluation, and another 15 articles offered recommendations for translational science E&T. The most prevalent NCATS Translational Science Principles were boundary-crossing partnerships (77%) and cross-disciplinary team science (75%). Among publications describing E&T opportunities, the most reported modalities were experiential learning (64%) and courses (61%) and the most reported participants were graduate students (68%) and postdoctoral fellows (54%). About half of these articles (n = 15) reported an evaluation, covering a range of proximal to distal outcomes. Recommendations emphasized the value of translational science E&T across training and career stages and the use of varied modalities to reach diverse audiences. This review highlights strengths and opportunities for growth in translational science E&T. Enhancements to content, expansion of participants and modalities, and rigorous evaluations will contribute to building a highly qualified, diverse translational science workforce.

Open innovation networks: a driver for knowledge mobilisation in schools?

PurposeIn organisational and innovation research, the term “open innovation” refers to the inflow and outflow of knowledge to and from organisations: with open innovation theory suggesting active exchanges of knowledge with external actors leads to the development of exploitable new ideas. In the field of education, however, the exchange of knowledge with external parties represents a paradigm shift. In response, this article presents findings from research design to explore the nature and composition of school innovation networks, and the effects of such these networks on knowledge mobilisation.Design/methodology/approachThe study draws on data from a representative random sample of 411 German school leaders. Respondents were asked to detail their engagement in open and closed innovation activity and their school's external collaborations during the last 12 months. A latent class distal outcome model was developed to examine whether different types of collaboration associate with different knowledge mobilisation processes.FindingsThe study findings suggest that schools in Germany mainly use internal knowledge for innovation, with external knowledge exchange taking place on a very limited basis. Knowledge mobilisation varies depending on the innovation network. The authors use the findings to indicate new insights for how schools can further innovate learning and teaching in future.Originality/valueAlthough there is increasing discussion on Professional Learning Networks in schools, the discourse on knowledge mobilisation within educational networks is limited, making concept of open innovation so far completely absent from discourses on school improvement. This paper initiates the population of this new research space.

Intervening Early: Socioemotional Interventions Targeting the Parent–Infant Relationship

Responsive, nurturing parenting helps infants and young children develop secure, organized attachments as well as adequate self-regulatory capabilities. However, when parents experience challenges, they often have difficulty providing responsive, nurturing care. In this article, we provide an overview of interventions that have been developed to enhance parental responsiveness, and we discuss in detail three interventions that have particularly strong evidence of effectiveness. For each intervention, we describe the intervention's purported mechanism and the evidence supporting its engagement as well as proximal and distal intervention outcomes. The three interventions described vary in duration from 6 to 32 sessions on average and are variously implemented in the home or office. Nonetheless, all three interventions have strong evidence of effectiveness in engaging the intervention mechanism of parental responsiveness and show impressive effects on children's attachment and self-regulatory capabilities. We also discuss challenges in disseminating interventions in the community.

Patterns, predictors, and outcomes of situated expectancy-value profiles in an introductory chemistry course.

Using latent profile analysis, we identified profiles of expectancy beliefs, perceived values, and perceived costs among 1433 first- and second-year undergraduates in an introductory chemistry course for STEMM majors. We also investigated demographic differences in profile membership and the relation of profiles to chemistry final exam achievement, science/STEMM credits completed, and graduating with a science/STEMM major. Four motivational profiles were identified: Moderately Confident and Costly (profile 1), Mixed Values-Costs/Moderate-High Confidence (profile 2), High Confidence and Values/Moderate-Low Costs (profile 3), and High All (profile 4). Underrepresented students in STEMM were more likely to be in profile 2 relative to profile 3. First-generation college students were more likely to be in profile 4 than profile 3. Finally, students likely to be in profile 3 had higher final exam grades than the other profiles and were more likely to graduate with a science major compared to profile 1. There were no differences in graduating science major between profile 3 and the other two profiles. Thus, profile 3 was most adaptive for both proximal (final exam) and distal (graduating with a science major) outcomes. Results suggest that supporting motivation early in college is important for persistence and ultimately the talent development of undergraduate STEMM students.

Impact of shared decision making on healthcare in recent literature: a scoping review using a novel taxonomy

Abstract Background Numerous articles and reviews discussed the effects of shared decision making (SDM) on concept-specific and direct outcomes, showing great variety in methodology and results. Objectives This scoping review accentuates effects of shared decision making interventions on more distal and distant outcomes related to the healthcare experience of patients and physicians, the economy and treatment parameters. Eligibility criteria The search considered randomized controlled trials (RCTs), their secondary analyses and follow-up reports comparing shared decision making interventions against control conditions. Sources of evidence MEDLINE (through PubMed) and reference lists of included articles were systematically appraised. Charting methods First, relevant outcome effects were extracted following the authors’ conclusions. Second, all outcomes were sorted into one of five different effect levels: individual, interactional, organizational, systemic and clinical. Results The search process identified 120 eligible reports, representing 116 randomized controlled trials and four follow-up reports with a variety in research topics, intervention types, outcome measurements and effects. Most of the 296 extracted outcomes were reported as not affected by shared decision making (205). While some outcomes improved at least slightly (81), few tended to decline (7) or revealed mixed results (3). Considering the five outcome effect levels, individual and clinical outcomes were reported more frequently than interactional, organizational and systemic ones. However, many individual outcomes could be counted as systemic and vice versa. Conclusions Shared decision making can improve distal and distant outcomes depending on the healthcare context. Individual, systemic and clinical outcomes have been more frequently appraised than interactional and organizational ones. Single database search and limited assessment of articles’ risk of bias and effect size narrow reliability of our results.

Development of a digital biomarker and intervention for subclinical depression: study protocol for a longitudinal waitlist control study

BackgroundDepression remains a global health problem, with its prevalence rising worldwide. Digital biomarkers are increasingly investigated to initiate and tailor scalable interventions targeting depression. Due to the steady influx of new cases, focusing on treatment alone will not suffice; academics and practitioners need to focus on the prevention of depression (i.e., addressing subclinical depression).AimWith our study, we aim to (i) develop digital biomarkers for subclinical symptoms of depression, (ii) develop digital biomarkers for severity of subclinical depression, and (iii) investigate the efficacy of a digital intervention in reducing symptoms and severity of subclinical depression.MethodParticipants will interact with the digital intervention BEDDA consisting of a scripted conversational agent, the slow-paced breathing training Breeze, and actionable advice for different symptoms. The intervention comprises 30 daily interactions to be completed in less than 45 days. We will collect self-reports regarding mood, agitation, anhedonia (proximal outcomes; first objective), self-reports regarding depression severity (primary distal outcome; second and third objective), anxiety severity (secondary distal outcome; second and third objective), stress (secondary distal outcome; second and third objective), voice, and breathing. A subsample of 25% of the participants will use smartwatches to record physiological data (e.g., heart-rate, heart-rate variability), which will be used in the analyses for all three objectives.DiscussionDigital voice- and breathing-based biomarkers may improve diagnosis, prevention, and care by enabling an unobtrusive and either complementary or alternative assessment to self-reports. Furthermore, our results may advance our understanding of underlying psychophysiological changes in subclinical depression. Our study also provides further evidence regarding the efficacy of standalone digital health interventions to prevent depression.Trial registration Ethics approval was provided by the Ethics Commission of ETH Zurich (EK-2022-N-31) and the study was registered in the ISRCTN registry (Reference number: ISRCTN38841716, Submission date: 20/08/2022).

Trajectories of Perceived Stress among Students in Transition to College: Mindset Antecedents and Adjustment Outcomes.

There is growing evidence of a clear association between students' perceived stress and their adjustment to life at college. However, the predictors and implications of distinct changing patterns of perceived stress during the transition to college life are less clear. To address these research gaps, the current study aims to identify distinct patterns of perceived stress trajectories among 582 Chinese first-year college students (Mage = 18.11, SDage = 0.65; 69.40% female) across the first 6 months upon enrollment. Three distinct profiles of perceived stress trajectories, i.e., low-stable (15.63%), middle-decreasing (69.07%), and high-decreasing (15.29%), were identified. Moreover, individuals who followed the low-stable trajectory showed better distal outcomes (specifically, higher levels of well-being and academic adjustment) 8 months after enrollment than those who followed the other two trajectories. Furthermore, two types of positive mindset (a growth mindset of intelligence and a stress-is-enhancing mindset) contributed to differences in perceived stress trajectory, either independently or jointly. These findings highlight the significance of identifying different patterns of perceived stress among students during the transition to college, as well as the protective roles of both a stress mindset and a mindset of intelligence.

Distal Target Vessel Quality and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention

BackgroundDistal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm. ObjectivesThe study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention. MethodsWe examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. ResultsA total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01). ConclusionsA poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose.

Analysis of Postoperative Distal Radius Fracture Outcomes in the Setting of Osteopenia and Osteoporosis for Patients with Comorbid Conditions

Distal radius fractures (DRFs) are among the most common orthopedic injuries, especially in the elderly. A wide variety of approaches have been advocated as successful treatment modalities; yet, there remains variability in practice patterns of DRF in patients with osteoporosis and osteopenia. Using large data set analysis, we sought to determine the risk profile of operative fixation of DRF in patients with low bone mineral density. A commercially available health care database, PearlDiver, was queried for all patients who underwent open reduction internal fixation of DRFs between 2010 and 2020. The study population was divided into groups based on the presence or absence of osteopenia or osteoporosis and was further classified by patients who were receiving bisphosphonate therapy. Complication rates were calculated, including rates of malunion, surgical site infection, osteomyelitis, hardware failure, and hardware removal. Five-year future fragility fractures were defined in hip, vertebrae, humerus, and wrist fractures. Chi-square analysis and logistic regression were performed to determine an association between these comorbidities and various postoperative complications. A total of 152,926 patients underwent open reduction internal fixation of a DRF during the study period. Chi-square analysis of major complications at 3 months showed a statistically significant increase in malunion in patients with osteopenia (P= .05) and patients with osteoporosis (P= .05) who underwent open reduction internal fixation. Logistic regression analysis at 12 months after surgery demonstrated that osteopenia was associated with an increased risk of hardware failure (P < .0001), hardware removal (P < .0001), surgical site infection (P < .0001), and malunion (P= .004). Osteoporosis was associated with a significantly increased risk of hardware failure (P= .01), surgical site infection (P < .0001), and malunion (P < .0001). We demonstrated, using large data set analysis, that DRF patients with osteopenia and osteoporosis are predicted to be at increased risk of multiple postoperative complications, and thus, bone density should be strongly considered in treatment planning for these patients. Prognostic III.

Quality of life profiles and their associations with depressive symptoms and cognitive impairment of community-dwelling older adults in Hong Kong.

This study aimed to (1) explore the quality of life (QoL) profiles of older adults in Hong Kong and (2) examine their association with predictors (age, sex, body mass index, and depressive symptoms) and distal outcome (cognitive impairment) using a person-centered approach. A total number of 328 community-dwelling older adults in Hong Kong were invited to participate in this study. Data from 259 older adults were identified as valid for the primary analysis. Latent profile analysis was used to explore QoL profiles. Multinomial logistic regression using the R3STEP function in Mplus was used to explore the predictive role of age, sex, body mass index, and depressive symptoms in profile membership. The Bolck-Croon-Hagenaars approach was used to examine how the distal outcome of cognitive impairment differs as a function of QoL profiles. Three QoL profiles emerged from the latent profile analysis (Low, Moderate and High QoL). It was found that depression, but not age, sex, or body mass index, significantly predicted QoL profile membership. The results of the Bolck-Croon-Hagenaars analysis revealed no significant differences in cognitive impairment across the three QoL profiles. This is the first study that examined the relationship between QoL, depressive symptoms and cognitive impairment of older adults using a person-centered approach. The findings provide additional information for the evidence obtained from variable-centered approach on the associations among variables abovementioned. Our additional focus on the antecedents of emergent QoL profiles also provide practical knowledge regarding timely treatment for or prevention of depressive symptoms, which we submit will be crucial for enhancing the QoL of older adults.