Improvements In Self-reported Quality Research Articles

Original Research: Exploring Frontline Nurses' Self-Perceived Levels of QI Engagement and QI Competence.

Nurse engagement in quality improvement (QI) is critical in the delivery of safe high-quality care, yet few studies have evaluated frontline nurses in this area. The purpose of this study was to identify and compare levels of self-reported QI engagement and QI competence among frontline nurses and nurse leaders. This study used a cross-sectional descriptive design. A convenience sample of frontline nurses (bedside RNs and advanced practice nurses) and nurse leaders from acute and ambulatory care sites completed the Nursing Quality Improvement in Practice (NQuIP) tool, which measures engagement and competence (knowledge, skills, and attitudes) in QI. Data from 6,351 surveys completed by frontline nurses and nurse leaders representing 66 sites nationwide were analyzed. Only 52.5% of all respondents reported participating in QI. Knowledge scores were relatively high, while skills scores-especially those related to using QI tools-were low. Overall attitudes toward QI were positive. Nurse leaders scored significantly higher in engagement and competence than the frontline nurses they supervise. The study findings indicate that nurse engagement in QI is limited. Although nurses' knowledge levels appear to be high, their limited competency in QI-related skills may contribute to low QI engagement. Leaders must make efforts to increase nurse engagement in order to attain high-quality outcomes. Using the NQuIP tool will allow leaders to evaluate nurses' self-perceived QI competence and engagement, which will aid in identifying target areas and developing effective strategies for improvement.

Preliminary findings from project Twenty21 Australia: An observational study of patients prescribed medicinal Cannabis for chronic pain, anxiety, posttraumatic stress disorder and multiple sclerosis

Background Since medical access to medicinal cannabis (MC) was legalised in Australia in 2016, numbers of people prescribed MC have increased exponentially. There is a need for safety and effectiveness data on the longer-term use of MC in real-world settings. This paper describes the methodology of Project Twenty21 Australia, an observational study that commenced early in 2022 and its preliminary findings. Method This study tests whether medicinal cannabis is effective in four primary conditions: chronic pain, anxiety, posttraumatic stress disorder and multiple sclerosis (MS). Participants are prescribed MC from within a Project Formulary, completing questionnaires at baseline then 3 monthly for up to 12 months. Results Between the start of the study in February and 30 August 2022, 278 participants had been recruited into the study: 50.7% female, 48.2% male and 1.1% non-binary with average age 39.2 years (18–77). Patients reported a low quality of life and high levels of co-morbidity. Three-month data, available for 71 participants, indicate that MC was associated with substantial improvements in self-reported quality of life, general health, mood/depression and sleep with standardised effect size estimates ranging from 0.57 to 0.93. Three adverse reactions were reported. Conclusions This paper describes the protocol used for an observational study conducted in Australia assessing the effectiveness of MC in four main conditions. We have established the feasibility of collecting real-world data on symptoms and quality of life in people receiving treatment with MC. Preliminary evidence suggests that MC may be effective in improving quality of life, general health, mood and sleep.

Online Cognitive Behavior Therapy for Two College Students With Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder among college students. Although there is growing literature supporting the effectiveness of cognitive behavioral therapy (CBT) for this population, no previous study has investigated the feasibility of it being delivered online. In addition, recent evidence suggests that online therapy could be possible for other diagnoses such as depression, anxiety, or health-related disorders. Therefore, research in this area could be critical, as online settings could also improve accessibility to evidence-based interventions for college students with ADHD. This study describes the implementation of CBT for ADHD intervention delivered online for two college students with this diagnosis. We found improvements in both self-reported and clinician-assessed outcomes, in measuring ADHD-related behaviors, executive functioning, emotional comorbidities, and quality of life. These changes were more evident in the case that was more severe at pre-treatment, and were maintained at a 6-month follow-up; even further improvements in self-reported quality of life were observed. These findings support the potential feasibility and clinical utility of online CBT in this population.

Survey of Nursing Faculty Preparation for Guiding DNP Quality Improvement Projects.

Quality improvement (QI) projects comprise the majority of University of Maryland School of Nursing (UMSON) Doctor of Nursing Practice (DNP) projects. An online survey was completed by 51% (n = 38) of faculty, who teach or mentor DNP students, and was analyzed using quantitative and descriptive methods. Faculty were somewhat or not familiar with developing a QI charter 68.4%, human error theory and error proofing 63.2%, driver diagrams 60.5%, characteristics of high-reliability organizations 60.5%, and Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines 55.3%. The faculty were most interested in learning more about (n = 97 responses) were human error theory and error proofing (28.9%), SQUIRE guidelines (26.3%), statistical process control (21.1%), and implementation strategies and tactics (21.1%). The most commonly identified challenges included identifying QI projects (24%), project time constraints (16%), keeping up-to-date on QI concepts, methods, and tools (12%), and balancing professional workload (10%). Gaps in self-reported QI knowledge indicate there is a need for further development of DNP and PhD prepared faculty at the UMSON.

Family Medicine Residency Graduates' Preparation for Quality Improvement Leadership.

Training in quality improvement (QI) is a standard component of family medicine residency education. Graduating family medicine residents' ability to lead QI initiatives is unknown. We assessed the preparedness of graduating family medicine residents to lead QI projects and to identify factors that may increase such readiness. Milestone data for all graduating family medicine residents were linked to a practice demographic questionnaire completed by the same residents who registered for the American Board of Family Medicine certification examination between 2014 and 2017. The change in self-assessed QI preparedness over time and its association with faculty-assigned milestone ratings were examined using descriptive and regression analyses. The questionnaire had a 100% response rate (12 208 responded). Between 2014 and 2017, the percentage of residents who self-reported being "extremely" or "moderately" prepared to lead QI projects increased from 72.7% (2208 of 3038) to 75.8% (2434 of 3210, P = .009). Self-reported QI team leadership was associated with 93% higher odds of feeling extremely prepared compared to moderately prepared (odds ratio 1.93, 95% CI 1.58-2.35). The average midyear faculty-assigned milestone rating for QI among residents who felt "extremely" prepared was 3.28 compared to 3.14 among those who felt "not at all" prepared. Over the past 4 years, family medicine residents' self-assessed preparedness to lead QI projects has barely increased. There was no correlation between self-assessed preparation and faculty-assigned milestone rating. However, we found a small association between self-reported QI leadership and self-assessed QI preparedness.

Cognitive effects of donepezil therapy in patients with brain tumors: a pilot study.

Cognitive dysfunction is prevalent among brain tumor patients treated with radiotherapy (RT) and chemotherapy. However, there are no approved pharmacological interventions for cognitive dysfunction in cancer patients. The goal of this pilot study was to examine the efficacy of donepezil, an acetylcholinesterase inhibitor used to treat Alzheimer's disease, in improving cognitive functions in brain tumor patients previously treated with RT + chemotherapy or chemotherapy alone. Fifteen patients with a brain tumor received a single daily dose of donepezil for 24 weeks (5 mg for 4 weeks, then 10 mg for 20 weeks). Patients completed cognitive evaluations prior to initiating therapy (baseline), and about 12 weeks (mid-study) and 24 weeks (end-of-study) subsequent to initiation of donepezil therapy. The results of linear mixed models analysis, controlling for each patient's baseline cognitive test score, showed a significant post-baseline improvement in attention (WAIS-III digit span forward; p = 0.037), graphomotor speed (WAIS-III digit symbol; p = 0.035) and visual memory (BVMT-R-delay; p = 0.025). There was also an improvement in self-reported quality of life (FACT-Br, social well-being subscale; p = 0.01). The findings of this pilot study suggest that treatment with donepezil may improve some aspects of cognitive functions and quality of life in brain tumor patients. Similar findings were reported in two prior trials of donepezil in brain tumor survivors.

Paranasal Sinus Balloon Catheter Dilation for Treatment of Chronic Rhinosinusitis: A Systematic Review and Meta-analysis.

Paranasal sinus balloon catheter dilation (BCD) represents a commonly used tool in the management of chronic rhinosinusitis (CRS) for which the indications, utilization, and outcomes have not been well established. A systematic review and meta-analysis were undertaken to evaluate change in quality of life and sinus opacification following paranasal sinus BCD in the treatment of CRS. MEDLINE and EMBASE databases. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilized to identify English-language studies reporting patient outcomes following BCD for CRS. Primary outcomes included the impact of BCD on validated measures of quality of life and sinonasal opacification. Systematic review identified 17 studies for qualitative analysis. Studies generally included cases with limited disease based on radiographic opacification. Five studies contained extractable data for change in 20-Item Sinonasal Outcome Test (SNOT-20) 1 year following BCD, with significant improvement in self-reported quality of life (P = .04). Five studies reported a significant change in paranasal sinus opacification following BCD (P < .001). Two studies directly compared change in SNOT-20 between BCD and endoscopic sinus surgery, without demonstration of significant difference in outcome (P = .07). Subgroup analysis found that change in SNOT-20 score was greater after BCD in the operating room than in the office (P = .004). Current evidence supporting the role of BCD in CRS remains incomplete. Long-term within-group improvements in quality-of-life and sinus opacification scores are demonstrated among a restricted adult population with CRS. Additional study is needed to further evaluate the role for BCD in specific settings and patient subgroups.

Emergency department quality improvement activity: an inventory from the American Board of Emergency Medicine Maintenance of Certification program.

The American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program requires every ABEM-certified physician to attest to participating in a quality improvement (QI) activity every 5 years. Understanding the type and frequency of these QI activities could inform the emergency medicine community about the variety of QI activities in which emergency physicians (EPs) are involved. These QI activities could provide ideas for the development of additional quality measures. This was a retrospective descriptive study of self-reported QI activity attestations from the ABEM MOC program during 2013. Attestations were provided by ABEM-certified EPs using the ABEM MOC website. The type, number, and cumulative frequency of activities are reported. ABEM received 9,380 attestations for QI activities in 91 different categories. The three most commonly reported activities were acute myocardial infarction-percutaneous coronary intervention within 90 minutes of arrival (includes door-to-balloon time), door-to-doctor times, and throughput time measures. These three activities comprised 36.4% of attestations. More than half (54.4%) of the attestations were captured by the five most frequently attested activities, 67.1% by the top seven categories, and 89.9% by the top 21 categories. Of these 21 categories, 10 involved clinical protocols, nine were time-centered measures, and two were patient-centered activities. This report demonstrates that diverse QI activities occur in emergency departments (EDs) across the United States. The majority of reported projects are nested in a few categories, following recognized areas of emphasis in emergency care, particularly in areas using time-sensitive metrics.

Abstract 144: Forced Aerobic Exercise Enhances Upper Extremity Task Practice in Patients with Stroke

Introduction: Aerobic exercise (AE) has been shown to improve cardiovascular health in individuals with stroke; however, the potential role of AE in enhancing neuroplasticity after stroke has not been systematically studied. We have implemented a forced exercise (FE) cycling intervention, initially developed for individuals with Parkinson’s disease, with a cohort of individuals with chronic stroke. We hypothesize that intensive AE training, when paired with repetitive task practice (RTP), will “prime” the central nervous system, to exploit the motor learning effects of task practice. Hypothesis: Individuals who perform FE followed by RTP will demonstrate greater improvements in motor and non-motor function compared to the voluntary rate aerobic exercise (VE) + RTP and RTP only groups. Individuals in both AE groups (FE and VE) will demonstrate greater improvements in VO2peak compared to the RTP only group. Methods: Fifteen individuals 6-12 months post-stroke were enrolled into one of the following groups: 1) Forced Exercise + RTP (FE + RTP); 2) Voluntary Exercise + RTP (VE + RTP); and 3) Time-matched RTP. Participants in the AE groups completed one 45-minute session of stationary cycling followed immediately by one 45-minute session of upper extremity RTP; however, the rate of cycling for the FE group was augmented to approximately 35% faster than their voluntary rate. All participants completed a total of 24 exercise sessions over an 8-week period. Results: While all three groups made significant improvements in motor function as measured by the Fugl-Meyer Assessment (p=.03), the FE+RTP group exceeded the VE+RTP and RTP only groups, approaching statistical significance (p=0.06), despite the two AE groups completing 44% less RTP practice time than the RTP group. Improvements in self-reported quality of life and depressive symptomology also improved across all three groups, with trends favoring the FE group. VO2peak improved by 1.1 and 2.68 mL/kg/min for the FE+RTP and VE+RTP groups, respectively; while VO2peak decreased by 0.85mL/kg/min in the RTP group. Conclusion: FE + RTP is a promising intervention to enhance motor and non-motor function, in addition to aerobic capacity in individuals 6-12 months after stroke.

Improvement in self-reported quality of life with cognitive therapy for recurrent major depressive disorder

BackgroundMajor depressive disorder (MDD) is common, often recurrent and/or chronic. Theoretically, assessing quality of life (QoL) in addition to the current practice of assessing depressive symptoms has the potential to offer a more comprehensive evaluation of the effects of treatment interventions and course of illness. MethodsBefore and after acute-phase cognitive therapy (CT), 492 patients from Continuation Phase Cognitive Therapy Relapse Prevention trial (Jarrett et al., 2013; Jarrett and Thase, 2010) completed the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Inventory of Depressive Symptomatology Self-report (IDS-SR) and Beck Depression Inventory (BDI); clinicians completed Hamilton Rating Scale for Depression-17-items. Repeated measures analysis of variance evaluated the improvement in QoL before/after CT and measured the effect sizes. Change analyses to assess clinical significance (Hageman and Arrindell, 1999) were conducted. ResultsAt the end of acute-phase CT, a repeated measure analysis of variance produced a statistically significant increase in Q-LES-Q scores with effect sizes of 0.48–1.3%; 76.9–91.4% patients reported clinically significant improvement. Yet, only 11–38.2% QoL scores normalized. An analysis of covariance showed that change in depression severity (covariates=IDS-SR, BDI) completely accounted for the improvement in Q-LES-Q scores. LimitationsThere were only two time points of observation; clinically significant change analyses lacked matched normal controls; and generalizability is constrained by sampling characteristics. ConclusionsQuality of life improves significantly in patients with recurrent MDD after CT; however, this improvement is completely accounted for by change in depression severity. Normalization of QoL in all patients may require targeted, additional, and/or longer treatment.

An Individualized Exercise Prescription to Attenuate Symptoms Associated With Postural Orthostatic Tachycardia Syndrome

An Individualized Exercise Prescription to Attenuate Symptoms Associated With Postural Orthostatic Tachycardia Syndrome

A Multidimensional Home-Based Care Coordination Intervention for Elders with Memory Disorders: The Maximizing Independence at Home (MIND) Pilot Randomized Trial

To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders. 18-month randomized controlled trial of 303 community-living elders. 28 postal code areas of Baltimore, MD. Age 70+ years, with a cognitive disorder, community-living, English-speaking, and having a study partner available. 18-month care coordination intervention to systematically identify and address dementia-related care needs through individualized care planning; referral and linkage to services; provision of dementia education and skill-building strategies; and care monitoring by an interdisciplinary team. Primary outcomes were time to transfer from home and total percent of unmet care needs at 18months. Intervention participants had a significant delay in time to all-cause transition from home and the adjusted hazard of leaving the home was decreased by 37% (Hazard ratio: 0.63, 95% Confidence Interval: 0.42-0.94) compared with control participants. Although there was no significant group difference in reduction of total percent of unmet needs from baseline to 18 months, the intervention group had significant reductions in the proportion of unmet needs in safety and legal/advance care domains relative to controls. Intervention participants had a significant improvement in self-reported quality of life (QOL) relative to control participants. No group differences were found in proxy-rated QOL, neuropsychiatric symptoms, or depression. A home-based dementia care coordination intervention delivered by non-clinical community workers trained and overseen by geriatric clinicians led to delays in transition from home, reduced unmet needs, and improved self-reported QOL.

Does cognitive behavioral therapy or graded exercise therapy reduce disability in chronic fatigue syndrome patients? Objective measures are necessary.

Clinical trials of cognitive behavioral therapy and graded exercise therapy have consistently demonstrated improvement in self-reported quality of life and improvement of symptoms. However, due to the nature of these therapies, it is not possible to carry out a double-blinded trial design or fully control for reporting biases. Therefore, to make strong claims about efficacy and reductions in disability, objective methods should be used such as neuropsychological testing, actigraphy, and repeat exercise testing.

Transforaminal lumbar interbody fusion and posterior lumbar interbody fusion utilizing BMP-2 in treatment of degenerative spondylolisthesis: neither safe nor cost effective

Background:With the rise of health care costs, there is increased emphasis on evaluating the cost of a particular surgical procedure for quality adjusted life year (QALY) gained. Recent data have shown that surgical intervention for the treatment of degenerative spondylolisthesis (DS) is as cost-effective as total joint arthroplasty. Despite these excellent outcomes, some argue that the addition of interbody fusion supplemented with bone morphogenetic protein (BMP) enhances the value of this procedure.Methods:This review examines the current research regarding the cost-effectiveness of the surgical management of lumbar DS utilizing interbody fusion along with BMP.Results:Posterolateral spinal fusion with instrumentation for focal lumbar spinal stenosis with DS can provide and maintain improvement in self-reported quality of life. Based on the available literature, including nonrandomized comparative studies and case series, the addition of interbody fusion along with BMP does not lead to significantly better clinical outcomes and increases costs when compared with more routine posterolateral fusion techniques.Conclusions:To enhance the value of the surgical management for DS, costs must decrease or there should be substantial improvement in effectiveness as measured by clinical outcomes. To date, there is insufficient evidence to support the use of interbody fusion devices along with BMP to treat routine cases of focal stenosis accompanied by DS, which are routinely adequately treated utilizing posterolateral fusion techniques.

Cognitive stimulation to improve cognitive functioning in people with dementia

Cognitive stimulation is an intervention for people with dementia which offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory usually in a social setting, such as a small group. Its roots can be traced back to Reality Orientation (RO), which was developed in the late 1950s as a response to confusion and disorientation in older patients in hospital units in the USA. RO emphasised the engagement of nursing assistants in a hopeful, therapeutic process but became associated with a rigid, confrontational approach to people with dementia, leading to its use becoming less and less common.Cognitive stimulation is often discussed in normal ageing as well as in dementia. This reflects a general view that lack of cognitive activity hastens cognitive decline. With people with dementia, cognitive stimulation attempts to make use of the positive aspects of RO whilst ensuring that the stimulation is implemented in a sensitive, respectful and person-centred manner.There is often little consistency in the application and availability of psychological therapies in dementia services, so a systematic review of the available evidence regarding cognitive stimulation is important in order to identify its effectiveness and to place practice recommendations on a sound evidence base. To evaluate the effectiveness and impact of cognitive stimulation interventions aimed at improving cognition for people with dementia, including any negative effects. The trials were identified from a search of the Cochrane Dementia and Cognitive Improvement Group Specialized Register, called ALOIS (updated 6 December 2011). The search terms used were: cognitive stimulation, reality orientation, memory therapy, memory groups, memory support, memory stimulation, global stimulation, cognitive psychostimulation. Supplementary searches were performed in a number of major healthcare databases and trial registers to ensure that the search was up to date and comprehensive. All randomised controlled trials (RCTs) of cognitive stimulation for dementia which incorporated a measure of cognitive change were included. Data were extracted independently by two review authors using a previously tested data extraction form. Study authors were contacted for data not provided in the papers. Two review authors conducted independent assessments of the risk of bias in included studies. Fifteen RCTs were included in the review. Six of these had been included in the previous review of RO. The studies included participants from a variety of settings, interventions that were of varying duration and intensity, and were from several different countries. The quality of the studies was generally low by current standards but most had taken steps to ensure assessors were blind to treatment allocation. Data were entered in the meta-analyses for 718 participants (407 receiving cognitive stimulation, 311 in control groups). The primary analysis was on changes that were evident immediately at the end of the treatment period. A few studies provided data allowing evaluation of whether any effects were subsequently maintained. A clear, consistent benefit on cognitive function was associated with cognitive stimulation (standardised mean difference (SMD) 0.41, 95% CI 0.25 to 0.57). This remained evident at follow-up one to three months after the end of treatment. In secondary analyses with smaller total sample sizes, benefits were also noted on self-reported quality of life and well-being (standardised mean difference: 0.38 [95% CI: 0.11, 0.65]); and on staff ratings of communication and social interaction (SMD 0.44, 95% CI 0.17 to 0.71). No differences in relation to mood (self-report or staff-rated), activities of daily living, general behavioural function or problem behaviour were noted. In the few studies reporting family caregiver outcomes, no differences were noted. Importantly, there was no indication of increased strain on family caregivers in the one study where they were trained to deliver the intervention. There was consistent evidence from multiple trials that cognitive stimulation programmes benefit cognition in people with mild to moderate dementia over and above any medication effects. However, the trials were of variable quality with small sample sizes and only limited details of the randomisation method were apparent in a number of the trials. Other outcomes need more exploration but improvements in self-reported quality of life and well-being were promising. Further research should look into the potential benefits of longer term cognitive stimulation programmes and their clinical significance.

The Relationship Between Perceived Practice Quality and Quality Improvement Activities and Physician Practice Dissatisfaction, Professional Isolation, and Work-Life Stress

The importance of physician well-being has been well-documented. However, little is known about how physicians' self-reported quality improvement (QI) activities and quality of care are related to their practice dissatisfaction, professional isolation, and work-life stress. We surveyed a random sample of 1884 physicians in Massachusetts by mail and assessed their practices' participation in QI activities and quality of care, as well as their feelings of professional isolation, work-life stress, and practice dissatisfaction. A total of 1345 physicians responded (71.4% response rate). Most respondents reported QI activities in their practices (85%) and subsequent evaluation of these activities (62%). Approximately one-third (33%) reported quality problems in their practice. In linear regression analyses, the presence of quality problems was independently associated with increased professional isolation, work-life stress, and practice dissatisfaction. In contrast, physicians from practices that were involved in the evaluation of QI activities had significantly less isolation, stress, and dissatisfaction. Participation in QI activities was also independently associated with less dissatisfaction. A substantial fraction of physicians reported moderate to severe problems with isolation (17%), work-life stress (31%), and dissatisfaction (27%). Substantial practice dissatisfaction, professional isolation, and work-life stress are experienced by physicians and they seem to be inversely correlated with QI activities. Physicians who perceive quality problems in their practices are more likely to experience dissatisfaction, isolation, and stress. Efforts to engage physicians in QI and systems change should assess how these programs affect physicians themselves and the care that they deliver.

Biorretroalimentação para treinamento do equilíbrio em hemiparéticos por acidente vascular encefálico: estudo preliminar

Como disfunções do equilíbrio são freqüentes nos pacientes hemiparéticos por acidente vascular encefálico (AVE), o treinamento do equilíbrio é meta fundamental em seu tratamento. O objetivo deste estudo preliminar foi verificar os efeitos da biorretroalimentação, por treinamento em plataforma instável computadorizada, em seis pacientes hemiparéticos por AVE (três homens e três mulheres, com idade média de 56,2 anos). Os pacientes foram avaliados, antes e após o tratamento, quanto a mobilidade funcional (pelo teste de levantar e caminhar cronometrado, TUGT na sigla em inglês), alcance funcional, qualidade de vida relacionada à saúde (pelo Perfil de Saúde de Nottingham) e equilíbrio sobre prancha instável. O treinamento foi feito na mesma prancha, em 23 sessões de cerca de 30 minutos cada, durante oito semanas. Os resultados indicam melhora do equilíbrio, em média, de 119,1% com pés separados e de 79,6% com pés juntos (p&lt;0,001); melhora média do alcance funcional de 15% (p&lt;0,001); melhora da mobilidade de 25,6% (p&lt;0,001); e discreta melhora nos escores da auto-avaliação de qualidade de vida. O programa de treinamento resultou pois em melhoras significativas na amostra estudada, sugerindo que a biorretroalimentação do equilíbrio pode ser uma ferramenta valiosa na reabilitação de pacientes hemiparéticos em decorrência de AVE.

Assessment of health-related quality of life after surgical treatment of focal symptomatic spinal stenosis compared with osteoarthritis of the hip or knee

Background context In the last decade, the number of patients undergoing surgical treatment for lumbar spinal stenosis (LSS), particularly instrumented fusions, has significantly increased. The surgical procedures for LSS represent a significant cost to the health-care system and are a priority focus for most governments, insurers, hospital administrators, and spine care physicians. Purpose The purpose of this study was to directly compare the relative improvement in self-reported quality of life after surgical intervention for matched groups of patients with primary hip or knee osteoarthritis (H-OA/K-OA) and focal lumbar spinal stenosis (FLSS). Study design/setting Observational cohort study of prospectively collected outcomes. Patient sample Patients, following elective primary one- to two-level spinal decompression (n=90) with (n=28/90) or without fusion for FLSS, were compared with a matched (age, sex, and time of surgery) cohort of patients who had undergone elective total hip (n=90) or total knee (n=90) arthroplasty (total joint arthroplasty [TJA]) for primary osteoarthritis. Outcome measures Medical Outcomes Study Short Form-36 (SF-36). Methods Patents were obtained for prospective outcomes databases (TJA and spine). Inclusion and exclusion criteria were independently applied, and matching was performed in a blinded fashion. The primary outcome measure was the relative change between preoperative and 2-year postoperative SF-36 questionnaires. Data were analyzed with the t test and repeated measures analysis of variance (ANOVA). Results The three groups (FLSS/H-OA/K-OA) were equally matched with respect to mean age (64/63/65 years), sex (female/male, 51/39 for all groups), body mass index (BMI) (27/24/27), and American Society of Anesthesiologists (ASA) physical status (2/2/2). Comparison of preoperative SF-36 physical component summary (PCS) scores and mental component summary (MCS) scores between groups showed no statistical difference (PCS: FLSS=32.0, H-OA=30.2, K-OA=31.3 [p=.32, ANOVA]/MCS: FLSS=43.5, H-OA=45.0, K-OA=46.2 [p=.25, ANOVA]). Postoperatively, PCS improved significantly for all groups (1 year—PCS: FLSS=39.6, H-OA=44.5, K-OA=38.5 [p<.0001 for all groups]; 2 years—PCS: FLSS=38.6, H-OA=43.2, K-OA=37.1 [p<.0001 for all groups]). At both 1- and 2-year follow-ups, the PCS improvement between groups was greater for the H-OA group compared with the FLSS (p=.0037, p=.0073) and K-OA (p=.00016, p=.00053) groups. At the 1-year follow-up, MCS did not significantly increase for any group; however, 2 years postoperatively, MCS improved significantly for the FLSS and H-OA groups (2 years—MCS: FLSS=50.3, H-OA=50.9, K-OA=44.8 [p=.00021, p=.00079, p=.35]). At the 1-year follow-up, there was no statistical difference in MCS improvement between groups (p=.45, ANOVA). Two years postoperatively, the MCS for both the FLSS and H-OA groups was significantly greater than that for the K-OA group (p=.0014, p=.00055). Conclusions The results of this study show that surgical intervention for FLSS can obtain and maintain improvement in self-reported quality of life comparable to that of total hip and knee arthroplasty. This study provides data to support the need for prospective cost-effectiveness studies for the surgical management of appropriately selected patients suffering from FLSS.

The early identification of cognitive impairment

The early and accurate identification of dementia helps to ensure the delivery of appropriate treatment and allows people with dementia and their carers to plan for the future. This article describes a research evaluation of a new screening, assessment and referral service for people with early-stage dementia and their carers who reside in one of Northern Ireland’s integrated health and social services trusts. A total of 435 referrals were made to the service during the first 33 months; most were female (70%) with an average age of 80 (SD = 7.68) and a mild/moderate (71%) cognitive impairment (mean Mini-mental State Examination score of 20.21 (SD = 6.10)). A research interview was conducted with 20 consecutive service users and their carers ( n = 21) following their initial assessment by a community psychiatric nurse and again four months later. Users recorded an overall improvement in self-reported quality of life and their use of health and social services remained unchanged. Carers valued highly the information and support provided by the project; their QoL improved and ‘stress and strain’ (as measured by the General Health Questionnaire-30 and Carers’ Checklist) decreased. Generally, stakeholders such as referral agents reported that the new service made an important contribution to dementia care, although some professionals thought that the service needed to be better ‘networked’ in order to avoid duplication of resources. Overall, the findings from this evaluation help to address the lack of available information about ways in which to organize and deliver early-stage dementia care.

Efficacy of thermal balloon ablation in patients with abnormal uterine bleeding

OBJECTIVE: The purpose of this study was to assess changes in menstrual pattern, quality of life, and patient satisfaction after thermal balloon ablation for abnormal uterine bleeding. STUDY DESIGN: One hundred forty-one women who underwent thermal balloon ablation in our institution initially had their charts reviewed for demographics, procedure data, clinical history, and follow-up. Thereafter, a telephone interview was conducted to assess postprocedural menstrual pattern, quality of life, and patient satisfaction. Data were compared with the use of appropriate tests for categoric or continuous variables and logistic regression. RESULTS: The median follow-up time was 18 months, and a telephone interview was obtained for 119 of 141 patients. A reduction in days per cycle (9.6 vs 3.1 days, P<.0001) and in pads per day (12.8 vs 2.5 pads/d, P<.0001) and an improvement in self-reported quality of life scores (2.8 vs 9.0, P<.0001) were observed after thermal balloon ablation. Hysterectomy was required in 21 of 141 patients (15%). Assessment of the level of satisfaction showed that 96% of patients were satisfied or very satisfied with the procedure. No major complications or deaths were related to thermal balloon ablation. CONCLUSION: Thermal balloon ablation is a safe and efficient method to treat abnormal uterine bleeding. It reduces the menstrual flow, improves the quality of life, and remarkably fulfills expectations in selected patients.