Lower Function Scores Research Articles

High Neuroticism Is Related to More Overall Functional Problems and Lower Function Scores in Men Who Had Surgery for Non-Relapsing Prostate Cancer.

The personality trait of neuroticism is associated with adverse health outcomes after cancer treatment, but few studies concern men treated for prostate cancer. We examined men with high and low neuroticism treated with radical prostatectomy for curable prostate cancer without relapse. We compared overall problems and domain summary scores (DSSs) between these groups, and if high neuroticism at pre-treatment was a significant predictor of overall problems and DSSs at follow-up. A sample of 462 relapse-free Norwegian men self-rated neuroticism, overall problems, and DSSs by the EPIC-26 before surgery and at three years’ follow-up. Twenty-one percent of the sample had high neuroticism. Patients with high neuroticism reported significantly more overall problems and DSSs at pre-treatment. At follow-up, only overall bowel problems and urinary irritation/obstruction and bowel DSSs were different. High neuroticism was a significant predictor of overall bowel problems and bowel and irritation/obstruction DSSs at follow-up. High neuroticism at pre-treatment was significantly associated with a higher rate of overall problems both at pre-treatment and follow-up and had some significant predictions concerning bowel problems and urinary obstruction at follow-up. Screening for neuroticism at pre-treatment could identify patients in need of more counseling concerning later adverse health outcomes.

Warming-needle moxibustion with different lengths of moxa stick for asthenospermia with kidney deficiency and liver depression: a randomized controlled trial

To explore the clinical effect of warming-needle moxibustion with different lengths of moxa stick for asthenospermia with kidney deficiency and liver depression. A total of 240 patients with asthenospermia of kidney deficiency and liver depression were randomly divided into a 4-cm group (moxibustion with 4-cm moxa stick, 60 cases, 3 cases dropped off), a 3-cm group (moxibustion with 3-cm moxa stick, 60 cases, 4 cases dropped off), a 2-cm group (moxibustion with 2-cm moxa stick, 60 cases, 2 cases dropped off) and an acupuncture group (60 cases, 3 cases dropped off). All patients were treated with warming-needle moxibustion with different lengths of moxa stick or conventicnal acupuncture at Zhongwan (CV 12), Guanyuan (CV 4), Zhongji (CV 3), Guilai (ST 29), Yaoyangguan (GV 3), Guanyuanshu (BL 26), etc., once a day, five times a week; 4-week treatment was taken as one course, a total of two courses of treatment were given. The semen routine indexes, seminal plasma biochemical indexes, sex hormone levels and TCM syndrome score were compared before and after treatment among the 4 groups. After treatment, the sperm density, sperm viability, ratio of grade A sperm, ratio of grade A and B sperm, seminal plasma fructose and neutral α-glucosidase were higher than those before treatment (P<0.05, P<0.01), and the sperm deformity rates were lower than those before treatment in the 4-cm group and the 3-cm group (P<0.01, P<0.05). The ratio of grade A sperm, ratio of grade A and B sperm, seminal plasma fructose and neutral α-glucosidase in the 4-cm group were higher than the other three groups (P<0.05, P<0.01), and the sperm deformity rate was lower than the other three groups (P<0.05). After treatment, except for dizziness and tinnitus score, each-domain score and total scores of TCM syndrome scale in the 4-cm group and the 3-cm group were lower than those before treatment (P<0.01, P<0.05). The each-domain score of depression, weak waist and knees, low sexual function and total score in the 4-cm group were lower than those in the other three groups (P<0.05, P<0.01). The total effective rate was 87.7% (50/57) in the 4-cm group, which was higher than 78.6% (44/56) in the 3-cm group, 77.6% (45/58) in the 2-cm group and 70.2% (40/57) in the acupuncture group (P<0.05, P<0.01). The warming-needle moxibustion with 4-cm moxa stick could effectively improve quality and motility of sperm and clinical symptoms in patients with asthenospermia of kidney deficiency and liver depression, which is superior to moxibustion with 3-cm, 2-cm moxa sticks and conventional acupuncture.

Substantial Impairment of Quality of Life during COVID-19 Pandemic in Patients with Advanced Rectal Cancer.

The aim of this study was to analyze the quality of life of patients with advanced rectal cancer before and during the COVID-19 pandemic and to determine whether the pandemic affected patients’ quality of life. The study included 389 patients and was performed from May 2010 to June 2021. The fifteen months from March 2020 to June 2021 were categorized as the COVID-19 period. Patients were surveyed using the QLQ-C30 and QLQ-CR38 questionnaires. The questionnaires were used at different phases of radiochemotherapy: prior to RCT (day 1), during RCT (day 14), at the end of RCT (day 35), and prior to mesorectal surgery (day 70). Scores were formed from the questions. In addition, scores were analyzed for different age groups (<64 and >64) and sexes (female and male). Overall, patients reported lower functional scores and higher symptom scores during the pandemic than before the pandemic. Although it had been expected that older and younger patients would differ clearly, there were only minor differences. The comparison between the two sexes showed very different scores, with female patients having lower functional scores and higher symptom scores than male patients before and especially during COVID-19. In conclusion, age does not play a major role in quality of life, but sex does play an important role in perception of functioning and symptoms. COVID-19 also had a major impact on patients’ lives, as it was a very isolating and stressful time for everyone, especially cancer patients, which was reflected in worsening scores.

Phase Angle, a Cornerstone of Outcome in Head and Neck Cancer.

In patients with head and neck cancer, malnutrition is common. Most cases are treated by chemo-radiotherapy and surgery, with adverse effects on the aerodigestive area. Clinical and biochemical characteristics, health-related quality of life, survival, and risk of death were studied. The selected subjects were divided into normal- and low-phase-angle (PA) groups and followed up for at least two years. Mean ages were 67.2 and 59.3 years for low and normal PA, respectively. Patients with PA < 4.42° had significant differences in age, anthropometric and biochemical indicators of malnutrition, and inflammatory status compared to patients with PA > 4.42°. Statistical differences were found in the functional and symptom scales, with lower functional scores and higher symptom scores in patients with low PA. Median survival was 19.8 months for those with PA < 4.42° versus 34.4 months for those with PA > 4.42° (p < 0.001).The relative risk of death was related to low PA (2.6; p < 0.001). The percentage of living patients (41.7%) is almost the same as the percentage of deceased subjects (43.1%; p = 0.002), with high death rates in patients with PA < 4.42°. Phase angle was the most crucial predictor of survival and a risk factor for death in the studied cases.

The influence of local pain on balance control in patients with chronic ankle instability

BackgroundLocal pain around the ankle joint is a common symptom in patients with chronic ankle instability (CAI). However, whether the local pain would impose any influence on the balance control performance of CAI patients is still unknown.MethodsA total of twenty-six subjects were recruited and divided into the following two groups: pain-free CAI (group A) and pain-present CAI (group B). Subjects in both groups received two independent tests: the star excursion balance test and the single-leg stance test, in order to reflect their balance control ability more accurately.ResultsCompared with group A, the group B showed significantly more episodes of the history of sprains, decreased ankle maximum plantarflexion angle, and lower Cumberland scores (all p < 0.05). In the star excursion balance test, group B demonstrated a significantly reduced anterior reach distance than group A (p < 0.05). During the single leg stance test, group B showed a significant increase in the magnitude of electromyographic signals both in peroneus longus and soleus muscles than group A (each p < 0.05). Additionally, group B had a significantly more anterolaterally positioned plantar center of pressure than group A (p < 0.05).ConclusionCAI patients with local pain around the ankle joint had more episodes of sprains and lower functional scores when compared to those without pain. The balance control performance was also worse in the pain-present CAI patients than those without pain.

Adults with Longstanding Strabismus: Psychosocial and Functional Impacts and Reasons behind Surgery Delay.

Purpose The aims of the study were to determine the reasons behind surgical correction delay in adult patients with strabismus, reveal motivations for seeking treatment, and study the psychosocial and functional impacts of strabismus on patients using an Arabic version of the Adult Strabismus-20 (AS-20) questionnaire. Methods and Patients. This study included 79 patients aged ≥18 years and had strabismus for at least one year prior to surgical correction and 40 controls without known visual defects. After a comprehensive ophthalmic exam during their preoperative visit, a validated questionnaire was administered to patients to collect sociodemographic data, reasons for surgery delay, and motivations for seeking treatment now. A translated version of the AS-20 questionnaire was then presented to patients and controls. Total AS-20 (and its subscales: psychosocial and function) scores were calculated and analyzed. All relationships between sociodemographic characteristics, the onset of deviation, presence of diplopia, type and size of deviation, and the changes in the scores of AS-20 (and its subscales) were investigated. Results A total of 79 adult patients with strabismus (cases) and 40 subjects with normal vision (control group) were included in this study. The mean age (SD) was 34.10 (11.5) years for cases (range: 18–61) and 34.20 (11.2) years for controls (range: 18–65) (p=0.964). About half (55.7%, n = 44) of the patients were males compared to (57.5%, n = 23) of the controls. The reasons for strabismus surgery delay reported by the patients were the following: surgery was not offered by an ophthalmologist (35.4%), surgery was offered but declined by the patient due to fear from surgical complications (22.8%), nonaffordability (17.7%), surgery was offered but refused because patients thought they were too old for surgery or patient was not bothered by appearance (15.2%), and patient never sought care (8.9%). The reasons for seeking surgical treatment after this delay were as follows: for cosmetic issues (27.8%), a better understanding of strabismus surgery and its potential complications (20.3%), pressure from family and friends (16.5%), improved economic status (13.9%), relationship/marriage prospects (13.9%), and to improve chances of getting a job (7.6%). When compared to control, patients have significantly lower mean scores of total AS-20 (50.57 vs. 88.01) and its psychosocial (49.59 vs. 87.84) and functional (51.55 vs. 88.19) subscales. AS-20 total score was significantly lower among females and in patients with large deviation size (>25 PD). The psychosocial subscale of AS-20 was significantly lower in females, patients with younger age of onset, and those with large deviation size (>25 PD). Female gender, large deviation size, vertical deviation, and having diplopia correlated significantly with a lower functional score. Conclusion Strabismus has a profound psychosocial and functional impact on affected individuals, especially females and patients with large deviation sizes. Many adult patients with strabismus tend to delay surgical correction; most of these delays could be avoided by better public education, increased awareness among health care providers, and changing health insurance policies to cover the costs of strabismus surgery.

Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis.

Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic outcomes in patients with PWFs who had undergone anatomical reduction and internal fixation and to identify the predictors that impair clinical and radiologic outcomes. The clinical records of 60 patients with elementary PWFs who had undergone anatomical reduction and internal fixation between January 2005 and July 2015 were reviewed retrospectively. The Harris hip score (HHS) and modified Merle d’Aubigné clinical hip scores (MMAS) were used to evaluate the clinical outcome. Preoperative and final follow-up radiographs were cross checked to identify poor radiographic outcomes that included the presence of advanced osteoarthritis and osteonecrosis, as well as the need for conversion to total hip arthroplasty. Acetabular dome comminution was assessed from computerized tomography, and the outcomes were further evaluated according to the involvement of fragment comminution. The fracture comminution and age were negatively correlated with functional outcomes (correlation coefficients were −0.41 and −0.39 in HHS and MMAS, respectively) and were significantly related to the severity of osteoarthritis and osteonecrosis as well as the need for total hip arthroplasty. Regarding the radiographic factors, significantly worse post-operative HHS and MMAS were found in the fracture comminution group. In the subanalysis of the status of fracture comminution, patients with fragment comminution involving the acetabular dome had significantly lower functional scores than those with other fracture patterns. In conclusion, age, fracture comminution, and dome comminution were the prognostic indicators of advanced osteoarthritis and poor functional scores after the anatomical reduction and internal fixation of PWFs. We emphasized the relevance of acetabular dome comminution as an important contributing factor to clinical and radiographic outcomes.

The Huntington’s Disease Health Index: Initial Evaluation of a Disease-Specific Patient Reported Outcome Measure

When developed properly, disease-specific patient reported outcome measures have the potential to measure relevant changes in how a patient feels and functions in the context of a therapeutic trial. The Huntington's Disease Health Index (HD-HI) is a multifaceted disease-specific patient reported outcome measure (PROM) designed specifically to satisfy previously published FDA guidance for developing PROMs for product development and labeling claims. In preparation for clinical trials, we examine the validity, reliability, clinical relevance, and patient understanding of the Huntington's Disease Health Index (HD-HI). We partnered with 389 people with Huntington's disease (HD) and caregivers to identify the most relevant questions for the HD-HI. We subsequently utilized two rounds of factor analysis, cognitive interviews with fifteen individuals with HD, and test-retest reliability assessments with 25 individuals with HD to refine, evaluate, and optimize the HD-HI. Lastly, we determined the capability of the HD-HI to differentiate between groups of HD participants with high versus low total functional capacity score, prodromal versus manifest HD, and normal ambulation versus mobility impairment. HD participants identified 13 relevant and unique symptomatic domains to be included as subscales in the HD-HI. All HD-HI subscales had a high level of internal consistency and reliability and were found by participants to have acceptable content, relevance, and usability. The total HD-HI score and each subscale score statistically differentiated between groups of HD participants with high versus low disease burden. Initial evaluation of the HD-HI supports its validity and reliability as a PROM for assessing how individuals with HD feel and function.

Association between post-traumatic stress symptoms and functional health among internally displaced people in Myanmar.

INTRODUCTION: Internally displaced persons (IDPs) are individuals forced to leave their homes and move within their country. Post-traumatic stress symptoms (PTSS) are prevalent in this population. To investigate trauma symptoms and functional health of IDPs in Myanmar and identify the factors associated with their functional health according to the presence/absence of PTSS. This cross-sectional study included 201 IDPs who completed a questionnaire on functional health, PTSS, resilience, social support and hope. The analysis included descriptive statistics, t-tests, Pearson's correlation coefficients and multiple linear regression with interaction analyses. Over one-third of the participants had PTSS, with low functional health scores. The greater the resilience, the better the functional health. The higher participants' PTSS, the poorer their functional health. There was a significant interaction between resilience and PTSS. Tailored resilience-building programs, as well as health policies and services, are needed to enhance IDPs' functional health and help them overcome PTSS. Psychological first aid should be provided to minimize PTSS experienced in situations of ongoing conflict and violence. Mental health nurses should be trained to assess IDPs' health status and tailor interventions accordingly.

Patient-perceived knee enlargement after total knee arthroplasty: prevalence, risk factors, and association with functional outcomes and radiological analysis.

In clinical practice, many patients complained that their knees became larger after total knee arthroplasty (TKA), yet no studies have described this phenomenon. We named this as "patient-perceived enlargement of knee" (PPEK). This study aimed to investigate the prevalence of PPEK after TKA; assess the association between PPEK and demographics, surgical options, or component size; assess the influence of PPEK on patient satisfaction and functional outcomes; and determine whether there was radiological difference between patients with or without PPEK. We reviewed patients that underwent unilateral primary TKA between May 2018 and April 2019. We investigated the prevalence of PPEK and acquired functional scores and satisfaction. Patients were divided into two groups according to whether they complained of PPEK. In radiological evaluation, we measured anterior and posterior condyle offset (ACO and PCO) of the femur, tibial coverage lines, tibial overhanging lines, and femoral overhanging lines. A total of 389 patients were enrolled and 101 patients felt their knee became "larger" after TKA. Patients with PPEK had significantly shorter height and lower weight, yet component size distribution showed no statistical difference. Patients with PPEK had significantly lower functional scores and satisfaction. Patients with PPEK had significantly larger ACO, shorter postoperative PCO, more ACO increase, and less anterior underhang of the tibia. PPEK is common in TKA patients, especially in individuals with smaller height and weight. PPEK is associated with poor satisfaction and lower functional scores. In radiology, post-operative ACO, PCO, and anterior underhang of the tibial component were correlated with PPEK.

Association between Patient-Reported Outcomes and Survival in Patients with Advanced Urothelial Carcinoma Treated with Atezolizumab.

Atezolizumab is an immune checkpoint inhibitor (ICI) and a frontline treatment of patients with cisplatin-ineligible advanced urothelial carcinoma (UC). There is limited evidence on the prognostic value of patient reported outcomes (PROs) in advanced UC treatment, particularly in the context of ICI therapy. To investigate the prognostic association of PROs with survival in patients with advanced UC treated with atezolizumab. This study used data from 467 patients with advanced UC initiating atezolizumab in the IMvigor211 trial. Pre-treatment PROs association with overall survival (OS) and progression free survival (PFS) was assessed using Cox proportional hazard analysis. PROs were recorded via the European Organisation for Research and Treatment of Cancer QLQ-C30. Discrimination performance was assessed via the C-statistic (c). Patient reported physical function, pain, appetite loss, global health, fatigue, role function, constipation, nausea and vomiting, dyspnoea, and insomnia were significantly associated with OS and PFS on univariable and adjusted analysis (P < 0.05). Physical function (c = 0.63), pain (c = 0.63), appetite loss (c = 0.62), global health status (c = 0.62), and fatigue (c = 0.62), were the most prognostic factors of OS. The OS discrimination performance of physical function (c = 0.61) was superior to ECOG PS (c = 0.58). Of patients assessed by investigators as having no performance restrictions (ECOG PS of 0), 38 (18%) and 91 (42%) self-reported low and intermediate physical function scores, respectively. Pre-treatment PROs were identified as independent prognostic factors of OS and PFS. Patient-reported physical function was more prognostic of OS than ECOG PS. This highlights a potential for PROs to enable improved patient stratification in ICI trials.

Effect of Upper Arm Position Changes on the Occurrence of Ipsilateral Shoulder Pain After Single-Operator Port Thoracoscopy

BackgroundThe aim of this study was to explore the factors associated with the occurrence of ISP after VATS to reduce the incidence of ISP and improve patients' quality of life.MethodsThe data of patients were collected between June 2020 and August 2020 in the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital. The angle of upper arm was measured intraoperatively. The patient's postoperative shoulder function was quantified using the Constant-Murley shoulder function rating score. The proportional hazards model was applied to identify multiple influence factors.ResultsA total of 140 eligible patients met criteria. At postoperative day 3, only the age influenced patients' shoulder pain. At postoperative day 14, univariate and multivariate logistic regression analyses showed that age (odds ratio [OR]: 1.098 [1.046-1.152]; P < 0.001) and upper arm Angle A (OR: 1.064 [1.011-1.121]; P = 0.018) were independent risk factors for low shoulder function scores. However, height was its protective factor (OR: 0.923 [0.871-0.977]; P = 0.006). At postoperative day 42, univariate and multivariate logistic regression analyses showed that age (OR: 1.079 [1.036-1.124]; P < 0.001) was a risk factor for low shoulder function scores, and height (OR: 0.933 [0.886-0.983]; P = 0.009) was its protective factor. In contrast, upper arm Angle B was not statistically associated with low shoulder function scores (P>0.05). In addition, the reduction in ipsilateral Shoulder scores after surgery was higher in patients with more than 113° of angle A (P = 0.025).ConclusionISP was closely related to the angle of anterior flexion of the upper arm on the patient's operative side intraoperatively. The increase in the degree of postoperative shoulder injury is more pronounced for an anterior flexion angle of >113°. Therefore, we recommend that the angle of anterior flexion of the upper extremity should be <113° intraoperatively.

The role of preoperative opioid use in shoulder surgery-A systematic review.

Emerging evidence suggests preoperative opioid use may increase the risk of negative outcomes following orthopedic procedures. This systematic review evaluated the impact of preoperative opioid use in patients undergoing shoulder surgery with respect to preoperative clinical outcomes, postoperative complications, and postoperative dependence on opioids. EMBASE, MEDLINE, CENTRAL, and CINAHL were searched from inception to April, 2021 for studies reporting preoperative opioid use and its effect on postoperative outcomes or opioid use. The search, data extraction and methodologic assessment were performed in duplicate for all included studies. Twenty-one studies with a total of 257,301 patients were included in the final synthesis. Of which, 17 were level III evidence. Of those, 51.5% of the patients reported pre-operative opioid use. Fourteen studies (66.7%) reported a higher likelihood of opioid use at follow-up among those used opioids preoperatively compared to preoperative opioid-naïve patients. Eight studies (38.1%) showed lower functional measurements and range of motion in opioid group compared to the non-opioid group post-operatively. Preoperative opioid use in patients undergoing shoulder surgeries is associated with lower functional scores and post-operative range of motion. Most concerning is preoperative opioid use may predict increased post-operative opioid requirements and potential for misuse in patients. Level IV, Systematic review.

Quality of life of adolescents with menstrual problems in Klang Valley, Malaysia: a school population-based cross-sectional study

ObjectiveTo describe the prevalence of menstrual problems (heavy menses bleeding, dysmenorrhoea and oligomenorrhoea) and its impact towards quality of life among adolescents in Klang Valley, Malaysia.DesignCross-sectional study.SettingAdolescent girls at secondary...

Positive effect of immunomodulatory therapies on disease progression in Huntington's disease? Data from a real-world cohort.

Background:The role of neuroinflammation and autoimmune processes in neurodegenerative diseases is not fully understood. Activation of microglia with expression of proinflammatory cytokines supports the hypothesis that immune processes may play an important role in the pathophysiology of Huntington’s disease (HD) and thus, immunomodulating therapies might have potential neuroprotective properties. Until now, no disease-modifying therapy (DMT) is available for HD.Objective:The aim of this research was to characterize a cohort of patients suffering from both HD and autoimmune demyelinating diseases of the central nervous system (classified as G35-37 in ICD-10; ADD-CNS) in comparison to HD cases without ADD-CNS. In particular, we were interested to investigate potential modulating effects on disease manifestation and progression of HD over time of prescribed immunomodulating medications (DMT).Methods:We analyzed the course of HD regarding motoric, functional, and cognitive aspects, using longitudinal data of up to 2 years from the worldwide registry study ENROLL-HD. Additional cross-sectional data in the largest cohort worldwide of HD patients was analyzed using demographic and molecular genetic parameters. Data were analyzed using analysis of variance (ANOVA) for cross-sectional and repeated-measures ANOVA for longitudinal parameters in IBM SPSS Statistics V.27.Results:Within the ENROLL-HD database, we investigated N = 21,116 participants and identified n = 60 participants suffering from ADD-CNS. Molecular, genetic, and demographic data did not differ between groups. The subgroup of n = 32 participants with motor-manifest HD revealed better cognitive performance in five out of eight cognitive tests at baseline with less progression over time in two tests (all p < 0.05). Differentiation between DMT-treated and untreated patients revealed better cognitive and motor performance in the DMT group; those patients, however, tended to be younger. Pre-manifest HD patients simultaneously diagnosed with ADD-CNS (n = 12) showed lower functional scores and more decline over time when compared with other pre-manifest HD (p < 0.05).Conclusion:Patients suffering from motor-manifest HD and simultaneously from ADD-CNS have better cognitive capacities compared with other motor-manifest HD patients. Moreover, DMTs might have beneficial effects on progression of neurodegeneration including the motor phenotype. However, this effect might have been biased by younger age in DMT-treated patients. Pre-manifest HD patients showed more functional impairment as expected due to their additional ADD-CNS disease.

Increased Prevalence of Depressive Symptoms in Patients Undergoing Revision for Periprosthetic Joint Infection.

BackgroundPeriprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. Patients undergoing revision for PJI may experience psychological distress and symptoms of depression, both of which are linked to poor postoperative outcomes. We, therefore, aim to identify the prevalence of depression and depressive symptoms in patients before treatment for PJI and their link to functional outcomes.MethodsPatients undergoing either debridement with implant retention (DAIR) or 2-stage exchange for PJI with minimum 1-year follow-up were retrospectively reviewed. The 2-stage (n = 37) and single-stage (n = 39) patients that met inclusion criteria were matched based off age (±5 years), gender, and body mass index (±5) to patients undergoing aseptic revisions. Outcomes evaluated included a preoperative diagnosis of clinical depression and preoperative and postoperative Veterans RAND 12 Item Health Survey mental component score and physical component score.ResultsCompared to matched controls, the prevalence of depressive symptoms was significantly greater in patients undergoing 2-stage exchange preoperatively (40.5% vs 10.8%, P < .01) but not postoperatively (21.6% vs 10.8%, P = .20). Patients undergoing DAIR with either preoperative depressive symptoms (31.3 vs 40.9, P = .05) or a preoperative diagnosis of depression (27.7 vs 43.1, P < .01) had significantly lower physical component scores postoperatively.ConclusionsPatients undergoing 2-stage exchange for PJI have a four times higher prevalence of preoperative depressive symptoms than patients undergoing aseptic revision. Patients undergoing DAIR with depression or preoperative depressive symptoms have lower functional scores postoperatively. Orthopedic surgeon screening of PJI patients with referral for treatment of depression may help improve outcomes postoperatively.

Health-related quality of life one year after the diagnosis of oesophageal cancer: a population-based study from the Swedish National Registry for Oesophageal and Gastric Cancer

BackgroundPopulation-based patient reported outcome data in oesophageal cancer are rare. The main purpose of this study was to describe health-related quality of life (HRQOL) 1 year after the diagnosis of oesophageal cancer, comparing subgroups of curatively and palliatively managed patients.MethodsThis is a nationwide population-based cohort study, based on the Swedish National Registry for Oesophageal and Gastric Cancer (NREV) with prospectively registered data, including HRQOL instruments from the European Organisation for Research and Treatment of Cancer including the core and disease specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Patients diagnosed with oesophageal cancer between 2009 and 2016 and with complete HRQOL data at 1 year follow-up were included. HRQOL of included patients was compared to a reference population matched by age and gender to to a previous cohort of unselected Swedish oesophageal cancer patients. Linear regression was performed to calculate mean scores with 95% confidence intervals (CI) and adjusted linear regression analysis was used to calculate mean score differences (MD) with 95% CI.ResultsA total of 1156 patients were included. Functions and global health/quality of life were lower in both the curative and palliative cohorts compared to the reference population. Both curatively and palliatively managed patients reported a severe symptom burden compared to the reference population. Patients who underwent surgery reported more problems with diarrhoea compared to those treated with definitive chemoradiotherapy (dCRT) (MD -14; 95% CI − 20 to − 8). Dysphagia was more common in patiens treated with dCRT compared to surgically treated patients (MD 11; 95% CI 4 to 18). Those with palliative intent due to advanced tumour stage reported more problems with dysphagia compared to those with palliative intent due to frailty (MD -18; 95% CI − 33 to − 3).ConclusionsOne year after diagnosis both curative and palliative intent patients reported low function scores and severe symptoms. Dysphagia, choking, and other eating related problems were more pronounced in palliatively managed patients and in the curative intent patients treated with dCRT.

Electromyographic findings in primary lateral sclerosis during disease progression

ObjectiveTo characterize electromyographic (EMG) findings in patients with primary lateral sclerosis (PLS) during the disease course. MethodsIn PLS patients we scored spontaneous activity and motor unit action potential (MUP) pattern on EMG. We compared patients according to lower (group A) and higher (group B) EMG scores. EMG studies were repeated at intervals longer than 11 months; two or three repeat studies were required for inclusion in the analysis. ResultsWe studied 22 patients. Fasciculation potentials were found in 13 and fibrillations/positive sharp waves (fibs/sw) in 3 patients. Both were stable over time. Most patients had MUP abnormalities (n = 17), with worsening in the lower limbs in patients with three evaluations (p = 0.010). Compared to group A (n = 12), patients of group B (n = 10) had a significant shorter disease duration (median 10.9 vs 15.2 years, p < 0.001), lower functional score at both first (39 vs 45, p = 0.034) and last (29 vs 38, p = 0.003) evaluations, and had a faster functional decline (0.19 vs 0.08, p = 0.004). ConclusionsMost PLS patients showed minor and stable EMG abnormalities, without progression to ALS. Patients with more EMG abnormalities have a faster progression. SignificanceEMG abnormalities in most PLS patients are minor and stable.

Impact of Dementia on Patterns of Home Care After Inpatient Rehabilitation Discharge for Older Adults After Hip Fractures

ObjectiveTo describe differences in home care use in the 30 days after discharge from inpatient rehabilitation after a hip fracture among older adults with dementia compared with those without dementia. DesignRetrospective cohort study of individually linked health administrative data. SettingCommunity-dwelling older adults after discharge from inpatient rehabilitation facilities in Ontario, Canada. ParticipantsA total of 17,263 older adults (N=17,263), of whom 2489 had dementia (14.4%), who were treated for hip fracture in acute care and then admitted to inpatient rehabilitation facilities between January 1, 2011 and March 31, 2017. InterventionsNot applicable. Main Outcome MeasuresThe proportion receiving home care services and number of visits (physiotherapy, occupational therapy, nursing, personal/homemaking) in the 30 days after discharge were compared by dementia status with multivariate models, stratified by sex. ResultsCompared with those without dementia, adults with dementia were older, had lower functional scores, and were more likely to receive home care services in the 30 days after discharge from inpatient rehabilitation (87.0% vs 79.0%, P<.001), including personal/homemaking services (66.1% vs 46.4%, P<.001) and occupational therapy (45.3% vs 37.4, P<.001) but not physiotherapy (55.8% vs 56.2%, P=.677) or nursing (19.6% vs 18.7%, P=.268). After adjustment, older adults with dementia were more likely to receive home care in both men (odds ratio [OR] =2.01; 95% confidence interval [CI], 1.57-2.57) and women (OR=1.50; 95% CI, 1.30-1.74) as well as more services (rate ratio men=1.60; 95% CI, 1.44-1.79; rate ratio women=1.50; 95% CI, 1.41-1.60). ConclusionsAmong older adults discharged from inpatient rehabilitation, older adults with dementia received home care services more often than older adults without dementia. However, irrespective of sex and dementia status, almost half of this population (44%) did not receive physiotherapy. We recommend that, resources permitting, all older adults receive physiotherapy to facilitate recovery.

Quality of life in keratoconus: evaluation with Keratoconus Outcomes Research Questionnaire (KORQ)

To assess the quality of life of keratoconus patients using the Keratoconus Outcomes Research Questionnaire (KORQ), translated and validated in Portuguese language. The KORQ is the only validated keratoconus specific questionnaire and has a high rating for its psychometric properties. This cross-sectional study enrolled 100 keratoconus patients from a tertiary referral eye hospital between April 2018 and June 2019. Associations between age, sex, allergic conjunctivitis, keratoconus stage, best-corrected visual acuity (BCVA), maximum simulated keratometry (Kmax), steep keratometry (K2), pachymetry, treatments performed, hydrops, and KORQ scores were evaluated using univariate (Wilcoxon test and the Kruskal Wallis test) and multivariate linear regression with stepwise backward modeling. Lower KORQ scores are associated with better quality of life, whereas, higher scores are associated with greater impairment of functional activities and symptoms. Among the 100 patients, mild, moderate, and severe keratoconus were observed in 15%, 46% and 39% of participants, respectively. Univariate analysis showed lower function scores values, with male sex (p < 0.05) and both functional and symptom scores were significantly associated with BCVA < 0.3 (LogMAR) (p < 0.05). Multivariate analysis indicated significantly lower functional scores in individuals with BCVA < 0.3 (LogMAR) (p < 0.001) and those with a history of crosslinking treatment (p = 0.022), while symptom scores were only significantly associated with only BCVA < 0.3 (LogMAR) (p < 0.001). In patients with keratoconus, BCVA in the better eye and history of crosslinkig were factors associated with better quality of life scores using the KORQ.