Quality Of Outcomes Research Articles

Self-reflecting strategies applied by EFL high school teachers for teaching quality improvement

ABSTRACT Recent studies in Vietnam found that metacognitive strategies were employed with consistent practice to enhance student learning outcomes significantly. Positive perceptions of reflective teaching practices contribute to teachers’ professional development regarding teaching quality and student outcomes. This study aimed to examine common self-reflecting strategies that were most frequently implemented in the teaching process to improve teaching quality. The tools of the questionnaire and semi-structured interviews were employed to collect quantitative and qualitative data for this descriptive study. The participants were EFL teachers teaching at high schools in most of the provinces in the Mekong Delta. The research findings showed that teachers perceived common strategies of self-reflecting, although they did not often apply them in their teaching performance. Regarding this, they focused on implementing peer observation, students’ feedback, and teachers’ diaries instead of video – audio recordings in their teaching. Some pedagogical implications and research suggestions about the effectiveness of the application of self-reflecting strategies in improving teachers’ teaching or developing their profession were proposed in the study.

Factors influencing patient engagement in decision making for catheter ablation of atrial fibrillation: a cross-sectional survey.

Patient engagement in decision making could improve healthcare quality and health outcome, which has been emphasized in atrial fibrillation (AF) management guidelines. However, patients report relatively low level of engagement in decision making for catheter ablation (CA). Therefore, this study aims to explore the influencing factors of AF patient engagement in decision making for CA. A cross-sectional study was conducted. A total of 836 patients were recruited from six tertiary hospitals in Shanghai. Adapted version of the Control Preferences Scale, Chinese version of the All Aspects of Health Literacy Scale, Chinese version of the Facilitation of Patient Involvement Scale and the Atrial Fibrillation Knowledge Questionnaire were used to measure patient engagement in decision making, health literacy, perception of physician facilitation and AF knowledge, respectively. Of the 750 patients who returned valid questionnaires, 20.2% of the patients reported active engagement in decision making, 39.5% reported collaborative engagement, and 40.3% reported passive engagement. Compared with patients perceiving passive engagement, those with collaborative or active engagement were more likely to be female, have higher income, moderate EHRA class (II and III), higher perception of physician facilitation, higher health literacy and higher AF knowledge (P＜0.05 for all). The collaborative engagement group exhibited a shorter AF duration. The degree of patient engagement in CA decision making varied, with most perceiving passive engagement. Patient engagement in decision making was influenced by gender, income, duration of AF, EHRA class, perception of physician facilitation, health literacy and AF knowledge.

Factors affecting prostate cancer detection through asymptomatic PSA testing in primary care in England: Evidence from the 2018 National Cancer Diagnosis Audit.

Background Prostate-Specific Antigen (PSA) is used in primary care for prostate cancer detection, either for symptomatic assessment or asymptomatic testing following an informed decision. Aim To estimate the proportion of prostate cancer cases diagnosed following asymptomatic PSA testing, and patient and practice factors influencing this route. Design and setting 2018 English National Cancer Diagnosis Audit (NCDA) data were analysed, with linkage to the national cancer registry, practice-level Quality Outcomes Framework (QOF), and General Practice Patient Survey (GPPS) data. All 2018 NCDA patients with a diagnosis of prostate cancer were included (n = 9,837). Method Patients with recorded biomarker testing and no recorded symptoms prior to diagnosis were classified as asymptomatic PSA detected prostate cancer. Patient (age, ethnicity, deprivation, co-morbidities) and GP practice (geographical location, area deprivation, list size, urgent suspected cancer referral rate, QOF outcomes, GPPS results) factors were analysed for association with asymptomatic PSA testing using mixed effects logistic regression models. Results 1,884 out of 9,837 (19%) prostate cancer cases were detected following asymptomatic PSA testing, 982 (52.1%) of whom were patients aged 50-69 years. Younger age, non-White ethnicity, lower deprivation, and lower co-morbidity count were associated with an increased likelihood of diagnosis following asymptomatic PSA testing. There was a 13-fold variation between practices in the odds of asymptomatic PSA-detected cases, without clear explanatory GP practice-level factors. Conclusion One in five patients with prostate cancer in England are diagnosed after asymptomatic PSA testing in primary care, with large variation in asymptomatic PSA detection between GP practices.

A Significant Correlation of Glutamine and Interlukin-6 with Pregnancy Rate in Women Undergoing ICSI

Background: The composition of follicular fluid (FF) is significantly influenced by metabolic factors, and the analyses of metabolites in FF could reveal the correlation between metabolites and oocyte quality, embryo development, and pregnancy outcome. FF provides nutrients and growth factors that promote oocyte growth, development, and maturation. Objective: To investigate the relationship between serum and FF glutamine and FF IL-6 levels and their influence on the pregnancy rate in women who are undergoing an ICSI treatment cycle. Materials and Methods: A prospective cross-sectional study was performed on 90 women aged 20- 44 years who underwent ICSI treatment from July 2023 to February 2024. Serum and follicular fluid collected on the day of oocyte pick-up were used as biological material. The embryological laboratory examined the retrieved follicular fluid and collected oocytes using stereomicroscopy. ELISA analysed serum, FF glutamine and FF IL-6. The ICSI method was utilized for fertilization. The pregnancy test is done by measuring serum BHCG. Statistical data processing was conducted using the software package SPSS 23. Results: There was a highly significant correlation between FF glutamine and FF IL-6 (p < 0.001) and a positive correlation between FF glutamine and FF IL-6 with pregnancy rate ( p < 0.001) (p < 0.001 ). Conclusion The correlation of FF glutamine and FF IL-6 affects the pregnancy rate in women undergoing ICSI. FF glutamine and FF IL-6 can be considered predictors for pregnancy while serum glutamine has no significance.

Does Hospital–Physician Integration Improve Hospital Performance? Results from a USA Longitudinal Study

In a dynamic healthcare industry, aligning the goals and objectives of hospitals and physicians through integration has been suggested to influence performance. Physicians’ leadership and active involvement in governance can direct resource usage, Electronic Health Record (EHR) implementation, price negotiation, better coordination, and continuity of services for patients, thus affecting performance. This study aimed to examine the relationship between physician integration and hospital performance, investigating both financial and quality outcomes. We used a longitudinal study design. Our sample was hospital-level data from 2014 to 2019, which contained 6000 U.S. hospital-year observations. The dependent variables were quality outcomes (readmission rates) and financial outcomes (total and operating margins). The independent variable explored three dimensions of integration: high, low, and overall integration. Findings showed no impact of hospital–physician integration on quality outcomes and financial performance. High-integration hospitals did not show any significant relationships with quality outcomes and financial performance compared to hospitals that did not have high integration. Hospital–physician integration may have little potential to bring clinical integration even though vertical integration is present. A commitment to improving quality as a strategic priority may be vital in impacting quality outcomes, followed by financial performance.

Long Term Outcomes of Pain, Disability and Quality of Life in Open vs Minimally Invasive Surgery of Transforaminal Lumbar Interbody Fusion

Objective: This study aims to evaluate the short- and long-term outcomes—specifically in terms of pain, disability, and quality of life—between minimally invasive surgery (MIS) and open transforaminal lumbar interbody fusion (TLIF) for treating lumbar spondylolisthesis. Study Design and Setting: A prospective cohort study was carried out at Liaquat National Hospital & Medical College, Karachi, and a teaching institution in South Asia. The study included patients with chronic back pain for over three months, unresponsive to medical treatment or accompanied by radicular symptoms, with MRI-confirmed grade I and II degenerative lumbar spondylolisthesis, lateral recess stenosis, and unilateral disc herniation. Patients with spinal metastasis, previous surgeries, inflammatory arthritis, or metabolic bone diseases were excluded. Methodology: The outcomes of MIS-TLIF and open-TLIF were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and SF-36 quality of life scores at 1, 6, and 24 months postoperatively. Results: Among 93 patients, 35 underwent open-TLIF and 58 received MIS-TLIF. MIS-TLIF resulted in significantly less blood loss and faster recovery. At four weeks, the MIS group had lower VAS and ODI scores, and higher SF-36 scores. Similar trends continued at six months, with improvements in ODI and SF-36. By 24 months, the MIS group maintained lower ODI scores, though VAS and SF-36 scores were comparable. Conclusion: MIS-TLIF shows superior outcomes, especially in the early postoperative phase, with reduced morbidity and improved quality of life, making it a preferable option in resource-limited settings.

Evaluating a targeted selective speech, language, and communication intervention at scale – Protocol for the Happy Talk cluster randomised controlled trial.

Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

Effects of organizational climate on employee job satisfaction and psychological well-being: the role of technological influence in Chinese higher education

BackgroundIn the Chinese education sector, educators’ job satisfaction (JoS) is considered critical to educational quality and student outcomes. One critical area of inquiry is the organizational climate (OC) and its impact on JoS, and psychological well-being (PW), with technological influence (TI) moderating effect.PurposeThe current study has tried to look at the exact relationship among OC, PW, and JoS for educators working in the Chinese higher education setting. It also discusses the moderating role of TI on OC and JoS.Design/methodologyThis study uses a quantitative cross-sectional survey design, grounded in post-positivism assumptions. Data collection involved sampling 690 respondents in the Chinese higher education setting via WeChat.FindingsThe study methodology part included a pre-test, translation validation, demographic characteristics of participants, and results that showed a significant positive influence on JoS for PW and OC. The study also confirms the positive effect of PW on JoS. Moreover, the mediating role of PW within the OC–JoS link is also supported. Furthermore, TI positively moderates the OC–JoS relationship, thus it implies a supportive role of technology in enhancing the educators’ satisfaction. The model indicated that OC, PW, and TI explain 72.4% of the variation in JoS.ConclusionIn this respect, the findings offer some practical insights for educational institutions and policymakers to facilitate enhancement strategies for OC, thus recognizing its influence on JoS and the well-being of educators. Understanding how technology can play a moderating role presents the strategic occasion to utilize technological tools for a more satisfying work environment.

Enhanced patient journey associated with improved overall survival in colon cancer patients: A study by the Ligurian Oncology Network.

Colon cancer imposes a significant burden on global healthcare systems, necessitating efforts to improve oncology care quality and patient outcomes. We studied the correlation between care quality and survival outcomes among colon cancer patients within the Ligurian Oncology Network (Italy). We developed an Overall Quality Score (OQS) to evaluate the impact of oncology care quality on survival outcomes within the Ligurian Oncology Network. OQS indicators were selected through expert consensus, covering screening, diagnosis, treatment, and follow-up. A sample of colon cancer patients diagnosed in 2012 was randomly selected from administrative healthcare data. Analyses were performed using two models: a binary model (High and Low OQS) and a stratified model (Low, Medium, and High OQS). Statistical analysis involved survival curves, log-rank tests, and Cox proportional hazards models using SAS 9.4. Of 175 eligible colon cancer patients, 150 were included. Following a median follow-up of 7.6 years, a correlation between High-OQS (⩾ 65%) and prolonged disease-free survival was observed (unadjusted HR 0.57, 95%CI 0.33-0.99, log-rank p=0.041). The five-year disease-free survival rate for High-OQS patients was 70% (95%CI 57-80%), compared to 53% (95%CI 41-64%) for Low-OQS patients. Similarly, the five-year overall survival rate was 78% (95%CI 65-86%) for High-OQS patients, compared to 58% (95%CI 45-68%) for Low-OQS patients (unadjusted HR 0.56, 95%CI 0.31-1.00, log-rank p=0.048). Our findings highlight the potential impact of the patient journey on colon cancer survival outcomes. Optimising care pathways might improve patient outcomes in colon cancer management.

Scope of practice and opioid prescribing behavior of nurse practitioners serving Medicare beneficiaries.

Policymakers aiming to increase access to health care while simultaneously keeping costs low and quality high are considering expanding the practice authority and prescriptive authority of nurse practitioners in order to address primary care shortages. While we know this increases access, some researchers argue that the expansion of job autonomy of nurse practitioners can compromise the quality and safety of rendered medical services. This paper investigates quality and safety outcomes in prescribing behaviors of nurse practitioners who have prescribed opioids for Medicare Part D beneficiaries using a unique source of policy variation, nurse practitioners with the ability to prescribe medication who move to either states with or without physician supervision. We find that scope of practice expansions do not compromise quality and safety in terms of potential abuse or misuse of prescriptive authority.

Intersecting impacts: urban noise pollution on sleep quality and mental health outcomes

This study probes the intricate dynamics between urban noise pollution, sleep quality, and mental health, centering on Generation Z-those in their formative years and early adulthood. It aims to illuminate the particular impacts of environmental noise on the well-being of these younger urban dwellers. Through a multidisciplinary lens, the research assesses how persistent urban noise exposure perturbs sleep-a critical factor in psychological health-and fosters stress, anxiety, and depression in this demographic. By integrating objective acoustical measurements with Gen Z's subjective health reports, the methodology quantifies urban noise's influence on sleep and its ripple effects on mental health. Additionally, it evaluates noise mitigation strategies like soundproofing and urban greenery, for their potential to mitigate these adverse outcomes. Mapping the nexus between environmental noise, sleep disturbance, and mental health concerns among Generation Z, the study seeks to enrich understanding and guide interventions for improved urban habitats, better sleep, and enhanced mental well-being, addressing a significant public health issue.

Impact of nurse-led palliative care on symptom management and life quality outcomes in elderly cancer patients: A retrospective study.

The objective was to explore impacts of nurse-led palliative care interventions on elderly cancer patients in terms of symptom management and life quality outcomes. This retrospective study examined 150 cancer patients from January 2021 to September 2023, divided into 2 groups based on nurse-led palliative care receipt. The observation group (n = 90) received nurse-led palliative care while the control group (n = 60) received routine nursing frequency was 3 times per week for 6 months. The treatment-related symptoms (therapy-related symptoms checklist, TRSC) was used to evaluate the symptom improvement rate of patients, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used to evaluate the improvement of patients' quality of life, and Chinese version of the Brief Pain Inventory (BPI-C) and Chinese version of the Brief Fatigue Inventory (BFI-C) were used to access the improvement of pain and fatigue respectively. Following the intervention, symptom improvement rate in the observation group exhibited markedly superior compared to the control group (100% vs 91.67%, P < .05) and a significant improvement in the patient's health-related quality of life was observed in the observation group at 1, 3, and 5 months postintervention (P < .05). In additional, the observation group displayed notably lower scores on both BPI-C and the BFI-C in contrast to the control group (P < .05). Nurse-led palliative care interventions can effectively improve symptom management and quality of life in elderly cancer patients compared to routine nursing care.

Mobility Loss in Hospitalized Adults Predicts Poor Clinical Outcomes.

The Johns Hopkins Activity and Mobility Program is a systematic approach to measure and improve patient mobility. The purpose of this study was to evaluate the relationship between mobility loss and quality outcomes. A retrospective cohort study design was used. Patients were categorized into 3 groups (gain, loss, no change in mobility) using the Johns Hopkins Highest Level of Mobility (JH-HLM) scores. The association between mobility loss and falls risk, in-hospital mortality, delirium, discharge to a facility, length of stay, and 30 day readmissions were assessed. Those who lost mobility were more at risk of being a high fall risk, in-hospital mortality, delirium, discharging to a facility, and had 48% longer lengths of stay. There was no association between mobility loss and 30-day readmissions. Loss of mobility assessed using JH-HLM scores is associated with worse patient outcomes.

Association of Participation in Medicare's Oncology Care Model With Spending, Utilization, and Quality Outcomes Among Commercially Insured and Medicare Advantage Members.

The Oncology Care Model (OCM), a value-based payment model for traditional Medicare beneficiaries with cancer, yielded total spending reductions that were outweighed by incentive payments, resulting in net losses to the Centers for Medicare & Medicaid Services. We studied whether the OCM yielded spillover effects in total episode spending, utilization, and quality among commercially insured and Medicare Advantage (MA) members, who were not targeted by the program. This observational study used administrative claims from a large national payer, yielding 157,189 total patients with commercial insurance or MA with solid malignancies who initiated 229,376 systemic anticancer therapy episodes before (2012-2015) and during (2016-2021) the OCM at 125 OCM-participating practices (a subset of total OCM practices) and a 1:10 propensity-matched set of 860 non-OCM practices. We used difference-in-differences analyses to assess the association between the OCM and total episode spending, defined as medical spending during a 6-month episode. Secondary outcomes included hospitalization and emergency department (ED) utilization and quality measures. From the pre-OCM to the OCM period, mean total episode payments increased from $45,504 in US dollars (USD) to $46,239 USD for OCM-participating practices, and increased from $50,519 USD to $58,591 USD for non-OCM practices (adjusted difference-in-differences -$6,287 USD [95% CI, -$10,076 USD to -$2,498 USD], P = .001). The OCM was associated with adjusted spending decreases for both high-risk (-$6,756 USD [95% CI, -$10,731 USD to -$2,781 USD], P = .001) and low-risk (-$4,171 USD [95% CI, -$7,799 USD to -$543 USD], P = .025) episodes. OCM-associated spending reductions were strongest for outpatient (-$5,243 USD [95% CI, -$8,589 USD to -$1,897 USD], P = .002) and infused/injected anticancer drug (-$3,031 USD [95% CI, -$5,193 USD to -$869 USD], P = .006) spending. There were no associations between OCM participation and changes in hospital or ED utilization nor quality of care. The OCM was associated with reductions in spending for nontargeted members, a spillover effect.

Gender differences in postoperative pain, sleep quality, and recovery outcomes in patients undergoing visual thoracoscopic surgery

ObjectiveThe purpose of our study was to investigate the effect of gender on postoperative pain, sleep quality, and recovery outcomes in patients undergoing VATS surgery under general anesthesia. MethodPerioperative peripheral blood inflammatory markers system inflammation Index (SII) was recorded for perioperative inflammatory response. The visual analog scale (VAS) was used to evaluate pain level. And the Athens Insomnia Scale (AIS) was evaluated on the night before surgery (sleep preop 1), the first night after surgery (sleep POD 1), and the third night after surgery (sleep POD 3) for postoperative sleep. ResultIn this prospective cohort study, 79 males and 79 females were consecutively included. Females had significantly higher pain score (both rest and cough pain) compared to the males at 3 h after the surgery (3.85 ± 1.2 vs. 3.16 ± 1.1) (rest) (p < 0.001) and 5.10 ± 1.3 vs. 4.46 ± 1.6 (coughing) (p = 0.006)). Patients in the male group had significantly lower AIS scores than those in the female group at Sleep POD 1 and Sleep POD 3 (p = 0.024 and p = 0.045). And in both groups, postoperative SII was increased and statistically significant compared to preoperative SII (p < 0.001, respectively). Women presented higher levels of SII on the first day after surgery, and the increase of postoperative SII in females groups was significantly higher than that in male group when compared to preoperative SII (1806.33 ± 1314.8 vs 1430.55 ± 958.4) (p = 0.042). ConclusionThese findings highlight the complex multidimensional nature of postoperative pain, nausea and vomiting, sleep quality and the potential contributory role of sex in shaping these outcomes. Women had worse sleep quality, higher postoperative inflammatory response level and pain level than men.

Institutional Special Needs Plans In Nursing Homes: Substantial Enrollment Growth But Low Availability, 2006-21.

Institutional Special Needs Plans (I-SNPs) are a type of Medicare Advantage (MA) plan designed for long-term residents of nursing homes or those who live in the community but need a nursing home level of care. I-SNPs provide for on-site nurse practitioners in nursing homes to help improve primary care, care planning, and care coordination. Our study was the first to undertake a nationwide descriptive analysis of the I-SNP market. The share of long-stay nursing home residents enrolled in I-SNPs quadrupled from 2006 to 2021, from 2.2percent to 8.8percent. Despite this growth, nearly 70percent of nursing homes did not have any residents enrolled in I-SNPs in 2021, and in more than 60percent of US counties, there were no I-SNPs available. Nearly 94percent of long-stay nursing home residents who were enrolled in I-SNPs in 2021 were eligible for both Medicare and Medicaid. More research is needed to understand why I-SNPs enter certain markets and why long-stay nursing home residents choose to enroll in them; to assess I-SNP enrollment barriers; and to compare hospital admission rates and quality outcomes among long-stay nursing home residents by I-SNP enrollment status. Increased understanding of I-SNPs could inform policies to address long-standing concerns about the quality of care in nursing homes.

Association between Unmet Social Need and Ambulatory Quality of Care for U.S. Children

ObjectivesChildren who experience socioeconomic adversity often have worse health; however, less is known about their quality of care. We sought to evaluate the association between parent/caregiver-reported socioeconomic adversity and quality of pediatric primary, acute, and chronic ambulatory care on a national level. MethodsThis was a retrospective cohort study of 5,368 representative U.S. children (1-17 years) in the 2021 Medical Expenditure Panel Survey. Socioeconomic adversity was defined as parent/caregiver-reported food, housing, transportation, or utility insecurity in the past 12 months. Outcomes included 10 quality measures of primary, acute, and chronic care, and experience of care measured through parent/caregiver survey. We described variation in socioeconomic adversity and used multivariable regression to examine associations with quality outcomes. ResultsOne-third of parent/caregivers reported socioeconomic adversity. Food insecurity (23.6%) was most common followed by utility (19.5%), housing (15.0%), and transportation (4.7%) insecurity. Black (53.2%) and Hispanic (46.9%) parent/caregivers experienced the highest rates of socioeconomic adversity. Children with socioeconomic adversity received lower quality of care for 4 quality measures, including more frequent ED visits (Odds Ratio (OR)=1.69 [95% Confidence Interval (CI):1.28-2.23]), less favorable asthma medication ratio (OR=0.04 [95%CI:0.01-0.31]), and less frequent well child (OR=0.73 [95%CI:0.59-0.90]) and dental care (OR=0.76 [95%CI:0.63-0.94], p <.05 for all). There were no statistically significant differences in experience of care. ConclusionsSocioeconomic adversity is common among U.S children with disproportionate impact on Black and Hispanic families. There are significant disparities in pediatric primary, acute, and chronic care quality, based on parent/caregiver-reported socioeconomic adversity, highlighting the need for systems-level interventions.

Early intervention of extracorporeal shockwave therapy sustained positive long-term effect on rotator cuff healing: A randomized controlled trial with 3-year follow-up

BackgroundThe long-term effects of extracorporeal shockwave therapy (ESWT) on rotator cuff repair are unknown. ObjectivesTo investigate the functional outcomes and structural changes of ESWT at 3-year follow-up after rotator cuff repair. MethodsA randomized clinical trial was conducted, including patients who underwent rotator cuff repair. The patients were assigned to two groups based on whether they underwent radial ESWT 3 months postoperatively. The ESWT Group received 5 weeks of rehabilitation and ESWT weekly, whereas the CONTROL Group received only rehabilitation. Visual analog scale (VAS) pain score and functional scores were analyzed at 3 months (baseline), 6 months, and 3 years follow-up. In addition, MRI and ultrasonography were used to assess tendon maturation, integrity, tendon quality, acromiohumeral distance (AHD), and muscle fatty infiltration. ResultsFinally, 32 participants completed all the assessments. At the final follow-up, 2 patients in the ESWT Group (16.5 %) versus one patient in the CONTROL Group (6.25 %) had rotator cuff failure (P = 0.176). The ESWT treatment showed similar clinical outcomes in VAS-pain score, functional scores, tendon quality, AHD, and muscle fatty infiltration versus the CONTROL Group (Ps > 0.05). MRI analysis indicated improved tendon healing after ESWT treatment at both 6-month (P = 0.036) and 3-year follow-up (P = 0.028). ConclusionEarly intervention with radial ESWT sustained long-term effects on the healing of the repaired rotator cuff and similar functional outcomes at long-term follow-up compared with standard rehabilitation.

Mental health and health-related quality of life in adolescents surgically treated for hypospadias in childhood

BackgroundThere is limited research and conflicting results on the mental health and health-related quality of life of individuals surgically treated for hypospadias in childhood. Furthermore, the significance of patient-reported outcomes (PRO) in hypospadias is growing. More research is necessary on these topics, particularly in adolescents. ObjectiveWe aimed to compare mental health, health-related quality of life, body satisfaction, self-esteem, penile appearance, and sexual function outcomes in 16-year-old adolescents who had surgery for hypospadias in childhood with a healthy comparison group. Study designThe study involved 16-year-old adolescents who had surgery for hypospadias in one Norwegian hospital. An age-matched comparison group of healthy adolescents was previously recruited. The study assessed self-reported outcomes on mental health using the Strengths and Difficulties Questionnaire, health-related quality of life using the Pediatric Quality of Life Inventory, body satisfaction and self-esteem using the Self-Perception Profile for Adolescents, and genital perception and sexual function using the Pediatric Penile Perception Score and a non-validated structured interview. ResultsIn total, 117 adolescents operated for hypospadias and 61 healthy adolescents were included. The outcomes for mental health and health-related quality of life were not statistically different between groups. However, 18 (16%) hypospadias patients were classified as cases/borderline on mental health outcomes, compared to 2 (3%) in the comparison group (p=0.01). Patients classified as cases/borderline on mental health reported lower health-related quality of life, self-esteem, and more stressful life events. Self-reported penile appearance and sexual function were comparable between groups, however the proximal hypospadias group displayed lower satisfaction. DiscussionAlthough the present study had generally positive outcomes, a significant finding was that a higher number of adolescents who had previously undergone hypospadias surgery during childhood were classified as cases or borderline cases with respect to mental health issues. Hypospadias surgery in childhood may pose challenges for some patients during adolescence, particularly in the proximal group. Regular monitoring by healthcare professionals is crucial in providing necessary support. A limitation is the small size of the subgroups. ConclusionMost patients report good mental health, quality of life, and self-esteem even though patients with hypospadias report more mental health issues than the comparison group. Proximal hypospadias were less satisfied with penile appearance and sexual function. However, due to the small sample size, conclusions about this group should be treated cautiously. Assessing self-reported outcomes in follow-ups is important to identify adolescents who had hypospadias surgery and are at risk for reduced mental health.

Sexual Health and Quality of Life in Patients With Low-Risk Early-Stage Cervical Cancer: Results From GCIG/CCTG CX.5/SHAPE Trial Comparing Simple Versus Radical Hysterectomy.

Simple hysterectomy and pelvic node assessment (SHAPE) is a phase III randomized trial (ClinicalTrials.gov identifier: NCT01658930) reporting noninferiority of simple compared with radical hysterectomy for oncologic outcomes in low-risk cervical cancer. This study presents secondary outcomes of sexual health and quality of life (QOL) of the SHAPE trial. Participants were randomly assigned to receive either radical or simple hysterectomy. Sexual health was assessed up to 36 months postoperatively using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised and QOL using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Cervical Cancer-Specific Module (QLQ-CX24) questionnaires. Among participants with at least one QOL measure, clinical and pathologic characteristics were balanced and with no differences in preoperative baseline scores for sexual health or QOL between groups. FSFI total score met the cutoff for dysfunction up to 6 months (P = .02) in the radical hysterectomy group. Group differences favored simple hysterectomy for FSFI subscales: desire and arousal at 3 months (P ≤ .001) and pain and lubrication up to 12 months (P ≤ .018). Both groups met the cutoff for sexual distress but was higher in radical hysterectomy at 3 months (P = .018). For QLQ-CX24, symptom experience was significantly better up to 24 months (P = .031) and body image better at 3, 24, and 36 months (P ≤ .01) for simple hysterectomy. Sexual-vaginal functioning was significantly better up to 24 months (P ≤ .022) and more sexual activity up to 36 months (P = .024) in the simple hysterectomy arm. Global health status was significantly higher at 36 months for simple hysterectomy (P = .025). Simple hysterectomy was associated with lower rates of sexual dysfunction than radical hysterectomy, with a lower proportion of women having sustained sexual-vaginal dysfunction. These results further support the benefit of surgical de-escalation for low-risk cervical cancer.