Subjective Outcomes Research Articles

Long-term local control and cosmesis of perioperative interstitial brachytherapy for partial breast irradiation following breast-conserving surgery.

Multicatheter interstitial brachytherapy (MIB) is an established technique of partial breast irradiation (PBI). However, postoperative catheter implant is an invasive, inconvenient, and skillful procedure. In this study, local control and cosmesis of perioperative interstitial brachytherapy (PIB) by intraoperative catheter implant were evaluated by comparing with those of whole breast irradiation (WBI) following breast-conserving surgery (BCS). Between October 2007 and August 2019, consequent patients who underwent either PIB or WBI following BCS were included. In general, additional indications for PIB to WBI included age ≥ 40years, tumor ≤ 3cm, and pN0 or pNmi. WBI was initiated with a total dose of 50Gy in 25 fractions, whereas PBI was delivered immediately following BCS at 32Gy in eight fractions. Local recurrence (LR) was the primary endpoint, and subjective and objective cosmetic outcomes at 5years using the Harvard Cosmesis Scale and BCCT.core software, respectively, were the secondary endpoints. During the 10-year follow-up, the crude rate of LR was 3.8% (95% confidence interval [CI] 2.3-5.4) in 577 patients receiving PIB and 3.3% (95% CI 1.1-5.6) in 241 patients receiving WBI (P = 0.73). The 5- and 10-year LR-free survival rates in the PBI and WBI cohorts were 97.9% versus 97.9% and 95.4% versus 96.8%, respectively (P = 0.64). Multivariate analysis selected age < 50years as an independent risk factor for LR. Excellent or good cosmesis in the PBI and WBI cohorts assessed by subjective and objective measures was 89.5% versus 84.5% (P = 0.26) and 83.7% versus 68.1% (P < 0.005), respectively. Although this study was based on a retrospective chart review in a single institution, the largest series of data with a long follow-up suggested that acceptable local tumor control and cosmesis were achieved following PIB compared with WBI.

Use of a wearable device to improve sleep quality

ObjectivesThe present study aimed to analyze the effects of the use of a digital wellness device on improving sleep through reducing environmental noise.MethodsFifty-five self-reported light or moderate sleepers with difficulty falling or staying asleep due to environmental noise participated in the study. Objective sleep architecture data were collected via a wireless electroencephalogram (EEG) sleep monitor and subjective data were obtained through analysis of daily sleep diaries and responses to study-specific user experience surveys. Four primary outcomes specified a priori were analyzed for statistical significance: objectively measured sleep onset latency (SOL), wake after sleep onset (WASO), number of awakenings, and perceived SOL. Exploratory analysis through descriptive statistics was conducted for an additional 36 secondary outcomes.ResultsUse of the digital wellness device was associated with reduced SOL both objectively and subjectively. Perceived SOL was 32.5% reduced (p &amp;lt; 0.001, difference in means 7.5 min, 95% CI 22.3%–41.4% faster), and objectively measured SOL was 13.3% reduced (p = 0.030, difference in means 2.7 min, 95% CI = 1.4%–23.8% faster). No statistically significant differences were found for other primary outcomes. Among the subjective secondary outcomes, 100% of participants felt the device blocked environmental noise, 86% reported falling asleep more easily, 76% felt they stayed asleep longer, and 82% felt overall sleep quality was improved. No differences were observed among objectively measured secondary outcomes.ConclusionsParticipants fell asleep faster when using the wearable wellness device. Participants also perceived sleep quality improvements with the intervention, although no objective differences were measured. These findings show promise for using noise-masking digital wellness devices in noisy environments to improve sleep quality.

Improving Students’ Economic Learning Outcomes through Problem-Based Learning Methods

This study aims to evaluate the effectiveness of the problem-based learning method (PBL) in improving student learning outcomes in economics subjects at SMA Negeri 15 Palembang. The research method used was a quasi-experimental with a non-equivalent control group design, involving two classes of XI IPS selected as the experimental and control groups. The experimental group received economics learning with the PBL method, while the control group used conventional learning methods. Data were collected through learning outcome tests (pre-test and post-test) and analyzed using paired sample t-tests and independent sample t-tests to determine significant differences in learning outcomes between the two groups. The results showed that there was a significant increase in the learning outcomes of the experimental group compared to the control group. The average post-test score in the experimental group was higher than in the control group, indicating that the PBL method is effective in improving students’ understanding and critical thinking skills in economics material. In addition, observations during learning showed that the PBL method increased students’ active involvement in group discussions and problem-solving processes. This study concludes that the PBL method is an effective approach to improve students’ economic learning outcomes and can be used as an alternative learning method in the school curriculum. Recommendations are given for teachers to receive training to implement PBL optimally, as well as support from the school in providing adequate resources. The implication of this study is that PBL not only improves academic learning outcomes but also students’ collaborative and independent skills, which are important to face the challenges of 21st-century education.

Penerapan Model Pembelajaran Project Based Learning pada Outdoor Study Materi Seni Lukis sebagai Upaya Meningkatkan Hasil Belajar Siswa Kelas XII IPA 1 SMA Pertiwi 1 Padang

This type of research is classroom action research (PTK). The subjects of this research were students of class. This research is motivated by the problem of student learning outcomes. This research was carried out in two cycles, with two meetings in each cycle. Data collection in this research used teacher observation sheets, student observation sheets and evaluation sheets of student learning outcomes (tests and projects). This research aims to improve student learning outcomes in learning painting using the project based learning model in outdoor study at SMA Pertiwi 1 Padang. The results obtained in this research show that the Project based learning model in outdoor study can improve learning outcomes in fine arts subjects, especially painting material for class Completion in the pre-cycle was very low with a percentage of 30.6%, increasing in cycle I with a percentage of 72.2% of students completing and increasing in cycle II to 94.4%. Thus, it can be concluded that by applying the Project based learning model in outdoor study, it can improve learning outcomes for class XII IPA 1 on painting art material.

A randomized controlled clinical study to evaluate the efficacy of Karanja Patra Arka in the management of Dusta Vrana vis-à-vis Chronic Non-Healing Ulcer

Background: Dusta Vrana is a prevalent surgical issue that delays healing due to infection, slough, poor hygiene, and foreign bodies. A holistic approach is essential for chronic leg ulcer care, addressing underlying causes, accurate diagnosis, and peculiar treatment. Karanja patra is indicated for wound management in Arka Prakasha. Therefore, this study seeks to assess this aspect. Objectives: To evaluate the efficacy of Karanja Patra Arka in the management of Dushta Vrana and to compare the efficacy of Karanjapatra Arka and Gomutra Arka. Methodology: A single-blind study with a total number of 40 patients with selection criteria of Dushta Vrana were included in this study. In Group A Karanja Patra Arka wound dressing. In Control: Gomutra Arka dressing. Daily wound care for 30 days or granulation tissue formation. Weekly follow-ups and statistical analyses were done. Result: A significant improvement was noted in both subjective (Pain, Itching, and smell) and objective (Bates Jenson criteria) outcomes. Conclusion: Both Arkas shows improvement in subjective symptoms (smell, itching, pain), but differ in their objective outcomes. Karanjapatra Arka excelled in wound healing (Vrana Ropana), while Gomutra Arka showed stronger wound cleansing (Vrana Shodhana).

Visual Art and Medical Narratives as Universal Connectors in Health Communication: An Exploratory Study

Health-related information can often be overwhelming for consumers resulting in difficulty in interpretation and application. Historically, art and narratives have played key roles in communication within diverse populations however collectively have received little recognition as a means to enable health literacy. This study aims to investigate patient/caregiver narratives and visual art as a modality to improve knowledge translation and health literacy in the wider community. Nine recently discharged patients and 1 caregiver from a regional hospital were paired with 10 tertiary visual arts students for interview. Each narrative was transformed into visual art and exhibited at a community art gallery and to high school art students. Self-reported questionnaires generated data in subjective experience and learning outcomes. Health literacy was evaluated via voluntary gallery viewer and school student response surveys post-exhibition exposure. Exhibition surveys revealed 96.9% of gallery observers had learnt something new about illness or injury. High school students found the activity had improved (42%) or somewhat improved (38%) their understanding of illness and injury. Our findings suggest patient/caregiver narratives and visual art are equitable and effectual modalities for health service organizations to facilitate, affective and experiential learning, and improve health literacy within the community.

Good 5-year results and a low redislocation rate using an à la carte treatment algorithm for patellofemoral instability in patients with severe trochlea dysplasia.

Trochlear dysplasia is a major risk factor for recurrent patellar instability, reduced quality of lifeand osteoarthritis of the patellofemoral joint. Patellar instability in patients with trochlear dysplasia can be treated by trochleoplasty, usually in combination with medial patellofemoral ligament reconstruction (MPFL-R). An à la carte treatment algorithm, which also addresses patella alta, lateralisation of the tibial tuberosityand valgus or torsional malalignment when present has been standard in one clinic for treatment of patellar instability patients since 2009, based on the hypothesis that it results in optimal subjective and clinical outcome, normalisation of the lateral trochlea inclination (LTI) angle and a low rate of patellar redislocation. This prospective study reports the 5-year results for consecutive patients with high-grade trochlea dysplasia operated according to the algorithm 2010-2017, evaluated preoperatively and 1, 2and 5 years postoperatively. Clinical information on previous surgery and postoperative patellar stability, range-of-motion (ROM)and subsequent surgery were registered. Subjective outcome was evaluated by four patient-reported outcome measures (PROMs): Kujala, Lysholm, International Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score. The LTI angle was measured pre- and postoperatively on magnetic resonance imaging scans. There were 131 patients (87 females) with a median age of 22 years (range: 14-38). All had a trochleoplasty and an MPFL-R. Additional procedures (tibial tuberosity medialisation/distalisation and/or femoral/tibial osteotomy) were performed in 52%. All PROM scores improved from preoperatively to 1-year follow-up with further improvement at 2 and 5 years after surgery (p < 0.05). Three patients (2%) had a traumatic patellar dislocation 9, 12and 24 months postoperativelyand 38% underwent subsequent surgery (hardware removal, arthroscopically assisted brisement force, knee arthroscopy). A normalisation of the LTI angle (≥11°) was achieved in 76%. Treatment according to the à la carte algorithm for patients with patellar instability and high-grade trochlear dysplasia resulted in significant clinical and subjective improvement in all PROM scores and a very low redislocation rate (2%) 5years after surgery. Level II.

Penerapan Model Pembelajaran Problem Based Learning (PBL) untuk Meningkatkan Hasil Belajar Peserta Didik tentang Norma dan Aturan Kelas V SD Inpres Oesapa Kota Kupang

This study aims to improve student learning outcomes in Civics subjects through the application of the Problem Based Learning (PBL) learning model, this type of research is Classroom Action Research (PTK) which is carried out in two cycles. The research site was held at SD Inpres Oesapa Kupang City. The data collection techniques used were observation, test techniques and documentation studies. Data analysis technique is descriptive qualitative. The research subjects were fifth grade students of SD Inpres Oesapa which amounted to 27 st.udents consisting of 18 male students and 9 female students. Based on the research shows that the results in cycle I of 27 people who completed 11 people (41%), while those who did not complete 16 people (59%). However, in cycle II experienced an increase, namely Cycle II of 27 students declared complete amounted to 25 people (93%), while those who did not complete 2 people (7%). For 2 people who are not complete will be given remedial and enrichment by the homeroom teacher.

Kidney growth progression patterns in autosomal dominant polycystic kidney disease

BackgroundPrognosis for autosomal dominant polycystic kidney disease (ADPKD), the main inherited cause of kidney failure, relies on estimating cystic growth using linear formulas derived from height-adjusted total kidney volume (Ht-TKV). However, nonlinear renal growth patterns may occur in typical ADPKD. AimsTo determine kidney outcomes of subjects diagnosed with typical ADPKD exhibiting nonlinear, and unpredictable cystic growth during follow-up. MethodsRetrospective cohort study. We categorized TKV changes in individuals with typical ADPKD according to observed kidney growth trajectories. Ht-TKV was calculated from consecutive CT or MRI using the ellipsoid method. We compared estimated glomerular filtration rate (eGFR) trajectories with linear mixed models. ResultsWe included 83 individuals with ADPKD (67% women; age 47 ± 12 years; follow-up 5.2 years [IQR 2.8–9.0]). Three kidney growth patterns were observed: slow progression (24%, <3%/year linear increase), fast progression (39%, ≥3%/year linear increase), and atypical progression (37%, nonlinear growth). Adjusted ht-TKV change in mL/m/year was +1.4 (IQR –4.5 to +10.0), +40.3 (+16.9 to +89.3), and +32.8 (+15.9 to +85.9) for slow, fast, and atypical progressors, respectively (p <0.001). Atypical progressors exhibited a significantly greater decline in eGFR in mL/min/m²/year (–7.9, 95% CI –6.5, –3.9) compared to slow (–0.5, 95% CI –3.1 to +0.5) and fast progressors (–3.4, 95% CI –7.9, –2.0; between-group p <0.001). Atypical progressors had a higher proportion of acute complications, including hemorrhages, infections, and urolithiasis (84%), compared to slow (20%) and fast progressors (31%) (p <0.001). ConclusionIn typical ADPKD, nonlinear, abrupt, and unpredictable cyst growth occurs frequently, leading to a higher risk of acute complications and kidney function decline.

THE EFFECT OF CROSSWORD PUZZLE LEARNING MEDIA ON STUDENTS' SCIENCE LEARNING OUTCOMES IN FIFTH-GRADE SDN 28 SINGKAWANG

The purpose of this study was to describe whether there is a difference in learning outcomes between students who are taught using crossword puzzle media and those who do not use crossword puzzle media in the science subject of grade V students of SDN 28 Singkawang and to describe how much influence the crossword puzzle learning media has on students' learning outcomes in the science subject of grade V SDN 28 Singkawang . The data in this study are the learning outcomes of the control class and the learning outcomes of the experimental class. The data source is grade V students of SDN 28 Singkawang. The sampling technique used in this study is non-probability . The data collection technique used is an essay test technique . Based on the results of the study, 26 students from class A were obtained as the control class and 26 students from class B as the experimental class. The control class obtained the highest score in the pre-test, which was 90, and the post -test class was 95. The lowest score in the pre-test was 43 and the post-test was 43. The experimental class obtained the highest score in the pre-test, which was 90, and the post-test was 95. The lowest score in the pre-test was 43 and the post-test was 60. The results of this study can be assumed in the 2013 curriculum in learning Natural Sciences.

PENGEMBANGAN MEDIA MANIPULATIF UNTUK MENINGKATKAN PENCAPAIAN PEMBELAJARAN DAN KEMAMPUAN BERPIKIR KRITIS PADA MATERI SISTEM TATA SURYA SISWA KELAS VI

The aim of this research is to produce solar system manipulative media that meets the requirements and is effective in learning the solar system. This research uses the development method with the PLOMP model, with research subjects consisting of 22 students in the experimental class and 27 students in the control class. The results of the paired sample t-test were carried out to determine whether there were differences between the pretest and posttest results of students in the experimental class and the control class. The results showed that there was a significant influence before (pretest) and after the use of solar system manipulative media (posttest) on increasing student learning outcomes in science subjects with the material "Solar System." Based on the N-gain test calculation, the average N-gain value for the experimental class is 0.730, which shows that the increase in students' critical thinking abilities in the experimental class is at a high level. Meanwhile, the average N-gain for the control class is 0.480, which shows that the critical thinking abilities of students in the control class are at a medium level. Thus, it can be concluded that the critical thinking abilities of students who are taught using the manipulative media of the solar system are higher than those of students who are taught using image media

A Preliminary Study on the Adaptation and Validity of The Malay Version Device Oriented Subjective Outcome (DOSO) Scale

A Preliminary Study on the Adaptation and Validity of The Malay Version Device Oriented Subjective Outcome (DOSO) Scale

The Digital Learning Model to Enhance Students' Understanding and Interest in Learning: A Case Study at Cangkreng II Lenteng State Elementary School, Sumenep

Traditional learning models are often less effective in increasing elementary school students' interest in science and technology. The limitations of interactivity and visualization in traditional models encourage the need for digital-based learning innovations. This study aims to identify the impact of digital learning models on students' interest and learning outcomes in science subjects. The research used a qualitative approach with a case study method. The research subjects consisted of school teachers at Cangkreng II Lenteng Sumenep primary school. Data were collected through in-depth interviews, observation, and documentation, and analyzed using the Miles and Huberman analysis model which includes data condensation, data presentation, and conclusion. The findings indicate that digital learning models have great potential in improving the quality of science learning in primary schools. The use of interactive media, simulations, and engaging visualizations can help students build a better understanding of abstract science concepts. This research contributes to developing digital learning theory by demonstrating the effectiveness of technology-based learning models in improving students' motivation and learning achievement. The implication for learning practice is the importance of integrating digital technology into the science learning process to create a more enjoyable and effective learning environment.

Household income trajectory effect on oral health-related quality of life during the transition from childhood to adolescence.

To measure the effect of household income trajectory on oral health-related quality of life (OHRQoL) during the transition from childhood to adolescence over 10-years. This cohort study assessed 639 children aged 1-5 years in 2010 in Santa Maria, southern Brazil. After 10 years, the same participants were re-evaluated. Familiar household income was collected in both assessments. Four groups with different income trajectories were created by cluster analysis: "stable low income", "decreasing income", "increasing income", and "stable high income". OHRQoL was measured at follow-up using the short version of CPQ11-14. Demographic, and oral health-related information were also collected. A negative binomial regression analysis with robust variance was conducted. A total of 351 (54.9% of the original sample) participants with household income data at the baseline and follow-up were analyzed. Socioeconomic mobility and income remained the same for most of the participants over the 10 years. Participants belonging to the "stable high income" category presented 37% less risk of having a worse OHRQoL than participants belonging to the "stable low income" category. Groups that experienced changes in their income trajectories did not show significant changes in OHRQoL. Individuals with stable high income over time were protected from having impacts on their OHRQoL. Worsening or improvement in income over time do not influence OHRQoL. Our findings indicate that socioeconomic factors impact subjective patient outcomes, which are considered a fundamental aspect of clinical practice.

Tubomanometry-Score as Predictor of Outcome for Balloon Eustachian Tuboplasty in Patients With Eustachian Tube Dysfunction.

To investigate the predictive value of tubomanometry (TMM) in predicting subjective outcome of Balloon Eustachian Tuboplasty (BET) in patients with long-lasting Eustachian tube dysfunction (ETD). Retrospective case series. Single tertiary referral center. A total of 111 ETD patients undergoing 194 BET procedures were included. Demographics, TMM measurements, and tympanograms were registered before and 3 to 6 months after BET. The time ratio between the pressure increase in the nasopharynx and the outer ear canal was labelled R value. At follow-up, 58.8% of the patients were satisfied with BET outcomes. The prevalence of normal R values increased significantly at 30 mbar (12%, P = .024), 40 mbar (14%, P = .0082), and 50 mbar (13%, P = .011). The prevalence of R = 0 decreased at all three pressure levels (-20%, P = .0001; -15%, P = .0013, and -16%, P = .0005, respectively). Type A tympanograms increased from 37% to 56% (P = .0002), while type B tympanograms decreased from 44% to 25% (P = .0006). Stratifying TMM measurements (R ≤ 1, R > 1, and R = 0) showed that preoperative R values were not prognostic of subjective outcome. Preoperative type B tympanogram indicated a risk of poor subjective outcome. BET appeared to improve Eustachian tube function with reduced prevalence of pathologic R values and tympanograms. Although preoperative R values were not prognostic, TMM remains promising for assessing Eustachian tube function. Further studies are needed to refine TMM's role in predicting BET efficacy.

Ageism and Loneliness in People Over 50: Understanding the Role of Self-Perception of Aging and Social Isolation in a Chilean Sample.

Population aging represents a global challenge. In this context, loneliness has positioned itself as a critical problem with adverse effects on the physical and mental health of the elderly. This study aimed to explore the role of negative self-perception of aging (SPA) and social isolation as mediators in the relationship between ageism and loneliness. Structural equation modeling (SEM) was used in a sample of 307 people over 50 in Chile. The results show that both age discrimination and ageist stereotypes are directly associated with higher levels of loneliness. Negative SPA significantly mediated the relationships between discrimination and loneliness, as well as between stereotypes and loneliness. These findings highlight the importance of psychological and cultural variables in objective and subjective outcomes of interpersonal relationships, suggesting the need for interventions to mitigate the effects of ageism and improve SPA to favor healthy aging.

Rate and Timing of Progression to Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction in Patients With Systemic Inflammatory Disease: A Long-term Propensity-Matched Cohort Study.

Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopaedic procedures and one of the most well studied. Despite extensive research dedicated to ACLR, there is limited understanding of how chronic inflammatory systemic diseases (CIDs) such as rheumatoid arthritis and systemic lupus erythematosus affect outcomes. To compare the outcomes of ACLR in cohorts of patients with and without CID. Cohort study; Level of evidence, 3. A retrospective query of a regional data set was conducted for all patients who underwent ACLR from 1990 to 2021 for traumatic ACL rupture. All patients with CID were identified and propensity matched to non-CID controls. Baseline characteristics and clinical outcomes were identified through retrospective chart review, and patients were contacted for subjective outcomes. A total of 30 patients with ACLR and a diagnosis of CID were identified. These patients were propensity matched to 120 non-CID controls. Baseline demographic and surgical characteristics demonstrated no statistical differences. Follow-up duration was similar between the CID and non-CID groups (mean, 14.6 vs 14.2 years; P = .868). The CID cohort had a higher arthrofibrosis rate (16.7% vs 4.3%; P = .031), higher osteoarthritis rate (33.3% vs 16.7%; P = .041), higher total knee arthroplasty (TKA) rate (16.7% vs 3.3%; P = .016), and earlier time to TKA (14.7 vs 23.5 years; P = .032). Knee range of motion, infection rate, retear rate, time to retear, and time to osteoarthritis were not statistically different between the cohorts. The CID cohort had higher visual analog scale pain scores (mean, 2.00 vs 1.20; P = .043) but slightly higher satisfaction (mean, 3.92 vs 3.39; P = .043). There were no differences in preinjury Tegner, postoperative Tegner, change in Tegner, or IKDC score. In a univariate Cox regression model, the CID cohort had a retear hazard ratio of 1.43 (95% CI, 0.46-4.51; P = .537). Kaplan-Meier survival revealed no significant differences in retear-free survival between the CID and non-CID cohorts at 25 years (85.7% vs 87.3%; P = .53). The CID cohort had a TKA hazard ratio of 3.94 (95% CI, 1.05-14.8; P = .042). Kaplan-Meier survival demonstrated significantly decreased TKA-free survival at 25 years in the CID cohort (64.9% vs 91.2%; P = .029). CID increases the incidence of arthrofibrosis, osteoarthritis, and TKA in those undergoing ACLR. Patients with CID also undergo TKA significantly sooner than non-CID counterparts. Notably, the majority of patient-reported outcome measures are no worse in patients who have a CID diagnosis. Thus, ACLR constructs themselves may not necessarily fare worse in patients with CID. Nonetheless, these patients need to be cautiously counseled on the clinical outlook after their ACLR.

The Influence of Axial Length on Visual Quality following SMILE Surgery in Patients with High Myopia.

This retrospective study aimed to investigate the subjective and objective visual outcomes following Small Incision Lenticule Extraction (SMILE) surgery in high myopic patients with varying axial lengths (AL). The study enrolled 113 highly myopic patients (202 eyes) who underwent SMILE surgery at Shanghai's Tenth People's Hospital from July 2021 to September 2023. Patients were classified into three groups based on the axial length before surgery: Group A (AL < 26mm, 62 eyes), Group B (26mm ≤ AL < 27mm, 88 eyes), and Group C (AL ≥ 27mm, 52 eyes). Preoperative and postoperative evaluations included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), equivalent spherical error, and ocular higher-order aberrations. Subjective visual quality was assessed using the Quality of Vision (QoV) questionnaire. One year postoperatively, there were no notable differences found in safety, efficacy, or stability among the groups (P>0.05). Postoperative spherical aberration, horizontal, and vertical coma increased compared to preoperative values and showed a positive association with axial length (P<0.05). Horizontal and vertical trefoil remained stable at all follow-up points without any significant inter-group variances (P>0.05). Postoperative QoV scores were obviously higher in Groups A (45.45±5.49) and B (46.34±3.25) compared to Group C (49.15±7.89). There was no correlation between QoV scores and axial length observed. The induced horizontal trefoil showed a positive correlation with changes in lens thickness (LT) one year after SMILE (r=0.22, p=0.03). SMILE surgery is a safe and effective approach for correcting high myopia, exhibiting a significant correlation observed between ocular high-order aberrations and axial length.

Surgical intervention in traumatic brain injury: a systematic review and meta-analysis of decompressive craniotomy.

Traumatic brain injury (TBI) is considered a major cause of death globally, resulting from trauma. Decompressive craniectomy (DC) may improve functional outcomes in patients with TBI and its associated complications. This study was designed to determine safety and efficacy of DC in improving clinical outcomes in TBI patients compared to standard therapy. A systematic search was conducted across six electronic databases to identify relevant randomized controlled trials (RCTs) examining decompressive craniotomy (DC) and traumatic brain injury (TBI) from database inception until March 2021. The pooled risk ratio was estimated for categorical outcomes, while the pooled standardized mean difference with a 95% confidence interval was calculated for continuous outcomes. Statistical analysis software, including RevMan 5.4 and STATA version 17, was employed to perform this meta-analysis. The protocol for this study is registered with the OSF registry, ensuring transparency and reproducibility. A total of 656 studies were screened, and five RCTs involving 665 subjects (334 in the DC group and 331 in the control group) were included in this meta-analysis. Our meta-analysis revealed a non-significant trend towards a higher rate of favorable clinical outcomes in subjects who underwent DC compared to those in the medical treatment (MT) group (risk ratio (RR) 1.20, 95% confidence interval (CI) 0.70 to 2.08, P = 0.50). In contrast, the mortality rate was significantly lower in patients treated with DC compared to those receiving MT alone (RR 0.58, 95% CI 0.47 to 0.73, P < 0.001). Additionally, intracranial pressure (ICP) levels were significantly lower in subjects who underwent DC compared to those receiving MT alone (standardized mean difference (SMD): -0.87, 95% CI -1.58 to -0.16, P = 0.02). Furthermore, there was a statistically significant reduction in the duration of stay in the DC group compared to the MT alone group (SMD: -1.18, 95% CI -1.49 to -0.86, P < 0.001). This study presents evidence suggesting that DC is linked to a lower mortality rate, decreased ICP, and shorter hospital stays among patients with moderate to severe TBI. However, it did not show a significant impact on improving favorable clinical outcomes.

Outcomes of operative and nonoperative management of myotendinous Achilles tendon ruptures: a systematic review

BackgroundAchilles tendon ruptures are the most common lower extremity tendinous rupture. While there has been extensive research into the management of mid-substance Achilles tendon ruptures, there is a paucity of literature on the management of myotendinous Achilles tendon ruptures.MethodsThe aim of this systematic review is to compile all available literature on the treatment of myotendinous Achilles tendon tears. A systematic search of Web of Science, Embase, and Medline databases was performed for all studies published from database inception to April 13, 2024. All publications addressing the treatment of myotendinous Achilles ruptures of all levels of evidence were included. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented.ResultsA total of five studies with 70 patients were included for analysis. Sixty-seven patients underwent non-operative management with an average age ranging from 40.8 to 51.0 years. Three patients underwent operative management with ages of 16, 36, and 39. The majority of patients tore their Achilles tendon during sports. For nonoperatively treated patients, one group underwent immobilization for a total of 6 weeks and one study treated patients with functional rehabilitation. All patients were able to perform a single heel-raise, had good reported strength, and returned to work or sport. Nonoperative patients reported statistically significant improvements in subjective outcomes and high rates of satisfaction.ConclusionBoth nonoperative and operative management of myotendinous Achilles tendon ruptures demonstrated good outcomes after injury, although there is a limited amount of literature on this topic. Given that nonoperative treatment appears to yield good strength and return to activity, it may be preferred for the majority of patients. Operative management may be indicated in high level athletes. Imaging to determine the exact location of injury, quality of remaining tendon, and gap distance may further aid when considering treatment options. Higher level evidence studies are required to determine the optimal treatment of myotendinous Achilles tendon ruptures.Level of evidenceIV; Systematic review of Level IV-V studies.