Bilateral hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) has demonstrated favorable short-term outcomes. However, the long-term results remain unclear and warrant further investigation. To compare 10-year patient-reported outcomes (PROs), clinically significant outcomes (CSOs), and reoperation-free survivorship between bilateral and unilateral HA. It was hypothesized that both groups would demonstrate comparable PROs, CSO achievement, and survivorship. Cohort study; Level of evidence, 3. A prospective repository was retrospectively reviewed to identify patients undergoing bilateral HA for FAIS between January 2012 and January 2015 with 10-year follow-up. Patients were propensity-matched 1:1 to unilateral HA patients controlling for age, sex, body mass index, and Tönnis grade. Exclusions included revision HA, concomitant procedures, congenital hip disorders, non-FAIS pathologies, staged periacetabular osteotomy, Tönnis grade >1, and missing 10-year follow-up. Hip Outcome Score (HOS) subscale for Activities of Daily Living and the HOS Sports Subscale (HOS-SS), International Hip Outcome Tool, modified Harris Hip Score, and visual analog scale (VAS) for pain/satisfaction were collected. Minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and reoperation-free survivorship were compared. Improvements from baseline to 10 years were correlated between hips. Analysis of variance evaluated differences based on bilateral HA timing. A total of 80 hips in 40 patients with bilateral HA were matched to 80 hips in 80 patients with unilateral HA. Mean follow-up was 10.4 ± 0.6 years. PROs at all time points were comparable. MCID and PASS achievement rates were similar between groups. Reoperation-free survivorship was comparable (P = .70). Change in index hip scores positively correlated with contralateral hip changes. A 0- to 3-month interval demonstrated superior preoperative HOS-SS compared with 6 to 12 months, whereas a 3- to 6-month interval demonstrated superior 10-year VAS-Pain score compared with 0 to 3 months. Bilateral HA achieved long-term outcomes and reoperation-free survivorship comparable to those of unilateral HA. Index and contralateral hip outcomes were positively correlated. Shorter intervals between procedures were associated with better preoperative function, whereas intermediate intervals were associated with lower long-term pain, but finding this requires further investigation with larger sample sizes.

Meniscal tears occur at the time of anterior cruciate ligament (ACL) injury in 55% to 65% of patients. These tears exhibit different healing patterns and behavior compared with meniscal tears in a stable knee. The optimal management of different medial, lateral and bicompartmental tears during primary ACL reconstruction (ACLR) has yet to be defined. To evaluate the reoperation rates associated with different meniscal treatment strategies and analyze the effect of medial, lateral, and bicompartmental meniscal tears on ACLR outcomes. Cohort study; Level of evidence, 2. This investigation included 1137 patients undergoing primary ACLR with a concomitant meniscal injury. Patients with chondral defects and multiligament knee injuries were excluded. Meniscal treatments were divided into 3 categories: left in situ (LIS), partial meniscectomy (PM), and repair. Reoperation was defined as the primary endpoint, and multivariable analysis was conducted to identify patient and tear characteristics associated with reoperation. The influence of different treatment strategies on return to play (RTP), ACL reinjury rate, and patient-reported outcome measures (PROMs) was reported at 2 years. The PROMs recorded were the International Knee Documentation Committee (IKDC) score, the Marx Activity Rating Scale, and the Anterior Cruciate Ligament-Return to Sport after Injury score. The mean age was 24.0 ± 6.9 years, and 76% of patients were male. Most injuries were noncontact (64.9%), commonly resulting from pivoting/sidestepping (50.1%). No significant differences in injury mechanism, playing surface, or footwear type were found between medial, lateral, or bicompartmental tears. Reoperation rates for patients were low for lateral (1.3%), medial (2.6%), and bicompartmental tears (3.2%) LIS at the time of ACLR. The rate of reoperation/subsequent meniscectomy for medial meniscal repairs (14.8%) was significantly higher than for other medial treatments (hazard ratio 12.8; P < .001). Patients who underwent meniscal repair with a concomitant tear in the opposite compartment (repair + PM/LIS) had the highest reoperation rates (16.7%) and lowest RTP rates (60%). IKDC scores were significantly lower for patients who underwent lateral meniscal repair (81.1 ± 15.3) compared with other types of lateral meniscal management (P < .027). ACL reinjury rate was not influenced by meniscal treatment. A higher preoperative Marx score increased the risk of reoperation in all groups. Stable meniscal tears LIS during ACLR had low reoperation rates and good patient-reported outcomes, including patients with bicompartmental tears. Medial meniscal repairs had the highest risk of reoperation, particularly when another tear was present in the lateral compartment. Lateral meniscal repairs were associated with lower IKDC scores compared with other lateral meniscal treatment strategies.

Carpal tunnel release (CTR) is one of the most commonly performed hand surgeries, with both open and endoscopic techniques widely used. This study analyzes US historical trends in CTR utilization among Medicare beneficiaries and projects future procedural volumes through 2040. Medicare Part B National Summary data from 2000 to 2022 were used to estimate annual procedural volumes for open (Current Procedural Terminology [CPT] 64721) and endoscopic (CPT 29848) CTR. Adjustments were made to account for the increasing proportion of Medicare Advantage enrollees. Four forecasting models-log-linear, Poisson regression, negative binomial regression, and auto-regressive integrated moving average (ARIMA)-were applied. Model performance was evaluated using mean absolute error and root mean square error, with ARIMA selected for its superior predictive accuracy. From 2000 to 2022, the annual volume of open CTR increased by 180%, while endoscopic CTR grew by 959%. Auto-regressive integrated moving average projections indicate that open CTR will continue to grow at an average annual rate of 2.0%, reaching an estimated 424 271 procedures by 2040. Endoscopic CTR is projected to increase at a faster rate of 2.42% annually, with a forecasted volume of 184 723 by 2040. Despite this growth, open CTR is expected to remain the predominant approach. Carpal tunnel release utilization has increased substantially in the United States, with endoscopic techniques growing at a faster rate than open CTR. Despite this trend, open CTR is projected to remain the predominant approach. Future research should assess the economic impact, patient-reported outcomes, and factors influencing the adoption of each technique.

The management of hernia in immunocompromised patients remains a distinct surgical challenge, characterized by complex risk profiles, heightened susceptibility to infectious complications, and ambiguous consensus on optimal mesh selection and perioperative protocols. As the prevalence of immunosuppression continues to rise due to increasing organ transplant rates, autoimmune diseases, oncological therapies, and advanced age, understanding the nuances of mesh repair in this population is of paramount importance. This review synthesizes current evidence on the safety, efficacy, and outcomes of hernia mesh repair in immunocompromised adults, traversing mesh materials, infection mitigation strategies, surgical techniques, recurrence and complication rates, patient-reported outcomes, cost-effectiveness, and future research imperatives. Advanced mesh materials-particularly long-acting resorbable meshes-show superior long-term durability but at elevated cost. The risk for mesh infection and recurrence is proportionate to immunosuppression burden, comorbidities, and operative field contamination. Notably, modern synthetic meshes, when coupled with stringent perioperative infection control and risk-mitigation strategies, offer durable repair with acceptable safety profiles, even in immunocompromised hosts. There is insufficient evidence to support routine use of biologic mesh, except in select contaminated fields. Patient-reported metrics are increasingly recognized as essential for outcome assessment, though standardization remains incomplete. Cost-effectiveness favors synthetics unless contamination risks predominate or patient preference dictates otherwise. Gaps include inconsistent immunocompromised patient definitions, limited long-term data, and lack of tailored guidelines. Prospective, multicenter studies integrating real-world patient-reported and economic data are needed.

The value of EQ-5D-3L and EQ VAS as a patient-reported outcome measure for patients with ankylosing spondylitis in routine healthcare: an evaluation of construct validity and responsiveness based on the Swedish Rheumatology Quality Register.

Endoscopic resection is standard for small, well-differentiated rectal neuroendocrine tumors, but management of intermediate lesions remains unsettled. In a large single-center cohort with propensity score matching, endoscopic treatment of grade 1 tumors measuring 1.0-1.5 cm achieved high negative-margin rates and no observed recurrences over a median 54-month follow-up, mirroring outcomes for lesions &lt; 1 cm. Lymphovascular invasion was absent in the intermediate group, and endoscopic submucosal dissection was used more often than mucosal resection. These data support endoscopic resection as a feasible organ preserving option in carefully staged, well differentiated intermediate size tumors. Priorities now include prospective, multicenter validation; standardized pre-resection staging with high-resolution endoscopy and endoscopic ultrasound; refined risk stratification incorporating depth and lymphovascular invasion; pragmatic surveillance schedules; and assessment of patient-reported outcomes, function, and costs. Developing decision tools and targeted training to optimize endoscopic technique may further expand safe, individualized care, and health economic analyses.

In 2023, the first North American Hip Arthroscopy Registry was released: the Hip Surgical Treatment Registry (HipSTR). HipSTR is a prospective web-based data collection registry designed to gather baseline patient information, procedural data, and surgical outcomes. To present the initial demographic and surgical overview data for patients enrolled in 2023. Cohort study; Level of evidence, 3. Beta testing of HipSTR occurred between February 2023 and July 23, 2023, by 7 surgeons on >400 patients. Starting July 23, 2023, HipSTR was made available for enrollment by North American orthopaedic surgeons. HipSTR is a free, digitally administered registry integrated with cloud-based (Patient IQ) outcome database capturing preoperative demographics, patient-reported outcome (PRO) measures, and intraoperative surgical data. As of December 31, 2023, 14 surgical sites with 21 participating surgeons were enrolling hip arthroscopy patients, totaling 1098 patients in the calendar year 2023. The registry included 65% female patients and 34% male patients, with a mean age of 36.6 ± 14 years. Baseline compliance was 90%. Mean preoperative PRO measures (the 12-item International Hip Outcome Tool, EuroQol 5 Dimension 5 Level Visual Analog Scale, and Hip Single Assessment Numeric Evaluation scores) were 39.7 ± 19.0, 69.6 ± 19.6 and 39.1 ± 21.7, respectively, indicating the significant impact of their hip pain. In total, 315 patients described themselves as an athlete. Surgical findings revealed a variety of hip pathology, including 45% CAM lesions, 43% labral tears, 38% acetabular chondral lesions, 26% pincer morphology. Among patients with CAM and pincer/anterior inferior iliac spine morphology, 98% and 75% underwent femoral osteoplasty and acetabuloplasty, respectively. Additionally, 56% of all patients with acetabular cartilage injury underwent acetabular chondroplasty and 9% underwent microfracture. Notably, 16% of patients had prior surgery on their affected hip. Formal capsulotomies were performed in 68.3% of patients and of these, 83% had their capsulotomy fully repaired. These findings provide initial insights into the demographics and clinical profiles of North American patients undergoing hip arthroscopy as well as the types of procedures performed. These data, along with future contributions as the registry expands, will enhance understanding of the pathologies managed with hip arthroscopy, evaluate PRO measures to assess procedural efficacy, and guide efforts in the prevention and management of hip pain.

Introduction: This review specifically focuses on interventional clinical trials in leukemias and myelodysplastic syndromes (MDS), summarizing how patient-reported outcome measures (PROMs) have been implemented to evaluate treatment effects rather than to directly influence clinical outcomes. Objective: Clinical outcomes of interest typically include response rates, disease-free survival (DFS), and overall survival (OS). Patient-reported outcome measures (PROMs) are standardized questionnaires that collect information regarding health outcomes directly from the patient and are used to evaluate new treatments and healthcare quality. In addition, the use of PROMs in cancer care has been shown to improve patient-provider communication and patient satisfaction. Material and Methods: This is a qualitative, narrative synthesis and review structured around PROMs focused on six critical themes: symptoms/symptom burden, physical, emotional, social/role, and functional status, and global health status measurement. Results: PROMs that are assessed in oncologic research include the EORTC QLQ-C30, FACT-Leu, QLQ-CLL16, and EQ-5D. PROs are associated with clinical outcomes such as DFS and OS, and the FACT-Leu scales, HRQOL and physical functioning scores were independent prognosticators of OS in patients with AML. Conclusions: Through our review, notable trends were identified that further highlight the importance of greater incorporation of PRO measures in future clinical trials, particularly in the understudied realm of hematologic malignancies, in order to better delineate the link between survival and HRQOL.

To comprehensively examine global research developments in varicose vein treatment over the past decade by combining bibliometric analysis with an overview of clinical trial trends, highlighting shifts in therapeutic strategies and emerging priorities. A bibliometric assessment was carried out using the Web of Science Core Collection, focusing on English articles and reviews published between January 1, 2014 and December 31, 2024. Tools such as VOSviewer, CiteSpace, and SciExplorer were used to analyze publication patterns, geographic and institutional contributions, author collaborations, co-citation networks, keyword co-occurrences, and emerging research themes. Additionally, a comprehensive review of 374 clinical trials from PubMed was performed to explore trends in study design, treatment modalities, and patient-reported outcomes across the same period. A total of 3110 publications were identified, with the annual output showing substantial growth, peaking in 2021. The leading contributors were the United States, China, and the United Kingdom, with prominent institutions like Imperial College London and Mayo Clinic being notable contributors. The analysis of key journals revealed a strong presence of Phlebology and The Journal of Vascular Surgery. Keyword analysis highlighted ongoing interest in "endovenous laser ablation" and "compression therapy," while emerging topics such as "pelvic congestion syndrome," "cyanoacrylate closure," and "patient-reported outcomes" are gaining attention. The clinical trial review showed a steady rise in studies, particularly between 2014 and 2024, with a notable peak around 2015. Randomized controlled trials dominated, focusing on minimally invasive techniques such as endovenous laser ablation, RFA, and tissue adhesives. Geographic distribution aligned with the bibliometric analysis, with dominant contributions from the United States, China, and Europe. The primary focus of these trials included efficacy, safety, recurrence, and patient-centered outcomes, with a growing emphasis on long-term effects and the use of innovative devices. Over the past decade, research on varicose vein treatment has seen substantial progress, driven by developments in minimally invasive technologies and a patient-focused approach. The combined bibliometric and clinical trial analyses highlight a continuing trend toward personalized, tech-enabled therapies. Integrating these insights will be crucial for guiding future research towards sustained efficacy and individualized care strategies.

Achieving proper skin closure after total knee arthroplasty (TKA) is crucial for minimizing complications, as the surrounding skin is under significant tension during the early postoperative period. Cyanoacrylate, or skin adhesive, supplements subcuticular suture closure, providing a secure, watertight seal while lowering infection risk. This study compared wound healing, complications, and patient-reported outcomes between suture closure and suture plus adhesive. A total of 167 patients undergoing primary TKA were enrolled in a prospective single-blinded protocol change study at a single institution from August 2023 to September 2024. Patients had their wound closed with subcuticular 3-0 Monocryl suture (n = 69) or suture plus cyanoacrylate adhesive (S + C) (n = 98), alternating techniques every 3 months. Scar healing was assessed through photographic review at 1 month, evaluating scabbing and scar length. Wound complications, stiffness, and readmission rates were recorded. Patient satisfaction was measured at 6 months using the Patient and Observer Scar Assessment Scale (POSAS) score. Bivariate analyses evaluated differences between groups. Wound complications occurred at a similar rate between suture (11.6%) and S + C (14.3%; p = 0.784). Stiffness was reported in 6.6% of patients (8.7% suture vs. 5.1% S + C; p = 0.365). A 90-day readmission occurred in 3.6% (4.4% suture vs. 3.1% S + C; p = 0.692). Scar healing assessments showed 19.1% of patients had more than two scabs, with a higher frequency in S + C (24.2%) than sutures (12.5%; p = 0.193). The mean scar length was slightly longer in S + C (15.0 vs. 14.5 cm; p = 0.148). No cosmetic differences were noted between groups according to the mean POSAS score (5.0 ± 4.18 sutures vs. 5.1 ± 5.57 S + C; p = 0.641). Both sutures and cyanoacrylate adhesive demonstrated comparable clinical and patient-reported outcomes following TKA. The cyanoacrylate adhesive group had a slightly higher rate of minor wound healing concerns. Both closure methods are viable options, and the choice of technique can be left to the surgeon.

The Dutch flagship project Next Generation ImmunoDermatology (NGID) aims to profile five chronic immune-mediated inflammatory skin diseases: atopic dermatitis (AD), plaque psoriasis (PSO), hidradenitis suppurativa (HS), chronic spontaneous urticaria (CSU) and cutaneous lupus erythematosus (CLE) in comparison with cutaneous T-cell lymphoma subtype mycosis fungoides (MF) and healthy volunteers. Within NGID, a clinical study entitled: 'SKIN disease profiling by an Exploratory, pRospective, biomarker study in dermatoloGY practice (SKINERGY)' will be conducted as a multicentre, parallel-cohort, open-label, observational, longitudinal basket study. Objectives include evaluation of disease-related characteristics in comparison to those of healthy volunteers and evaluation of biomarkers for disease stratification and (targeted) treatment response in patients in a real-world clinical setting. Additionally, differences and similarities in disease characteristics between diseases, changes over time, and profiles of responders versus non-responders will be evaluated. Patients with AD (N = 120), PSO (N = 160), HS (N = 80), CSU (N = 120) and CLE (N = 120) will be enrolled in groups of N ≤ 40 patients per treatment. Matched healthy volunteers (N = 120) and the MF cohort (N = 120) will serve as control groups. Assessments include blood sampling, skin punch biopsies, tape stripping, skin swabs, (multimodal) imaging, tele-health and patient- and physician-reported outcomes. This manuscript describes the study protocol prior to data collection and its strategic evaluation of multi-omics profiling. Patient advocacy groups co-defined the research agenda and contributed to study design and informed consent document development, ensuring alignment with patients' needs and real-world relevance. SKINERGY will generate a machine learning-ready dataset with information about changes in various biomarkers over time, including histology, metabolomics, spatial proteomics, transcriptomics, lipidomics, microbiomics, imaging biomarkers, tele-health, patient-reported outcome measures (PROMs) and clinical parameters. Identified biomarker profiles within SKINERGY may guide targeted treatment selection, enhance targeted therapeutic response in clinical practice and improve understanding of disease pathology in chronic immune-mediated skin diseases.

Financial Reasoning in Radiology: Interpreting Risk, Value, and Capital Allocation for Resilient and High-Value Imaging Services.

A core set of patient-reported outcomes (PROs) for systemic lupus erythematosus (SLE) has not been established, and no studies have compared predictive validity of disease-specific and generic quality of life (QOL) instruments. We aimed to compare the predictive validity of the Lupus PRO and Medical Outcomes Study Short-Form-12 (SF-12) for damage accrual in patients with SLE. The Lupus PRO questionnaire contains both health-related (HR) and non-HR-QOL measures, whereas the SF-12 indices are the physical component summary (PCS), mental component summary (MCS), and role-social component summary (RCS). Damage accrual was evaluated using an increase of one unit in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). We examined the association and predictive accuracy of the Lupus PRO and SF-12 scores at baseline for damage accrual using survival models for recurrent events. Among 1326 patients, those with a higher HR-QOL on Lupus PRO at baseline showed significantly lower damage accrual (hazard ratio: 0.94, 95% confidence interval [CI]: 0.89-0.99), whereas higher PCS and RCS of SF-12 were associated with lower damage accrual (0.92, 95% CI: 0.86-0.98; 0.92, 95% CI: 0.86-0.99). The Akaike Information Criterion, Bayesian Information Criterion, C-index, and area under the curve were comparable between the Lupus PRO and SF-12. Only higher PCS of the SF-12 was associated with glucocorticoid-independent SDI. Predictive metrics and discriminatory performance were comparable between the Lupus PRO and SF-12. Our findings highlight both disease-specific and generic QOL measurements can be valuable options for core set outcomes.

The Patient Journey: From Diagnosis to Therapeutic Management of Chronic Hand Eczema.

This study aims to evaluate the tolerability and effectiveness of the off-label use of rimegepant as acute migraine treatment in adolescents. Calcitonin gene-related peptide (CGRP) levels are elevated during migraine attacks. Gepants, oral CGRP receptor antagonists, have demonstrated effectiveness as acute and preventive migraine treatment in adults. They are generally well tolerated with limited side effects. Their use for migraine is approved by the United States Food and Drug Administration (FDA) in adults; however, data on their use in adolescents remain limited. This is a retrospective chart review of pediatric patients <18 years of age who received at least one dose of rimegepant as acute migraine treatment at Dell Children's Medical Center between 2020 and 2023. Effectiveness was evaluated using patient-reported outcomes during clinic visits. Tolerability was assessed through vital signs, laboratory data, and patient-reported side effects pre- and post-rimegepant use. Data were analyzed using descriptive and inferential statistics. Twelve adolescents who received at least one dose of rimegepant were identified. The mean age at first dose was 15.3 years (SD ± 1.5); nine (75%) were female. Migraine types included episodic migraine without aura (n = 4, 33%), episodic migraine with aura (n = 1, 8%), chronic migraine without aura (n = 4, 33%), and hemiplegic migraine (n = 3, 25%). The mean number of headache days per month at baseline was 11.5 (SD ± 11.8). Patients tried a mean of 3.9 (SD ± 2.4) acute medications prior to rimegepant use. During follow-up, 10 of 12 (83%) patients reported either resolution or improvement of their migraine attacks with rimegepant use. There were no statistically significant height, weight, blood pressure, or laboratory changes after rimegepant use, and no patients reported side effects. Rimegepant may be a safe and effective acute migraine treatment in adolescents. No adverse events occurred, and the medication appears to be safe and well-tolerated. These findings support the need for larger prospective and randomized controlled trials to further evaluate the tolerability and effectiveness of gepants in the pediatric population.

Background/Objectives: Postoperative sensory loss is a frequent morbidity following parotidectomy, yet the necessity of preserving the greater auricular nerve (GAN) during parotidectomy remains debated. While some surgeons prioritize nerve sacrifice for better oncological exposure, others advocate for preservation to maintain quality of life (QoL). This narrative review provides a comprehensive synthesis of current evidence regarding the impact of GAN sacrifice on objective sensory modalities, subjective disturbances, and long-term QoL. Methods: A literature search was performed (January 2000–August 2025). Twenty studies, including RCTs and cohorts, were reviewed to synthesize evidence on objective sensory modalities and patient-reported outcomes. Sensory assessments (Semmes–Weinstein monofilaments, VAS, and two-point discrimination) and the POI-8 QoL questionnaire were analyzed. Results: GAN preservation, particularly of the lobular branch, is associated with better early sensory recovery (1–6 months). In the long term (&gt;12 months), although the sensory gap narrows between groups, the sacrifice group exhibits significantly higher rates of persistent anesthesia in localized regions, notably the earlobe. Regarding QoL, while global scores often show no significant long-term differences, 35% of patients with GAN sacrifice continue to experience functional limitations in specific activities, such as telephone use or wearing earrings. Conclusions: Although patients demonstrate adaptation to sensory loss, GAN preservation offers potential benefits in daily function and comfort; thus, it is advised when oncologically feasible. To overcome the high heterogeneity in current evidence, future multicenter trials utilizing unified objective measurements on predefined regions of interest are necessary to further clarify the functional benefits of nerve preservation and establish definitive surgical guidelines.

Background/Objective: Self-perceived hearing handicap (SPHH) reflects functional consequences of hearing loss beyond audiometric measures. Clarifying its relationship with audiometric severity and demographic factors is important for understanding age-related hearing loss (ARHL). This study examined associations between SPHH, audiometric measures, age, and sex in individuals with ARHL. Methods: A total of 145 adults (50 men, 95 women) aged 60–89 years (mean 71.65 ± 7.19 years) participated. Hearing status was defined using better-ear pure-tone average thresholds at 0.5, 1, 2, and 4 kHz (BE PTA-4), with ≥20 dB HL as the cutoff and World Health Organization (WHO)-defined severity categories. SPHH was assessed using the Croatian Hearing Handicap Inventory for the Elderly–Screening version (HHIE-S-CRO). HHIE-S-CRO total and subscale scores were examined across BE PTA-4 values and hearing loss categories. Associations were analyzed using correlation and linear regression adjusted for age and sex; group differences were tested using the Kruskal–Wallis test, and ordinal logistic regression assessed monotonic trends across ordered severity categories. Results: HHIE-S-CRO total and subscale scores increased with worsening BE PTA-4 and across hearing loss categories, with substantial overlap. Strong correlations were observed between HHIE-S-CRO scores and audiometric measures. In linear regression, BE PTA-4 was independently associated with HHIE-S-CRO total, emotional, and social/situational scores, whereas age and sex were not. Kruskal–Wallis tests showed significant differences across hearing loss categories. Ordinal logistic regression anchored to WHO severity categories demonstrated graded associations for HHIE-S-CRO total and emotional scores, while the social/situational subscale showed greater dispersion and overlap despite a statistically significant association. Conclusions: SPHH in ARHL shows a strong association with audiometric severity, with particularly robust correspondence for overall and emotional domains, underscoring the complementary role of patient-reported outcome measures alongside audiometric assessment.

Analyzing longitudinal patient-reported outcomes (PROs) remains methodologically challenging, particularly in populations with high mortality rates during follow-up. Many PRO studies overlook this issue, potentially leading to biased estimates and limited clinical interpretability. We discuss various methods for analyzing patients who died during follow-up in PRO analyses and examine how these methods affect the interpretation of the study outcomes, using a clinical example in older patients with cancer. For our clinical example, we included adults aged 70 years with cancer from a prospective cohort. Quality of life (QoL) was assessed with the EuroQoL 5-Dimension (EQ-5D) tool at baseline and 6 and 12 months after treatment initiation. We applied six different methods: Four methods calculated absolute changes in mean scores; two methods estimated the proportion of patients with a changed QoL. Of the 1218 participants, 321 (26%) died within 12 months. Methods restricted to the 897 survivors at the end of follow-up lead to results that are difficult to interpret due to selection bias. In linear mixed models, EQ-5D scores are implicitly reconstructed for the 321 participants that died, creating a hypothetical view of QoL assuming no patients died. Alternative approaches, such as the "while-alive" strategy or composite endpoint strategies, treating death as the worst possible score on the EQ-5D, produce more complete views of the QoL. The interpretation of longitudinal PROs strongly depends on the chosen method, associated estimands and how patients that died are addressed: different methods lead to different estimates and conclusions. Properly defining the research question and choosing the most appropriate method is essential for meaningful interpretations for clinicians and patients.

Digital literacy training within interventions to support older adults with cardiovascular disease in using technologies: a systematic review.

Patient-reported outcome measurement supports high quality patient-centred palliative care. Little is known about whether their digital application is feasible in palliative home care. To test the feasibility of digital patient-reported outcome measure (ePROM) in specialist palliative home care (SPHC)Design:A feasibility study employing a mixed-methods design (Palli-MONITOR Phase II). The tested ePROM intervention was based on the electronic version of the Integrated Palliative Care Outcome Scale (eIPOS). Data collection included the recruitment and drop-out rates, ePROM user characteristics and information on technical feasibility, and focus groups with SPHC professionals. Descriptive statistics were used to analyse the quantitative data, while focus groups were analysed using the framework approach. Integrated analysis was conducted through joint display. Four German SPHC teams; patients used personal devices to complete eIPOS, with data sent to the SPHC electronic medical record; professionals joined focus groups. The overall recruitment rate was 4.7% (82/1744), and 22.7% (82/361) among eligible patients. 60/82 patients completed the study. A total of 470 eIPOS forms were submitted to the SPHC teams. The rate of non-responses for closed-ended IPOS-items was low (max. 5.3%). Professionals noted that recruitment was challenged by patients' unstable conditions, short care duration, time constraints, team attitudes and technical barriers like limited internet access or device unfamiliarity. Not all patients in SPHC can use ePROMs due to limited life expectancy and technical barriers. However, consistent and complete use of eIPOS forms indicates that it is feasible for digitally literate patients and can effectively support care.