Patient Reports Research Articles

Interpretation of immediately released health information: Informing patient medical education in breast oncology

BackgroundThe Cures Act mandated immediately released health information. In this study, we investigated patient comprehension of mammography reports and the utility of online resources to aid report interpretation. MethodsPatients who received a normal mammogram from February to April 2022 were invited to complete semi-structured interviews paired with health literacy questionnaires to assess patient's report comprehension before and after internet search. ResultsThirteen selected patients via purposeful sampling completed interviews. Most patients described their initial understanding of the mammography report as “good” and improved to between “good” and “very good” after an internet search. Patients suggested “a little column on the side" for medical terminology, “an extra prompt" for making an appointment, or a recommendation for “good sites” to improve mammography reports. ConclusionPatients varied in their ability to independently interpret medical reports and seek additional resources. While online resources marginally improved patient understanding, actionable and clear resources are needed.

Neurosarcoidosis-Induced Winging Scapula: Efficacy of Infliximab Treatment in Addressing Multifaceted Challenges.

Sarcoidosis, a systemic granulomatous disease primarily affecting the respiratory and lymphatic systems, can rarely manifest as neurosarcoidosis either in isolation or alongside other systemic symptoms. Here, we describe the case of a 45-year-old male with a history of recurrent sinusitis refractory to antibiotics, who presented to the emergency department with sinus congestion and dysphagia. Clinical examination revealed left lower motor neuron facial palsy and enlarged submandibular salivary glands. Despite obtaining negative results from various antibody panels, the patient exhibited elevated Angiotensin Converting Enzyme levels of 83 nmol/kg/min. Additionally, computed tomography chest scans revealed bilateral hilar and mediastinal lymph node enlargement, findings consistent with sarcoidosis. Otorhinolaryngology evaluation for dysphagia confirmed left vocal cord palsy. Following a negative infectious disease workup, submandibular salivary gland biopsy confirmed sarcoidosis. Treatment with mycophenolate mofetil and oral steroids led to gradual improvement in salivary gland swelling, dysphagia, and facial palsy. However, worsening left shoulder pain prompted further investigation, revealing winging of the left scapula on repeat examination. Magnetic resonance imaging (MRI) of the cervical spine revealed a six mm hyperintensity in the left dorsal cord at the C5 level, suggesting possible neurosarcoidosis vs. demyelinating disease. Subsequently, the patient was prescribed anti-tumor necrosis factor alpha inhibitor infliximab. Subsequent MRI of the cervical spine, conducted six months after initiating Infliximab therapy, indicated resolution of the lesions. This positive outcome was supported by the patient's report of symptom improvement, notably reduced shoulder pain and improvement in left scapular winging. This case underscores the unusual co-occurrence of Bell's palsy and vocal cord palsy in the same patient, along with the potential contribution of neurosarcoidosis to the winged scapula. Additionally, it sheds light on the positive response of neurosarcoidosis to Infliximab therapy.

Comparison of different dual-wavelength photobiomodulation protocols application in third molar extractions. A split-mouth randomized controlled trial

ObjectiveTo compare the use of PBMT in the soft tissue and bone healing after third molar extraction using the dual-wavelength laser directly into the post-extraction alveoli (PBMT-I), or PBMT with a red laser directly into the alveoli and with an infrared laser externally on the patient's face (PBMT-IE). MethodsTwenty patients underwent extraction of four third molars were involved in this split-mouth double-blind randomized controlled trial. The Post-extraction alveoli were treated with the following protocols: PBMT-IE: Application of a red laser directly into the alveolus, and infrared laser irradiation transcutaneously and PBMT-I: Application of dual-wavelength laser intraorally. Patients were clinically evaluated 3, 7, 14, 30, and 90 days after the surgical procedure. The analyses in this study were divided into qualitative (centered on the patient's report and on the evaluators' analysis), and quantitative analyses (measurement of the vertical and horizontal dimensions of the face with the objective of measuring post-surgical edema and radiographic analyses for evaluation of the density and structure of the newly formed bone). ResultsA progressive improvement was observed in all parameters evaluated in this study, however, this improvement was time dependent, with no distinct effect observed between the PBMT treatments applied. ConclusionThe different dual-wavelength PBMT protocols induced a similar postoperative clinical course in third molar extraction surgeries, with a reduced occurrence of complications and a good healing pattern of hard and soft tissues.

Feasibility, acceptability, and outcome responsiveness of the SYMPERHEART intervention to support symptom perception in persons with heart failure and their informal caregivers: a feasibility quasi-experimental study

BackgroundSymptom perception is an important process of heart failure (HF) self-care that persons with HF need in order to master self-care management. It also leads to better patient outcomes. Symptom perception consists of body observation and analysis, which are both challenging. We aimed to test the feasibility, acceptability, and outcome responsiveness of a novel intervention (SYMPERHEART) delivered to persons with HF with their informal caregiver.MethodsWe designed SYMPERHEART as a complex evidence-informed education and support intervention targeting body observation and analysis. We conducted a feasibility quasi-experimental study with a single group pre-post-test design. We included three subsamples: persons with HF receiving home-based care, their informal caregivers exposed to SYMPERHEART, and home-care nurses who delivered SYMPERHEART during 1 month. We assessed feasibility by recruitment time, time to deliver SYMPERHEART, eligibility rate, and intervention fidelity. We assessed acceptability by consent rate, retention rate, persons with HF engagement in body observation, and treatment acceptability. Outcome responsiveness was informed by patient-reported (PRO) and clinical outcomes: HF self-care and the informal caregivers’ contribution to HF self-care, perception of HF symptom burden, health status, caregivers’ burden, and HF events. We performed descriptive analyses for quantitative data and calculated Cohen’s d for PROs. A power analysis estimated the sample size for a future full-scale effectiveness study.ResultsWe included 18 persons with HF, 7 informal caregivers, and 9 nurses. Recruitment time was 112.6 h. The median time to deliver SYMPERHEART for each participant was 177.5 min. Eligibility rate was 55% in persons with HF. Intervention fidelity revealed that 16 persons with HF were exposed to body observation and analysis. Consent and retention rates in persons with HF were 37.5% and 100%, respectively. Participants engaged actively in symptom and weight monitoring. Treatment acceptability scores were high. Symptom perception and informal caregivers’ contribution to symptom perception were found to be responsive to SYMPERHEART. We estimate that a sample size of 50 persons with HF would be needed for a full-scale effectiveness study.ConclusionsSYMPERHEART was found to be feasible and acceptable. This feasibility study provides information for a subsequent effectiveness study.Trial registrationISRCTN. ISRCTN18151041, retrospectively registered on 4 February 2021, ICTRP Search Portal.

Digital-Reported Outcome from Medical Notes of Schizophrenia and Bipolar Patients Using Hierarchical BERT

Patient-reported (PRO) and clinician-reported (CRO) outcomes are assessment instruments that are completed by patients and trained healthcare professionals, respectively. A PRO is a report of the direct experience of the patient with a given disease condition. A CRO is an assessment of the condition of the patient by the healthcare provider. PROs may not be accessible to all patients, especially those suffering from severe disease conditions. CROs are time-consuming and therefore administered infrequently. In the present study, we introduce a new form of assessment, the digital-reported outcome (DRO), which is automatically derived from the medical notes of the patient. DROs have a low overhead and can be generated at each patient’s visit to complement other outcome-assessment instruments and enhance clinical decision support by identifying at-risk patients. In this study, a DRO is developed to evaluate the functional impairment in the daily activities of two cohorts of patients suffering from bipolar disorder and schizophrenia. The input of the DRO is a single medical note from the electronic medical record of the patient. This note is submitted to a hierarchical bidirectional encoder representations from transformers (BERT) model. First, a sentence-level embedding is produced for each sentence in the note using a token-level attention mechanism. Second, an embedding for the entire note is constructed using a sentence-level attention mechanism. Third, the final embedding is classified using a feed-forward neural network. The model is trained to classify patients into moderate or severe functioning impairment levels according to the general assessment of functioning (GAF) scale, a CRO instrument for the assessment of the impact of mental illness on the daily activities of the patient. The DRO is validated using medical notes that were labeled by multiple healthcare providers from different healthcare institutions. The results indicate that a general DRO is able to classify patients from the two cohorts according to the two functioning impairment levels (severe versus moderate) prior to the onset of disease with an AUC of 76%. Disease-specific DROs are only applicable after the onset of the disease and produced AUCs of nearly 85%. The methodology introduced in the present paper is practical and can support the automated monitoring of the severity of the functioning impairment of bipolar and schizophrenia patients. Extending the proposed DRO to other psychiatric conditions and types of impairments is the subject of ongoing research work.

Special Issue PRO-Analysis of Clinically Meaningful Change on Patient-Reported Outcomes: Renewed Insights About Covariate Adjustment

ABSTRACT Determining clinically meaningful change (CMC) in a patient-reported (PRO) measure is central to its existence in gauging how patients feel and function, especially for evaluating a treatment effect. Anchor-based approaches are recommended to estimate a CMC threshold on a PRO measure. Determination of CMC involves linking changes or differences in the target PRO measure to that in an external (anchor) measure that is easier to interpret than and appreciably associated with the PRO measure. One type of anchor-based approach for CMC is the “mean change method” where the mean change in score of the target PRO measure within a particular anchor transition level (e.g. one-category improvement) is subtracted from the mean change in score of within an adjacent anchor category (e.g. no change category). In the literature, the mean change method has been applied with and without an adjustment for the baseline scores for the PRO of interest. This article provides the analytic rationale and conceptual justification for keeping the analysis unadjusted and not controlling for baseline PRO scores. Two illustrative examples are highlighted. The current research is essentially a variation of Lord’s paradox (where whether to adjust for a baseline variable depends on the research question) placed in a new context. Once the adjustment is made, the resulting CMC estimate reflects an artificial case where the anchor transition levels are forced to have the same average baseline PRO score. The unadjusted estimate acknowledges that the anchor transition levels are naturally occurring (not randomized) groups and thus maintains external validity.

Closing the cancer care gap with a patient-reported nutrition screening: A retrospective analysis of a quality improvement project on an oncology ward (CCC study)

Early identification of patients at risk for malnutrition followed by individualized nutrition interventions is a central step to the provision of appropriate nutrition care. However, a health care professional (HCP)-based nutrition screening is not always consistently integrated into routine care. Patient-reported (PR) nutrition screening could thus potentially alleviate the burden on the HCPs and contribute to a greater number of patients who are identified and treated for malnutrition. In 2021 a Quality Improvement Project (QIP) at our out-patient oncology clinic was undertaken to implement the change from a HCP-based nutrition screening to a PR-screening. This was followed by a retrospective analysis in which the primary outcome measure was the rate of nutrition consultations initiated for patients undergoing cancer therapy. In total n=1657 patient data sets derived from comparable time periods before and after the QIP were analyzed and compared. Both groups had a comparable mean age and gender distribution. The most common diagnosis in both groups was gastrointestinal tumors. The change in routine care from a HCP-based nutrition screening to a PR-screening led to a significant increase in nutrition consultation rates (RD=19%; p<0.001; 95% CI 14.4%-23.5%) and screening rates (RD =30.5%; p <0.001; 95% CI 26.2%-34.7%). The change to PR-screening potentially facilitates an increase in nutrition screening rates. This in turn leads to an increased rate of patients identified at risk for malnutrition and thus referrals for nutrition consultations. Our findings indicate that a PR nutrition screening tool could play a role in closing the care gap and contribute to reducing rates of malnutrition among this population where screening is not consistently integrated into routine care.

Outcomes and Functional Results after Gastropexy without Fundoplication in Patients with Paraoesophageal Hernia

Abstract Background Paraoesophageal hernias (PEH) are associated with a high complication rate and often occur in elderly and fragile patients. Gastropexy without fundoplication, in which the stomach is attached to the anterior abdominal wall is an accepted alternative procedure and considered a low-risk intervention. However, outcomes and functional results are hardly described in literature. Aims Our study aims to evaluate short-term outcomes and the long-term quality of life of patients that underwent a gastropexy as treatment for PEH. Methods Single center cohort analysis of all consecutive patients who underwent hiatal repair and gastropexy for PEH without fundoplication from 2015 to 2021. Postoperative outcomes and functional results were retrospectively collected via chart review of postoperative routine follow-up. Reflux symptoms developed postoperatively were reported using the published and validated quality of life questionnaire: GERD-Health Related Quality of Life Questionnaire (GERD-HRQL). Postoperative complications were reported according to Clavien-Dindo complication grade. Results Thirty patients (median age: 72 years (65-80)) were included, 40% classified as ASA III. Main PEH symptoms were reflux (63%), abdominal/thoracic pain (47%), pyrosis (33%), anorexia (30%), and food blockage (26%). Twenty-six laparoscopies were performed (86%). Major complications (III-IVb) occurred in 9 (30%). Seven patients (23%) had PEH recurrence, all re-operated, performing a new gastropexy. Median follow-up was 38 (17-50) months, one patient was lost. Twenty-two patients (75%) reported symptoms resolution with median GERD-HRQL score of 4 (1-6). 72% (n=21) reported operation satisfaction. GERD-HRQL was comparable between patients who were re-operated for recurrence and others: 5 (2-19) versus 3 (0-6), p=0.100. Conclusions Gastropexy without fundoplication was performed by laparoscopy in the majority of cases with acceptable complications rates. Two-thirds of patient's report symptoms resolution, and long-term quality-of-live associated to reflux symptoms is good. Although the rate of PEH recurrence requiring a new re-intervention remains increased (23%), it does not seem to affect long-term functional results.

Is Pain in the Uninjured Leg Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Lower Extremity Injury?

Patients recovering from lower extremity injuries often interpret discomfort associated with increased use of the uninjured leg as a potential indication of harm. If expressed concerns regarding contralateral leg pain are associated with unhelpful thinking regarding symptoms, they can signal orthopaedic surgeons to gently reorient these thoughts to help improve comfort and capability during recovery. We asked: (1) Among people recovering from isolated traumatic lower extremity injury, is pain intensity in the uninjured leg associated with unhelpful thoughts and feelings of distress regarding symptoms, accounting for other factors? (2) Are pain intensity in the injured leg, magnitude of capability, and accommodation of pain associated with unhelpful thoughts and feelings of distress regarding symptoms? Between February 2020 and February 2022, we enrolled 139 patients presenting for an initial evaluation or return visit for any traumatic lower extremity injury at the offices of one of three musculoskeletal specialists. Patients had the option to decline filling out our surveys, but because of the cross-sectional design, required fields on the electronic survey tools, and monitored completion, there were few declines and few incomplete surveys. The median age of participants was 41 years (IQR 32 to 58), and 48% (67 of 139) were women. Fifty percent (70 of 139) injured their right leg. Sixty-five percent (91 of 139) had operative treatment of their fracture. Patients completed measures of pain intensity in the uninjured leg, pain intensity in the injured leg, lower extremity-specific magnitude of capability, symptoms of depression, symptoms of health anxiety, catastrophic thinking, and accommodation of pain. Multivariable analysis sought factors independently associated with pain intensity in the uninjured leg, pain intensity in the injured leg, magnitude of capability, and pain accommodation, controlling for other demographic and injury-related factors. Greater pain intensity in the uninjured leg (regression coefficient [RC] 0.09 [95% CI 0.02 to 0.16]; p < 0.01) was moderately associated with more unhelpful thinking regarding symptoms. This indicates that for every one-unit increase in unhelpful thinking regarding symptoms on the 17-point scale we used to measure pain catastrophizing, pain intensity in the uninjured leg increases by 0.94 points on the 11-point scale that we used to measure pain intensity, holding all other independent variables constant. Greater pain intensity in the injured leg (RC 0.18 [95% CI 0.08 to 0.27]; p < 0.01) was modestly associated with more unhelpful thinking regarding symptoms. Greater pain accommodation (RC -0.25 [95% CI -0.38 to -0.12]; p < 0.01) was modestly associated with less unhelpful thinking regarding symptoms. Greater magnitude of capability was not independently associated with less unhelpful thinking regarding symptoms. A patient's report of concerns regarding pain in the uninjured limb (such as, "I'm overcompensating for the pain in my other leg") can be considered an indicator of unhelpful thinking regarding symptoms. Orthopaedic surgeons can use such reports to recognize unhelpful thinking and begin guiding patients toward healthier thoughts and behaviors. Level II, prognostic study.

Determining the impact of genomic classifier testing on patient-reported quality of life after prostatectomy: Results from the G-MINOR randomized trial.

345 Background: Decipher is a tissue-based genomic classifier (GC) developed and validated in the post-radical prostatectomy (RP) setting to help guide adjuvant treatment decisions for prostate cancer (PCa). We conducted the first prospective, randomized trial assessing the impact of GC testing on adjuvant therapy use. Here, we determine the impact of GC testing on patient reported (PRO) quality of life outcomes (QoL) in men at high-risk of post-RP recurrence. Methods: The G-MINOR trial is a prospective, unblinded, randomized trial which enrolled 356 patients from 12 centers in the Michigan Urological Surgery Improvement Collaborative (MUSIC). Patients were enrolled between Aug 2016-July 2018. Eligible patients had undergone RP within 9 months of enrollment, had pT3-4 disease and/or positive surgical margins, and a post-RP PSA &lt;0.1ng/mL. Patients were assigned to either the GC or usual-care (UC) group using cluster-crossover block randomization assignments. Evaluable patients (338) were followed for at least 18 months. PROs were obtained using the Expanded Prostate Cancer Index Composite (EPIC-26) survey at baseline (before RP), 3, 6, 12, and 24 months after RP. Results: A total of 226/338 evaluable men (67%) had PRO data for this analysis (116 UC arm/110 GC arm). Median age was 65 years. Of the 226 men included in the PRO analysis, a total of 23 (9 UC arm/14 GC arm) had adjuvant treatment (p = 0.22). At 12 months follow-up, those in the GC arm had no significant change in adjusted mean difference in domain score from baseline compared to those in the UC arm for urinary irritative (UIR) function (1.0, 95% CI [-2.9– 4.9], p=0.6), urinary incontinence (UI) (0.8, 95% CI [-5.1– 6.7], p=0.8), or sexual function (SF) (0.5, 95% CI [-6.9– 7.9], p=0.9). This remained true at 24 months for all three domains [UIR; (2.3, 95% CI [-2.1– 6.6], p=0.3)], [UI; (-0.3, 95% CI [-7.3– 6.7], p=0.9)], [SF; (1.5, 95% CI [-6.8– 9.7], p=0.7)]. Conclusions: In the first ever randomized trial testing the clinical utility of a GC test in localized PCa, longitudinal patient reported QOL outcomes were not significantly different between men who underwent risk stratification with or without Decipher. Clinical trial information: NCT02783950 .

ABORDAGEM FISIOTERAPÊUTICA NA MIELOPATIA COMPRESSIVA SECUNDÁRIA À AMILOIDOSE: RELATO DE CASO

Myelopathy is an umbrella term used to refer to disorders that affect the spinal cord. There are several mechanisms that can cause it, however, secondary spinal cord compression, amyloidosis, is one of the rarest forms. The aim of the present study is to report the physiotherapy approach in compressive myelopathy secondary to amyloidosis. This is a descriptive study with a mixed approach, of the case report type, carried out during the supervised internship of neurofunctional physiotherapy, of the graduation course in physiotherapy, at the Community University of the Chapecó Region (UNOCHAPECÓ). Data collection was carried out through the neurofunctional assessment script and specific scales on the patient's case, a study carried out from May to July 2022, totaling nine visits, between assessment, treatment and reassessment. The patient under study is 55 years old, male, with a diagnosis of compressive myelopathy secondary to amyloidosis. It was possible to observe objective improvement through the Romberg and Timed Get Up And Go tests in the variables of balance and risk of falls, and subjective improvements, through the patient's report in relation to psychological aspects such as a feeling of well-being and disposition after the consultations. . It was noted that the physiotherapeutic approach adopted in this patient resulted in an improvement in the functional framework and brought psychological benefits such as a feeling of well being and disposition after the consultations. In addition, it made it possible to better understand and understand a rare condition with few reports in the literature.

ODP352 Steroid-sparing immunosuppressive therapy controls refractory headaches due to lymphocytic hypophysitis: a case report

Abstract Background Systemic glucocorticoid therapy has been used to control headaches associated with lymphocytic hypophysitis (LH), a rare autoimmune inflammation of the pituitary gland and stalk. Steroid-sparing immunosuppressive therapies, like mycophenolate mofetil (MM), have proven to be effective for patients with many systemic inflammatory and rheumatological conditions. However, the safety and efficacy of steroid-sparing immunosuppressive therapies for LH has not been studied. Clinical Case Here we report a case of a 31-year-old male who presented with worsening headache, fatigue, polyuria, insomnia, low libido, and decreased appetite. His laboratory results were consistent with central diabetes insipidus (DI), central hypothyroidism, central adrenal insufficiency, and hypogonadotropic hypogonadism without evidence of growth hormone deficiency. Initial pituitary MRI revealed pituitary enlargement and thickening of the stalk. He was started on desmopressin, levothyroxine, testosterone cypionate, and physiologic glucocorticoid replacement with prednisone 5mg daily. He continued to endorse incapacitating occipital headaches not relieved by ibuprofen, topiramate, gabapentin, amitriptyline, sumatriptan, or rizatriptan, and only temporary relieved by occipital nerve blocks. A pituitary biopsy confirmed the diagnosis of LH. Given his persistent, debilitating headaches, prednisone was increased to supraphysiologic doses. Headaches resolved on prednisone 40mg daily but recurred two months after tapering down to prednisone 5mg daily. Pituitary MRI after 4 months revealed a mild interval increase in enhancement and thickening of the pituitary stalk. Prednisone was increased to 20mg daily, and he was started on MM for progressive inflammation. Prednisone was tapered down to 5mg daily over the course of 3 months as MM dose was increased to 1000mg twice a day. Headaches completely resolved. After 4 months of MM therapy, pituitary MRI showed decrease in size of pituitary stalk thickening and pituitary, consistent with treatment effect. After 6 months of MM therapy, MRI brain showed further decrease in pituitary size and resolution of pituitary stalk thickening. He did not experience any adverse effect on MM. Serial complete blood counts, liver function tests, and basic metabolic panels were normal. Two years after diagnosis and one year on MM therapy, his DI resolved, his adrenal insufficiency was well managed with prednisone 4mg daily, he was euthyroid on levothyroxine 75mcg daily, and his hypogonadism was treated adequately with testosterone cypionate 50mg weekly with improved libido and energy. Conclusion MM was effective in treating intractable headaches caused by biopsy-proven LH. Radiologic signs of improvement in pituitary inflammation coincided with patient's report of headache relief and initiation of MM, without concurrent use of supraphysiologic glucocorticoids. Treatment was well-tolerated with no reported adverse effect. Steroid-sparing immunosuppressive therapy like MM may be considered as a therapy for LH, particularly in patients who depend on prolonged courses of supraphysiologic glucocorticoid treatment to alleviate symptoms. Presentation: No date and time listed

Phonation Threshold Pressure as a Unique Outcome Measure of Phonatory Physiology Changes Following Submucosal Saline Injection for Vocal Fold Scarring

Purpose: This study aimed to describe the utility of phonation threshold pressure (PTP) measurement as an additional outcome measure for changes in vocal fold vibration secondary to submucosal saline injection in the case of an individual with idiopathic vocal fold scarring. Method: An 8-week program of voice therapy, followed by submucosal saline infusion, was administered, using multiple outcome measures to assess voice quality, effort, and function in a 38-year-old woman with idiopathic bilateral vocal fold scarring. Transoral rigid video-endoscopy with stroboscopy in conjunction with the Stroboscopy Evaluation Rating Form provided measures of the vibratory characteristics of the vocal folds (amplitude, mucosal wave, nonvibratory portion, edge smoothness, and straightness). Auditory-perceptual measures were obtained using the Consensus Auditory-Perceptual Evaluation of Voice. Acoustic measures included jitter (%local), shimmer (%local), harmonics-to-noise ratio (dB), and Cepstral Spectral Index of Dysphonia. Additionally, PTP was measured 1 day prior to, and 1 month after, saline infusion. Results: Acoustic, auditory-perceptual, and stroboscopic variables suggested minimal change to the vibratory properties of the vocal folds in response to submucosal saline infusion for the treatment of vocal fold scarring. PTP measurements across the patient's frequency range, however, revealed a marked decrease post infusion. This was consistent with the patient's report of improved functioning and her request for repeat saline infusion. Conclusion: These results are consistent with the possibility of using PTP as an independent means of quantifying changes in phonatory physiology across the frequency range in patients with vocal fold scarring. Supplemental Material: https://doi.org/10.23641/asha.21313725

Exergaming in patients with a left ventricular assist device: a feasibility study.

Exercise games (exergames) have been recently proposed as a mode of facilitating physical activity in patients with chronic diseases. Although patients supported with left ventricular assist devices (LVADs) benefit from physical activity, specific LVAD-related issues hinder their ability to exercise properly. The objective of this study was to assess the feasibility and safety of exergaming in LVAD-supported patients. Eleven LVAD-supported patients were enrolled in a 4week exergaming programme using Nintendo Wii console with five sport games. Patients were instructed to play for 30min a day, 5days a week. Data on exercise capacity and exergaming were collected by using the 6min walk test (6MWT) and a daily self-report diary, respectively. Feasibility of using the console and its safety was assessed by a semi-structured patient interview. Quality of life was assessed by the Minnesota Living with Heart failure Questionnaire (MLHFQ) and the Cantril's Ladder of Life. Safety was assessed by patient's report in interview and diary. The study group consisted of 10 male patients and 1 female patient, mean age of 67±7years, of whom 10 were supported with the HeartMate 3 LVAD for a median of 10 (interquartile range 3, 21) months. Baseline exercise capacity assessed by the 6MWT ranged from 240 to 570m (mean 448±112). After 4weeks of exergaming, 6MWT distance increased from a mean of 448±112 (evaluated in six patients) to 472±113m (P=0.023). Patients' Cantril's Ladder of Life score improved numerically from an average of 6.13 to 7.67, as did their MLHFQ score from 45.9±27 to 38.7±18, with higher and lower scores, respectively, reflecting higher quality of life. No specific LVAD-related safety issues regarding exergaming were reported. Exergaming was found to be a safe and feasible mode for encouraging physical activity in LVAD-supported patients and carries a potential for improving exercise capacity and quality of life in these patients. Larger scale studies are warranted to further investigate the effect of exergaming in this patient population.

Efficacy of Newly Developed Kombucha-Based Specialized Food Product for Treatment of Constipation-Predominant Irritable Bowel Syndrome

ObjectivesAim: to assess the efficacy of kombucha-based specialized food product, enriched with inulin in patients with constipation-predominant irritable bowel syndrome.MethodsThe study (NCT05164861) was approved by LEC and enrolled subjects with constipation-predominant irritable bowel syndrome (according to ROME IV). The subjects were randomized to receive either 220 ml of a non-alcoholic drink, based on pasteurized kombucha (KG), enriched with inulin (1.15 g/100ml) or 220 ml water (control group, CG), for 10 days. Except study product, subjects were advised to follow their usual diet. Standard examination included evaluation of stool frequency (bowel movements per day), stool form (with the Bristol stool scale) and evaluation of concomitant symptoms (abdominal pain/discomfort, abdominal fullness, bloating, and feeling of incomplete bowel emptying) with the use of 5-point Likert scale before (BL) and 10 days after the start of intervention (EOT).ResultsThe complete data of 40 subjects were available for the analysis. Significant increase of stool frequency was found at the EOT compared to BL in KG (n = 20), Mean ± SD: 0.60 ± 0.31 to 0.85 ± 0.19 times/day; p = 0.004, while there was no change in CG (n = 20): 0.63 ± 0.33 vs 0.72 ± 0.28, p > 0.05. Mean values of stool scale form increased in KG (2.95 ± 1.15 to 4.4 ± 0.97; p = 0.001), while remained unchanged in CG (2.94 ± 1.2 vs 3.4 ± 1.2, p = 0.6). Mean values of the Bristol stool scale in KG and CG differed significantly at EOT (p = 0.018). Significant decrease in mean values of incomplete bowel emptying feeling was found in KG (1.88 ± 0.78 at BL vs 1.41 ± 0.56 points at EOT, p = 0.015), but not in the control group. There was no difference in patient's reports for other symptoms between KG and CG.ConclusionsNew specialized kombucha-based drink enriched with inulin is well-tolerated and increases stool frequency and consistency in patients with constipation-predominant irritable bowel syndrome.Funding SourcesRussian Science Foundation (research grant # 19-76-30,014).

Treatment of obstructive sleep apnea and hypopnea syndrome with use of gradual mandibular advanced intraoral apparatus: A case report

Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) is a progressive disorder of the respiratory system that seriously affects the general health and, consequently, the quality of life of an individual. The aim of the present study was to report a case of moderate OSAHS treated with the supervised use of the Gradual Mandibular Advancement Intraoral Appliance (AIO). The treatment was followed up through the patient's report, evaluation of the Epworth Sleepiness Scale, and its result was confirmed by the baseline polysomnography exam. After the treatment period, there was an improvement in the symptoms reported by the patient and in the polysomnographic parameters. The patient went from a moderate OSAHS condition, with an Apnea and Hypopnea Index (AHI) of 24.7 events per hour, to a mild condition with an AHI of 10.7 events per hour. Thus, it can be concluded based on the present case that the AIO was effective for the conservative treatment of moderate OSAHS.

Sensitive skin: A relevant syndrome, be aware.

Sensitive skin is clinically defined by characteristic sensory perceptions including tightness, abnormal stinging, burning, tingling, pain and pruritus. Facial erythema may occur, and other body areas can be involved. Sensitive skin affects extremely the quality of life. According with the International Forum for the Study of Itch (IFSI), sensitive skin is defined as a syndrome. The unpleasant sensations described are in response to stimuli that normally should not provoke such sensations. Moreover, these unpleasant sensations cannot be explained by any skin disease. Sensitive skin is always considered when any new consumer health, cosmetic or household product is introduced in the market. Once sensitive skin is recognized, it is mandatory to identify specific triggers that commonly induce symptoms and even cutaneous visible signs. Sensitive skin syndrome can be exacerbated by an allergic setting and environmental factors (cold, hot, dryness, pollution, wind, chemicals ...), a source of intolerance and unpleasant sensations. Cosmetics are the main triggering factors of sensitive skin according to patient's reports. The presence of potentially irritant substances in their composition increases the clinical expression of symptoms. As sensitive skin is frequent, and it is increasing based on the current development of cosmetic use worldwide, there is a need to develop better skin care products. The continuous research of active and safe skin care products to prevent and treat sensitive skin is extremely welcome.

New complementary perspectives for inpatient physical function assessment: matched clinician-report and patient-report short form measures from the PROMIS adult physical function item bank

PurposeTo develop two item content-matched, precise, score-level targeted inpatient physical function (PF) short form (SF) measures: one clinician-reported, one patient-reported. Items were derived from PROMIS PF bank content; scores are reported on the PROMIS PF T-score metric.MethodsThe PROMIS PF item bank was reviewed for content measuring lower-level PF status (T-scores 10–50) with high item set score-level reliability (≥ 0.90). Selected patient-reported (PR) items were also edited to function as clinician-reported (CR) items. Items were reviewed by clinicians and field tested; responses were assessed for meeting PROMIS measure development standards. New CR and PR items were calibrated using patient responses to the original PROMIS PF items as anchoring data. SFs were constructed, based on content and precision.ResultsNine PROMIS PF items were candidates for CR and PR inpatient PF assessment; three new items were written to extend content coverage. An inpatient sample (N = 515; 55.1% female; mean age = 66.2 years) completed 12 PR items and was assessed by physical therapists (using 12 CR items). Analyses indicated item sets met expected measure development standards. Twelve new CR and three new PR items were linked to the PROMIS PF metric (raw score r = 0.73 and 0.90, respectively). A 5-item CR SF measure was constructed; score-level reliabilities were ≥ 0.90 for T-scores 13–45. A 5-item PR SF measure was assembled, mirroring CR SF content.ConclusionsTwo item content-matched SFs have been developed for clinician and patient reporting and are an effective, efficient means of assessing inpatient PF and offer complementary perspectives.

Physical Therapy interventions and Response to Treatment in a 13-year-old Female with Paramyotonia Congenita

<h3>Research Objectives</h3> 1. To understand paramyotonic congenita. (PMC) 2. To consider specific tests and measures to examine patients with paramyotonic congenita. 3. To investigate specific interventions used to treat patients with paramyotonic congenita. <h3>Design</h3> The study design is a single case report with a 2 month follow-up. <h3>Setting</h3> The setting is an institutional outpatient pediatric physical therapy clinic. <h3>Participants</h3> The participant is a 13-year-old female with paramyotonia congenita. Patient had a 4 month history of increasing low back pain and bilateral hip pain secondary to diagnosis of paramyotonia congenita with decreased hip, and back range of motion due to increased pain and muscle tone. <h3>Interventions</h3> Aquatic Therapy in heated pool (99°F, 37.2°C) Therapeutic Exercise, Hip, Shoulder, Back stretches Therapeutic Modalities, Ultrasound Patient education <h3>Main Outcome Measures</h3> Function, Pain rating, Goniometry. <h3>Results</h3> -Decreased pain with exposure with heated environments such as heated therapy pool, for 1-3 days -Targeted application of ultrasound to painful areas greater reduced pain, for up to 13 days. -Use of goniometry, as a standardized measurement tool, was greater influenced to the patient's level of reported pain -Energy conservation techniques further reduced the patient's report of pain at home and school. <h3>Conclusions</h3> Physical therapy intervention may be an effective treatment option in reducing pain in a 13-year old girl with PMC. Treatment modalities utilizing the application of heat may have decreased pain for several days at a time, and deeper heating options appear to yield greater effectiveness at reducing pain for longer periods of time. <h3>Author(s) Disclosures</h3> All authors declare that there are no conflicts of interest.

Case Report: Atonic PNES Capture in fMRI

Psychogenic Non-Epileptic Seizures (PNES) are a misunderstood and disabling pathology, characterized by a paroxysmal occurrence of clinical signs without the epileptic activity. Resting-state functional MRI (fMRI) studies in patients with PNES have shown abnormal functional connectivity of the resting-state networks, especially in the limbic and motor systems, and in the precuneus. However, the transient nature of PNES episodes prevents us from elucidating the underlying mechanisms of seizures. Here, we report the case of a patient who presented an atonic episode of PNES during a 3T fMRI session. The patient is a 23-year-old woman, suffering from post-traumatic stress disorder, with no neurological comorbidities. The preprocessing of the fMRI images involved realignment, co-registration, segmentation, normalization, denoising (PhysIO toolbox), and smoothing. The time boundary of the seizure was defined according to the patient's reports, and the seizure period was contrasted with the resting state period before the seizure. A whole-brain analysis showed significant activations (left inferior temporal gyrus, left temporo-occipital junction) and deactivations (right precuneus, right superior parietal lobule, right postcentral gyrus, bilateral lingual gyri, inferior occipital gyri, and cerebellar lobules; right insula in a sub-thresholded analysis). Activations and deactivations occurred in four cerebral networks: emotional processing, agency, self-perception, and dissociation. To our knowledge, this report is the first published case of functional MRI during PNES. These results could confirm the emotional and dissociative hypothesis of the physiopathology of PNES and highlight future targets for neuromodulation.