General Health Status Of Patients Research Articles

General Health Status in Patients of Adhesive Capsulitis visiting Rehabilitation Department of Fauji Foundation Hospital Rawalpindi, Pakistan

Objective: To investigate the general health status in patients of Adhesive Capsulitis Study Design: Prospective study Place and duration: Occupational Therapy Unit of Rehabilitation Department of Fauji Foundation Hospital Rawalpindi from July 1, 2019 to September 30, 2019. Methodology: There were many patients suffering from shoulder pain. Among them, 52 patients who were suffering from adhesive capsulitis included. After the history of subjects, assessed for pain and restriction of range of motion in their affected shoulder. Lateral rotation, abduction, and medial rotation (LAM) test was performed. The inclusion criteria for subjects was symptomatic shoulder problems with restricted active and passive range of motion along with positive (LAM) test in ages between 30 to 80 years. The exclusion criteria was: (1) any neurological conditions affecting shoulder (2) any pathology other than adhesive capsulitis (3) any surgery of head, neck or upper limb. Data was analyzed using SPSS 25. Results: Our study showed that all 52 patients were suffering from a very acute state of pain, sleep cycle disturbance, difficulty in activities of daily living (ADLs) and recreational activities. Some patients were jobless due to acute shoulder pain of adhesive capsulitis. Conclusion: Adhesive capsulitis disturbs the daily life, sleep cycle, activities of daily living and difficulty in recreational activities. it is advocated that further researches must be conducted to point out the difficulties of such patients.

General health status of a sample of patients with burning mouth syndrome: A case-control study.

The relationship of burning mouth syndrome (BMS) with possible alterations in patients' general health has been subject of study and controversy during the last years. To analyse the general health status of patients with BMS, comparing it with a control group. A case-control study was conducted to compare the diseases, medications, blood test alterations, disturbances in general health, oral quality of life, xerostomia, sleep quality and psychological status between a group of 20 patients with BMS and a group of 40 patients who did not suffer from this disease. BMS patients suffered more comorbidities and consumed more medications than controls. More mental, behavioural or neurodevelopmental disorders in BMS patients were found, consuming more drugs for nervous and cardiovascular systems, and alimentary tract and metabolism. Lower levels of iron and higher levels of folic acid were found in BMS patients compared to controls. General health status, oral health impact, sleepiness, psychological status and xerostomia levels were also significantly worsened in BMS patients than in controls. BMS patients presented a worsened health status over controls suffering more comorbidities, consuming more medications and showing adverse results in all the health variables analysed in this study.

The Experience of Tinnitus and Its Interaction With Unique Life Histories-Life Events, Trauma and Inner Resources Narrated by Patients With Tinnitus.

Background: The challenges facing people with chronic tinnitus include finding relief and rebuilding quality of life. However, previous traumatic episodes may influence adjustment and prolong suffering. Recovery implies reducing aggravating reactions and improving social roles, relationships and interests. Self-narratives about living with tinnitus have not yet received the attention they deserve in the research literature. Thus, the main goal of the present study was to illustrate how tinnitus suffering interacts with the participants' unique life histories.Method: Four women and one man (ages 52–58) took part in the study after consulting a special hearing clinic for annoying tinnitus. Criteria for inclusion were that tinnitus was regarded as a problem with negative consequences for quality of life. The participants should be willing to share how the experience of tinnitus suffering interacts with their previous life story. Narrative methodology was employed in order to achieve the goals of the study. We used unstructured interviews with free conversation, which allowed for rich narratives with full contextual meaning.Results: The findings, based on the narrative analysis, revealed that three out of five participants presented a regressive form of narrative indicating ongoing struggles beyond tinnitus itself, which they were unable to bring to closure. For them, valued goals were continuously thwarted by frustrating circumstances in their lives, either past events or current unresolved issues. Progressive and stable narratives, as identified in the other two participants, demonstrated values that rely on others' attitude and understanding toward their suffering, in sharp contrast to the regressive narratives. We suggest that a central issue in tinnitus rehabilitation should be to help suffering patients to overcome unresolved conflicts and thereby extend their ability for a fuller commitment in life.Conclusion: Considering enduring tinnitus as a chronic condition, whose course is likely to vary depending on the patient's general health status, an alteration of progressive and stable narratives is likely to occur during the lifespan. A progressive narrative shows similarities to the core construct of the salutogenesis model of health promotion (1). In conclusion, a narrative approach in tinnitus rehabilitation can be health promoting by offering the patient the opportunity to engage in storytelling, which in turn can increase comprehensibility and a sense of coherence.

Oral manifestations in patients with renal diseases

Background: Chronic renal diseases (CRDs), a progressive and irreversible decline in renal function with the most implications in dentistry. Kidneys have the following functions: filtering waste metabolic products, maintaining electrolyte balance and the volume of extracellular liquid, and regulating the acid–base balance and endocrine secretions (prostaglandins, erythropoietin, rennin, and Vitamin D). Objectives: To find a correlation between chronic renal conditions and oral cavity and to evaluate the manifestations of CRDs in the oral cavity. Results: Various oral manifestations such as mucosal pallor, petechiae, ecchymosis, uremic stomatitis, and periodontal changes are observed in patients with CRDs. Conclusions: CRDs have a significant impact on oral health, which needs intervention at an early stage of disease and its management to improve the general health status of patients.

Professional negligence during nitrous oxide sedation and child fatality in dental office and suggested precautions: A short communication on childcare and nitrous oxide sedation

Paediatric death inside dental office by the effect of anaesthesia in dentistry is a very difficult case but not rare. In this article, we reviewed more than thirty studies with data focussing on death associated with dental anaesthesia using nitrous oxide (N2O). In children, most cases died at the age of 2–5 years. Hypoxia was the most common cause of death and cardiovascular, respiratory. Although rare death following general anaesthesia in dentistry, it is a critical side effect mostly seen in adult patients with compromised health conditions. Therefore, appropriate case selection in regard to patient's general health status as well as standard technical and equipment conditions is mandatory to reduce the risk of death during N2O dental anaesthesia in children. We have also given the list of guidelines and dietary care for children during N2O anaesthetic procedures inside the dental office.

Does the Reflux Symptom Index Predict Increased Pharyngeal Events on HEMII-pH Testing and Correlate with General Quality of Life?

To determine the ability of the reflux symptom index (RSI) to predict objective impedance and pH-probe testing, and to examine the relationship between disease-specific and general health status in patients diagnosed with laryngopharyngeal reflux (LPR). Adults presenting to a tertiary care academic center with a primary voice complaint completed the RSI and the Patient-Reported Outcomes Measurement Information System 10-item global health instrument (PROMIS). An RSI score ≥13 was considered abnormal. Objective testing for LPR was performed using hypopharyngeal-esophageal multichannel intraluminal impedance catheter with dual pH (HEMII-pH) testing; a positive test was defined as more than one pharyngeal impedance events over 24 hours. Spearman rho analyses were applied, and the sensitivity and specificity of the RSI to detect HEMII-pH findings were determined. One hundred four patients underwent HEMII-pH testing. Mean scores were 16.7 (95%CI 15.1-18.3) for RSI. Sixty-three (60.6%) patients were diagnosed with LPR by HEMII-pH testing. RSI scores were moderately correlated with PROMIS physical (Spearman rho 0.43, P < 0.0001), social (Spearman rho 0.33, P < 0.0001) and mental health (Spearman rho 0.33, P < 0.0001) scores. The RSI has a sensitivity and specificity of 66.7% and 31.7%, respectively, for detecting pharyngeal events on HEMII-pH testing. There is moderate sensitivity and lack of specificity of the RSI for detecting increased pharyngeal reflux events. Reflux-specific and general health status instruments are correlated. Further investigation could assess the diagnostic ability of RSI compared proximal reflux events on HEMII-pH, as well as whether health status instruments can be used to detect clinically meaningful change in the LPR population.

Factors affecting guideline adherence in the initial treatment of non-muscle invasive bladder cancer: Retrospective study in a French peripheral hospital

To assess whether the initial treatment of non-muscle invasive bladder cancer (NMIBC) was performed according to the guidelines, and to determine the reasons why initial treatment was not provided in nonadherence cases. We retrospectively reviewed all patients with NMIBC who underwent their first transurethral resection of bladder tumor (TURBT) at a peripheral hospital, between 2007 and 2016. The treatment offered to the patient was compared to the European Association of Urology guidelines according to risk stratification. For each patient who did not receive the treatment according to the guidelines, one of the following reasons was identified: poor patient compliance, poor patient general health status, urologist's decision, lack of resources. One hundred fifty-nine patients were included with a mean age of 72.2 years at the time of NMIBC diagnosis. The low-risk patients were strictly treated according to the guidelines. Among the intermediate-risk patients, 14% received mitomycin C. Among the high-risk patients, 39% received intravesical Bacillus Calmette-Guerin. In the nonadherence cases (61%), the reasons were related to the patient in 44% of cases (poor compliance, 21%; poor patient general health status, 23%), urologist's decision in 54% of cases, and lack of resources in 2% of cases. Thirty-seven percent of the high-risk patients underwent re-resection. Overall, adherence to NMIBC guidelines was low in all treatment types (intravesical therapy, re-resection, or cystectomy for very high-risk patients), but this finding was similar to that in previous studies. Reasons were mainly related to the urologist's decision or to the patient condition (poor compliance or poor general health status). 3.

Multiple Treatment Comparisons for Large and Massive Rotator Cuff Tears: A Network Meta-analysis.

There is no consensus about the best choice between all the options available for large and massive rotator cuff tear (mRCTs) management. To determine the comparative effectiveness of current treatment options for management of large and mRCTs. Network meta-analysis. We searched the Cochrane systematic reviews, MEDLINE and EMBASE databases for all trials of adults with large and mRCTs that report preoperative and postoperative functional scores after an intervention option. The network meta-analysis included 20 trials with 1233 patients with 37.24 months follow-up. Eight treatment options for management of large and mRCTs were compared. The primary effectiveness outcome was the functional score. This meta-analysis did not show statistically significant differences between conservative, partial repair, patch or platelet rich plasma (PRP) augmentation, reverse total shoulder arthroplasty, and complete repair. Latissimus dorsi (LD) transfer was ranked first for effectiveness [standardized mean difference (SMD): 2.17, 0.28-4.07] and debridement ranked last (SMD: -2.15, -3.13 to -1.17). Latissimus dorsi transfer seems to be most effective for management of large and mRCTs, although some heterogeneity was observed in this network meta-analysis of full text reports. The choice of the operating technique depends on the patient's general health status and his expectations. When a decision has been reached to perform surgery, a repair, even if partial, should be attempted. Procedures involving biologic augmentation (eg, PRP) seem to convey no additional benefit while introducing more risk. Debridement alone should be avoided.

Reliability and validity of the Turkish Version of Arthritis Research UK Musculoskeletal Health Questionnaire.

This study aims to investigate the validity and reliability of the Turkish version of the Musculoskeletal Health Questionnaire (MSK-HQ-T) for assessing the general health status in patients with axial spondyloarthritis (ax-SpA). One hundred ax-SpA patients (42 males, 58 females; mean age 40.3±9.1 years; range, 18 to 65 years) who were able to speak and understand Turkish language were included in this study. All participants answered MSK-HQ-T, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Short-Form 36 (SF-36). MSK-HQ-T was repeated five-seven days later for test-retest and internal consistency reliability. The Cronbach's alpha value was 0.912, demonstrating high internal consistency. The test-retest score of MSK-HQ-T was 0.968, which was significant. The correlation of MSK-HQ-T with the subgroup scores of SF-36 was statistically significant (p<0.001). The correlation between MSK-HQ-T and the total scores of BASDAI and BASFI was statistically significant (r=-0.788, p<0.001; r=-0.743, p<0.001). The MSK-HQ-T is a reliable and valid questionnaire to assess general health status in Turkish patients with ax-SpA.

Economic Interplay of Medicare and Audiology

Over the past 10 years, numerous efforts have been undertaken to change the standing of audiology within the Medicare program. These efforts have focused on several key factors, including (1) allowing Medicare beneficiaries to access audiology services without a physician referral and (2) having Medicare pay for audiology treatment services such as audiologic rehabilitation or cerumen removal. These proposed changes are often tied to the political perspective of reducing costs to Medicare or more importantly, increasing patient access while reducing co-pays for Medicare beneficiaries and improving patient outcomes. To understand the financial impact of these efforts on clinical practices at the provider and patient levels, we looked into Medicare payments for audiologic procedures (current and previous years’ payments are available on the Medicare website). This information led us to access the Medicare databases that listed each individual audiologist and the specific characteristics of the beneficiaries they served. We discovered that Medicare tracks details such as how many Medicare beneficiaries are served by an audiologist, how many procedure codes are billed, the amount billed per provider, and the amount allowed by Medicare. These same databases include the demographic characteristics of patients served by each provider and, perhaps most interestingly, the percentage of patients with various comorbidities for each provider. For example, on average, nearly 65 percent of patients seen by audiologists in 2017 had hypertension, 55 percent had hyperlipidemia, 29 percent had diabetes, and 25 percent had chronic kidney disease. These data led us to question the relation of these comorbidities to hearing status, as well as the role of audiologists with respect to these comorbidities. The relationship between kidney disease and hearing loss has long been appreciated, and evidence of a more significant relationship between cardiovascular disease and hearing and between cognitive status and hearing loss is emerging. It certainly wouldn't be the role of audiologists to manage diabetes or hypertension, but might audiologists have a role in assessing the general health status of patients even if that assessment is asking the right questions? Or might the audiologist have a role in the early identification of comorbid conditions that helps reduce costs to patients and to payers? By extension, it is time to revisit the current audiology test battery to ensure that processes are sensitive and robust enough in identifying markers not only of hearing loss but also of other medical conditions. The Centers for Medicare and Medicaid Services (CMS) grant audiologists the right to provide reimbursable clinical services that are medically necessary to Medicare beneficiaries and, in return, expect outcomes and recommendations to help manage and treat these patients. By considering patients in the context of their overall health, audiologists may be able to provide further economic benefit to patients and payers, particularly if they can get beyond the pure tone audiogram and the idea that hearing loss exists in isolation from other health conditions. As we undertake this project to examine the financial impact of Medicare on audiology practices, we've come to realize that audiology practices can have a significant financial impact on Medicare and their beneficiaries. One of our key takeaways was that audiologists have the knowledge and skills necessary to identify, manage, and treat Medicare beneficiaries who have a confluence of health-related issues that may be identified early by the audiologist or mitigated by audiology services. Audiologists must proactively offer their full scope of hearing and balance services to these patients and secure our role in the evaluation and management of individuals with hearing and balance disorders. Thoughts on something you read here? Write to us at [email protected]

Sa1887 – General Health Status in Patients with Moderate to Severe Ulcerative Colitis Receiving Ustekinumab: Results from the Phase 3 Unifi Induction and Maintenance Studies

Sa1887 – General Health Status in Patients with Moderate to Severe Ulcerative Colitis Receiving Ustekinumab: Results from the Phase 3 Unifi Induction and Maintenance Studies

Do Curve Characteristics Influence Stenosis Location and Occurrence of Radicular Pain in Adult Degenerative Scoliosis?

Study DesignRetrospective cohort. ObjectiveThe aim of this study was to describe the various locations of spinal stenosis (LSS) in lumbar scoliosis and its related clinical symptoms. IntroductionAdults with lumbar scoliosis often present with pain and disability. Association of scoliosis and stenosis is not rare, but remains sparsely explored. Consequences of scoliosis on stenosis location and treatment remain debatable. MethodsPatients operated for symptomatic LSS with lumbar scoliosis (Cobb angle >20°) from 2015 to 2016 were included. All patients completed preoperative clinical and neurologic examination. Coronal and sagittal radiographic parameters, rotatory subluxation (RS), and spondylolisthesis were analyzed on full spine radiographs. Computed tomographic scan multiplanar reconstructions were performed to measure central, foraminal, and lateral recess stenosis, from T10 to the sacrum. ResultsA total of 76 patients were included (69 ± 9 years old, 77% female). Sixty percent had neurogenic claudication, and L5 was the most common radicular pain (41%). The mean Cobb angle was 33° ± 16°. Overall, 35 (46%) patients had coronal malalignment; in 69%, side of the coronal tilt corresponded to side of the concavity of the lumbosacral curve. Sixty patients had RS (most frequent level L3–L4). In 50% of the cohort, RS was located at the junction between the lumbar and lumbosacral curves. In 70% (n = 53) of the patients, central stenosis occurred at the junction between the lumbar and lumbosacral curves. Foraminal and lateral stenosis were most frequently observed in the concavity of the distal lumbosacral curve. L5 radicular pain was significantly more frequent in case of lumbosacral contra-curve and right coronal malalignment. ConclusionLSS is frequent in lumbar scoliosis. Relationships exist between curve characteristics and symptomatic LSS in lumbar scoliosis; especially, concavity of the lumbosacral contra-curve and the junctional level between the lumbar curve and the lumbosacral contra-curve. Therefore, accurate analysis of stenosis in ASD seems mandatory, to at least perform decompression because perfect planned treatment for stenosis and scoliosis correction might not always be possible because of the patient's general health status. Level of EvidenceLevel 4.

Cross-sectional survey of life quality of patients with deep partial-thickness and above burns on head and face at discharge and analysis of its influencing factors

Objective: To study the quality of life and its influencing factors of patients with deep partial-thickness and above burns on head and face at discharge, and to guide clinical nurses to provide targeted nursing for patients. Methods: A cross-sectional survey was conducted on 42 patients with deep partial-thickness and above burns on head and face who met the inclusion criteria. The patients were hospitalized from January 2014 to November 2017 in the Department of Burns and Plastic Surgery of our hospital and were selected by adopting the convenient sampling method. On the day before discharge, the Chinese version of the Abbreviated Burn Specific Health Scale was used to assess the scores in various fields of patients' quality of life and total scores. The self-designed general situation questionnaire was used to investigate the gender, age, education level, occupation, marital status, cause of injury, and source of expenses of patients, and the scores in various fields of quality of life of patients in various general conditions and total scores were recorded. Data were processed with t test or one-way analysis of variance. The indicators with statistically significance in the total score difference in the above analysis were chosen, and multivariate linear regression analysis was performed to screen the factors influencing the quality of life of patients. Results: Totally 42 groups of questionnaires were sent out and 42 groups of valid questionnaires were retrieved. The effective recovery rate was 100%. The total score of quality of life of patients at discharge was (49±10) points. The scores of general health status (57±23) points, social relations (56±18) points, physical function (49±17) points, and mental health (41±20) points were ranked from high to low. There were statistically significant differences in the scores of physical function, mental health, and general health status among patients of different age groups (F=8.115, 14.182, 19.285, P<0.01). There were statistically significant differences in the scores of mental health, social relations, and general health status among patients with different educational levels (F=3.312, 51.176, 21.852, P<0.05 or P<0.01). There were statistically significant differences in the scores of mental health and general health status among patients with different occupations (F=3.667, 2.947, P<0.05). The scores of mental health and social relations of married patients were significantly higher than those of unmarried patients (t=27.096, 4.885, P<0.05 or P<0.01). There were statistically significant differences in the scores of physical function, mental health, social relations, general health status of patients with different causes of injury (F=3.000, 5.438, 4.005, 9.125, P<0.05 or P<0.01). There were statistically significant differences in the scores of mental health and general health status of patients with different sources of expenses (F=10.456, 3.368, P<0.05 or P<0.01). The total scores of quality of life of patients with different gender and causes of injury were similar (t=0.407, F=1.145, P>0.05); there were statistically significant differences in the total scores of quality of life of patients of different age groups, with different education levels, occupations, sources of expenses, and marital status (F=2.947, 17.064, 9.324, 4.101, t=7.225, P<0.05 or P<0.01). Multivariate linear regression analysis showed that age, education level, occupation, marital status, and source of expenses were the factors influencing the quality of life of patients at discharge (t=-2.437, 8.037, -2.994, 5.016, 3.519, P<0.05 or P<0.01). Conclusions: The quality of life of patients with deep partial-thickness and above burns on head and face is at a low level at discharge. The influencing factors include age, education level, occupation, marital status, and source of expenses. Nurses should screen the relevant items when the patient is hospitalized. Emphasis should be laid on young, with undergraduate and above education, unmarried, self-funded patients, and those engaged in occupations with high facial requirements, to minimize the negative mood of patients, encourage them to face life, choose the right career, and improve their quality of life.

Typhoid ileal perforation in Shisong, Northwestern Cameroon

Background: The study aims to provide an overview of the spectrum of perforated typhoid fever cases and their outcome that were managed in resource constrained rural mission hospital, Northwestern of Cameroon. Methods: This was a retrospective observational study which was conducted in St Elizabeth Catholic General Hospital, Shisong, Northwestern region of Cameroon over a two year period covering January 2016 and December 2018. The patients included were those admitted and diagnosed of typhoid ileal perforation. Data collected were analyzed using SPSS computer software version 22. Results: During the study period, thirty-eight patients underwent surgery for typhoid ileal perforation. They included 26 (68.43%) males and 12 (31.57%) females with Male to Female ratio of 2.2: 1. Sixty -five percent of cases occurred between the months of July and September. The most common presentations were with abdominal pains (92.11%), and abdominal distention (92.11%). X-ray abdomen revealed pneumo -peritoneum in 26 (68.4%) cases, while ultrasound detected free peritoneal collection in 34 (90%) cases. Perforations were surgically treated depending upon the number of perforations, general health status of patient and degree of fecal contamination. Perforated typhoid still carries dismal prognosis. The mortality was associated with duration of delay in obtaining blood pre - operatively for patients requiring transfusion (p=0.018) and duration of presentation to operation time interval (p=0.026). Conclusion: Typhoid intestinal perforation is still endemic in our setting with dismal prognosis. Urgent public health concerted effort is required with emphasis on preventive measures such as safe drinking water, appropriate sewage disposal, and typhoid vaccination. Educating the populace on early and prompt diagnosis, adequate resuscitation as well as early surgery in patients with typhoid ileal perforation to keep the mortality low.

Life Quality and Its Related Factors of Patients with Multiple Myeloma during Maintenance Therapy

To evaluate the quality of life (QOL) on patients with multiple myeloma(MM) during maintenance therapy and to explore the related factors important for QOL. The demography, clinical and laboratorial data of 66 MM patients during maintenance therapy were collected and explored by using a cross-sectional question naire(EORTC QLQ C30 V 3.0). The statistical analysis was performed using Nowegram normal mode(NM) and reference values(RV) of MM patients which were used as control. In comparison with Nowegran normal mode, the scores of general health status, physical function, role function and social function of patients during maintenance therapy were lower than those of normal mode (61.3, 73.9, 65.4 and 65.2 vs 75.3, 89.9, 83.3 and 85.8 respectively), while the scores of constipation and financial difficulty were higher than those of normal mode(16.7 and 44.4 vs 10.7 and 9.7 respectively) (P<0.05). In comparison with reference values, the scores of general health status, emotional and coguitive functions of patients during maintenance therapy were significantly higher than those of reference values(61.3, 81.7 and 84.3 vs 55.7, 71.3 and 78.1 respectively) (P<0.05). In addition, the maintenance therapy yet decreasd the scores of fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss and constipation of patients, but increased the score of financial difficulty of patients (P<0.05). The age of initial diagnosis, serum LDH level, peripheral neuropathy, high ratio of own expense and underlying diseases were main factors affecting the general health status of patients (P<0.05), while the decrease of Hb level, increase of blood Ca++ level and accompanied genetic changes negatively influence the QOL (P<0.05), while the high culture level showed positive effect on QOL (P<0.05). The choise of drugs for maintenace (therapy thalidomide and bortezomib) not had significant effect on QOL of patients. The maintenance therapy can improve the QOL of MM patients, the age at initial diagnses, serum LDH level, peripheral neuropathy and high ratio of own expence are the main factors affecting the QOL of MM patients.

P406 General health status in patients with moderate to severe ulcerative colitis receiving ustekinumab: results from the Phase 3 UNIFI induction and maintenance studies

P406 General health status in patients with moderate to severe ulcerative colitis receiving ustekinumab: results from the Phase 3 UNIFI induction and maintenance studies

Comparative effects of clinic- and virtual reality-based McKenzie extension therapy in chronic non-specific low-back pain

PurposeThe study compared the influence of Clinic-Based McKenzie Therapy (CBMT) and a Virtual Reality Game (VRG) version on pain intensity, back extensor muscles endurance, activity limitation, participation restriction, fear avoidance belief, kinesiophobia, and general health status of patients with chronic non-specific low-back pain.MethodsThis quasi-experimental study involved 46 patients (CBMT: &lt;i&gt;n&lt;/i&gt; = 24; VRG: &lt;i&gt;n&lt;/i&gt; = 22) with ‘directional preference’ for extension, randomized into CBMT or VRG group. Treatment was applied thrice weekly for 8 weeks. Outcomes were assessed at the end of the 4&lt;sup&gt;th&lt;/sup&gt; and 8&lt;sup&gt;th&lt;/sup&gt; week. Data analysis employed descriptive and inferential statistics of independent t-test, Mann-Whitney U test, repeated measure ANOVA, Friedman’s ANOVA, and ANCOVA. The significance level was set as α = 0.05.ResultsThere were no significant differences in the treatment outcomes (mean change) across the groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05), except for kinesiophobia, where VRG led to a significantly higher decline in mean rank at week 4 (28.3 vs. 19.1; &lt;i&gt;p&lt;/i&gt; = 0.018) and 8 (28.7 vs. 18.7; &lt;i&gt;p&lt;/i&gt; = 0.009), and vitality (a general health status item) at week 4 (27.6 vs. 19.8; &lt;i&gt;p&lt;/i&gt; = 0.042) and 8 (28.1 vs. 19.3; &lt;i&gt;p&lt;/i&gt; = 0.042). ANCOVA showed that significant baseline parameters were not significant predictors of vitality (F = 1.986; &lt;i&gt;p&lt;/i&gt; = 0.070) or kinesiophobia (F = 0.866; &lt;i&gt;p&lt;/i&gt; = 0.563) outcomes.ConclusionsThe VRG mode of McKenzie therapy is comparable with the clinic-based approach in most outcomes. VRG has a superior effect on kinesiophobia, but may take a higher toll on vitality/energy.

Surgical treatment of acute complicated diverticulitis in the elderly.

Although the true prevalence is unknown, colonic diverticulosis is one of the most common disease of the digestive tract in Western countries. Based on administrative data of hospitalized patients, the incidence of diverticulitis has been increasing in last decades. In general, elderly patients undergo less frequently an elective colonic resection; but a substantial part of emergency surgeries is performed in elderly patients. In these older patients the choice of any clinical and surgical option is to be correlated not only to the severity of diverticulitis, but also to general status and the co-existing comorbidities. In this regard, it is mandatory that all patients undergo a multidimensional, comprehensive geriatric assessment to correctly identify those who are fit, vulnerable or frail. The analysis of data currently available highlights three relevant elements: type and severity of peritoneal contamination, hemodynamic conditions (stable or unstable), and concomitant comorbidities (fit or frail status). There is no single ideal surgical treatment that can be considered as gold standard for all clinical presentations; the final clinical decision-making should always be based on patient's general health status, severity of peritonitis and of sepsis. In a septic elderly patient who is hemodynamically unstable, treatment should be as prompt as possible independent of the Hinchey's stage, and could include either a Mickulicz stoma or a DCS strategy. In an elderly patient who is fit and hemodynamically stable, the surgical options are similar to those in a younger patient. If a patient is frail but hemodynamically stable, he should be treated with a Hartmann's procedures.

A comparative study of pattern recognition algorithms for predicting the inpatient mortality risk using routine laboratory measurements

Laboratory tests are a common and relatively cheap way to assess the general health status of patients. Various publications showed the potential of laboratory measurements for predicting inpatient mortality using statistical methodologies. However, these efforts are basically limited to the use of logistic regression models. In the present paper we use anonymized data from about 40,000 inpatient admissions to the Inselspital in Bern (Switzerland) to evaluate the potential of powerful pattern recognition algorithms employed for this particular risk prediction. In addition to the age and sex of the inpatients, a set of 33 laboratory measurements, frequently available at the Inselspital, are used as basic variables. In a large empirical evaluation we demonstrate that recent pattern recognition algorithms (such as random forests, gradient boosted trees or neural networks) outperform the more traditional approaches based on logistic regression. Moreover, we show how the predictions of the pattern recognition algorithms, which cannot be directly interpreted in general, can be calibrated to output a meaningful probabilistic risk score.

Adipose Tissue-Derived Stromal Cells for Wound Healing.

Skin as the outer layer covers the body. Wounds can affect this vital organ negatively and disrupt its functions. Wound healing as a biological process is initiated immediately after an injury. This process consists of three stages: inflammation, proliferation, remodeling. Generally, these three stages occur continuously and timely. However, some factors such as infection, obesity and diabetes mellitus can interfere with these stages and impede the normal healing process which results in chronic wounds. Financial burden on both patients and health care systems, negative biologic effect on the patient's general health status and reduction in quality of life are a number of issues which make chronic wounds as a considerable challenge. During recent years, along with advances in the biomedical sciences, various surgical and non-surgical therapeutic methods have been suggested. All of these suggested treatments have their own advantages and disadvantages. Recently, cell-based therapies and regenerative medicine represent promising approaches to wound healing. Accordingly, several types of mesenchymal stem cells have been used in both preclinical and clinical settings for the treatment of wounds. Adipose-derived stromal cells are a cost-effective source of mesenchymal stem cells in wound management which can be easily harvest from adipose tissues through the less invasive processes with high yield rates. In addition, their ability to secrete multiple cytokines and growth factors, and differentiation into skin cells make them an ideal cell type to use in wound treatment. This is a concise overview on the application of adipose-derived stromal cells in wound healing and their role in the treatment of chronic wounds.