SF-36 Mental Scores Research Articles

Periacetabular Osteotomy Improves Pain and Function in Patients With Lateral Center-edge Angle Between 18° and 25°, but Are These Hips Really Borderline Dysplastic?

AbstractBackgroundThe treatment of mild or borderline acetabular dysplasia is controversial with surgical options including both arthroscopic labral repair with capsular closure or plication and periacetabular osteotomy (PAO). The degree to which improvements in pain and function might be achieved u

Temporary postoperative treatment with compartment-unloading knee braces or wedge insoles does not improve clinical outcome after partial meniscectomy

PurposeTo investigate whether temporary postoperative compartment-unloading therapy after arthroscopic partial meniscectomy (APM)—with either knee braces or wedge insoles—leads to superior clinical outcome as compared to controls. This difference in clinical outcome was tested in the form of two knee scores, physical activity and general health outcome over the first postoperative year.MethodsSixty-three patients who underwent arthroscopic partial meniscectomy (APM) were randomized to one of the following three groups: 12 weeks postoperative knee compartment-unloading therapy with either a knee brace (brace group) or wedge insoles (insole group) or no specific postoperative therapy (control group). Patient-reported outcome was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC Score), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the MARX score (physical activity) and the SF-12 (general health).ResultsSixty-three patients were available for analysis. Except for the SF-12 mental score, all other scores showed significant improvement over time. With regard to the hypotheses proposed, no significant group * time interactions were observed for any of the outcome parameters. This means that the group (i.e. the type of postoperative treatment) was not related to the degree of improvement of any of the scores.ConclusionsIt was concluded that 12 weeks of compartment-unloading therapy—with either a knee brace or wedge insoles—is ineffective with regard to clinical outcome after APM. This applies to the knee score outcome, physical activity and general health outcome over the first year following APM.Level of evidenceRandomized controlled trial, Level I.

Friday, September 28, 2018 3:00 PM–4:00 PM abstracts: optimizing lumbar disc surgery: 215. Patients presenting with a lumbar far-lateral herniated nucleus pulposus can expect similar postoperative outcomes to those presenting with a central or paracentral herniation

BACKGROUND CONTEXT A far lateral herniated nucleus pulposus (HNP) consists of 7%-12% of all disc herniations. 'Far lateral' is often used to describe a lumbar disc herniation that compresses the exiting nerve root at the same level, lateral to the neural foramen. The far lateral disc herniations have been described to elicit radicular leg pain that is more severe than a central or paracentral lumbar disc herniation due to direct compression of dorsal root ganglion, and are said to have a more acute onset in their clinical symptoms. However, literature does not provide much description of the comparative postoperative outcomes between those presenting with a far lateral HNP and those with a central or paracentral herniation. PURPOSE The goal of this study is to examine the pre- and postoperative outcomes between patients presenting with a central or paracentral versus a far lateral HNP. STUDY DESIGN/SETTING Retrospective cohort series. PATIENT SAMPLE We performed a retrospective cohort analysis of patients who underwent a primary lumbar microdiscectomy between 2009 and 2015 by one of two senior orthopaedic spine surgeons for lumbar spinal stenosis. Patients were excluded from analysis if they had any previous lumbar surgery, an unstable spondylolisthesis, were under 18 years of age at the time of surgery, or had postoperative follow up less than 3 months. Patients were divided into two groups based on the location of the HNP (central or paracentral versus far-lateral). OUTCOME MEASURES Patient reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, Visual Analog Scales (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey (SF-12) scores, and the Veterans Rand 12-Item Health Mental and Physical Survey (VR-12) scores. METHODS Baseline patient characteristics were compared using chi-squared analysis and independent sample t-tests for categorical and continuous data, respectively. Bivariate and multivariate regressions were subsequently used to compare clinical outcomes between procedure groups. Multivariate analyses controlled for differences in baseline patient characteristics. RESULTS Overall, 212 consecutive patients who fulfilled our inclusion criteria were assessed. Average follow-up was 24.14 months (range 3–78 months). There were 191 patients who presented with a central or paracentral HNP, while 21 patients presented with a far-lateral HNP. There were no significant differences in the demographic variables between these two groups. Patients with a far lateral disc herniation presented with a trend towards a shorter duration of symptoms prior to surgery (24.5 vs. 31.5 months; p=.052). On multivariate analysis, patients with a far lateral disc herniation presented with significantly lower SF-12 mental (52.14±13.49 vs. 55.1±6.55; p=.034) and physical scores (24.76±7.5 vs. 36.9±11.1; p=.008). Similarly, the far-lateral disc herniation patients also presented with significantly lower VR-12 mental (47.2±12.8 vs. 56.9±7.0; p=.024) and physical scores (25.8±8.7 vs.39.38±11.8; p=.005). However, postoperatively, all patients have similar SF-12 and CR-12 survey scores. The improvement in ODI score was significantly lower in the patients presenting with a far lateral disc herniation (7.8±15.1 vs. 28.3±21.5; p=.002). No significant difference in re-operation rates was found (p=.236). CONCLUSIONS Patients presenting with far lateral disc herniations present with significantly lower SF-12 mental and physical scores as well as lower VR-12 mental and physical scores. However, at approximately 2 years following a lumbar microdecompression surgery, both groups of patients express similar successful outcomes, including SF-12 and VR-12 survey scores. Re-operation rates are similar between the two groups. Despite compression at the site of the dorsal root ganglion and the reported greater difficulty in addressing far lateral disc herniations, patients presenting with these far lateral disc herniations can expect similar outcomes to those patients present with herniations in the central or paracentral region.

Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy

BackgroundPolypharmacy is common in older people and associated with potential harms. The aim of this study was to analyse the characteristics of an older multimorbid population with polypharmacy and to identify factors contributing to excessive polypharmacy in these patients.MethodsThis cross-sectional analysis is based on the PRIMA-eDS trial, a large randomised controlled multicentre study of polypharmacy in primary care. Patients’ baseline data were used for analysis. A number of socioeconomic and medical data as well as SF-12-scores were entered into a generalized linear mixed model to identify variables associated with excessive polypharmacy (taking ≥10 substances daily).ResultsThree thousand nine hundred four participants were recruited. Risk factors significantly associated with excessive polypharmacy were frailty (OR 1.45; 95% CI 1.22–1.71), > 8 diagnoses (OR 2.64; 95% CI 2.24–3.11), BMI ≥30 (OR 1.18; 95% CI 1.02–1.38), a lower SF-12 physical health composite score (OR 1.47; 95% CI 1.26–1.72), and a lower SF-12 mental health composite score (OR 1.33; 95% CI 1.17–1.59) than the median of the study population (≤36.6 and ≤ 48.7, respectively). Age ≥ 85 years (OR 0.83; 95% CI 0.70–0.99) led to a significantly lower risk for excessive polypharmacy. No association with excessive polypharmacy could be found for female sex, low educational level, and smoking. Regarding the study centres, being recruited in the UK led to a significantly higher risk for excessive polypharmacy compared to being recruited in Germany 1/Rostock (OR 1.71; 95% CI 1.27–2.30). Being recruited in Germany 2/Witten led to a slightly significant lower risk for excessive polypharmacy compared to Germany 1/Rostock (OR 0.74; 95% CI 0.56–0.97).ConclusionsFrailty, multimorbidity, obesity, and decreased physical as well as mental health status are risk factors for excessive polypharmacy. Sex, educational level, and smoking apparently do not seem to be related to excessive polypharmacy. Physicians should especially pay attention to their frail, obese patients who have multiple diagnoses and a decreased health-related quality of life, to check carefully whether all the drugs prescribed are evidence-based, safe, and do not interact in an unfavourable way.Trial registrationThis trial has been registered with Current Controlled Trials Ltd. on 31 July 2014 (ISRCTN10137559).

Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty at 2-years Follow-up

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proved to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with two years follow-up. Methods: This prospective study included 59 patients who underwent transfibular total ankle arthroplasty from May 2013 to December 2015. The mean age was 51.6 ± 13.4 years. All patients were followed for at least 24 months postoperative with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiologically preoperatively and at 6, 12, and 24 months postoperatively. Results: At 24 months, patients demonstrated statistically significant improvement in the American Orthopaedic Foot and Ankle Society score from 33.6 to 88.1 (P<0.01), VAS scale from 79.3 to 14.0 (P<0.01) and SF-12 Physical and Mental Composite Scores from 29.9 and 44.6 to 74.4 and 95.3, respectively (P<0.01). Ankle dorsiflexion and plantarflexion improved from 5.5 and 8.8 degrees to 24.2 and 20.0 degrees, respectively (P<0.01). Radiographically, patients demonstrated neutral alignment of the ankle with a tibio-talar ratio of 34.9 ± 9.2 and hindfoot alignment view angle of 1.2 ± 7.0 degrees. No patient demonstrated any radiographic evidence of tibial or talar lucency at 24 months. Seven patients underwent reoperation for removal of symptomatic hardware; one patient developed a postoperative prosthetic infection requiring placement of an antibiotic spacer. Conclusion: This study demonstrates that transfibular total ankle replacement is a safe and effective option for the patients for ankle arthritis with improvements in patient-reported outcomes, range of motion, and radiological parameters. However, further studies are required to determine the mid- and long-term performance of these implants.

Screening for Anxiety and Depressive Symptoms in Type 2 Diabetes Using Patient-Reported Outcome Measures: Comparative Performance of the EQ-5D-5L and SF-12v2.

Objective. To evaluate the performance of EQ-5D-5L (EuroQol Five-Dimension, Five-Level Questionnaire) and SF-12-v2 (12-item Medical Outcomes Health Survey–Short Form, Version 2) in screening for anxiety and depressive symptoms in adults with type 2 diabetes. Methods. Cross-sectional data from a population-based study of type 2 diabetes in Alberta, Canada, were used. Anxiety symptoms (using the 2-item Generalized Anxiety Disorder questionnaire) were categorized into absent (<3) versus present (≥3). Depressive symptoms (using the 8-item Patient Health Questionnaire) were categorized according to two severity cut-points: absent (<10) versus mild (≥10), and absent (<15) versus moderate-severe (≥15). The performance of the measures in screening for anxiety and depressive symptoms was evaluated using receiver operating curve (ROC) analysis. Results. Average age of participants (N = 1,391) was 66.8 years (SD 10.2), and 47% were female. Seventeen percent of participants screened positive for mild and 5.9% for moderate-severe depressive symptoms, and 11.3% for anxiety symptoms. For comorbid symptoms, 8.6% screened positive for anxiety and any depressive symptoms, and 4.6% for anxiety and moderate-severe depressive symptoms. The EQ-5D-5L anxiety/depression dimension and the SF-12 mental composite summary score had the best performance in screening for anxiety (area under ROC: 0.89, 0.89, respectively), depressive symptoms (any: 0.88, 0.92; moderate-severe: 0.90, 0.90), and comorbid anxiety and depressive symptoms (any: 0.92, 0.91; moderate-severe: 0.92, 0.90). These were followed by SF-12 feeling downhearted/depressed item (range = 0.83–0.85), while the lowest performance was for the EQ-5D-5L index score (0.80–0.84) and the SF-12 mental health domain (0.81–0.82). Conclusion. The EQ-5D-5L and the SF-12 are suitable tools for screening for anxiety and depressive symptoms in adults with type 2 diabetes. These tools present a unique opportunity for a standardized approach for routine mental health screening within the context of routine outcome measurement initiatives, where screening is recommended.

Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft.

This study was performed to evaluate the efficacy of reconstructing bone stock in Vancouver B3 periprosthetic femoral fractures (PFFs) using an impacted cancellous allograft cortical or combined with cortical strut allograft. We retrospectively assessed 39 Vancouver-type B3 periprosthetic fractures in 39 patients. Having different bone defects in the femur, 20 patients were treated with intramedullary impacted cancellous allograft, and 19 patients were treated with impacted cancellous allograft combined with cortical strut allograft. The median follow-up time was 58months. Thirty-three patients completed the follow-up as scheduled, and three of them underwent re-operation (9.1%, 3/33). The last evaluated mean hip Harris score was 81.8; WOMAC pain, stiffness, and function scores were 82.3, 79.0, and 81.3, respectively. The satisfaction score was 86.6, and the SF-12 mental and physical scores were 40.4 and 51.1, respectively, for all patients. These outcomes were without significant difference between the two treatment groups (p > 0.05). The facture union was achieved in all the hips (100%). The stem was fixed with bone ingrowth in 24 patients and with fibrous fixation in eight, while stem fixation was not achieved for the remaining patient. The stem subsided less than 3mm in 23 patients and 3-5mm in nine patients. One patient had > 5mm subsidence. The femoral bone stock was improved in 18 patients and remained unchanged in 14 patients; only one patient suffered a diminished bone stock. The radiographic assessment outcomes exhibited little difference between the two treatment groups (p > 0.05). Osseous union of the cortical strut to the host femur occurred in six patients with partial union and ten with complete union. There was moderate and mild graft resorption in three and 13 hips, respectively. The use of impacted cancellous allograft and cortical strut allograft to reconstruct bone stock can provide reliable options and satisfactory results.

Effects and costs of predictive risk stratification in primary care: randomised stepped wedge trial

BackgroundThe ageing UK population needs safe approaches to reduce emergency hospital admissions. Predictive risk stratification modelling (PRiSM) estimates risk that individuals will suffer emergency admission to hospital within 12 months and selects patients for preventative community care to avoid admissions.AimTo evaluate the introduction of (PRiSM) into primary care.MethodFunded by NIHR, we used randomised stepped wedge design to estimate (cost) effectiveness of introducing PRiSM software into 32 participating practices in urban South Wales, supported by practice-based training, clinical support through two local ‘GP champions’, and technical support through telephone help-desk. Outcome measures included: emergency hospital admissions (primary), other hospital activity, and GP activity, all estimated from routine data; patient-reported SF-12 health-related quality of life scores; and NHS costs.ResultsAcross 230,000 participants, PRiSM implementation increased: emergency hospital admission rates by 1.1% (95% confidence interval [CI] = 1.0% to 1.3%); Emergency Department attendance rates by 3.0% (95%CI = 2.8% to 3.2%); outpatient visit rates by 5.5% (95%CI = 5.1% to 5.8%); GP activity by 1.1% (95% CI = 0.7% to 1.4%); and NHS costs per patient by £76 (95%CI = £46 to £106). Questionnaires completed by 1400 randomly sampled participants showed that: PRISM improved SF-12 physical scores by 1.5 points (95%CI = 0.8 to 2.2); but not SF-12 mental scores (95%CI = −1.5 points to +0.3). The direct cost of introducing PRiSM was £0.11/patient/year.ConclusionThe introduction of PRiSM increased emergency hospital admissions and other NHS activity without clear evidence of benefit.

Fecundity and Quality of Life of Women Treated for Solid Childhood Tumors Between 1948 and 1992 in France.

To describe fecundity in female survivors of childhood cancer and consider the correlation with quality of life (QOL). Of 1744 women treated for childhood cancer before the age of 15 years at one of eight French cancer treatment centers between 1948 and 1992, 1187 who were alive in 2005 were sent a self-administered questionnaire, including questions about health status, QOL (MOS SF-36), and fecundity. A standardized fecundity ratio (SFR) was calculated (SFR: observed/expected number of children) for each individual based on a national reference. Of the 972 individuals (82%) who responded, 53% had at least 1 child. The overall SFR, 0.65, was dependent upon the initial diagnosis, more decreased in Central Nervous System tumors (0.24; p < 10-3) than in Germ cell (0.46; p = 0.03) or Sympathetic Nervous System tumors (0.79; p = 0.02). The average QOL motor score was 72.5 ± 19.5, and the average mental score was 61.4 ± 16.7. After adjusting for age, pathology, and self-reported sequelae in the questionnaires, it was determined that SF-36 mental (p = 0.002) and motor (p < 0.0002) scores correlated positively with fecundity, and SF-36 scores correlated negatively with locomotor late effects (p < 0.0001), growth insufficiency (p = 0.002), and psychological disorders (p < 0.001). Gonadal insufficiency was correlated with neither motor nor mental scores. Women treated for childhood cancer demonstrated impaired fecundity that correlated with poor QOL, as registered by the SF-36. Patients should be warned of the risk of impaired fecundity early during the follow-up. If possible, preservation of fertility should be prioritized at initiation of therapy.

The outcome of interlocking nailing of humeral shaft fractures, a one year hospital based study

Background: The outcome of interlocking nailing of humeral shaft fractures is controversial Variations in implants, operative technique and follow-up parameters hinder comparative studies. The aim of this investigation was to evaluate the humeral nailing system according to clinical results, and to recognise advantages and disadvantages of interlocking. Methods: A total of 30 humeral shaft fractures were treated with an Antegrade interlocking humeral nail. Results: At 12-month follow-up, bone consolidation was present in 30 cases; in 1 case complications developed. Constant shoulder score, mean Morrey elbow score, SF-12 physical score or SF-12 mental score. Conclusion: Antegrade interlocking nailing of humeral shaft fractures can result in good functional outcome and unimpaired quality of life. Compression interlocking can minimise the fracture gap and increase the biomechanical stiffness. Potential disadvantages of compression interlocking include possible bending or loosening of the locking screw in the dynamic oblong hole.

Responsiveness of the anxiety/depression dimension of the 3- and 5-level versions of the EQ-5D in assessing mental health.

Anxiety and depression disorders are associated with significantly lower health-related quality of life (HRQL). The EQ-5D is a commonly used generic measure of HRQL; it captures mental health through a single domain-the anxiety/depression dimension. Evidence on the responsiveness of this measure in assessing changes in mental health changes is limited. To examine the performance of the anxiety/depression dimension (A/D) of the 3- and 5-level (3L and 5L) versions of the EQ-5D in assessing changes in mental health. Data from two patient populations were used: 495 adults post-discharge from general internal medicine ward (EQ-5D-3L), and 225 type 2 diabetes patients who screened positive for depressive symptoms (EQ-5D-5L). Anchor-based approach along with effect sizes (ES) and ROC analysis was used. Anchors included patient health questionnaire 9-items "PHQ9" and generalized anxiety disorder 2-item questionnaire "GAD2" for EQ-5D-3L, and PHQ9 and SF-12 mental composite summary scores (MCS) for EQ-5D-5L. A/D change was quantified as the difference between follow-up and baseline levels. The A/D dimension of the EQ-5D-3L showed limited responsiveness to changes in depressive symptoms measured by PHQ9 and for anxiety symptoms measured by GAD2, whereby in those who improved or deteriorated in either symptom, more than half of the patients did not have an A/D change. In the ROC analysis, the A/D dimension of the EQ-5D-3L showed weak performance with C-indices ranging from 0.58 to 0.63 and probability of detection of depressive or anxiety symptoms ranging between 20 and 40%, which are all well below acceptable ranges. Similar results were observed for the A/D dimension of the EQ-5D-5L; although the performance was slightly better, it was still below acceptable range. In patients who improved or deteriorated based on the PHQ9 or MCS, around a third had no changes on the A/D dimension. The performance of the A/D dimension of the EQ-5D-5L was also very limited with C-indices ranging between 0.67 and 0.76, and probability of detection between 50 and 67%, slightly better than that of the 3L, yet unsatisfactory. Although the A/D of both EQ-5D-3L and 5L was limited in capturing changes in mental health in these populations, the 5L was slightly more responsive than the 3L. While the performance was better for depressive than anxiety symptoms, it varied by the direction of change. Further research using other measures of mental health in other populations is warranted.

Clinical measurements versus patient-reported outcomes: analysis of the American Shoulder and Elbow Surgeons physician assessment in patients undergoing reverse total shoulder arthroplasty

BackgroundThe American Shoulder and Elbow Surgeons (ASES) score is composed of a patient-reported portion and a physician assessment. Although the patient-reported score is frequently used to assess postoperative outcomes after shoulder arthroplasty, no previous studies have used the physician-assessment component. This study evaluated the relationship of the ASES physician-assessment measurements with patient-reported shoulder and general health outcomes.MethodsA retrospective review of a prospectively collected multicenter database was used to analyze patients who underwent primary reverse total shoulder arthroplasty (RTSA) from 2012 to 2015 with a minimum 2-year follow-up. ASES physician-assessment and patient-reported components and 12-Item Short Form Health Survey (SF-12) general health questionnaires were obtained preoperatively and 2 years postoperatively. The relationship between ASES physician measurements with ASES patient-reported outcome (PRO) scores and SF-12 Physical and Mental domain scores was assessed with Pearson correlation coefficients.ResultsIncluded were 74 patients (32 men; mean age, 69.2 years; body mass index, 29.4 kg/m2). Preoperative physician measurements and PRO scores were not significantly correlated. Postoperatively, only the ASES physician-measured active (R = 0.54, P < .01) and passive forward flexion (R = 0.53, P < .01) demonstrated moderate correlation with ASES patient scores. The remaining clinical measurements had no significant correlations with ASES patient or SF-12 scores. During the 2-year period, only improvements in active forward flexion correlated with improvements in ASES patient scores (R = 0.36, P < .01).ConclusionsLittle correlation exists between clinical measurements from the ASES physician component and PROs, including the ASES patient-reported and SF-12 general health surveys, in RTSA patients. Improvement in active forward flexion is the only clinical measurement correlated with PRO improvement at 2 years.

Ninety-Day Costs, Reoperations, and Readmissions for Primary Total Knee Arthroplasty Patients With Varying Body Mass Index Levels

BackgroundWe compared 90-day costs and outcomes for primary total knee arthroplasty patients among nonobese (body mass index [BMI] 18.5-24.9), overweight (25-29.9), obese (30-34.9), severely obese (35-39.9), morbidly obese (40-49.9), and super-obese (50+) cohorts. MethodsWe conducted a retrospective review of an institutional database of total knee arthroplasty patients from 2006 to 2013 with a minimum of 3-year follow-up. Sixty-five super-obese patients were identified, and five other cohorts were randomly selected in a 2:1 ratio (total, n = 715). Demographics, 90-day outcomes (costs, reoperations, and readmissions), and outcomes after 3 years (revisions and change scores for Short-Form Health Survey [SF-12], Knee Society Scores, and Western Ontario and McMaster Universities Arthritis Index) were aggregated. ResultsThe 90-day costs were significantly greater in the morbidly obese ($11,568 ± $1,960) and super-obese ($14,021 ± $7,903) cohorts relative to the smaller BMI cohorts ($9,938 – $10,352). The increased cost from readmissions was the main driver of costs. The outcome change scores were similar across all the BMI cohorts for Knee Society Scores, SF-12 Mental Health Composite Score, and Western Ontario and McMaster Universities Arthritis Index, but not for the SF-12 Physical Health Composite Score. At the midterm follow-up, there was no statistical difference in repeat surgery or aseptic revision rates. Septic revisions were significantly greater in the super-obese cohort relative to the other cohorts (6.2% vs 0.8-3.1%). ConclusionHealth-care policy based purely on the economic costs may place morbidly obese and super-obese patients at risk of losing arthroplasty care, thereby denying them access to the comparable quality of life improvements.

Abstract P6-11-12: Health-related quality of life, symptom burden and management in older women with breast cancer across the illness trajectory

Abstract Background: Symptom burden has a negative impact on Health-Related Quality of Life (HRQoL). Identifying symptom burden and sources utilized for symptom management at different points in the cancer trajectory may guide development of supportive care services for older patients with breast cancer. Methods: This was secondary analysis of survey data from the University of Alabama at Birmingham Health System Cancer Community Network, which includes 12 hospitals across the Southeast. Female Medicare beneficiaries with breast cancer were surveyed from 2013-2015 via telephone. Demographic information, treatment status, HRQoL (Short Form Health Survey, SF-12), symptom burden (MD Anderson Symptom Inventory, MDASI), and sources used for symptom management (e.g. doctors, nurses) were collected. Descriptive statistics were computed for all variables of interest. HRQoL, overall symptom burden, and individual symptom scores by treatment status were compared using standardized mean differences (Cohen's d) and Student's t-tests. Simple linear regression was used to determine the association between symptom burden and HRQoL scores. A 10% False-Discovery-Rate was used to adjust for multiple inference. Results: 321 women age 65 years and older with breast cancer were included in the survey sample; 141 (45%) were on treatment with chemotherapy (9%), radiation (1%), recurrence treatment (6%), or other planned cancer treatment (29%). Similar HRQoL scores were observed for participants on and off treatment, with SF-12 physical scores of 39.2 (SD 11.5) vs. 41.4 (SD 11.9, d=.19) and SF-12 mental scores of 52.5 (SD 9.7) vs. 53.2 (SD 9.4, d=.07). Symptom burden was also similar, with overall MDASI severity scores of 2.5 (SD 1.9) and 2.2 (SD 1.7, d=.17). For participants on treatment, fatigue and disturbed sleep were the most severe symptoms with average scores of 4.4 (SD 3.0) and 3.6 (SD 3.2), respectively. For participants off treatment, the most severe symptoms were fatigue and memory problems with average scores of 3.8 (SD 3.1) and 3.1 (SD 2.7). A small difference in disturbed sleep was observed, with participants on treatment reporting more symptom severity (3.6 [SD 3.2] vs 2.7 [SD 2.9], d=.3, p=.01). Minor differences were observed for the severity of other specific symptoms between the groups. For patients both on and off treatment, MDASI scores were strongly and significantly associated with decreased SF-12 physical (on: β=-3.0 [SE 0.4], R2=.21, p&amp;lt;.001; off: β=-3.8 [SE 0.4], R2=.34, p&amp;lt;.001) and SF-12 mental scores (on: β=-3.1 [SE 0.3], R2=.34, p&amp;lt;.001; off: β=-3.1 [SE 0.3], R2=.34, p&amp;lt;.001). The three most common sources to manage symptoms used by participants in both groups were nurses (47%), doctors (26%), and friends/neighbors (26%). Conclusion: Quality of life and overall symptom burden were similar for patients on and off treatment, with only a small difference in disturbed sleep. Overall symptom burden was strongly associated with decreased HRQoL among older females with breast cancer. Nurses were the most common source utilized for symptom management, suggesting the importance of systematic trainings, particularly for nurses, on symptom management and supportive care services for patients on and beyond treatment. Citation Format: Halilova KI, Williams CP, Azuero A, Kvale EA, Yagnik SK, Goertz H-P, Pizu M, Rocque GB. Health-related quality of life, symptom burden and management in older women with breast cancer across the illness trajectory [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-12.

Increase SF-12 mental score, reduce overweight and number of problems! How we performed a patient-focused primary prevention to younger vulnerable patients in General Practice, Denmark

Increase SF-12 mental score, reduce overweight and number of problems! How we performed a patient-focused primary prevention to younger vulnerable patients in General Practice, Denmark

Plating for midshaft clavicular fractures: The impact on quality of life and functional outcome

IntroductionSeveral studies report on functional outcome after operative treatment for midshaft clavicular fractures. According to the published data not much is known about the quality of life after operative treatment. The purpose of this study is to investigate long term patient reported quality of life (QoL) and functional outcome after plating for midshaft clavicular fractures. MethodsPatients between 16 and 65 years of age, with a midshaft clavicular fracture which were treated with plate fixation between 2006 and 2014, were included. Information was extracted from hospital records and all patients were asked to participate in an online survey. Primary outcome was QoL (SF-36 and EQ-5D-5L). Secondary outcomes were complications, reoperation rate, patient– and cosmetic satisfaction, pain, and functional outcome (DASH). ResultsIn a retrospective cohort design, 164 patients were included, 101 completed the online survey. Patients reported a good QoL and functional outcome. The mean physical- and mental SF36 score were 53.9±7.3 and 52.3±9.9 (0–100), the EQ-5D-5L score was 0.88±0.17 (−0.59 to 1.0) and the average DASH was 8.45±14.0 (0–100). Furthermore, there was a strong correlation between the functional outcome and QoL (p<0,001). Seventeen patients developed at least one complication (10%) and seventy-seven patients got a reoperation, with isolated implant removal as the leading cause of reoperation (80,5%). ConclusionPatients which received operative treatment for a midshaft clavicle fracture have an excellent QoL, and a good functional outcome. Furthermore, there is a strong relationship between functional outcome and the QoL.

Quality of Life and Psychological Aspects in Patients with Visual Impairment Secondary to Uveitis: A Clinical Study in a Tertiary Care Hospital in Brazil

ABSTRACTPurpose: To evaluate the quality of life in individuals with bilateral visual impairment secondary to uveitis and its association with sociodemographic, clinical and psychosocial aspects.Methods: Data were collected through a structured interviews, using four forms; the SF-12v2, HADS, NEI-VFQ-25 and a specific form developed to collect clinical and sociodemographic data.Results: 80 patients were included with a mean age of 42.8 years; 63.8% female; 57.5% with permanent reduction of familiar income. The average number of medical visits was 15.2 ±10.7/year. In terms of health-related quality of life (HRQol), the mean of VFQ-25 score was 36.6 ± 15.1 and the mean of SF-12 physical and mental components scores were 43.3 ± 9.9 and 44.9 ± 12.2. Anxiety and depression symptoms were found in 65.1% and 32.5% of patients, respectively.Conclusions: Visual impairment has impact on several scales of HRQoL leading to productivity loss and consumption of health resources.

L-DOPA-induced dyskinesias, motor fluctuations and health-related quality of life: the COPARK survey.

Studies assessing the correlations between L-DOPA-induced dyskinesias (LIDs) and motor fluctuations with health-related quality of life (HRQoL) in Parkinson's disease (PD) have yielded conflicting results. This study aimed to assess the relationship between LIDs and motor fluctuations with HRQoL in patients with PD, and to assess the relative contribution of their severity and duration in a large sample of patients with PD. A total of 683 patients with PD from the COPARK survey were evaluated. HRQoL was assessed using the 39-Item Parkinson's Disease Questionnaire (PDQ-39) (primary outcome) and 36-Item Short Form Survey (SF-36). The daily duration and severity of LIDs were obtained from Unified Parkinson's Disease Rating Scale (UPDRS) IV items 32 and 33, respectively. The daily duration of motor fluctuations was obtained from UPDRS IV item 36 and severity was estimated as the difference between the UPDRS 2 (Activities of Daily Living) score in 'OFF' versus 'ON' condition. A total of 235 patients with PD (35%) experienced motor fluctuations and 182 (27%) experienced LIDs. The PDQ-39 total and SF-36 physical scores were significantly worse in patients with LIDs, after adjusting for the presence of motor fluctuations. The PDQ-39 total score and SF-36 physical and mental score were significantly worse in patients with motor fluctuations, after adjusting for the presence of LIDs. The severity of LIDs and the duration of motor fluctuations significantly and independently affected PDQ-39 scores. The SF-36 physical score was affected only by the severity of motor fluctuations, whereas the mental score was not affected by any of the aforementioned variables. Our findings suggest that LIDs (mainly their severity) and motor fluctuations (mainly their duration) correlate independently with HRQoL in patients with PD.

The impact of transcatheter aortic valve implantation on quality of life: A mixed methods study

ObjectiveTo provide an in-depth understanding of patients' views about the impact of transcatheter aortic valve implantation on self-reported quality of life. BackgroundTranscatheter aortic valve implantation is considered to be the gold standard of care for inoperable patients diagnosed with severe symptomatic aortic stenosis. Mid- to long-term clinical outcomes are favourable and questionnaire data indicates improvements in quality of life but an in-depth understanding of how quality of life is altered by the intervention is missing. MethodsA mixed methods study design with a total of 89 in-depth qualitative interviews conducted with participants (39% male; mean age 81.7 years), 1 and 3 months post TAVI, recruited from a regional centre in England. Data were triangulated with questionnaire data (SF-36 and EQ5D-VAS) collected, pre, 1 and 3 months post implantation. ResultsParticipants’ accounts were characterised by four key themes; shortened life, extended life, limited life and changed life. Quality of life was changed through two mechanisms. Most participants reported a reduced symptom burden and all explained that their life expectancy was improved. Questionnaire data supported interview data with gradual improvements in mean EQ-5D scores and SF-36 physical and mental domain scores at 1 and 3 months compared to baseline. ConclusionFindings suggest that TAVI was of variable benefit, producing considerable improvements in either mental or physical health in many participants, while a smaller proportion continued to deteriorate.

Direct-acting antivirals for chronic hepatitis C.

Direct-acting antivirals for chronic hepatitis C.