Significant Improvements In SF-36 Scores Research Articles

Distal Clavicle Fracture Repair: Clinical Outcomes of a Surgical Technique Utilizing a Combination of Cortical Button Fixation and Coracoclavicular Ligament Reconstruction.

Background:When treated conservatively, unstable distal clavicle fractures demonstrate a high symptomatic nonunion rate. While a variety of surgical techniques have been described, many of these techniques are associated with high failure rates and hardware-related complications. The surgical technique used in this study has shown promising biomechanical results; however, long-term clinical results have not yet been described.Purpose:To assess the clinical and radiological outcomes of a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and coracoclavicular (CC) ligament reconstruction.Study Design:Case series; Level of evidence, 4.Methods:We conducted a retrospective review of 22 consecutive patients with displaced, unstable Neer type II or V distal clavicle fractures who underwent this surgical technique from 2012 to 2019. Primary outcome variables were radiographic union, patient satisfaction, and postoperative shoulder function. Preoperative and postoperative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, postoperative complications, time to radiographic union, and preoperative and postoperative CC distance. Quality of life was assessed using preoperative and postoperative 36-Item Short Form Health Survey (SF-36) scores.Results:Nearly all (21/22) patients were available for a final review; 1 patient was lost to follow-up at 2 weeks. All 21 patients achieved radiographic union by 4 months (mean, 60.38 days; range, 41-84 days; 95% CI, 53.80-66.96 days). All patients were satisfied with the surgical procedure and their functional outcome. The mean UCLA score improved from 5.36 (95% CI, 4.14-6.60) preoperatively to 32.52 (95% CI, 30.56-34.48) postoperatively (mean difference, 27.14; P < .001). The mean ASES score improved from 16.23 (95% CI, 9.79-22.67) preoperatively to 88.11 (95% CI, 81.82-94.40) postoperatively (mean difference, 71.91; P < .001). Statistically significant improvements in SF-36 scores were seen in the physical functioning, role limitations due to physical health, pain, social functioning, and emotional well-being categories. There were 3 postoperative complications, including 1 patient with a minor complication secondary to hardware irritation, 1 patient with adhesive capsulitis, and 1 patient with wound dehiscence requiring wound closure.Conclusion:We describe a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and CC ligament reconstruction that resulted in a 100% union rate and excellent clinical outcomes with acceptable complications.

Health-Related Quality of Life after Bariatric Surgery and its Correlation with Glycaemic Status in Hong Kong Chinese Adults.

To evaluate health-related quality of life (HRQOL) following bariatric surgery and its correlation with different glycaemic status in Hong Kong Chinese adults. In 2002-2008, obese Chinese adults were recruited for bariatric surgery, undergoing laparoscopic adjustable gastric banding or laparoscopic sleeve gastrectomy. Patients were invited to complete the Chinese Hong Kong Medical Outcomes Study Short-Form Health Survey (SF-36) at baseline and at 1-year post operation. Sixty patients (60 % female) completed baseline and 1-year follow-up HRQOL assessments. Mean age was 38 years and mean BMI was 41.6 kg/m(2). At baseline, 30.0 % of patients had diabetes and 31.7 % prediabetes. Mean absolute weight reduction 1 year after bariatric surgery was 19.8 kg. Statistically significant improvements in SF-36 scores were demonstrated in all physical domains and in three of the four psychological domains. Greater body weight reduction was associated with greater improvements in certain physical domains postoperatively. After adjusting for co-variables, abnormal glucose tolerance was associated with greater improvements in five of the eight HRQOL domains. Bariatric surgery resulted in significant gains in HRQOL as well as significant reductions in body weight in obese Chinese adults. This study suggests that bariatric surgery offers greater HRQOL improvements in patients with prediabetes and diabetes compared with normoglycaemic individuals.

Augmenting Immune Responses to Varicella Zoster Virus in Older Adults: A Randomized, Controlled Trial of Tai Chi

To evaluate the effects of a behavioral intervention, Tai Chi, on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV) and on health functioning in older adults. A prospective, randomized, controlled trial with allocation to two arms (Tai Chi and health education) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX, the live attenuated Oka/Merck VZV vaccine licensed to prevent varicella. Two urban U.S. communities between 2001 and 2005. A total of 112 healthy older adults aged 59 to 86. The primary endpoint was a quantitative measure of VZV-CMI. Secondary outcomes were scores on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The Tai Chi group showed higher levels of VZV-CMI than the health education group (P<.05), with a significant rate of increase (P<.001) that was nearly twice that found in the health education group. Tai Chi alone induced an increase in VZV-CMI that was comparable in magnitude with that induced by varicella vaccine, and the two were additive; Tai Chi, together with vaccine, produced a substantially higher level of VZV-CMI than vaccine alone. The Tai Chi group also showed significant improvements in SF-36 scores for physical functioning, bodily pain, vitality, and mental health (P<.05). Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine.

Observational Study of an Arts-in-Medicine Program in an Outpatient Hemodialysis Unit

Long-term hemodialysis is associated with impaired quality of life (QOL) and depression, which are thought to worsen compliance with the treatment regimen. With the success of our hospital's Arts-in-Medicine Program, we launched a similar set of activities in the long-term dialysis unit and sought to measure their effects. At baseline and 6 months, we administered the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Beck depression scales to 46 patients (44% men; mean age, 52 years) and assessed their percentage of achieved dialysis time, interdialytic weight gain, and predialysis laboratory results. We tested for a relationship between these variables and Arts-in-Medicine Program participation (low and high; 51% and 49%). Arts in Medicine was offered each shift, led by artists, and included artwork, crocheting, crafts, seasonal displays, poetry, and playing musical instruments. At 6 months, the patients, nurses, technicians, and physicians subjectively believed that Arts in Medicine had a positive impact on the unit. In paired comparisons to baseline, there was significant improvement in SF-36 scores for Role-Physical (mean values, 34.4 to 38.7; P = 0.04), less weight gain (3.6 to 3.2 kg; P = 0.02), greater serum carbon dioxide content (20.4 to 22.5 mEq/L [mmol/L]; P < 0.01), greater phosphate levels (5.3 to 5.7 mg/dL [1.71 to 1.84 mmol/L]; P = 0.04), and a trend to less depression (Beck score, 15.3 to 12.1; P = 0.07). Regression analyses showed that high participation correlated with improved SF-36 scores for Social Function (11.1-unit increase; P = 0.01), Bodily Pain (7.6-unit increase; P = 0.04), and Role-Physical (6.6-unit increase; P = 0.06), as well as a trend to greater albumin levels (0.11 g/dL [1.1 g/L]; P = 0.08), but with greater phosphate (0.8 mg/dL [0.26 mmol/L]; P = 0.01) and lower calcium levels (0.3 mg/dL [0.07 mmol/L]; P = 0.07). Participation in a new Arts-in-Medicine Program correlated with improved QOL measures, and there were encouraging trends for depression, as well as certain laboratory and hemodialysis parameters.

Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma.

We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. The principle symptoms in multiple myeloma result from bone destruction, especially the spine. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps (IBT) into the vertebral body. The purpose of the IBT is to restore the vertebral body back toward its original height, while creating a cavity that can be filled with highly viscous bone cement. Fifty-five consecutive kyphoplasty procedures were performed in 18 patients with osteolytic vertebral compression fractures resulting from multiple myeloma. Cement leakage and any complications were recorded. Early objective analysis was made by comparing preoperative and latest Short Form 36 Health Survey scores. Height restoration was estimated by measuring vertebral height on lateral radiographs. The mean age of patients was 63.5 years, mean duration of symptoms was 11 months, and mean follow-up was 7.4 months. There were no major complications related directly to use of this technique. On average, 34% of height lost at the time of fracture was restored. Asymptomatic cement leakage occurred at two (4%) of 55 levels. Significant improvement in SF36 scores occurred for Bodily Pain (23.2 to 55.4, P =.0008), Physical Function (21.3 to 50.6, P =.0010), Vitality (31.3 to 47.5, P =.010), and Social Functioning (40.6 to 64.8, P =.014). Kyphoplasty was efficacious in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. Kyphoplasty is associated with early clinical improvement of pain and function as well as some restoration of vertebral body height.

Kyphoplasty in the treatment of vertebral fractures secondary to multiple myeloma

Sean Dudeney, MD, Mohamed Hussein, MD, Isador H. Lieberman, MD, Cleveland, OH, USABackground context: We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of vertebral compression fractures resulting from multiple myeloma. The principle symptoms in multiple myeloma result from bone destruction. The spine is the most affected skeletal structure. Vertebral involvement results in compression fractures that give rise to severe pain and progressive kyphosis. Present treatment includes bed rest, analgesics and bracing, which result in further bone resorption. Antimyeloma therapy controls the disease but does not provide significant structural relief. Augmentation of vertebral compression fractures with polymethylmethacrylate, that is, vertebroplasty, has been used with success to treat pain. This technique does not attempt to restore the height of the collapsed vertebral body and has high cement leakage rates. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body. Once inflated, the bone tamps restore the vertebral body back toward its original height, while creating a cavity that can be filled with highly viscous bone cement, resulting in lower leakage rates.Methods: Forty-five consecutive kyphoplasty procedures were performed in 15 patients with vertebral compression fractures resulting from multiple myeloma over 22 sessions. Comparing preoperative and latest SF36 scores made objective analysis. Height restoration was estimated by measuring vertebral height on pre- and postoperative lateral radiographs. Cement leakage and any complications were recorded prospectively.Results: The mean age of patients was 63 years (range, 48 to 79 years), and the mean duration of symptoms was 5.8 months, mean follow-up of 4.9 months. Levels treated ranged from T6 to L5 (T11=6, T12=6, L1=7). There were no major complications related directly to use of this technique or use of the inflatable bone tamp. On average, 28% of height lost at the time of fracture was restored. Asymptomatic cement leakage occurred at 2 of 45 levels (4%). Significant improvement in SF36 scores occurred for bodily pain (22.6 to 55.0; p=.002) and physical function (19.3 to 50.7; p=.0023), as well as vitality (30.7 to 48.9; p=.022), social functioning (38.4 to 64.3; p=.016) and mental health (59.1 to 76.3; p=.048).Conclusion: The kyphoplasty balloon bone tamp was efficacious in the treatment of vertebral compression fractures resulting from multiple myeloma. Kyphoplasty is a well-tolerated procedure associated with early clinical improvement of pain and function as well as some restoration of vertebral body height in these patients. Restoration of a functional spine is of ever increasing importance as improvements in medical management increases survival in multiple myeloma.

Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial

Objectives: To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function.Design: A pragmatic multicentre randomised controlled trial,...