Total Functional Score Research Articles

P759 Correlation of quality-of-life components with sexual function scores and disease duration in patients with inflammatory bowel disease

Abstract Background Inflammatory Bowel Disease (IBD) has a negative impact on quality of life (QOL), and sexuality is one of its major determinants. The impact of disease characteristics on sexuality and intimacy is one of the main concerns of IBD patients. Despite the obvious relevance of this problem, knowledge of the extent and the determinants of sexual dysfunction in persons with IBD is limited. The main goal of the study was to determine the correlation of quality of life (QOL) and it’s components in patients with IBD, and to investigate the impact of disease duration on QOL components. Methods In this cross-sectional study patients fulfilled anonymous validated questionnaire on their sexual function. In International Index of Erectile Function (IIEF) for males, five domains were evaluated through questions on erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. In women were six domains assessed, desire, arousal, lubrication, orgasmic function, satisfaction and pain. For both scores, higher scores indicated a better function. Patients also fulfilled IBDQ-32, a validated questionnaire for assessing quality of life in IBD patients that consists of four main components (social, emotional, systemic and bowel function). Results In this study we have enrolled 202 patients who fulfilled the questionnaire (133 CD, 69 UC). Among them 122 were men and 80 women. Average age of included patients was 39.2 ± 11.02. Prevalence of SD in women was 70% (n = 60) and 18% (n = 22) in males. Female patients with sexual dysfunction had lower emotional and social QOL (p = 0.035 and p = 0.03, respectively). Total male IIEF sexual function score correlated significantly with all of the components of IBDQ; emotional (rho=0.36, p < 0.001) systemic (rho=0.24, p = 0.006), social (rho=0.28, p = 0.002), bowel (rho=0.27, p = 0.002) and with total IBDQ (rho=0.36, p < 0.001). Regarding erectile function score, there was also correlation with all of the components of IBDQ. Total female sexual function FSFI score correlated significantly only with systemic component of IBDQ (rho=0.25, p = 0.02). Interestingly, in male patients disease duration correlate negatively with emotional and social component of IBDQ (rho = −0.21, p = 0.02 and rho=-023, p = 0.01, respectively), which was not the case in female patients. Conclusion The results show correlation of sexual function score with components of QOL, which were more correlated in male patients. Our results suggest that longer disease duration might have positive impact on emotional and social life in male patients, which could be connected with achieving disease control and accepting the disease. It is important to provide proper psychological support, medical treatment and educational information.

Surgically induced weight loss effects on sexual quality of life of obese men: a prospective evaluation.

Sexual difficulties are common among obese patients, but only a few research studies have examined the relationship between obesity and sexual quality of life (QoL). The aim of this study is to investigate the efficacy of bariatric surgery to improve sexual function and related quality of life in obese men. Prospective study including consecutive male patients undergoing bariatric surgery procedures, both sleeve gastrectomy and Roux en Y gastric bypass, between 2013 and 2017. Anthropometric parameters, biochemical and hormonal assessment and QoL questionnaires [International Index of Erectile Function (IIEF), Sexual Desire Inventory (SDI), Short Form-36 (SF-36) health survey questionnaire] were collected before and 12months after surgery. 44 male patients were recruited in the study. 40/44 (90.91%) underwent a SG and 4/44 a RYGB (9.09%). Median age was 43.45years. Waist Circumference, Hip Circumference, body weight and body mass index significantly decreased 12months after surgery, with a median weight loss of 49kg and a median BMI difference of 14.28kg/m2 12months after surgery. Basal glycaemia, HbA1c, basal insulin, triglycerides, HDL cholesterol and CRP levels significantly decreased, while FSH, total testosterone and SHBG levels significantly increased. IEEF total score was significantly higher 12months after surgery. Univariate analysis identified SHBG, estradiol and inhibin B levels, IIEF erectile function, IIEF intercourse satisfaction, IIEF total and SF-36 physical functioning scores as significant negative predictive factors of sexual improvement. None of them reached the statistical significance in the multivariate analysis. Sexual impairment in morbidly obese men represents an underestimated problem, with a high prevalence in the IIEF domains in our series. Bariatric surgery represents the most effective therapy of morbid obesity, having a tremendous impact on metabolic profile, sexual function and self-perceived QoL.

Sustainers: Hospitals with sustained superior performance.

The purpose of this article was to investigate the organizational and market-level variables associated with sustained superior hospital performance on Value-Based Purchasing total performance scores (TPS). TPS for 2014 through 2017 was obtained from the Centers for Medicare & Medicaid Services Hospital Compare website. Market-level data were from the 2017 Area Health Resource File, and hospital-level data were from the 2014 American Hospital Association Annual Survey database. We specified a logistic regression model to identify significant predictors of hospitals with sustained superior performance on TPS, that is, "sustainers." Only 8.4% of hospitals were classified as sustainers. Hospitals located in rural markets with a high Medicare Advantage penetration had a higher likelihood of being classified as sustainers. High RN staffing levels, lower Medicare share of inpatient days, not-for-profit ownership, and small size were all significant organizational predictors of sustained superior performance. Both modifiable characteristics, such as nurse staffing levels, and nonmodifiable characteristics, such as rural markets and small hospital size, are associated with the likelihood of hospitals sustaining superior performance over time. Managers need to carefully examine their staffing levels as they pursue interventions to sustain high TPS overtime. Moreover, factors such as Medicare share of inpatient days and size need to be considered when understanding barriers to sustained performance on Value-Based Purchasing domains.

Total Functional Score of Enhancer Elements Identifies Lineage-Specific Enhancers That Drive Differentiation of Pancreatic Cells.

The differentiation of embryonic stem cells into various lineages is highly dependent on the chromatin state of the genome and patterns of gene expression. To identify lineage-specific enhancers driving the differentiation of progenitors into pancreatic cells, we used a previously described computational framework called Total Functional Score of Enhancer Elements (TFSEE), which integrates multiple genomic assays that probe both transcriptional and epigenomic states. First, we evaluated and compared TFSEE as an enhancer-calling algorithm with enhancers called using GRO-seq-defined enhancer transcripts (method 1) versus enhancers called using histone modification ChIP-seq data (method 2). Second, we used TFSEE to define the enhancer landscape and identify transcription factors (TFs) that maintain the multipotency of a subpopulation of endodermal stem cells during differentiation into pancreatic lineages. Collectively, our results demonstrate that TFSEE is a robust enhancer-calling algorithm that can be used to perform multilayer genomic data integration to uncover cell type-specific TFs that control lineage-specific enhancers.

Pengukuran Kinerja Departemen Fresh Food Tiara Dewata Supermarket Denpasar dengan Metode Balanced Scorecard

This research was conducted at the Department of Fresh Food Tiara Dewata Supermarket, Denpasar. The purpose of this study was to measure the performance of the Fresh Food Department at Tiara Dewata Supermarket with the Balanced Scorecard method and determine the actions that companies need to take to improve performance. This research was conducted by observation to the location, interviews with management and the distribution of questionnaires to respondents. The results showed that the total performance score on each perspective was a financial of 38.53%; a customer perspective of 33.05%; an internal business process perspective of 9.44%; and a learning and growth perspective of 23.10%. Based on the criteria of the total score of performance appraisal shows that Tiara Dewata Supermarket is in a "Very Healthy category (AAA)" condition with a total overall performance score of 104.12%. The action that needs to be taken by Tiara Dewata Supermarket is to maintain performance on the perspective that the value has reached the target, namely sales growth and employee training level. Companies also need to improve and improve performance on the level of customer satisfaction, the level of customer perception of fresh food products, lead time processes, defective products, employee retention rates, attendance levels and employee satisfaction levels at a perspective that has not yet reached company targets.
 Keywords: performance measurement, balanced scorecard, tiara dewata supermarket

Associations of Preoperative Patient Mental Health and Sociodemographic and Clinical Characteristics With Baseline Pain, Function, and Satisfaction in Patients Undergoing Rotator Cuff Repairs

Background: Shoulder pain and dysfunction are common indications for rotator cuff repair surgery, yet the factors that are associated with these symptoms are not fully understood. Purpose/Hypothesis: This study aimed to investigate the associations of patient and disease-specific factors with baseline patient-reported outcome measures (PROMs) in patients undergoing rotator cuff repair. We hypothesized that tear size and mental health status, as assessed by the Veterans RAND 12-Item Health Survey mental component score (VR-12 MCS), would be associated with baseline total Penn Shoulder Score (PSS) and its pain, function, and satisfaction subscale scores. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We prospectively identified 12 patient factors and 12 disease-specific factors as possible statistical predictors for baseline PROMs in patients undergoing surgical repair of superior-posterior rotator cuff tears at a single institution over a 3-year period. Multivariable statistical modeling and Akaike information criterion comparisons were used to investigate the unique associations with, and relative importance of, these factors in accounting for variation in baseline PSS and its subscale scores. Results: A total of 1442 patients who had undergone surgery by 23 surgeons met inclusion criteria, with a baseline median total PSS of 38.5 (pain, 12; function, 24.2; satisfaction, 2). Adjusted R2 in multivariable models demonstrated that the 24 general patient and disease-specific factors accounted for 22% to 24% of the variability in total PSS and its pain and function subscale scores. Large/massive tear size was significantly associated with worse PSS total score and function score but not pain or satisfaction scores. Lower VR-12 MCS was significantly associated with worse total PSS and all 3 subscale scores. Among other factors significantly associated with baseline PROMs were sex, race, preoperative opioid use, years of education, employment status, acromion status, and adhesive capsulitis. Lower VR-12 MCS, preoperative opioid use, female sex, and black race were the factors most strongly associated with baseline PROMs. Conclusion: Large/massive tear size, lower VR-12 MCS, and several additional patient and disease-specific factors are associated with baseline PROMs in patients undergoing rotator cuff repair. Further studies are needed to investigate whether these factors will also predict poor postoperative PROMs.

Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture

BackgroundGlobally, hip fractures are among the top 10 causes of disability in adults. For displaced femoral neck fractures, there remains uncertainty regarding the effect of a total hip arthroplasty as compared with hemiarthroplasty.MethodsWe randomly assigned 1495 patients who were 50 years of age or older and had a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty. All enrolled patients had been able to ambulate without the assistance of another person before the fracture occurred. The trial was conducted in 80 centers in 10 countries. The primary end point was a secondary hip procedure within 24 months of follow-up. Secondary end points included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health end points.ResultsThe primary end point occurred in 57 of 718 patients (7.9%) who were randomly assigned to total hip arthroplasty and 60 of 723 patients (8.3%) who were randomly assigned to hemiarthroplasty (hazard ratio, 0.95; 95% confidence interval [CI], 0.64 to 1.40; P=0.79). Hip instability or dislocation occurred in 34 patients (4.7%) assigned to total hip arthroplasty and 17 patients (2.4%) assigned to hemiarthroplasty (hazard ratio, 2.00; 99% CI, 0.97 to 4.09). Function, as measured with the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, pain score, stiffness score, and function score, modestly favored total hip arthroplasty over hemiarthroplasty. Mortality was similar in the two treatment groups (14.3% among the patients assigned to total hip arthroplasty and 13.1% among those assigned to hemiarthroplasty, P=0.48). Serious adverse events occurred in 300 patients (41.8%) assigned to total hip arthroplasty and in 265 patients (36.7%) assigned to hemiarthroplasty.ConclusionsAmong independently ambulating patients with displaced femoral neck fractures, the incidence of secondary procedures did not differ significantly between patients who were randomly assigned to undergo total hip arthroplasty and those who were assigned to undergo hemiarthroplasty, and total hip arthroplasty provided a clinically unimportant improvement over hemiarthroplasty in function and quality of life over 24 months. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov number, NCT00556842.)

Sexual counseling to patients with myocardial infarction: Nurses' performance, responsibility and confidence

Background & Aim: One of the main concerns in patients with myocardial infarction is that there is no return to sexual activities. Sexual counseling is an interaction between patient and nurse that requires appropriate performance, responsibility, and confidence. The present study aimed to determine nurses' performance, responsibility, and confidence in sexual counseling of myocardial infarction patients. Methods & Materials: This descriptive/analytical cross-sectional study was carried out on 180 nurses from the cardiac care unit (CCU) at the hospitals located in southeastern Iran in 2018. Sampling was performed with the census method; and the data collection tool was a demographic information form and questionnaire, involving nurses' performance, responsibility, and confidence in sexual counseling of cardiac patients. Information was analyzed using SPSS software (ver.18) through descriptive and inferential statistics, including t-test, ANOVA, and Pearson correlation coefficient. The significance level was considered as 0.05. Results: The mean of total performance scores in the nurses was 14.54 ± 4.4, indicating the average performance of nurses in the sexual counseling of myocardial infarction patients. The total mean score of responsibility was 14.32±2.7, indicating their average responsibility in sexual consultation. The total mean score of confidence was 12.86±2.35, indicating their average confidence in the sexual counseling of cardiac patients. Conclusion: The present research showed that nurses’ performance and confidence were not high or acceptable in the sexual counseling of patients with a myocardial infarction, which can lead to some dangerous events such as recurrent myocardial infarction or sudden death. Thus, holding some workshops or training related to the sexual counseling of the patients can assist nurses to be better in this case.

Epidemiologic Study of Female Sexual Dysfunction in Delta of Egypt

Abstract Background: Female sexual dysfunction (FSD) is charac-terised by disturbances in sexual desire and psycho-physiological changes associated with the sexual response cycle. Female sexual dysfunction (FSD) is defined as disorders of libido, arousal, orgasm, and sexual pain that lead to personal distress or interpersonal difficulties. It is a common problem, affecting 30-78% of women. Aim of Study: Was to report the epidemiologic aspects of female sexual dysfunction in Delta of Egypt. Patients and Methods: This study was designed as a cross-sectional one and conducted on married women attending urology and/or gynecology outpatient clinic in Delta of Egypt mainly Tanta University Hospitals; between April 2017 and October 2018. Counseling was performed to explain the goals, steps and security of information of the study with 2822 attending married women to outpatient clinics, 310 women refused to share in the. The response rate was 89%. The number of included women in the study was 2512. Results: Based on the total sexual function score, 1455 (57.9%) had sexual complaints (group A) while 1057 women (42.1 %) had no sexual disturbance (group B). The total score of FSFI ranged from 4.6 to 25.7 in group A (mean=) and from 27.3 to 35.1 in group B (mean=). (p=0.001) Comparison of the individual domain scores showed that women in the sexual dysfunction group had significantly lower scores in all domains as compared to those without sexual dysfunction (p=0.001). Conclusion: Female sexual dysfunction is highly prevalent problem but underestimated due to cultural, religious factors, lack of awareness and information about sex.

Hospitalists staffing levels and hospital performance.

To examine the association between hospitalists staffing levels and contract type with CMS Total Performance Score (TPS). Total performance scores were obtained from CMS, hospital-level data from the 2015 American Hospital Association Annual Survey Database, and unemployment rates from the Area Resource Health File. We used cluster analysis to classify hospitals based on the distribution of various hospitalist contracts, and we used regression analysis to examine the association between TPS and hospitalist staffing levels and contract distributions. Hospital-level predictors included hospitalists staffing levels, RN staffing levels, and Magnet status. Market-level variables were unemployment rates and competition. Higher staffing levels of employed hospitalists or hospitalists with a group contract are associated with higher TPS (with coefficient estimates of 0.85 and 0.83, respectively, and the same standard error of 0.22). Higher staffing levels of hospitalists under individual contract are negatively associated with TPS (with coefficient estimate of -0.43 and standard error of 0.21). Based on the regression analysis using hospital clusters as independent variables, hospitals with individual contracts or without hospitalists providing care had significantly worse TPS compared to hospitals that predominantly employ hospitalists (with coefficient estimate of -1.80 and standard error of 0.61). Magnet status, RN staffing levels, and small and medium size were positively associated with TPS. Medicare share of inpatient days, teaching status, AMCs, and for-profit and public nonfederal ownership were negatively associated with TPS. Adequate hospitalist staffing level is important for hospitals to achieve better performance. Hospitals need to consider the mix of arrangements or contracts that they have with hospitalists.

Cognitive dysfunction in patients with cancer pain (CP): A multicenter cross-sectional study from China.

81 Background: Pain is one of the most common symptoms in cancer patients and often has a negative impact on patients’ functional status and quality of life. Cognitive dysfunction can impact the assessment and treatment of pain. Taking analgesics may worsen the cognitive dysfunction. The study of the prevalence of cognitive dysfunction and the association with analgesics in the CP patients is rare in China. This study aimed to investigate the prevalence of cognitive dysfunction in Chinese CP patients and analyze the related factors. Methods: A total of 220 Chinese CP patients in 9 first-grade hospitals received the following assessment: the functional assessment of cancer therapy-cognitive function (FACT-Cog) and numerical rating scale (NRS), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). ANOVA and multiple linear regression analysis were performed to explore the related factors. Results: A total of 220 Chinese CP patients received the assessment: The overall incidence of cognitive dysfunction in CP patients was 33.64%, with an average cognitive function score 105.93±21.39. The total cognitive function score and each dimension were negatively correlated with the pain, depression, and anxiety levels. The analgesics did not affect the cognitive function of CP patients. Sleep and smoking history were two key factors influencing the cognitive function. Conclusions: An effective management of pain, depression, anxiety, sleep, and smoking are recommended to protect the cognitive function of patients under CP stress. It is safe and reliable to regularly use the analgesics for CP patients. Clinical trial information: NCT03641820.

2660 Bimanual Fundamentals: Validation of A New Virtual Reality Curriculum for Advanced Laparoscopic Skills Training

Study Objective To determine face- and construct validity for the new ‘Bimanual Fundamental Curriculum’ for the Simendo Virtual Reality Laparoscopy Simulator and prove efficiency as a training and objective assessment tool for surgical resident's advanced psychomotor skills. Design Prospective multi-center cohort study. Power calculation was performed. The curriculum was new developed for more experienced laparoscopic trainees. It consists of five exercises, focused on bimanual precision training. Setting Two University hospitals in the Netherlands. Patients or Participants Three groups according surgical experience: medical students (novices, N=17), residents PGY 4-6 (intermediate, N=15) and laparoscopic specialists (experts, N=15) in the field of gynecology, surgery and urology. Interventions Participants (N=47) performed the five exercises three consecutive times. The first run was used as introduction and the second and third run were used for analysis. Intermediates and experts filled out a questionnaire afterwards, regarding reality of the simulator and training goals of each exercise. Statistical analysis of performance was performed between novices, intermediates, and experts. Parameters task time, collisions/displacements, and path length were compared. Additionally, a total performance score was calculated for each participant. Measurements and Main Results Face validity scores regarding realism and training goals were overall positive (median scores of 4 on a 5-point Likert scale). Participants felt the curriculum was a useful addition to the previous curricula (71.9%) and the simulator would fit in their residency programs (96.8%). Construct validity results showed significant differences on the great majority of measured parameters between groups. Experts outperformed intermediate is the three most difficult exercises. The simulator is able to differentiate between performers with different levels of laparoscopic experience (p Conclusion Face- and construct validity for the new Bimanual Fundamental curriculum for this virtual reality simulator could be established. The curriculum is suitable to use in resident's training programs to improve and maintain advanced psychomotor skills.

A Pilot Investigation of Computerized Cognitive Rehabilitation for Post-Stroke Patients: Cognitive Function and Satisfaction

The aim of this pilot study was to investigate the effects of computerized cognitive rehabilitation on patients after they had each experienced an acute stroke and evaluate the association between rehabilitation satisfaction and age. Eighteen patients who had each experienced an acute stroke participated in the study. They were assigned to two groups: the experimental group (n = 12) and control group (n = 6). Interventions were performed with each group for 30 minutes per day, five times per week, for four weeks. The experimental group engaged in computerized cognitive rehabilitation, and the control group participated in traditional cognitive rehabilitation. In addition, both groups engaged in traditional cognitive rehabilitation for four weeks according to an established schedule. The Lowenstein Occupational Therapy Cognitive Assessment test (LOTCA) was performed to measure cognitive function. The Visual Analog Satisfaction Scale (VASS) was used to measure satisfaction with cognitive rehabilitation—specifically, overall satisfaction, therapeutic effects, interest, and intention to reuse. After the interventions, total cognitive function scores for both groups were significantly improved compared to scores before the interventions. However, the experimental group showed significant improvement in more sub-items of cognitive function compared to the control group. There was no significant difference in satisfaction between the two groups after the interventions. In the experimental group, overall satisfaction and interest in computerized cognitive rehabilitation were significantly lower among elderly participants when compared to middle-aged participants. Computerized cognitive rehabilitation may have a positive effect on cognitive function improvement. However, computerized cognitive rehabilitation programs must be developed to meet the specific characteristics and needs of elderly stroke patients.

Ancillary Service Utilization and Impact in Huntington's Disease.

Prior Huntington's disease (HD) studies suggest ancillary services improve motor symptoms, cognition, mood, and quality of life but frequency of use and clinicalcharacteristics are unclear. Describe ancillary service utilization in a cohort of individuals with HD and determine which participant characteristics are associated with ancillary service utilization. Retrospective cross-sectional analysis of Enroll-HD database. Participants were grouped by therapy: physical and/or occupational (PT/OT), psychotherapy and/or counseling (PC), speech and/or swallowing (ST). We performed bivariate comparisons analysis of demographic and disease characteristics between those with/without each therapy and to analyze one-year mean change in assessment scores. Of 4751 participants, 1537 (32.35%) utilized therapies (11.82% PT/OT, 5.33% PC, 3.01% ST, 1.98% all three, 10.21% two therapies). PT/OT participants had worse motor and functional scores: mean UHDRS motor score (41.17 vs. 38.05, p = 0.002), median total functional capacity score (TFC) (8.00 vs. 9.00, p < 0.001). PC participants had worse mood but better cognitive and functional scores: median depression score (7.00 vs. 2.00, p < 0.001), median MMSE (28.00 vs. 26.00, p < 0.001), median TFC (10.00 vs. 8.00, p < 0.001). ST participants had more dysarthria, and worse cognitive and functional scores: dysarthria (32.2% vs. 20.1% p < 0.001), mean correct Symbol Digit Modality Test (16.79 vs. 23.27, p < 0.001), median TFC (6.00 vs. 9.00, p < 0.001). Over one year, PC participants' depression scores improved compared to untreated (- 1.24 vs. - 0.11, p = 0.040). ST participants' depression scores worsened (1.14 vs. - 0.23, p = 0.044). Mean change in TFC was not significant for any therapies. Only 32% of Enroll-HD site participants received ancillary services. Use correlated with expected clinical characteristics, though impact of use remains unclear.

Impact of interventions and tumor stage on health-related quality of life in patients with hepatocellular carcinoma.

This study aims to examine the health-related quality of life in patients with hepatocellular carcinoma. 181 patients attending a tertiary center outpatient clinic were interviewed and completed the short form 36 (SF36) questionnaire. The SF36 was used to assess health-related QoL. Cross-sectional analyses by group (age, gender, clinical scores, systemic, and local interventions) as well sequel questionnaires were conducted. Participants included were 79% (143/181) men [mean age at first SF36: 63.8 (± 12.3; 18.4-85.8)years]. Barcelona Clinic Liver Cancer (BCLC) stadium C was associated with significantly lower SF36 total scores, and elevated initial alpha-fetoprotein (AFP) concentrations were associated with lower SF36 functional and mental health sum scores throughout the course of the third questionnaire. Patients treated with sorafenib had within the sub-dimension scores a significantly lower result for role limitations due to physical health compared to patients without sorafenib treatment. Patients who underwent a transarterial chemoembolization (TACE) had within the sub-dimension scores a significantly higher result for control of pain compared to patients without TACE. Kaplan-Meier analysis revealed significant survival benefits for patients who underwent any intervention at the first SF36 (mean survival in years 4.3 vs. 1.6; P < 0.01) as well as for patients who underwent hepatic resection (mean survival in years 6.3 vs. 2.7; P < 0.0001). Advanced tumor stages marked by BCLC stadium C and elevated initial AFP concentrations were associated with lower SF36 total scores and functional sum scores, respectively. During the course of sorafenib treatment, the sub-dimensional score for role limitations due to physical health decreased significantly, whereas TACE performance was associated with a significant improvement of the control of body pain.

Correlation between hospital finances and quality and safety of patient care.

BackgroundHospitals under financial pressure may struggle to maintain quality and patient safety and have worse patient outcomes relative to well-resourced hospitals. Poor predictive validity may explain why previous studies on the association between finances and quality/safety have been equivocal. This manuscript employs principal component analysis to produce robust measures of both financial status and quality/safety of care, to assess our a priori hypothesis: hospital financial performance is associated with the provision of quality care, as measured by quality and safety processes, patient outcomes, and patient centered care.MethodsThis 2014 cross-sectional study investigated hospital financial condition and hospital quality and safety at acute care hospitals. The hospital financial data from the Centers for Medicare and Medicaid Services (CMS) cost report were used to develop a composite financial performance score using principal component analysis. Hospital quality and patient safety were measured with a composite quality/safety performance score derived from principal component analysis, utilizing a range of established quality and safety indicators including: risk-standardized inpatient mortality, 30-day mortality, 30-day readmissions for select conditions, patient safety indicators from inpatient admissions, process of care chart reviews, CMS value-based purchasing total performance score and patient experience of care surveys. The correlation between the composite financial performance score and the composite quality/safety performance score was calculated using linear regression adjusting for hospital characteristics.ResultsAmong the 108 New York State acute care facilities for which data were available, there is a clear relationship between hospital financial performance and hospital quality/safety performance score (standardized correlation coefficient 0.34, p<0.001). The composite financial performance score is also positively associated with the CMS Value Based Purchasing Total Performance Score (standardized correlation coefficient 0.277, p = 0.002); while it is negatively associated with 30 day readmission for all outcomes (standardized correlation coefficient -0.236, p = 0.013), 30-day readmission for congestive heart failure (standardized correlation coefficient -0.23, p = 0.018), 30 day readmission for pneumonia (standardized correlation coefficient -0.209, p = 0.033), and a decrease in 30-day mortality for acute myocardial infarction (standardized correlation coefficient -0.211, p = 0.027). Used alone, operating margin and total margin are poor predictors of quality and safety outcomes.ConclusionsStrong financial performance is associated with improved patient reported experience of care, the strongest component distinguishing quality and safety. These findings suggest that financially stable hospitals are better able to maintain highly reliable systems and provide ongoing resources for quality improvement.

Predictors of therapeutic treatment outcome in adolescent chronic tic disorders.

Chronic tic disorders may have a major impact on a child's function. A significant effect has been shown for combined habit reversal training (HRT) and exposure response prevention (ERP) treatment delivered in an individual and group setting. The present study examines predictors and moderators of treatment outcome after an acute therapeutic intervention. Fifty-nine children and adolescents were randomised to manualised treatment combining HRT and ERP as individual or group training. Age, gender, baseline tic severity, Premonitory Urge for Tics Scale (PUTS) scores, Beliefs about Tic Scale (BATS) scores, hypersensitivity and comorbid psychiatric symptoms were analysed as predictors of outcome. The same characteristics were examined as moderators for individual versus group treatment. Outcome measures included the change in total tic severity (TTS) score and functional impairment score (as measured by the Yale Global Tic Severity Scale (YGTSS)). Internalising symptoms predicted a lesser decrease in functional impairment. The occurrence of obsessive-compulsive symptoms predicted a larger decrease in TTS. Baseline hypersensitivity and high scores on depressive symptoms favoured individual treatment. High baseline PUTS scores favoured group therapy. This is the first study examining factors predicting and moderating perceived functional impairment following a therapeutic intervention. The study adds to the knowledge on predictors and moderators of TTS. Furthermore, this is the first study examining the effect of the BATS score. The study points towards factors that may influence treatment outcome and that require consideration when choosing supplemental treatment. This applies to comorbid anxiety and depressive symptoms, and to the child's belief about their tics and premonitory urge. None.

Virtual Reality for Screening of Cognitive Function in Older Persons: Comparative Study.

BackgroundThe prevalence of dementia, which presents as cognitive decline in one or more cognitive domains affecting function, is increasing worldwide. Traditional cognitive screening tools for dementia have their limitations, with emphasis on memory and, to a lesser extent, on the cognitive domain of executive function. The use of virtual reality (VR) in screening for cognitive function in older persons is promising, but evidence for its use is sparse.ObjectiveThe primary aim was to examine the feasibility and acceptability of using VR to screen for cognitive impairment in older persons in a primary care setting. The secondary aim was to assess the module’s ability to discriminate between cognitively intact and cognitively impaired participants.MethodsA comparative study was conducted at a public primary care clinic in Singapore, where persons aged 65-85 years were recruited based on a cut-off score of 26 on the Montreal Cognitive Assessment (MoCA) scale. They participated in a VR module for assessment of their learning and memory, perceptual-motor function, and executive function. Each participant was evaluated by the total performance score (range: 0-700) upon completion of the study. A questionnaire was also administered to assess their perception of and attitude toward VR.ResultsA total of 37 participants in Group 1 (cognitively intact; MoCA score≥26) and 23 participants in Group 2 (cognitively impaired; MoCA score<26) were assessed. The mean time to completion of the study was 19.1 (SD 3.6) minutes in Group 1 and 20.4 (3.4) minutes in Group 2. Mean feedback scores ranged from 3.80 to 4.48 (max=5) in favor of VR. The total performance score in Group 1 (552.0, SD 57.2) was higher than that in Group 2 (476.1, SD 61.9; P<.001) and exhibited a moderate positive correlation with scores from other cognitive screening tools: Abbreviated Mental Test (0.312), Mini-Mental State Examination (0.373), and MoCA (0.427). A receiver operating characteristic curve analysis for the relationship between the total performance score and the presence of cognitive impairment showed an area under curve of 0.821 (95% CI 0.714-0.928).ConclusionsWe demonstrated the feasibility of using a VR-based screening tool for cognitive function in older persons in primary care, who were largely in favor of this tool.

The relationship between body mass index, body image, and sexual function: A survey on Iranian pregnant women.

BackgroundThe prevalence of sexual problems is high during pregnancy. Despite this, there are limited data about the impact of physical and psychological factors such as body weight and body image on sexual function in pregnant women.Objective To investigate the relationship between body mass index, body image, and sexual function among pregnant women.Materials and Methods In this cross-sectional study, a total of 206 Iranian pregnant women (106 with normal weight and 100 overweight women) in their 2nd and 3rd trimesters of pregnancy were surveyed. Survey instruments included the Female Sexual Function Index and Multidimensional Body-Self Relations Questionnaire.ResultsThe prevalence of female sexual disorder was 72.3% in this survey. Diminished sexual desire/appetite was the most common problem reported by the participants (37.9%). The mean score of sexual problem and body image were not significantly different among overweight and normal weight women in the 2nd (p = 0.945 and p = 0.800, respectively) and 3rd trimesters of pregnancy (p = 0.310 and p = 0.507, respectively). Further, there were no relationships between the body mass index plus body image and the total female sexual function score (p = 0.44 and p = 0.837, respectively). However, the relationship between the appearance evaluation with lubrication (p = 0.043) and subjective weight with two subscales of sexual satisfaction (p = 0.005) and orgasm (p = 0.019) were significant.ConclusionThe findings from this study revealed that there were no relationships between body mass index plus body image score and the sexual function in pregnancy. Therefore, a further research is recommended to study other potential factors affecting sexual function during pregnancy.

Clinical application study of acupotomy-injection technique with targeted three-point in the treatment of frozen shoulder

To observe the clinical efficacy of minimally invasive acupotomy-injection technique with targeted three-point in the treatment of frozen shoulder. From March 2017 to November 2018, a total of 140 patients with frozen shoulder were randomly divided into observation group and control group. The observation group was made up of 70 patients, including 30 males and 40 females; the mean age was (59.2±11.5) years old; the mean duration of disease was (6.76±4.14) months; the observed patients were treated with acupotomy-injection technique with targeted three-point. There were also 70 patients in the control group, made up of 29 males and 41 females; the mean age was (58.9±11.8) years old; the mean duration of disease was (6.65±3.98) months; the control group was treated with the small needle knife therapy. Before treatment and one month after the treatment, the pain levels of both groups were assessed using the short-form McGill pain questionnaire, and the shoulder function was evaluated using the Constant-Murley Shoulder Outcome Scoring. The clinical efficacy of between groups was compared after treatment, and finally, the improvement rate of pain degree was used to evaluate the therapeutic effect of the patients. The PRI, VAS, PPI and total pain scores of frozen shoulder patients in both groups decreased significantly one month after the treatment compared with those before treatment (P<0.01). Compared with the control group, the observation group exhibited a more significant decrease in pain scores (P<0.01). Furthermore, the shoulder pain, muscle strength, ADL, ROM and total function scores of frozen shoulder patients in the two groups were significantly improved one month after the treatment compared with those before treatment(P<0.01). The inter-group comparison indicated that the pain, ADL, ROM and total function scores were improved obviously in the observation group when compared to those in the control group(P<0.01), but no remarkable difference was found between muscle strength score and the control group(P>0.05). In addition, the markedly effective rate of pain improvement was 70.0% and 45.7% in the observation group and the control group, respectively, meanwhile, the corresponding total effective rate was 97.1% and 84.3%, respectively. The application of acupotomy-injection technique with targeted three-point in the treatment of frozen shoulder shows definite efficacy, easy operation, little pain and high safety. Therefore, it is an ideal method for minimally invasive treatment.