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Background Lateral ankle sprain (LAS) is a common injury with incidence rates reported at 7.2 per 1000 person-years. Physical examination strategies provide limited information to guide rehabilitation that can maximize clinical outcomes. Early and accurate diagnostic information using ultrasound imaging enables individualized care and the ability to monitor healing along with its response to activity and rehabilitation. Purpose The purpose of this study was to describe and observe the outcomes associated with Point of Care Ultrasound (POCUS) guided early management of acute and sub-acute lateral ankle sprains. Study Design Case series Methods Individuals with a LAS within the prior 28 days underwent a clinical evaluation to include a POCUS exam to assess ligamentous integrity. Objective and POCUS findings were integrated to classify each LAS into one of four categories. Each grade of ankle sprain corresponded to levels of bracing for the protection of injured structures with each patient receiving physical therapy care based on rehabilitation guidelines. Participants completed the Foot and Ankle Ability Measure (FAAM) activities of daily living and Sports subscale, the Foot and Ankle Outcome Score (FAOS), Patient Reported Outcomes Measurement Information Systems Global Health, Tampa Scale of Kinesiophobia (TSK-11), Cumberland Ankle Instability Tool (CAIT), and the Numeric Pain Rating Scale as well as the Ankle Lunge Test and Figure 8 measurements at baseline, 4 weeks, 8 weeks and 12 weeks post enrollment. The FAAM Sport subscale, all FAOS subscales, and the TSK-11 were also collected at 24 weeks while the CAIT was collected at baseline and 24 weeks. Results Fourteen participants were enrolled with 11 participants completing all data collection. FAAM Sport scores significantly improved at 4, 8, 12 and 24 weeks. All components of the FAOS significantly increased except for Sport scores at four weeks and Quality of Life scores at four and eight weeks. Conclusion POCUS guided early management and ligamentous protection of LASs resulted in significant short and long-term improvement in function and return to sporting activity. This case series highlights the feasibility of using ultrasound imaging to assess the severity of ligamentous injury and align bracing strategies for ligamentous protection. The observations from this case series suggest that functional bracing strategies focused on ligamentous protection to promote healing and reduce re-injury rates does not delay improvement in functional outcomes. Level of Evidence Level IV, Case Series [ABSTRACT FROM AUTHOR]

Background and Purpose Conservative management of anterior shoulder dislocation (ASD) is associated with greater recurrence compared with surgical management. Current rehabilitation protocols may not adequately challenge shoulder stability to encourage adaptive coping strategies. Apprehension-based training (ABT) is a new treatment concept derived from the supine moving apprehension test (SMAT), a previously validated performance measure among patients with ASD. The purpose of this case report is to describe the application of ABT in a patient with recurrent ASD. Study Design Case report Case Description The subject was a 23-year-old male with bilateral recurrent ASD. The subject underwent a 17-week exercise program involving gradual exposure to increased anterior instability loads based on the SMAT movement pattern. The Western Ontario Shoulder Instability Index (WOSI), Patient-Specific Functional Scale (PFPS), Tampa Scale of Kinesiophobia, SMAT, shoulder internal and external rotation muscle strength were measured via hand-held dynomometry before and after training. Outcomes Following treatment, clinically meaningful gains in quality of life (WOSI) and shoulder function (PSFS) were noted. Kinesiophobia decreased, SMAT and shoulder internal rotator strength increased beyond their respective minimal detectable change. Four months after treatment, quality of life and shoulder function remained improved, and the subject reported a reduced rate of ASD. Discussion Apprehension-based training involving gradual exposure to shoulder instability loads may hold potential for improving the management of patients with ASD. Further testing of this concept is warranted. [ABSTRACT FROM AUTHOR]

Background Pelvic floor dysfunction (PFD) occurs when muscles of the pelvic floor become weakened, impaired, or experience tension leading to a variety of complications. Due to the reactive nature and high demands of many sports, athletes are at increased susceptibility and of particular interest concerning PFD. Hypothesis/Purpose The purpose of this study was to explore the prevalence of PFD among college-aged athletes, assess how PFD impacted athletic performance, and identify contributing factors for increased likelihood of PFD in athletes. Study Design Cross-Sectional Study Methods All fully active LVC NCAA Division 3 athletes were recruited for screening for PFD using the Cozean Pelvic Dysfunction Screening Protocol and were surveyed on their self-knowledge of PFD. Athletes who scored > 3 on this tool completed an additional survey, created by the investigators, to identify the impact PFD had on their athletic performance and personal life and were then randomly assigned to one of three investigators to undergo a noninvasive coccygeal assessment to determine underactive, overactive, or normal pelvic floor muscle (PFM) activity. Results Fifty-three Division III male and female athletes between the ages of 18-25 years old participated in the study. Statistically significant differences were found between Cozean scores and demographic factors of age (p <0.001), gender (p <0.05), self-knowledge of PFD (p <0.001), and sport (p <0.001) among all participants that contributed to the increased likelihood of PFD. Thirteen athletes scored > 3 on the Cozean with the 92.3% experiencing under/over active PFM activity and the majority indicating that PFD significantly impacted their athletic performance and quality of life. Conclusion The results indicate that older female NCAA Division III college athletes who participate in swimming and who possess self-knowledge of PFD are more likely to experience PFD. Additionally, these athletes are likely to encounter a significant impact on their athletic performance and quality of life. These results provide preliminary evidence on the need of PFD awareness and assessment among college athletes. [ABSTRACT FROM AUTHOR]

Outcomes of mitral transcatheter edge-to-edge repair (MTEER) in patients with secondary mitral regurgitation (sMR) and preserved left ventricular ejection fraction (LVEF) are uncertain. This study sought to describe outcomes of MTEER for sMR with preserved LVEF. Using the STS/ACC TVT (Society of Thoracic Surgeons–American College of Cardiology Transcatheter Valve Therapy) Registry, we evaluated the risk-adjusted outcomes of MTEER for sMR with LVEF >50% by the severity of residual mitral regurgitation (MR), and we compared these outcomes to patients undergoing MTEER for sMR with LVEF of 20% to 50%. Among 12,083 patients, LVEF was >50% in 3,011 (24.9%) and 20% to 50% in 9,072 (75.1%). Technical success, in-hospital complications, the 1-year death rate, and the 1-year Kansas City Cardiomyopathy Questionnaire score were similar in patients with LVEF >50% vs LVEF of 20% to 50%. The 1-year adjusted risk of heart failure hospitalization was lower in patients with LVEF >50% vs LVEF of 20% to 50% (adjusted HR: 0.81; 95% CI: 0.68-0.97; P = 0.02). Among patients with LVEF >50%, residual MR was ≤ mild in 76.0% and moderate in 19.0%. Compared with ≤ mild MR, moderate residual MR was associated with increased 1-year risks of death (adjusted HR: 1.46; 95% CI: 1.01-2.10; P = 0.04) and heart failure hospitalization (adjusted HR: 1.82; 95% CI: 1.32-2.52; P < 0.001). At 1 year, the KCCQ score improved in patients with LVEF >50% treated with MTEER (residual MR grade ≤ mild, 28.7 ± 26.8; moderate MR, 25.7 ± 27.2; > moderate MR, 21.6 ± 12.0; all P < 0.05). In patients with sMR and preserved LVEF, MTEER was associated with a high rate of technical success, a low rate of complications, and large improvements in health status. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: To ascertain patient and caregiver satisfaction with an individualized case management intervention to improve transition from inpatient rehabilitation care to the community after traumatic brain injury (TBI). Setting: Participants from 6 National Institute on Disability, Independent Living, and Rehabilitation Research-funded TBI Model Systems sites in the United States. Participants: Adult, English-speaking patients with TBI who had moderate-to-severe TBI and were discharged from a TBI Model Systems site and who were in the intervention arm of the Brain Injury Rehabilitation: Improving the Transition Experience pragmatic clinical trial, as well as their caregivers. Design: A survey of participants in the intervention arm, which included an individualized case management program administered by a TBI Care Manager (TCM) who facilitated resource connection, education, and support. Main Measures: Satisfaction with intervention was measured through Likert-scaled and open-ended questions. The survey was administered verbally through telephone, audio-recorded, and transcribed. Descriptive statistics were calculated for categorical variables, and content analysis was conducted for open-ended responses. Results: Patient and caregiver participants were satisfied with the intervention and highlighted the benefits of the interpersonal and practical support provided by the TCM. Participants identified the need for a more intensive intervention and clear expectations of the TCM role, as well as gaps in available medical and rehabilitation services in the community, as areas for improvement. Conclusion: Patients with TBI and their caregivers reported satisfaction with the individualized case management program in supporting their transition from inpatient rehabilitation to the community. Further research is needed to understand the impact on outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Understanding the impact of biomarker‐based dementia risk estimation in people with mild cognitive impairment (MCI) and their care partners is critical for patient care. METHODS: MCI patients and study partners were counseled on Alzheimer's disease (AD) biomarker and dementia risk was disclosed. Data on mood, quality of life (QoL), and satisfaction with life (SwL) were obtained 1 week and 3 months after disclosure. RESULTS: Seventy‐five dyads were enrolled, and two‐thirds of the patients opted for biomarker testing. None of the participants experienced clinically relevant depression or anxiety after disclosure. All dyads reported moderate to high QoL and SwL throughout the study. Patients reported more subthreshold depressive symptoms 1 week and lower QoL and SwL 3 months after disclosure. In patients, depression (odds ratio [OR]: 0.76) and anxiety (OR: 0.81) were significant predictors for the decision against biomarker testing. DISCUSSION: No major psychological harm is to be expected in MCI patients and care partners after dementia risk disclosure. TRIAL REGISTRATION: This study is registered in the German clinical trials register (Deutsches Register Klinischer Studien, DRKS): http://www.drks.de/DRKS00011155, DRKS registration number: DRKS00011155, date of registration: 18.08.2017. Highlights: Patients with mild cognitive impairment (MCI) and study partners were counseled on Alzheimer's disease (AD) biomarker‐based dementia risk estimation.About two‐thirds of patients opted for biomarker testing and received their dementia risk based on their AD biomarker status.Patients who decided in favor or against CSF biomarker testing differed in psychological features.We did not observe major psychological harm after the dementia risk disclosure.Coping strategies were associated with better subsequent mood and well‐being in all participants. [ABSTRACT FROM AUTHOR]

The article addresses the multifactorial nature of chronic cough, its impact on quality of life, and its diagnostic challenges, particularly for singers. Topics include the relationship between chronic cough and laryngopharyngeal reflux (LPR), the various other causes of chronic cough that voice teachers should be aware of, and the need for singers and teachers to be informed healthcare consumers.

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Curative technologies improve patient's survival and/or quality of life but increase financial burdens. Effective prevention benefits all three. We summarize estimation methods and provide examples of how much money is spent per quality-adjusted life year (QALY) or life year (LY) on treating a catastrophic illness under a lifetime horizon and how many QALYs/LYs and lifetime medical costs (LMC) could be potentially saved by prevention. We established cohorts by interlinkages of Taiwan's nation-wide databases including National Health Insurance. We developed methods to estimate lifetime survival functions, which were multiplied with the medical costs and/or quality of life and summed up to estimate LMC, quality-adjusted life expectancy (QALE) and lifetime average cost per QALY/LY for catastrophic illnesses. By comparing with the age-, sex-, and calendar year-matched referents simulated from vital statistics, we obtained the loss-of-QALE and loss-of-life expectancy (LE). The lifetime cost-effectiveness ratios of ventilator-dependent comatose patients, dialysis, spinal cord injury, major trauma, and cancers were US$ 96,800, 16,200–20,000, 5500–5,900, 3400–3,600, and 2900–11,900 per QALY or LY, respectively. The successful prevention of lung, liver, oral, esophagus, stomach, nasopharynx, or ovary cancer would potentially save US$ 28,000–97,000 and > 10 QALYs; whereas those for end-stage kidney disease, stroke, spinal injury, or major trauma would be US$ 55,000–300,000 and 10–14 QALYs. Loss-of-QALE and loss-of-LE were less confounded indicators for comparing the lifetime health benefits of different technologies estimated from real-world data. Integration of prevention with treatment for resources allocation seems feasible and would improve equity and efficiency. [ABSTRACT FROM AUTHOR]

This study was conducted as a randomized controlled experimental trial with the aim of determining the effect of acupressure on menopausal symptoms and quality of life in postmenopausal women, as well as the correlation between the two. This randomized controlled experimental study was conducted between May and November 2021 with women coming to a Menopause School in Turkey. A Descriptive Characteristics Form, the Menopause Rating Scale, and the World Health Organization Quality of Life Scale Short Form were used to collect data. The study was performed with 61 patients in an acupressure group (n = 30) and a control group (n = 31). Acupressure was performed on the acupressure group in 30-minute sessions 3 times a week for 4 weeks, a total of 12 sessions. No intervention was performed on the control group. When the groups were compared, it was seen that the menopause symptom scores of the acupressure group were lower than those of the control group, and that their quality of life scores in the bodily and psychological areas were higher (P < .05). When within group comparisons were considered, it was seen that menopause symptoms declined over time in the acupressure group, and the scores of all dimensions of quality of life increased (P < .05). It was found that acupressure applied to women during menopause may reduce menopause symptoms and may improve their quality of life. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the effect of yoga on the premenstrual syndrome, perceived stress level and the quality of life. The study was conducted as a randomized controlled trial at a university in Turkey. A yoga group = 39, a control group = 41, total of n = 80 female students participated in the study. In the study, firstly, the preview was made, then the yoga group was applied two days a week for eight weeks, the second follow-up was made after the application, and lastly, the last follow-up was made in the 24th week. Four questionnaire surveys were applied on students. When the yoga group compared with the control group in terms of premenstrual syndrome, the quality of life and perceived stress level in the 2nd follow-up, a statistically significant decrease was found in the mean between the menstrual and premenstrual period, and the quality of life increases in the yoga group compared to the control group students. Practicing yoga in university students with premenstrual syndrome reduced premenstrual symptoms and raised quality of life. Yoga can be recommended to girls with premenstrual syndrome (PMS) to reduce PMS and improve quality of life. [ABSTRACT FROM AUTHOR]

Purpose: Interest in the quality of life (QoL) of patients with inflammatory bowel disease (IBD) has recently increased. Although measurement tools have been devised for IBD in general, there is no specific tool for measuring the QoL of patients with ulcerative colitis (UC). Therefore, we developed a QoL questionnaire specifically for patients with UC. Materials and Methods: The Korean Ulcerative Colitis-Specific Questionnaire (K-UCSQ) was developed through item generation, raw-scale construction, focus group meetings, and multi-center field tests. Two hundred patients with UC were recruited for a field test of the K-UCSQ, and subsequent responses to the Inflammatory Bowel Disease Questionnaire (IBDQ) were also obtained. After performing factor analyses to ensure construct validity, the K-UCSQ was finalized as a four-domain, 28-item questionnaire. Subsequent analyses evaluated the reliability of the K-UCSQ in terms of Cronbach’s alpha, concurrent validity in comparison with the pre-established IBDQ, and predictive validity of the area under the ROC curve (AUC) for clinically relevant QoL outcomes. Results: A Cronbach’s alpha of 0.94 showed excellent reliability. Furthermore, correlation analyses demonstrated the concurrent validity of the K-UCSQ in comparison with the IBDQ. The K-UCSQ also showed high validity in predicting the perceived overall health (AUC of 0.812 vs. 0.797 using the IBDQ) and past 2-week QoL (AUC of 0.864 vs. 0.859 using the IBDQ). Conclusion: The newly developed K-UCSQ is concise, bathroom problem-emphasizing, and UC-specific, suggesting that it could be a valid and reliable UC-specific instrument for QoL measurement. [ABSTRACT FROM AUTHOR]

BACKGROUND: Home noninvasive ventilation (NIV) may improve chronic hypercarbia in COPD and patient-important outcomes. The efficacy of home high-flow nasal cannula (HFNC) as an alternative is unclear. METHODS: We searched MEDLINE, Embase, Cochrane CENTRAL, Scopus, and ClinicalTrials.gov for randomized trials of subjects from inception to March 31, 2023, and updated the search on July 14, 2023. We performed a frequentist network meta-analysis and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed randomized controlled trials (RCTs) comparing NIV, HFNC, or standard care in adult subjects with COPD with chronic hypercapnic respiratory failure. Outcomes included mortality, COPD exacerbations, hospitalizations, and quality of life (St George Respiratory Questionnaire [SGRQ]). RESULTS: We analyzed 24 RCTs (1,850 subjects). We found that NIV may reduce the risk of death compared to standard care (relative risk 0.82 [95% CI 0.66-1.00]) and probably reduces exacerbations (relative risk 0.71 [95% CI 0.58-0.87]). HFNC probably reduces exacerbations compared to standard care (relative risk 0.77 [0.68-0.88]), but its effect on mortality is uncertain (relative risk 1.20 [95% CI 0.63-2.28]). HFNC probably improves SGRQ scores (mean difference -7.01 [95% CI -12.27 to -1.77]) and may reduce hospitalizations (relative risk 0.87 [0.69-1.09]) compared to standard care. No significant difference was observed between HFNC and NIV in reducing exacerbations. CONCLUSIONS: Both NIV and HFNC reduce exacerbation risks in subjects with COPD compared to standard care. HFNC may offer advantages in improving quality of life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Post-COVID-19 syndrome has affected millions of people, with rehabilitation being at the center of non-pharmacologic care. However, numerous published studies show conflicting results due to, among other factors, considerable variation in subject characteristics. Currently, the effects of age, sex, time of implementation, and prior disease severity on the outcomes of a supervised rehabilitation program after COVID-19 remain unknown. METHODS: This was a non-randomized case-control study. Subjects with post-COVID-19 sequelae were enrolled. Among study participants, those who could attend an 8-week, supervised rehabilitation program composed the intervention group, whereas those who couldn't the control group. Measurements were collected at baseline and 8 weeks thereafter. RESULTS: Study groups (N = 119) had similar baseline measurements. Participation in rehabilitation (n = 47) was associated with clinically important improvements in the 6-min walk test (6MWT) distance, adjusted (for potential confounders) odds ratio (AOR) 4.56 (95% CI 1.95-10.66); 1-min sit-to-stand test, AOR 4.64 (1.88-11.48); Short Physical Performance Battery, AOR 7.93 (2.82-22.26); health-related quality of life (HRQOL) 5-level EuroQol-5D (Visual Analog Scale), AOR 3.12 (1.37-7.08); Montreal Cognitive Assessment, AOR 6.25 (2.16-18.04); International Physical Activity Questionnaire, AOR 3.63 (1.53-8.59); Fatigue Severity Scale, AOR 4.07 (1.51-10.98); Chalder Fatigue Scale (bimodal score), AOR 3.33 (1.45-7.67); Modified Medical Research Council dyspnea scale (mMRC), AOR 4.43 (1.83-10.74); Post-COVID-19 Functional Scale (PCFS), AOR 3.46 (1.51-7.95); and COPD Assessment Test, AOR 7.40 (2.92-18.75). Time from disease onset was marginally associated only with 6MWT distance, AOR 0.99 (0.99-1.00). Prior hospitalization was associated with clinically important improvements in the mMRC dyspnea scale, AOR 3.50 (1.06-11.51); and PCFS, AOR 3.42 (1.16-10.06). Age, sex, and ICU admission were not associated with the results of any of the aforementioned tests/grading scales. CONCLUSIONS: In this non-randomized, case-control study, post-COVID-19 rehabilitation was associated with improvements in physical function, activity, HRQOL, respiratory symptoms, fatigue, and cognitive impairment. These associations were observed independently of timing of rehabilitation, age, sex, prior hospitalization, and ICU admission. [ABSTRACT FROM AUTHOR]

Because young children cannot self-report symptoms, there is a need for parent surrogate reports. Although early work suggested parent-child alignment for eosinophil esophagitis (EoE) patient-reported outcomes (PROs), the longitudinal alignment is unclear. We sought to assess the agreement and longitudinal stability of PROs between children with EoE and their parents. A total of 292 parent-child respondents completed 723 questionnaires over 5 years in an observational trial in the Consortium of Eosinophilic Gastrointestinal Disease Researchers. The change in and agreement between parent and child Pediatric Eosinophilic Esophagitis Symptom Score version 2 (PEESSv2.0) and Pediatric Quality of Life Eosinophilic Esophagitis Module (PedsQL-EoE) PROs over time were assessed using Pearson correlation and Bland-Altman analyses. Clinical factors influencing PROs and their agreement were evaluated using linear mixed models. The cohort had a median disease duration equaling 3.7 years and was predominantly male (73.6%) and White (85.3%). Child and parent PEESSv2.0 response groups were identified and were stable over time. There was strong correlation between child and parent reports (PEESSv2.0, 0.83;PedsQL-EoE, 0.74), with minimal pairwise differences for symptoms. Longitudinally, parent-reported PedsQL-EoE scores were stable (P ≥.32), whereas child-reported PedsQL-EoE scores improved (P =.026). A larger difference in parent and child PedsQL-EoE reports was associated with younger age (P <.001), and differences were driven by psychosocial PRO domains. There is strong longitudinal alignment between child and parent reports using EoE PROs. These data provide evidence that parent report is a stable proxy for objective EoE symptoms in their children. [ABSTRACT FROM AUTHOR]

Background: Many individuals with congenital heart disease (CHD) undergo open heart surgery, resulting in prominent scarring. However, little research has assessed the impact of surgical scarring on body image in this population. Objective: Within this cross-sectional study, associations between body image concerns, anxiety and depression symptoms, and health-related quality of life among individuals with CHD were evaluated. Methods: Young adults with CHD (N = 138) completed the Body Image Disturbance Questionnaire along with other patient-reported outcome measures. Results: Scores on the Body Image Disturbance Questionnaire were lower (mean, 1.3 ± 0.5) than populations with diabetes amputations, craniofacial conditions, idiopathic scoliosis, and clinical controls. Higher Body Image Disturbance Questionnaire scores were reported among women (P = .003) and were associated with greater anxiety (P = .000) and depression (P = .13) after controlling for sex. Conclusions: Body image concerns related to cardiac surgery scarring are especially prominent in women and associated with greater emotional distress, suggesting potential clinical relevance for evaluating body image concerns in persons with CHD. [ABSTRACT FROM AUTHOR]

Background: Ventricular assist device (VAD) implantation has become an alternative treatment for patients with end-stage heart failure. In Germany, valid and reliable instruments to assess health-related quality of life in patients with VAD are lacking. Objective: The aim of this study was to present the psychometric validation of the German version of the Quality of Life with a Ventricular Assist Device questionnaire. Methods: In a multicenter, cross-sectional study, 393 participants (mean age, 58.3 years; 85.8%male, 60.3%bridge to transplant, and 72.8%living with VAD for =2 years) completed the German Quality of Life with a Ventricular Assist Device questionnaire of physical, emotional, social, cognitive, and meaning/spiritual domains. Item and confirmatory factor analyses were conducted to test item difficulty and discrimination and the underlying structure, respectively. To examine internal consistency, Cronbach a was assessed. Convergent construct validity was tested using the Kansas City Cardiomyopathy Questionnaire and the Patient Health Questionnaire-9. Readability was examined using Flesch Reading Ease index and Vienna Factual Text Formula. Results: The Quality of Life with a Ventricular Assist Device showed reasonable itemdifficulty (Ptotal = .67) and mostly moderate to high discriminatory power (rit > 0.30). In confirmatory factor analysis, root-mean-square error of approximation (0.07) was acceptable for model fit, but no other indices. Acceptable internal consistency was found (a = 0.79), with the exception of the cognitive domain (α = 0.58). The overall questionnaire and single domains demonstrated convergent validity (r = 0.45, P < .001). The questionnaire showed adequate readability (Flesch Reading Ease, 64.11; Vienna Factual Text Formula, 6.91). Conclusion: Findings indicate a promising standardized clinical instrument to assess health-related quality of life in patients with VAD. [ABSTRACT FROM AUTHOR]

Background: Family caregivers are at a high risk for lowquality of life due to caregiving-related stress. Caregivers' stress is commonly assessed using self-reported measures, which reflect relatively subjective and long-term stress related to caregiving, but objective biologicalmarkers of stress are rarely used for caregivers. The purposes of this studywere (1) to determine whether caregiver characteristics were associated with stress assessed using a stress biomarker (serum cortisol) and a self-reported caregiving distress measure (Caregiver Burden Inventory) and (2) to determine the predictability of both stress measures for quality of life in caregivers of patients with heart failure. Methods: Taiwanese family caregivers (N = 113; mean age, 54.5 years; 70.8% female) of patients with heart failure completed surveys including caregiving distress and quality of life measured by the Caregiver Burden Inventory and the Short Form-36 (physical and psychological well-being subscales), respectively, and provided blood samples for serum cortisol. Independent t tests, correlation, and hierarchical regression were conducted. Results: Single caregivers had higher serum cortisol levels than married caregivers (P = .002). Men had significantly higher serum cortisol levels than women (P = .010), but men reported lower caregiving distress thanwomen (P = .049). Both serumcortisol (β = -0.32, P = .012) and caregiving distress (β = -0.29, P = .018) were significant predictors of quality of life in the physical well-being scale while controlling for caregivers' characteristics and depressive symptoms. Serum cortisol (β = -0.28, P = .026) and caregiving distress (β = -0.25, P = .027) also predicted quality of life in the psychological well-being scale. Conclusions: Serum cortisol and self-reported caregiving distress have similar predictability for quality of life in family caregivers of patientswith heart failure. Reducing stress and caregiving distress is critical to improving quality of life in this population. [ABSTRACT FROM AUTHOR]

Background: Heart failure may cause peripheral and respiratory muscle alterations, dyspnea, fatigue, and exercise intolerance, worsening the quality of life of patients. Objectives: The aims of this study were to analyze respiratory muscle strength and quality of life of patients with heart failure and correlate them with clinical variables and functional classification. Methods: This cross-sectional study involved patients with heart failure. A manovacuometer assessed maximum inspiratory and expiratory pressures, and quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire. Functional classification was categorized according to the New York Heart Association (NYHA) class in I, II, III, or IV. Results: We included 60 patients (66.7%male) with a mean age of 62.0 years and mean left ventricular ejection fraction of 42.0%. Maximum inspiratory pressure and maximum expiratory pressure were close to normal (>70% of predicted) in most patients; however, a subgroup composedmostly of patients with dilated heart failure and NYHA class III (n = 21) presented lowmaximum inspiratory pressure values (59.2%; 95%confidence interval, 55.7%-62.8%). The mean total score of theMinnesota Livingwith Heart Failure Questionnairewas 44.4 points, being negatively correlated with left ventricular ejection fraction (r = -0.29, P = .02). Patients withNYHAclass III and disease duration longer than 120months presented higher total (P < .01) and physical dimension scores. Conclusions: Most patients had respiratory muscle strength close to normal; however, thosewith dilated heart failure and NYHA class III presented lowmaximum inspiratory pressure values. Quality of life wasmoderately compromised, mainly because of long disease duration, NYHA class III, and low left ventricular ejection fraction. [ABSTRACT FROM AUTHOR]

In advanced stages of rheumatoid arthritis (RA), the pattern of joint involvement leads to varied types of foot deformities such as forefoot, midfoot, and hindfoot deformities. We aim to evaluate midfoot and hindfoot deformities and their effect on functional outcomes in RA patients. In this prospective cross-sectional study clinical and radiological evaluations of 100 adult RA patients were studied for midfoot and hindfoot deformities. The RA disease activity, functional disability level, specific foot and ankle assessments, gait speed, and balance tests were assessed. Radiological examinations of the weight-bearing feet in a standing position were done. We found that the most frequent deformity type was the planovalgus foot (24%). There were statistically significant differences between the types of foot deformities and disease duration, disease activity, falls, Tinetti and Berg balance Test, and health assessment questionnaire-disability index. The multivariate regression analysis of independent correlates of falling detected that patients with equinovarus deformity were 2.5 times more liable for falling with 63.5% predictive power. According to the predictive criteria of deformity type for falling, the equinocavovarus type had accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 84.5%, 98.5%, 99%, and 84%, respectively. We found in RA patients, midfoot and hindfoot deformities cause a significant reduction of functional ability and quality of life. The early detection of foot deformities requires a good awareness of the clinical and radiographic diagnosis of different types of deformities thus reducing the possible functional disabilities via early management by combined orthotic, physiotherapy, and surgical treatments. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is prevalent in young females and is known to affect fertility. Minimal research has examined fertility perspectives in adolescents with PCOS, despite adult research revealing relationships between infertility and psychosocial well-being and quality of life. We examined fertility perspectives/concerns in adolescents with PCOS and an age- and body mass index (BMI)–matched control group and explored associations with quality of life. This was a cross-sectional study of female adolescents (13–21 years of age) with PCOS (n = 50) and age- and BMI-matched controls (n = 50), recruited at a large Midwestern pediatric center. Surveys assessed sociodemographics, hirsutism, fertility perspectives and quality of life. Descriptive statistics and Welch's 2-sample t-tests were used to examine fertility perspectives and quality of life. Of the 103 approached, 100 participants were enrolled (97% recruitment rate), with 50 participants in each group. Parenthood goals did not significantly differ between groups; >70% expressed desire to have biological children. However, PCOS participants reported significantly higher concerns about future fertility (p <.01) without differences in fertility knowledge or support (p =.53). Most PCOS participants stated they would feel angry if their provider withheld this information and reported wanting more information. Quality of life did not differ between groups. Our study suggests that irrespective of PCOS status, most adolescents aspire to parenthood. Notably, many with PCOS lack awareness of infertility risks but express heightened concerns. In contrast to adult studies, fertility concerns among adolescents with PCOS were not associated with decreased quality of life, suggesting that earlier fertility counseling may improve outcomes. [ABSTRACT FROM AUTHOR]

• Pleural effusion is a common presentation of acute decompensated heart failure (ADHF). • Patients with ADHF who are admitted to the hospital and have pleural effusions report poorer quality of life than those without pleural effusions. • The greater the volume of pleural fluid, the greater the negative impact on the quality of life. Pleural effusion (PE) is a common manifestation of acute decompensated heart failure (ADHF); however, its influence on the quality of life (QoL) is unknown. To identify whether PE detected using thoracic ultrasound (TUS) is associated with poorer QoL in patients with ADHF and a reduced ejection fraction (≤40 %). We conducted a prospective, longitudinal, descriptive, observational, single-center study at a university hospital in Mexico. We included participants with a reduced left ventricular ejection fraction who were admitted for ADHF. We performed TUS and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) within the first 48 h of hospitalization. Forty patients with ADHF (30 males and 10 females; mean age, 51.24 ± 16.942 years) were included in this study. The participants were categorized into two groups: those with (n = 25, 62.5 %) or without (n = 15, 37.5 %) PE on TUS. We found a statistically significant association between the presence of PEs and a worse perception of QoL. The mean MLHFQ score in the group of patients with PEs was 40 points, compared to 12 points in the group without PEs (p < 0.001). Poorer QoL was associated with a higher quantity of pleural fluid, as evidenced by the greater number of intercostal spaces occupied by the PE (p < 0.001). Patients with ADHF and a reduced ejection fraction who present with PE have a worse perception of QoL than patients without PE. [ABSTRACT FROM AUTHOR]

• Clients with Borderline Personality Disorder exhibit a complex array of presenting problems. • Identifying a client's "core problem" brings precision and clarity to Dialectical Behavior Therapy case formulation. • Treating the core problem leads to reductions in high-priority target behaviors and increases in quality of life. In her later years of teaching and training, Linehan (personal communication) spoke of an assessment construct that she referred to as a client's "core problem." In this paper, we trace the historical roots of this concept, review and clarify its current operationalization, anticipate common therapist questions and challenges to identifying a client's core problem, and provide a case example to illustrate its utility for Dialectical Behavior Therapy (DBT) case formulation and treatment planning. We propose that conceptualizing a client's core problem holds great promise for enhancing the therapist's effective and efficient delivery of DBT. [ABSTRACT FROM AUTHOR]

Data on the impact of pharmacist-led pharmaceutical care (PC) on pharmaceutical therapy-related and health-related quality of life (HRQoL) and their sensitivities to PC provision in patients with heart failure (HF) are scarce. This study aimed to assess the impact of pharmacist-led PC on HRQoL employing the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and 5-level EuroQol 5 dimension (EQ-5D-5L) and on pharmaceutical therapy-related quality of life using the Patient-Reported Outcomes Measure of Pharmaceutical Therapy (PROMPT) in HF patients and compare sensitivities to the PC provision of these three tools. A single-blinded randomized controlled trial was conducted at a tertiary public hospital in Thailand between November 2022 and May 2023. Overall, 250 patients were randomly divided into the usual care (UC) (N = 124) and PC (N = 126) groups. Mixed effects models were used to investigate the differences in the mean change scores of PROMPT, EQ-5D-5L, and MLHFQ between the UC and PC groups. The sensitivities to PC provision of the three measures were evaluated using standardized effect sizes (SESs). Significant differences were found in five of eight domains and the total score of the PROMPT between the PC and UC groups (all p < 0.05). However, no significant differences were found in the EQ-5D-5L and MLHFQ between the two groups (both p > 0.05). The SESs of the five domains and total score of PROMPT ranged from 0.29 to 1.65, considered small-to-large effect sizes, whereas the SESs of EQ-5D-5L and MLHFQ were −0.4 to 0, considered small effect sizes. Pharmacist-led PC can positively affect pharmaceutical therapy-related quality of life using PROMPT in HF patients. Additionally, PROMPT is more sensitive to PC provision than EQ-5D-5L and MLHFQ. • Pharmacists can play an important role in providing pharmaceutical care for heart failure patients. • PROMPT is more sensitive to pharmaceutical care provision than EQ-5D-5L and MLHFQ. • PROMPT can be used as a health outcome measure of providing pharmaceutical care. • PROMPT can be used as a process measure to identify drug-related needs. [ABSTRACT FROM AUTHOR]

In musculoskeletal and sports medicine, pain has traditionally been linked to tissue injury, often assuming a linear correlation between tissue damage and pain intensity. However, modern pain science has illuminated the complexity of the human pain experience, incorporating psychosocial elements, nervous system sensitization, immune responses, and structural changes in the brain as factors. This contemporary understanding of pain has proven highly beneficial for both clinicians treating individuals in pain and those experiencing pain. Pain neuroscience education (PNE) provides individuals in pain with an understanding of the underlying neurobiology and neurophysiology of their pain experience, which has been shown to result in decreased self-reported pain, reduced disability, the alleviation of fear and fear-avoidance behaviors, diminished pain catastrophizing, and improved movement. Currently, research on PNE predominantly focuses on interventions with individuals with persistent or chronic pain conditions. However, those who experience acute, sub-acute, and perioperative pain also have the potential for elevated levels of fear, fear-avoidance, and pain catastrophizing, indicating potential benefits from PNE. This invited commentary seeks to inform readers about the latest advancements in pain science and propose a conceptual model for delivering PNE in acute pain experiences. Level of Evidence 5 [ABSTRACT FROM AUTHOR]

• In 1,458 newly diagnosed breast cancer patients, lower relative peak cardiopulmonary fitness was independently associated with higher rates of moderate depression, poor sleep quality, and clinical fatigue. • Lower relative peak cardiopulmonary fitness was also independently associated with a higher likelihood of experiencing any symptom and multiple symptoms. • Both lower relative peak cardiopulmonary fitness and lower relative upper body muscular endurance were independently associated with a higher rate of clinical fatigue. • Relative peak cardiopulmonary fitness appears to be a critical fitness component associated with multiple patient-reported symptoms in newly diagnosed breast cancer patients. Newly diagnosed breast cancer patients experience symptoms that may affect their quality of life, treatment outcomes, and survival. Preventing and managing breast cancer-related symptoms soon after diagnosis is essential. The purpose of this study was to investigate the associations between health-related fitness (HRF) and patient-reported symptoms in newly diagnosed breast cancer patients. This study utilized baseline data from the Alberta Moving Beyond Breast Cancer Cohort Study that were collected within 90 days of diagnosis. HRF measures included peak cardiopulmonary fitness (peak volume of oxygen consumption (VO 2peak)), maximal muscular strength and endurance, flexibility, and body composition. Symptom measures included depression, sleep quality, and fatigue. Adjusted multivariable logistic regression was performed for analyses. Of 1458 participants, 51.5% reported poor sleep quality, 26.5% reported significant fatigue, and 10.4% reported moderate depression. In multivariable-adjusted models, lower relative VO 2peak was independently associated with a greater likelihood of all symptom measures, including moderate depression (p < 0.001), poor sleep quality (p = 0.009), significant fatigue (p = 0.008), any symptom (p < 0.001), and multiple symptoms (p < 0.001). VO 2peak demonstrated threshold associations with all symptom measures such that all 3 lower quartiles exhibited similar elevated risk compared to the highest quartile. The strength of the threshold associations varied by the symptom measure with odds ratios ranging from ∼1.5 for poor sleep quality to ∼3.0 for moderate depression and multiple symptoms. Moreover, lower relative upper body muscular endurance was also independently associated with fatigue in a dose-response manner (p = 0.001), and higher body weight was independently associated with poor sleep quality in an inverted U pattern (p = 0.021). Relative VO 2peak appears to be a critical HRF component associated with multiple patient-reported symptoms in newly diagnosed breast cancer patients. Other HRF parameters may also be important for specific symptoms. Exercise interventions targeting different HRF components may help newly diagnosed breast cancer patients manage specific symptoms and improve outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Advanced technologies in radiation treatment deliveries require high accuracy and precision in setup before treatment to get accurate dose delivery for planned target volumes. During imaging procedures, patients are getting extra doses from kilovoltage computed tomography (KVCT) and megavoltage computed tomography (MVCT). Computed tomography dose index is an important dosimetric parameter to know the degree of radiation-induced side effects. Aim: The main aim of this study is to quantify the dose received by patients during MVCT imaging procedures, weighted computed tomography dose index (CTDIw), volume computed tomography dose index (CTDIvol) and dose length product (DLP). Methods and materials: This study has been performed on Radixact X9 LINAC machine with 6MV flattening filter-free (FFF) photon beam for treatment and imaging with 3.5 MeV average photon energy. CTDIw and dose length product (DLP) have been calculated for different scanning lengths 18 cm, 10 cm and 0.7 cm with fine, normal and coarse modes with standard imaging A1SL1 ion chamber, cheese phantom and tomoelectrometer. Results: CTDIw, CTDIvol, and DLP have been calculated with cheese phantom using A1SL1 ion chamber. CTDIw for 0.7 cm is 2.16 cGy, 1.14 cGy and 0.77 cGy for fine normal and coarse modes, respectively. Conclusion: CTDIw is a dosimetric index to know the dose levels at center and periphery of patient according to scan length. It gives an idea about how much additional dose is received by the patient during the imaging procedures. High pitch gives the lesser absorbed dose. DLP gives the knowledge about stochastic effects from radiation to patients after MVCT. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Konuralp Medical Journal / Konuralp Tip Dergisi is the property of Duzce University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND Pursuing initial invasive or conservative management of chronic coronary disease (CCD) is a preference-sensitive decision that should include shared decision-making. Communicating the benefits of either approach is challenging, as individual patients rarely achieve the population-averaged outcomes reported in clinical trials. Our objective was to develop a patient decision aid (PDA) with patient-specific estimates of outcomes for initial invasive versus conservative management of CCD, based on the ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches). METHODS: This was a multiphase mixed-methods study using focus groups of outpatients with CCD, caregivers, clinicians, and researchers. Focus groups were held in Kansas City, MO and New York City, NY between September 2021 and June 2022. Patients with CCD were included if they had a positive stress test within 1 year. Phase 1 focused on patient priorities for outcomes to guide treatment decisions. Phase 2 involved PDA development and refinement. Phase 3 involved further refinement and member checking. Key themes involving shared decision-making and treatment preferences were elicited from focus groups using a deductive approach to develop a PDA representing the outcomes most important to patients. RESULTS Of 46 patient and caregiver participants, the mean age was 63.5 years, 53% were female, 61% were White, 24% were Black, and 9% were Hispanic. When deciding between treatments, participants valued shared decision-making but generally deferred decisions to clinicians. The outcomes most important to participants were survival and quality of life, followed by physical functioning and symptoms. To represent these outcomes, participants favored simple visualizations, such as a speedometer or health meter. When deciding between treatment options, participants preferred to use the PDA collaboratively with a clinician instead of as a stand-alone tool. CONCLUSIONS Our novel, patient-centered approach to developing a PDA for CCD with patient-specific outcomes has the potential to rapidly translate clinical trial results to individual patients and support shared decision-making. [ABSTRACT FROM AUTHOR]

Copyright of Formación Universitaria is the property of Centro de Informacion Tecnologica (CIT) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: In cats affected by severe thoracolumbar spinal cord pathologies, paraplegia and paraparesis, often accompanied by urinary retention, pose significant challenges, impacting both the cats' welfare and owners' lives. This study aimed to assess the quality of life (QoL) of cats affected by these conditions, and to evaluate the social and familial implications for caregivers. Methods: The study was structured into two parts. The first part comprised direct observations of aspects of QoL in cats both in household and shelter settings, while the second part involved the distribution of questionnaires to cat owners and shelter operators. Results: Cats with paraplegia/paraparesis and urinary retention can maintain a good QoL, with hindlimb mobility significantly influencing QoL scores. Shelter cats showed a comparable QoL to household cats, challenging the anecdotal beliefs that shelter cats with severe neurological impairments are destined to lead substandard lives. Operator surveys highlighted the feasibility of managing these cats in shelter environments, emphasising the importance of collaboration between caregivers and veterinary professionals. Likewise, owner surveys revealed a manageable time commitment for care, with most owners achieving proficiency in manual bladder expression within 1 month. Despite challenges, most of the owners reported positive experiences and did not contemplate euthanasia for their cats. Regular veterinary visits and occasional physiotherapy were common practices among caregivers. Conclusions and relevance: Owners who respond to the questionnaire and shelter operators have a high commitment to cats with paraplegia/paraparesis. Although the study acknowledges this potential bias, it suggests that dedicated care can ensure a good QoL for cats with severe spinal injuries, both in shelter and household settings. Effective communication between caregivers and veterinary professionals is essential for accurate information dissemination and optimal care provision. This research contributes to raising awareness of managing these conditions and emphasises the importance of collaborative care approaches in veterinary medicine. [ABSTRACT FROM AUTHOR]

This study aimed to assess the mental health and quality of life (QOL) in gynaecological cancer patients, and to identify key risk factors for improved management. In addition, during a period of reduced impact of a novel coronavirus (COVID-19) infection, we sought to examine its current impact on mental health and QOL. A cross-sectional study was conducted among 175 gynaecological cancer patients. The survey assessed QOL (The World Health Organization Quality of Life-Bref, anxiety and depression (Hospital Anxiety and Depression Scale (HADS)). Multivariable linear regression was used for analysis. Being diagnosed in the last one year was associated with higher HADS depression score (p < 0.001) and recurrence was associated with both higher HADS anxiety and depression scores (p = 0.004 and p < 0.001). Age ≤60 years old was a significant negative predictor for psychological health (p = 0.002) and overall QOL (p = 0.017). Complications during surgery were identified as a significant negative predictor affecting psychological health (p = 0.018), but did not affect the other domains. Disease recurrence was observed to significantly influence QOL scores in physical health (p = 0.014) and overall QOL (p < 0.001). This study highlights that recurrence has a significant impact on mental health and QOL of gynaecological cancer patients. Patients diagnosed within last year should be carefully assessed for risk of depression. Younger patients and those with surgical complications may experience reduced QOL. Importantly, COVID-19 showed no apparent negative impact on the mental health or QOL in these patients, which is no longer considered a significant contributor to adverse effects. [ABSTRACT FROM AUTHOR]

Breast cancer is the most commonly diagnosed cancer among women globally, with significant impacts on physical, emotional, and functional well-being. Traditional rehabilitation methods may not fully address the multifaceted challenges faced by breast cancer survivors (BCSs), prompting exploration into innovative approaches such as Virtual Reality (VR) technology. The present review aims to assess the effectiveness of VR in alleviating pain, improving Range of Motion (ROM), enhancing muscle strength, and augmenting the overall quality of life in patients undergoing breast cancer rehabilitation. A comprehensive review of existing literature was conducted, focusing on studies investigating the use of VR in breast cancer rehabilitation. PubMed, Scopus, PEDro and Google scholar were searched for articles addressing VR interventions targeting pain management, ROM improvement, muscle strength enhancement, and quality of life enhancement in breast cancer patients. Findings yielded total 12 articles matching the selection criteria. VR technology has shown promising results in addressing the multifaceted needs of breast cancer patients. VR also serves as a distraction tool, positively impacting psychological well-being and mitigating negative psychological symptoms associated with the disease. VR represents a non-pharmacological approach to pain management and rehabilitation in breast cancer patients. Its ability to engage emotional, cognitive, and attention processes contributes to its effectiveness in enhancing overall quality of life. Further research is warranted to elucidate the long-term benefits and optimal utilization of VR technology in breast cancer rehabilitation programs. [ABSTRACT FROM AUTHOR]

Antimicrobial photodynamic therapy (aPDT) is a non-invasive approach used for microbial decontamination, and it can also be beneficial as an adjunctive strategy for oral infections. The success of treatment in the long term is increasingly recognized to be influenced by patient's perception of the disease and its improvement. Recently, aPDT has been suggested as a dual approach to tissue repair, pain relief, and enhancement of oral health-related quality of life (OHRQoL). The first pathway involves the antimicrobial and anti-inflammatory effects of aPDT. It not only eliminates microorganisms but also helps regulate the immune response and reduce inflammation, leading to a faster and more effective healing process. This, in turn, provides relief from pain and associated symptoms, aiding in the management of treatment complications. The second pathway involves aPDT's ability to modulate nociception and alleviate pain. aPDT induces analgesia by releasing neurotransmitters such as β-endorphin, serotonin, and acetylcholinesterase. It also interacts with mitochondria through photoreceptors, initiating intracellular processes that alleviate pain. Furthermore, the therapy inhibits nerve fibers, reducing nerve impulse conduction and altering the pain threshold. Considering that the impact on patients' pain and OHRQoL is an important aspect of the decision-making process, this study aimed to review patient-based outcome measures during aPDT and assess its effects on pain and OHRQoL in patients. Understanding these factors will contribute to a better assessment of the overall benefits and effectiveness of aPDT as a treatment option for oral infections. [ABSTRACT FROM AUTHOR]

To compare the quality of life (QOL), cosmesis and cost-utility of open surgery (OS), vacuum-assisted breast biopsy (VABB) and high intensity focused ultrasound (HIFU) for fibroadenoma (FA). A total of 162 patients with 267 FAs were enrolled. Baseline characteristics and treatment information were recorded. Patients were followed up at 3-, 6- and 12-month post-treatment. QOL was evaluated by health survey. Breast cosmesis was evaluated by self-rating survey and Harvard Scale. A decision-analytic model was established and incremental cost was calculated for cost-utility analysis. For QOL evaluation, there was no difference of physical component summary (PCS) score in three groups (P > 0.05), while the mental component summary (MCS) score was significantly higher in HIFU group than the other two groups at 3- and 6-month post-treatment (P < 0.05). The proportion of patients satisfied with breast cosmesis was significantly higher in HIFU group (96.49%) than in VABB group (54.90%) and OS group (49.99%) (P < 0.05). By Harvard Scale, 27.78%, 78.42% and 100.00% of patients were rated as excellent and good in OS group, VABB group and HIFU group, respectively (P < 0.05). To acquire a quality-adjusted life year (QALY), cost of OS, VABB and HIFU was 1034.31 USD, 1776.96 USD and 1277.67 USD, respectively. When compared to OS, incremental cost analysis showed HIFU was cost-effective, while VABB was not. OS, VABB and HIFU were all effective and safe for FA, but among these three treatments, HIFU had the best QOL improvement, breast cosmesis and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background and Aims It is uncertain whether ulcerative colitis leads to accumulated bowel damage on cross-sectional image. We aimed to characterise bowel damage in patients with ulcerative colitis using magnetic resonance imaging [MRI], and to determine its relation with duration of disease and the impact on patients' quality of life. Methods In this prospective study, patients with ulcerative colitis [UC] in endoscopic remission underwent MRI without bowel cleansing, and completed quality-of-life questionnaires. Participants' magnetic resonance findings were analysed considering normal values and thresholds determined in controls with no history of inflammatory bowel disease [ n =40], and in patients with Crohn's disease with no history of colonic involvement [ n  = 12]. Subjects with UC were stratified according to disease duration [< 7 years vs 7‒14 years vs > 14 years]. Results We analysed 41 subjects with ulcerative colitis [20 women; Mayo endoscopic subscore 0 in 38 [92.7%] and 1 in three [7.3%]]. Paired segment-by-segment comparison of magnetic resonance findings in colonic segments documented as being affected by ulcerative colitis versus controls showed that patients with ulcerative colitis had decreased cross-sectional area [ p  ≤ 0.0034] and perimeter [ p  ≤ 0.0005] and increased wall thickness [ p  = 0.026] in all segments. Colon damage, defined as wall thickness ≥ 3 mm, was seen in 22 [53.7%] patients. Colon damage was not associated with disease duration or quality of life. Conclusions Morphological abnormalities in the colon were highly prevalent in patients with ulcerative colitis in the absence of inflammation. Structural bowel damage was not associated with disease duration or quality of life. [ABSTRACT FROM AUTHOR]

Background and Aims Standardising health outcome measurements supports delivery of care and enables data-driven learning systems and secondary data use for research. As part of the Health Outcomes Observatory [H2O] initiative, and building on existing knowledge, a core outcome set [COS] for inflammatory bowel diseases [IBD] was defined through an international modified Delphi method. Methods Stakeholders rated 90 variables on a 9-point importance scale twice, allowing score modification based on feedback displayed per stakeholder group. Two consecutive consensus meetings were held to discuss results and formulate recommendations for measurement in clinical practice. Variables scoring 7 or higher by ≥80% of the participants, or based on consensus meeting agreement, were included in the final set. Results In total, 136 stakeholders (45 IBD patients [advocates], 74 health care professionals/researchers, 13 industry representatives, and four regulators) from 20 different countries participated. The final set includes 18 case-mix variables, three biomarkers [haemoglobin to detect anaemia, C-reactive protein and faecal calprotectin to detect inflammation] for completeness, and 28 outcomes (including 16 patient-reported outcomes [PROs] and one patient-reported experience). The PRO-2 and IBD-Control questionnaires were recommended to collect disease-specific PROs at every contact with an IBD practitioner, and the Subjective Health Experience model questionnaire, PROMIS Global Health and Self-Efficacy short form, to collect generic PROs annually. Conclusions A COS for IBD, including a recommendation for use in clinical practice, was defined. Implementation of this set will start in Vienna, Berlin, Barcelona, Leuven, and Rotterdam, empowering patients to better manage their care. Additional centres will follow worldwide. [ABSTRACT FROM AUTHOR]

In this paper, we explore how the concepts of autonomy and autonomous choice are understood in the context of spinal cord injury in the academic literature, both in reporting on research results and more broadly on outcomes and quality of life. We find inconsistent, framework‐absent portrayals of autonomy as well as an absence of discourse that draws upon ethical constructs and theory. In response, we advance a person‐centered framework for spinal cord injury research that combines both lived experience and a disability ethics approach to fill this gap. [ABSTRACT FROM AUTHOR]

Background. Structural stigma and institutionalised discrimination towards people living with HIV remain pervasive in many settings. However, qualitative explorations of experiences of stigma, health and social service engagement, and quality of life among people living with HIV in Singapore remain under-researched. Methods. Semi-structured interviews were conducted with 73 participants in Singapore. These included 56 people living with HIV (30 men who have sex with men, 23 heterosexual men, and 3 women) and 17 stakeholders including healthcare professionals and other allied workers. Interviews focused on participant perspectives or experiences of HIV diagnosis, navigating healthcare, attitudes towards HIV, and impact of HIV on relationships. Data were analysed through inductive thematic analysis. Results. Our findings were framed within a minority stress model, highlighting the distal and proximal stressors relating to living with HIV. With regard to distal stressors, participants highlighted that they had experienced or were aware of institutionalised discrimination towards people living with HIV across various aspects of their lives. These included experiences - overt and covert - of discrimination in education, workplace, and healthcare settings. With regard to proximal stressors, participants highlighted the role of anticipated stigma and the stress of concealment. This included participants' fear of potential legal and/or social repercussions resulting from the disclosure of their HIV status, actions that they may not be able to anticipate and articulate. Although employers may not overtly discriminate, the fear of such anticipated discrimination influenced decisions to conceal HIV status in job applications and workplaces. This restricted agency for the people living with HIV in our study by affecting their regular medical follow-ups, socialising behaviours, and overall quality of life. Consequently, many participants felt that concealment of their status, and forgoing potential educational, employment, and even health opportunities, were the only ways of protecting themselves from such forms of stigma and discrimination. Conclusions. This study found that anticipated stigma and discrimination diminished the quality of life of people living with HIV in Singapore. Implementing an anti-discrimination framework could address the unpredictability and alleviate the manifold unknowns of anticipated stigma. [ABSTRACT FROM AUTHOR]

Lymphoedema is a progressive long-term condition that detrimentally affects many aspects of quality of life -- physical, emotional, and social. The introduction of lymphoedema patient-reported outcome measures (PROMs) has supported patients to communicate the psychological impact, raising concerns such as anxiety, fear, low mood, and poor body image. However, some healthcare professionals report feeling ill-equipped to respond effectively to these needs. This study explored lymphoedema healthcare professionals (LHCP) psychological and emotional education needs. A Google Forms survey was developed based on literature and expert opinion and disseminated via email to all staff (120) within Lymphoedema Wales Clinical Network (LWCN). Data demonstrated statistically significant correlations between levels of perceived confidence, perceived skills to discuss psychological issues, and level of psychological training received (p <0.001). However, nearly three-quarters of participants reported never receiving psychological training. This study represents the first step in understanding psychological education needs of LHCP and indicates future opportunities to potentially improve clinical practice in this area. [ABSTRACT FROM AUTHOR]

• Six-months of physical exercise improved quality of life in children with epilepsy. • Seizure frequency did not increase with the exercise program. • A Six-month of exercise program improved motor and Cardiorespiratory Fitness. • Monitoring by the researchers stimulated the performance of physical exercise. to investigate the effects of a physical exercise (PE) program, supported by wearable technology (WT), in children with drug-resistant epilepsy (DRE). 29 children with DRE were randomized to experimental (EG) and control (CG) groups. To encourage PE, the EG performed one hour of aerobic activity three days a week for six months, outside the school setting. Compliance was monitored using activity wristbands, with data reported weekly by parents. Health - related quality of life (HRQoL), seizure frequency, physical activity (PA), physical fitness (musculoskeletal, motor, and Cardiorespiratory Fitness), and body composition, were assessed at baseline, at three and six months. Seizure frequency in the last six months evolved from 10.5 seizures/week at baseline, to 4.5 at the end of the study in the EG, and from 5.2 seizures/week to one in the CG. Significant differences were found in weekly hours-PE (η2= 0.49); motor fitness (η2= 0.08); Cardiorespiratory Fitness (η2= 0.19); weight (η2= 0.003); Triceps skinfold thickness (η2= 0.05); lower limb muscular strength (η2= 0.03); HRQoL (η2= 0.02); and PA (η2= 0.22). Post-hoc ANOVA revealed that EG improved significantly (p < 0.05) between baseline and six months. Negative correlations were observed between PA and seizure frequency. Supported by WT, children with DRE increased the weekly hours of PE at three and six months, with no increase in seizure frequency. Our study provides evidence of the effectiveness of PE for improving HRQoL. [ABSTRACT FROM AUTHOR]

Introduction: Inpatient rehabilitation is the best time window to improve patient performance post-stroke. Little is known about the type and effectiveness of activity interventions. This study aims to review activities of daily living interventions and evaluate their effectiveness on activity performance for stroke inpatients. Method: MEDLINE, Embase, CINAHL and Web of Science were searched. Randomised controlled trials investigating the effects of activities of daily living interventions for stroke inpatients were included. Two reviewers independently selected the studies and extracted data. Meta-analysis was conducted on relevant data with a random effect model with 95% CI. Results: Fourteen randomised controlled trials involving 602 stroke inpatients, were included. Both experimental and control groups offered activities of daily living interventions. Thirteen experimental groups offered added components, such as imagery and repetitive practice. Five studies reported significant improvement in activity performance within experimental and control groups. A meta-analysis of 12 randomised controlled trials with 512 participants revealed non-significant results for activity performance between the two groups. Conclusion: Both experimental and control groups in the included studies provided activities of daily living interventions. Added components were included in 13 out of 14 experimental groups. Meta-analysis revealed no significant difference between the two groups as they both offered activities of daily living interventions. [ABSTRACT FROM AUTHOR]

Fibromyalgia often deteriorates the quality of life of patients on physical, emotional, socio-familial, and professional levels. To describe the characteristics of fibromyalgia patients and to assess the impact of fibromyalgia on their quality of life. A questionnaire was provided to the fibromyalgia patients at the pain management center of Tunis, during the last ten years and the sociodemographic data, journey characteristics and satisfaction regarding the quality of their care were recorded and the impact of fibromyalgia on the quality of life was assessed using the Fibromyalgia Impact Questionnaire (FIQ). The work included 110 patients, 93 females and 13 males (F:M 7.2:1) and a mean age of 52 ± 12 years. 65 % reported an initial pain visual analog scale (VAS) ≥ 7. The mean consultation and diagnostic delays were 75 ± 30 and 44 ± 28 months, respectively. 94 % of patients were initially misdiagnosed, despite consulting more than two different physicians. The mean FIQ total was 77.5 ± 13.Age, female gender, and manual professions were related to a more impaired physical impact of fibromyalgia (p = 0.02; p = 0.01; p = 0.03, respectively). Patients whose fibromyalgia trigger was persistent stress (n = 50) reported more impaired FIQ (p = 0.001). Patients with shorter consultation and diagnostic delays reported more improvement (p = 0.001 and p = 0.01, respectively). Patients treated with tricyclic antidepressants and vitamins felt significantly improved (p = 0.02 and p = 0.002). Non-pharmacological treatments included physical therapy, yoga, acupuncture, and thermal baths. The quality of life in fibromyalgia patients is frequently impaired, and the journey is complex and ambivalent. [ABSTRACT FROM AUTHOR]