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Aims: Open tibial fractures are often life-changing injuries and patient outcomes remain poor despite the introduction of national management guidelines. The longer-term impact to the patient can be considerable but this is often overlooked in the literature. This study aims to establish the functional, physical, and psychosocial impact of sustaining an open tibial fracture.Methods: We reviewed 69 consecutive Gustilo-Anderson grade IIIB and IIIC open tibial fractures that presented to our Major Trauma Centre (MTC) between September 2012 and April 2018. Each participant was interviewed and sent patient-reported outcome questionnaires, a minimum of 12 months following injury. Our primary outcome was the Lower Extremity Functional Scale (LEFS). Secondary outcomes included the Short-Form 36 Healthy Survey (SF-36), Sickness Impact Profile 128 (SIP) and return to occupation. Subgroups were analysed according to age, Injury Severity Score (ISS) and limb amputation.Results: The mean follow up was 43 months. 96% were grade IIIB and 4% grade IIIC. The response rate for our study was 72%. The mean LEFS was 42 (IQR 21.5-58.5). All total and sub-domain scores within both the SF-36 and SIP questionnaires were reduced when compared to normative population data. Only 48% of patients returned to full time employment. Subgroup analysis revealed significantly reduced LEFS, SIP and SF-36 subdomain scores for those with a presenting ISS >14 and those undergoing limb amputation.Conclusion: Patients are at significant risk of longer-term functional, physical and psychosocial harm after suffering an open tibial fracture. Those sustaining major polytrauma or amputation demonstrated to have the greatest risk of poor outcome. Early identification of these individuals likely to suffer most from their injury would help direct appropriate resources to those with greatest need at the earliest opportunity. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the perception of health-related quality of life (HRQoL) in Portuguese patients with narcolepsy, and to compare the results to normative data. Methods: Fifty-one narcoleptic adults (26M, 25F), aged between 18 and 80years (mean=43.35, SD=15.32), were included in the final analysis of a multicentric cross-sectional study. The Medical Outcome Study – 36 Item Short-Form Survey (SF-36) was used to assess quality of life, and the Beck Depression Inventory (BDI) was used for self-assessment of depression. Results: Several HRQoL domains were significantly lower than National surveys, except physical function and bodily pain (p between 0.000 and 0.006). SF-36 presented the lowest score in vitality (39.93). Deterioration was significantly higher in role physical (p =0.006), vitality (p =0.011), and mental health (p =0.008) in women, and in physical function (p =0.003) and bodily pain (p =0.045) in elderly subjects. Those with higher literacy had better physical function (p =0.046). Conclusion: HRQoL is significantly deteriorated in narcoleptics, affecting all dimensions (except physical function and bodily pain) when compared with the general Portuguese population. The results are consistent with studies of narcolepsy in other countries in demonstrating the profound impact of this disorder on quality of life. [Copyright &y& Elsevier]

Abstract: Aim: To determine the effect on quality of life and cost effectiveness of specialist nurse early supported discharge for women undergoing major abdominal and/or pelvic surgery for benign gynaecological disease compared with routine care. Study design: Randomised controlled trial comparing specialist nurse supported discharge with routine hospital care in gynaecology. The SF-36, a generic health status questionnaire, was used to measure women''s evaluation of their health state before surgery and at 6 weeks after surgery. A further questionnaire scoring patient symptoms, milestones of recovery, information given and satisfaction, was administered prior to discharge from hospital and at 6 weeks thereafter. Setting: Gynaecology service at the Western Infirmary Glasgow, part of North Glasgow University, NHS Trust. Participants: One hundred and eleven women scheduled for major abdominal or pelvic surgery for benign gynaecological disease. Main outcome measures: SF-36 health survey questionnaire baseline scores were reported before surgery and at 6 weeks follow-up. Complications, length of hospital stay, readmission, information on discharge support and satisfaction of women were recorded at discharge from hospital and at 6 weeks follow-up. A cost consequence analysis was conducted based on the perspective of the NHS. Results: The addition of a specialist nurse to routine hospital care in gynaecology significantly reduced the post-operative length of hospital stay p =0.001, improved information delivery and satisfaction of women. The specialist nurse supported discharge group was associated with significantly lower total costs to the NHS than routine care resulting principally from the difference in the cost of the post-operative length of stay. Conclusions: Women undergoing major abdominal and pelvic surgery were discharged home earlier with provision of support from a specialist gynaecology nurse. The results of this study suggest that duration of hospital stay can be shortened by the introduction of a specialist nurse without introducing any adverse physical and psychological effects. This process of care is associated with receipt of information on health and lifestyle issues and maintenance of high levels of patient satisfaction and demonstrates the effectiveness of the specialist nurse role in the provision of health information for women. Earlier hospital discharge at 48h after major abdominal and pelvic surgery is an acceptable, cost effective alternative to current routine practice in the absence of further randomised evidence. [Copyright &y& Elsevier]

Abstract: Psychobiological effects associated with a progressive body weight loss may help to improve the understanding of psychological barriers to weight loss. We hypothesized that a moderate body weight loss (about 10% of initial body weight) is accompanied with some negative psychological impact. Four questionnaires [SF-36 Health Survey, Three-Factor Eating Questionnaire (TFEQ), Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI)] were administered at each phase of a body weight loss program that consisted of a supervised diet and exercise clinical intervention to 11 obese men (mean BMI=33.4 kg/m2, mean age=38 yr). The three phases investigated were: 1) at the beginning of the intervention (baseline); 2) after 5±1 kg body weight loss (Phase 1); and 3) after 10±1 kg body weight loss (Phase 2). Using the SF-36 Health Survey, physical and mental health were shown to be significantly improved at Phase 1 (p <0.05). The TFEQ showed that cognitive dietary restraint increased (p <0.001), and both disinhibition (p <0.05) and susceptibility to hunger (p <0.05) were significantly reduced at both Phase 1 and 2 compared to baseline. Depression as measured by the BDI significantly increased at Phase 2 (p <0.05) compared to baseline and Phase 1. However, the mean BDI scores observed remained below the cut-off point for likely clinical significance. Finally, the PSQI showed that sleep quality was significantly improved at Phase 1 compared to baseline (p <0.01). Altogether, these results suggest that a substantial improvement in the psychobiological profile occurs with a 5-kg weight loss (Phase 1) but that with additional weight loss (Phase 2) a small, but significant increase in depression occurred and seems to be associated with the increase in rigid restraint of eating. However, prospective studies with a larger sample are needed to confirm and deepen these results. [Copyright &y& Elsevier]

Abstract: Background: In order to determine the magnitude of the short- or medium-term effects of tobacco use on the health-related quality of life (HRQOL) of smokers and ex-smokers, and to compare them with the estimated long-term effects reported in other studies, a cross-sectional epidemiological study was designed. Methods: A representative study of the general population over 14 years of age was conducted in the western health area of Valladolid, Spain. HRQOL was evaluated using the SF-36 Health Questionnaire. Differences in HRQOL among smokers, non-smokers, and former smokers were determined. Standardized scores from the general population and long-term effects of tobacco exposure were compared. Results: Former smokers had a better HRQOL than smokers and non-smokers on the emotional dimensions, especially “vitality” and “role emotional”, while differences between the groups on the physical and emotional dimensions did not reach statistical significance. Smokers displayed deterioration in “bodily pain”, “general health”, “vitality”, “social function”, and “role emotional”, while deterioration in ex-smokers only occurred in “bodily pain” and “general health.” The variable package/year was correlated with “general health.” Conclusions: Short- and medium-range effects of tobacco consumption on HRQOL cannot be demonstrated with the SF-36 Health Questionnaire in the general Spanish population, whereas long-term effects can. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the psychometric performances of the 36-item short form (SF-36), a tool measuring health-related quality of life (HRQoL) in patients with narcolepsy or other sleep disorders, presenting excessive daytime sleepiness (EDS) as the main symptom. To compare the HRQoL of patients with narcolepsy with the Italian norm. To disclose the clinical predictors influencing the HRQoL. Patients and Methods: One hundred and eight adults with narcolepsy, 115 with obstructive sleep apnea syndrome (OSAS) and 42 with idiopathic hypersomnia (IH) enrolled for a multicentric cross-section study employing self-administered questionnaires investigating the HRQoL (SF-36), EDS and cataplexy. A psychometric analysis and the standardized scoring of the 8 scales of the SF-36 were performed. The correlation between SF-36 scales and clinical features of narcolepsy was measured by a multiple linear regression analysis. Results: SF-36 satisfied the recommended psychometric standards. Patients with narcolepsy had all domains except Bodily Pain lower than the Italian norm. Some of the variance of Physical Functioning (R2 0.07), Role functioning-Physical (R2 0.31), General Health (R2 0.15), Vitality (R2 0.10), Social Functioning (R2 0.21) and Role functioning-Emotional (R2 0.15) was explained both by EDS (inverse correlation) and disease duration (direct correlation). Conclusions: The SF-36 form is a reliable outcome measure for hypersomniac disorders. Narcolepsy seriously impacts patients’ HRQoL in terms of physical and mental well-being and impairs physical and emotional functions, restricting social life. EDS is the main symptom determining this impairment. However, disease duration plays a role in counterbalancing this feature, probably by means of adaptation. [Copyright &y& Elsevier]