602 results on '"Patient report"'
Search Results
2. A comprehensive systematic review of health-related quality of life measures in short stature paediatric patients
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Adedeji, Adekunle, Witt, Stefanie, Innig, Florian, and Quitmann, Julia
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- 2024
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3. Hand therapist use of patient-reported outcomes.
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Valdes, Kristin, Naughton, Nancy, and Rider, John V.
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CROSS-sectional method ,ARM ,ALLIED health personnel ,HAND injury treatment ,HEALTH outcome assessment - Abstract
The use of standardized outcome measures is essential for best clinical practice by hand therapists to determine patient status, progress, and the outcome of interventions. A better understanding of current patient-reported outcome (PRO) use in hand and upper extremity practice is warranted. This study sought to understand what outcome measures are being used in clinical practice, how they are being used, and the perceived usefulness of PROs by active members of the American Society of Hand Therapists (ASHT). This study employed a cross-sectional design. The web-based survey was distributed through Qualtrics (Qualtrics, Salt Lake City, Utah) to active members of ASHT with an email address on file. The survey consisted of multiple choice and open-ended questions. A total of 348 members responded to the survey. Seven hundred thirty-two different outcome measures were reported to be used by the hand therapist respondents. The most used outcome measure was Quick DASH by 38% of the respondents. Two hundred seventy-five (88%) indicated that their workplace advocated the use of PROs. Most respondents indicated that there were not constraints preventing the use of a PRO. Few therapists respondents use a psychosocial PRO in clinical practice. Most of the hand therapist respondents to our survey use a PRO and discuss the results with their clients. The Quick DASH was the PRO used most often by hand therapists. Only a few hand therapists use a psychosocial tool to measure patient status in clinical practice. • Over 700 different PROs were reported to be used by the hand therapist respondents. • The most used outcome measure was Quick DASH. • Few therapist respondents use a psychosocial PRO in clinical practice. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Patient reported quality of life in limb girdle muscular dystrophy
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Kovalchick, Laurel V, Bates, Kameron, Statland, Jeffrey, Weihl, Conrad, Kang, Peter B, Lowes, Linda P, Mozaffar, Tahseen, Straub, Volker, Wicklund, Matthew, Heatwole, Chad, and Johnson, Nicholas E
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Biomedical and Clinical Sciences ,Biological Psychology ,Clinical Sciences ,Neurosciences ,Psychology ,Intellectual and Developmental Disabilities (IDD) ,Muscular Dystrophy ,Brain Disorders ,Clinical Research ,Rare Diseases ,Management of diseases and conditions ,7.1 Individual care needs ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Female ,Humans ,Male ,Middle Aged ,Muscle Weakness ,Muscular Dystrophies ,Limb-Girdle ,Patient Reported Outcome Measures ,Phenotype ,Quality of Life ,Registries ,Surveys and Questionnaires ,Young Adult ,Quality of life ,Limb girdle muscular dystrophy ,Patient report ,Dysferlin ,Calpain-3 ,FKRP ,Dysferlin ,Calpain-3 ,Medical Physiology ,Neurology & Neurosurgery ,Clinical sciences ,Biological psychology - Abstract
This study determined the frequency and impact of symptoms on quality of life in patients diagnosed with limb girdle muscular dystrophy (LGMD). Participants with a diagnosis of LGMD in registries based at the Coalition to Cure Calpain-3, the Jain foundation, and the Global FKRP Registry competed a survey to report the frequency and relative impact of themes and symptoms of LGMD. Frequency, mean impact, and population impact scores were calculated, and responses were categorized by age, symptom duration, gender, employment status, use of assistive devices, and LGMD subtypes. 134 participants completed the survey. The most prevalent themes included an inability to do activities (100%), limitation with mobility (99.3%), and lower extremity weakness (97.0%). Themes with the greatest impact were: limitations with mobility, lower extremity weakness, and an inability to do activities. Symptom duration and the use of assistive devices were associated with the presence of multiple themes. Employment was associated with the impact of several themes with no differences in frequency. The prevalence and impact of these themes vary in the LMGD population. The most prevalent and impactful themes were related to weakness, but additional concerns related to emotional challenges should also be considered in clinical and research settings.
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- 2022
5. Methodological and Statistical Considerations for the National Children's Study
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Hays, Ron D, Hubble, David, Jenkins, Frank, Fraser, Alexa, and Carew, Beryl
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Paediatrics ,Biomedical and Clinical Sciences ,Pediatric ,reliability ,validity ,surveys ,patient report ,outcomes ,Paediatrics and Reproductive Medicine ,Other Medical and Health Sciences - Abstract
The National Children's Study (NCS) statistics and item response theory group was tasked with promoting the quality of study measures and analysis. This paper provides an overview of six measurement and statistical considerations for the NCS: (1) Conceptual and Measurement Model; (2) Reliability; (3) Validity; (4) Measurement Invariance; (5) Interpretability of Scores; and (6) Burden of administration. The guidance was based primarily on recommendations of the International Society of Quality of Life Research.
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- 2021
6. Patient Report on the Impact of Coronavirus Disease 2019 and Living With Lung Cancer
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Tendai M. Chihuri, MD, MPH, Upal Basu Roy, PhD, MPH, Amy Moore, PhD, Anne-Marie Baird, PhD, Tracey L. Grant, MS, and Bellinda L. King-Kallimanis, PhD
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COVID-19 ,Lung cancer ,Patient report ,COVID-19 vaccination ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction: Several studies have highlighted coronavirus disease 2019 (COVID-19)–related disruptions in treatment and care in people living with lung cancer. However, few studies have assessed patient-reported perspectives on treatment disruption. This study aims to report the patient perspectives on the impact of COVID-19, vaccination access, and coverage on people living with lung cancer. Methods: Data are from a larger online longitudinal study being run by a lung cancer nonprofit organization, LUNGevity Foundation. The survey is open to all patients living with lung cancer and their caregivers. These analyses focus on data captured in the COVID-19 module and the vaccine questionnaire. Descriptive statistics were computed for categorical and ordinal variables. Results: Overall, 164 people living with lung cancer completed the COVID-19 module. Of these, 54% reported disruption in access to treatment, appointments, participating in research and clinical trials. Participants living with stage IV disease were likely to be more concerned about COVID-19 (35%) compared with those with stage I, II, and III. More than half (66%) had tested for COVID-19 of this group 88% tested negative. There was a correlation among participants testing positive for COVID-19 and the number of household members who also tested positive for COVID-19. In the sample who completed the vaccine survey, almost all (98%) were vaccinated against COVID-19. When a recommendation came from a health care professional, an oncologist was the most likely referral source (33%). Conclusions: An integrative patient-reported view on the impact of COVID-19 is important for adequate preparation to ensure undisrupted treatment and allocation of resources.
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- 2023
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7. The Patient’s Perspective on Proton Radiotherapy of Skull Base Meningioma: A Retrospective Cross-Sectional Survey.
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Seidensaal, Katharina, Sailer, Jonas, Harrabi, Semi Ben, von Gehlen, Johannes, Seidensaal, Irina, Weykamp, Fabian, Bernhardt, Denise, Debus, Jürgen, and Herfarth, Klaus
- Abstract
Background: Radiotherapy plays an important role in the management of skull base meningioma. The aim of the study was to investigate patient-reported outcomes. Methods: A questionnaire of 20 items was sent to 192 patients with meningioma of the skull base who have been treated with proton therapy at a single institution. The survey included dichotomous, scaling, and open questions about symptoms, social distancing, rehabilitation, work, reintegration, limitations in recreational activities, as well as daily life activities and correlating diagnoses. Additionally, symptoms were reported retrospectively by the patients at different time points. In total, 128 patients (66.7%) responded. The median age at the time of RT was 55 years (range: 28-91); the majority were female (79%). The median time between the treatment of meningioma and the survey was 38.5 months (range: 7-100). Results: The most common initial symptoms were visual impairment (N=54, 42.2%), dizziness (N=38, 29.7%), and double vision (N=32, 25%). The most limiting symptom in daily life at the time of the survey was fatigue (N=31, 24.2%); a significant proportion of patients reported depression as associated with diagnosis (31.3%). Only 53% of patients reported occupational activity before treatment, this number did not increase with time. Only N= 40 (31.3%) and N=35 (27.3%) patients reported no limitations in daily household chores or recreational activities by the disease and treatment. The course of cognitive function after treatment showed a temporary deterioration with subsequent improvement. Except for the improvement in emotional functioning, most domains showed a temporary deterioration during radiotherapy, still, the values reached after 6 months differed weekly or moderately from the initial values. Conclusion: Besides neurological deficits, patients with skull base meningioma experience a variety of unspecific symptoms, which can be most limiting in daily life. Even successful treatment does not necessarily translate into the alleviation of those symptoms. A greater focus on the characterization of those symptom complexes is necessary. Greater focus on functional structures such as the hippocampus might improve the results. Due to the retrospective character, this study is hypothesis-generating. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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8. The Patient’s Perspective on Proton Radiotherapy of Skull Base Meningioma: A Retrospective Cross-Sectional Survey
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Katharina Seidensaal, Jonas Sailer, Semi Ben Harrabi, Johannes von Gehlen, Irina Seidensaal, Fabian Weykamp, Denise Bernhardt, Jürgen Debus, and Klaus Herfarth
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skull base meningioma ,proton therapy ,cross sectional study ,patient report ,radiotherapy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundRadiotherapy plays an important role in the management of skull base meningioma. The aim of the study was to investigate patient-reported outcomes.MethodsA questionnaire of 20 items was sent to 192 patients with meningioma of the skull base who have been treated with proton therapy at a single institution. The survey included dichotomous, scaling, and open questions about symptoms, social distancing, rehabilitation, work, reintegration, limitations in recreational activities, as well as daily life activities and correlating diagnoses. Additionally, symptoms were reported retrospectively by the patients at different time points. In total, 128 patients (66.7%) responded. The median age at the time of RT was 55 years (range: 28-91); the majority were female (79%). The median time between the treatment of meningioma and the survey was 38.5 months (range: 7-100).ResultsThe most common initial symptoms were visual impairment (N=54, 42.2%), dizziness (N=38, 29.7%), and double vision (N=32, 25%). The most limiting symptom in daily life at the time of the survey was fatigue (N=31, 24.2%); a significant proportion of patients reported depression as associated with diagnosis (31.3%). Only 53% of patients reported occupational activity before treatment, this number did not increase with time. Only N= 40 (31.3%) and N=35 (27.3%) patients reported no limitations in daily household chores or recreational activities by the disease and treatment. The course of cognitive function after treatment showed a temporary deterioration with subsequent improvement. Except for the improvement in emotional functioning, most domains showed a temporary deterioration during radiotherapy, still, the values reached after 6 months differed weekly or moderately from the initial values.ConclusionBesides neurological deficits, patients with skull base meningioma experience a variety of unspecific symptoms, which can be most limiting in daily life. Even successful treatment does not necessarily translate into the alleviation of those symptoms. A greater focus on the characterization of those symptom complexes is necessary. Greater focus on functional structures such as the hippocampus might improve the results. Due to the retrospective character, this study is hypothesis-generating.
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- 2022
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9. Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study.
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Redebrandt, Henrietta N., Brandt, Christian, Hawran, Said, and Bendix, Tom
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RADICULOPATHY ,NECK pain ,MAGNETIC resonance imaging ,CERVICAL plexus ,CERVICAL vertebrae ,LUMBOSACRAL region ,JUDGMENT (Psychology) - Abstract
Objectives: Cervical nerve root compression can lead to radiculopathy in the arm. Some studies have reported low accuracy in determining the responsible nerve root in both cervical and lumbar regions. This prospective, observational, pragmatic study aimed to determine the accuracy of the clinical evaluation relative to magnetic resonance imaging (MRI) findings in patients with arm radiculopathy. Methods: Patients with neck pain and neck‐related arm pain referred to a spine unit underwent a standard clinical neurological examination and cervical spine MRI. The clinical examination required a judgment of the most likely cervical root involved, including the side. The Interobserver reproducibility was tested. Using MRI, the most likely nerve root involved according to radiology was assessed. Results: Eighty‐three patients met the inclusion criteria. The Interobserver reproducibility between clinical evaluators was 58%, with a modest κ coefficient (0.33, 95% confidence interval [CI]: 0.18–0.47) classified only as "fair agreement." Only 31% (95% CI: 22–42) of the 83 patients exhibited full agreement regarding the suspected cervical root as assessed via the clinical evaluation and MRI. In another 28% (95% CI: 18–39), the clinical evaluation identified an adjacent level to that identified on MRI. Conclusions: In cervical radiculopathy, the clinical‐neurological examination diagnosed the same in 31% or an adjacent cervical root in 28% of the patients in relation to the most affected cervical root on MRI. [ABSTRACT FROM AUTHOR]
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- 2022
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10. National Implementation of an Electronic Patient-Reported Outcome Measures Program for Joint Replacement Surgery: Pilot Study.
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Heath, Emma L., Ackerman, Ilana, Lorimer, Michelle, Rainbird, Sophia, O'Donohue, Grace, Brock, Andrew, Graves, Stephen, and Harris, Ian
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JOINT surgery ,MEDICAL care costs ,HEALTH programs ,STATISTICIANS ,DATA analysis - Abstract
Background: There is a global emphasis on expanding data collection for joint replacement procedures beyond implant attributes and progression to revision surgery. Patient-reported outcome measures (PROMs) are increasingly considered as an important measure of surgical outcomes from a patient's perspective. However, a major limitation preventing wider use of PROMs data in national data collection has been the inability to systematically collect and share electronic information with relevant stakeholders in a comprehensive and financially sustainable manner. Objective: This study reports on the development of an electronic data capture and reporting system by a national registry for the collection of PROMs and the processes used to identify and overcome barriers to implementation and uptake. The study also aims to provide a cost breakdown of establishing and maintaining a nationwide electronic PROMs program. Methods: Between 2018 and 2020, 3 governance and advisory committees were established to develop and implement a PROMs pilot program nested within a nationwide joint replacement registry. The program involved electronic collection of preoperative and 6-month postoperative data for hip, knee, or shoulder replacement surgery from 44 Australian hospitals. Resource requirements for the program included a project manager, software developers, data manager, and statistician. An online platform was tested, refined, and implemented for electronic PROMs collection with scalability considered for future expansion to all Australian hospitals and additional data fields. Technical capabilities included different access for multiple user types, patient registration, automatic reminders via SMS text messages and email, online consent, and patient outcome real-time dashboards accessible for different user groups (surgeons, patients, hospitals, and project stakeholders). Results: During the PROMs pilot period there were 19,699 primary procedures undertaken with 10,204 registered procedures in the electronic system. This equated to 51.80% of people who had a joint replacement at participating hospitals during this period. Patient registration and data collection were efficient (20-30 seconds and 10-12 minutes, respectively). Engagement with the reporting dashboards (as a proportion of those who viewed their dashboard) varied by user group: 197/277 (71.1%) hospital administrators, 68/129 (52.7%) project stakeholders, 177/391 (45.3%) surgeons, and 1138/8840 patients (12.9%). Cost analysis determined an overall cost per patient of Aus $7-15 (approximately US $5-12) for 2 PROMs collections per joint replacement procedure once the program was established. Conclusions: Successful implementation of an orthopedic PROMs program with planned scalability for a broader national rollout requires significant funding and staffing resources. However, this expenditure can be considered worthwhile, given that collection and reporting of PROMs can drive health care improvement processes. Further consideration of strategies to improve stakeholder engagement with electronic reporting dashboards (particularly for patients and surgeons) will be critical to the ongoing success of a national PROMs program. [ABSTRACT FROM AUTHOR]
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- 2022
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11. Exemplar-based genre instruction: The case of medical professional writing.
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Farooqui, Afnan, Sonbul, Suhad, Al Zahrani, Sahar, and Gaffas, Zainab
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MEDICAL writing ,ENGLISH as a foreign language ,WORKBENCHES ,MEDICAL students ,REPORT writing ,LISTENING comprehension ,INPAINTING - Abstract
Medical students who are learning English as a foreign language (EFL) need to master the ability to write professional reports. Several studies have focused on professional writing in the context of English as a second language (ESL) with advanced learners, but lower-intermediate EFL learners have yet to be examined. This study aimed to implement an exemplar-based genre instruction programme to examine its effectiveness in terms of improving Saudi EFL learners' ability to write patient reports. The study consisted of two phases: analysis of the moves/steps of patient reports and exemplar-based genre instruction. First, the moves/steps in 30 authentic patient reports were analysed to build the framework which was then compared to another framework based on the work of Bench et al. (2014). Second, an exemplarbased genre instruction programme was implemented over six weeks with 36 EFL Saudi medical learners, and the outcomes were evaluated. The findings revealed that increased genre awareness improved the quality of learners' writing, particularly their grammar and vocabulary. Teachers of English for specific purposes (ESP) may need to focus on increasing learners' awareness of the medical-report genre's lexico-grammatical features in addition to its moves. [ABSTRACT FROM AUTHOR]
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- 2022
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12. Symptom continuum reported by affective disorder patients through a structure-validated questionnaire
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Fanjia Guo, Jingyi Cai, Yanli Jia, Jiawei Wang, Nenad Jakšić, Zsuzsanna Kövi, Marina Šagud, and Wei Wang
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Bipolar I and II disorders ,Factor analyses ,Major depressive disorder ,Patient report ,Symptom continuum ,Psychiatry ,RC435-571 - Abstract
Abstract Background Affective disorders, such as major depressive (MDD), bipolar I (BD I) and II (BD II) disorders, are overlapped at a continuum, but their exact loci are not clear. The self-reports from patients with affective disorders might help to clarify this issue. Methods We invited 738 healthy volunteers, 207 individuals with BD I, 265 BD II, and 192 MDD to answer a 79 item-MATRIX about on-going affective states. Results In study 1, all 1402 participants were divided random-evenly and gender-balanced into two subsamples; one subsample was used for exploratory factor analysis, and another for confirmatory factor analysis. A structure-validated inventory with six domains of Overactivation, Psychomotor Acceleration, Distraction/ Impulsivity, Hopelessness, Retardation, and Suicide Tendency, was developed. In study 2, among the four groups, MDD scored the highest on Retardation, Hopelessness and Suicide Tendency, whereas BD I on Distraction/ Impulsivity and Overactivation. Conclusion Our patients confirmed the affective continuum from Suicide Tendency to Overactivation, and described the different loci of MDD, BD I and BD II on this continuum.
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- 2020
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13. How to Optimize Integrated Patient Progress Notes: A Multidisciplinary Focus Group Study in Indonesia
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Kamil H, Rachmah R, Wardani E, and Björvell C
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integrated documentation ,indonesia ,patient report ,safety ,service quality ,Medicine (General) ,R5-920 - Abstract
Hajjul Kamil,1 R Rachmah,1 Elly Wardani,1 Catrin Björvell2 1Nursing Leadership and Management Department, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia; 2Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, SwedenCorrespondence: Elly WardaniNursing Leadership and Management Department, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, IndonesiaEmail ellywardani@unsyiah.ac.idIntroduction: Hospitals in Indonesia are obligated to implement Integrated Patient Progress Notes (IPPNs), also known as the “Catatan Perkembangan Pasien Terintegrasi”. A progress note contains the entire interaction between patients and health professionals, including physicians, nurses, pharmacists, dietitians, and physiotherapists. However, since the first launch in 2012, obstacles and problems in completing this integrated documentation remains nationwide.Aim: The objective of this investigation was to identify health professional’s perspectives on obstacles and problems using IPPNs and facilitators that may optimize their use.Methods: Five focus group discussions (FGDs) involving 37 participants took place. All FGDs were recorded, translated, and transcribed verbatim. A thematic analysis was used to interpret the data.Results: The thematic analysis of the material revealed three main categories for each of the two topics; Topic 1. Perceived problems hindering integrated documentation: lack of supervision, competence, workload; topic 2: perceived strategies to optimize integrated documentation: organizational support, joint practices, integrating technology with IPPN.Conclusion: The results indicate that health professionals see the importance of using IPPNs but only if implemented with educational and organizational support and that the use of an electronic patient record may be more effective than a paper record. To continue the implementation of IPPNs, it is suggested that it is preceded by educational and organizational support.Keywords: integrated documentation, Indonesia, patient report, safety, service quality
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- 2020
14. Methodological and Statistical Considerations for the National Children's Study
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Ron D. Hays, David Hubble, Frank Jenkins, Alexa Fraser, and Beryl Carew
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reliability ,validity ,surveys ,patient report ,outcomes ,Pediatrics ,RJ1-570 - Abstract
The National Children's Study (NCS) statistics and item response theory group was tasked with promoting the quality of study measures and analysis. This paper provides an overview of six measurement and statistical considerations for the NCS: (1) Conceptual and Measurement Model; (2) Reliability; (3) Validity; (4) Measurement Invariance; (5) Interpretability of Scores; and (6) Burden of administration. The guidance was based primarily on recommendations of the International Society of Quality of Life Research.
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- 2021
- Full Text
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15. Reconstruction for Bilateral Internal Jugular Vein Perfusion Disruption
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Ryunosuke Umeda, Yoshiko Suyama, Kohei Fukuoka, Maki Morita, Kento Ikuta, Haruka Kanayama, Makoto Ohga, Makoto Nakagaki, Takahiro Fukuhara, Kazunori Fujiwara, and Shunjiro Yagi
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plastic surgery procedures ,cervicoplasty ,General Medicine ,microsurgery ,Patient Report ,neck dissection ,jugular vein - Abstract
When resecting the internal jugular veins bilaterally in surgery for head and neck cancer, it is necessary to perform neck dissection in two stages or to reconstruct the internal jugular veins in one stage. Reconstruction of the internal jugular vein using grafting or direct anastomosis to the external jugular vein have both been reported. We report the case of a 53-year-old man with accidental injury to the left internal jugular vein after resection of the right internal jugular vein for supraglottic cancer. The left internal jugular vein was damaged near the inflow of the subclavian vein, making vein grafting difficult. Therefore, internal jugular venous return was reestablished by end-to-side anastomosis of the left internal jugular vein to the left external jugular vein system. In this surgical procedure, by incising the internal jugular vein obliquely, it was not necessary to match the calibers of the internal jugular vein and the external jugular vein system, and a smooth hemodynamic body was reconstructed. In addition, we were able to reconstruct the internal jugular vein while preserving blood flow in the external jugular vein system. End-to-side anastomosis of the internal jugular vein to the external jugular system is an option for internal jugular vein reconstruction.
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- 2023
16. Perioperative Infusion Management for Adhesive Bowel Obstruction with Congenital Nephrogenic Diabetes Insipidus: A Case Report
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Miyauchi, Wataru, Matsunaga, Tomoyuki, Sakano, Yu, Makinoya, Masahiro, Shimizu, Shota, Miyatani, Kozo, Shishido, Yuji, Sakamoto, Teruhisa, and Fujiwara, Yoshiyuki
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diabetes insipidus ,intravenous ,perioperative period ,General Medicine ,Patient Report ,nephrogenic ,infusions - Abstract
Congenital nephrogenic diabetes insipidus (CNDI) is a rare disease that results in polyuria due to decreased responsiveness to the antidiuretic hormone in the collecting ducts of the kidney. Without compensation by drinking large amounts of water, dehydration and hypernatremia can rapidly develop. We present a case of a patient originally diagnosed with CNDI who required surgery and a fasting period due to adhesive bowel obstruction. The patient was a 46-year-old man who was originally diagnosed with CNDI. He was prescribed trichlormethiazide but self-discontinued treatment in the process. His normal urine output was about 7,000–8,000 mL/day. He underwent robot-assisted radical cystectomy and uretero-cutaneostomy for bladder cancer. Two years later, he was hospitalized due to adhesive bowel obstruction. A 5% glucose solution was infused, and the dose was adjusted according to the urine volume and electrolytes. An adhesiotomy was performed due to recurrent bowel obstruction in a short period of time. A 5% glucose solution was used as the main infusion during the perioperative period. Once drinking water was resumed after surgery, urinary output and electrolytes were easily controlled. In conclusion, patients with CNDI should be given a 5% glucose solution as the primary infusion, and the infusion volume should be adjusted by monitoring daily urine output, electrolytes, and blood glucose levels. Infusion management is easier if oral intake is initiated as early as possible.
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- 2023
17. Assessing the engagement of children and families in selecting patient-reported outcomes (PROs) and developing their measures: a systematic review.
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McNeill, Malcolm, Noyek, Samantha, Engeda, Eshetu, and Fayed, Nora
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PATIENT reported outcome measures , *TREATMENT effectiveness , *FAMILIES - Abstract
Purpose: To assess child and family engagement in the selection of patient-reported outcomes for clinical studies/clinical settings and development of patient-reported outcome measures (PROMs)/patient-reported experience measures (PREMs) across the pediatric literature.Methods: Databases were reviewed: EMBASE, MEDLINE, and PsycINFO. Articles published from December 2009 to September 2018 pertaining to the selection of outcomes or development of PROMs/PREMs for children or families were included. The International Association for Public Participation (IAP2) Spectrum of Public Participation was used to classify levels of engagement across each article; IAP2 plots engagement on a spectrum across five stages (from minimal to most engagement): Inform, Consult, Involve, Collaborate, and Empower.Results: 9019 non-duplicate articles were screened; 36 articles met inclusion criteria, seven studies focused on the selection of outcomes, and 29 studies pertained to PROM/PREM development. Twenty-three articles adhered to 'Involve' level of engagement. Four articles were categorized as 'Collaborate,' seven articles were classified as 'Consult,' and three articles were categorized as 'Inform'.Conclusion: Children and families were sparsely engaged as co-conductors or equal partners in the selection or development of PRO research; involvement remained on the mid-low end of the IAP2 Spectrum. Engaging with children and families as collaborators can improve the patient-centredness, rigour, and applicability of PROM/PREM research. [ABSTRACT FROM AUTHOR]- Published
- 2021
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18. A Trimming Technique: A Case Report of a Novel Surgical Approach for Cesarean Scar Dehiscence During Cesarean Section
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Katsura, Daisuke, Tsuji, Shunichiro, Hoshiyama, Takako, Zen, Rika, Inatomi, Ayako, and Murakami, Takashi
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General Medicine ,Patient Report - Abstract
Cesarean section can lead to residual myometrial thickness thinning and cesarean scar syndrome. We report a novel trimming technique for residual myometrial thickness recovery in women with cesarean scar syndrome. Case 1: A 33-year-old woman who developed cesarean scar syndrome (CSS) and abnormal uterine bleeding post-cesarean scar became pregnant following hysteroscopic treatment. The myometrium at previous scar was dehiscent; therefore, a transverse incision was made above the scar. Post-operative uterine recovery failed owing to lochia retention, and developed cesarean scar syndrome again. Case 2: A 29-year-old woman who developed cesarean scar syndrome post-cesarean section became pregnant spontaneously. The myometrium at the previous scar was dehiscent like case 1. Scar repair was performed using a trimming technique during cesarean section; there were no subsequent complications and she conceived again spontaneously. Performing this novel surgical procedure during cesarean section may contribute to residual myometrial thickness recovery in women with cesarean scar syndrome.
- Published
- 2023
19. A Case of Pediatric Garré’s Osteomyelitis Caused by Germ Infection in the Lower Impacted Wisdom Tooth
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Yoshida, Yu, Shingu, Takayuki, Harada, Yuuki, Ida, Sumire, and Takubo, Kazuko
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mandible ,tooth germ ,osteomyelitis ,General Medicine ,Patient Report - Abstract
Garré’s osteomyelitis, first described by Carl Garré in 1893, is a type of chronic osteomyelitis accompanied by hyperplastic periostitis. This condition affects relatively young patients and occurs in the fibula, femur, and other long bones as chronic non-purulent sclerosing osteomyelitis. Further, reactive periosteal bone formation develops due to chronic irritation or infection. In the maxillofacial region, it often occurs in the first molar region of the mandible due to caries and other similar causes, and it is rarely associated with impacted teeth. Herein, we present a 12-year-old female patient who primarily complained of swelling on the right side of the mandible. Despite taking antibiotics prescribed at local otolaryngologist, the swelling did not completely resolve. Thus, the patient was referred to the Department of Otorhinolaryngology at our hospital, where a dental-related disease was suspected. On a computed tomography scan, radiolucent findings were observed around the germ of the impacted wisdom tooth as well as hyperostosis in the lower jaw. Thus, Garré’s osteomyelitis was suspected. The patient received oral anti-inflammatory treatment by the incision prior to surgery. Thereafter, the tooth germ was enucleated and newly-formed bone, which was laterally located to the cortical bone of the mandible, was removed under the effect of general anesthesia. On computed tomography scan 9 months after the surgery, hyperostosis in the angle of the mandible disappeared. Thereafter, pain and swelling did not recur, and the patient was doing well.
- Published
- 2023
20. Patients' perception on the quality of care for multiple endocrine neoplasia disorders in Europe: an online survey from a patient support group.
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Drewitz, Karl Philipp, Grey, Jo, Brügmann, Petra, Pichl, Josef, Sammarco, Martina, Aarts, Monique, van Genechten, Dirk, Brandi, Maria-Luisa, and Schaaf, Ludwig
- Abstract
Purpose: European Patient Advocacy Groups (ePAGs) within the Endo-ERN identified a lack of knowledge about quality of care (QoC) of patients with multiple endocrine neoplasia (MEN). The aim of this study was to identify inequalities in care and to encourage improvements. Methods: The European MEN Alliance (EMENA) developed and conducted a survey, using the European Commissions' EUSurvey platform. Patient groups and healthcare professionals (HCPs) distributed the survey. Results: A total of 288 participants completed the survey (MEN1 n = 203, MEN2 n = 67, MEN3 n = 18) from 18 European countries. The majority of respondents were recruited via patient groups (58%), aged between 41 and 60 years (53%) and were female (67%). All participants reported having been diagnosed on average 5.58 years (95%-CI: 4.45–6.60) after first symptoms occurred. This timeframe was lower in the group with MEN2 (2.97 years, 95%-CI: 1.37–4.57). Most of the participants (67%) received their diagnosis by a positive gene test after presenting with one or more MEN-related tumours. Overall QoC was rated as either "good" (43%) or "excellent" (36%). Conclusion: The results of this unique Europe-wide, patient-driven survey on QoC of patients with MEN show that ratings for overall QoC were lower than ratings for different aspects of care. This may be because of the complex nature of care for genetic syndromes. Furthermore, patients who connect with patient groups may be deemed "expert patients" whose answers are not representative of the overall MEN patient community. We hope that Endo-ERN can support further education and training for HCPs based on these results. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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21. "You will eat shoe polish if you think it would help"—Familiar and lesser‐known themes identified from mixed‐methods analysis of a cluster headache survey.
- Author
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Schindler, Emmanuelle A. D., Cooper, Vanessa, Quine, Douglas B., Fenton, Brenda T., Wright, Douglas A., Weil, Marsha J., and Sico, Jason J.
- Subjects
- *
TREATMENT of cluster headaches , *VITAMINS , *NEUROLOGISTS , *HEALTH services accessibility , *SUBSTANCE abuse , *COFFEE , *RESEARCH methodology , *INTERNET , *HEALTH outcome assessment , *MEDICAL care costs , *PATIENTS' attitudes , *SURVEYS , *DIETARY supplements , *PHYSICAL activity , *DESCRIPTIVE statistics , *EXERCISE , *CLUSTER headache , *HEADACHE , *THEMATIC analysis , *DISEASE management , *SECONDARY analysis - Abstract
Objective: To characterize patient‐reported ideas and concerns about cluster headache, treatment options, and management strategies. Background: Cluster headache patients experience severe pain and often suffer additional consequences from their disease. Patients have identified methods to cope with and combat cluster headache that are not widely known. Methods: Secondary analysis was performed using deidentified data from the online Clusterbusters Medication Use survey, wherein 10 questions allowed for freely written comments. Using mixed‐methods techniques, neurologists with expertise in headache medicine identified themes from these comments. Subgroup analysis sought to identify variables associated with specific themes. Results: Among 2274 free‐text responses from 493 adult participants, 23 themes were identified. Themes commonly discussed in the literature included such topics as "nothing worked" (24.7%, 122/493), "side effects" (12.8%, 63/493), and difficulties with "access/cost" (2.4%, 12/493). Less widely recognized themes included the use of "illicit substances" (35.5%, 175/493) and "vitamins/supplements" (12.2%, 60/493) in disease management. Lesser‐known themes included "coffee" (5.3%, 26/493) and "exercise/physical activity" (4.7%, 23/493). Using strict significance criteria, no subgroup was associated with any theme. Several poignant quotes highlighted patient thoughts and experiences. Conclusions: This mixed‐methods analysis identified challenges endured by cluster headache patients, as well as a variety of patient‐directed disease management approaches. The volunteered information spotlights pharmacological, physiological, and psychological aspects of cluster headache that warrant further exploratory and interventional investigation. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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22. Patient-Reported Morbidity Instruments: A Systematic Review.
- Author
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Oemrawsingh, Arvind, Swami, Nishwant, Valderas, José M., Hazelzet, Jan A., Pusic, Andrea L., Gliklich, Richard E., and Bergmark, Regan W.
- Subjects
- *
META-analysis , *DISEASES , *MYOCARDIAL infarction , *MEDICAL records , *COMORBIDITY , *SYSTEMATIC reviews , *RISK assessment , *QUESTIONNAIRES ,MEDICAL standards ,RESEARCH evaluation - Abstract
Objectives: Although comorbidities play an essential role in risk adjustment and outcomes measurement, there is little consensus regarding the best source of this data. The aim of this study was to identify general patient-reported morbidity instruments and their measurement properties.Methods: A systematic review was conducted using multiple electronic databases (Embase, Medline, Cochrane Central, and Web of Science) from inception to March 2018. Articles focusing primarily on the development or subsequent validation of a patient-reported morbidity instrument were included. After including relevant articles, the measurement properties of each morbidity instrument were extracted by 2 investigators for narrative synthesis.Results: A total of 1005 articles were screened, of which 34 eligible articles were ultimately included. The most widely assessed instruments were the Self-Reported Charlson Comorbidity Index (n = 7), the Self-Administered Comorbidity Questionnaire (n = 3), and the Disease Burden Morbidity Assessment (n = 3). The most commonly included conditions were diabetes, hypertension, and myocardial infarction. Studies demonstrated substantial variability in item-level reliability versus the gold standard medical record review (κ range 0.66-0.86), meaning that the accuracy of the self-reported comorbidity data is dependent on the selected morbidity.Conclusions: The Self-Reported Charlson Comorbidity Index and the Self-Administered Comorbidity Questionnaire were the most frequently cited instruments. Significant variability was observed in reliability per comorbid condition of patient-reported morbidity questionnaires. Further research is needed to determine whether patient-reported morbidity data should be used to bolster medical records data or serve as a stand-alone entity when risk adjusting observational outcomes data. [ABSTRACT FROM AUTHOR]- Published
- 2020
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23. Practical Barriers to Medication Adherence: What Do Current Self- or Observer-Reported Instruments Assess?
- Author
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Chan, Amy Hai Yan, Cooper, Vanessa, Lycett, Helen, and Horne, Rob
- Subjects
PATIENT compliance ,DATA extraction ,SOCIAL context ,AMED (Information retrieval system) ,META-analysis - Abstract
Introduction: Practical adherence barriers (e.g., medication frequency) are generally more amenable to intervention than perceptual barriers (e.g., beliefs). Measures which assess adherence barriers exist, however these tend to measure a mix of factors. There is a need to identify what practical barriers are captured by current measures. Aim: To identify and synthesise the practical adherence barriers which are assessed by currently available self- or observer-report adherence measures. Methods: A search for systematic reviews of self- or observer-report report adherence measures was conducted. Three electronic databases (Embase, Ovid Medline, and PsycInfo) were searched using terms based on adherence, adherence barriers and measures. Systematic reviews reporting on adherence measures which included at least one self- or observer-report questionnaire or scale were included. Adherence measures were extracted and coded on whether they addressed perceptual or practical barriers, or both. Practical items were then analysed thematically. Results: Following screening of 272 initial abstracts, 20 full-text papers were reviewed. Four were excluded after full-text review, leaving 16 systematic reviews for data extraction. From these, 187 different adherence measures were extracted and coded, and 23 unique measures were identified as assessing practical barriers and included in the final analysis. Seven key themes were identified: formulation; instructions for use; issues with remembering; capability—knowledge and skills; financial; medication supply and social environment. Conclusion: Existing adherence measures capture a variety of practical barriers which can be grouped into seven categories. These findings may be used to inform the development of a measure of practical adherence barriers. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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24. Symptom continuum reported by affective disorder patients through a structure-validated questionnaire.
- Author
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Guo, Fanjia, Cai, Jingyi, Jia, Yanli, Wang, Jiawei, Jakšić, Nenad, Kövi, Zsuzsanna, Šagud, Marina, and Wang, Wei
- Subjects
- *
AFFECTIVE disorders , *EXPLORATORY factor analysis , *CONFIRMATORY factor analysis , *MENTAL depression - Abstract
Background: Affective disorders, such as major depressive (MDD), bipolar I (BD I) and II (BD II) disorders, are overlapped at a continuum, but their exact loci are not clear. The self-reports from patients with affective disorders might help to clarify this issue. Methods: We invited 738 healthy volunteers, 207 individuals with BD I, 265 BD II, and 192 MDD to answer a 79 item-MATRIX about on-going affective states. Results: In study 1, all 1402 participants were divided random-evenly and gender-balanced into two subsamples; one subsample was used for exploratory factor analysis, and another for confirmatory factor analysis. A structure-validated inventory with six domains of Overactivation, Psychomotor Acceleration, Distraction/ Impulsivity, Hopelessness, Retardation, and Suicide Tendency, was developed. In study 2, among the four groups, MDD scored the highest on Retardation, Hopelessness and Suicide Tendency, whereas BD I on Distraction/ Impulsivity and Overactivation. Conclusion: Our patients confirmed the affective continuum from Suicide Tendency to Overactivation, and described the different loci of MDD, BD I and BD II on this continuum. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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25. Sleep quality matters more to community-dwelling individuals than nocturia frequency.
- Author
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Rose, GE, Ervin, C, and Bower, WF
- Abstract
Objective: The objective of this study is to identify variables that describe nocturia-related bother in a sample of community-dwelling individuals. Materials and methods: Community-dwelling individuals age 40 years and older who woke to pass urine at night completed an online questionnaire. Participants were asked (i) their top three concerns in relation to nocturia, (ii) to agree or disagree with a list of statements related to bother, and (iii) to complete the Nocturia Impact Diary items. Fisher exact test and the Mann–Whitney U test were used to assess whether differences in nocturia-related bother existed when comparing participants stratified by nocturia severity. Results: Moderate to extreme nocturia-related bother was described by 56% of the 202 respondents and by 68% of individuals with nocturia two or more times per night. Effects of nocturia, specifically sleep disruption and impact on daytime function, were the most cited concerns. Low nocturia-related health literacy was evident. The sample was younger (83% age <70 years), predominantly female (74%) and nocturia treatment naïve (95%). Conclusion: The study highlights the potential to evaluate patient care based on change in sleep and daytime function rather than solely on nocturia frequency. A suite of patient-reported outcome measures adjunctive to clinical data may have utility in quantifying meaningful change to patients after treatment for nocturia. Level of evidence: Not applicable for this multicentre audit. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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26. Dramatic Amelioration in Serial Magnetic Resonance Imaging in an 'Isolated Brainstem' Reversible Encephalopathy Syndrome Case
- Author
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Matsumoto, Namiko, Ogawa, Toshihide, Hishikawa, Nozomi, Takao, Yoshiki, and Fujii, Shinya
- Subjects
posterior reversible encephalopathy syndrome ,hypertensive encephalopathy ,magnetic resonance imaging ,diffusion-weighted magnetic resonance imaging ,General Medicine ,Patient Report - Abstract
Posterior reversible encephalopathy syndrome (PRES) is characterized by transient vasogenic edema predominantly in supratentorial areas within the posterior circulation regions. Although PRES with only brainstem involvement is quite rare, accurate diagnosis is important because prompt antihypertensive therapy contributes to a favorable outcome. Herein, we report a case with isolated brainstem PRES showing dramatical improvement in an apparent diffusion coefficient (ADC) value of the lesion in magnetic resonance imaging (MRI) after clinical remission. The present case suggests the association between favorable clinical course and complete amelioration on MRI.
- Published
- 2023
27. Measurement Properties of Headache-Specific Outcomes Scales in Adolescent Athletes.
- Author
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Piebes, Sarah K., Snyder, Alison R., Bay, R. Curtis, and McLeod, Tamara C. Valovich
- Subjects
- *
ANALYSIS of variance , *ATHLETES , *COMPUTER software , *STATISTICAL correlation , *GOODNESS-of-fit tests , *HEADACHE , *HEADACHE in adolescence , *HIGH school athletes , *HEALTH outcome assessment , *QUALITY of life , *STATISTICS , *U-statistics , *DATA analysis , *RESEARCH methodology evaluation , *SYMPTOMS ,RESEARCH evaluation - Abstract
Context: Recurrent headaches significantly affect health-related quality of life (HRQOL) in adults; the impact of headache on HRQOL among adolescents is unknown, and the psychometric properties of headache-specific outcomes instruments have not been adequately studied in this population. Objective: To evaluate the psychometric properties of the Headache Impact Test (HIT-6) and Pediatric Migraine Disability Assessment (PedMIDAS) in healthy adolescent athletes. Design: Descriptive survey. Setting: High school athletic training facilities during the fall sports season. Participants: 177 high school athletes (89 males and 88 females). Interventions: A survey consisting of a demographic and concussion-history questionnaire, a graded symptom scale, the HIT-6, and the PedMIDAS. Internal consistency (α), test-retest reliability (rs), Bland-Altman analyses, and the Mann-Whitney U test were used to evaluate psychometric properties and age and gender differences. Main Outcome Measures: The HIT-6 and PedMIDAS item and total scores. Results: Test-retest reliability for the HIT-6 total score was rs = .72, and reliability of individual items ranged from rs = .52 to .67. The test-retest reliability for the PedMIDAS total score was rs = .61, and reliability of individual items ranged from rs = .23 to .62. Both scales demonstrated acceptable internal consistency: HIT-6 α = .89-.90 and PedMIDAS α = .71-.75. Conclusions: The authors found moderate test-retest reliability for the HIT-6 and the PedMIDAS in a healthy adolescent athlete population. Research on the applicability and utility of the HIT-6 and PedMIDAS in concussed adolescents is warranted. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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28. Clinical Outcomes Assessment for the Management of Sport-Related Concussion.
- Author
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McLeod, Tamara C. Valovich and Register-Mihalik, Johna K.
- Subjects
- *
BRAIN concussion , *HEALTH outcome assessment , *QUALITY of life , *SOCCER , *SPORTS injuries , *DECISION making in clinical medicine , *SYMPTOMS - Abstract
Patient Scenario: An adolescent female youth soccer athlete, with a previous concussion history, suffered a second concussion 4 wk ago. Her postconcussive symptoms are affecting her school performance and social and family life. Clinical Outcomes Assessment: Concussion is typically evaluated via symptoms, cognition, and balance. There is no specific patient-oriented outcomes measure for concussion. Clinicians can choose from a variety of generic and specific outcomes instruments aimed at assessing general health-related quality of life or various concussion symptoms and comorbidities such as headache, migraine, fatigue, mood disturbances, depression, anxiety, and concussion-related symptoms. Clinical Decision Making: The data obtained from patient self-report instruments may not actively help clinicians make return-to-play decisions; however, these scales may be useful in providing information that may help the athlete return to school, work, and social activities. The instruments may also serve to identify issues that may lead to problems down the road, including depression or anxiety, or serve to further explore the nature of an athlete's symptoms. Clinical Bottom Line: Concussion results in numerous symptoms that have the potential to linger and has been associated with depression and anxiety. The use of outcomes scales to assess health-related quality of life and the effect of other symptoms that present with a concussion may allow clinicians to better evaluate the effects of concussion on physical, cognitive, emotional, social, school, and family issues, leading to better and more complete management. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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29. Mindfulness Training with a Fencing Athlete Who Was Troubled by an Uncharacteristic Inability to Perform Well Competitively: A Case Report
- Author
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Toshiki Fukuzaki
- Subjects
athletes ,mindfulness ,General Medicine ,positive thinking ,Patient Report ,performance - Abstract
Positive thinking is one of the psychological skills that mental training programs aim to help athletes cultivate in order to enhance performance. It has been noted, however, that some athletes do not find positive thinking effective for that purpose. This case report describes a fencing athlete who used positive thinking to cope with negative ruminations prior to a competition and then stopped using positive thinking and engaged in mindfulness. As a result of applying mindfulness, the patient developed the ability to take part in competitions without obsessing and without negative ruminations. These findings show the importance of assessing, in detail, how the psychological skills training used with athletes is affecting their cognition, behavior, and performance and of implementing appropriate interventions based on these assessments.
- Published
- 2023
30. Chronic Active Epstein?Barr Virus Infection Indistinguishable from Autoimmune Hepatitis: A Case Report
- Author
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Ikeda, Suguru, Sugihara, Takaaki, Kihara, Takuya, Hoshino, Yoshiki, Matsuki, Yukako, Nagahara, Takakazu, Oyama, Kenji, Okano, Jun-ichi, Kuwamoto, Satoshi, Horie, Yasushi, and Isomoto, Hajime
- Subjects
Epstein–Barr virus ,autoimmune hepatitis ,EBV-encoded small RNA1 ,General Medicine ,Patient Report ,chronic active EBV infection - Abstract
Chronic active Epstein–Barr virus (CAEBV) infection is a rare disease, mainly affecting children, typically characterized by persistent infectious mononucleosis (IM)-like symptoms. We describe an adult case of CAEBV without IM-like symptoms, which was indistinguishable from autoimmune hepatitis (AIH). A 60-year-old woman with liver damage was diagnosed with AIH (International Diagnostic Score: 16 points). She had been treated with prednisolone for three years; however, her transaminases had never normalized. She was admitted for another liver biopsy due to repeated high fevers and worsening of her liver damage over two months. Her EBV-DNA copy number was 2.9 × 10(4) copies/μg DNA, and EBV-encoded small RNA1-positive lymphocytic infiltration was observed in both the present and previously collected (three years ago) liver tissue samples. This case implies that hepatic involvement in a CAEBV without IM-like symptoms is difficult to distinguish from AIH and may be misdiagnosed. In some steroid resistant AIH cases, evaluating for CAEBV may be valuable.
- Published
- 2022
31. Interdisziplinär-multimodales sektorenübergreifendes Assessment und bedarfsorientierte Steuerung für Patienten mit Rückenschmerzen: Prospektive Evaluation eines integrierten Versorgungsprojekts.
- Author
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Bienek, K., Marnitz, U., Seidel, W., Seifert, C., von Pickardt, B., and Lindena, G.
- Abstract
Copyright of Manuelle Medizin is the property of Springer Nature 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.)
- Published
- 2019
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32. The myotonic dystrophy experience: a North American cross-sectional study.
- Author
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Hagerman, Katharine A., Howe, Sarah J., Heatwole, Chad R., and Christopher Project Reference Group
- Subjects
- *
CAREGIVERS , *COGNITION disorders , *COMPARATIVE studies , *DIAGNOSIS , *ECONOMIC aspects of diseases , *EMPLOYMENT , *FAMILIES , *INCOME , *RESEARCH methodology , *MEDICAL cooperation , *MEDICAL errors , *MYOTONIA atrophica , *RESEARCH , *RESEARCH funding , *ACTIVITIES of daily living , *SOCIOECONOMIC factors , *EVALUATION research , *DISEASE prevalence , *CROSS-sectional method , *PSYCHOLOGICAL factors - Abstract
Introduction: Myotonic dystrophy (DM) is a chronic, multisystemic, neurological condition. Patients and caregivers are uniquely suited to identify what symptoms are most important and highlight the unmet needs that are most relevant to DM.Methods: We conducted a North American, cross-sectional study of people with DM type-1, congenital DM, and DM type-2 and their family members. We sent patients and caregivers separate surveys to identify and quantitate the issues of greatest importance, examine the differences between groups, and identify the most important challenges experienced by this population.Results: 1,180 people with DM and 402 family members/caregivers responded to the surveys. They reported considerable physical and cognitive symptoms, extensive diagnostic delays, and varying clinical phenotypes on the basis of DM type.Discussion: Marked disease burden and numerous unmet needs exist in DM. These needs vary based on DM type and highlight the complex clinical phenotypes of these neurological disorders. Muscle Nerve 59:457-464, 2019. [ABSTRACT FROM AUTHOR]- Published
- 2019
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33. Interdisziplinär-multimodales sektorenübergreifendes Assessment und bedarfsorientierte Steuerung für Patienten mit Rückenschmerzen.
- Author
-
Bienek, K., Marnitz, U., Seidel, W., Seifert, C., von Pickardt, B., and Lindena, G.
- Abstract
Copyright of Der Schmerz is the property of Springer Nature 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.)
- Published
- 2019
- Full Text
- View/download PDF
34. Gallbladder Cancer with Biliary Intraepithelial Neoplasia Complicated by Pancreaticobiliary Maljunction: A Case Report
- Author
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Sugezawa, Ken, Murawaki, Yoshiyuki, Sakamoto, Teruhisa, and Fujiwara, Yoshiyuki
- Subjects
gallbladder cancer ,immunohistochemistry ,General Medicine ,biliary intraepithelial neoplasia ,Patient Report ,pancreaticobiliary maljunction - Abstract
We report herein a case of gallbladder cancer with biliary intraepithelial neoplasia (BilIN) complicated by pancreaticobiliary maljunction (PBM). A 60-year-old woman was referred to our hospital for thickening of the gallbladder wall diagnosed via ultrasonography at the referring clinic. The Radiographic images showed thickening of the gallbladder wall and a high confluence of pancreaticobiliary ducts outside the duodenal wall without dilatation of the bile duct. The amylase level in the bile duct was highly elevated. The patient was initially diagnosed with PBM without biliary dilatation, and laparoscopic cholecystectomy was performed. Histopathology of the resected specimen revealed gallbladder cancer localized in the mucosa propria with widespread BilIN. Immunohistochemical analyses showed positive results for S100P,IMP3 and p16(ink4a) in tumor cells, but a positive result for only IMP3 in adenocarcinoma. Expression of p53 was negative. Oncogenic KRAS mutations were not detected in tumor cells. The patient was diagnosed with gallbladder cancer with BilIN complicated by PBM. This case report may be useful in clarifying the carcinogenic process and genetic mutations for gallbladder cancer associated with PBM.
- Published
- 2022
35. Precancerous Pyloric Gland Metaplasia in the Biliary Epithelium Associated with Congenital Biliary Dilatation in a Three-Month-Old Infant
- Author
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Shuichi Takano, Toshimichi Hasegawa, Kohga Masuda, Takehiko Hanaki, Naruo Tokuyasu, Teruhisa Sakamoto, Kanae Nosaka, and Yoshiyuki Fujiwara
- Subjects
biliary tract cancer ,congenital biliary dilatation ,pyloric gland metaplasia ,General Medicine ,Patient Report ,pancreaticobiliary maljunction ,precancerous lesion - Abstract
Pyloric gland metaplasia in the biliary epithelium is a precancerous lesion and has been confirmed in patients with congenital biliary dilatation presenting with overt biliary tract cancer. A patient was found to have an intra-abdominal cyst on fetal ultrasonography and was born at 37 weeks of gestation with a body weight of 2,636 g. Abdominal distension and repeated vomiting appeared 2 days after birth. Congenital biliary dilatation was diagnosed by imaging, wherein the common bile duct was enlarged to 9–10 cm in size, and the surrounding organs were extensively compressed; however, there was no sign of pancreatitis or cholangitis. Biliary drainage was performed through the gallbladder at 6 days of age, but it was insufficient because of the narrow and twisted cystic duct and changed to common bile duct at 18 days to relieve the compression. Because the body weight gain was poor due to loss of large amount of bile, the dilated bile duct and gallbladder were resected and hepatic duct Roux-Y jejunostomy was performed at 115 days of age with 4,500 g of body weight. Intraoperative imaging showed a pancreaticobiliary maljunction, and the pancreatic enzyme activities of the bile in the biliary system were remarkably elevated. Histopathological examination revealed pyloric gland metaplasia in the gallbladder epithelium and cystic duct. The patient is now over 2 years old and has been doing well without any complications. Based on our experience, precancerous pyloric gland metaplasia of the biliary epithelium may already occur even in a 3-month-old infant presenting with congenital biliary dilatation.
- Published
- 2022
36. Parent-Mediated Toilet Training for a Child with Autism Spectrum Disorder through Teleconsultation: A Case Report
- Author
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Hisashi Ito and Masahiko Inoue
- Subjects
toilet training ,consultation ,autism spectrum disorder ,General Medicine ,Patient Report ,defecation - Abstract
In defecation training, parent-mediated intervention via teleconsultation is helpful because the number of instructions for establishing defecation habits is limited. In the case report of the present study, defecation training was conducted based on gradual target setting and differential reinforcement through teleconsultation via email for a Caucasian 5-year-old boy with autism spectrum disorder (ASD) who lived in Greece. As a result of the intervention, namely the gradual target setting and differential reinforcement, in-bowl defecations increased at home.
- Published
- 2022
37. Brachial Artery Dissection Caused by Closed Elbow Dislocation in a Snowboarder: A Case Report and Review of Literature
- Author
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Shinpei Enokida, Koji Nawata, Hiroaki Kuroda, Takeo Otsuki, and Hideki Nagashima
- Subjects
body regions ,arteriotomy ,intimal disruption ,cardiovascular system ,duplex-sonography ,cardiovascular diseases ,General Medicine ,Patient Report - Abstract
This report describes a rare case of brachial artery dissection associated with closed elbow dislocation caused by a snowboarding injury. After peripheral ischaemic findings in the right upper extremity were confirmed, urgent duplex-sonography was performed to diagnose the brachial artery injury. Urgent revascularisation surgery was promptly performed, and arterial dissection was diagnosed by intraoperative findings, in which the adventitia of the brachial artery was intact and the intima was disrupted. In this case, because there was no golden time window before undertaking urgent revascularisation surgery, duplex-sonography was very useful for making an emergency diagnosis. To diagnose arterial dissection, because the adventitia of the brachial artery is intact, it is necessary to perform arteriotomy to identify intimal disruption in the brachial artery. When diagnosing traumatic elbow dislocation, it is important to suspect arterial dissection.
- Published
- 2022
38. Endoscopic Ablation of Upper Tract Urothelial Carcinoma: A Report of Two Cases with Long Disease Recurrence-Free Periods
- Author
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Yamane, Hiroshi, Honda, Masashi, Shimizu, Ryutaro, Teraoka, Shogo, Kimura, Yusuke, Yumioka, Tetsuya, Iwamoto, Hideto, Morizane, Shuichi, Hikita, Katsuya, and Takenaka, Atsushi
- Subjects
radical nephroureterectomy ,kidney-sparing surgery ,General Medicine ,upper tract urothelial carcinoma ,Patient Report ,laser ablation therapy ,urothelial carcinoma - Abstract
Upper tract urothelial carcinoma (UTUC) is a relatively rare disease that accounts for 5% to 10% of all urothelial carcinomas (UCs). Radical nephroureterectomy (RNU) with a bladder cuff is the current gold standard for the management of UTUC; however, endoscopic ablation is also an option for low-risk UTUC to preserve kidney function. Herein, we present two cases of solitary kidney with a right lower ureteral tumor. Both patients underwent left RNU in the past. An 82-year-old man with a right ureteral tumor whose histopathological examination revealed low-grade UC. Laser ablation was performed with ureteroscopy, and there was no recurrence for 7 years after treatment. A 67-year-old woman with a right lower ureteral tumor whose histopathological examination also revealed low-grade UC. Laser ablation was performed, and there was no recurrence for 5 years after the treatment. We closely followed-up our two patients after RNU. This allowed for early detection of tumor recurrence, after which we could perform laser ablation therapy.
- Published
- 2022
39. Video-Assisted Thoracoscopic Surgery Using Extracorporeal Membrane Oxygenation for Intractable Pneumothorax
- Author
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Miwa, Ken, Nakanishi, Atsuyuki, Miyamoto, Tatsuya, Ohno, Takashi, Kidokoro, Yoshiteru, Haruki, Tomohiro, and Nakamura, Hiroshige
- Subjects
pneumothorax ,General Medicine ,extracorporeal membrane oxygenation ,Patient Report ,video-assisted thoracoscopic surgery - Abstract
Intractable pneumothorax with poor lung function that has received multiple conservative treatments may occur. Case 1 was a 70-year-old woman with aspergilloma who was admitted for pneumothorax. Case 2 was a 68-year-old man with acute exacerbation of interstitial pneumonia who developed pneumothorax. In both cases, multiple conservative therapies were administered, but the leak continued; thus, operations using veno-venous extracorporeal membrane oxygenation (ECMO) were planned. By video-assisted thoracoscopic surgery (VATS), we obtained the optimal surgical field by lung collapse. We removed many blood clots that were used for pleurodesis, ligated the bulla in case 1, and covered the leak point with strengthening agents in case 2. For cases of intractable pneumothorax, lung collapse by ECMO is advantageous because we can check details and leak points even in blood clots or in poor condition of the lung, and we can maneuver the lung in poor condition with a clear surgical field.
- Published
- 2022
40. Robot-Assisted Total Hysterectomy of Extremely Unusual Pelvic Anatomy: A Case Report and Literature Review
- Author
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Nagata, Hiroki, Komatsu, Hiroaki, Nakaso, Takaya, Kudoh, Akiko, Azuma, Yukihiro, and Taniguchi, Fuminori
- Subjects
anatomy ,robotic surgery ,General Medicine ,didelphic uterus ,hysterectomy ,Patient Report ,endocervical glandular hyperplasia - Abstract
We report a case of robot-assisted total hysterectomy in a patient with extremely rare pelvic anatomy. Robot-assisted total laparoscopic hysterectomy was performed for lobular endocervical glandular hyperplasia on the left side of the uterus. The sigmoid colon was present between the two uterine corpora of a uterine didelphys and was attached to the bladder via the mesentery and fat. During surgery, the surgeon left the console and confirmed the magnetic resonance images. The surgery was then completed safely after the surgeon understood the anatomy. The postoperative condition was good, and the patient was discharged on postoperative day 5. Robot-assisted surgery has various advantages, including a good field of view, accuracy of instrument movement, and ease of viewing information in the medical record by pausing the operation. Robot assisted surgery improves not only safety and operational precision but also intraoperative convenience. Further studies are needed regarding the specific anatomy seen in this case.
- Published
- 2022
41. Hemostatic Control with Gelatin Sponge and Quantum Molecular Resonance Coagulation in a Case of Glomus Tympanicum
- Author
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Kazunori Fujiwara, Yuko Yokoyama, Yasuomi Kunimoto, Tasuku Watanabe, and Hiroaki Yazama
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Arterial Embolization ,Pulsatile flow ,General Medicine ,Blood flow ,Patient Report ,atticotomy ,Surgery ,Glomus tympanicum ,medicine.anatomical_structure ,Coagulation ,Hemostasis ,hemostasis ,Medicine ,Tympanic cavity ,Pure tone audiometry ,glomus tympanicum ,coagulation ,business - Abstract
Surgical removal of tumor is the primary treatment of choice for glomus tympanicum (GT). However, because the tumor has abundant blood flow, bleeding control is crucial, and preoperative embolization may be performed. Here, we report the case of a 46-year-old female who visited our hospital with a complaint of right pulsatile tinnitus. A red pulsatile mass was found in the right tympanic cavity, and she was diagnosed with class B1 GT and subsequently underwent surgical treatment. We judged that bleeding could be controlled by intratympanic cavity manipulation alone and decided to perform transmeatal tumor resection without preoperative arterial embolization. After creating a tympanomeatal flap and performing an atticotomy, some pieces of Spongel(®) were inserted between the tumor and the tympanic wall. The Spongel(®) absorbed the blood and created a space between the tumor and tympanic wall, which allowed for the insertion of the tip of the Vesalius(®) handpiece to coagulate the tumor. The coagulation caused the tumor to shrink, thereby widening the space and allowing for further resection. Although the surgical manipulation caused bleeding, complete resection was achieved by the application of Spongel(®) and coagulation with Vesalius(®). Since the tip of the Vesalius(®) was not burned, hemostasis was successfully achieved, and the operation proceeded while maintaining a clear field of view. There was little bleeding and no postoperative complications. The patient was discharged on the sixth postoperative day. One year after surgery, pure tone audiometry showed no change in the level of bone conduction. Spongel(®) and Vesalius(®) are useful tools that allow to safely perform surgeries even in narrow spaces such as the tympanic cavity.
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- 2021
42. Reattachment of hydrated fractured fragment of permanent maxillary central incisor, one of its kind (2 year follow up): A case report
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Swati Kale, Sahili Mungekar-Markandey, and Nidhi Chowhan
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Orthodontics ,Fractured tooth ,Fragment (computer graphics) ,business.industry ,Resin composite ,Treatment options ,stomatognathic diseases ,Maxillary left central incisor ,stomatognathic system ,Medicine ,Maxillary central incisor ,Patient report ,business ,Anterior teeth - Abstract
Background: Traumatic injuries to maxillary anterior teeth are seen in children and adolescents to major extent resulting into anterior teeth fractures. Different treatment strategies are available for its management, although tooth fragment reattachment is considered to be a feasible treatment option due to its comprehensibility, aesthetics, and functional success. Case Description: Present case reports a case of a 10-year-old girl patient with a fractured permanent maxillary left central incisor (Ellis class II) with emphasis on hydration and reattachment of the fractured fragment. The present paper reports the reattachment of the stored fractured fragment in milk as a hydrating medium. The fragment was reattached using an adhesive bonding system and a resin composite material on the mesioincisal angle of 21 and the distoincisal angle was built up with traditional method. At 2-years follow up tooth maintain its vitality along with aesthetics and function. Conclusion: The retrieved fractured fragment of anterior teeth can be stored in milk till patient report to clinic followed by hydrating the fractured fragment using normal saline in dental office before reattachment. Clinical Significance: Management of available fractured tooth fragment by reattachment technique, offers a feasible and minimal non-invasive option for the dental clinician.
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- 2021
43. Efficient and Effective Review of Clinical Trial Safety Data Using Interactive Graphs and Tables
- Author
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Southworth, Harry, Krause, Andreas, editor, and O'Connell, Michael, editor
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- 2012
- Full Text
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44. Sequential Treatment of Extreme Maxillary Hypoplasia: A Historical Patient Report of an Edentulous Adult Patient With Ankyloglossia
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M. Brix, Louis Saint-Denis, and E. Simon
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Adult ,Male ,Palatal Expansion Technique ,Maxillary hypoplasia ,medicine.medical_treatment ,Overjet ,Orthognathic surgery ,Le Fort I osteotomy ,Maxilla ,Humans ,Osteotomy, Le Fort ,Medicine ,Ankyloglossia ,Orthodontics ,Orthognathic Surgical Procedures ,business.industry ,General Medicine ,medicine.disease ,Sequential treatment ,Sagittal plane ,medicine.anatomical_structure ,Otorhinolaryngology ,Surgery ,Mouth, Edentulous ,Patient report ,business - Abstract
INTRODUCTION The management of multiple dimensions in orthognathic surgery often requires careful planning. Too large discrepancies could require a sequential procedure to make alignment of the archs possible. REPORT OF CASE The authors report a case of a 30-year-old partially edentulous man with severe maxillary hypoplasia caused by an untreated ankyloglossia. The transverse deficiency was estimated at more than 15 mm and the sagittal discrepancy shows a negative overjet of 11.5 mm. These wide deficits needed a 2-step surgery and the use of computed-aided design/computed-aided manufacturing. The first step was a palatal expansion by a fan-shaped Le Fort I osteotomy. The second step treated sagittal discrepancy and re-expanded the maxilla.At the end, the sagittal dimension got normal and the maxilla have been widened to almost 7 mm. CONCLUSION Custom-made surgery is very useful for uncommon cases, in particular for toothless patients. It facilitates complex operations and allows precise results.
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- 2021
45. Clinicians’ Feedback on Patient/Carer Experience After Switching of Growth Hormone Treatment in Pediatric Patients During COVID-19
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Yashasvi Suvarna, Marco Cappa, Joanne Blair, and Kelly Warth
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Health Policy ,growth disorders ,Medicine (miscellaneous) ,Usability ,Context (language use) ,Device use ,Growth hormone ,Norditropin® ,Growth hormone treatment ,Clinical Practice ,Patient Preference and Adherence ,somatropin ,Family medicine ,medicine ,virtual consultations ,Patient report ,business ,Pharmacology, Toxicology and Pharmaceutics (miscellaneous) ,Social Sciences (miscellaneous) ,Original Research ,ease of use - Abstract
Joanne Blair, 1 Kelly Warth, 2 Yashasvi Suvarna, 3 Marco Cappa 4 1Department of Endocrinology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK; 2Instar, London, UK; 3Global Medical Affairs, Novo Nordisk Global Business Services (GBS), Bangalore, India; 4Endocrinology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, ItalyCorrespondence: Joanne BlairDepartment of Endocrinology, Alder Hey Children’s NHS Foundation Trust, Liverpool, L12 2AP, UKTel +44 151 252 5335 Fax +44 151 282 4606Email Jo.Blair@alderhey.nhs.ukPurpose: This study investigated why some clinicians switched growth hormone (GH) brands in pediatric patients with GH-related disorders to Norditropin® since the start of the COVID-19 pandemic, the clinicians’ perceptions of the results, and whether observations from this period of disruption could inform clinical practice in the future.Patients and Methods: Clinicians (N=106) from the UK, France, Italy, and Japan who had switched at least one patient to Norditropin® from a GH therapy manufactured by a different pharmaceutical company between February and November 2020 participated. They completed an online survey and submitted patient report forms for up to three switched patients.Results: Since the start of COVID-19, 39– 54% of the reported consultations were virtual (ie, via telephone or online means) in the UK, France, and Italy. Overall, 17% of patients seen by respondents in the survey were switched to a different GH brand; approximately two-thirds of switches were to Norditropin®. Clinicians’ top considerations in choosing a GH brand were patient/carer feedback, patient support programs, and the need for easy-to-use therapies in the context of virtual consultations. The top reasons for switching patients to Norditropin® included ease of use, device features and benefits, better patient/carer feedback, and ease of training in device use via virtual consultations. Norditropin® was considered suitable for use in virtual or in-person consultations or a mixture of both. Based on patient/carer feedback, 66% of clinicians believed that patients preferred Norditropin® to their previous therapy in terms of overall satisfaction.Conclusion: In this survey, key considerations in prescribing GH therapy were ease of use and acceptability to patients and carers. If virtual consultations increasingly replace in-person ones, ease in training patients/carers in device use will be particularly important. A majority of clinicians considered that their patients preferred Norditropin® to their previous therapy.Keywords: growth disorders, somatropin, virtual consultations, ease of use, Norditropin®
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- 2021
46. A Case of Gorham-Stout Disease Treated with Fistula Closure by Transmeatal Approach
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Kazunori Fujiwara, Tasuku Watanabe, Hiroaki Yazama, Satoshi Koyama, and Yasuomi Kunimoto
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medicine.medical_specialty ,Osteolysis ,business.industry ,Fistula ,General Medicine ,medicine.disease ,Patient Report ,Gorham-Stout disease ,Surgery ,Cerebrospinal fluid ,medicine.anatomical_structure ,fistula closure ,medicine.artery ,Vestibule ,Lymphangioma ,Temporal bone ,medicine ,Middle ear ,cerebrospinal fluid leakage ,Internal carotid artery ,business ,bacterial meningitis ,osteolysis - Abstract
Gorham-Stout disease, a rare and intractable disease of unknown etiology, causes systemic bone lysis and replacement with lymphoid tissue. Here, we report a case of Gorham-Stout disease with cerebrospinal fluid leakage in a 16-year-old boy. The patient complained of nasal discharge, right ear obstruction, fever, and headache. A computed tomography scan of the head showed osteolysis around the right internal carotid artery, vestibule, and cochlea and osteolytic changes in the left parietal bone. It was suggested that the patient had bacterial meningitis owing to the leakage of cerebrospinal fluid from the fistula caused by the temporal bone osteolysis. He was treated with meropenem, and a transmeatal fistula closure and a bone biopsy of the left parietal bone were performed. Intraoperatively, osteolysis was observed on the promontory and around the internal carotid artery. The fistula was closed by dense filling and compression around the fistula, in the middle ear cavity, and in the external auditory canal. The symptoms disappeared after the surgery. Bone biopsy showed the presence of a lymphangioma, and Gorham-Stout disease was diagnosed. Prophylactic bisphosphonate therapy was initiated. A 4-year follow-up revealed no progression of the disease.
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- 2021
47. How patients describe their diagnosis compared to clinical documentation
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Kelly T. Gleason and Maria R. Dahm
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Technical language ,Clinical Biochemistry ,Medicine (miscellaneous) ,Documentation ,Cohort Studies ,medicine ,Electronic Health Records ,Humans ,Medical diagnosis ,business.industry ,Health Policy ,Biochemistry (medical) ,Public Health, Environmental and Occupational Health ,Electronic medical record ,Emergency department ,Patient-centered care ,Patient Discharge ,Female ,Patient report ,Emergency Service, Hospital ,business ,Cohort study - Abstract
Objectives To explore how patients describe their diagnoses following Emergency Department (ED) discharge, and how this compares to electronic medical record (EMR) documentation. Methods We conducted a cohort study of patients discharged from three EDs. Patients completed questionnaires regarding their understanding of their diagnosis. Inclusion criteria: adult ED patients aged 18 and older seen within the last seven days. We independently compared patient-reported new diagnoses following discharge to EMR-documented diagnoses regarding diagnostic content (identical, insignificantly different, different, not enough detail) and the level of technical language in diagnostic description (technical, semi-technical, lay). Results The majority of participants (n=95 out of 137) reported receiving a diagnosis and stated the given diagnosis. Of those who reported their diagnosis, 66%, were females (n=62), the average age was 43 (SD 16), and a fourth (n=24) were Black and 66% (n=63) were white. The majority (84%) described either the same or an insignificantly different diagnosis. For 11% the patient-reported diagnosis differed from the one documented. More than half reported their diagnosis using semi-technical (34%) or technical language (26%), and over a third (40%) described their diagnosis in lay language. Conclusions Patient-reported diagnoses following ED discharge had moderate agreement with EMR-documented diagnoses. Findings suggest that patients might reproduce verbatim semi-technical or technical diagnoses they received from clinicians, but not fully understood what the diagnosis means for them.
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- 2021
48. Prehospital identification of large vessel occlusion using the FAST‐ED score
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Pekka Virtanen, Markku Kuisma, Janne Kinnunen, Daniel Strbian, Tuukka Puolakka, HUS Emergency Medicine and Services, University of Helsinki, Anestesiologian yksikkö, Helsinki University Hospital Area, HUS Medical Imaging Center, Neurologian yksikkö, and HUS Neurocenter
- Subjects
Emergency Medical Services ,medicine.medical_specialty ,Intraclass correlation ,VALIDATION ,3124 Neurology and psychiatry ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,large vessel occlusion ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Retrospective Studies ,Computed tomography angiography ,THROMBOLYSIS ,medicine.diagnostic_test ,business.industry ,Clinical judgement ,EMS ,Field assessment ,STROKE SCALE ,3112 Neurosciences ,TRIAGE ,General Medicine ,THROMBECTOMY ,medicine.disease ,stroke ,Triage ,3. Good health ,Neurology ,DELAY ,Emergency medicine ,Neurology (clinical) ,Patient report ,business ,CLINICAL-SCALES ,030217 neurology & neurosurgery ,Large vessel occlusion - Abstract
Objectives The prehospital identification of stroke patients with large vessel occlusion (LVO) enables appropriate hospital selection and reduces the onset-to-treatment time. The aim of this study was to investigate whether the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale could be reconstructed from existing prehospital patient reports and to compare its performance with neurologist's clinical judgement using the same prehospital data. Materials & Methods All patients transported by ambulance using stroke code on a six-month period were registered for the study. The prehospital patient reports were retrospectively evaluated using the FAST-ED scale by two investigators. The performance of FAST-ED score (>= 4 points) in LVO identification was compared to neurologist's clinical judgement ('LVO or not'). The presence of LVO was verified using computed tomography angiography imaging. Results A total of 610 FAST-ED scores were obtained. The FAST-ED had a sensitivity of 57.8%, specificity of 87.2%, positive predictive value (PPV) of 37.3%, negative predictive value (NPV) of 93.4% and area under curve (AUC) of 0.724. Interclass correlation coefficient for both raters over the entire range of FAST-ED was 0.92 (0.88-0.94). The neurologist's clinical judgement raised sensitivity to 79.4%, NPV to 97.1% and PPV to 45.0% with an AUC of 0.837 (p < .05). Conclusions The existing patient report data could be feasibly used to reconstruct FAST-ED scores to identify LVO. The binary FAST-ED score had a moderate sensitivity and good specificity for prehospital LVO identification. However, the FAST-ED was surpassed by neurologist's clinical judgement which further increased the sensitivity of identification.
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- 2021
49. Successful Resolution of Fecal Impaction During Endoscopy Using a Looped Guidewire
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Takeshi Hashimoto, Atsushi Yanagitani, Tomoyuki Okada, and Hajime Isomoto
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medicine.medical_specialty ,Endoscope ,medicine.medical_treatment ,colonography ,Lumen (anatomy) ,Colonoscopy ,conservative treatment ,Patient Report ,03 medical and health sciences ,0302 clinical medicine ,medicine ,endoscopy ,disimpaction ,medicine.diagnostic_test ,business.industry ,Sigmoid colon ,Fecal impaction ,General Medicine ,Enema ,medicine.disease ,Surgery ,Endoscopy ,medicine.anatomical_structure ,fecal impaction ,030220 oncology & carcinogenesis ,Abdomen ,030211 gastroenterology & hepatology ,business - Abstract
Fecal impaction is the impaired excretion of a large fecal mass, and mild cases are treated by enema and osmotic laxatives. However, treatment-resistant cases need more invasive alternatives. A woman in her 60s presented with abdominal discomfort. Her abdomen was soft and without tenderness. Computed tomography revealed a large mass of feces in her sigmoid colon and no intestinal dilatation proximal to the mass. Endoscopy confirmed a fecal mass occupying the lumen. A glycerin enema, oral administration of polyethylene glycol, and enteral administration of amidotrizoic acid during colonoscopy were ineffective. We maneuvered a guidewire to form a loop at the tip of an endoscope, with which we subdivided the mass for successful removal. The patient’s abdominal discomfort disappeared immediately. Endoscopic disimpaction is far less invasive than surgery and should be considered when treating fecal impaction cases, without severe obstructive colitis, which are nonresponsive to conservative treatment.
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- 2021
50. Surgical patient values frame and modify the impact of risk factors for non-routine postdischarge care: A mixed-methods study
- Author
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Xavier Baldwin, Paul Mihas, Ursula Adams, Stephanie T Lumpkin, Timothy S. Carey, and Karyn B. Stitzenberg
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Adult ,Male ,medicine.medical_specialty ,Psychological intervention ,Aftercare ,Patient Readmission ,Colonic Diseases ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Aged ,High rate ,Surgical team ,business.industry ,General Medicine ,Emergency department ,Middle Aged ,Patient Acceptance of Health Care ,Colorectal surgery ,Rectal Diseases ,Healthcare utilization ,030220 oncology & carcinogenesis ,Emergency medicine ,Female ,Surgery ,Self Report ,Patient report ,Emergency Service, Hospital ,business ,Attitude to Health ,Algorithms ,Surgical patients - Abstract
Background Adult colorectal surgery patients continue to have high rates of readmissions, despite known risk factors for non-routine postdischarge care (emergency department (ED) visit or rehospitalization) and countless interventions to address these. It is unclear how the difficult-to-quantify patient perspective frames and modifies the impact of these quantifiable risk factors. Study design We identified consecutive adult inpatient colorectal surgery patients from 2017 to 2018. This mixed methods study merged data from electronic health records and in-depth patient interviews. Results We enrolled 258 participants, surveyed 167, and interviewed 18. Depressive symptoms represent one of many risk factors confirmed to increase non-routine healthcare utilization (RR 1.85, 95% CI 1.02–3.37), though the patient perspective explained why these symptoms seemed to greatly impact some patients more than others. Additionally, consistent with patient report, patients with non-routine postdischarge care (26%) were less likely to report communication with their surgical team (80% vs 97%, p Conclusion Patient perspectives add depth and understanding of the impact of risk factors on non-routine post-discharge care. This expanded knowledge explains why one patient is more likely to visit an ED close to home whereas another patient might prefer to visit their surgeon’s clinic directly. Effective strategies to reduce unplanned postdischarge care should be tailored.
- Published
- 2021
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