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Minimum clinically important difference

Harvey C Quon, Aldrich Ong, Patrick Cheung, William Chu, Hans T Chung, Danny Vesprini, Amit Chowdhury, Dilip Panjwani, Geordi Pang, Renee Korol, Melanie Davidson, Ananth Ravi, Boyd McCurdy, Liying Zhang, Alexandre Mamedov, Andrea Deabreu, Andrew Loblaw
BACKGROUND AND PURPOSE: Prostate stereotactic body radiotherapy (SBRT) regimens differ in time, dose, and fractionation. We completed a multicentre, randomized phase II study to investigate the impact of overall treatment time on quality of life (QOL). MATERIAL AND METHODS: Men with low and intermediate-risk prostate cancer were randomly assigned to 40 Gy in 5 fractions delivered once per week (QW) vs. every other day (EOD). QOL was assessed using the Expanded Prostate Cancer Index Composite...
March 15, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Charalambos Vlachopoulos, Christos Georgakopoulos, Iosif Koutagiar, Dimitrios Tousoulis
Peripheral artery disease (PAD) affects approximately one in five persons older than 70 years of age and it is often present in patients with concomitant vascular disease in different body territories (e.g. coronary artery disease). Diagnosis at an early stage is important in order to achieve improvement in patient's symptoms and prognosis. Remarkable improvements in the field of noninvasive and invasive imaging techniques have led to an advanced level the management of patients with PAD. Throughout this review article, the clinically available diagnostic modalities in PAD are presented...
March 14, 2018: Current Opinion in Pharmacology
Michael J Ingargiola, Felipe Molina Burbano, Amy Yao, Saba Motakef, Paymon Sanati-Mehrizy, Nikki M Burish, Lisa R David, Peter J Taub
Background: The recently increased minimum aesthetic surgery requirements set by the Plastic Surgery Residency Review Committee of the ACGME highlight the importance of aesthetic surgery training for plastic surgery residents. Participation in resident aesthetic surgery clinics has become an important tool to achieve this goal. Yet, there is little literature on the current structure of these clinics. Objectives: The authors sought to evaluate current practices of aesthetic resident-run clinics in the United States...
March 14, 2018: Aesthetic Surgery Journal
Neil E O'Connell, Louise Marston, Sally Spencer, Lorraine H DeSouza, Benedict M Wand
BACKGROUND: This is an updated version of the original Cochrane Review published in 2010, Issue 9, and last updated in 2014, Issue 4. Non-invasive brain stimulation techniques aim to induce an electrical stimulation of the brain in an attempt to reduce chronic pain by directly altering brain activity. They include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES), transcranial direct current stimulation (tDCS), transcranial random noise stimulation (tRNS) and reduced impedance non-invasive cortical electrostimulation (RINCE)...
March 16, 2018: Cochrane Database of Systematic Reviews
Brian W Carey, James Harty
BACKGROUND: The ATTUNE Knee by DePuy Synthes was introduced in 2013. It is designed to provide better range of motion and address patient-reported instability. The PFC Sigma Knee, an earlier prosthesis by DePuy Synthes, is a common knee replacement with a strong clinical track record. Our aim is to compare the outcomes after primary total knee replacement for end-stage knee osteoarthritis of the PFC and ATTUNE knee systems in 21 patients who each have prosthesis in opposite knees using WOMAC, Oxford Knee and SF-12 scores and evaluation of range of motion...
March 15, 2018: Journal of Orthopaedic Surgery and Research
William Becker, Philippe Hujoel, Burton E Becker
BACKGROUND: Numerous studies indicate implants placed immediately after extraction or with minimally invasive procedures have excellent long-term success and survival rates. There is general agreement that implants must be stable after implant placement. This study evaluated implant stability changes from the time of implant placement to second stage (prior to restoration). Resonance frequency analysis (RFA) was determined for two commercially available units (Osstell, Osstell USA, Columbia, MD and Penguin, Penguin Integration Diagnostics, Sweden)...
March 13, 2018: Clinical Implant Dentistry and related Research
Michael J Taunton, Robert T Trousdale, Rafael J Sierra, Ken Kaufman, Mark W Pagnano
BACKGROUND: The choice of surgical approach for THA remains controversial. Some studies suggest that the direct anterior approach (DAA) leads to less muscle damage than the miniposterior approach (MPA), but there is little high-quality evidence indicating whether this accelerates recovery, or whether this approach-which may be technically more demanding-is associated with component malposition or more complications. QUESTIONS/PURPOSES: (1) Does the DAA result in faster return to activities of daily living than the MPA? (2) Does the DAA have superior patient-reported outcome measures than the MPA? (3) Does the DAA result in improved radiographic outcomes than the MPA? (4) Does the DAA have a higher risk of complications than the MPA? METHODS: Between March 1, 2013, and May 31, 2016, 116 patients undergoing primary unilateral THA were randomized to either the DAA or MPA; 15 patients withdrew after randomization, and one died 6 months after surgery from a stroke unrelated to the procedure...
February 2018: Clinical Orthopaedics and related Research
Matthieu Ollivier, Sébastien Parratte, Ludovic Lino, Xavier Flecher, Sébastien Pesenti, Jean-Noël Argenson
BACKGROUND: Previously published studies reported benefits of computer-assisted surgery (CAS) in terms of radiographic implant position in TKA, but whether these improvements result in clinically important survival differences or functional differences that a patient might perceive at a minimum 10-year followup remains largely unknown. QUESTIONS/PURPOSES: We performed a prospective randomized trial and asked whether CAS (1) improved survival free from aseptic loosening; and (2) demonstrated any clear difference in patient-reported outcomes at latest followup using validated outcome measures at minimum 10-year followup...
January 2018: Clinical Orthopaedics and related Research
Jasmina Sterz, Vanessa Britz, Matthias Münzberg, Martina Kadmon, Iris Schleicher, Adrian Meder, Rainer Kamp, Maren Janko, Ingo Marzi, Miriam Rüsseler
BACKGROUND: The national competence-based catalogue of learning-goals in surgery (NKLC) defines competence levels for each of its 230 goals, including "competence level in 1: factual knowledge" up to "competence level 3: independent action". Aside from the cumulative examinations influencing the learning behaviour of students, those teaching targets do not affect the second state examination. This study analyses the extent to which the questions of the German second medical licensing examination compiled by the IMPP (central German institute for medical and pharmaceutical examinations) are congruent with the trauma-surgical and orthopaedic learning goals in the NKLC, in which this thematic focus is emphasised...
March 9, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Rikke Vibeke Nielsen
Increasing evidence indicate that pain is insufficiently treated following surgical procedures. It is essential that pain treatment is effective with a minimum of side effects in order to promote postoperative rehabilitation. Multimodal analgesia is most likely an important strategy in reducing postoperative pain. Combinations of different analgesics with different mechanisms of action may have an additive analgesic effect with fewer side effects compared to using a single drug. However, there is still a pronounced lack of documentation for the effect and side effects of these multimodal analgesic regimes...
March 2018: Danish Medical Journal
Sanne M Kloosterboer, Brenda C M de Winter, Soma Bahmany, Linda Al-Hassany, Annet Dekker, G C Dieleman, Teun van Gelder, Bram Dierckx, Birgit C P Koch
BACKGROUND: Dried Blood Spot (DBS) sampling offers a minimally invasive sampling method for therapeutic drug monitoring of antipsychotics. To facilitate implementation in clinical practice, the aim of this study was to perform a clinical validation study of a DBS method for quantification of risperidone, aripiprazole, pipamperone and its major metabolites 9-OH risperidone and dehydro-aripiprazole in a real-life, clinical setting. METHODS: Paired DBS and venous plasma samples were analyzed (n=35 for risperidone, n=21 for aripiprazole, n=21 for pipamperone)...
March 2, 2018: Therapeutic Drug Monitoring
Tiro Mmopelwa, Selim Ayhan, Selcen Yuksel, Vugar Nabiyev, Asli Niyazi, Ferran Pellise, Ahmet Alanay, Francisco Javier Sanchez Perez Grueso, Frank Kleinstuck, Ibrahim Obeid, Emre Acaroglu
OBJECTIVES: To identify the factors that affect SF-36 mental component summary (MCS) in patients with adult spinal deformity (ASD) at the time of presentation, and to analyse the effect of SF-36 MCS on clinical outcomes in surgically treated patients. METHODS: Prospectively collected data from a multicentric ASD database was analysed for baseline parameters. Then, the same database for surgically treated patients with a minimum of 1-year follow-up was analysed to see the effect of baseline SF-36 MCS on treatment results...
March 1, 2018: Acta Orthopaedica et Traumatologica Turcica
Gonzalo Sirgo, Federico Esteban, Josep Gómez, Gerard Moreno, Alejandro Rodríguez, Lluis Blanch, Juan José Guardiola, Rafael Gracia, Lluis De Haro, María Bodí
BACKGROUND: Big data analytics promise insights into healthcare processes and management, improving outcomes while reducing costs. However, data quality is a major challenge for reliable results. Business process discovery techniques and an associated data model were used to develop data management tool, ICU-DaMa, for extracting variables essential for overseeing the quality of care in the intensive care unit (ICU). OBJECTIVE: To determine the feasibility of using ICU-DaMa to automatically extract variables for the minimum dataset and ICU quality indicators from the clinical information system (CIS)...
April 2018: International Journal of Medical Informatics
Elaine Setiawan, Sophia Attwells, Alan A Wilson, Romina Mizrahi, Pablo M Rusjan, Laura Miler, Cynthia Xu, Sarita Sharma, Stephen Kish, Sylvain Houle, Jeffrey H Meyer
BACKGROUND: People with major depressive disorder frequently exhibit increasing persistence of major depressive episodes. However, evidence for neuroprogression (ie, increasing brain pathology with longer duration of illness) is scarce. Microglial activation, which is an important component of neuroinflammation, is implicated in neuroprogression. We examined the relationship of translocator protein (TSPO) total distribution volume (VT ), a marker of microglial activation, with duration of untreated major depressive disorder, and with total illness duration and antidepressant exposure...
February 26, 2018: Lancet Psychiatry
Deborah Wilson, Gayle Dolan, Heather Aird, Shirley Sorrell, Timothy J Dallman, Claire Jenkins, Lucy Robertson, Russell Gorton
Fifteen cases of Shiga toxin-producing Escherichia coli (STEC) O157 infection were associated with the consumption of contaminated food from two related butchers' premises in the north-east of England. Ten cases were admitted to hospital and seven cases developed haemolytic uraemic syndrome. A case control study found a statistically significant association with the purchase of raw and/or ready-to-eat (RTE) food supplied by the implicated butchers' shops. Isolates of STEC O157 were detected in two raw lamb burgers taken from one of the butchers' premises...
February 28, 2018: Microbial Genomics
Dietrich Doll, F Bosche, A Hauser, P Moersdorf, I Sinicina, J Grunwald, F Reckel, M M Luedi
PURPOSE: Hair in the pilonidal sinus is not growing within the sinus cavity, as hair follicles are not present there. Not few pilonidal patients do not have intergluteal hair, which is said to be the causative agent of folliculitis and pilonidal genesis. So, what is the real source of the hair forming the typical pilonidal hair nest? METHODS: A trifold approach was used: First, axial hair strength testing of pilonidal hair and body hair harvested from head, lower back (glabella sacralis), and cranial third of intergluteal fold...
February 28, 2018: International Journal of Colorectal Disease
Micaela Gobeille, Alexis Malkin, Richard Jamara, Nicole C Ross
PURPOSE: This prospective cohort study examined clinical outcomes of low vision rehabilitation (LVR) delivered by a mobile clinic. METHODS: Participants were recruited from those scheduled for mobile clinic LVR and met the United States definition of legal blindness. Participants completed the Massof Activity Inventory (AI) before LVR, 3 months post-LVR, and 1 year post-LVR. Change scores and measures of clinical effect (i.e. Cohen's effect size and minimum clinically important difference, MCID) were calculated for each time point and compared...
March 2018: Ophthalmic & Physiological Optics: the Journal of the British College of Ophthalmic Opticians (Optometrists)
Ifaz T Haider, Prism Schneider, Andrew Michalski, W Brent Edwards
INTRODUCTION: Atypical femoral fractures (AFF) are characterized as low-energy fractures of the femoral shaft or subtrochanteric region. Femoral geometry is known to play a role in AFF risk; it is hypothesized that high-risk geometries are associated with elevated femoral shaft strain. However, it is not well known which geometric parameters have the greatest effect on strain, or whether interaction between parameters is significant. The purpose of this study was to thoroughly quantify the relationship between femoral geometry and diaphyseal strain, using patient specific finite element (FE) modelling in concert with parametric mesh morphing...
February 23, 2018: Bone
Thomas J M Kootstra, Suzanne C Wilkens, Mariano E Menendez, David Ring
BACKGROUND: In prior work we demonstrated that patient-rated physician empathy was the strongest driver of patient satisfaction after a visit to an orthopaedic hand surgeon. Data from the primary care setting suggest a positive association between physician empathy and clinical outcomes, including symptoms of the common cold. It is possible that an empathic encounter could make immediate and measureable changes in a patient's mindset, symptoms, and functional limitations. QUESTIONS/PURPOSES: (1) Comparing patients who rated their physicians as perfectly empathic with those who did not, is there a difference in pre- to postvisit change in Patient Reported Outcome Measurement Information System (PROMIS) Upper Extremity Function scores? (2) Do patients who gave their physicians perfectly empathic ratings have a greater decrease in pre- to postvisit change in Pain Intensity, PROMIS Pain Interference, and PROMIS Depression scores? METHODS: Between September 2015 and February 2016, based on the clinic patient flow, 134 new patients were asked to participate in this study...
February 23, 2018: Clinical Orthopaedics and related Research
Mike H Bao, Benjamin J Keeney, Wayne E Moschetti, Nicholas G Paddock, David S Jevsevar
BACKGROUND: Approximately one-half of all US surgical procedures, and one-third of orthopaedic procedures, are performed at teaching hospitals. However, the effect of resident participation and their level of training on patient care for TKA postoperative physical function, operative time, length of stay, and facility discharge are unclear. QUESTIONS/PURPOSES: (1) Are resident participation, postgraduate year (PGY) training level, and number of residents associated with absolute postoperative Patient-Reported Outcomes Measurement Information System (PROMIS-10) global physical function score (PCS), and achieving minimum clinically important difference (MCID) PCS improvement, after TKA? (2) Are resident participation, PGY, and number of residents associated with increased TKA operative time? (3) Are resident participation, PGY, and number of residents associated with increased length of stay after TKA? (4) Are resident participation, PGY, and number of residents associated with higher odds of patients being discharged to another inpatient facility, rather than to their home (facility discharge)? METHODS: We performed a retrospective study using a longitudinally maintained institutional registry of TKAs that included 1626 patients at a single tertiary academic institution from April 2011 through July 2016...
February 14, 2018: Clinical Orthopaedics and related Research
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