Background
A subgroup of patients undergoing TKA is unhappy with the outcome of surgery and preoperative psychological factors may play a role in their dissatisfaction.
Questions/purposes
We asked ...whether (1) psychological factors, as measured by preoperative self-reported questionnaires, predicted poor outcome after TKA, and (2) whether certain psychological factors examined predicted poor outcome better than others.
Methods
We performed a systematic review and meta-analysis of prospective observational studies published in MEDLINE, CINAHL
®
, EMBASE™, and PsycINFO
®
databases from their date of inception to October 2013, augmented with a manual search of bibliographies. Study eligibility was performed according to an a priori protocol. Included studies were assessed for quality according to the Newcastle-Ottawa scale. Two reviewers independently performed the search, identified eligible studies, assessed their methodologic quality, and extracted data. Outcomes of interest included postoperative dissatisfaction, pain, or limited function of the patients.
Results
A total of 19 studies (17 cohort studies and two cross-sectional surveys) containing data on 9046 TKAs performed in 8704 adult patients were included in the review. Mean patient age was 68 years and followup ranged from 6 to 60 months (mean study followup, 14 months). Clinical and methodologic heterogeneity in study design prevented the statistical pooling of data and subsequent meta-analysis. Dissatisfaction rates with TKA ranged from 7.5% to 28.3%. Psychological health was deemed a significant predictor of satisfaction, pain, or function at a minimum of 6 months after TKA in 16 studies. The remaining three studies did not find this relationship. Baseline mental health factors may affect patient satisfaction, their long-term perception of pain, and their motivation to return to the desired level of function. We were unable to determine the most relevant psychological states or the most appropriate way to assess them with our systematic review.
Conclusions
The preoperative psychological state of a patient may affect the outcome after a TKA. A comprehensive psychological assessment of patients is required to examine the long-term effect of such psychological factors on the eventual outcomes of TKA once the recovery phase is complete and to assess the effect that treatment for these psychological conditions may have on decreasing the dissatisfaction rate with TKA in this population.
Background
Studies have been conducted to determine 30‐day and 365‐day mortality rates after surgical procedures in different regions; however, there is a lack of data for mortality rates in New ...South Wales (NSW), Australia. The aim of this study was to determine 30‐day and 365‐day post‐operative mortality rates after selected common operations performed in NSW.
Methods
Using the Centre for Health Record Linkage, we linked the NSW Admitted Patient Data Collection with the NSW Registry of Births, Deaths and Marriages and Australian Bureau of Statistics to retrospectively calculate 30‐day and 365‐day post‐operative mortality rates for 21 selected surgical procedures between 2000 and 2009. One year (365 days) standardized mortality ratios, and proportion of public and private hospital admissions and mortality, were calculated for each procedure.
Results
Thirty‐day mortality was lower than in previous studies for femur fracture fixation (3.7%), cervical spine fusion (0.8%), prostatectomy (0.2%), coronary valve replacement (4.2%), pulmonary resection (2.5%), bariatric surgery (0.07%) and pancreaticoduodenectomy (6.2%). Thirty‐day mortality was higher than previously reported for abdominal aortic aneurysm (12.6%) and tonsillectomy (0.02%). One‐year mortality rates ranged from 0.2% for tonsillectomy and bariatric surgery, to 24.6% for hip fracture fixation.
Conclusions
Thirty‐day mortality rates in NSW are similar, if not lower for most procedures when compared with rates reported in other studies. The reported mortality rates for each procedure allow clinicians and patients to be more informed of surgical risks.
Gastric bypass surgery is an effective intervention to manage morbid obesity. However, there have been suggestions that patients who do not comply to follow-up lose less weight. This study evaluated ...the influence of patient’s follow-up compliance on weight loss post gastric bypass surgery. From the search of MEDLINE and EMBASE, four studies (
n
= 365) were identified and majority of these studies concluded that compliance with follow-up leads to increased weight loss. Our meta-analysis of these studies found increase in the percentage of excess weight loss (%EWL) at 1-year post gastric bypass surgery (mean difference 6.38 % %EWL, 95 % CI 1.68–11.15) when patients were compliant with follow-up. Therefore, this review found that continued long-term follow up of gastric bypass patients has the potential to increase postoperative weight loss.
Abstract
Background
Studies have been conducted to determine 30‐day and 365‐day mortality rates after surgical procedures in different regions; however, there is a lack of data for mortality rates in
...N
ew
S
outh
W
ales (
NSW
),
A
ustralia. The aim of this study was to determine 30‐day and 365‐day post‐operative mortality rates after selected common operations performed in
NSW
.
Methods
Using the
C
entre for
H
ealth
R
ecord
L
inkage, we linked the
NSW A
dmitted
P
atient
D
ata
C
ollection with the
NSW R
egistry of
B
irths,
D
eaths and
M
arriages and
A
ustralian
B
ureau of
S
tatistics to retrospectively calculate 30‐day and 365‐day post‐operative mortality rates for 21 selected surgical procedures between 2000 and 2009. One year (365 days) standardized mortality ratios, and proportion of public and private hospital admissions and mortality, were calculated for each procedure.
Results
Thirty‐day mortality was lower than in previous studies for femur fracture fixation (3.7%), cervical spine fusion (0.8%), prostatectomy (0.2%), coronary valve replacement (4.2%), pulmonary resection (2.5%), bariatric surgery (0.07%) and pancreaticoduodenectomy (6.2%). Thirty‐day mortality was higher than previously reported for abdominal aortic aneurysm (12.6%) and tonsillectomy (0.02%). One‐year mortality rates ranged from 0.2% for tonsillectomy and bariatric surgery, to 24.6% for hip fracture fixation.
Conclusions
Thirty‐day mortality rates in
NSW
are similar, if not lower for most procedures when compared with rates reported in other studies. The reported mortality rates for each procedure allow clinicians and patients to be more informed of surgical risks.
Background
Parents of children with cancer must learn and retain crucial information necessary to provide safe care for their child. Smartphone applications (apps) provide a significant opportunity ...to meet the informational needs of these parents. We aimed to develop, refine, and evaluate a smartphone app, informed by the Children's Oncology Group (COG) expert consensus recommendations, to support the informational needs of parents of children with cancer.
Procedure
We employed a user‐centered iterative mixed‐methods approach in two phases (prototype development/refinement and pilot testing). We engaged parents and clinicians in evaluating the app via qualitative interviews and standardized tools that measured app quality (Mobile Application Rating Scale MARS), usability (System Usability Scale SUS), and acceptability (System Acceptability Scale SAS). We evaluated early usage patterns after public release.
Results
Thirty‐two parents and 17 clinicians participated. Mean (± standard deviation SD) scores for app quality, usability, and acceptability were: MARS: 4.5 ± 0.7 on a 5‐point scale; SUS: 86.7 ± 23.8 on a 100‐point scale; and SAS: superior (61%); similar (28%); inferior (11%) to written materials. Qualitative findings largely confirmed the quantitative data. Downloads of the app during the first year following public release have exceeded 5000.
Conclusions
The COG KidsCare app prototype was found to be of high quality and received high usability and acceptability ratings. Further testing is needed to determine app effectiveness in improving parental knowledge regarding care of children with cancer.
Introduction
Artificial intelligence (AI) and neuroimaging offer new opportunities for diagnosis and prognosis of dementia.
Methods
We systematically reviewed studies reporting AI for neuroimaging in ...diagnosis and/or prognosis of cognitive neurodegenerative diseases.
Results
A total of 255 studies were identified. Most studies relied on the Alzheimer's Disease Neuroimaging Initiative dataset. Algorithmic classifiers were the most commonly used AI method (48%) and discriminative models performed best for differentiating Alzheimer's disease from controls. The accuracy of algorithms varied with the patient cohort, imaging modalities, and stratifiers used. Few studies performed validation in an independent cohort.
Discussion
The literature has several methodological limitations including lack of sufficient algorithm development descriptions and standard definitions. We make recommendations to improve model validation including addressing key clinical questions, providing sufficient description of AI methods and validating findings in independent datasets. Collaborative approaches between experts in AI and medicine will help achieve the promising potential of AI tools in practice.
Highlights
There has been a rapid expansion in the use of machine learning for diagnosis and prognosis in neurodegenerative disease
Most studies (71%) relied on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset with no other individual dataset used more than five times
There has been a recent rise in the use of more complex discriminative models (e.g., neural networks) that performed better than other classifiers for classification of AD vs healthy controls
We make recommendations to address methodological considerations, addressing key clinical questions, and validation
We also make recommendations for the field more broadly to standardize outcome measures, address gaps in the literature, and monitor sources of bias
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