Adults treated surgically for lumbar disc herniation in adolescence have a higher degree of lumbar disc degeneration than controls. We aimed to establish whether the degree of lumbar degeneration ...differs at diagnosis or at follow-up between surgically and non-surgically treated individuals.
We identified individuals with a lumbar disc herniation in adolescence diagnosed with magnetic resonance imaging (MRI) and contacted them for follow-up MRI. Lumbar degeneration was assessed according to Pfirrmann, Modic, and total end plate score (TEP score). Patient-reported outcome measures at follow-up comprised the Oswestry Disability Index (ODI), EQ-5D-3-level version, 36-Item Short Form Health Survey (SF-36), and Visual Analogue Scale (VAS) for back and leg pain. Fisher's exact test, Mann-Whitney U tests, Wilcoxon tests, and logistic regression were used for statistical analysis.
MRIs were available at diagnosis and after a mean of 11.9 years in 17 surgically treated individuals and 14 non-surgically treated individuals. Lumbar degeneration was similar at diagnosis (P = 0.2) and at follow-up, with the exception of higher TEP scores in surgically treated individuals at levels L4-L5 and L5-S1 at follow-up (P ≤ 0.03), but this difference did not remain after adjustment for age and sex (P ≥ 0.8). There were no significant differences in patient-reported outcome measures between the groups at follow-up (all P ≥ 0.2).
Adolescents with a lumbar disc herniation have, irrespective of treatment, a similar degree of lumbar degeneration at the time of diagnosis, and similar lumbar degeneration and patient-reported outcomes at long-term follow-up.
In many pain conditions, there is lingering pain despite healed tissue damage. Our previous study shows that individuals who underwent surgery for lumbar disk herniation (LDH) during adolescence have ...worse health, more pain, and increased disk degeneration mean 13 years after surgery compared with controls. It is unclear if walking patterns segregate surgically treated LDH adolescents and controls at mean 13-year follow-up.
Here, we analyzed the relationship between gait, back morphology and other health outcomes in a cohort of individuals treated surgically because of lumbar disk herniation compared with controls.
We analyzed gait during a walking paradigm, back morphology at the site of surgery, and standardized health outcomes, among individuals who received surgery for LDH as adolescents, "cases" (n = 23), compared with "controls" (n = 23).
There were gait differences in head (
= 0.021) and trunk angle (
= 0.021) between cases and controls in a direction where cases exhibited a posture associated with sickness. The gait variance was explained by subjective pain and exercise habits rather than objective disk degeneration.
Over a decade after surgery for LDH during adolescence, health among cases is worse compared with controls. The head and trunk angles differ between cases and controls, indicating that the residual pain lingers and may cause changes in movement patterns long after a painful episode in early life. Gait may be a useful target for understanding maintenance of pain and disability among individuals treated surgically for LDH during adolescence.
Persistent pain is a common and disabling health problem that is often difficult to treat. There is an increasing interest in medicinal cannabis for treatment of persistent pain; however, the limited ...superiority of cannabinoids over placebo in clinical trials suggests that positive expectations may contribute to the improvements.
To evaluate the size of placebo responses in randomized clinical trials in which cannabinoids were compared with placebo in the treatment of pain and to correlate these responses to objective estimates of media attention.
A systematic literature search was conducted within the MEDLINE and Embase databases. Studies published until September 2021 were considered.
Cannabinoid studies with a double-blind, placebo-controlled design with participants 18 years or older with clinical pain of any duration were included. Studies were excluded if they treated individuals with HIV/AIDS or severe skin disorders.
The study followed the Preferred Reporting Items for Systematic Review and Meta-analyses reporting guideline. Data were extracted by independent reviewers. Quality assessment was performed using the Risk of Bias 2 tool. Attention and dissemination metrics for each trial were extracted from Altmetric and Crossref. Data were pooled and analyzed using a random-effects statistical model.
Change in pain intensity from before to after treatment, measured as bias-corrected standardized mean difference (Hedges g).
Twenty studies, including 1459 individuals (mean SD age, 51 7 years; age range, 33-62 years; 815 female 56%), were included. Pain intensity was associated with a significant reduction in response to placebo, with a moderate to large effect size (mean SE Hedges g, 0.64 0.13; P < .001). Trials with low risk of bias had greater placebo responses (q1 = 5.47; I2 = 87.08; P = .02). The amount of media attention and dissemination linked to each trial was proportionally high, with a strong positive bias, but was not associated with the clinical outcomes.
Placebo contributes significantly to pain reduction seen in cannabinoid clinical trials. The positive media attention and wide dissemination may uphold high expectations and shape placebo responses in future trials, which has the potential to affect the outcome of clinical trials, regulatory decisions, clinical practice, and ultimately patient access to cannabinoids for pain relief.
Supply chain finance (SCF) can improve supply chain performance by facilitating longer payment terms for buyers and better access to financing for suppliers. In spite of these clear benefits, there ...is empirical evidence for some hesitation and resistance to SCF adoption, manifesting in an often substantial time lag between a buyer's introduction of SCF and its adoption by all targeted suppliers. Observed adoption processes often resemble the s-shaped Bass-curve suggesting that successful early adoptions support adoption decisions by other suppliers. Based on these observations, we consider supplier SCF adoption decisions within a diffusion model, to obtain insights regarding a buyer's optimal SCF introduction decisions in terms of timing and payment terms. We find that initial payment terms and procurement volume strongly affect the optimal timing of SCF introduction and optimal payment term extensions. The degree to which the buyer can influence suppliers in their adoption decisions affects the optimal introduction timing, but not optimal payment terms. Interestingly, our results suggest that, in spite of the clear benefits, many buyers might be well-advised to postpone their SCF implementations.
The aim of this study was to develop a short questionnaire measuring health‐related quality of life (HRQoL) in chronic wounds. Three validated instruments assessing HRQoL in chronic wounds—the ...Freiburg Life Quality Assessment for wounds, the Cardiff Wound Impact Schedule, and the Würzburg Wound Score—were completed by 154 German leg ulcer patients in a longitudinal study. For implementation in the new, shorter questionnaire Wound‐QoL, all of those 92 items that covered the core content of the three questionnaires and showed good psychometric properties were selected. Internal consistency, convergent validity, and responsiveness were analyzed using the study data on the selected items (a new approach called virtual validation). Subscales were determined with factor analysis. Item, instruction, and response scale wording were harmonized. Seventeen items were included in the Wound‐QoL, which could be attributed to three subscales on everyday life, body, and psyche. Both global score and subscale scores were internally consistent with Cronbach's alpha between 0.71 and 0.91. The global score showed significant convergent validity (r = 0.48 to 0.69) and responsiveness (r = 0.18 to 0.52); the same was true for the subscale scores. The Wound‐QoL for measurement of HRQoL in chronic wounds proved to be internally consistent, valid, and responsive in German leg ulcer patients. The findings of this virtual validation study need to be confirmed in a longitudinal validation study on the final Wound‐QoL, which is currently being conducted.
: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In ...this article, we examine the synthetic epidermal skin substitute Suprathel
as a substitute in the treatment of partial thickness burns.
: A systematic review following the PRISMA guidelines has been performed. Sixteen Suprathel
and 12 porcine xenograft studies could be included. Advantages and disadvantages between the treatments and the studies' primary endpoints have been investigated qualitatively and quantitatively.
: Although Suprathel had a nearly six times larger TBSA in their studies (
< 0.001), it showed a significantly lower necessity for skin grafts (
< 0.001), and we found a significantly lower infection rate (
< 0.001) than in Porcine Xenografts. Nonetheless, no significant differences in the healing time (
= 0.67) and the number of dressing changes until complete wound healing (
= 0.139) could be found. Both products reduced pain to various degrees with the impression of a better performance of Suprathel
on a qualitative level. Porcine xenograft was not recommended for donor sites or coverage of sheet-transplanted keratinocytes, while Suprathel
was used successfully in both indications.
: The investigated parameters indicate that Suprathel
to be an effective replacement for porcine xenografts with even lower subsequent treatment rates. Suprathel
appears to be usable in an extended range of indications compared to porcine xenograft. Data heterogeneity limited conclusions from the results.
Chronic wounds have a major socioeconomic impact due to their frequency, chronicity, and societal costs. Patients experience substantial quality of life (QoL) impairments. The use of questionnaires ...for a continuous assessment of QoL and resulting interventions to improve the situation of the individual are an important cornerstone of a guideline‐based wound care. The aim of this study was to investigate the validity of the Wound‐QoL questionnaire. Patients with chronic wounds from two different centers were included in the prospective study. All patients completed the Wound‐QoL and two other QoL questionnaires (European Quality of Life‐5 Dimensions, EQ‐5D, and Freiburg Life Quality Assessment for wounds, FLQA‐wk) at baseline and at two more time points (4 and 8 weeks, respectively). Wound status was defined with an anchor question. Two hundred and twenty‐seven patients (48.5% women) participated in the study. Mean age was 66.9 years (range 17–96, median 69.5). Indications were venous leg ulcers (40.1%), pyoderma gangraenosum (14.1%), diabetic or ischemic foot ulcers (5.3%), pressure ulcers (2.6%), and other etiologies (30.0%). The Wound‐QoL showed good internal consistency, with high Cronbach's alpha in all the subscales and in the global scale in all time points (>0.8). Convergent validity was satisfactory since there were significantly (p ≤ 0.001) good correlations with the EQ‐5D (range = 0.5–0.7) and FLQA‐wk global score (r > 0.8) at every time point. Responsiveness was high, too. The Wound‐QoL is a simple, valid tool for the longitudinal assessment of QoL in patients with chronic wounds. This questionnaire is suitable for use in clinical trials, quality of care studies and clinical routine.
Background
The aim of this study was to develop and validate a short and feasible questionnaire to measure health-related quality of life (HRQoL) in patients with peripheral artery disease (PAD). The ...content of the new instrument is intended to correspond with the simultaneously developed instrument Patient Benefit Index for PAD (PBI-PAD), which evaluates treatment goals and benefits in this patient group.
Methods
Fifty patients stated their disease burden on free-text questionnaires, which was used by an interdisciplinary expert panel to develop 12 items for the new instrument, named Quality of Life questionnaire for patients with peripheral artery disease (QOLPAD). The validity of the instrument was tested in patients from Germany with PAD stages I to IV who completed the QOLPAD, EuroQol questionnaire (EQ-5D-3L; EuroQol visual analogue scale (EQ VAS)), and Vascular Quality of Life questionnaire (VascuQoL) before (baseline) and three months after (follow-up) treatment.
Results
One hundred and three patients were included at baseline (mean age: 68.6 years; 68% male), among whom, 57 provided data at follow-up. Most patients (86.4%) rated the completion of QOLPAD as being easy. Internal consistency was satisfactory, with a Cronbach’s alpha of 0.74 (baseline) and 0.84 (follow-up). Convergent validity was indicated by significant correlations with the EQ-5D-3L (baseline: − 0.62; follow-up: − 0.81), EQ VAS (baseline: − 0.44, follow-up: − 0.79), VascuQoL global score (baseline: − 0.77; follow-up: − 0.87), global rating of impairment (baseline: 0.64; follow-up: 0.71), and PAD stage (baseline: 0.40; follow-up: 0.67). Sensitivity to change was confirmed by significant correlations of change in the QOLPAD with changes in convergent criteria; however, the high number of dropouts limits the generalizability of this finding.
Conclusion
This study provided evidence that the QOLPAD is internally consistent and valid in patients receiving treatment for PAD in Germany.
VReanimate II: training first aid and reanimation in virtual reality Bucher, Kristina; Blome, Tim; Rudolph, Stefan ...
Journal of computers in education (the official journal of the Global Chinese Society for Computers in Education),
03/2019, Letnik:
6, Številka:
1
Journal Article
Recenzirano
First aid saves lives and reanimation is an important part of it. In order to be able to perform the correct steps in emergency situations, appropriate behaviors must be learned and trained by as ...many people as possible. Nevertheless, easily accessible training opportunities are quite rare. We therefore developed a virtual reality (VR) application,
VReanimate
, that teaches about aspects of first aid in a controlled digital environment. In the first part of this article, we describe related work and conceptual and implementation details of our approach, that is based on a non-textual and situated training in authentic scenarios. In the second part of this article, we present an evaluation of the system, including results concerning its usability and effects on the knowledge gain of different users. Conducting a mixed methods study, we were able to observe a significant improvement in regard to knowledge about correct procedures in emergency situations and could confirm our hypothesis, that a non-textual and situated design can be helpful for this purpose.
PDF
