Search Results (580)

Nurse practitioners (NPs) are increasingly integrated into surgical care teams, complementing traditional surgical roles. However, the relationship between their involvement and patient-reported outcome measures (PROMs), such as pain and anxiety, remains understudied. Purpose: To examine the types of care from NPs in surgical units during the perioperative period and evaluate their association with length of stay, pain, and anxiety. Methods: Our prospective comparative study in two surgical units at a tertiary medical center included 315 patients: 156 received care from NPs, and 159 received usual care. Data were collected at three time points: post-operative day one (T0), during hospitalization (T1), and 14 days post-discharge (T2). Measures included the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, and an intervention checklist completed by the NPs. Findings: NPs performed primarily in-hospital interventions including care coordination (40%) and medication management (44%). Patients treated by NPs reported significantly lower in-hospital anxiety compared to usual care (p = 0.001). The length of stay and pain levels were not significantly associated with NP care. Discussion: NPs in surgical settings provide patient-centered care associated with lower in-hospital anxiety. Further research is recommended to validate these findings in diverse settings. Full article

Background and Objectives: Breast reconstruction after mastectomy has been shown to significantly improve psychosocial wellbeing and quality of life. Enhanced Recovery After Surgery (ERAS) protocols, especially those tailored to breast reconstruction, have revolutionized recovery by reducing complications, pain, opioid use, and hospital stay while improving patient satisfaction. The purpose of this narrative review was to present existing practices and supporting evidence within current ERAS protocols, as well as propose a modern ERAS framework centered around enhancing the patient experience following breast reconstruction. Methods: A focused literature search was conducted to identify studies investigating emerging approaches to patient care and surgical techniques adopted as part of a broader ERAS workflow Results: Some recent innovations include digital ERAS tracking, robot-assisted techniques, neurotization, and closed incision negative pressure therapy (ciNPT). These innovations show promise in reducing morbidity following reconstruction and may greatly improve sensory and functional outcomes. These advancements also reflect a shift toward more holistic, patient-centered care, extending beyond immediate clinical needs to address long-term wellbeing through psychosocial support and patient-reported outcome measures. Incorporating tools that validate patient perspectives helps guide interventions to optimize satisfaction and recovery. Conclusions: Future research should aim to standardize ERAS protocols by incorporating evidence-based practices, reinforcing breast reconstruction as a patient-centered, evidence-driven process that is focused on comprehensive recovery and improved quality of life. Full article

Background/Objectives: Avascular necrosis of the femoral head is a debilitating condition that, if left untreated, leads to progressive arthritis necessitating total hip replacement (THR). In the younger adult population, there is a drive towards joint-preserving procedures, particularly where alternative techniques such as core decompression or vascularised bone grafting are anticipated to fail. Proximal femoral osteotomy is a technique that aims to remove the necrotic segment from the weight bearing area. The presented review aims to examine the efficacy of this technique in the management of avascular necrosis of the femoral head, reporting both rates of conversion to total hip replacement and patient reported outcomes. Methods: This systematic review was conducted according to PRISMA guidelines. A search was conducted of PubMed, Ovid Medline, EMBASE, and the Cochrane Library using pre-defined search terms. Data were extracted, and descriptive data presented. Quality of each study was assessed using the NIH quality assessment tool for case series studies. Results: Fifty-three studies with data for 2686 osteotomies are presented. Progression of radiological arthrosis was present in 40% of cases, with 20.3% of patients having undergone conversion to THR at a mean of 75.4 months (range 20–132 months). Patient-reported outcome measures were recorded in 1416 patients, of which the Harris Hip Score was the most commonly utilised. This score improved from a mean of 58.3 to 84.4 at a mean follow-up of 102 months. Conclusions: Osteotomy represented a valid head-preserving technique in the armamentarium against avascular necrosis of the femoral head, with conversion to THR required in 20.3% of patients at 7 years. In those patients who did not require THR, PROMS were similar to the arthroplasty population. Full article

Objective: Hearing rehabilitation using hearing aids keeps increasing in the general population. Patient-related outcome measures are essential to evaluate benefits. Although the IOI-HA is routinely used in France, its translated version from 2002 has never been validated. This study aimed to assess the psychometric properties of the French version of the IOI-HA questionnaire. Design: Controlled, prospective, monocentric study performed between February 2024 and January 2025. The forward–backward technique was used for translation of the questionnaire. Study Sample: 100 patients fitted with hearing aids completed the questionnaire. Thirty-five patients were retested 15 days after first completion. Results: Internal consistency, assessed by Cronbach’s alpha, was 0.863. Mean IOI-HA item scores ranged from 3.3 to 4.57. All seven items had a high degree of consistency with the total score, except for item Q1 which had a moderate score (0.45). Cronbach’s alpha after item deletion confirmed internal consistency. Intra-class correlation coefficients ranged from 0.622 (Q7) to 0.767 (Q5) and were all statistically significant (p < 0.001), revealing high reliability over time. No significant correlation was found between item scores and age, unilateral or bilateral hearing aid use or accompanying symptoms (tinnitus, dizziness). Conclusions: The French translation of the IOI-HA questionnaire, published in 2002, is a valid and reliable questionnaire evaluating hearing aid satisfaction. This validated questionnaire can now be used in daily clinical practice. Full article

Study Design: Prospective observational study. Background: Lumbar spinal stenosis (LSS) impairs balance and gait function, increasing fall risk and limiting quality of life. Although postoperative recovery of balance is clinically important, longitudinal data using multidimensional balance assessments are limited. Methods: A prospective cohort study was conducted in 101 patients (mean age 74.9 ± 6.9 years) undergoing surgery for LSS. The Brief Balance Evaluation Systems Test (Brief BESTest), Oswestry Disability Index (ODI), Modified Falls Efficacy Scale (MFES), Zurich Claudication Questionnaire (ZCQ), and Visual Analog Scales (VAS) for pain/numbness were evaluated preoperatively and at 6 and 12 months postoperatively. Changes over time and correlations between Brief BESTest and PROMs were analyzed. Results: The total Brief BESTest score significantly improved from 13.3 ± 5.3 preoperatively to 16.1 ± 5.1 at 6 months and 16.0 ± 5.1 at 12 months (p < 0.01). Subdomains including Anticipatory Adjustments, Postural Responses, Sensory Orientation, and Stability in Gait improved significantly, while Stability Limits did not. At 12 months postoperatively, ODI decreased by 19.1%, ZCQ symptom and function scores improved by 0.8 and 0.9 points, respectively, and VAS scores improved by 17.1 mm for low back pain, 26.5 mm for lower limb pain, and 19.5 mm for numbness, all showing marked improvements from baseline. MFES also increased significantly postoperatively. The Brief BESTest score correlated significantly with MFES and ZCQ-PFS at baseline, and with ODI, ZCQ, and VAS scores at 12 months. Conclusions: Balance ability in LSS patients improved after surgery, as measured by the Brief BESTest, with clinically meaningful changes maintained for 12 months. Improvements in balance were significantly associated with reductions in pain, disability, and fear of falling, suggesting the Brief BESTest is a comprehensive indicator of postoperative recovery. Full article

Background/Objectives: This study aimed to assess the long-term clinical performance of full-arch fixed restorations made of fiber-reinforced composite (FRC) supported by four ultra-short implants (4.0 × 5.0 mm) in patients with edentulous, atrophic mandibles. Methods: Ten patients were treated at Sapienza University of Rome and monitored over a 10-year period. Each case involved the placement of four plateau-design implants with a pure conometric connection and a calcium phosphate-treated surface. The final prostheses were fabricated using CAD/CAM-milled Trinia^® fiber-reinforced composite frameworks. Clinical parameters included implant and prosthesis survival, marginal bone level (MBL), peri-implant probing depth (PPD), and patient-reported outcome measures (PROMs). Results: Implant and prosthesis survival reached 100% over the 10-year follow-up. MBL data showed a minor bone gain of approximately 0.11 mm per 5 years (p < 0.0001). PPD remained stable under 3 mm, with a minimal increase of 0.16 mm over the same period (p < 0.0001). PROMs reflected sustained high patient satisfaction. No technical complications, such as chipping or framework fracture, were observed. Conclusions: Rehabilitation of the edentulous mandible with ultra-short implants and metal-free FRC prostheses proved to be a minimally invasive and long-lasting treatment option. The 10-year follow-up confirmed excellent implant and prosthetic outcomes, favorable peri-implant tissue health, and strong patient satisfaction. Nonetheless, further studies with larger sample sizes are needed to confirm these encouraging results and strengthen the clinical evidence. Full article

Background and Objectives: Specialized nurses play an essential role in managing pulmonary fibrosis. While tele-nursing has the potential to optimize disease management, current evidence regarding its impact remains limited. This study aimed to evaluate a tele-nursing intervention that provided unscheduled access to a specialized nurse via phone or email for both patients and caregivers. Materials and Methods: This was a prospective, single-center, open-label, and pre–post pilot study. Participants and their caregivers were provided with direct access to a specialized nurse, by phone and email, for unscheduled consultations. Patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) were collected at baseline and after three months of tele-nursing access. PREMs were assessed using a 10-point Likert scale questionnaire, and PROMs were evaluated using the King’s Brief Interstitial Lung Disease (K-BILD) and the Living with Pulmonary Fibrosis (L-PF) questionnaires. Results: A total of 47 patients with pulmonary fibrosis receiving antifibrotic drugs were enrolled. At three months, 44 patients and 34 caregivers completed the questionnaires. Four patients did not complete the study due to death, lung transplantation, or transition to end-of-life care. No significant changes were observed in PROMs. However, PREMs showed significant improvements, with most scores exceeding 9/10. Patient satisfaction increased by 28% (p < 0.001), and caregiver satisfaction by 30% (p < 0.001). Caregivers of patients who did not complete the study also reported high satisfaction, comparable to that of other caregivers. Conclusions: A pragmatic and affordable tele-nursing program, based on direct phone and email consultations, may enhance patient and caregiver satisfaction in the management of pulmonary fibrosis. Full article

Objective: To compare the effect of different bone augmentation procedures, namely, autogenous bone blocks (ABBs) versus guided bone regeneration (GBR), on patient-reported outcomes (PROMs). Methods: This systematic review was conducted according to the PRISMA guidelines. A MEDLINE, Embase, and Web of Science search was conducted by two independent reviewers in combination with a free-hand search in relevant journals until June 2025. Outcomes were PROMs to enhance our understanding of the evolution of these procedures. Results: The electronic search yielded 6291 articles. After title screening, 67 articles were further analyzed for abstract review, which resulted in 14 articles eligible for full-text reading. Six articles were finally included based on the exclusion and inclusion criteria with a total of 295 patients. The overall study quality was low, since only two RCTs could be included. One study demonstrated a high risk of bias. Different PROMs were examined and compared such as pain, edema, neurosensory disturbance, Patient-Reported Predominant Symptom, OHIP-14, postoperative analgesic usage, willingness to repeat, and likelihood to recommend. Meta-analysis was not achievable due to a lack of direct comparisons and heterogeneity in terms of PROMs. Evaluation points varied between pretreatment and up to nearly 10-years of follow-up. Conclusions: Despite significant heterogeneity and reporting, this systematic review concluded that ABB and GBR are well-tolerated procedures. Trends such as transient postoperative pain and swelling with a minor occurring of neurosensory disturbances were reported in a few studies. Overall, a good perception of postoperative recovery was reported for both treatment modalities. Good quality of life was noted related to GBR procedures. Patient-reported outcomes were only analyzed for patients who completed the entire follow-up period. This may introduce bias, as patients who dropped out and were more likely to experience complications were not represented, potentially resulting in a more favorable portrayal of the outcomes. Further well-conducted prospective studies with a long follow-up are needed for an evidence-based evaluation and comparison of PROMs for these procedures. Full article

Background/Objectives: Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life. Research has focused largely on older women, while experiences of younger women remain relatively underexplored despite challenges unique to this population. Informed by the biopsychosocial model of illness, this study aims to assess the symptom burden, treatment goals, and information needs of younger women complaining of prolapse by analyzing questionnaire responses from an existing electronic Personal Assessment Questionnaire—Pelvic Floor (ePAQ-PF) dataset. Methods: Mixed-methods content analysis was conducted using free-text data from an anonymized multi-site ePAQ-PF dataset of 5717 responses collected across eight UK NHS trusts (2018–2022). A quantitative, deductive approach was first used to identify younger women (≤50 years old) with self-reported prolapse. ePAQ-PF scores for younger women with prolapse were compared with those aged >50 years, using Mann–Whitney tests. Free-text response data were analyzed inductively to qualitatively explore younger women’s symptom burden, treatment goals, and information needs. Results: Of the 1473 women with prolapse identified, 399 were aged ≤50 years. ePAQ-PF scores of the younger cohort demonstrated significantly greater symptom severity and bother than those aged >50, particularly in bowel, prolapse, vaginal, body image, and sexual health domains (p < adjusted threshold). Qualitative analysis undertaken to understand women’s concerns and priorities produced five health-related themes (physical health; functionality; psychosocial and emotional wellbeing; reproductive and sexual health; and healthcare journeys) and a sixth intersecting theme representing information needs. Conclusions: The findings highlight the substantial symptom burden of younger women with prolapse, as well as treatment goals and information needs specific to this population. The development of age-specific resources is identified as a requirement to support this group. Full article

Background: The transapical off-pump NeoChord procedure is a recognized minimally invasive surgical approach for the treatment of severe degenerative mitral regurgitation. This study aims to report the initial Greek experience with the NeoChord procedure, presenting mid-term clinical and echocardiographic outcomes from a single cardiothoracic surgical center, with a median follow-up duration of 20 months. Methods: In this study, 42 symptomatic patients with moderate to severe and severe primary mitral regurgitation underwent mitral valve repair with the Neochord procedure between March 2018 and December 2024. All patients were evaluated clinically and echocardiographically by the Heart team preoperatively, after 1 month, and at the last follow-up (end of 2024). The primary endpoint was established as the presence of a major clinical event (all-cause mortality, reintervention due to deterioration of MR, and cardiac-related rehospitalization). Results: The median age of patients was 69 [61.75–79.25] years, and 69% of patients were men. The median EuroScore II was 1.79 [1.32–2.48], and the STS-PROM MV repair score was 3.18 [2.28–4.66]. Regarding the preprocedural mitral valve anatomical evaluation, 35 patients had type A (83.3%),4 had type B(9.5%), whereas only two patients had type C and 1 with type D anatomy. The median of LAI was 1.2 [1.15–1.25], whereas the CI was 4 [2.15–5]. More than two neochordae were implanted in 34 patients (81%). MR severity improved at 1-month (<moderate:92.85%) and at the last follow-up (<moderate:92.1%). NYHA class decreased within 1 month (I + II: 95.23%) after the procedure and was maintained at the last follow-up (I + II: 94.73%). The median left ventricular ejection fraction (LVEF) before the procedure was 63 [58–67]%, which significantly decreased to 57 [53–61]% at the 1-month follow-up (2-sided p < 0.001). At the final follow-up, LVEF increased to 65 [60–68]%, however, this change was not statistically significant compared to the preprocedural value. During the follow-up period, four deaths were documented—three due to non-cardiac and one attributable to a cardiac cause. Two cases proceeded to reoperation for surgical valve implantation due to recurrent mitral valve regurgitation 6 months and 8 months after the NeoChord procedure. Conclusions: Transapical off-pump NeoChord implantation offers a minimally invasive alternative to conventional surgery for symptomatic patients with moderate-to-severe or severe primary mitral regurgitation. Among patients with suitable mitral valve anatomy, the procedure has demonstrated a favorable safety profile and promising mid-term outcomes, in terms of cardiac mortality, as well as freedom from reoperation and rehospitalization. Full article

Background: Histologic chorioamnionitis (HCA) is a placental inflammatory condition characterized by neutrophilic infiltration of the fetal membranes, often occurring without overt clinical signs or symptoms. Risk factors include prolonged labor, premature rupture of membranes (PROM) exceeding 12 h, nulliparity, labor dystocia, and lower socioeconomic status. Although HCA frequently presents as a subclinical condition, its early diagnosis remains challenging. Nevertheless, HCA is associated with an increased risk of maternal and neonatal morbidity, including early-onset neonatal sepsis, cerebral palsy, and long-term neurodevelopmental impairment. We report the case of a 29-year-old primigravida at 40 + 0 weeks of gestation, admitted for decreased fetal movements. Discussion: Cardiotocographic (CTG) monitoring revealed a “zigzag pattern” in the absence of maternal fever, leukocytosis, or tachycardia. Due to the CTG findings suggestive of possible fetal compromise, in addition to reduced fetal movements, an emergency cesarean section was performed. Intraoperative findings included heavily meconium-stained amniotic fluid, then the examination of the placenta confirmed acute HCA with a maternal inflammatory response, without evidence of fetal inflammatory response. Conclusion: This case highlights the crucial role of CTG abnormalities, particularly the “zigzag pattern,” as an early marker of subclinical intrauterine inflammation. Early recognition of such patterns may facilitate timely intervention and improve perinatal outcomes in cases of histologic chorioamnionitis. Full article

Background/Objectives: Colorectal cancer (CRC) patients undergoing chemotherapy often experience anemia, oxidative stress, and immune suppression, significantly impacting their quality of life and treatment outcomes. Normobaric oxygen (NBO) therapy, which delivers oxygen at atmospheric pressure with an elevated oxygen concentration, has shown the potential to enhance erythropoiesis, reduce oxidative stress, and modulate immune function. However, its efficacy in CRC patients remains underexplored. This study aims to evaluate the effects of NBO exposures on (1) supporting erythropoiesis by measuring erythropoietin (EPO) levels and hypoxia-inducible factor 1-alpha (HIF-1α), (2) reducing oxidative stress and improving stress and emotional well-being, and (3) modulating immune function by assessing cytokine profiles. Secondary objectives include assessing the impact of NBO on patient-reported outcome measures (PROMs) such as stress, anxiety, depression, and quality of life. Methods: This is a prospective, randomized, double-blind, placebo-controlled clinical trial. A total of 254 CRC patients undergoing chemotherapy will be randomized 1:1 to receive either active NBO therapy (n = 127, study group) or placebo NBO therapy (n = 127, control group). The intervention will consist of 10 NBO sessions over five weeks. Primary outcomes include biomarkers of erythropoiesis, oxidative stress, and immune response. Secondary outcomes assess quality of life and psychological well-being. Data will be collected at baseline, mid-intervention, post-intervention, and during two follow-up visits (3 and 6 months post-intervention). Results: The study hypothesizes that NBO therapy will improve erythropoiesis, reduce oxidative stress, and enhance immune function in CRC patients, leading to improved quality of life and clinical outcomes. Conclusions: Findings from this trial may establish NBO as a novel supportive therapy for CRC patients undergoing chemotherapy. Full article

To compare the clinical characteristics of inherited retinal diseases (IRDs) caused by biallelic versus monoallelic variants in the RP1, BEST1, and PROM1 genes. A total of 52 patients (26 female) with genetically confirmed IRDs were retrospectively selected from the records of the Harkness Eye Institute Clinical Coordinating Center at Columbia University Irving Medical Center. In RP1, 3 individuals with biallelic variants and 22 patients with monoallelic variants classified as pathogenic or likely pathogenic were selected. In BEST1, eight individuals with biallelic variants and nine individuals with monoallelic variants classified as either pathogenic or likely pathogenic were included. In PROM1, four individuals with biallelic variants and six patients with monoallelic variants classified as pathogenic or likely pathogenic were selected. All patients underwent multimodal retinal imaging and, when available, full-field electroretinography (ffERG). In all three genes, individuals with biallelic variants had markedly earlier disease onset and more severe phenotypes. In RP1, on SD-OCT, foveal involvement was observed in all biallelic cases (3/3, 100%) and in 4/22 (18%) monoallelic cases. In BEST1, the average age of onset in the biallelic cohort was 7.12 years, and the average age was 32.7 years in the monoallelic cohort. Four of eight (50%) patients in the biallelic group were additionally found to have widespread serous lesions outside of the central macula. This finding was not observed in the monoallelic group. Three of eight (38%) biallelic BEST1 patients had moderate reductions in their photopic flicker. All monoallelic BEST1 patients had photopic responses within the normal range. PROM1 biallelic cases showed severe functional impairment on ffERG, while most monoallelic cases retained normal responses. In the biallelic cohort, four of four (100%) of patients had severely attenuated or extinguished photopic responses. In the monoallelic PROM1 group, four of five (80%) monoallelic PROM1 patients had normal photopic responses, and P2-2 had mildly attenuated photopic responses. Individuals with biallelic variants exhibited earlier disease onset, more severe retinal degeneration, and significantly reduced retinal function compared with those with monoallelic variants. These observations highlight the role of loss-of-function mechanisms in more aggressive disease courses and underscore the importance of considering zygosity when determining prognosis and planning gene-based therapies. Full article

The COVID-19 pandemic exposed the urgent need for scalable, reliable telemedicine tools to manage mild cases remotely and avoid overburdening healthcare systems. This study evaluates StepCare, a remote monitoring medical device, during the first pandemic wave at a single center in Spain. Among 35 patients monitored, StepCare showed high clinical reliability, aligning with physician assessments in 90.4% of cases. Patients and clinicians reported excellent usability and satisfaction. The system improved workflow efficiency, reducing triage time by 25% and associated costs by 84%. These results highlight StepCare’s value as a scalable, patient-centered solution for remote care during health crises. Full article

Tooth wear is a growing oral health concern with implications for function, esthetics, and psychological well-being, ultimately affecting oral health-related quality of life (OHRQoL). While clinical indices assess tooth wear severity, they fail to capture patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). This narrative review aims to identify and synthesize the use of PROs and PROMs used in adults with tooth wear and to map their assessed domains against the Wilson and Cleary model of health outcomes, highlighting gaps and guiding the development of condition-specific instruments. A comprehensive search of the literature was conducted across PubMed, MEDLINE, and Embase. Studies involving PROMs in adults with tooth wear were included. Extracted data encompassed psychometric properties and domains assessed. PROMs such as the OHIP, OES, OIDP, and QMFQ have been frequently used, focusing on functional limitation, esthetic perception, and psychological distress. However, no single instrument comprehensively addresses all relevant domains of the Wilson and Cleary model. Moreover, variation in tools and constructs limits comparability across studies and clinical settings. Existing PROMs capture only partial aspects of the patient experience related to tooth wear. When mapping these instruments to a validated theoretical model, significant gaps become evident, especially in terms of general health perceptions and overall quality of life metrics. To improve the evaluation and management of tooth wear in clinical settings, it is essential to create a condition-specific PROM based on a solid conceptual framework. Full article