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Risk factors for mortality in 600 patients in vegetative and minimally conscious states.

A significant proportion of patients who survive traumatic or nontraumatic severe acquired brain injuries experiences disorders of consciousness. The vegetative state and the minimally conscious state may have different prognoses, and while some patients regain awareness, others have negative outcomes and die. The aim of this work is to identify age-related, medical and behavioural risk factors for mortality in those patients. Participants were enrolled from June 2009 to March 2012 in 107 Italian health care institutions. Univariate and multivariate Cox proportional hazard models were adopted

Association of Preoperative Tibial Varus Deformity With Joint Line Orientation and Clinical Outcome After Open-Wedge High Tibial Osteotomy for Medial Compartment Osteoarthritis: A Propensity Score-Matched Analysis.

BACKGROUND: The correction of lower limb deformity should be performed at the site of deformity to maintain knee joint orientation. However, … en the groups. The proportions of patients achieving improvement in the clinical outcome beyond the minimal clinically important difference (MCID) or minimally important change were compared between the groups. RESULTS: After propensity score matching, 32 patients were selected for each group. The mechanical hip-knee-ankle angle was corrected without significant difference from a mean …

Comparing focused ultrasound and uterine artery embolization for uterine fibroids-rationale and design of the Fibroid Interventions: reducing symptoms today and tomorrow (FIRSTT) trial.

OBJECTIVE: To present the rationale, design, and methodology of the Fibroid Interventions: Reducing Symptoms Today and Tomorrow (FIRSTT) study. DESIGN: Randomized clinical trial. SETTING: Two academic medical centers. PATIENT(S): Premenopausal women with symptomatic uterine fibroids. INTERVENTION(S): Participants are randomized to two U.S. Food and Drug Administration-approved minimally invasive treatments for uterine leiomyomas: uterine artery embolization and magnetic resonance-guided focused ultrasound. MAIN OUTCOME MEASURE(S): The primary endpoint is defined as the need for an additio

Improved peripheral airway reactance is associated with clinical remission after biologic therapy in severe asthma.

BACKGROUND: Small airways dysfunction (SAD) is increasingly recognized as a treatable trait in severe asthma and may influence the likelihoo … ry-derived area under the reactance curve greater than or equal to 0.65 kPa/L, corresponding to the minimal clinically important difference, was significantly associated with 4CR (adjusted odds ratio, 2.61 [1.02-6.65]; P < .05). In the standard-of-care group (3CR: 42.6%; 4CR: 25%), a higher baseline area under the reactance curve greater than or equal to 1.0 kPa/L was associated with a …

Fatty change in rotator cuff muscles following reverse total shoulder arthroplasty: does the humeral component design matter?

BACKGROUND: Fatty change progression is an important factor influencing treatment decisions for shoulder disorders. Appropriate evaluation a … implant design, fatty change in each rotator cuff muscle, and clinical outcomes were analyzed. The Minimal Clinically Important Difference (MCID) was explored for variables independently associated with outcomes in the primary multivariable models. RESULTS: Sixteen patients underwent inlay and 25 underwent onlay humeral component implantation. Fatty change progression rates were simil …

The long-term course of the Health Assessment Questionnaire in patients with systemic sclerosis.

OBJECTIVE: The Health Assessment Questionnaire-Disability Index is an important outcome measure reflecting functional disability, but knowledge on its course over time in patients with systemic sclerosis is scarce. Therefore, we investigated the long-term course of the Health Assessment Questionnaire-Disability Index and its association with baseline characteristics in systemic sclerosis patients. METHODS: Systemic sclerosis patients, fulfilling the European League Against Rheumatism and the American College of Rheumatology 2013 criteria, were included from the Leiden Combined Care in Systemi

Impact of preoperative depression on 2-year clinical outcomes following adult spinal deformity surgery: the importance of risk stratification based on type of psychological distress.

OBJECTIVE The objective of this study was to isolate whether the effect of a baseline clinical history of depression on outcome is independe … ssed using univariate and multivariate linear regression analyses. The probability of achieving ≥ 1 minimal clinically important difference (MCID) on the ODI based on the DRAM's Modified Somatic Perceptions Questionnaire (MSPQ) score was estimated. RESULTS Of 267 patients, 66 (24.7%) had self-reported preoperative depression. Patients with baseline depression had significantly more preo …

Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions.

PURPOSE: Medical and health policy providers should be aware of the impact of adult spinal deformity (ASD) on health-related quality of life … ion. Differences between ASD and the other chronic conditions were always greater than the reported minimal clinically important differences. When compared with individuals reporting no medical conditions, SF-36 scores from the population with self-reported chronic conditions ranged from -2.5 to -14.1. Comparable scores for patients with ASD ranged from -10.9 to -45.0. Physical function …

Minimum acceptable outcomes after lumbar spinal fusion.

BACKGROUND CONTEXT: Defining success after spinal surgery remains problematic. The minimal clinically important difference (MCID) in pain or functional outcomes is a common metric often calculated independent of perceived risk and morbidity, which is an important consideration in large procedures such as spinal fusion and instrumentation. PURPOSE: The purpose of this study was to describe a method of assessing treatment success based on prospective, patient-reported "minimum acceptable" outcome for which they would undergo a procedure. These goals can then be compared at follow-up to gauge ho…

Exercise for improving outcomes after osteoporotic vertebral fracture.

BACKGROUND: Vertebral fractures are associated with increased morbidity (e.g. pain, reduced quality of life) and mortality. Therapeutic exercise is a non-pharmacological conservative treatment that is often recommended for patients with vertebral fractures to reduce pain and restore functional movement. This is an update of a Cochrane Review first published in 2013. OBJECTIVES: To assess the effects (benefits and harms) of exercise intervention of four weeks or greater (alone or as part of a physical therapy intervention) versus non-exercise/non-active physical therapy intervention, no interv

Nasal Suctioning Therapy Among Infants With Bronchiolitis Discharged Home From the Emergency Department: A Randomized Clinical Trial.

IMPORTANCE: Although nasal suctioning is the most frequently used supportive management for bronchiolitis, its benefit remains unknown. OBJECTIVE: To evaluate the effectiveness of enhanced vs minimal nasal suctioning in treating infants with bronchiolitis after discharge from the emergency department (ED). DESIGN, SETTING, AND PARTICIPANTS: This single-blind, parallel-group, randomized clinical trial was conducted from March 6, 2020, to December 15, 2022, at 4 tertiary-care Canadian pediatric EDs. Participants included otherwise healthy infants aged 1 to 11 months with a diagnosis of bronchi

Rate of complications and short-term Functional Results of Revision Total Knee Arthroplasty for Tibio-femoral Instability: do stability and range of motion are restored in 62 revisions.

BACKGROUND: Tibio-femoral instability (TFI) due to ligament imbalance is a growing cause of revision total knee arthroplasty (TKA). The resu … he variation between preoperative OKS and one-year follow-up was greater than or equal to 5 points (Minimal Clinically Important Difference (MCID) following TKA). Complication rate and risk factors influencing the outcome were also analyzed. RESULTS: Of the 62 patients, 59 could be assessed at one year using postoperative OKS (one death at 0.66 years from unrelated reason, and two had …

Intracoronal tooth bleaching - A review and treatment guidelines.

Intracoronal bleaching is a minimally invasive procedure that was introduced into dentistry in the 19th century. The role of that procedure in enhancing the colour of teeth subjected to internal discolouration while being conservative made it extremely popular amongst dental professionals. Different materials and techniques have been utilized over the years attempting to obtain predictable long-term results while minimizing any associated risks. Contemporarily, bleaching agents are mainly based on peroxide-releasing compounds in different formulations and delivery systems. Different theories h

What Is the Numerical Nature of Pain Relief?

Pain relief, or a decrease in self-reported pain intensity, is frequently the primary outcome of pain clinical trials. Investigators commonl … lications for clinical pain research, ranging from statistical modeling of trial data to the use of minimal clinically important differences and patient-clinician communication.

Minimal important differences and response shift in health-related quality of life; a longitudinal study in patients with multiple myeloma.

BACKGROUND: We previously reported that changes of 6-17 percent in the EORTC QLQ-C30 scores are regarded important by patients with multiple myeloma and thus may be considered as Minimal Important Differences (MIDs). However, patients' internal standard of measurement may have changed over time (response shift, RS). In the present work, we evaluated whether myeloma patients experience RS and if this could affect the MID-estimates. METHODS: Between 2006 and 2008, 239 patients with multiple myeloma completed the EORTC QLQ-C30 at baseline (T1) and after three months (T2). At T2, patients were as

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… Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407–15. doi: 10.1016/0197-2456(89)90005-6. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC. …

Low-dose extracorporeal shock wave therapy for previously untreated lateral epicondylitis.

OBJECTIVE: To determine the effectiveness of low-energy extracorporeal shock wave therapy (ESWT) in the treatment of previously untreated lateral epicondylitis. DESIGN: Randomized double-blind (patient and outcome assessor) controlled trial with power to show a clinically important difference in success rate between groups at the 0.05 level. Block randomization was stratified by unilateral or bilateral epicondylitis. SETTING: Community study at the University of Calgary. PARTICIPANTS: Participants were recruited by poster advertisements in physicians' offices, fitness and sports centers, an

Midterm Outcomes of Primary Osteochondral Autograft Transfer for Symptomatic Chondral Defects of the Knee.

BACKGROUND: While the deleterious long-term effects of microfracture are well documented, studies examining the long-term clinical outcomes … t the 10-year follow-up (P < .001). Overall, 69% and 67% of patients treated with OAT surpassed the minimal clinically important difference (MCID), for the IKDC and KOS-ADL scores, respectively, at the 2-year follow-up. Similarly, 60% and 33.3% of patients treated with OAT surpassed the MCID and SCB, respectively, for the IKDC score at the 10-year follow-up. The overall reoperation rate …

Correlates of atherosclerosis in coronary arteries of patients undergoing angiographic evaluation.

The correlations between lipid and lipoprotein measurements and other risk factors of coronary artery disease were evaluated in 101 men undergoing coronary angiography. Clinically significant disease was present in 75 patients, whereas 24 had no observable lesions and 2 had minimal lesions. Comparisons of individual lipid and lipoprotein levels were nearly all significantly different between patients with and patients without clinically significant disease; however, no single variable could predict the presence of disease among patients. Logistic regression analysis identified five factors: ap

Outcome Scores and Survivorship of Patients Undergoing Primary Hip Arthroscopy With Borderline Hip Dysplasia: A Propensity-Matched Study With Minimum 10-Year Follow-up.

BACKGROUND: Patients with borderline hip dysplasia (BHD) and concomitant femoroacetabular impingement syndrome (FAIS) have demonstrated simi … tional Hip Outcome Tool, visual analog scale (VAS) for pain and satisfaction. Achievement rates for minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were compared between groups. Kaplan-Meier survivorship curves were assessed between groups. RESULTS: At a mean follow-up of 10.3 ± 0.3 years, 28 patients with BHD (20 women; age, 30.8 ± 10.8 years …

Immunology of SARS-CoV-2 infection in children.

Children and adolescents exhibit a broad range of clinical outcomes from SARS-CoV-2 infection, with the majority having minimal to mild symptoms. Additionally, some succumb to a severe hyperinflammatory post-infectious complication called multisystem inflammatory syndrome in children (MIS-C), predominantly affecting previously healthy individuals. Studies characterizing the immunological differences associated with these clinical outcomes have identified pathways important for host immunity to SARS-CoV-2 and innate modulators of disease severity. In this Review, we delineate the immunological