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Context: Early physical activity (PA) after concussion may promote symptom resolution. Prior studies have investigated exercise frequency/duration, yet precise PA intensity or volume required for optimal recovery requires further investigation. moderate to vigorous physical activity (MVPA) is beneficial for physical health. We investigated whether sedentary time, light activity time, MVPA time, or activity frequency in the weeks following concussion are associated with time to symptom resolution among adolescents. Design: Prospective cohort study. Methods: Adolescents 10–18 years of age were tested ≤14 days of concussion and followed until symptom resolution. At the initial visit, participants rated symptom severity and were provided wrist-worn activity trackers to monitor PA for the following week. PA behavior was categorized each day based on heart rate: sedentary (resting), light PA (50%–69% age-predicted max heart rate), and MVPA (70%–100% age-predicted max heart rate). Symptom resolution was defined as the date when participants reported cessation of concussion-like symptoms. Patients were not given specific PA instructions, though some may have received instructions from their physician. Results: Fifty-four participants were included in the study (54% female; mean age = 15.0 [1.8] y; initially assessed 7.5 [3.2] d after concussion). Female athletes recorded more sedentary time (900 [46] vs 738 [185] min/d; P =.01; Cohen d = 0.72), and less time in light PA (194.7 [64.5] vs 224 [55] min/d; P =.08; Cohen d = 0.48) and MVPA (23 [17] vs 38 [31] min/d; P =.04; Cohen d = 0.58) than male athletes. After adjusting for sedentary time, hours per day with >250 steps, sex, and initial symptom severity, more MVPA time was associated with faster symptom resolution time (hazard ratio = 1.016; 95% confidence interval, 1.001–1.032; P =.04). Conclusion: Our findings offer preliminary insight into how varying PA intensities affect concussion recovery, as MVPA may be a higher intensity than what is typically prescribed in concussion care. [ABSTRACT FROM AUTHOR]

Background: Disadvantaged socioeconomic position (SEP) is an important predictor of poor health in children with chronic kidney disease (CKD). The time course over which SEP influences the health of children with CKD and their carers is unknown. Methods: This prospective longitudinal study included 377 children, aged 6–18 years with CKD (stages I–V, dialysis, and transplant), and their primary carers. Mixed effects ordinal regression was performed to assess the association between SEP and carer-rated child health and carer self-rated health over a 4-year follow-up. Results: Adjusted for CKD stage, higher family household income (adjusted odds ratio (OR) (95% CI) 3.3, 1.8–6.0), employed status of primary carers (1.7, 0.9–3.0), higher carer-perceived financial status (2.6, 1.4–4.8), and carer home ownership (2.2, 1.2–4.0) were associated with better carer-rated child health. Household income also had a differential effect on the carer's self-rated health over time (p = 0.005). The predicted probabilities for carers' overall health being 'very good' among lower income groups at 0, 2, and 4 years were 0.43 (0.28–0.60), 0.34 (0.20–0.51), and 0.25 (0.12–0.44), respectively, and 0.81 (0.69–0.88), 0.84 (0.74–0.91), and 0.88 (0.76–0.94) for carers within the higher income group. Conclusions: Carers and their children with CKD in higher SEP report better overall child and carer health compared with those in lower SEP. Carers of children with CKD in low-income households had poorer self-rated health compared with carers in higher-income households at baseline, and this worsened over time. These cumulative effects may contribute to health inequities between higher and lower SEP groups over time. [ABSTRACT FROM AUTHOR]

Background Numerous studies have revealed age-related inequalities in colorectal cancer care. Increasing levels of frailty in an ageing population may be contributing to this, but quantifying frailty in population-based studies is challenging. Objective To assess the feasibility, validity and reliability of the Hospital Frailty Risk Score (HFRS), the Secondary Care Administrative Records Frailty (SCARF) index and the frailty syndromes (FS) measures in a national colorectal cancer cohort. Design Retrospective population-based study using 136,008 patients with colorectal cancer treated within the English National Health Service. Methods Each measure was generated in the dataset to assess their feasibility. The diagnostic codes used in each measure were compared with those in the Charlson Comorbidity Index (CCI). Validity was assessed using the prevalence of frailty and relationship with 1-year survival. The Brier score and the c-statistic were used to assess performance and discriminative ability of models with included each measure. Results All measures demonstrated feasibility, validity and reliability. Diagnostic codes used in SCARF and CCI have considerable overlap. Prevalence of frailty determined by each differed; SCARF allocating 55.4% of the population to the lowest risk group compared with 85.1% (HFRS) and 81.2% (FS). HFRS and FS demonstrated the greatest difference in 1-year overall survival between those with the lowest and highest measured levels of frailty. Differences in model performance were marginal. Conclusions HFRS, SCARF and FS all have value in quantifying frailty in routine administrative health care datasets. The most suitable measure will depend on the context and requirements of each individual epidemiological study. [ABSTRACT FROM AUTHOR]

Context: The relationship between physical activity (PA) and fear of pain with movement (ie, kinesiophobia) during concussion recovery is unknown. Kinesiophobia may limit PA, while PA after concussion may reduce kinesiophobia. Our purpose was to examine the correlation between PA and self-reported kinesiophobia during concussion recovery for adolescents with and without persistent symptoms. Design: Prospective cohort study of children ages 10–18 years within 14 days of concussion. Methods: Participants rated kinesiophobia using the Tampa Scale of Kinesiophobia (TSK) at initial (≤14 d postconcussion) and return to play (RTP) assessments, and wore activity monitors between assessments. Our primary outcome was TSK score change from initial to RTP assessments. We grouped participants based on whether they experienced persistent symptoms (symptoms ≥28 days) or not (symptoms <28 days) and calculated correlation coefficients (Pearson r for normally distributed and Spearman rho for nonnormally distributed variables) between PA variables and TSK change scores. Results: Among the 41 participants enrolled, 44% developed persistent symptoms (n = 18; age = 14.5 [2.0] y; 50% female; symptom duration = 57.3 [6.2] d; RTP = 66.8 [6.4] d) and 56% did not (n = 23; age = 14.9 [1.8] y; 48% female; symptom duration = 15.2 [1.5] d; RTP = 21.7 [1.9] d). For the persistent symptoms group, greater TSK change scores (mean = −2.5 [5.7] point change) were significantly and moderately correlated with higher daily step count (r = −.60, P =.008) and exercise frequency (r = −.63, P =.005), but were not correlated with exercise duration (ρ = −.12, P =.65). Among the no persistent symptoms group, TSK change scores (mean = −6.0 [5.0] point change) were not correlated with step count (r = −.18, P =.41) or exercise duration (ρ =.10, P =.67), and the correlation with frequency was low and not significant (r = −.34, P =.12). Conclusions: Regular PA during concussion recovery, regardless of duration or intensity, may help reduce kinesiophobia for those experiencing persistent symptoms. [ABSTRACT FROM AUTHOR]

Aims: This study reports on the Exeter-Trident total hip arthroplasty (THA) using an alumina ceramic-on-ceramic bearing with 10-year clinical and radiographic follow-up. Patients and methods: Between January 2001 and January 2006, 275 THAs were performed. Mean age at surgery was 52.7 (17–86) years, with 84 patients (33.6%) aged <50 years. The primary outcome was all-cause construct survival at minimum 10 years. Secondary outcomes included functional and noise scores. Radiographs were compared between baseline and latest follow-up and assessed for component loosening, migration and lysis. Results: No patient was lost to follow-up. Mean follow-up for surviving patients was 12.5 (9.5–15.6) years. Kaplan-Meier survival for all-cause revision was 94.0% (95% CI, 90.5–97.5) at 14.3 years. 2 patients had a femoral component fracture. All scores improved significantly at latest follow-up. HSS-NQ for 247 hips (90.2%) at mean 9.1 (7.0–14.4) years post implantation showed most hips (93.1%) reported no more than occasional noise. At minimum 5 years, radiolucency around the acetabular component was observed in 2 hips (0.8%), and lysis at the interface in 1 hip (0.4%). On the femoral side, endosteal lysis was observed in 7 hips. Conclusions: The Exeter-Trident THA with alumina ceramic-on-ceramic bearings performed well in this population. Patients are at low risk of revision in the first decade. However, there is a small risk of stem fracture as a late complication and some patients experience significant noise. [ABSTRACT FROM AUTHOR]

Background. There are many different haematological malignancy subtypes. Most follow chronic pathways that are uncertain and unpredictable, which may lead to feelings of anxiety and distress. The provision of information can ameliorate such difficulties, but patients are known to have unmet needs in this regard. The aim of this study is to explore experiences of information sharing among patients with chronic blood cancers and the factors impacting this process. Methods. The study is set within a UK cohort of blood cancer patients, where care is provided across 14 hospitals according to national clinical guidelines. Purposive sampling was used to identify expert participants (based on experience), and in-depth qualitative interviews were conducted with 35 patients, 10 with a relative present. The study was intended to inform practice and utilised qualitative description, with thematic content analysis and systematic data coding. Results. Experiences of information sharing varied. Most patients described this positively, but not all. Several barriers and facilitators were identified, which are discussed within five themes: (1) shock affects ability to process information, (2) the importance of time to facilitate information exchange, (3) personal relationships have an impact on meeting information needs, (4) HCP interpersonal skills are central to good information sharing, and (5) communication skills and terminology. Conclusions. Patients with chronic blood cancers prefer to engage in information sharing when they are not in a state of shock, and when they have adequate time to process material that is effectively and sensitively delivered, by HCPs they know and trust. [ABSTRACT FROM AUTHOR]

Background: Self-perception is an important internal resource, and violence exposure can negatively impact children's view of themselves. Although camp interventions can enhance self-perception, research has not yet examined whether camp interventions improve self-perception among children affected by family violence. Camp-based interventions promote health equity by addressing common barriers to service engagement. Objective: Using a non-masked, parallel randomized controlled design, this pilot study evaluated whether a camp-based intervention (i.e., Camp HOPE) enhanced self-perception among youth exposed to family violence. Method: Participants included 47 children aged 7–12 (M = 9.55, SD = 1.63; 79% Black/African American) and one of their adult caregivers seeking services from a Family Justice Center. Children were assigned to the camp (n = 23) or waitlist control (n = 24) condition using block randomization. Caregiver-child dyads completed evaluations at baseline, 2-month follow-up, and 5-month follow-up. Children reported on three self-perception domains: Social Competence, Behavioral Conduct, and Global Self-Worth (GSW). Piecewise latent growth curve models evaluated between-group differences in self-perception at 2- and 5-month follow-up. Results: Findings from intent-to-treat analyses indicated that Camp HOPE may have a temporary, negative impact on children's GSW (Diff. = − 2.65; SE = 1.22; p = 0.029; g = 0.63). Supplemental "as-treated" analyses revealed no significant differences between children who attended and did not attend the camp. Conclusions: Results are inconsistent with previous findings that camp interventions enhance self-perception, raising important questions about the unique experiences of youth exposed to family violence. Given these findings, Camp HOPE America might consider modifications to enhance effectiveness. [ABSTRACT FROM AUTHOR]

Reaction time (RT) is a critical element of return to participation (RTP), and impairments have been linked to subsequent injury after a concussion. Current RT assessments have limitations in clinical feasibility and in the identification of subtle deficits after concussion symptom resolution. To examine the utility of RT measurements (clinical drop stick, simple stimulus-response, single-task Stroop, and dual-task Stroop) to differentiate between adolescents with concussion and uninjured control individuals at initial assessment and RTP. Prospective cohort study. A pediatric sports medicine center associated with a regional tertiary care hospital. Twenty-seven adolescents with a concussion (mean age = 14.8 ± 2.1 years; 52% female; tested 7.0 ± 3.3 days postconcussion) and 21 uninjured control individuals (mean age = 15.5 ± 1.6 years; 48% female). Participants completed the Post-Concussion Symptoms Inventory (PCSI) and a battery of RT tests: clinical drop stick, simple stimulus-response, single-task Stroop, and dual-task Stroop. The concussion group demonstrated slower clinical drop stick (β = 58.8; 95% CI = 29.2, 88.3; P <.001) and dual-task Stroop (β = 464.2; 95% CI = 318.4, 610.0; P <.001) RT measures at the initial assessment than the uninjured control group. At 1-month follow up, the concussion group displayed slower clinical drop stick (238.9 ± 25.9 versus 188.1 ± 21.7 milliseconds; P <.001; d = 2.10), single-task Stroop (1527.8 ± 204.5 versus 1319.8 ± 133.5 milliseconds; P =.001; d = 1.20), and dual-task Stroop (1549.9 ± 264.7 versus 1341.5 ± 114.7 milliseconds; P =.002; d = 1.04) RT than the control group, respectively, while symptom severity was similar between groups (7.4 ± 11.2 versus 5.3 ± 6.5; P =.44; d = 0.24). Classification accuracy and area under the curve (AUC) values were highest for the clinical drop stick (85.1% accuracy, AUC = 0.86, P <.001) and dual-task Stroop (87.2% accuracy, AUC = 0.92, P <.002) RT variables at initial evaluation. Adolescents recovering from concussion may have initial RT deficits that persist despite symptom recovery. The clinical drop stick and dual-task Stroop RT measures demonstrated high clinical utility given high classification accuracy, sensitivity, and specificity to detect postconcussion RT deficits and may be considered for initial and RTP assessment. [ABSTRACT FROM AUTHOR]

Background: The Wireless Stimulation Endocardially for CRT (WiSE‐CRT) system is a novel technology used to treat patients with dyssynchronous heart failure (HF) by providing leadless cardiac resynchronization therapy (CRT). Observational studies have demonstrated its safety and efficacy profile, however, the treatment cost‐effectiveness has not previously been examined. Methods: A cost‐effectiveness evaluation of the WiSE‐CRT System was performed using a cohort‐based economic model adopting a "proportion in state" structure. In addition to the primary analysis, scenario analyses and sensitivity analyses were performed to test for uncertainty in input parameters. Outcomes were quantified in terms of quality‐adjusted life year (QALY) differences. Results: The primary analysis demonstrated that treatment with the WiSE‐CRT system is likely to be cost‐effective over a lifetime horizon at a QALY reimbursement threshold of £20 000, with a net monetary benefit (NMB) of £3781 per QALY. Cost‐effectiveness declines at time horizons shorter than 10 years. Sensitivity analyses demonstrated that average system battery life had the largest impact on potential cost‐effectiveness. Conclusion: Within the model limitations, these findings support the use of WiSE‐CRT in indicated patients from an economic standpoint. However, improving battery technology should be prioritized to maximize cost‐effectiveness in times when health services are under significant financial pressures. [ABSTRACT FROM AUTHOR]

Background: A validated clinical risk tool has been developed to identify pediatric and adolescent patients at risk of developing persisting symptoms after concussion, but has not been prospectively investigated within a sample of athletes seen after concussion by primary care sports medicine physicians and/or athletic trainers. Purpose: To determine whether a validated clinical risk prediction tool for persistent postconcussive symptoms (PPCSs) predicted which patients would develop PPCSs when obtained within 14 days of concussion among a multicenter sample of adolescent athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Pediatric and adolescent patients (8-18 years of age) from 7 pediatric medical centers and 6 secondary school athletic training facilities who were diagnosed with a concussion and presented ≤14 days after concussion were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study during their initial visit and were followed until symptom resolution. Clinical risk scores (Predicting and Preventing Post-concussive Problems in Pediatrics [5P]) and total symptom severity were obtained using the Post-Concussion Symptom Inventory at the initial visit (mean, 4.9 ± 2.9 days after concussion). Participants were then compared based on symptom resolution time: PPCS group (≥28 days to symptom resolution) and no-PPCS group (<28 days). The authors assessed the odds of developing PPCSs based on the 5P risk score using a binary logistic regression model and the utility of the clinical risk prediction tool to identify total time to symptom resolution using a Cox proportional hazards model. Results: A total of 184 participants enrolled, underwent initial evaluation, and were followed until symptom resolution (mean age, 15.2 ± 2.1 years; 35% female). The mean time to symptom resolution across the entire sample was 17.6 ± 3.7 days; 16% (n = 30) of participants developed PPCS. Those in the PPCS group had significantly greater mean initial total 5P risk scores than those in the no-PPCS group (7.9 ± 1.7 vs 5.9 ± 2.3, respectively; P <.001). After adjustment for initial symptom severity, time to assessment, and assessment setting, a higher initial total 5P risk score was associated with a significantly greater odds of developing PPCSs (adjusted odds ratio, 1.49; 95% CI, 1.07-2.08; P =.019). Furthermore, a higher 5P risk score was significantly associated with longer total symptom resolution time (hazard ratio, 0.80; 95% CI, 0.74-0.88; P <.001). Conclusion: In a multicenter sample of youth athletes seen in different outpatient health care settings, the 5P risk score accurately predicted which athletes may be at risk for developing PPCSs. [ABSTRACT FROM AUTHOR]

Background: Grit is the disposition to strive for long-term goals despite setbacks and challenges. Given the lengthy, arduous process of rehabilitation after anterior cruciate ligament reconstruction (ACLR), an athlete's grit may predict postoperative outcomes across time. Purpose/Hypothesis: The primary aim of the study was to evaluate the relationships between baseline (preoperative) grit and postoperative knee outcomes across the year after ACLR among adolescents. We hypothesized that athletes with more grit would achieve better postoperative outcomes over time than less gritty athletes. Study Design: Cohort study; Level of evidence, 2. Methods: All participants completed the Short Grit Scale, the Pediatric International Knee Documentation Committee (Pedi-IKDC) Scale, the Lysholm Knee Scoring Scale, the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric scale for pain interference and mobility, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), and the Quality of Life in Neurological Disorders (NeuroQoL) Lower Extremity Function Short Form at a preoperative appointment and then again at approximately 3, 6, and 12 months after ACLR. We constructed linear mixed models to assess the relationships between baseline grit, time, age, sex, and postoperative outcome measures (statistical significance of α =.05). Results: We included 137 participants (mean age 15.8 ± 2.74 years, 70% female) from a prospective registry of athletes undergoing ACLR by 1 surgeon at a single institution. There were no statistically significant changes in grit over time or differences in grit between age and sex. Higher baseline grit was significantly associated with greater postoperative HSS Pedi-FABS scores (β = 3.72 ± 1.46; P =.01; 95% CI, 0.85-6.59) and NeuroQoL scores across time (β = 3.37 ± 0.93; P <.001; 95% CI, 1.55-5.20). There were no significant associations between baseline grit and Pedi-IKDC, Lysholm, and PROMIS pain interference or mobility scores. Conclusion: Athletes with higher baseline grit reported superior postoperative physical function and activity level over the course of 1 year after ACLR compared with less gritty athletes. Grit may be a useful measure in predicting success in regaining physical function across time after ACLR in adolescent athletes. [ABSTRACT FROM AUTHOR]

Sever's disease (calcaneal apophysitis) is a common condition in youth athletes, including those who participate in barefoot sports. Health care professionals often recommend that young athletes with Sever's disease wear heel cups in their shoes while active, but barefoot athletes are unable to use heel cups. To compare the efficacy of 2 braces used by barefoot athletes with Sever's disease. Randomized controlled clinical trial. Pediatric sports medicine clinic. A total of 43 barefoot athletes aged 7 to 14 years were enrolled, and 32 completed the study (age = 10.3 ± 1.6 years; 29 girls, 3 boys). Participants were randomized to the Tuli's Cheetah heel cup (n = 16) or Tuli's The X Brace (n = 16) group for use during barefoot sports over the 3-month study period. Participants completed self-reported assessments after diagnosis (baseline) and 1, 2, and 3 months later. The primary outcome was the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical score (3 months postenrollment). The secondary outcomes were OxAFQ-C school or play and emotional scores and the visual analog scale pain score. The percentage of time wearing the brace during barefoot sports was not different between the Cheetah heel cup and The X Brace groups (82% versus 64% of the time in sports; P =.08). At 3 months, we observed no differences for the OxAFQ-C physical (0.79 versus 0.71; P =.80; Hedges g = 0.06), school or play (0.94 versus 1.00; P =.58; Hedges g = 0.26), or emotional (1.00 versus 1.00; P =.85; Hedges g = 0.21) score. Visual analog scale pain scores during activities of daily living and sports were lower (better) at the 2- and 3-month time points than at baseline (P <.001). Both groups demonstrated improvements in ankle and foot function across time, but no between-groups differences were seen at 3 months. Given these results, barefoot athletes with Sever's disease may consider using either brace with barefoot activity to help improve pain and functional status. [ABSTRACT FROM AUTHOR]

Purpose: Varus alignment of the tibial baseplate and limb > 3° might adversely affect baseplate fixation after total knee arthroplasty (TKA), especially for unrestricted kinematically aligned (KA) TKA which aligns a majority of baseplates in varus. The purposes of this study were to determine whether baseplate migration at 1 year (1) was significantly less than a stability limit of 0.5 mm, (2) increased over time, and (3) was related to varus alignment of the baseplate and limb after unrestricted KA TKA. Methods: Thirty-five patients underwent unrestricted KA TKA using a fixed-bearing, cemented, medial conforming tibial insert with posterior cruciate ligament retention. Using model-based radiostereometric analysis, maximum total point motion (MTPM) (i.e., largest displacement on the baseplate) was computed at 6 weeks, 3 months, 6 months, and 1 year postoperatively relative to the day of surgery. Baseplate and limb alignment were measured postoperatively on long-leg CT scanograms. Results: At 1 year, mean MTPM of 0.35 mm was significantly less than the 0.5 mm stability limit (p = 0.0002). Mean MTPM did not increase from 6 weeks to 1 year (p = 0.3047). Notably, 89% (31/35) of tibial baseplates and 46% (16/35) of limbs were > 3° varus. Baseplate and limb alignment had no relationship to MTPM at 1 year (|r|≤ 0.173, p ≥ 0.3276). Conclusion: Low and non-progressive tibial baseplate migration 1 year after unrestricted KA TKA with a medial conforming design should allay any concern that unrestricted KA TKA increases risk of baseplate loosening due to varus alignment of the baseplate and limb. Level of evidence: Level II, therapeutic prospective cohort study. [ABSTRACT FROM AUTHOR]

Evidence supports use of the relative motion extension (RME) approach following extensor tendon repairs in zones V-VI yielding good or excellent outcomes. To demonstrate how a 3-year internal audit and regular review of emerging evidence guided our change in practice from our longstanding use of the Norwich Regimen to the RME approach using implementation research methods. We compared the outcomes of both approaches prior to the formal adoption of the RME approach. Prospective clinical audit. A prospective audit of all consecutive adult finger extensor tendon repairs in zones IV-VII rehabilitated in our tertiary public health hand centre was undertaken between November 2014 and December 2017. Each audit year, outcomes were reviewed regarding the Norwich regimen and the RME early active motion approaches. As new evidence emerged, adjustments were made to our audit protocol for the RME approach. Discharge measurements of the range of motion of the affected and contralateral fingers and complications were recorded. During the 3-year audit, data was available on 79 patients (56 RME group including 59 fingers with 71 tendon repairs; 23 Norwich group including 28 fingers with 34 tendon repairs) with simple (n = 68) and complex (n = 11) finger extensor tendon zones IV-VI repairs (no zone VII presented during this time). Over time, the practice pattern shifted from the Norwich Regimen approach to the RME approach (and with the use of the RME plus [ n = 33] and RME only [ n = 23] approaches utilized). All approaches yielded similar good to excellent outcomes per total active motion and Miller's classification, with no tendon ruptures or need for secondary surgery. An internal audit of practice provided the necessary information regarding implementation to support a shift in hand therapy practice and to gain therapist or surgeon confidence in adopting the RME approach as another option for the rehabilitation of zone IV-VI finger extensor tendon repairs. • Audit is valuable in changing hand therapy practice alongside emerging evidence. • We have adopted relative motion post finger extensor tendon repairs in zones IV-VI. • Relative motion and Norwich's early active motion approaches provide similar outcomes. [ABSTRACT FROM AUTHOR]

• Prescription of exercise relative motion orthoses is common practice with limited evidence. • Exercise relative motion orthosis (RM) orthosis were implemented for 6 weeks to improve limited proximal interphalangeal joint motion. • Active and passive proximal interphalangeal joint movement improved, agreeing with unpublished results. • Patient comments were mostly positive about exercise RM orthosis wear. • Orthotic wear instruction for exercise RM orthoses differs from protective RM orthoses. Prospective, multicenter, consecutive case series There are 3 categories of relative motion orthoses; protective, exercise and adaptive, with only 2 unpublished studies that prescribed for exercise. These orthoses are of 2 types: relative motion extension (RME) orthoses and relative motion flexion (RMF) orthoses. To describe prescription of relative motion (RME and RMF) exercise orthoses when used to assist recovery of proximal interphalangeal joint (PIPJ) movement after injury or surgery. Therapists enrolled patients who had limited PIPJ movement after injury or surgery and demonstrated greater passive than active isolated PIPJ movement. Relative motion exercise orthoses and usual hand therapy treatments were implemented for 6 weeks. Measures of PIPJ motion, pain, and patient-report of orthotic wear time and perceived benefit were recorded at the time of orthotic intervention, at 3 weeks and at 6 weeks. Eight therapists from 4 private hand therapy clinics implemented RM exercise orthoses in 14 patients with limited PIPJ flexion (RME orthoses) and 6 patients with limited PIPJ extension (RMF orthoses). One participant prescribed a RMF orthosis failed to complete the study. Isolated PIPJ active flexion improved for those prescribed RME orthoses (n = 14/14) and isolated PIPJ active extension improved for those prescribe a RMF orthosis (n = 2/5). Most patient-reports were positive about the relative motion experience. Although diagnoses and prescription times differed, the outcomes of this patient series prescribed relative motion exercise orthoses agree with those of 2 unpublished case series; all in support relative motion exercise orthoses to improve limited PIPJ movement. Future studies implementing relative motion exercise orthoses to recover limited PIPJ movement after injury or surgery may be worthwhile. [ABSTRACT FROM AUTHOR]

Background: Identifying women aged 30–39 years at increased risk of developing breast cancer could allow them to consider screening and preventive strategies. Research is underway to determine the feasibility of offering breast cancer risk assessment to this age group. However, it is unclear how best to deliver and communicate risk estimates to these women, in order to avoid potential harms such as undue anxiety and increase benefits such as informed decision-making. Objectives: This study aimed to investigate women's views on, and requirements for, this proposed novel approach to risk assessment. Design: A cross-sectional qualitative design was used. Methods: Thirty-seven women aged 30–39 years with no family history or personal history of breast cancer participated in seven focus groups (n = 29) and eight individual interviews. Data were analysed thematically using a framework approach. Results: Four themes were developed. Acceptability of risk assessment service concerns the positive views women have towards the prospect of participating in breast cancer risk assessment. Promoting engagement with the service describes the difficulties women in this age group experience in relation to healthcare access, including mental load and a lack of cultural awareness, and the implications of this for service design and delivery. Impact of receiving risk results focuses on the anticipated impacts of receiving different risk outcomes, namely, complacency towards breast awareness behaviours following low-risk results, an absence of reassurance following average-risk results and anxiety for high-risk results. Women's information requirements highlights women's desire to be fully informed at invite including understanding why the service is needed. In addition, women wanted risk feedback to focus on plans for management. Conclusion: The idea of breast cancer risk assessment was received favourably among this age group, providing that a risk management plan and support from healthcare professionals is available. Determinants of acceptability of a new service included minimising effort required to engage with service, co-development of invitation and risk feedback materials and the importance of educational campaigning about the potential benefits of participation in risk assessment. [ABSTRACT FROM AUTHOR]

Clinical reaction-time (RT) measures are frequently used when examining patients with concussion but do not correlate with functional movement RT. We developed the Standardized Assessment of RT (StART) to emulate the rapid cognitive demands and whole-body movement needed in sport. To assess StART differences across 6 cognitive-motor combinations, examine potential demographic and health history confounders, and provide preliminary reference data for healthy collegiate student-athletes. Prospective, cross-sectional study. Clinical medicine facilities. A total of 89 student-athletes (56 [62.9%] men, 33 [37.1%] women; age = 19.5 ± 0.9 years, height = 178.2 ± 21.7 cm, mass = 80.4 ± 24 kg; no concussion history = 64 [71.9%]). Student-athletes completed health history questionnaires and StART during preseason testing. The StART consisted of 3 movements (standing, single-legged balance, and cutting) under 2 cognitive states (single task and dual task [subtracting by 6's or 7's]) for 3 trials under each condition. The StART trials were calculated as milliseconds between penlight illumination and initial movement. We used a 3 × 2 repeated-measures analysis of variance with post hoc t tests and 95% CIs to assess StART cognitive and movement differences, conducted univariable linear regressions to examine StART performance associations, and reported StART performance as percentiles. All StART conditions differed (P ≤.03), except single-task standing versus single-task single-legged balance (P =.36). Every 1-year age increase was associated with an 18-millisecond (95% CI = 8, 27 milliseconds) slower single-task cutting RT (P <.001). Female athletes had slower single-task (15 milliseconds; 95% CI = 2, 28 milliseconds; P =.02) and dual-task (28 milliseconds; 95% CI = 2, 55 milliseconds; P =.03) standing RT than male athletes. No other demographic or health history factors were associated with any StART condition (P ≥.056). The StART outcomes were unique across each cognitive-motor combination, suggesting minimal subtest redundancy. Only age and sex were associated with select outcomes. The StART composite scores may minimize confounding factors, but future researchers should consider age and sex when providing normative data. [ABSTRACT FROM AUTHOR]

Objective. To systematically map the existing evidence on self-perceived health among adults aged 60 and older in Latin America and the Caribbean, describe the use of the single-item measure of self-perceived health with this population, and identify gaps in the existing literature. Methods. Following PRISMA Extension for Scoping Reviews guidelines, eight databases were searched for publications that were published between 2009 and 2019 and reported self-perceived health of adults over 60 years old in Latin America and the Caribbean. Data on study characteristics, sample characteristics, and the use and analysis of the self-perceived health measure were charted. Results. The database and secondary searches identified 516 articles. After removing duplicates and assessing titles and abstracts for inclusion, 263 full-text articles were assessed for eligibility using the inclusion criteria and an additional 89 articles were excluded. Ultimately, 174 articles were included in the scoping review. Studies included participants from 17 countries in the region, led in frequency by Brazil with 120 articles. The self-perceived health question most often included a five-category response scale (130), and response options were predominantly divided into two (86) or three (48) categories for analysis. Conclusions. Information on the health and social needs of people aged 60 and older across Latin America and the Caribbean, particularly their perceptions of health, is limited. We highlight the need to expand research throughout the region, include particularly vulnerable populations, utilize data from longitudinal and qualitative studies, and call for transparency in how questions and responses are worded and analyzed. This review serves to inform future studies, programs, and policies directed at this population. [ABSTRACT FROM AUTHOR]

Simple Summary: Routine neoadjuvant therapy for resectable and borderline resectable pancreatic cancer is gaining popularity, but its true oncological benefit remains disputed. Whilst the genotypic and phenotypic heterogeneity of pancreatic cancer is becoming increasingly appreciated, there is currently no method to determine whether certain patients will benefit from a neoadjuvant approach and whether others will benefit from a surgery-first approach. In this study, a previously validated prognostic triple biomarker panel is shown to predict genetic subtypes and clinical phenotypes of pancreatic cancer and also the optimal treatment strategy (neoadjuvant vs. surgery-first) for patients with resectable and borderline resectable pancreatic cancer. The genomic heterogeneity of pancreatic ductal adenocarcinoma (PDAC) is becoming increasingly appreciated. We aimed to evaluate the ability of a triple biomarker panel (S100A4, Ca-125, and mesothelin) to predict: (i) genetic PDAC subtypes; (ii) clinical phenotypes; and (iii) the optimal treatment strategy (neoadjuvant vs. surgery-first) in resectable and borderline resectable PDAC. Patients who underwent resection for resectable and borderline resectable PDAC were included from one single-institutional cohort and one multi-institutional cohort from the Australian Pancreatic Genome Initiative (APGI). Tumors were immunohistochemically evaluated for S100A4, Ca-125, and mesothelin, and a subset from the APGI cohort underwent RNA sequencing. This study included 252 and 226 patients from the single institution and the APGI cohorts, respectively. Triple-negative biomarker status correlated with non-squamous PDAC genotypes (p = 0.020), lower rates of distant recurrence (p = 0.002), and longer median overall survival (mOS) with the surgery-first approach compared with neoadjuvant treatment (33.3 vs. 22.2 mths, p = 0.038) in resectable PDAC. In contrast, the triple-positive disease was associated with longer mOS with neoadjuvant treatment compared with the surgery-first approach (29.5 vs. 13.7 mths, p = 0.021) in resectable and borderline resectable PDAC. In conclusion, the triple biomarker panel predicts genetic PDAC subtypes, clinical phenotypes, and optimal treatment strategies in resectable and borderline resectable PDAC. [ABSTRACT FROM AUTHOR]

The original 26‐item Self‐Compassion Scale (SCS; Neff, 2003) and 12‐item Short‐Form Self‐Compassion Scale (SF‐SCS; Raes et al., 2011) are scales commonly used in cross‐sectional and longitudinal research to assess the global self‐compassion construct and its six facets. We introduce the Single‐Item Self‐Compassion Scale (SISC; 'I have high self‐compassion') to measure the global self‐compassion construct in time‐, space‐ and resource‐limited contexts (e.g., daily diaries, experience sampling and nationally representative surveys). Additionally, the SISC will expand knowledge about self‐compassion by providing researchers whose primary interest is not self‐compassion with a convenient, face‐valid option to measure self‐compassion. Across 10 samples (four cross‐sectional, four longitudinal and two 7‐day daily diary; N = 2,477), we demonstrated that the SISC has acceptable psychometric properties. Specifically, the SISC was temporally consistent, correlated adequately with the SCS and SF‐SCS, exhibited nearly identical correlational patterns when compared with the SCS and SF‐SCS with a wide range of criterion measures (e.g., self‐esteem, personality, affective and social functioning, mental health and demographic variables) and saved 12 min over a 7‐day diary. Results replicated among students, community samples and across the United States, Turkey and Malaysia. Thus, we provide the field with an alternative measure of the global self‐compassion construct that complements the SCS and SF‐SCS. [ABSTRACT FROM AUTHOR]

Purpose: Large population studies now demonstrate that frailty is prevalent in all adult age groups. Limited data exist on the association between frailty and surgical outcome in younger patients. The aim of the study was to explore the agreement between frailty identification tools and collect pilot data on their predictive value for frailty-associated outcomes in an adult surgical population.Study Design: Prospective cohort study.Results: Frailty scores were recorded in 200 patients (91 men), mean (range) age 57 (18-92) years. The prevalence of prefrailty was 52%-67% and that of frailty 2%-32% depending on the instrument used. Agreement between the instruments was poor, kappa 0.08-0.17 in pairwise comparisons. Outcome data were available on 160 patients. Only the frailty phenotype was significantly associated with adverse outcomes, RR 6.1 (1.5-24.5) for postoperative complications. The three frailty scoring instruments studies had good sensitivity (Clinical Frailty Scale (CFS)-90%, Accumulation Deficit (AD)-96%, Frailty Phenotype (FP)-97%) but poor specificity (CFS-12%, AD-13%, FP-18%) for the prediction of postoperative complications. All three instruments were poorly predictive of adverse outcomes with likelihood ratios of CFS-1.02, AD-1.09 and FP-1.17.Conclusions: This study showed a significant prevalence of prefrailty and frailty in adult colorectal surgical patients of all ages. There was poor agreement between three established frailty scoring instruments. Our data do not support the use of current frailty scoring instruments in all adult colorectal surgical patients. However, the significant prevalence of prefrailty and frailty across all age groups of adult surgical patient justifies further research to refine frailty scoring in surgical patients. [ABSTRACT FROM AUTHOR]

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of several Functional Neurological Disorders (FND) including dissociative seizures. However, its implementation in secondary mental health and specialist services within the English National Health Service (NHS) is scarce. The aim of this pilot study was to explore the estimates of the therapeutic effects of a 3-session course of this treatment as well as establish safety and acceptability for a complex patient group. The study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Participants completed self-report outcome measures at the start, at the end and 1 month following the completion of therapy. Three open-ended questions examined their therapy experiences qualitatively and these were analysed through thematic analysis. All participants who started the treatment (N = 17) completed the intervention and attendance rates were very high (95%). No serious adverse effects were observed and the CORE-OM and BSI showed improvements both at the end of the treatment and at follow-up. Healthcare utilisation was also reduced, including acute medications, A&E attendances and crisis-line usage. The results provide preliminary support for the safe use of ISTDP in this complex group of participants, but further evidence from controlled and randomized studies is warranted. [ABSTRACT FROM AUTHOR]

Background: Tracheal intubation (TI) practice across pediatric emergency departments (EDs) has not been comprehensively reported. We aim to describe TI practice and outcomes in pediatric EDs in contrast to those in intensive are units (ICUs) and use the data to identify quality improvement targets. Methods: Consecutive TI encounters from pediatric EDs and ICUs in the National Emergency Airway Registry for Children (NEAR4KIDS) database from 2015 to 2018 were analyzed for patient, provider, and practice characteristics and outcomes: adverse TI‐associated events (TIAEs), oxygen desaturation (SpO2 < 80%), and procedural success. A multivariable model identified factors associated with TIAEs in the ED. Results: A total of 756 TIs in 13 pediatric EDs and 12,512 TIs in 51 pediatric/cardiac ICUs were reported. Median (interquartile range [IQR]) patient age for ED TIs was higher (32 [7–108] months) than that for ICU TIs (15 [3–91] months; p < 0.001). Proportion of TIs for respiratory decompensation (52% of ED vs. 64% ICU), shock (26% vs. 14%), and neurologic deterioration (30% vs. 11%) also differed by location. Limited neck mobility was reported more often in the ED (16% vs. 6%). TIs in the ED were performed more often via video laryngoscopy (64% vs. 29%). Adverse TIAE rates (15.6% ED, 14% ICU; absolute difference = 1.6%, 95% confidence interval [CI] = –1.1 to 4.2; p = 0.23) and severe TIAE rates (5.4% ED, 5.8% ICU; absolute difference = –0.3%, 95% CI = –2.0 to 1.3; p = 0.68) were not different. Oxygen desaturation was less commonly reported in ED TIs (13.6%) than ICU TIs (17%, absolute difference = –3.4%, 95% CI = –5.9 to –0.8; p = 0.016). Among ED TIs, shock as an indication (adjusted odds ratio [aOR] = 2.15, 95% CI = 1.26 to 3.65) and limited mouth opening (aOR = 1.74, 95% CI = 1.04 to 2.93) were independently associated with TIAEs. Conclusions: While TI characteristics vary between pediatric EDs and ICUs, outcomes are similar. Shock and limited mouth opening were independently associated with adverse TI events in the ED. [ABSTRACT FROM AUTHOR]

This article presents an overview of the first three waves of data collection for Ten to Men: The Australian Longitudinal Study on Male Health (TTM). TTM is Australia's first national and representative longitudinal study of men aged 10–55 years who resided in private dwellings at recruitment. Findings address knowledge gaps and build the evidence base on male health to inform policy and program development. This article provides an update on the study's progress; it details the study's broad methodology and provides a brief overview of the measures available, potential uses and how data can be accessed. [ABSTRACT FROM AUTHOR]

Background: Gastro-intestinal (GI) intolerance is a frequently reported outcome in patients with kidney failure receiving maintenance dialysis and those who have received kidney transplants. Symptoms of GI intolerance (diarrhoea, constipation, bloating, abdominal pain, heart burn, and reflux) are associated with significant reduction in quality of life, morbidity, and increased used of healthcare resources. Having chronic kidney disease (CKD), together with related changes in diet and medication, may alter the gut microbiota and the microbial-derived uraemic metabolites that accumulate in kidney failure, and contribute to various complications including chronic diarrhoea, opportunistic infections, and drug-related colitis. Despite the high disease burden among patients with kidney replacement therapies, GI symptoms are often under-recognised and, consequently limited resources and strategies are devoted to the management of gastrointestinal complications in patients with CKD.Methods: The CKD Bowel Health Study is a multi-centre mixed-methods observational longitudinal study to better understand the bowel health and GI symptom management in patients with CKD. The program comprises of a longitudinal study that will assess the burden and risk factors of GI intolerance in patients treated with maintenance dialysis; a semi-structured interview study that will describe experiences of GI intolerance (including symptoms, treatment, self-management) in transplant candidates and recipients; and a discrete choice experience to elicit patient preferences regarding their experiences and perspectives of various intervention strategies for the management of GI symptoms after kidney transplantation.Discussion: This proposed program of work aims to define the burden the GI intolerance in patients with kidney failure and generate evidence on the patients' experiences of GI intolerance and their perspectives on their clinical and own management strategies of these symptoms, ensuring a patient-centred approach to guide clinical decision making and to inform the best study design for intervention trials.Trial Registration: This study is registered on the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000548831 . This study has been approved by the Western Sydney Local Health District Human Research Ethics Committee of New South Wales Health (HREC ETH03007). This study is supported by a National Health and Medical Research Council (NHMRC) Australia Investigator Grant (APP1195414), and an NHMRC Australia Postgraduate Scholarship (APP2005244). [ABSTRACT FROM AUTHOR]

Objectives: To examine the effect of sleep disturbances on concussion symptom recovery and to examine the effect of melatonin prescription on symptom improvement among concussed adolescents with sleep problems. Design: Longitudinal test–retest. Setting: Sports medicine clinic. Participants: Patients aged 8 to 18 years, diagnosed with a concussion, evaluated within 14 days after injury, and evaluated again 15 to 35 days after injury. Independent Variables: We grouped patients based on whether they reported sleep disturbances within 14 days of injury. Main Outcome Measures: Outcome measures included symptom severity, headache severity, melatonin prescription, and the change in symptom severity between visits. Results: Two hundred twenty-five patients were included: 36% who reported sleep problems (44% female; age = 14.4 ± 2.0 years; evaluated 7.3 ± 3.8 and 23.2 ± 5.4 days after injury) and 64% who did not (32% female; age = 14.6 ± 2.3 years; evaluated 7.2 ± 3.4 and 23.0 ± 5.3 days after injury). Those with sleep problems reported higher symptom severity than those without across the 2 visits (22.1 ± 14.3 vs 14.6 ± 12.5; P < 0.001). There was no significant difference in the change in symptom severity between visits among those who received [median = 9-point improvement; interquartile range (IQR) = 1-14] and did not (median = 9, IQR = 2-18) receive a melatonin prescription (P = 0.80). Conclusions: Sleep problems among pediatric patients within 2 weeks of concussion are associated with more severe symptoms. Melatonin prescription was not associated with faster symptom recovery. [ABSTRACT FROM AUTHOR]

To decrease opioid overdose mortality, prisons and jails in the US are increasingly offering medications for opioid use disorder (OUD) to incarcerated people. It is unknown how receipt of these medications in a correctional setting affects health services use after release. In this article we analyze changes in postrelease health care use after the implementation of a statewide medications for OUD program in the unified jail and prison system of the Rhode Island Department of Corrections. Using Medicaid claims data, we examined individual health care use in the community before and after receipt of medications for OUD while incarcerated. We found that inpatient admissions did not change, emergency department visits decreased, and both nonacute outpatient services and pharmacy claims increased after people received medications for OUD while incarcerated. There was no change in total health care costs paid by Medicaid. Our findings provide evidence that people's use of health care services paid for by Medicaid did not increase after they started medications for OUD in correctional settings. Given the frequent interaction of people with OUD with the criminal justice system, offering evidence-based treatment of OUD in correctional settings is an important opportunity to initiate addiction treatment. [ABSTRACT FROM AUTHOR]

Background: Impairments in postural stability are common following concussion. However, subjectively-scored assessments of postural control, such as the Balance Error Scoring System, may not accurately reflect postural instability. Objective measures, such as gait performance, can more accurately identify ongoing impairments in postural control throughout concussion recovery. Recent technological advances make gait evaluations more feasible across different clinical settings. Purpose: To compare performance on smartphone measured single- and dual-task gait evaluations among adolescent concussion participants and healthy controls across two timepoints. Methods: We evaluated concussed participants at initial (n=13; 14.6±1.3 years; 54% female; 5.5±1.6 days post-concussion) and follow-up visits (33.2±3.3 days post-concussion), and healthy control participants (n=21; 15.5±1.6 years; 48% female) at two timepoints 27.3±0.7 days apart on single- and dual-task gait performance. Single-task gait trials consisted of walking at a self-selected pace for 20 meters. Single-task cognitive trials involved responding to a cognitive task while standing in place. For dual-task trials, participants completed gait and cognitive tasks simultaneously. During each trial a smartphone affixed to the lumbar spine measured gait velocity and cognitive response accuracy and response time. We conducted a 2x2 mixed effects ANOVA to examine changes between groups across the testing timeline. Results: Concussion participants reported significantly greater symptom severity than control participants at the initial timepoint (23.1±13.5 vs 7.4±8.5; p=0.001); however, this difference did not persist to the second timepoint (p=0.99). The concussion group demonstrated significant improvements in single-task gait velocity between timepoints; although, between-group differences in gait velocity were not observed at either timepoint (Figure 1). No differences in cognitive accuracy between groups were identified. However, concussed participants performed worse than healthy controls on cognitive response time at both time points in single- and dual-task testing (Figure 2). Further, response time improved between testing periods for single-task, but not dual-task, conditions. Conclusion: Smartphone gait evaluations indicate improvement in single-task gait velocity during concussion recovery. However, no significant differences in gait velocity were found between concussed and control participants at either time point in single- or dual-task gait conditions. Interestingly, concussion patients had slower cognitive responses than healthy controls at both time points, despite no differences in cognitive accuracy or symptom severity at time 2. Our preliminary findings suggest that smartphone gait evaluations are effective in measuring changes in gait velocity and cognitive performance following adolescent concussion, as well as detecting subtle differences in gait and cognitive performance between concussed and control patients throughout recovery. Figure 1. Concussion and control group means at Time 1 and Time 2 for average gait velocity. Error bars represent the 95% confidence interval for the mean. Figure 2. Concussion and control group means at Time 1 and Time 2 for Stroop task response times. Error bars represent the 95% confidence interval for the mean. [ABSTRACT FROM AUTHOR]

Context: Survivors of allogeneic hematopoietic stem cell transplantation (alloHCT) may experience cognitive impairment over time post-treatment, but early identification of these individuals is limited. Objectives: We previously reported a prospective evaluation of cognitive functioning over the first 6 months of alloHCT. Here, we report an extension of this study, with specific aims to (1) evaluate the trajectory of cognitive outcomes over the first 6 years post-alloHCT, and (2) determine the extent to which late cognitive impairment is predicted by earlier impairment. Methods: Participants completed objective and subjective cognitive measures before alloHCT, and at 100 days, 6 months, and 6 years post-alloHCT. Outcome trajectories were determined using linear mixed effects models. Relationships between early and late cognitive impairment were assessed using logistic regression and receiver operator curves. Results: This analysis is based on longitudinal data from 59 participants, of whom 20 provided data at 6-year follow-up. Longitudinal models revealed an overall stability of cognitive outcomes over time, except for psychomotor efficiency/processing speed performance, which significantly improved (p =.049). However, poor learning/memory and cognitive complaints were persistently observed. At 6 years, 40% of relapse-free survivors met the impairment criteria. Impairment at 100 days was associated with impairment 6 years (OR = 20.00, p =.028) and demonstrated good accuracy in classifying those who were impaired and not impaired at 6 years (AUC =.79; 95% CI =.56-1.00). Conclusion: Poor cognitive outcomes among long-term alloHCT survivors are associated with cognitive functioning during the early post-treatment period. Early identification of survivors likely to experience poor cognitive outcomes may be possible, enabling timely intervention to mitigate long-term negative impacts. [ABSTRACT FROM AUTHOR]

Background and Objectives The associations between physical frailty and depressive symptoms among older individuals were established in the existing literature. Taking the person–environment perspective, we argue that neighborhood environment could either buffer the stress derived from being physically vulnerable or worsen it by adding another layer of stressors in the environmental context when physical health declined. The objectives of this study were to explore to what extent the neighborhood-level characteristics moderate the relationship between physical frailty and depressive symptoms. Research Design and Methods Using the China Health and Retirement Longitudinal Study 2011 wave, 6,245 individuals aged 60 years and older were included for analyses. Multilevel mixed-effects models were fitted to examine the moderating effects of urbanicity and neighborhood-level socioeconomic status (SES) on the relationship between frailty and depressive symptoms among older adults, controlling for individual-level characteristics. Results Results showed a stronger relationship between deterioration in physical health and depressive symptoms in rural neighborhoods and neighborhoods with lower SES, after controlling for individual-level SES. Also, the moderating effects of the neighborhood-level socioeconomic factors remained after controlling for urbanicity, indicating that neighborhood SES works beyond the rural–urban contexts. Discussion and Implications Findings from this study demonstrate the important roles of neighborhood socioeconomic characteristics in reshaping, and the need to redefine, China's rural–urban dichotomy. The findings also identified neighborhoods with low SES as potential targets for policy and practice to reduce the stress associated with health decline. [ABSTRACT FROM AUTHOR]

Objective: To evaluate recovery trajectories among youth athletes with a concussion and healthy controls across different domains using a quantitative and multifaceted protocol. Study design: Prospective repeated measures. Participants: Youth athletes diagnosed with a concussion between the ages of 8 and 18 years were evaluated (1) within 10 days after injury, (2) approximately 3 weeks after injury, and (3) after return-to-play clearance. Control participants completed the same protocol. Setting: Sport concussion clinic. Interventions: N/A. Main outcome measures: Participants underwent a multifaceted protocol that assessed symptoms (postconcussion symptom scale [PCSS]), dual-task gait, event-related potentials (ERPs), and eye tracking. Results: Sixty-seven athletes participated: 36 after concussion (age = 14.0 ± 2.6 years; 44% female) and 31 controls (age = 14.6 ± 2.2 years; 39% female). Concussion symptoms were higher for the concussion group compared with controls at the first (PCSS = 31.7 ± 18.8 vs 1.9 ± 2.9; P < 0.001) and second time points (PCSS = 10.8 ± 11.2 vs 1.8 ± 3.6; P = 0.001) but resolved by the final assessment (PCSS = 1.7 ± 3.6 vs 2.0 ± 3.8; P = 0.46). The concussion group walked slower during dual-task gait than controls at all 3 tests including after return-to-play clearance (0.83 ± 0.19 vs 0.95 ± 0.15 m/s; P = 0.049). There were no between-group differences for ERP connectivity or eye tracking. Those with concussions had a decrease in ERP connectivity recovery over the 3 time points, whereas control participants' scores increased (concussion Δ = -8.7 ± 28.0; control Δ = 13.9 ± 32.2; χ² = 14.1, P = 0.001). Conclusions: Concussion is associated with altered dual-task gait speeds after resolution of concussion symptoms, but ERP and eye tracking measures did not demonstrate between-group differences across time. Some objective approaches to concussion monitoring may support with identifying deficits after concussion, but further work is required to delineate the role of gait, electrophysiological, and eye tracking methods for clinical decision-making. [ABSTRACT FROM AUTHOR]

11-17 Health outcomes research findings have had a major influence on changes in paediatric cancer therapy and have informed health-screening strategies of childhood cancer survivors. 7-10 Current understanding of late health outcomes in adult survivors of childhood cancer has largely been the result of a number of cohort studies that have been instrumental in identifying, quantifying and characterizing cancer treatment-related health risks. Robust characterization of health outcomes and cancer-, cancer treatmentand health behaviour-related exposures provide an unparalleled opportunity to identify novel associations and to refine our understanding of the effects of cancer and its treatment on the health of aging survivors. Whereas SJLIFE does not specify age at cancer diagnosis, SJCRH generally restricts acceptance to children<25 years of age at the time of cancer diagnosis. [Extracted from the article]

OBJECTIVES: To prospectively investigate the recovery of athlete-reported symptoms and the condition-specific health-related quality of life (HRQoL) following sport-related concussion. DESIGN: Prospective matched-cohort study. METHODS: We recruited amateur athletes who were diagnosed with sport-related concussion by emergency department physicians. Study participants were assessed at 3 time points following sport-related concussion. At each assessment, participants completed 5 condition-specific HRQoL patient-reported outcome measures to evaluate participants' perceptions of the effects of specific concussion-related symptoms on their HRQoL. We performed log-linear analyses to assess the proportion of concussed participants with clinically impaired condition-specific HRQoL compared with the proportion of participants in the control group with clinically impaired condition-specific HRQoL. RESULTS: Fifty participants with sport-related concussion and 50 control participants matched by sex, age, and activity completed the study. Upon return to sporting activity, there was a significantly greater proportion of participants in the concussion group who perceived that headache, neck pain, and dizziness had an adverse effect on their HRQoL compared with the control group. Two weeks after return to sporting activity, there was still a significantly greater proportion of participants in the concussion group who perceived that headache (χ²1 = 9.0; odds ratio [OR] = 4.4; 95% confidence interval [CI]: 1.5, 15.2; P = .003) and dizziness (χ²1 = 9.5; OR = 13.5; 95% CI: 1.8, 604.9; P = .006) had an adverse effect on their HRQoL compared with the proportion of clinically impaired participants in the control group. CONCLUSION: Of concussed participants, 1 in 4 perceived that headache and dizziness had adverse effects on their HRQoL after returning to sporting activity following sport-related concussion compared with nonconcussed, control participants. [ABSTRACT FROM AUTHOR]

Background: The use of patient-reported outcomes (PROs) for routine cancer distress screening is endorsed globally as a quality-care standard. However, there is little research on the integration of PROs in "real-world" oncology practices using implementation science methods. The Improving Patient Experience and Health Outcome Collaborative (iPEHOC) intervention was established at multisite disease clinics to facilitate the use of PRO data by clinicians for precision symptom care. The aim of this study was to examine if patients exposed to the intervention differed in their healthcare utilization compared with contemporaneous controls in the same time frame.Methods: We used a PRE- and DURING-intervention population cohort comparison study design to estimate the effects of the iPEHOC intervention on the difference in difference (DID) for relative rates (RR) for emergency department (ED) visits, hospitalizations, psychosocial oncology (PSO), palliative care visits, and prescription rates for opioids and antidepressants compared with controls.Results: A small significantly lower Difference in Difference (DID) (- 0.223) in the RR for ED visits was noted for the intervention compared with controls over time (0.947, CI 0.900-0.996); and a DID (- 0.0329) for patients meeting ESAS symptom thresholds (0.927, CI 0.869-0.990). A lower DID in palliative care visits (- 0.0097), psychosocial oncology visits (- 0.0248), antidepressant prescriptions (- 0.0260) and an increase in opioid prescriptions (0.0456) in the exposed population compared with controls was also noted. A similar pattern was shown for ESAS as a secondary exposure variable.Conclusion: Facilitating uptake of PROs data may impact healthcare utilization but requires examination in larger scale "real-world" trials. [ABSTRACT FROM AUTHOR]

Introduction The understanding of the biology and epidemiology of, and the optimal therapeutic strategies for, breast cancer (bca) in younger women is limited. We present the rationale, design, and initial recruitment of Reducing the Burden of Breast Cancer in Young Women (ruby), a unique national prospective cohort study designed to examine the diagnosis, treatment, quality of life, and outcomes from the time of diagnosis for young women with bca. Methods Over a 4-year period at 33 sites across Canada, the ruby study will use a local and virtual recruitment model to enrol 1200 women with bca who are 40 years of age or younger at the time of diagnosis, before initiation of any treatment. At a minimum, comprehensive patient, tumour, and treatment data will be collected to evaluate recurrence and survival. Patients may opt to complete patient-reported questionnaires, to provide blood and tumour samples, and to be contacted for future research, forming the core dataset from which 4 subprojects evaluating genetics, lifestyle factors, fertility, and local management or delivery of care will be performed. Summary The ruby study will be the most comprehensive repository of data, biospecimens, and patient-reported outcomes ever collected with respect to young women with bca from the time of diagnosis, enabling research unique to that population now and into the future. This research model could be used for other oncology settings in Canada. [ABSTRACT FROM AUTHOR]

Objective: To determine the test-retest correlation of an objective eye-tracking device among uninjured youth athletes. Design: Repeated-measures study. Setting: Sports-medicine clinic. Participants: Healthy youth athletes (mean age = 14.6 ± 2.2 years; 39% women) completed a brief, automated, and objective eye-tracking assessment. Independent variables: Participants completed the eye-tracking assessment at 2 different testing sessions. Main outcome measures: During the assessment, participants watched a 220-second video clip while it moved around a computer monitor in a clockwise direction as an eye tracker recorded eye movements. We obtained 13 eye movement outcome variables and assessed correlations between the assessments made at the 2 time points using Spearman's Rho (rs). Results: Thirty-one participants completed the eye-tracking evaluation at 2 time points [median = 7 (interquartile range = 6-9) days between tests]. No significant differences in outcomes were found between the 2 testing times. Several eye movement variables demonstrated moderate to moderately high test-retest reliability. Combined eye conjugacy metric (BOX score, rs = 0.529, P = 0.008), the variance of the ratio for both eye movements in the horizontal (rs = 0.497, P = 0.013) and vertical (rs = 0.446; P = 0.029) movement planes along the top/bottom of the computer screen, and the variance of the left and right eye movement along the bottom segment of the computer screen (rs = 0.565; P = 0.004) each demonstrated moderate between-test correlations. Conclusions: Automated and quantitative eye movement and conjugacy metrics provide relatively stable measurements among a group of healthy youth athletes. Thus, their inclusion as a visual tracking metric may be complementary to other visual examination techniques when monitoring concussion recovery across time. [ABSTRACT FROM AUTHOR]

PURPOSE The Edmonton Symptom Assessment System (ESAS) is a validated instrument whose use has been standardized in the Ontario cancer system to measure symptoms among ambulatory patients with cancer. The objective was to examine the effect of ESAS exposure on visits to the emergency department (ED) and hospitalizations. METHODS This was a retrospective matched cohort study conducted in Ontario, Canada. The study included patients ≥ 18 years of age diagnosed with cancer between 2007 and 2015. Patients were considered exposed if they were screened with ESAS at least once during the study period, and their first ESAS screening date was defined as the index date. Each exposed patient was matched randomly to a patient with cancer without ESAS assessment using a combination of hard matching (birth year ± 2 years, cancer diagnosis date ± 1 year, cancer type, and sex) and propensity score matching (14 variables, including cancer stage, treatments received, and comorbidities). A multivariable Andersen-Gill recurrent event model was used to evaluate the effect of ESAS on the rate of health care use. RESULTS The analysis included 128,893 matched pairs that were well balanced on baseline measures. After adjusting for other variables, patients with ESAS had lower rates of both ED visits (relative rate [RR], 0.92; 95% CI, 0.91 to 0.93) and hospitalizations (RR, 0.86; 95% CI, 0.85 to 0.87) compared with patients without ESAS. CONCLUSION ESAS exposure is independently associated with decreased rates of ED visits and hospitalizations. This provides real-world evidence of one potential positive impact of standardized symptom assessment in cancer care. [ABSTRACT FROM AUTHOR]

Background: Concussion prognosis is a challenging clinical task. Identification of measures useful for persistent symptom risk can help optimize treatment pathways and allow clinicians to offer appropriate anticipatory guidance.Research Question: Can a multifaceted single/dual-task postural control assessment within one week of a diagnosed concussion identify the odds of developing persistent post-concussion symptoms (PPCS; symptoms that persist for more than 28 days post-concussion)?Methods: We conducted a prospective cohort study of youth and young adult athletes who were evaluated within 7 days of injury, and followed until they no longer reported concussion symptoms. Participants were grouped into those who developed PPCS and those who did not. During the initial evaluation, participants completed a postural control evaluation in single/dual-task conditions. We calculated six gait performance variables (in single/dual-task conditions), nine quiet stance performance variables, and three cognitive task performance (standing and walking) variables. We conducted between-group comparisons to identify candidate PPCS prognostic variables, and multivariable models to adjust for covariates (age, post-injury evaluation time, history of concussion, and BMI).Results: Sixty-six participants completed the study: 24% reported PPCS (mean age = 16.9 ± 3.5 years; 50% female; evaluated 4.2 ± 1.9 days post-injury) and 74% (mean age = 18.3 ± 3.0 years; 52% female; evaluated 3.5 ± 1.6 days post-injury) did not. Between-group comparisons indicated greater dual-task transverse plane center-of-mass (COM) range of motion (ROM) (13.1 ± 4.3 vs. 9.9 ± 2.5 degrees; p = 0.013) and lateral step variability (5.1 ± 1.4 vs. 4.0 ± 1.2 cm; p = 0.003) for the PPCS group relative to the no PPCS group. After multivariable modeling, dual-task transverse plane COM ROM (adjusted odds ratio = 1.34, 95% CI = 1.07, 1.68) and lateral step variability (adjusted odds ratio = 1.85, 95% CI = 1.13, 3.05) were significantly associated with PPCS.Significance: Dual-task transverse plane movement and lateral step variability demonstrate viable prognostic ability for PPCS among youth and young adult athletes and, along with other established factors, may add incremental value to PPCS prognosis models. [ABSTRACT FROM AUTHOR]

Background: Early referral of cancer patients for palliative care significantly improves the quality of life. It is not clear which patients can benefit from an early referral, and when the referral should occur. A Delphi Panel study proposed 11 major criteria for an outpatient palliative care referral. Objective: To operationalize major Delphi criteria in a cohort of lung cancer patients, using a prospective approach, by linking health administrative data. Design: Population-based observational cohort study. Setting/Subjects: The study population comprised 38,851 cases of lung cancer in the Ontario Cancer Registry, diagnosed from January 1, 2012, to December 31, 2016. Measurements: We operationalized 6 of the 11 major criteria (4 diagnosis or prognosis based and 2 symptom based). Patients were considered eligible (index event) for palliative care if they qualified for any criterion. Among eligible patients, we identified those who received palliative care. Results: Twenty-eight thousand one hundred sixty-four patients were eligible for palliative care by qualifying for either the diagnosis- or prognosis-based criteria (n = 21,036, 76.5%), or for symptom-based criteria (n = 7128, 23.5%). A total of 23,199 (82.4%) patients received palliative care. The median time from palliative care eligibility to the receipt of first palliative care or death or maximum study follow-up was 56 days (range = 17–348). Conclusions: We operationalized six major criteria that identified the majority of lung cancer patients who were eligible for palliative care. Most eligible patients received the palliative care before death. Future research is warranted to test these criteria in other cancer populations. [ABSTRACT FROM AUTHOR]

Background: Bundled consent, the practice of obtaining anticipatory consent for a predefined set of intensive care unit procedures, increases the rate of informed consent conversations and incorporation of patients' wishes into medical decision-making without sacrificing patients' or surrogates' understanding. However, the adoption rate for this practice in academic and nonacademic centers in the United States is unknown. Objective: To determine the national prevalence of use of bundled consent in adult intensive care units and opinions related to bundled consent. Methods: A random sample of US hospitals with medical/surgical intensive care units was selected from the AHA [American Hospital Association] Guide. One intensive care unit provider (bedside nurse, nurse manager, or physician) from each hospital was asked to self-reportuse of per-procedure consent versus bundled consent, consent rate for intensive care unit procedures, and opinions about bundled consent. Results: Of the 238 hospitals contacted, respondents from 100 (42%) completed the survey; 94% of respondents were nurses. The prevalence of bundled consent use was 15% (95% CI, 9%–24%). Respondents using per-procedure consent were more likely than those using bundled consent to self-report performing invasive procedures without consent. Users of bundled consent unanimously recommended the practice, and 49% of respondents using per-procedure consent reported interest in implementing bundled consent. Results: Bundled consent use is uncommon in academic and nonacademic intensive care units, most likely because of conflicting evidence about the effect on patients and surrogate decision makers. Future work is needed to determine if patients, family members, and providers prefer bundled consent over per-procedure consent. [ABSTRACT FROM AUTHOR]

Background: Uterovaginal prolapse is a prevalent gynaecological issue, which can have a negative impact on the quality of life of women. Hysterectomy and vaginal repair are conventional treatments to address apical prolapse; however, women are increasingly requesting uterine‐preserving alternatives. Aims: This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. Materials and Methods: This retrospective cohort study presents outcomes of 157 patients who underwent laparoscopic mesh sacrohysteropexy at a private practice in South Australia during 2007–2017. Primary outcome is the success rate according to the pelvic organ prolapse quantification (POP‐Q) system. Secondary measures included complication rates and patients identified as having Stages III‐IV prolapse and their outcomes. Results: The median age was 58 years (27–86 years), median parity was 2 (0–6), and median body mass index was 26.8 (23–29.9). One hundred and thirty‐four women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and four women had an isolated laparoscopic hysteropexy. The mean pre‐operative point C was 0.60. The mean change from pre‐operative point C to post‐operative point C was 7.6 cm (P < 0.01). Of the 136 patients (98.6%) seen at post‐operative 4–6 weeks, all had Stage 0 POP‐Q scores. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow‐up. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre‐operative Stage III‐IV disease and number of vaginal deliveries. Conclusions: Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data. [ABSTRACT FROM AUTHOR]

Background: Human neural stem cell implantation may offer improved recovery from stroke. We investigated the feasibility of intracerebral implantation of the allogeneic human neural stem cell line CTX0E03 in the subacute-chronic recovery phase of stroke and potential measures of therapeutic response in a multicentre study.Methods: We undertook a prospective, multicentre, single-arm, open-label study in adults aged >40 years with significant upper limb motor deficits 2-13 months after ischaemic stroke. 20 million cells were implanted by stereotaxic injection to the putamen ipsilateral to the cerebral infarct. The primary outcome was improvement by 2 or more points on the Action Research Arm Test (ARAT) subtest 2 at 3 months after implantation.Findings: Twenty-three patients underwent cell implantation at eight UK hospitals a median of 7 months after stroke. One of 23 participants improved by the prespecified ARAT subtest level at 3 months, and three participants at 6 and 12 months. Improvement in ARAT was seen only in those with residual upper limb movement at baseline. Transient procedural adverse effects were seen, but no cell-related adverse events occurred up to 12 months of follow-up. Two deaths were unrelated to trial procedures.Interpretation: Administration of human neural stem cells by intracerebral implantation is feasible in a multicentre study. Improvements in upper limb function occurred at 3, 6 and 12 months, but not in those with absent upper limb movement at baseline, suggesting a possible target population for future controlled trials.Funding: ReNeuron, Innovate UK (application no 32074-222145).Trial Registration Number: EudraCT Number: 2012-003482-18. [ABSTRACT FROM AUTHOR]

Background: Poor socioeconomic and health-related quality of life (HRQOL) outcomes in survivors of childhood cancer can lead to distress and overall negatively impact the lives of these individuals. The current report has highlighted the impact of stroke and stroke recurrence on mortality, psychological HRQOL, and socioeconomic outcomes within the Childhood Cancer Survivor Study (CCSS).Methods: The CCSS is a retrospective cohort study with longitudinal follow-up concerning survivors of pediatric cancer who were diagnosed between 1970 and 1986. Mortality rates per 100 person-years were calculated across 3 periods: 1) prior to stroke; 2) after first stroke and before recurrent stroke; and 3) after recurrent stroke. Socioeconomic outcomes, the standardized Brief Symptoms Inventory-18, the Medical Outcomes Study 36-Item Short Form Health Survey, and the CCSS-Neurocognitive Questionnaire also were assessed.Results: Among 14,358 participants (median age, 39.7 years), 224 had a stroke after their cancer diagnosis (single stroke in 161 patients and recurrent stroke in 63 patients). Based on 2636 deaths, all-cause late mortality rates were 0.70 (95% CI, 0.68-0.73) prior to stroke, 1.03 (95% CI, 0.73-1.46) after the first stroke, and 2.42 (95% CI, 1.48-3.94) after the recurrent stroke. Among 7304 survivors, those with stroke were more likely to live with a caregiver (single stroke odds ratio [OR], 2.3 [95% CI, 1.4-3.8]; and recurrent stroke OR, 5.3 [95% CI, 1.7-16.8]) compared with stroke-free survivors. Stroke negatively impacted task efficiency (single stroke OR, 2.4 [95% CI, 1.4-4.1] and recurrent stroke OR, 3.3 [95% CI, 1.1-10.3]) and memory (single stroke OR, 2.1 [95% CI, 1.2-3.7]; and recurrent stroke OR, 3.5 [95% CI, 1.1-10.5]).Conclusions: Stroke and stroke recurrence are associated with increased mortality and negatively impact HRQOL measures in survivors of pediatric cancer. [ABSTRACT FROM AUTHOR]

While various tools such as the International Prognostic Index (IPI) and its derivatives exist for risk-stratification of diffuse large B-cell lymphoma (DLBCL) at diagnosis, patient and disease characteristics capable of predicting outcome after high-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT) are not clearly defined. We retrospectively analyzed medical records of 111 DLBCL patients (78 relapsed and 33 refractory) who underwent HDC/ASCT at our institution from 2010-2015. After a median follow-up time of 4.6 years (interquartile range [IQR] 2.2-8.1), the likelihood of 5-year progression-free survival (PFS) was 62.2% (95% CI, 53.4%-72.4%) and the likelihood of 5-year overall survival (OS) was 68.9% (95% CI, 60.7%-78.2%). More than three chemotherapy regimens prior to ASCT was the only variable associated with lower likelihood of PFS (P = .004) and OS (P = 0.026). Male gender and high IPI score at time of ASCT were also associated with lower likelihood of PFS (P = .043; P = .013). NCCN IPI and age-adjusted IPI at time of ASCT were not predictive of outcome following ASCT. Patients with refractory and relapsed disease had similar outcomes post-ASCT (P = .207 for PFS, P = .073 for OS). [ABSTRACT FROM AUTHOR]

Background: Lack of quality preventive care has been associated with poorer outcomes for pregnant women with low incomes. Health policy changes implemented with the Affordable Care Act (ACA) were designed to improve access to care. However, insurance coverage remains lower among women in Medicaid nonexpansion states. We compared health care use and adverse birth outcomes by insurance status among women giving birth in a large health system in a Medicaid nonexpansion state. Materials and Methods: We conducted a population-based retrospective cohort study using data for 9,613 women with deliveries during 2014–2015 at six hospitals associated with a large vertically integrated health care system in North Carolina. Adjusted logistic regression and zero-inflated negative binomial models examined associations between insurance status at delivery (commercial, Medicaid, or uninsured) and health care utilization (well-woman visits, late prenatal care, adequacy of prenatal care, postpartum follow-up, and emergency department [ED] visits) and outcomes (preterm birth, low birth weight, preeclampsia, and gestational diabetes). Results: Having Medicaid at delivery was associated with lower rates of well-woman visits (rate ratio [RR] 0.25, 95% CI 0.23–0.28), higher rates of ED visits (RR 2.93, 95% CI 2.64–3.25), and higher odds of late prenatal care (odds ratio [OR] 1.18, 95% CI 1.03–1.34) compared to having commercial insurance, with similar results for uninsured women. Differences in adverse pregnancy outcomes were not statistically significant after adjusting for patient characteristics. Conclusions: Findings suggest that large gaps exist in use of preventive care between Medicaid/uninsured and commercially insured women. Policymakers should consider ways to improve potential and realized access to care. [ABSTRACT FROM AUTHOR]

Context: The tandem gait test is a method for assessing dynamic postural control and part of the Sport Concussion Assessment Tool, versions 3 and 5. However, its reliability among child and adolescent athletes has yet to be established. Objective: To examine the test-retest reliability of the single-task and dual-task tandem gait test among healthy child and adolescent athletes. Design: Descriptive laboratory study. Setting: Sports injury-prevention center. Patients or Other Participants: Uninjured and healthy athletes between the ages of 9 and 18 years. Intervention(s): Tandem gait measures repeated 3 times across the period of approximately 1 month. Main Outcome Measure(s): Participants completed the tandem gait test under single-task and dual-task (ie, while simultaneously executing a cognitive task) conditions. Our primary outcome measure was completion time during the single-task and dual-task conditions. We also assessed cognitive accuracy and response rate while participants completed the dual-task tandem gait test. Results: Thirty-two child and adolescent athletes completed the study (mean age = 14.3 ± 2.4 years; females = 16). Single- task tandem gait times were similar across the 3 testing sessions (14.4 ± 4.8, 13.5 ± 4.2, and 13.8 ± 4.8 seconds; P = .45). Dual-task tandem gait times steadily improved across the test timeline (18.6 ± 6.9, 16.6 ± 4.5, and 15.8 ± 4.7 seconds; P = .02). Bivariate correlations indicated moderately high to high agreement from test 1 to test 2 (single-task r= .627; dual-task r= 0.655) and from test 2 to test 3 (single-task r = 0.852; dual-task r = 0.775). Both the single-task (intraclass correlation coefficient; ICC [3,1] = 0.86; 95% confidence interval [CI] = 0.73, 0.93) and dual-task (ICC [3,1] = 0.84; 95% CI = 0.69, 0.92) conditions demonstrated high reliability across testing sessions. Conclusions: Tandem gait outcome measures demonstrat¬ed high test-retest reliability in both the single- and dual-task conditions. The overall reliability was within the acceptable range for clinical practice, but improvements across tests suggested a moderate practice effect. Tandem gait represents a reliable, dynamic, postural-control test that requires minimal space, cost, and time. [ABSTRACT FROM AUTHOR]

Background: Recent studies have demonstrated improved outcomes with real‐time patient‐reported outcome questionnaires (PRO questionnaires) using questions adapted for patient use from the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE). Outside of the clinical trial setting, limited information exists on factors affecting the completion of PRO questionnaires in routine practice. The primary aim of this prospective cross‐sectional study was to evaluate patient willingness to complete PRO questionnaires on a regular basis and to better understand responder biases to improve patient feedback. Materials and Methods: Patients performing PRO‐CTCAE toxicity and symptom PRO questionnaires in oncology clinics at Princess Margaret Cancer Centre from 2013 to 2016 were assessed for their willingness to complete PRO questionnaires using a nine‐item, tablet‐based acceptability survey. Patient‐reported characteristics (i.e., age, sex, language, marital status, education, occupation, etc.), cancer type, treatment modalities, and health metrics (i.e., Eastern Cooperative Oncology Group) were also collected. Characteristics were evaluated by logistic regression (odds ratios [OR]) using the primary outcome with prespecified levels of significance for univariate (p ≤.10), and additional multivariate (p ≤.05) testing. Results: A total of 1,792 patients (median age 60 years; range 18–97) with various cancer diagnoses were assessed. A greater proportion of female (56%) and white (74%) respondents with an annual household income of <$100,000 (69%) participated. More than half (58%) of respondents were willing to complete PRO questionnaires at every clinic visit, and a high proportion (77%) found utility in reporting physical and emotional feelings to clinicians using PRO questionnaires. In general, patients did not find that PRO questionnaires made clinic visits more difficult (93%). In uni‐ and multivariable testing, patients were more willing to complete sleep‐ and fatigue‐related PRO questionnaires relative to chemotoxicity‐based PRO questionnaires (OR 1.52; p =.012). Patients aged 40–65 versus 18–40 years were also more likely to report high PRO questionnaire acceptability (OR 1.49; p =.025). Additional patient characteristics such as white ethnicity (OR 1.76), Canada as country of birth (OR 1.66), and English language (OR 2.15) relative to other had higher acceptability on uni‐ (p <.001) and multivariable (p <.001) analyses. Patients reporting treatment intent as palliative (OR 0.69; p =.0013) or hematological (OR 0.73; p =.027) were less likely to report high PRO questionnaire acceptability on univariable analysis; however, only palliative patients (OR 0.72) maintained this effect on multivariable testing (p =.012). Patients reporting higher health utility scores (per change in.05) also had significantly increased PRO questionnaire acceptability in uni‐ (OR 1.06; p <.001) and multivariable (OR 1.05; p =.008) analyses. No significant differences in PRO questionnaire acceptability were seen between cancer types, education level, household income, employment status, or treatment modality. Conclusion: Routine assessment using PRO questionnaires is associated with moderate acceptability by patients with cancer. Specific patient characteristics are associated with higher completion willingness. Additional research is necessary to identify factors associated with low acceptability of PRO questionnaires and to develop site‐, ethnicity‐, and treatment‐specific instruments to assess the value of PRO questionnaires for symptom monitoring in clinical practice. Implications for Practice: This study will help to identify the clinical, demographic, and survey characteristics associated with willingness to complete patient‐reported outcome questionnaires regularly in the cancer outpatient setting. regorafenib dosing in patients with metastatic or recurrent gastrointestinal stromal tumors after failure of imatinib and sunitinib. [ABSTRACT FROM AUTHOR]

Objective  To determine longitudinal measurements of resting energy expenditure (REE) by indirect calorimetry (IC) in healthy term infants during the first 2 months of life. Study Design  An outpatient prospective pilot study was performed in healthy term infants to estimate REE by measuring expired gas fractions of oxygen (O 2) and carbon dioxide (CO 2) with IC in a respiratory and metabolic steady state. Results  A total of 30 measurements were performed. Fourteen subjects completed measurements at both 1 and 2 months of life, and two subjects had only measurements made at 1 month of life. Mean REE values were 64.1 ± 12.7 and 58.4 ± 14.3 kcal/kg/d at 1 and 2 months of age, respectively. Mean O 2 consumption and CO 2 production measurements were 9.3 ± 2.0 and 7.7 ± 1.2 mL/kg/min and 8.1 ± 2.2 and 6.4 ± 1.1 mL/kg/min at 1 and 2 months of age, respectively. Conclusion  This pilot study demonstrates longitudinal measurements of REE by IC in healthy term infants during the first 2 months of life. We also demonstrate that, overall, there is consistency in REE values in this population, with a likely decrease in individual longitudinal measurements over the first 2 months of life. [ABSTRACT FROM AUTHOR]

Background: Incarceration is associated with increased risk of hypertension and cardiovascular disease mortality. We used data from the Veterans Aging Cohort Study (VACS) to explore the impact of incarceration on blood pressure (BP) control.Methods: Among hypertensive VACS participants, we measured the association between self-reported recent incarceration or past (not recent) history of incarceration and BP control in the year following the survey. To analyze the association between incarceration and BP control, we used logistic regression models adjusted for sociodemographic characteristics, clinical factors (HIV status and body mass index), and behavioral factors (history of smoking, unhealthy alcohol use, illicit drug use). We explored potential mediators including post-traumatic stress disorder (PTSD), depression, primary care engagement, and adherence to antihypertensive medications.Results: Among the 3515 eligible VACS participants, 2304 participants met the inclusion criteria. Of these, 163 (7 %) reported recent incarceration, and 904 (39 %) reported a past history of incarceration. Participants with recent or past history of incarceration were more likely to have uncontrolled BP than those without a history of incarceration (67 % vs. 56 % vs. 51 %, p < 0.001). In multivariable analysis, recent incarceration (adjusted odds ratio [AOR] = 1.57 95 % confidence interval [CI]: 1.09-2.26), but not a past history of incarceration (AOR = 1.08 95 % CI: 0.90-1.30), was associated with uncontrolled BP compared with those who were never incarcerated.Conclusions: Among patients with a history of hypertension, recent incarceration is associated with having uncontrolled BP following release. Interventions are needed for recently released individuals to improve hypertension outcomes. [ABSTRACT FROM AUTHOR]