The Impact of Non-Pharmacological Interventions on Delirium in Neurological Intensive Care Unit Patients: A Single-Center Interrupted Time Series Trial.

Background: Delirium is a pathobiological brain process that is frequently observed in Intensive Care Unit (ICU) patients, and is associated with longer hospitalization as well as long-term cognitive impairment. In neurological ICU patients, delirium may be more treatment-resistant due to the initial brain injury. This study examined the effects of a multicomponent non-pharmacological nursing intervention program on delirium in neurological ICU patients. Methods: A single-center interrupted time series trial was conducted in adult neurological ICU patients at high risk for developing delirium who were non-delirious at admission. A multicomponent nursing intervention program focusing on modifiable risk factors for delirium, including the optimalization of vision, hearing, orientation and cognition, sleep and mobilization, was implemented as the standard of care, and its effects were studied. The primary outcome was the number of delirium-free and coma-free days alive at 28 days after ICU admission. The secondary outcomes included delirium incidence and duration, ICU and hospital length-of-stay and duration of mechanical ventilation. Results: Of 289 eligible patients admitted to the ICU, 130 patients were included, with a mean age of 68 ± 11 years, a mean APACHE-IV score of 79 ± 25 and a median predicted delirium risk (E-PRE-DELIRIC) score of 42 [IQR 38-50]). Of these, 73 were included in the intervention period and 57 in the control period. The median delirium- and coma-free days alive were 15 days [IQR 0-26] in the intervention group and 10 days [IQR 0-24] in the control group (level change -0.48 days, 95% confidence interval (95%CI) -7 to 6 days, p = 0.87; slope change -0.95 days, 95%CI -2.41 to 0.52 days, p = 0.18). Conclusions: In neurological ICU patients, our multicomponent non-pharmacological nursing intervention program did not change the number of delirium-free and coma-free days alive after 28 days.

Post-Intensive Care Syndrome in Patients Suffering From Acute Subarachnoid Hemorrhage: Results From an Outpatient Post-ICU Aftercare Clinic.

Introduction Survivors of an acute subarachnoid hemorrhage (aSAH) may suffer from a long-term neurological disability, cognitive impairment, anxiety, and depression, which can also be related to post-intensive care syndrome (PICS). The aim of this study was to examine the prevalence of PICS symptoms in post-intensive care (ICU) aftercare aSAH patients. Methods We conducted an observational cohort study in aSAH patients from a post-ICU aftercare clinic (ICU-AC). PICS symptoms were evaluated using the Impact of Event Scale-Revised (IES-R), Hospital Anxiety and Depression Scale (HADS), and a medical questionnaire for physical and cognitive functioning. Results A total of 110 patients were included. The prevalence of anxiety and depressive symptoms was 23.6% and 19.1%, respectively. Post-traumatic stress disorder (PTSD) was seen in 26.4%. Cognitive complaints were lack of concentration (63.6%), short-term memory loss (45.8%), and reduced speed of thinking (60.9%). The most reported physical complaints were fatigue (73.6%), limitations in daily activity (72.7%), muscle weakness (41.8%), pain (36.4%), and weight loss (30.9%). PICS symptoms related to all three domains were present in 30% of patients. Conclusion The prevalence of PICS in patients after aSAH is high. Even in patients without aSAH-related neurological impairment who were discharged home, a high prevalence of PICS symptoms was reported. Early screening for PICS should comprise all three domains and is important to facilitate a better tailored rehabilitation of these patients.

Emotionally focused couple therapy in cancer survivor couples with marital and sexual problems: a replicated single-case experimental design.

Objective: The current research examined the effect of Emotionally Focused Couples Therapy (EFCT) on perceived intimacy, affect, and dyadic connection in cancer survivor couples with relationship challenges. Method: In this longitudinal replicated single-case study, positive and negative affect, intimacy, partner responsiveness, and expression of attachment-based emotional needs were reported every 3 days before and during treatment. Thirteen couples, with one partner having survived colorectal cancer or breast cancer, participated for the full duration of the study. Statistical analysis of the data was performed using randomization tests, piecewise regression, and multilevel analyses. Results: Adherence to the therapeutic protocol was tested and found adequate. Compared with baseline, significant positive effects on affect variables were found during the therapeutic process. Positive affect increased and negative affect decreased. Partner responsiveness, perceived intimacy, and the expression of attachment-based emotional needs improved, but only in the later phase of treatment. Results at the group level were statistically significant, whereas effects at the individual level were not. Discussion: This study found positive group-level effects of EFCT on affect and dyadic outcome measures in cancer survivors. The positive results warrant further research, including randomized clinical trials, to replicate these effects of EFCT in cancer survivor couples experiencing marital and sexual problems.

ShareHeart: A patient journey map of patients with ischemia and non-obstructive coronary artery disease based on qualitative research.

AIMS AND OBJECTIVES: To visualise the health care experiences and needs of patients with ischemia with non-obstructive coronary arteries in a patient journey map. As such, future design challenges can be provided, and it can be used for future healthcare optimization. BACKGROUND: Ischemia with non-obstructive coronary arteries is a chronic cardiac condition caused by vascular dysfunctions. Ischemia with non-obstructive coronary arteries is often unrecognised, significantly impairs daily functioning, and is more prevalent among women. Patients' experiences remain unexplored, and a clear patient-centered care pathway is lacking. DESIGN: A qualitative interpretative research design was performed and the standards for reporting qualitative research (SRQR) has been used. METHODS: In total, 36 women were included and participated in eight semi-structured focus group interviews. Thematic analysis was used, and identified themes were further classified using 'patient journey mapping.' Additionally, Picker's 'eight principles of patient-centered care' were linked to the results and integrated in the patient journey map. RESULTS: Participants experienced a lack of familiarity with the specific cardiac condition by healthcare providers, repeated hospitalisation, testing and referrals, shortage of specialised cardiologists, and feelings of not being heard. In addition, needs for a multidisciplinary treatment program (including physical and psychological support), better information provision, and an easily accessible contact person were expressed. CONCLUSIONS: The resulting patient journey map shows how patients experienced and interacted with the current healthcare system. Overall, the results show a complex and long healthcare pathway and important themes for healthcare experiences and needs were identified. Future research could focus on the development and implementation of a patient-centered evidence-based clinical pathway optimising experiences and quality of life. RELEVANCE TO CLINICAL PRACTICE: The visual tool can help health care professionals, policy makers, and researchers improve healthcare provision which is patient-centered and tailored to the preferences of patients with ischemia with non-obstructive coronary arteries.

Psychological risk factors that characterize acute stress disorder and trajectories of posttraumatic stress disorder after injury: a study using latent class analysis.

Background: The course and different characteristics of acute and posttraumatic stress disorder (ASD, PTSD) in trauma populations are unclear. Objective: The aims were to identify longitudinal trajectories of PTSD, to establish a risk profile for ASD and PTSD based on patients' sociodemographic, clinical, and psychological characteristics, and to study the effect of ASD and dissociation on PTSD during 12 months after trauma. Method: Patients completed questionnaires after inclusion and at 3, 6, 9, and 12 months afterwards. Trajectories were identified using repeated measures latent class analysis (RMLCA). The risk profile was based on a ranking of importance of each characteristic using Cohen's d effect sizes and odds ratios. The impact of ASD and dissociation on PTSD was examined using logistic regression analyses. Results: Altogether, 267 patients were included. The mean age was 54.0 (SD = 16.1) and 62% were men. The prevalence rate of ASD was approximately 21.7% at baseline, and 36.1% of trauma patients exhibited PTSD at 12 months after injury. Five trajectories were identified: (1) no PTSD symptoms, (2) mild, (3) moderate, (4) subclinical, and (5) severe PTSD symptoms. These trajectories seemed to remain stable over time. Compared with patients in other trajectories, patients with ASD and (subclinical) PTSD were younger and scored higher on anxiety, depressive symptoms, neuroticism, and trait anxiety. Regarding dissociation symptoms, inability to recall memories about the event was significantly more present than an altered sense of reality, (105 (40.7%) versus 56 (21.7%), p = .031), although that symptom had the strongest likelihood for PTSD. Patients with dissociation were significantly at risk for PTSD than patients without dissociation (OR = 4.82; 95%CI: 1.91-12.25). Conclusions: Psychological factors characterized ASD and trajectories of PTSD during 12 months post-trauma. Healthcare providers who are aware of these findings could early identify patients at risk for ASD and PTSD and refer them for patient-centred interventions.

Antecedentes: El curso y las diferentes características del trastorno de estrés agudo y postraumático (TEA, TEPT) en poblaciones traumatizadas no están claros.Objetivo: Los objetivos fueron identificar las trayectorias longitudinales del TEPT, establecer un perfil de riesgo para el TEA y el TEPT basado en las características sociodemográficas, clínicas y psicológicas de los pacientes, y estudiar el efecto del TEA y la disociación en el TEPT durante los 12 meses posteriores al trauma.Método: Los pacientes completaron cuestionarios tras la inclusión y a los 3, 6, 9 y 12 meses después. Las trayectorias se identificaron mediante un análisis de clases latentes de medidas repetidas (RMLCA). El perfil de riesgo se basó en una clasificación de la importancia de cada característica utilizando los tamaños del efecto d de Cohen y cocientes de probabilidades (odds ratios). El impacto del TEA y la disociación en el TEPT se examinó mediante análisis de regresión logística.Resultados: En total, se incluyeron 267 pacientes. La edad media era de 54,0 (SD = 16,1) y el 62% eran hombres. La tasa de prevalencia de TEA fue de aproximadamente el 21,7% al inicio, y el 36,1% de los pacientes traumatizados presentaban TEPT a los 12 meses de la lesión. Se identificaron cinco trayectorias: (1) sin síntomas de TEPT, (2) leve, (3) moderada, (4) subclínica y (5) síntomas graves de TEPT. Estas trayectorias parecían permanecer estables a lo largo del tiempo. En comparación con los pacientes de otras trayectorias, los pacientes con TEA y TEPT (subclínico) eran más jóvenes y puntuaban más alto en ansiedad, síntomas depresivos, rasgos de neuroticismo y ansiedad. En cuanto a los síntomas de disociación, la incapacidad de recordar el suceso estaba significativamente más presente que la alteración del sentido de la realidad (105 (40,7%) frente a 56 (21,7%), p = 0,031), aunque este síntoma tenía la probabilidad más alta de TEPT. Los pacientes con disociación tenían un riesgo significativo de TEPT que los pacientes sin disociación (OR = 4,82; IC 95%: 1,91-12,25).Conclusiones: Los factores psicológicos caracterizaron el TEA y las trayectorias del TEPT durante los 12 meses posteriores al trauma. Los profesionales de la salud que conozcan estos hallazgos podrían identificar precozmente a los pacientes con riesgo de TEA y TEPT y remitirlos a intervenciones centradas en el paciente.

Sexual health-related care needs among young adult cancer patients and survivors: a systematic literature review.

PURPOSE: Young adult cancer patients and survivors have age-specific care needs, but care needs related to sexual health are poorly understood. A systematic literature review was conducted to examine sexual health-related care needs among patients/survivors diagnosed with cancer during young adulthood (age: 18-39 years). The prevalence and types needs were assessed along with associated patient factors. METHODS: Four major databases were screened to identify relevant studies, which were also assessed for risk of bias; all following PRISMA guidelines. RESULTS: Identified studies (N = 35) often assessed sexual health-related care needs by whether participants experienced a generic need for support from providers. The prevalence of such needs ranged between 8 and 61.7% and was higher in female survivors and those with more health impairments. The type of diagnosis could also play a role in these varying prevalence rates, but was not systematically tested in included studies. Types of sexual health-related care needs were clustered into practical/emotional support needs (e.g., coping with physical side effects), information needs (e.g., more details), and communication needs (e.g., providers should initiate conversations, validate concerns, be empathetic/open). Needs should be addressed in-person and/or online. CONCLUSIONS: The extent of needs related to sexual health varies among young adult patients and survivors, but types of needs center around improving provision of support and information by providers. IMPLICATIONS FOR CANCER SURVIVORS: Sexual health should routinely be addressed alongside other potential effects of cancer treatment to allow for constructive conversations between patients and providers. Referrals to (online) resources or specialists should be tailored to individual preferences.

Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies.

INTRODUCTION: Post-intensive care syndrome (PICS) has only recently been recognized as a new clinical entity in patients surviving their intensive care unit (ICU) stay due to critical illness. With increasing survival rates of ICU patients worldwide, there is a rising interest regarding post-ICU recovery. AREAS COVERED: First, based on the current literature a definition is provided of PICS, including the domains of impairments that comprise PICS along with the etiology and risk factors. Second, preventive measures and possible treatment strategies integrated in the follow-up care are described. Third, the authors will discuss the current SARS-Cov-2 pandemic and the increased risk of PICS in these post-ICU patients and their families. EXPERT OPINION: PICS is a relatively new entity, which not only encompasses various physical, cognitive, and psychological impairments but also impacts global health due to long-lasting detrimental socioeconomic burdens. Importantly, PICS also relates to caregivers of post-ICU patients. Strategies to reduce this burden will not only be needed within the ICU setting but will also have to take place in an interdisciplinary, multifaceted approach in primary care settings. Additionally, the SARS-Cov-2 pandemic has a high burden on post-ICU patients and their relatives.

Patients' experiences and wellbeing after injury: A focus group study.

BACKGROUND: Injury can have physical, psychological and social consequences. It is unclear which factors have an impact on patients' wellbeing after injury. This study aimed to explore, using focus groups, patients' experiences and wellbeing after injury and which factors, impede or facilitate patients' wellbeing. METHODS: Trauma patients, treated in the shock room of the Elisabeth-TweeSteden Hospital, the Netherlands, participated in focus groups. Purposive sampling was used. Exclusion criteria were younger than 18 years old, severe traumatic brain injury, dementia, and insufficient knowledge of the Dutch language. The interviews were recorded, transcribed verbatim, and analyzed using coding technique open, axial, and selective coding, based on phenomenological approach. RESULTS: Six focus groups (3 to 7 participants) were held before data saturation was reached. In total, 134 patients were invited, 28 (21%) agreed to participate (Median age: 59.5; min. 18 -max. 84). Main reasons to decline were fear that the discussion would be too confronting or patients experienced no problems regarding the trauma or treatment. Participants experienced difficulties on physical (no recovery to pre-trauma level), psychological (fear of dying or for permanent limitations, symptoms of posttraumatic stress disorder, cognitive dysfunction), social (impact on relatives and social support) wellbeing. These are impeding factors for recovery. However, good communication, especially clarity about the injury and expectations concerning recovery and future perspectives could help patients in surrendering to care. Patients felt less helpless when they knew what to expect. CONCLUSIONS: This is the first study that explored patients' experiences and wellbeing after injury. Patients reported that their injury had an impact on their physical, psychological, and social wellbeing up to 12 months after injury. Professionals with the knowledge of consequences after injury could improve their anticipation on patients' need.

The Relationship Between Psychological Aspects and Trajectories of Symptoms in Total Knee Arthroplasty and Total Hip Arthroplasty.

BACKGROUND: This study aimed to examine different trajectories of physical symptoms in hip and knee arthroplasty patients from presurgery to 1 year postsurgery and relate this to preoperative anxiety and depressive symptoms. METHODS: Patients (N = 345) completed the Hip injury and Osteoarthritis Outcome Score or the Knee injury and Osteoarthritis Outcome Score to examine their preoperative and postoperative pain, stiffness, and function, presurgery, and 3, 6, and 12 months postsurgery. Presurgery anxiety and depressive symptoms were assessed using the 7-item Generalized Anxiety Disorder Scale and the 9-item Patient Health Questionnaire. Latent trajectory analysis was used to identify different subgroups in trajectories. The step-3 method was used to assess subgroup characteristics. RESULTS: The effect of time on pain, function, and stiffness was different between subgroups of patients. Knee patients belonged mainly to classes with least improvement. Least improvement in pain was characterized by a combination of high levels of both anxiety and depressive symptoms. Anxiety and depressive symptoms were independently related to less reduction in stiffness while little improvement in function was characterized by higher depressive symptoms. CONCLUSION: The results of this study indicate that anxiety and depressive symptoms were significantly, but differently, related to the distinct physical symptoms examined.

Unravelling sexual care in chronically ill patients: the perspective of GP practice nurses; Health Service Research.

BACKGROUND: Assessment of sexual health is important in chronically ill patients, as many experience sexual dysfunction (SD). The general practice nurse (GPN) can play a crucial part in addressing SD. OBJECTIVE: The aim of this cross-sectional study was to examine to which extent GPNs discuss SD with chronically ill patients and what barriers may refrained them from discussing SD. Furthermore, we examined which factors had an association with a higher frequency of discussing SD. METHODS: A cross-sectional survey using a 48-item questionnaire was send to 637 GPNs across the Netherlands. RESULTS: In total, 407 GPNs returned the questionnaire (response rate 63.9%) of which 337 completed the survey. Two hundred and twenty-one responding GPNs (65.6%) found it important to discuss SD. More than half of the GPNS (n = 179, 53.3%) never discussed SD during a first consultation, 60 GPNs (18%) never discussed SD during follow-up consultations. The three most important barriers for discussing SD were insufficient training (54.7%), 'reasons related to language and ethnicity' (47.5%) and 'reasons related to culture and religion' (45.8%). More than half of the GPNs thought that they had not enough knowledge to discuss SD (n = 176, 54.8%). A protocol on addressing SD would significantly increase discussing during SD. CONCLUSIONS: This study indicates that GPNs do not discuss SD with chronically ill patients routinely. Insufficient knowledge, training and reasons related to cultural diversity were identified as most important reasons for this practice pattern. Implementation of training in combination with guidelines on SD in the general practice could improve on the discussing of sexual health with chronic patients.

The association of depressive symptoms, personality traits, and sociodemographic factors with health-related quality of life and quality of life in patients with advanced-stage lung cancer: an observational multi-center cohort study.

BACKGROUND: Identification of patient-related factors associated with Health-Related Quality of Life (HRQoL) and Quality of Life (QoL) at the start of treatment may identify patients who are prone to a decrease in HRQoL and/or QoL resulting from chemotherapy. Identification of these factors may offer opportunities to enhance patient care during treatment by adapting communication strategies and directing medical and psychological interventions. The aim was to examine the association of sociodemographic factors, personality traits, and depressive symptoms with HRQoL and QoL in patients with advanced-stage lung cancer at the start of chemotherapy. METHODS: Patients (n = 151) completed the State-Trait Anxiety Inventory (trait anxiety subscale), the Neuroticism-Extraversion-Openness-Five Factor Inventory (NEO-FFI), the Center for Epidemiologic Studies Depression (CES-D), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Simple linear regression analyses were performed to select HRQoL and QoL associated factors (a P ≤ 0.10 was used to prevent non-identification of important factors) followed by multiple linear regression analyses (P ≤ 0.05). RESULTS: In the multiple regression analyses, CES-D score (ß = - 0.63 to - 0.53; P-values < 0.001) was most often associated with the WHOQOL-BREF domains and general facet, whereas CES-D score (ß = - 0.67 to - 0.40; P-values < 0.001) and Eastern Cooperative Oncology Group (ECOG) performance status (ß = - 0.30 to - 0.30; P-values < 0.001) were most often associated with the scales of the EORTC QLQ-C30. Personality traits were not related with HRQoL or QoL except for trait anxiety (Role functioning: ß = 0.30; P = 0.02, Environment: ß = - 0.39; P = 0.007) and conscientiousness (Physical health: ß = 0.20; P-value < 0.04). CONCLUSIONS: Higher scores on depressive symptoms and ECOG performance status were related to lower HRQoL and QoL in patients with advanced-stage non-small cell lung cancer. Supportive care interventions aimed at improvement of depressive symptoms and performance score may facilitate an increase of HRQoL and/or QoL during treatment.

Do dissatisfied patients have unrealistic expectations? A systematic review and best-evidence synthesis in knee and hip arthroplasty patients.

End-stage osteoarthritis is commonly treated with joint replacement. Despite high clinical success rates, up to 28% of patients are dissatisfied with the outcome.This best-evidence synthesis aimed to review studies with different forms of study design and methodology that examined the relationship between (fulfilment of) outcome expectations of hip and knee patients and satisfaction with outcome.A literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane, and Google Scholar to identify studies conducted up to November 2017. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale.In this best-evidence synthesis systematic review, the following main results could be seen. In only half of all studies were preoperative expectations associated with level of satisfaction, while in almost all studies (93%), fulfilment of expectations was related to satisfaction. The effect of met expectations did not differ between hip and knee patients or study design.Fulfilment of expectations seems to be consistently associated with patient satisfaction with outcome. Emphasis in future research must be placed on the operationalization and measurement of expectations and satisfaction to determine the (strength of the) influence of these different forms of assessment on the (existence of the) relationship. Cite this article: EFORT Open Rev 2020;5:226-240. DOI: 10.1302/2058-5241.5.190015.

High Pre-Operative Expectations Precede Both Unfulfilled Expectations and Clinical Improvement After Total Hip and Total Knee Replacement.

BACKGROUND: This prospective study aimed to examine whether patients' and physicians' outcome expectations were related to subjective (ie, fulfillment of expectations) and objective outcomes (ie, change in pain and function) in hip and knee arthroplasty patients up to 6 months post-surgery. METHODS: Patients' (N = 395) and physicians' outcome expectations were examined 1 week post-consultation. Patients' post-operative functional status and the extent of fulfillment of expectations were examined 5 weeks, 3 months, and 6 months post-surgery. Patients and physicians completed the Hospital for Special Surgery Hip/Knee Replacement (Fulfillment) Expectations Survey. Patients completed the Hip/Knee injury and Osteoarthritis Outcome Score. Linear regression analyses were performed to examine the relationship between physicians' expectations and patients' change in pain and function and extent of fulfillment of expectations, and a possible mediated effect of patients' pre-operative expectations. RESULTS: Patients' high expectations were consistently associated with better objective outcomes (ie, change in pain and function). Yet, high expectations in patients were also negatively related to subjective outcomes (ie, the extent of fulfillment of expectations). Physicians' expectations were only positively associated with objective improvement in knee patients, and not in hip patients. Additionally, knee patients' expectations partly mediated the relationship between physicians' expectations and change in pain and function, 6 months post-surgery. CONCLUSION: Although patients' high expectations were associated with better objective outcomes, improvement was still less than patients expected. Thus, patients often have too high expectations of outcomes of surgery. In addition, physicians were able to influence patients' expectations and to change experienced knee patients' outcomes.

A High Proportion of Patients Have Unfulfilled Sexual Expectations After TKA: A Prospective Study.

BACKGROUND: Most patients have high expectations about restoration of the knee function after TKA, expecting a more active life after retirement. However, 20% to 30% of patients report that their expectations are not met postoperatively. Among those unmet expectations may be the anticipation to engage in sexual activity after surgery, but few studies have evaluated sexual activity after arthroplasty. QUESTIONS/PURPOSES: In this study, our purposes were (1) to evaluate the anticipation and the fulfillment of sexual activity after TKA in men and women, and (2) to identify prognostic factors for the fulfillment of anticipated postoperative sexual activity. METHODS: This was a prospective, multicenter study of all 1371 patients scheduled for TKA between June 2012 and July 2015. The study was part of the Longitudinal Leiden Orthopaedics Outcomes of Osteoarthritis Study (LOAS). After screening according to LOAS inclusion criteria, 1213 respondents remained. Our primary study endpoint was whether sexual expectations were met 1 year after TKA; we used the sexual-activity-expectation question from the Hospital for Special Surgery (HSS) Knee Replacement Expectations Survey, which allows the patient to score the result on a 5-point scale. To assess postoperative fulfillment of sexual activity 1 year after TKA, we asked the patient to score the current status of sexual activity on the same 5-point scale: 1 (back to normal), 2 (large improvement), 3 (moderate improvement), 4 (slight improvement), and 5 (does not apply). Patients with incomplete data on the preoperative expectation- and postoperative fulfillment-question of sexual activity were excluded, leaving 71% (866 of 1213) patients for analysis. The difference between the pre- and postoperative scores determined whether expectations of sexual activity were unfulfilled (lower than expected) or fulfilled/exceeded (neutral or higher than expected). Pre- and postoperatively, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Short Form-12 Mental and Physical Component Summary scores (SF-12 MCS and SF-12 PCS), the EuroQoL-5 Dimensions (EQ-5D), and the EQ-5D VAS scale were used. Multivariate regression models were used for analysis. RESULTS: Preoperatively, 54% patients (467 of 866) anticipated postoperative sexual activity after recovery from surgery. Both genders showed that the proportion who anticipated "back to normal" sexual activity decreased with higher age. Likewise, postoperative fulfillment of anticipated sexual activity was found in 58% (111 of 191 for men; 159 of 276 for women). Younger women (younger than 65 years of age) experienced fulfillment more often compared with younger men. A positive postoperative change in functional and health status was associated with fulfilled/exceeded scores of patients anticipating postoperative sexual activity. A better preoperative health status, the EQ-5D VAS score (odds ratio [OR] 1.02 [95% CI 1.01 to 1.03]; p = 0.006), was associated with a higher likelihood of fulfillment of anticipated postoperative sexual activity. CONCLUSION: In both men and women, two of five patients who anticipated postoperative sexual activity indicated that their expectation of sexual activity was not met 1 year after TKA. These patients had worse functional recovery scores compared with patients who achieved the anticipated level of sexual activity. The latter is associated with functional recovery. Surgeons should be aware that many patients anticipate restoration of normal sexual activity, and that this may be the expectation for patients of all ages and for women and men alike. The results underscore the need for more qualitative research to understand this topic in greater depth. LEVEL OF EVIDENCE: Level II, therapeutic study.

Characterizing patients' expectations in hip and knee osteoarthritis.

PURPOSE: Previous research reported conflicting findings regarding the association of sociodemographic and clinical variables with expectations for surgical outcomes. The current study aimed to identify and characterize different subgroups of osteoarthritis patients with respect to amount and level of expectations, and to examine factors that are associated with expectations. METHODS: Hip and knee patients (n = 287) completed a questionnaire 1 week post consultation. Linear regression analyses were performed to examine whether sociodemographic (e.g., age, sex) and clinical factors (e.g., pain, function) were associated with expectations. Latent class analysis (LCA) was used to identify different subgroups and the step 3 method was conducted to assess subgroup characteristics. RESULTS: Mean age of patients was 70 years (SD = 8) and 57% of patients was female. Most improvement was expected in walking ability and pain relief. Higher expectations were associated with younger age, male sex, and functional disability. Both hip and knee patients could be classified into three subgroups. These subgroups differed significantly on pain and other symptoms, and functional disability. CONCLUSION: Both hip and knee patients reported pain and other osteoarthritis symptoms and functional disability and consequently had high expectations in these areas for treatment outcomes. Higher expectations were characterized by more pain, more symptoms and more functional disability. These insights could guide physicians in the discussion of expectations during consultation.

Psychometric properties of the psychosocial screening instrument for physical trauma patients (PSIT).

BACKGROUND: Early detection of psychosocial problems post-injury may prevent them from becoming chronic. Currently, there is no psychosocial screening instrument that can be used in patients surviving a physical trauma or injury. Therefore, we recently developed a psychosocial screening instrument for adult physical trauma patients, the PSIT. The aim of this study was to finalize and psychometrically examine the PSIT. METHODS: All adult (≥ 18 years) trauma patients admitted to a Dutch level I trauma center from October 2016 through September 2017 without severe cognitive disorders (n = 1448) received the PSIT, Impact of Events Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Rosenberg Self-Esteem Scale (RSES), State-Trait Anxiety Inventory-State (STAI-S), and the World Health Organization Quality of Life-Abbreviated version (WHOQOL-Bref). After 2 weeks, a subgroup of responding participants received the PSIT a second time. The internal structure (principal components analysis, PCA; and confirmatory factor analysis, CFA), internal consistency (Cronbach's alpha, α), test-retest reliability (Intraclass Correlation Coefficient, ICC), construct validity (Spearman's rho correlations), diagnostic accuracy (Area Under the Curve, AUC), and potential cut-off values (sensitivity and specificity) were examined. RESULTS: A total of 364 (25.1%) patients participated, of whom 128 completed the PSIT again after 19.5 ± 6.8 days. Test-retest reliability was good (ICC = 0.86). Based on PCA, five items were removed because of cross-loadings ≥ 0.3. Three subscales were identified: (1) Negative affect (7 items; α = 0.91; AUC = 0.92); (2) Anxiety and Post-Traumatic Stress Symptoms (4 items; α = 0.77; AUC = 0.88); and (3) Social and self-image (4 items; α = 0.79; AUC = 0.92). CFA supported this structure (comparative fit index = 0.96; root mean square error of approximation = 0.06; standardized rood mean square residual = 0.04). Four of the five a priori formulated hypotheses regarding construct validity were confirmed. The following cut-off values represent maximum sensitivity and specificity: 7 on subscale 1 (89.6% and 83.4%), 3 on subscale 2 (94.4% and 90.3%), and 4 on subscale 3 (85.7% and 90.7%). CONCLUSION: The final PSIT has good psychometric properties in adult trauma patients.

Positive Effect of Platelet-Rich Plasma on Pain in Plantar Fasciitis: A Double-Blind Multicenter Randomized Controlled Trial.

BACKGROUND: When nonoperative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporary pain reduction but no healing. Platelet-rich plasma (PRP) has proven to be a safe therapeutic option in the treatment of tendon, muscle, bone, and cartilage injuries. PURPOSE: To determine the effectiveness of PRP as compared with corticosteroid injections for chronic plantar fasciitis. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Patients with chronic plantar fasciitis were allocated to have steroid injection or PRP. The primary outcome measure was the Foot Function Index (FFI) Pain score. Secondary outcome measures were function, as scored by the FFI Activity, FFI Disability, and American Orthopaedic Foot & Ankle Society, and quality of life, as scored with the short version of the World Health Organization Quality of Life (WHOQOL-BREF). All outcomes were measured at baseline and at 4, 12, and 26 weeks and 1 year after the procedure. RESULTS: Of the 115 patients, 63 were allocated to the PRP group, of which 46 (73%) completed the study, and 52 were allocated to the control group (corticosteroid injection), of which 36 (69%) completed the study. In the control group, FFI Pain scores decreased quickly and then remained stable during follow-up. In the PRP group, FFI Pain reduction was more modest but reached a lower point after 12 months than the control group. After adjusting for baseline differences, the PRP group showed significantly lower pain scores at the 1-year follow-up than the control group (mean difference, 14.4; 95% CI, 3.2-25.6). The number of patients with at least 25% improvement (FFI Pain score) between baseline and 12-month follow-up differed significantly between the groups. Of the 46 patients in the PRP group, 39 (84.4%) improved at least 25%, while only 20 (55.6%) of the 36 in the control group showed such an improvement (P = .003). The PRP group showed significantly lower FFI Disability scores than the control group (mean difference, 12.0; 95% CI, 2.3-21.6). CONCLUSION: Treatment of patients with chronic plantar fasciitis with PRP seems to reduce pain and increase function more as compared with the effect of corticosteroid injection. REGISTRATION: NCT00758641 (ClinicalTrials.gov identifier).

Discrepancy between Expectations and Experiences after Prostate Cancer Treatment: A Dutch Multicenter Study.

OBJECTIVES: To evaluate possible discrepancies between patients' expectations concerning sexual side effects related to prostate cancer treatment, based on the obtained information prior to treatment. Moreover, to determine if demographic or clinical factors may have an effect on the accuracy of patients' expectations concerning sexual side effects after treatment. METHODS: A multicenter, cross-sectional survey was performed among men treated with prostatectomy, brachytherapy, external-beam radiotherapy and/or hormonal therapy. RESULTS: In total, 412 questionnaires were analyzed. Of men with sexual side effects after treatment, 1 in 3 (32.5%, n = 109) reported their complaints as worse than expected; significantly more often reported by men treated surgically (P = .001), men with a local stage tumor (P = .005) and by men with a lower prostate-specific antigen level at diagnosis (P = .046). It was significantly less often reported by men treated with radiotherapy combined with hormonal therapy (P = .031). Men who used brochures as an information source reported their sexual side effects significantly less often as worse than expected (P < .001). CONCLUSION: One in three men with sexual side effects after prostate cancer treatment, experienced their complaints as worse than expected based on the obtained information prior to treatment. Men treated with radiotherapy combined with hormonal therapy indicated less discrepancy between expectations and developed sexual side effects, whereas prostatectomy, low stage tumor and low prostate-specific antigen level were associated with more discrepancy. Brochures should be administered additionally to verbal information to improve patients' understanding of possible sexual side effects and to enhance the accuracy of patients' expectations.

Investigating the effect of a symposium on sexual health care in prostate cancer among Dutch healthcare professionals.

AIMS AND OBJECTIVES: To investigate whether a symposium aimed at healthcare professionals in the uro-oncological field changes knowledge, competence and general practice regarding sexual dysfunction after prostate cancer treatment. BACKGROUND: Sexual dysfunction is not frequently discussed by healthcare professionals; lack of knowledge and training are two of the most often reported barriers. Provision of additional training could improve knowledge, competence and general practice of healthcare professionals. DESIGN: Two questionnaires were used in this pre-post study to determine knowledge, competence and general practice at the time of the symposium and six months afterwards. METHODS: In order to perform repeated measures to analyse alterations among participating healthcare professionals (n = 55), the McNemar's test was used. A STROBE checklist was completed. RESULTS: Seventy-three per cent (n = 40) stated that not enough attention was paid to prostate cancer-related sexual dysfunction during their education. Nurses felt significantly less competent in discussing sexual function, advising on sexual dysfunction and actively inquiring sexual complaints compared to other healthcare professionals. After the symposium, sexual dysfunction was significantly more often discussed. No significant effects were found on knowledge on sexual dysfunction, knowledge on treatment of sexual dysfunction, competence in discussing sexual function, advising on sexual dysfunction, actively inquiring sexual complaints and rate of referral. Tools needed to address sexual dysfunction concerned written information materials (75.5%) and a website containing adequate information (56.6%). CONCLUSIONS: The symposium had no significant influence on knowledge, competence and rate of referral in men with sexual dysfunction after prostate cancer treatment. However, sexual dysfunction was more frequently discussed after the symposium, so increase of awareness of consequences of prostate cancer treatment was achieved. RELEVANCE TO CLINICAL PRACTICE: Consequences of prostate cancer treatment to sexual function should be taken in consideration in daily practice; written information materials and a website containing adequate information were indicated as valuable resources to address sexual dysfunction in routine consultations.

Treatment-Related Sexual Side Effects From the Perspective of Partners of Men With Prostate Cancer.

A cross-sectional survey was performed among partners and men who received treatment for prostate cancer to investigate whether demographic and clinical characteristics are associated with the extent of how difficult partners found it dealing with sexual side effects and the degree of having experienced sexual problems after treatment. Moreover, an aim was to determine whether sexual side effects have an impact on the relationship. A total of 171 partners were included. In all, 104 men (70.7%) experienced an increase in erectile complaints after treatment. Almost half of partners of men with an increase in erectile complaints (63.6%, n = 63) found it difficult to deal with sexual side effects and 63.5% (n = 66) experienced sexual problems. Partners with lower education levels experienced fewer sexual problems than partners with higher education levels (p < .001). Furthermore, no significant associations were found on demographic characteristics, number of comorbidities, clinical characteristics (prostate-specific antigen level; tumor, node, and metastasis staging; Gleason grading), and type of treatment. The majority of men (58.4%, n = 59) and partners (62.5%, n = 65) indicated to not have experienced the impact of sexual side effects on their relationship.