Core Set of Patient-Reported Outcome Measures for Measuring Quality of Life in Clinical Obesity Care.

PURPOSE: The focus of measuring success in obesity treatment is shifting from weight loss to patients' health and quality of life. The objective of this study was to select a core set of patient-reported outcomes and patient-reported outcome measures to be used in clinical obesity care. MATERIALS AND METHODS: The Standardizing Quality of Life in Obesity Treatment III, face-to-face hybrid consensus meeting, including people living with obesity as well as healthcare providers, was held in Maastricht, the Netherlands, in 2022. It was preceded by two prior multinational consensus meetings and a systematic review. RESULTS: The meeting was attended by 27 participants, representing twelve countries from five continents. The participants included healthcare providers, such as surgeons, endocrinologists, dietitians, psychologists, researchers, and people living with obesity, most of whom were involved in patient representative networks. Three patient-reported outcome measures (patient-reported outcomes) were selected: the Impact of Weight on Quality of Life-Lite (self-esteem) measure, the BODY-Q (physical function, physical symptoms, psychological function, social function, eating behavior, and body image), and the Quality of Life for Obesity Surgery questionnaire (excess skin). No patient-reported outcome measure was selected for stigma. CONCLUSION: A core set of patient-reported outcomes and patient-reported outcome measures for measuring quality of life in clinical obesity care is established incorporating patients' and experts' opinions. This set should be used as a minimum for measuring quality of life in routine clinical practice. It is essential that individual patient-reported outcome measure scores are shared with people living with obesity in order to enhance patient engagement and shared decision-making.

A dissociation between symbolic number knowledge and analogue magnitude information.

Semantic understanding of numbers and related concepts can be dissociated from rote knowledge of arithmetic facts. However, distinctions among different kinds of semantic representations related to numbers have not been fully explored. Working with numbers and arithmetic requires representing semantic information that is both analogue (e.g., the approximate magnitude of a number) and symbolic (e.g., what / means). In this article, the authors describe a patient (MC) who exhibits a dissociation between tasks that require symbolic number knowledge (e.g., knowledge of arithmetic symbols including numbers, knowledge of concepts related to numbers such as rounding) and tasks that require an analogue magnitude representation (e.g., comparing size or frequency). MC is impaired on a variety of tasks that require symbolic number knowledge, but her ability to represent and process analogue magnitude information is intact. Her deficit in symbolic number knowledge extends to a variety of concepts related to numbers (e.g., decimal points, Roman numerals, what a quartet is) but not to any other semantic categories that we have tested. These findings suggest that symbolic number knowledge is a functionally independent component of the number processing system, that it is category specific, and that it is anatomically and functionally distinct from magnitude representations.

Rapid hiv testing in urban outreach: a strategy for improving posttest counseling rates.

In 1998, 48% of persons who had HIV testing at publicly funded sites in the United States failed to return for test results and posttest counseling. Opportunities for timely HIV therapy were lost; valuable resources were wasted. This study tested the hypothesis that rapid HIV testing enables a high percentage of high-risk outreach clients to learn their serostatus. We did on-site counseling and rapid HIV testing at community-based organizations (e.g., chemical dependency programs, homeless shelters) in North Minneapolis. The project tested 735 persons. All but one (99.9%) learned their HIV serostatus. African Americans made up 79% of subjects. Rapid testing has a role to play in HIV outreach. It is useful in populations who are at high risk of HIV infection, who currently are not accessing HIV testing, and who have high failure to return rates. Future developments in rapid testing technology will make this testing option more convenient and cost-effective.

Discourse processing in women with fragile x syndrome: evidence for a deficit establishing coherence.

The language phenotype in individuals with fragile X syndrome (FXS) and its relation to the molecular genetics of the disorder was investigated. Previous research has focused on describing deviance in conversational speech, and has not yet examined component discourse skills. The ability of women with FXS to use coherence to select endings to humorous and straightforward passages was evaluated, and the relation of this with neuropsychological measures of working memory, executive functions, and molecular measures of the syndrome were also evaluated. Three groups of nonretarded women were examined: (a) 14 women with FXS who carry the full mutation; (b) 25 women who carry the premutation; and (c) 16 women without the fragile X mutation. The results indicated that subjects with the full mutation showed a dramatic deficit in selecting appropriate endings to jokes relative to stories, even though the jokes were identical to the stories except for their endings. The coherence deficit found in the jokes task for women with the full mutation was found to correlate strongly with the X activation ratio, and to a neuropsychological measure of working memory. The full mutation subjects' coherence deficit is discussed in terms of the additional demand to hold information in memory and shift set.

Asthma management. The case for aiming at control rather than merely relief.

Asthma is a common and eminently treatable disease. Most asthma patients are initially seen by primary care physicians, who are likely to have a significant part in management. Research has provided physicians with a better understanding of the pathophysiologic basis of asthma and new antiasthma agents. Guidelines have been published to disseminate asthma management information. On the basis of these advances, there appears to be no reason that informed physicians cannot play an important role in reversing recent trends of rising asthma morbidity and mortality.

The Family Stories Workshop: stories for those who cannot remember.

The Family Stories Workshop (FSW) is a process through which family members and friends of persons with dementing disorders living in nursing homes develop stories of these residents' lives. The stories are meant to help staff members to develop a better, more deeply felt understanding of the lives of the residents, persons who can no longer tell their own stories. The workshop is product-oriented and is not meant as a support group and works best in organizations emphasizing individualized care. This article describes the process of the FSW as well as outcomes from preliminary implementation. It suggests ways of using elements of the process to more broadly accomplish the FSW purposes.

Clinical trial of wax-matrix sustained-release niacin in a Russian population with hypercholesterolemia.

OBJECTIVE: To assess the clinical effectiveness and tolerability of wax-matrix, controlled-release nicotinic acid (CNA) in persons with hypercholesterolemia. DESIGN: Randomized, double-blind, placebo controlled, crossover trial. SETTING: Ambulatory clinic at an academic cardiology center in Moscow, Russia. PATIENTS: A volunteer sample of 135 men and women, aged 20 to 70 years, with hypercholesterolemia greater than 5.82 mmol/L (225 mg/dL) (70th-95th percentile for age and sex) who otherwise met study inclusion and exclusion criteria, were initially recruited into the study. Cholesterol levels were reduced to less than 5.82 mmol/L (225 mg/dL) in 46 subjects who participated in the initial diet intervention and were excluded from the drug intervention. Eighty-nine subjects were randomized into the clinical trial; 4 subjects (4.5%) dropped out of the study because of intolerance of CNA. INTERVENTION: Eight weeks of diet alone (American Heart Association Step I Diet) was followed by randomization to 2 treatment groups (1500 mg/d CNA [ENDURACIN] or placebo) for 2 months followed by a crossover of treatments for 2 months, followed by all subjects taking 2000 mg/d of CNA for 2 months. MAIN OUTCOME MEASURES: Significant improvements in baseline measures for total serum cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were observed after initial diet (TC, 6%; LDL-C, 6%; P < .001, t test), after 1500 mg/d CNA (TC, 14%; LDL-C, 18%; P < .001, t test), and after 2000 mg/d CNA (TC, 16%; LDL-C, 21%; P < .001, t test). Triglyceride, high-density lipoprotein cholesterol, and lipoprotein(a) levels also improved. No serious toxic reactions were encountered, and 4 subjects withdrew from the study because of intolerance of cutaneous and gastrointestinal adverse effects. CONCLUSION: Wax-matrix CNA is an effective and well-tolerated pharmacological treatment for hypercholesterolemia.

Nedocromil in the outpatient management of asthma.

OBJECTIVE: To more closely approximate the use of a nonsteroidal inhaled anti-inflammatory medication for asthma, nedocromil sodium, under actual ambulatory practice conditions. DESIGN: Large, open-label trial. PATIENTS: One thousand two hundred one patients from 286 primary care and specialty centers. INTERVENTION: Four weeks of treatment with nedocromil sodium (4 mg delivered from the valve and 3.5 mg delivered from the mouthpiece of a metered inhalor [2 puffs, four times daily]). MAIN OUTCOME MEASURES: Asthma symptom scores, peak expiratory flow rate, a lifestyle assessment measures questionnaire, and mean number of days missed per month from work or school. RESULTS: Statistically significant improvements were seen after 1 and 4 weeks of treatment for cough, daytime and nighttime asthma, morning tightness, peak expiratory flow rate, and all four measured lifestyle assessment factors (P < .001). An additional clinically relevant outcome measure, mean number of days missed per month from work or school, was reduced by 75% (P < .001). No serious adverse reactions were reported. CONCLUSION: This study reproduces the high level of efficacy and safety of nedocromil that was previously reported in placebo-controlled clinical studies.

Hypercholesterolemia. Dietary advice for patients regarding meat.

The contribution of beef, pork, lamb, and veal to total fat, saturated fat, and cholesterol intake must be evaluated from a total-diet standpoint. The hidden fats in snack foods and other processed foods contribute significantly to total fat and cholesterol intake. Patients with hypercholesterolemia can include a moderate amount of meat in their cholesterol-lowering diet provided they choose lean cuts of meat, trim visible fat, pay attention to portion size, and use low-fat cooking methods. Substituting skinless chicken or fish for meat may make sense from the standpoint of personal preference and dietary variety but does not confer additional benefits in terms of reducing blood cholesterol levels.

The medical director in non-institutional long-term care programs.

Non-institutional long-term care is a broad, poorly defined, rapidly developing field. The need for it, the technologic ability to provide it, and the amount of money spent on it are all growing. Reconciling the public's reluctance to support social programs with the inevitable overlap of social and medical needs in the care of the frail elderly presents a serious challenge in formulating policy. Medical directors of programs in non-institutional long-term care will have to face governmental constraints and will be responsible for developing and implementing new policy in the future.

Nedocromil: a new agent for the treatment of asthma.

Nedocromil sodium is a recently approved anti-inflammatory medication for the treatment of mild to moderate asthma. This pyranoquinolone blocks the inflammatory response in the airways by stabilizing inflammatory cells (mast cells, bronchial epithelial cells and alveolar macrophages), by preventing local release of inflammatory mediators, and by blocking chemotaxis and preventing the release of inflammatory mediators by inflammatory cells. Nedocromil may also be effective in blocking the neurogenic component of asthma. The drug is administered by metered-dose inhaler, two 4-mg inhalations four times per day. Clinical improvement usually occurs within two to four days. Studies of patients receiving nedocromil have shown a significant decrease in the number of days lost from work or school, an increase in morning peak flow rates and a decrease in need for bronchodilator medications. Overall, only 2 to 3 percent of patients discontinue therapy because of adverse side effects. With respect to cost, nedocromil is comparable to other inhaled anti-inflammatory agents, and it is a safe and effective first-line therapy for mild to moderate asthma in patients 12 years of age or older.

The outcome of strabismus surgery in childhood exotropia.

The results of squint surgery in 42 children with primary, non-paralytic, childhood exotropia are analysed. A 'favourable outcome', defined as a final alignment for near and distance within +/- 10 dioptres of straight, or within +/- 20 dioptres of straight with evidence of binocular single vision, was achieved in 39 (93%) children. The factors affecting the final outcome are discussed, including age of onset, age at the time of surgery, preoperative and post-operative amblyopia, refractive error, anisometropia, the surgical procedures used, and postoperative ocular alignment.

How to make sure your older patients are getting enough zinc.

Older patients with inadequate dietary habits tend to be at risk for mild to moderate zinc deficiency. Symptoms that can be of particular concern include slow wound healing, increased risk of infection, and a loss of acuity in taste and smell. The diagnosis of zinc deficiency is based on a review of the patient's eating habits; laboratory testing is not generally useful in the clinical setting. Most older adults can achieve an adequate zinc intake by eating a variety of foods each day, including meat, fish, and poultry. Supplementation is appropriate in cases of known or suspected frank zinc deficiency.

Plasma lipid response and nutritional adequacy in hypercholesterolemic subjects on the American Heart Association Step-One Diet.

OBJECTIVES: To determine the efficacy of the American Heart Association Step-One Diet for lowering blood lipid levels and to assess its nutritional adequacy in younger (< 50 years old) and older (> or = 50 years old) subgroups. STUDY DESIGN: A prospective cohort study; 383 subjects were instructed in the American Heart Association Step-One Diet. Adherence to the diet was assessed at 6 weeks. Eighty-seven subjects continued the diet for an additional 12 weeks. SETTING: General community participants: volunteers from community cholesterol screening programs and chart reviews at family practice clinics. STUDY PARTICIPANTS: Men and women, aged 20 to 70 years, with baseline low-density lipoprotein cholesterol levels between the 50th and 95th percentile, and excluded if receiving any medications that affect blood lipid levels or if there was a history of diabetes, gout, peptic ulcer, or liver disease. INTERVENTION: Instruction by a registered dietitian and adherence to the American Heart Association Step-One Diet for 6 (n = 383) and 18 weeks (n = 87). This diet involves an intake of total fat not to exceed 30% of calories, saturated fatty acids not to exceed 10% of calories, and dietary cholesterol limited to 300 mg/d. RESULTS: Subjects aged 50 to 70 years averaged a reduction in total cholesterol level and low-density lipoprotein cholesterol level of 4% after 6 weeks. At the end of 18 weeks, mean total cholesterol and low-density lipoprotein cholesterol levels in subjects younger than 50 years exceeded their baseline levels, and in those older than 50 years returned to baseline lipid levels. Inadequate intake of several micronutrients were reported, notably, zinc, calcium, and vitamins A, D, and E. CONCLUSIONS: When recommending the American Heart Association Step-One Diet to persons with hyperlipidemia, baseline dietary behavior should be assessed to determine whether that diet offers therapeutic advantage over the persons's self-selected diet. Follow-up should include monitoring of lipid response and nutritional adequacy. Special emphasis should be placed on selection of foods with appropriate micronutrient content.

Management of retinal vein occlusion.

Retinal vein occlusion is a common cause of visual loss. The clinical features, pathogenesis, aetiology and management of this condition are presented and discussed. It is an advantage to involve both the physician and the ophthalmologist in the management of the condition.

Are there medical conditions specifically underlying the development of rubeosis in central retinal vein occlusion?

Two hundred and thirty five patients with central retinal vein occlusion (mean age 64.9 years, 95% CI (63.3, 66.5) years), comprising 221 white Europeans, 10 Asians and 4 West Indians) were studied over a 7 year period of whom 13.2% (n = 31) developed rubeosis (mean age 70.1 years, 95% CI (66.3, 73.9) years; all white Europeans). Comparisons were made with 31 of the original 235 CRVO patients who did not develop rubeosis, and who were individually matched for age, sex and ethnic origin. The 31 patients developing rubeosis were significantly older (p = 0.013) than the 204 patients not developing rubeosis (mean age 64.1 years, 95% CI (62.3, 65.9) years). There was no significant difference between the CRVO group with rubeosis and the uncomplicated matched CRVO group in the prevalence rates of hypertension (64.5% vs. 45.2%), hyperlipidaemia (48.4% vs. 38.7%) or diabetes mellitus (9.7% vs. 12.9%). We conclude that neovascular glaucoma is more likely to occur in older subjects with CRVO.