BACKGROUNDWeight gain is a potential negative outcome of breast-cancer treatment,occurringin 50%-to-96%of breast-cancer patients,although the amount of weight gain isinconsistently reported in the literature.Research ...BACKGROUNDWeight gain is a potential negative outcome of breast-cancer treatment,occurringin 50%-to-96%of breast-cancer patients,although the amount of weight gain isinconsistently reported in the literature.Research has also shown a relationshipbetween overweight/obesity and breast-cancer mortality.Correspondingly,weight management is a self-care approach known to benefit quality of life(QOL).These research questions and analysis add to existing literature byexamining participants’body mass index(BMI)trend and its relationship withQOL indicators over seven years.AIMTo examine:(1)BMI trends among breast cancer survivors;and(2)The trends’relationship to QOL indicators over seven years.METHODSDuring the Breast Cancer and Lymphedema Project,378 patients’weight andheight were recorded by nurses prior to or just after beginning breast cancertreatment and repeated at quarterly-to-semiannual intervals over seven years.Additionally,participants annually completed the 36-Item Short Form HealthSurvey(SF-36),a valid and reliable tool assessing QOL and health concepts,including physical function,pain,and emotional well-being.BMI trends,changein BMI,and change in SF-36 subscales over seven years were calculated using arandom-intercept repeated-measures regression.Patients were placed into BMIcategories at each time point:Normal,Overweight and Obese.As patients’weights changed,they were categorized accordingly.RESULTSDuring the seven-year study and while controlling for age and residence,participants gained an average of 0.3534 kg/m^2(P=0.0009).This amountremained fairly consistent across BMI categories with those in the normal-weight category(n=134)gaining 0.4546 kg/m^2(P=0.0003);Overweight(n=190)gaining 0.2985 kg/m^2(P=0.0123);and obese(n=199)gaining 0.3147 kg/m^2,(P=0.0649).Age(under or over 55)and region(metro/micro vs small/rural)weresignificantly associated with BMI increase in both the normal and obesecategories.There were statistically significant(P<0.0100)changes in five of theeight SF-36 domains;however,the directions of change were different andsomewhat divergent from that hypothesized.Controlling for age and region,these five were statistically significant,so there were no change or differencesbetween the micropolitan/metropolitan and small town/rural groups.CONCLUSIONAlthough only modest increases in mean BMI were observed,mean BMI changewas associated with selected QOL indicators,suggesting the continued need forself-care emphasis during breast cancer survivorship.展开更多
Breast cancer(BC)is the most common malignant tumor and one of the top causes of cancer-related death worldwide(Sung et al.,2021).The recent advances in early tumor diagnosis coupled with more effective treatment stra...Breast cancer(BC)is the most common malignant tumor and one of the top causes of cancer-related death worldwide(Sung et al.,2021).The recent advances in early tumor diagnosis coupled with more effective treatment strategies resulted in a steady increase of long-term survivors(Nardin et al.,2020;Invernizzi et al.,2022).These improved survival rates led to a significantly higher incidence of disabling complications related to breast cancer and/or its treatment(Invernizzi et al.,2020a;D’Egidio et al.,2017;Zhong et al.,2020).展开更多
The number of long-term colorectal cancer (CRC) survivors has increased substantially over the past three decades due to both ongoing advances in early detection and improvements in cancer therapies. Adult survivors o...The number of long-term colorectal cancer (CRC) survivors has increased substantially over the past three decades due to both ongoing advances in early detection and improvements in cancer therapies. Adult survivors of CRC experience chronic health conditions due to normal issues associated with aging, which is further compounded by the long-term adverse effects of having had cancer and anti-cancer therapies. In addition, they are at a higher risk for CRC recurrences, new primary cancers, and other co-morbidities. This article will provide an overview of the clinical care of adult survivors of CRC. Epidemiologic data will be presented followed by a discussion of the approach to the care of long-term adult survivors of CRC, including surveillance of recurrences and new primary cancers, interventions to manage both physical and psychological consequences of cancer and its treatments, and strategies to address concerns related to unemployment and disability. Finally, we will explore the challenges of healthcare delivery, especially with respect to the coordination of follow-up between cancer specialists and primary care physicians, so as to ensure that all of the survivor’s health needs are met promptly and appropriately.展开更多
Objectives: To assess potential knowledge gaps between primary care providers (PCPs) and cancer specialists, Michigan Cancer Consortium guidelines were developed and disseminated statewide. We evaluated the impact of ...Objectives: To assess potential knowledge gaps between primary care providers (PCPs) and cancer specialists, Michigan Cancer Consortium guidelines were developed and disseminated statewide. We evaluated the impact of dissemination of these guidelines on PCP attitudes and beliefs regarding management of prostate cancer (PC) post-treatment sequelae. Methods: Guidelines were disseminated via hard-copy and web-link mailed to 12,000 Michigan PCPs in 2009, and via 5 CME presentations to 181 PCPs in 2010-2011. 132 initial surveys were collected from CME attendees and 549 follow-up surveys were received 20 months after the initial mailing. Results: Surveyed PCPs indicated erectile dysfunction (88%), incontinence (84%), anxiety (54%) and fear of the unknown (50%) as frequent post-treatment sequelae. A minority of PCPs (≤41%) felt “very comfortable” assessing PC patients for ten post-treatment sequelae at the initial survey, which increased by up to 27% on follow-up survey. 93% of PCPs that received guidelines by mail and CME presentation had incorporated them into practice, compared with 72% of PCPs that received guidelines solely by mailing. Similarly, a greater proportion reported practice pattern changes (65% vs. 34%, p = 0.0003). A higher proportion felt CME events (69% vs. 57%) and expert presentations (64% vs. 44%) were “very effective”, when comparing attendees and non-attendees. Conclusions: Guideline distribution resulted in increased comfort with survivorship issues and incorporation into the practices of the majority of PCPs surveyed. A greater impact was observed in PCPs that attended a CME presentation than in those that received guidelines only by mailing.展开更多
Overhunting of mammals may negatively affect plant populations though indirect impacts on mammal-plant interactions such as herbivory. In this paper, we examined how hunting of terrestrial mammals impacts the survival...Overhunting of mammals may negatively affect plant populations though indirect impacts on mammal-plant interactions such as herbivory. In this paper, we examined how hunting of terrestrial mammals impacts the survival of seedlings and juveniles of the palm Astrocaryum gratum. To determine A. gratum seedling survivorship patterns, an experiment with seedlings in 25 × 250-m plots exclosures and different levels of mammal species presence was conducted: all mammals, only Tayassu peccari potentially a major seedling predator and no animals excluded. More than 50,600 non-adults were measured for 27 months. We replicated these treatments in three forest categories: 1) no hunting, with an intact mammal community, 2) a lightly hunted region and 3) a heavily hunted area. Seedling survivorship under natural non-experimental conditions was highest in the heavily hunted (S(T) = 0.72), lower in moderate and lowest in unhunted forests. Experiments revealed that T. peccari was the main agent of palm seedling mortality and the most important factor determining seedling and juvenile survivorship, for example they caused the 84.61% deaths of the seedlings in unhunted forests. Thus, T. peccari feeding habits can influence forest dynamics and forest structure. T. peccari was also susceptible to hunting pressure and as the main seed and seedling predator in the system, its extinction should affect the survivorship and distribution of A. gratum in forests.展开更多
BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the nativ...BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.展开更多
Introduction: Cancer is a chronic debilitating disease that unnerves patients, communities, and nations. At some point in cancer patient’s disease experience, chemotherapy is used, and the patient is expected to adhe...Introduction: Cancer is a chronic debilitating disease that unnerves patients, communities, and nations. At some point in cancer patient’s disease experience, chemotherapy is used, and the patient is expected to adhere to treatment to improve survival and quality of life. Methods: This multisite Cluster Randomized Trial (CRT) evaluated the effectiveness of mobile phone Short Message Service (SMS) support on the adherence to treatment schedules among adult cancer patients in Kenya. Data was collected using questionnaires. Ethical approvals were obtained from relevant Ethical Review Boards (ERBs). Results: The mean adherence was 83%. There was a significant difference between treatment arms in relation to the adherence. The intervention arm had a higher mean adherence difference, M = 3.913, 95% CI 2.632-5.193, t (402) = 6.006, p ≤ 0.001), with Cohen’s d = 0.60. Although not significant, (χ<sup>2</sup>dd = 0.151, df = 1, p = 2.064), more women were perfect adheres than males. Perfect adherers were satisfied with SMS support (χ<sup>2</sup>dd = 7.620, df = 1, p = 0.06), were in the intervention arm (χ<sup>2</sup>dd = 22.942, df = 1, p ≤ 0.001), and had trust in the care provider (χ<sup>2</sup>dd = 10.591 p ≤ 0.001). SMS support was not significant in the multivariate analysis but had an estimated effect size of 0.958 (z = 1.424, p = 0.154, CI = 0.242-3.781), indicating that mean adherence was slightly better in the presence of the intervention. Conclusions: SMS-support intervention has demonstrated superiority in influencing adherence. Further, health system-related factors have a significant influence on the adherence to chemotherapy treatment. Interventions to re-design health systems that are responsive to unmet care needs of cancer patients must be explored. .展开更多
Background Greater physical activity is associated with improved outcomes in people living with and beyond cancer.However,most studies in exercise oncology use self-reported measures of physical activity.Few have expl...Background Greater physical activity is associated with improved outcomes in people living with and beyond cancer.However,most studies in exercise oncology use self-reported measures of physical activity.Few have explored agreement between self-reported and device-based measures of physical activity in people living with and beyond cancer.This study aimed to describe physical activity in adults affected by cancer across self-reported and device-assessed activity,to explore levels of agreement between these measures in terms of their utility for categorizing participants as meeting/not meeting physical activity guidelines,and to explore whether meeting guidelines is associated with fatigue,quality of life,and sleep quality.Methods A total of 1348 adults living with and beyond cancer from the Advancing Survivorship Cancer Outcomes Trial completed a survey assessing fatigue,quality of life,sleep quality,and physical activity.The Godin-Shephard Leisure-Time Physical Activity Questionnaire was used to calculate a Leisure Score Index(LSI)and an estimate of moderate-to-vigorous physical activity(MVPA).Average daily steps and weekly aerobic steps were derived from pedometers worn by participants.Results The percentage of individuals meeting physical activity guidelines was 44.3%using LSI,49.5%using MVPA,10.8%using average daily steps,and 28.5%using weekly aerobic steps.Agreement(Cohen'sκ)between self-reported and pedometer measures ranged from 0.13(LSI vs.average daily steps)to 0.60(LSI vs.MVPA).After adjusting for sociodemographic and health-related covariates,meeting activity guidelines using all measures was associated with not experiencing severe fatigue(odds ratios(ORs):1.43–1.97).Meeting guidelines using MVPA was associated with no quality-of-life issues(OR=1.53).Meeting guidelines using both self-reported measures were associated with good sleep quality(ORs:1.33–1.40).Conclusion Less than half of all adults affected by cancer are meeting physical activity guidelines,regardless of measure.Meeting guidelines is associated with lower fatigue across all measures.Associations with quality of life and sleep differ depending on measure.Future research should consider the impact of physical activity measure on findings,and where possible,use multiple measures.展开更多
Background Physical activity(PA)and reductions in sedentary behavior(SED)may mitigate cancer-related cognitive impairment.The purpose of this study was to examine(a)the associations between changes in PA,SED,and cogni...Background Physical activity(PA)and reductions in sedentary behavior(SED)may mitigate cancer-related cognitive impairment.The purpose of this study was to examine(a)the associations between changes in PA,SED,and cognitive function in cancer survivors before and during the coronavirus disease 2019(COVID-19)pandemic;and(b)clinical subgroups that moderate this association.Methods A cross-sectional survey was administered online to adult cancer survivors globally between July and November of 2020.This was a secondary analysis of a cross-sectional survey examining changes in self-reported PA and quality of life in cancer survivors before and during the COVID-19 pandemic.Self-reported Questionnaires assessed moderate-to-vigorous PA(MVPA)using the modified Godin Leisure Time Exercise Questionnaire,cognitive function using the Functional Assessment of Cancer Therapy-Cognitive Function(FACT-Cog)scale,and SED using the Domain-specific Sitting Time questionnaire.Cancer survivors were classified into no change in behavior,desirable change(i.e.,increase MVPA to meet PA guidelines or decrease SED by≥60 min/day),and undesirable change(i.e.,decrease MVPA to<150 min/week or increase SED by≥60 min/day).Analysis of covariance examined differences in FACT-Cog scores across the activity change categories.Planned contrasts compared differences in FACT-Cog scores between cancer survivors with(a)no meaningful change vs.any change,and(b)a desirable change vs.an undesirable change.Results There were no significant differences in FACT-Cog scores across activity-change categories in the full sample of cancer survivors(n=371;age=48.6±15.3 years(mean±SD)).However,cancer survivors who were diagnosed≥5 years ago(t(160)=–2.15,p=0.03)or who received treatment≥5 years ago(t(102)=–2.23,p=0.03)and who had a desirable change in activity reported better perceived cognitive abilities than those who had an undesirable change.Conclusion PA promotion efforts should consider reducing SED in addition to maintaining MVPA in long-term cancer survivors to mitigate cancer-related cognitive impairment during the COVID-19 pandemic.展开更多
Background Physical activity(PA)can improve the physical and psychological health of prostate and colorectal cancer survivors,but PA behavior change maintenance is necessary for long-term health benefits.OncoActive is...Background Physical activity(PA)can improve the physical and psychological health of prostate and colorectal cancer survivors,but PA behavior change maintenance is necessary for long-term health benefits.OncoActive is a print-and web-based intervention in which prostate and colorectal cancer patients and survivors receive automatically generated,personalized feedback aimed at integrating PA into daily life to increase and maintain PA.We evaluated the long-term outcomes of OncoActive by examining the 12-month follow-up differences between OncoActive and a control group,and we explored whether PA was maintained during a 6-month non-intervention follow-up period.Methods Prostate or colorectal cancer patients were randomly assigned to an OncoActive(n=249)or a usual care waitlist control group(n=229).OncoActive participants received PA advice and a pedometer.PA outcomes(i.e.,ActiGraph and self-report moderate-to-vigorous intensity PA(MVPA)min/week and days with≥30 min PA)and health-related outcomes(i.e.,fatigue,depression,physical functioning)were assessed at baseline,6 months,and 12 months.Differences between groups and changes over time were assessed with multilevel linear regressions for the primary outcome(ActiGraph MVPA min/week)and all additional outcomes.Results At 12 months,OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week,self-report MVPA min/week,or ActiGraph days with PA.Only self-report days with PA were significantly higher in OncoActive compared to the control group.For health-related outcomes only long-term fatigue was significantly lower in OncoActive.When exploratively examining PA within OncoActive,the previously found PA effects at the end of the intervention(6 months follow-up)were maintained at 12 months.Furthermore,all PA outcomes improved significantly from baseline to 12 months.The control group showed small but non-significant improvements from 6 months to 12 months(and from baseline to 12 months),resulting in a decline of differences between groups.Conclusion The majority of previously reported significant between-group differences at 6 months follow-up were no longer present at long-term follow-up,possibly because of natural improvement in the control group.At long-term follow-up,fatigue was significantly lower in OncoActive compared to control group participants.Computer-tailored PA advice may give participants an early start toward recovery and potentially contributes to improving long-term health.展开更多
基金Supported by the National Institute for Nursing Research,National Institutes of Health,No.R01NR05342 and R01 NR010293
文摘BACKGROUNDWeight gain is a potential negative outcome of breast-cancer treatment,occurringin 50%-to-96%of breast-cancer patients,although the amount of weight gain isinconsistently reported in the literature.Research has also shown a relationshipbetween overweight/obesity and breast-cancer mortality.Correspondingly,weight management is a self-care approach known to benefit quality of life(QOL).These research questions and analysis add to existing literature byexamining participants’body mass index(BMI)trend and its relationship withQOL indicators over seven years.AIMTo examine:(1)BMI trends among breast cancer survivors;and(2)The trends’relationship to QOL indicators over seven years.METHODSDuring the Breast Cancer and Lymphedema Project,378 patients’weight andheight were recorded by nurses prior to or just after beginning breast cancertreatment and repeated at quarterly-to-semiannual intervals over seven years.Additionally,participants annually completed the 36-Item Short Form HealthSurvey(SF-36),a valid and reliable tool assessing QOL and health concepts,including physical function,pain,and emotional well-being.BMI trends,changein BMI,and change in SF-36 subscales over seven years were calculated using arandom-intercept repeated-measures regression.Patients were placed into BMIcategories at each time point:Normal,Overweight and Obese.As patients’weights changed,they were categorized accordingly.RESULTSDuring the seven-year study and while controlling for age and residence,participants gained an average of 0.3534 kg/m^2(P=0.0009).This amountremained fairly consistent across BMI categories with those in the normal-weight category(n=134)gaining 0.4546 kg/m^2(P=0.0003);Overweight(n=190)gaining 0.2985 kg/m^2(P=0.0123);and obese(n=199)gaining 0.3147 kg/m^2,(P=0.0649).Age(under or over 55)and region(metro/micro vs small/rural)weresignificantly associated with BMI increase in both the normal and obesecategories.There were statistically significant(P<0.0100)changes in five of theeight SF-36 domains;however,the directions of change were different andsomewhat divergent from that hypothesized.Controlling for age and region,these five were statistically significant,so there were no change or differencesbetween the micropolitan/metropolitan and small town/rural groups.CONCLUSIONAlthough only modest increases in mean BMI were observed,mean BMI changewas associated with selected QOL indicators,suggesting the continued need forself-care emphasis during breast cancer survivorship.
文摘Breast cancer(BC)is the most common malignant tumor and one of the top causes of cancer-related death worldwide(Sung et al.,2021).The recent advances in early tumor diagnosis coupled with more effective treatment strategies resulted in a steady increase of long-term survivors(Nardin et al.,2020;Invernizzi et al.,2022).These improved survival rates led to a significantly higher incidence of disabling complications related to breast cancer and/or its treatment(Invernizzi et al.,2020a;D’Egidio et al.,2017;Zhong et al.,2020).
文摘The number of long-term colorectal cancer (CRC) survivors has increased substantially over the past three decades due to both ongoing advances in early detection and improvements in cancer therapies. Adult survivors of CRC experience chronic health conditions due to normal issues associated with aging, which is further compounded by the long-term adverse effects of having had cancer and anti-cancer therapies. In addition, they are at a higher risk for CRC recurrences, new primary cancers, and other co-morbidities. This article will provide an overview of the clinical care of adult survivors of CRC. Epidemiologic data will be presented followed by a discussion of the approach to the care of long-term adult survivors of CRC, including surveillance of recurrences and new primary cancers, interventions to manage both physical and psychological consequences of cancer and its treatments, and strategies to address concerns related to unemployment and disability. Finally, we will explore the challenges of healthcare delivery, especially with respect to the coordination of follow-up between cancer specialists and primary care physicians, so as to ensure that all of the survivor’s health needs are met promptly and appropriately.
文摘Objectives: To assess potential knowledge gaps between primary care providers (PCPs) and cancer specialists, Michigan Cancer Consortium guidelines were developed and disseminated statewide. We evaluated the impact of dissemination of these guidelines on PCP attitudes and beliefs regarding management of prostate cancer (PC) post-treatment sequelae. Methods: Guidelines were disseminated via hard-copy and web-link mailed to 12,000 Michigan PCPs in 2009, and via 5 CME presentations to 181 PCPs in 2010-2011. 132 initial surveys were collected from CME attendees and 549 follow-up surveys were received 20 months after the initial mailing. Results: Surveyed PCPs indicated erectile dysfunction (88%), incontinence (84%), anxiety (54%) and fear of the unknown (50%) as frequent post-treatment sequelae. A minority of PCPs (≤41%) felt “very comfortable” assessing PC patients for ten post-treatment sequelae at the initial survey, which increased by up to 27% on follow-up survey. 93% of PCPs that received guidelines by mail and CME presentation had incorporated them into practice, compared with 72% of PCPs that received guidelines solely by mailing. Similarly, a greater proportion reported practice pattern changes (65% vs. 34%, p = 0.0003). A higher proportion felt CME events (69% vs. 57%) and expert presentations (64% vs. 44%) were “very effective”, when comparing attendees and non-attendees. Conclusions: Guideline distribution resulted in increased comfort with survivorship issues and incorporation into the practices of the majority of PCPs surveyed. A greater impact was observed in PCPs that attended a CME presentation than in those that received guidelines only by mailing.
文摘Overhunting of mammals may negatively affect plant populations though indirect impacts on mammal-plant interactions such as herbivory. In this paper, we examined how hunting of terrestrial mammals impacts the survival of seedlings and juveniles of the palm Astrocaryum gratum. To determine A. gratum seedling survivorship patterns, an experiment with seedlings in 25 × 250-m plots exclosures and different levels of mammal species presence was conducted: all mammals, only Tayassu peccari potentially a major seedling predator and no animals excluded. More than 50,600 non-adults were measured for 27 months. We replicated these treatments in three forest categories: 1) no hunting, with an intact mammal community, 2) a lightly hunted region and 3) a heavily hunted area. Seedling survivorship under natural non-experimental conditions was highest in the heavily hunted (S(T) = 0.72), lower in moderate and lowest in unhunted forests. Experiments revealed that T. peccari was the main agent of palm seedling mortality and the most important factor determining seedling and juvenile survivorship, for example they caused the 84.61% deaths of the seedlings in unhunted forests. Thus, T. peccari feeding habits can influence forest dynamics and forest structure. T. peccari was also susceptible to hunting pressure and as the main seed and seedling predator in the system, its extinction should affect the survivorship and distribution of A. gratum in forests.
文摘BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.
文摘Introduction: Cancer is a chronic debilitating disease that unnerves patients, communities, and nations. At some point in cancer patient’s disease experience, chemotherapy is used, and the patient is expected to adhere to treatment to improve survival and quality of life. Methods: This multisite Cluster Randomized Trial (CRT) evaluated the effectiveness of mobile phone Short Message Service (SMS) support on the adherence to treatment schedules among adult cancer patients in Kenya. Data was collected using questionnaires. Ethical approvals were obtained from relevant Ethical Review Boards (ERBs). Results: The mean adherence was 83%. There was a significant difference between treatment arms in relation to the adherence. The intervention arm had a higher mean adherence difference, M = 3.913, 95% CI 2.632-5.193, t (402) = 6.006, p ≤ 0.001), with Cohen’s d = 0.60. Although not significant, (χ<sup>2</sup>dd = 0.151, df = 1, p = 2.064), more women were perfect adheres than males. Perfect adherers were satisfied with SMS support (χ<sup>2</sup>dd = 7.620, df = 1, p = 0.06), were in the intervention arm (χ<sup>2</sup>dd = 22.942, df = 1, p ≤ 0.001), and had trust in the care provider (χ<sup>2</sup>dd = 10.591 p ≤ 0.001). SMS support was not significant in the multivariate analysis but had an estimated effect size of 0.958 (z = 1.424, p = 0.154, CI = 0.242-3.781), indicating that mean adherence was slightly better in the presence of the intervention. Conclusions: SMS-support intervention has demonstrated superiority in influencing adherence. Further, health system-related factors have a significant influence on the adherence to chemotherapy treatment. Interventions to re-design health systems that are responsive to unmet care needs of cancer patients must be explored. .
基金funded by Cancer Research UK (grant numbers C43975/A27498 and C1418/A14133)
文摘Background Greater physical activity is associated with improved outcomes in people living with and beyond cancer.However,most studies in exercise oncology use self-reported measures of physical activity.Few have explored agreement between self-reported and device-based measures of physical activity in people living with and beyond cancer.This study aimed to describe physical activity in adults affected by cancer across self-reported and device-assessed activity,to explore levels of agreement between these measures in terms of their utility for categorizing participants as meeting/not meeting physical activity guidelines,and to explore whether meeting guidelines is associated with fatigue,quality of life,and sleep quality.Methods A total of 1348 adults living with and beyond cancer from the Advancing Survivorship Cancer Outcomes Trial completed a survey assessing fatigue,quality of life,sleep quality,and physical activity.The Godin-Shephard Leisure-Time Physical Activity Questionnaire was used to calculate a Leisure Score Index(LSI)and an estimate of moderate-to-vigorous physical activity(MVPA).Average daily steps and weekly aerobic steps were derived from pedometers worn by participants.Results The percentage of individuals meeting physical activity guidelines was 44.3%using LSI,49.5%using MVPA,10.8%using average daily steps,and 28.5%using weekly aerobic steps.Agreement(Cohen'sκ)between self-reported and pedometer measures ranged from 0.13(LSI vs.average daily steps)to 0.60(LSI vs.MVPA).After adjusting for sociodemographic and health-related covariates,meeting activity guidelines using all measures was associated with not experiencing severe fatigue(odds ratios(ORs):1.43–1.97).Meeting guidelines using MVPA was associated with no quality-of-life issues(OR=1.53).Meeting guidelines using both self-reported measures were associated with good sleep quality(ORs:1.33–1.40).Conclusion Less than half of all adults affected by cancer are meeting physical activity guidelines,regardless of measure.Meeting guidelines is associated with lower fatigue across all measures.Associations with quality of life and sleep differ depending on measure.Future research should consider the impact of physical activity measure on findings,and where possible,use multiple measures.
基金supported by the University of Toronto COVID-19 Student Engagement Award
文摘Background Physical activity(PA)and reductions in sedentary behavior(SED)may mitigate cancer-related cognitive impairment.The purpose of this study was to examine(a)the associations between changes in PA,SED,and cognitive function in cancer survivors before and during the coronavirus disease 2019(COVID-19)pandemic;and(b)clinical subgroups that moderate this association.Methods A cross-sectional survey was administered online to adult cancer survivors globally between July and November of 2020.This was a secondary analysis of a cross-sectional survey examining changes in self-reported PA and quality of life in cancer survivors before and during the COVID-19 pandemic.Self-reported Questionnaires assessed moderate-to-vigorous PA(MVPA)using the modified Godin Leisure Time Exercise Questionnaire,cognitive function using the Functional Assessment of Cancer Therapy-Cognitive Function(FACT-Cog)scale,and SED using the Domain-specific Sitting Time questionnaire.Cancer survivors were classified into no change in behavior,desirable change(i.e.,increase MVPA to meet PA guidelines or decrease SED by≥60 min/day),and undesirable change(i.e.,decrease MVPA to<150 min/week or increase SED by≥60 min/day).Analysis of covariance examined differences in FACT-Cog scores across the activity change categories.Planned contrasts compared differences in FACT-Cog scores between cancer survivors with(a)no meaningful change vs.any change,and(b)a desirable change vs.an undesirable change.Results There were no significant differences in FACT-Cog scores across activity-change categories in the full sample of cancer survivors(n=371;age=48.6±15.3 years(mean±SD)).However,cancer survivors who were diagnosed≥5 years ago(t(160)=–2.15,p=0.03)or who received treatment≥5 years ago(t(102)=–2.23,p=0.03)and who had a desirable change in activity reported better perceived cognitive abilities than those who had an undesirable change.Conclusion PA promotion efforts should consider reducing SED in addition to maintaining MVPA in long-term cancer survivors to mitigate cancer-related cognitive impairment during the COVID-19 pandemic.
基金funded by the Dutch Cancer Society (Koningin Wilhelmina Kankerfonds Kankerbestrijding,Grant No.NOU2012-5585).
文摘Background Physical activity(PA)can improve the physical and psychological health of prostate and colorectal cancer survivors,but PA behavior change maintenance is necessary for long-term health benefits.OncoActive is a print-and web-based intervention in which prostate and colorectal cancer patients and survivors receive automatically generated,personalized feedback aimed at integrating PA into daily life to increase and maintain PA.We evaluated the long-term outcomes of OncoActive by examining the 12-month follow-up differences between OncoActive and a control group,and we explored whether PA was maintained during a 6-month non-intervention follow-up period.Methods Prostate or colorectal cancer patients were randomly assigned to an OncoActive(n=249)or a usual care waitlist control group(n=229).OncoActive participants received PA advice and a pedometer.PA outcomes(i.e.,ActiGraph and self-report moderate-to-vigorous intensity PA(MVPA)min/week and days with≥30 min PA)and health-related outcomes(i.e.,fatigue,depression,physical functioning)were assessed at baseline,6 months,and 12 months.Differences between groups and changes over time were assessed with multilevel linear regressions for the primary outcome(ActiGraph MVPA min/week)and all additional outcomes.Results At 12 months,OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week,self-report MVPA min/week,or ActiGraph days with PA.Only self-report days with PA were significantly higher in OncoActive compared to the control group.For health-related outcomes only long-term fatigue was significantly lower in OncoActive.When exploratively examining PA within OncoActive,the previously found PA effects at the end of the intervention(6 months follow-up)were maintained at 12 months.Furthermore,all PA outcomes improved significantly from baseline to 12 months.The control group showed small but non-significant improvements from 6 months to 12 months(and from baseline to 12 months),resulting in a decline of differences between groups.Conclusion The majority of previously reported significant between-group differences at 6 months follow-up were no longer present at long-term follow-up,possibly because of natural improvement in the control group.At long-term follow-up,fatigue was significantly lower in OncoActive compared to control group participants.Computer-tailored PA advice may give participants an early start toward recovery and potentially contributes to improving long-term health.