BACKGROUND: Clinically-oriented outcome measures are increasingly being recognized as lacking in consideration of factors important to patients. There is an emerging move of guideline bodies advocating a more patient-centred approach. Aneurysms in autogenous arteriovenous fistula (AVF) can be considered unsightly and a constant reminder for patients of their dependence on dialysis. However, their impact on patient\'s perception has not previously been reported.
METHODS: Between April 2017-18, the Vascular Access Questionnaire (VAQ) was administered to prevalent haemodialysis patients across ten dialysis units via structured interviews, as part of a quality improvement project. Data for the subgroup of patients with aneurysmal AVF (categorised as per classification by Valenti et al.), were retrospectively evaluated and compared to the wider cohort.
RESULTS: Data were collected for 539 patients (median age: 66 years; 59% male), of whom 195 (36%) had aneurysmal AVF, with Type 2 morphology (cannulation site) being the most common (75%). Duration of AVF was found to be significantly associated with aneurysmal development, with estimated likelihoods of 11%, 43% and 61% after one, five and ten years, respectively. Interestingly, patients with diabetes had a significantly lower prevalence of aneurysmal development than those that were non-diabetic (25% vs. 43%, p < 0.001). Overall VAQ scores were not found to differ significantly by aneurysm status (p = 0.816) or across morphology types (p = 0.277). However, patients with aneurysmal AVF were significantly more concerned with the appearance of their AVF (p < 0.001) than the wider cohort. Despite this, patients with aneurysmal AVF gave significantly higher scores for satisfaction and ease of use and lower scores for bruising and clotting (p < 0.05).
CONCLUSIONS: Aneurysmal AVF are often cited as an important factor by patients for not proceeding with fistula formation. In this evaluation of patient reported experiences, those with aneurysmal AVF reported high satisfaction levels. This may help clinicians highlight positive patient reported outcomes of aneurysmal AVF during preprocedural consent processes.

Obesity poses a growing concern, with global predictions estimating over half the population to be overweight or obese by 2030 (1). While prior research has extensively explored the impact of obesity on hip and knee surgeries, a notable gap persists in understanding weight changes following foot and ankle procedures. This retrospective study focuses on the relationship between Body Mass Index (BMI) and Achilles debridement with flexor hallucis longus (FHL) transfer. Despite prevailing research on the adverse effects of obesity on orthopedic outcomes, few studies examine the reciprocal influence of surgeries on weight. A retrospective analysis of 136 patients undergoing primary Achilles debridement with FHL transfer was conducted. Data encompassing BMI, demographic information, and medical comorbidities were extracted from electronic medical records (EMRs). A clinically meaningful BMI change was considered as a 5% variation. Inferential statistics in the form of analysis of variance, t-test, and linear regression were employed for data analysis. Among the 136 patients in the study, no statistically significant BMI changes were noted up to two years after surgery (p = 0.9967). While obesity remains a significant factor in foot and ankle surgery complications, our study suggests that Achilles debridement with FHL transfer does not induce significant weight changes. Further research exploring factors influencing weight changes and varying outcomes across demographics is warranted. LEVEL OF EVIDENCE: III.

BACKGROUND: It is important to determine the health-related quality of life (HRQoL) to devise population-based cost-effective service delivery models. The present study aimed to evaluate the HRQoL of patients with refractive errors (RE) using generic and vision-specific instruments, identify the determinants of HRQoL, and examine the validity between the quality-of-life instruments for refractive errors.
METHODS: Face-to-face interviews were conducted with 515 participants with RE using generic as well as vision-specific HRQoL measures. Mean EuroQol-five dimensions-five levels (EQ-5D-5L) utility value, National Eye Institute-Visual Function Questionnaire-25 (NEI-VFQ-25) composite score, and EuroQol-Visual analogue scale (EQ-VAS) score were computed, and determinants of quality of life were determined using generalized linear regression model. The validity between generic and disease-specific measures was ascertained using Pearson\'s coefficient.
RESULTS: The mean EQ-5D-5L utility score for patients with RE was estimated as 0.72 (95% CI: 0.70-0.75). The mean NEI-VFQ-25 composite score and EQ-VAS score were 71.3 (95% CI: 69.8-73), and 74.7 (95% CI: 73.4-76.1), respectively. Visual acuity, gender, and presence of co-morbidities were significantly associated with quality of life. The concurrence between the generic and vision-specific instruments was found to be low to moderate.
CONCLUSIONS: The findings of the study indicate the importance of the value of quality of life for patients with RE, which could be taken into account by health administrators, doctors and researchers to carry out economic evaluations, since these measures provide a basis for an evaluation more precisely the impact of RE and guide the determination of efficient ways to alleviate the burden of treatable visual impairment. More research is required to explore the potential integration of a vision component, the sixth dimension, into the EQ-5D-5L instrument, given the moderate agreement observed between the generic and specific assessment tools.

Global outcomes have been reported to be associated with cerebrovascular reactivity (CVR) in the acute phase following moderate and severe traumatic brain injury (TBI). The association of CVR in the acute and chronic phase of injury with patient-reported health-related quality of life metrics (HRQOL) metrics has never been explored. The aim of this study is to examine the association of CVR, as measured by the cerebral oxygen indices (COx and COx_a), in the acute and chronic phase following moderate and severe TBI, with patient reported HRQOL. In this prospective cohort study, performed in a Canadian quaternary care center, the association between continuous acute and chronic phase CVR with patient reported HRQOL outcomes following moderate and severe TBI was examined. The main outcomes of interest of this study were validated measures of patient-reported HRQOL over various domains as measured by both the 12-Item Short-Form Health Survey (SF-12) and a Quality of Life after Brain Injury (QOLIBRI) questionnaire. In the 29 subjects of this cohort, acute phase CVR was found to be significantly more active in those with a favorable Mental Component Summary (MCS) scores of the SF-12 at early follow-up when measured by COx (-0.015 [IQR: -0.067 to 0.032] vs 0.040 [IQR: 0.019 to 0.137] for Favorable first MCS vs Unfavorable respectively; Mann-Whitney U test p-value = 0.046) and COx_a (0.038 [IQR: 0.009 to 0.062] vs 0.112 [IQR: 0.065 to 0.167] for Favorable first MCS vs Unfavorable respectively; Mann-Whitney U test p-value = 0.014). Further, multivariable logistic regression analysis found acute phase COx and COx_a to improve model performance when predicting favorable versus unfavorable early MCS scores over established parameters such as age and measures of injury severity. Associations between outcomes and chronic phase CVR were limited, potentially due to short recording periods. This is the first ever pilot study to identify a relationship between acute phase CVR following moderate-to-severe TBI with mental and cognitive outcomes as experienced by patients. Given the small cohort, these findings will need to be confirmed in a larger multicenter study. This highlights the need for additional examination of the role dysfunctional CVR may play in mental and cognitive outcomes, as well as patient-reported outcomes more generally following TBI.

In recent years, diabetes technologies have revolutionized the care of people with type 1 diabetes (T1D). Emerging evidence suggests that people with type 2 diabetes (T2D) can experience similar benefits from these advances in technology. While glycaemic outcomes are often a primary focus, the lived experience of the person with diabetes is equally important. In this review, we describe the impact of diabetes technologies on patient-reported outcome measures (PROMs). We highlight that most of the published studies investigated PROMs as secondary outcomes. Continuous glucose monitoring systems may have an important role in improving PROMs in individuals with T1D, which may be driven by the prevention or proactive management of hypoglycaemia. In people with T2D, continuous glucose monitoring may also have an important role in improving PROMs, particularly in those treated with insulin therapy. The impact of insulin pumps on PROMs seems positive in T1D, while there is limited evidence in T2D. Studies of hybrid closed-loop therapies suggest increased treatment satisfaction, improved quality of life and decreased diabetes-related distress in T1D, but it is unclear whether these benefits are because of a \'class-effect\' or individual systems. We conclude that PROMs deserve a more central role in trials and clinical practice, and we discuss directions for future research.

BACKGROUND: Childhood cancer treatment can lead to subfertility in adulthood. Fertility tissue preservation offers a way to safeguard future fertility, especially for prepubescent children, whose preservation options are limited. While this is a significant technological advance, it also presents unique challenges compared to other methods of fertility preservation. Clinical consensus is that all childhood cancer patients should receive high-quality, personalised survivorship care and that healthcare policy and practice must address the expectations and priorities of care recipients. We report the available information on the experiences of cancer survivors who preserved tissue for future fertility, to support the development of survivorship care informed by recipients\' perspectives and experiences to identify future research priorities.
METHODS: We conducted a scoping review following the recommendations of the Joanna Briggs Institute and the Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR). We searched for research that included patient reported outcomes from patients who underwent fertility tissue preservation (FTP) in childhood and early adulthood, following a cancer diagnosis, including outcomes reported by parents. Our search terms aimed to identify literature reporting on both ovarian and testicular tissue preservation. We searched Embase, Cinahl, PsycInfo, Medline, Scopus and Cochrane Database of Systematic Reviews alongside sources of grey literature, for relevant articles including all time-frames between 1980-2023, with support from an independent information specialist at the University of Leeds. Descriptive statistics were used to analyze the data and we present the results in tabular form to summarise the key information.
RESULTS: From 1956 unique records, 5 met our inclusion criteria. No literature was found reporting on the experiences of people who stored testicular tissue. The available literature only included reports from people who had stored ovarian tissue. We found that young women who had stored ovarian tissue faced complex emotional and ethical dilemmas in reproductive decisions post cancer and strongly desired their own biological children.
CONCLUSIONS: This scoping review is the first to report beyond clinical outcomes by focusing specifically on the self-reported outcomes of patients who preserved ovarian tissue in early life after a cancer diagnosis. It provides valuable insights into their experiences and highlights that ovarian tissue cryopreservation (OTC) presents distinct challenges compared to other forms of fertility preservation. We recommend separate consideration of the needs of patients with stored fertility tissue and call for further research to enable personalized survivorship care. To develop tailored care pathways for long-term well-being, patient-reported outcomes are also needed from individuals with stored testicular tissue, parents who consented to their child\'s tissue storage, and the healthcare professionals involved in their care. This review underscores a significant evidence gap between rapid FTP advancements and the availability of comprehensive care addressing these advancements. As FTP science evolves, patients need detailed information for informed decisions and ongoing support for their unique reproductive and endocrine health concerns throughout their survivorship journey.

OBJECTIVE: To characterize and stratify health-related quality of life in individuals with type 1 diabetes (T1D) using body mass index (BMI) and clustering analysis.
METHODS: Baseline data on individuals with T1D were pooled from two studies. A post hoc analysis of health-related quality of life, measured using the 36-item Short-Form questionnaire, was performed, referenced to the 2010 US general population. Descriptive statistics were presented for the pooled cohort and per BMI category. K-means clustering was performed. One-way analysis of variance was conducted to examine differences in clinical characteristics between clusters.
RESULTS: The pooled cohort consisted of 2256 individuals with T1D (age: 45.4 ± 15.0 years, BMI: 26.2 ± 4.6 kg/m2, diabetes duration: 22.7 ± 13.5 years). All quality-of-life domains were slightly lower than 50(the general population\'s mean), except for vitality. Individuals with a BMI ≥30 kg/m2 reported lower scores for bodily pain, physical functioning, general health, and vitality. A first cluster with a high and a second cluster with a low quality of life were identified, with significant differences in the mental (Cluster 1: 53.8 ± 6.8 vs. Cluster 2: 39.5 ± 10.7; p < 0.001) and physical component summary scores (Cluster 1: 49.6 ± 6.3 vs. Cluster 2: 35.2 ± 12.0; p < 0.001), which exceeded differences found between BMI categories.
CONCLUSIONS: In our population of people living with T1D, higher BMI may have adversely impacted physical domains of quality of life, but larger differences between the high- and low-quality-of-life cluster indicate that more factors play a role.

BACKGROUND: Adverse events following immunization (AEFIs), especially if serious, may impact vaccine recipients\' quality of life and financial well-being and fuel vaccine hesitancy. Nigeria rolled out COVID-19 vaccination in 2021 with little known about the impact of AEFIs on an individual\'s quality of life. No study in Africa has explored the health and financial impact of AEFIs. We explored patient-reported outcomes (PROs) of adverse events after COVID-19 vaccination and documented the lived experiences of those with serious AEFIs to understand the effect on their health, financial well-being, and attitude to future vaccinations.
METHODS: We conducted a convergent mixed-methods study using the RAND 36-item health survey and in-depth interviews to collect PROs on vaccine recipients in Nigeria. Eight health scale scores and two summary composite scores were used to measure the health-related quality of life outcomes from the survey and inductive analysis was used to identify themes from the interview scripts. The results of both studies were integrated in a joint display to highlight areas of concordance.
RESULTS: In total, 785 survey responses were analyzed (53% females, 68% aged 18-30 years). Responders reporting an AEFI were 58%, of whom 62% received the first dose only. Younger age and first vaccine dose (p < .001 respectively) were associated with experiencing an AEFI. Not reporting an AEFI was associated with better quality of life, measured as higher scores on all eight SF-36 Health scales and the physical and mental component summary scores. All six interviewees with serious AEFIs experienced physical, mental, and financial distress. Some expressed a strong negative attitude toward future COVID-19 vaccinations but not toward vaccines for routine immunization.
CONCLUSIONS: AEFIs negatively impact the health and financial well-being of affected individuals and their attitude to future vaccinations, especially if serious. Understanding the impact of AEFIs on people is important and should inform future policies and interventions. The results of our study can inform policy and planning for future mass vaccination campaigns in LMICs.

OBJECTIVE: This study aims to elucidate the association between MRI measurements of spine alterations and self-reported outcomes of pain and disability in individuals with non-specific low back pain, using a comprehensive perspective based on machine learning algorithm.
METHODS: 246 consecutive subjects were assessed. Pain severity in cervical, lumbar, and leg regions was determined using visual analogue scale, and functional disability was acquired by Oswestry Disability Index. Sagittal and axial MRI scans of the thoracolumbar spine were evaluated. Severity of disc degeneration, spinal canal stenosis, and presence of vertebral endplate lesions based on two different classification schemes involving the extent and the shape of defects were quantified at the levels from T12L1 to L5S1. The following parameters describing the lumbar region as a whole were calculated: maximum value along spinal levels, sum of values along levels, number of levels characterized by severe condition. The association with pain and disability was assessed by generalized multiple linear regression modelling.
RESULTS: Disc degeneration was identified as a predictor of disability and partially of pain, whereas canal stenosis was found associated with changes in pain in the leg region. Partial correlation values ranged from 0.11 to 0.32. Endplate lesions did not show significant associations.
CONCLUSIONS: A partial association between MRI measurements and self-reported outcomes of pain and disability was confirmed. Disc degeneration was the most correlated with the reported indexes, while canal stenosis mainly affected the pain levels in the leg region. The presence of endplate lesions did not demonstrate any significant relationships.

UNASSIGNED: Determine the effect of a novel acellular cannulated dermal allograft on tendon-to-bone healing, retear rates, and clinical outcomes over a 12-month period.
UNASSIGNED: This was a single surgeon prospective nonrandomized case series. Patients with medium sized full-thickness superior and posterosuperior rotator cuff tears, as confirmed by magnetic resonance imaging, were consented. Patients were excluded if they had fatty atrophy indicative of Goutallier grade III or IV. The allograft is a cannulated rectangular prism that has a 5-year shelf life, does not require prehydration, and does not need to be trimmed to size. Outcome metrics included ultrasound assessment at 1-year as well as 6-month patient-reported outcomes (PROs) scores.
UNASSIGNED: 31 patients consented and enrolled in this consecutive cohort series. 9 patients were excluded, and statistical analysis was performed on the remaining 22 patients. There were 9 females and 13 males. The average age was 59.27 ± 7.48 year old. The average supraspinatus short axis measurement in males was 0.56 ± 0.12 cm and 0.52 ± 0.09 cm in females (P = .44). The average supraspinatus long axis measurement in males was 0.61 ± 0.18 cm and 0.55 ± 0.14 cm in females (P = .46). The average infraspinatus short axis measurement in males was 0.48 ± 0.10 cm and 0.50 ± 0.13 in females (P = .74). The average infraspinatus long axis measurement in males was 0.44 ± 0.12 cm and 0.43 ± 0.08 cm in females (P = .84). Of the 19 patients who completed baseline and 6-month PRO\'s, 17 achieved the minimal clinical important difference for American Shoulder and Elbow Surgeons and Patient-Reported Outcomes Measurement Information SystemUE 7a. Retear occurred in 2 cases. The remaining 20 cases have all demonstrated healing or fully healed repairs at their most recent clinical visits with no additional cases of retears.
UNASSIGNED: This study is the first to report the results of a novel acellular dermal allograft for rotator cuff repair augmentation. Satisfactory PRO measures and robust tendon healing at 1 year, as measured by ultrasound, demonstrate the utility of a cannulated human acellular dermal allograft as a viable biologic augmentation device for rotator cuff repair.