Podcasts about health related quality

In dieser Folge spreche ich mit Florent Crépin, Geschäftsführer von Neurolite. Er stellt eine Depressions-Behandlung vor, die ohne Medikamente auskommt.Links :LinkedIn Instagram NeuroliteYoutube Instagram FlowFacebook FlowÜBER DEPRESSIONDepressionen.ch Stiftung Deutsche DepressionshilfeREFERENZENBarker et al. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985 May. Zur PublikationRush et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006 Nov. Zur PublikationFregni et al. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol. 2021 Apr. Zur PublikationWoodham et al. Home-based transcranial direct current stimulation treatment for major depressive disorder: a fully remote phase 2 randomized sham-controlled trial. Nat Med. 2025 Jan. Zur PublikationCipriani et al. Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute Treatment of Adults With Major Depressive Disorder: A Systematic Review and Network Meta-Analysis. Focus (Am Psychiatr Publ). 2018 Oct. Zur PublikationSaelens et al. Relative effectiveness of antidepressant treatments in treatment-resistant depression: a systematic review and network meta-analysis of randomized controlled trials. Neuropsychopharmacology. 2024 Dec. Zur PublikationGriffiths et al. Self-Administered “Flow” Transcranial Direct Current Stimulation (tDCS) Depression Treatment in a Crisis Resolution & Home Treatment (CRT) Service: Functioning, and Health-Related Quality of Life Outcomes. Open Journal of Psychiatry. 2024 Nov. Zur PublikationTomonaga et al. The economic burden of depression in Switzerland. Pharmacoeconomics. 2013 Mar. Zur PublikationDeutsche S3-Leitlinie und Nationale VersorgungsLeitlinie (NVL)  Kurzfassung – Lass mir Feedback da :)Hat dir die Folge gefallen? Ich würde mich über eine 5-Sterne-Bewertung sehr freuen! :)Webseite: https://www.psychologieunddenn.ch/Whatsapp-Gruppe (offen für alle): https://chat.whatsapp.com/JBcjpAaIaSeCRxmQMQWGXuMöchtest du Werbung schalten oder mit mir zusammenarbeiten. Dann schau hier vorbei.

In part one we looked at the 2022 article by Sierżantowicz et al., “Quality of Life after Bariatric Surgery A Systematic Review.” I do recommend reading that to understand the issues with the way “Health Related Quality of Life or HRQOL” is used in the studies we'll examine today as we take a deeper diver into two of the studies Sierżantowicz et al. included.Content note for discussion of suicide and self-harm. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.    Coronary Artery Calcium-Guided Primary Prevention Strategy 2.    Health-Related Quality of Life and Health Utility after Metabolic/Bariatric Surgery vs. Medical/Lifestyle Intervention in Individuals with Type 2 Diabetes and Obesity 3.    Suicide and suicide attempt in users of GLP-1 receptor agonists: a nationwide case-time-control study 4.    Self-Monitored Blood Glucose and Continuous Glucose Monitoring in Youth with Type 1 Diabetes and Medicaid Insurance 5.     Gestational Diabetes to Type 2 Diabetes—Is Poor Sleep to Blame?   For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

En lo último en salud y fitness edición de diciembre 2024, damos un paseo por las últimas tendencias, investigaciones y noticias en el mundo de la salud y el fitness. En este episodio vamos a platicar sobre cómo sacarle el máximo provecho al entrenamiento de resistencia combinándolo con los horarios de comida, una estrategia que está dando resultados muy concretos. También veremos qué dice la ciencia sobre mantener los músculos fuertes mientras envejecemos (y por qué es más importante de lo que crees). Le daremos un vistazo al cafestol, ese compuesto del café que genera tanto debate, y exploraremos una combinación interesante de nutrientes que podría ayudar a mantener la memoria aguda. Atajos Del Episodio 01:20 - Una combinación ganadora: Comer en horario restringido y entrenamiento de resistencia1 03:56 - La proteína y el entrenamiento de resistencia: clave para envejecer con vitalidad2 10:21 - El cafestol: beneficios inciertos y riesgos claros en la salud metabólica3 15:18 - Ácido fólico y vitamina D: una dupla prometedora para la memoria4 19:00 - DYG-400: Un extracto natural que ayuda a controlar el peso y los antojos5 Referencias: 1.      Ho, Y., Hou, X., Sun, F., Wong, S. H. S. & Zhang, X. Synergistic Effects of Time-Restricted Feeding and Resistance Training on Body Composition and Metabolic Health: A Systematic Review and Meta-Analysis. Nutrients (2024). 2.      Li, J., Wang, Y., Liu, F. & Miao, Y. Effect of Protein Supplementation Combined With Resistance Training in Gait Speed in Older Adults: A Systematic Review and Meta-Analysis of Randomized …. Journal of Aging and … (2024). 3.      Mellbye, F. D., Nguyen, M. D., Hermansen, K. & Jeppesen…, P. B. Effects of 12-Week Supplementation with Coffee Diterpene Cafestol in Healthy Subjects with Increased Waist Circumference: A Randomized, Placebo …. Nutrients (2024). 4.      Liu, W. et al. Effects of Vitamin D3 Combined with Folic Acid on Domain and Specific Cognitive Function among Patients with Mild Cognitive Impairment: A Randomized Clinical …. The Journal of … (2024). 5.      Hausenblas, H. A., Lynch, T. A. & Befus…, S. M. Efficacy of Dichrostachys Glomerata Supplementation on Overweight and Mildly Obese Adult's Weight, Mood, and Health-Related Quality of Life: A Randomized …. Journal of Dietary … (2024).

Dr. Richard Matulewicz is a urologic surgeon at Memorial Sloan Kettering Cancer Center (MSKCC). Dr. Matulewicz talks about health-related quality of life (HRQoL) considerations for testicular cancer patients and survivors, including what the future might hold for personalizing care based on a person's specific situation. Sponsored by Dee's Nuts. Use code "nutcheck" at checkout on https://grabdeesnuts.com Want to be a guest? Apply here: ⁠https://www.testicularcancerawarenessfoundation.org/it-takes-balls-submissions⁠ Follow Testicular Cancer Awareness Foundation: ⁠https://www.testescancer.org https://www.twitter.com/testescancer⁠ ⁠https://www.instagram.com/testescancer https://www.facebook.com/tca.org Connect with Dr. Matulewicz: https://www.mskcc.org/cancer-care/doctors/richard-matulewicz Follow Steven Crocker: https://www.twitter.com/stevencrocker https://www.instagram.com/stevencrocker https://www.facebook.com/steven.crocker2 Theme song: No Time Like Now - Tom Willner www.tomwillner.com

In this podcast, Janelle Hart, Managing Editor at Citeline, teams up with industry experts Mai Yee Mishir, Senior Director of Global Regulatory Affairs, and Sally-Ann McDowell, Senior Director of Clinical Development Strategy at Advanced Clinical, to discuss the vital role of HRQoL in clinical trials. Listen now.

Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?

Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?

Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?

Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?

Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?

Jane Anderson, FRCP, PhD - Health-Related Quality of Life: What Works Best for People Living With HIV?

On this episode of Oncology Unscripted, patient advocates Julie Johnson and Katie Coleman and radiation oncologist Dr. Matt Spraker host physical therapist Dr. Hillary Hinrichs and researcher Dr. Kelley Wood (@kcwood_phd on X) to discuss exercise and cancer rehabilitation. We kick off our discussion with an important question. What is cancer rehabilitation, and how is this different than exercise? Then, we discuss how patients can find out how cancer rehabilitation and exercise can play a role in their care. How can you ask your doctor whether you need a cancer rehab evaluation? How are doctors learning how to best use exercise and cancer rehab in their treatment plans? We close the discussion by examining the benefits that cancer rehabilitation can provide throughout a patients course of diagnosis, treatment, and beyond. Also, we review the risks and restrictions that may be important in the context of a cancer diagnosis. Here are some resources that can help you find a rehabilitation therapist, such as a physical, occupational, or speech/swallow therapist:American Physical Therapy Association - Find a Physical Therapist or Specialist Therapist Lymphology Association of North America - Find a Lymphedema TherapistReVital Cancer Rehab – Find a locationCheck out the ACSM Exercise Is Medicine, Moving Through Cancer website, it's a great patient resource! Here are some other things we discussed during the show:Schmitz et al., Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. (free access)Pergolotti et al., Impact of Real-World Outpatient Cancer Rehabilitation Services on Health-Related Quality of Life of Cancer Survivors. (free access)ECOG Performance Status 6-Minute Walk TestTimed Up and Go TestOncology Unscripted is a Photon Media production. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.Additional content from Katie Coleman can be found at her website, https://www.katiekickscancer.com/. This show and our opinions are meant for general informational purposes and are not medical advice. We encourage you to reach out to your doctors to discuss your individual case. 

 In this episode of the CPCJ podcast series, Multimedia Editor Pat Chibbaro interviews Julieta Moreno-Villagómez, author of the article entitled, "Health-Related Quality of Life in Mexican Children and Adolescents with Non-Syndromic Craniosynostosis" (coauthored by Miguel Castillo-Mimila, Guillermina Yáñez-Téllez, Belén Prieto-Corona and Antonio García-Méndez).

Is surgery for pediatric epilepsy "worth it"? What factors determine quality of life in families with a child who has epilepsy? Dr. Kette Valente talks with Dr. Mary Lou Smith, whose work has implications for clinical treatment decisions, as well as expectations for the impact of treatments in children with epilepsy. Support the showSharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.We welcome feedback and episode ideas at podcast@ilae.org.The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.

Today, you'll learn about how hearing aids may help you live longer, a potential breakthrough that could help usher in the age of quantum computing, and the incredible power of simply saying, “Hi”. Hearing Aids “Hearing aids may help people live longer.” EurekAlert! 2024. “Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohort.” by Janet S. Choi, M.D. et al. 2024. “The Impact of Hearing Loss and Its Treatment on Health-Related Quality of Life Utility: a Systematic Review with Meta-analysis.” by Ethan D. Borre, et al. 2023. Quantum Error Eraser “Quantum computers inch closer to viability with new ‘error eraser'.” by H. Hannan. 2024. “40 years of quantum computing.” Nature Reviews Physics. 2022. “Erasure conversion in a high-fidelity Rydberg quantum simulator.” by Pascal Scholl, et al. 2023. Smalltalk “New study highlights the psychological power of minimal social interactions.” by Eric W. Dolan. 2023. “Minimal Social Interactions and Life Satisfaction: The Role of Greeting, Thanking, and Conversing.” by Esra Ascigil, et al. 2023. Follow Curiosity Daily on your favorite podcast app to get smarter with Calli and Nate — for free! Still curious? Get exclusive science shows, nature documentaries, and more real-life entertainment on discovery+! Go to https://discoveryplus.com/curiosity to start your 7-day free trial. discovery+ is currently only available for US subscribers. Hosted on Acast. See acast.com/privacy for more information.

2023 was an exciting year for Surgical Palliative Care research! Join Drs. Katie O'Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington to discuss two seminal randomized controlled trials in the Surgical Palliative Care space. Hosts: ·    Dr. Katie O'Connell (@katmo15) is an Assistant Professor of Surgery at the University of Washington. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. ·    Dr. Ali Haruta is a PGY7 Hospice & Palliative Care fellow at the University of Washington, formerly a UW General Surgery resident and Parkland Trauma/Critical Care fellow.  ·    Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 General Surgery resident and current Surgical Oncology fellow at the University of Washington. ·    Dr. Virginia Wang is a PGY2 General Surgery resident at the University of Washington. Learning Objectives: ·    Discuss the current state of the RCT literature in Palliative Care & Surgical Palliative Care ·    Understand the primary outcomes of the Shinall and Aslakson trials as related to perioperative specialty palliative care intervention ·    Identify limitations in existing surgical palliative care RCTs & further opportunities for study ·    Identify underlying differences between medical oncology and surgical oncology patient populations References: 1.  Shinall MC, Martin SF, Karlekar M, et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg. 2023;158(7):747–755. doi:10.1001/jamasurg.2023.1396 https://pubmed.ncbi.nlm.nih.gov/37163249/ 2.  Aslakson RA, Rickerson E, Fahy B, et al. Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(5):e2314660. doi:10.1001/jamanetworkopen.2023.14660 https://pubmed.ncbi.nlm.nih.gov/37256623/ 3.  Ingersoll LT, Alexander SC, Priest J, et al. Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer. Patient Educ Couns. 2019;102(6):1098-1103. doi:10.1016/j.pec.2019.01.002 https://pubmed.ncbi.nlm.nih.gov/30642715/ 4.  Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741-749. doi:10.1001/jama.2009.1198 https://pubmed.ncbi.nlm.nih.gov/19690306/ 5.  Corn BW, Feldman DB, Hull JG, O'Rourke MA, Bakitas MA. Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database. Cancer. 2022;128(2):401-409. doi:10.1002/cncr.33907 https://pubmed.ncbi.nlm.nih.gov/34613617/ 6.  El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of Integrated Palliative and Oncology Care for Patients With Acute Myeloid Leukemia: A Randomized Clinical Trial. JAMA Oncol. 2021;7(2):238-245. doi:10.1001/jamaoncol.2020.6343 https://pubmed.ncbi.nlm.nih.gov/33331857/ 7.  More about the metrics from both the Shinall and Aslakson studies: a.     FACT-G – https://www.facit.org/measures/fact-g b.     FACIT-Pal – https://www.facit.org/measures/facit-pal c.     PROMIS-29 – https://heartbeat-med.com/resources/promis-29/ d.     PROPr (PROMIS-Preference) score – https://www.proprscore.com/ ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other surgical palliative care episodes here: https://app.behindtheknife.org/podcast-category/palliative-care

Drs Sandhya Srinivas and Tanya B. Dorff discuss metastatic hormone-sensitive prostate cancer, which patients are the best candidates for doublets vs triplets, and how we pick these patients. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/988737). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Prostate Cancer https://emedicine.medscape.com/article/1967731-overview Metastatic Hormone-Sensitive Prostate Cancer: Toward an Era of Adaptive and Personalized Treatment https://pubmed.ncbi.nlm.nih.gov/37220335/ Triplet or Doublet Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Updated Network Meta-Analysis Stratified by Disease Volume https://pubmed.ncbi.nlm.nih.gov/37055323/ PSMA PET in Imaging Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/35155262/ Risks and Cancer Associations of Metachronous and Synchronous Multiple Primary Cancers: a 25-Year Retrospective Study https://pubmed.ncbi.nlm.nih.gov/34556087/ The Promise of Metastasis-Directed Therapy for Oligometastatic Prostate Cancer: Going Beneath the Surface With Molecular Imaging https://pubmed.ncbi.nlm.nih.gov/35058322/ Gleason Score https://www.ncbi.nlm.nih.gov/books/NBK553178/ Luteinizing Hormone-Releasing Hormone (LHRH) Receptor Agonists Vs Antagonists: a Matter of the Receptors? https://pubmed.ncbi.nlm.nih.gov/23418666/ The Role of CYP17A1 in Prostate Cancer Development: Structure, Function, Mechanism of Action, Genetic Variations and Its Inhibition https://pubmed.ncbi.nlm.nih.gov/29372682/ Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Long-Term Survival Analysis of the Randomized Phase III E3805 CHAARTED Trial https://pubmed.ncbi.nlm.nih.gov/29384722/ Abiraterone for Prostate Cancer Not Previously Treated With Hormone Therapy https://pubmed.ncbi.nlm.nih.gov/28578639/ Abiraterone Plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/28578607/ Health-Related Quality of Life in Metastatic, Hormone-Sensitive Prostate Cancer: ENZAMET (ANZUP 1304), an International, Randomized Phase III Trial Led by ANZUP https://pubmed.ncbi.nlm.nih.gov/34928708/ Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/35179323/ Abiraterone Plus Prednisone Added to Androgen Deprivation Therapy and Docetaxel in De Novo Metastatic Castration-Sensitive Prostate Cancer (PEACE-1): a Multicentre, Open-Label, Randomised, Phase 3 Study With a 2 × 2 Factorial Design https://pubmed.ncbi.nlm.nih.gov/35405085/

In this episode, Nikos Dedes, Jeff Taylor, and Bernadette Sharp—people living with HIV—discuss how switching to long-acting ART has affected their quality of life. They are joined by 2 healthcare professionals—Iskandar Azwa,MBChB, MRCP, and Beng Eu, MBBS—who provide insights on how they assess and document health-related quality of life for their patients. The discussion focuses on personal experiences with how LA ART has improved health-related quality of life, including:Avoidance of drug–drug interactionsImproved confidentiality Decreased stigmaPresenters:Iskandar Azwa, MBChB, MRCPAssociate ProfessorInfectious DiseasesFaculty of MedicineUniversity of MalayaKuala Lumpur, MalaysiaNikos DedesPositive VoiceAthens, GreeceBeng Eu, MBBSDoctorPrahran Market Clinic Melbourne, Victoria, AustraliaBernadette SharpAdvocateJeff TaylorExecutive DirectorHIV+Aging Research ProjectPalm Springs, CaliforniaContent based on an online CME program supported by an independent educational grant from ViiV Healthcare.ViiV Healthcare was not involved in the development of content or selection of faculty for this educational activity.Link to downloadable slides: https://bit.ly/488WwT7Link to full program: bit.ly/3EwEnRJ

Diet treatments are often used with the aim of reducing seizure frequency and severity — but they may have other benefits as well. Findings from a recent study conducted in Norway suggest that dietary treatments may normalize emotional symptoms and that health-related quality of life (HRQOL) might be an indicator of successful diet treatment in the future. Joy Mazur spoke with Dr. Magnhild Kverneland about the study's results and its implications.   Health-related quality of life in adults with drug-resistant focal epilepsy treated with modified Atkins diet in a randomized clinical trial was published in Epilepsia in March 2023. Related studies: Anxiety and depressive disorders in people with epilepsy: A meta-analysis Scott A, et al., 2017 Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life Roehl K, et al., 2019 Support the showSharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.

Dr. H. Tarik Kani talks to Dr. Axel Dignass (Germany) about his recent publication about the impact of Ustekinumab on health-related quality of life in moderate-to-severe Crohn's disease which was an open-label, multicenter, randomized study evaluated the quality of life prospectively in Crohn's patients who treated with Ustekinumab.

The July 2023 replay of past episodes showcases five interviews on social determinants of health in neurology. The episode begins with an interview with Dr. Heather Leeper on the links between pain and depression with unemployment due to CNS cancer. The episode continues with an interview with Dr. Wyatt Bensken on racial and ethnic difference in antiseizure medication prescription. The next interview is with Dr. Scott Mendelson on race-ethnic disparities in stroke thrombolysis. The fourth interview is with Dr. Vikas Kotagal on neighborhood socioeconomic factors in people with various movement disorders. The final episode is with Dr. Daniel Di Luca on racial and ethnic differences in quality of life among people with Parkinson's disease.   Related Podcast Links: Links Between Pain & Depression with Unemployment Due to CNS Cancer:  https://directory.libsyn.com/episode/index/id/26356875 Racial and Ethnic Differences in Antiseizure Medications Among People with Epilepsy on Medicaid: https://directory.libsyn.com/episode/index/id/25916646 Race-Ethnic Disparities in Stroke Thrombolysis: https://directory.libsyn.com/episode/index/id/23377391 Social Determinants of Health in Patients with Movement Disorders: https://directory.libsyn.com/episode/index/id/26531040 Racial and Ethnic Differences in Quality of Life in Parkinson Disease: https://directory.libsyn.com/episode/index/id/27196008 Related Article Links: Association of Employment Status With Symptom Burden and Health-Related Quality of Life in People Living With Primary CNS Tumors: https://n.neurology.org/content/100/16/e1723 Racial and Ethnic Differences in Antiseizure Medications Among People With Epilepsy on Medicaid: A Case of Potential Inequities: https://cp.neurology.org/content/13/1/e200101  Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke: https://n.neurology.org/content/98/16/e1596 Neighborhood Social Determinants of Health in Patients Seen in Neurology Movement Disorders Clinics: https://cp.neurology.org/content/13/2/e200142 Racial and Ethnic Differences in Health-Related Quality of Life for Individuals With Parkinson Disease Across Centers of Excellence: https://n.neurology.org/content/100/21/e2170   Visit NPUb.org/Podcast for associated article links

Patients may be the experts on their own conditions, but data that captures health-related quality of life is often underutilized in research. The PKD Foundation is working with IQVIA to create a registry of patients with autosomal dominant polycystic kidney disease, a rare kidney condition. The ADPKD registry focuses on patient-reported, health-related quality of life data. The organization believes the registry will not only provide new insights into the condition but help with the design of efficient clinical trials and accelerate the development of new treatments. We spoke to President and CEO of the PKD Foundation Susan Bushnell, Vice President of Research Programs at PKD Foundation Elise Hoover, and Senior Director of Global Strategic Planning for IQVIA's Integrated Health Practice David Voccola, about the new registry, how it is leveraging technology to enable patients to drive insights into their condition, and the challenges it needs to overcome.

Dr Matt Ellington from Central Texas Pediatric Orthopedics joins the show this month! We discuss pain management for ACL reconstruction and the danger of opioid use disorders, as well as grit scores and Dr Ellington's pearls for a variety of sports cases. The lightning round highlights the outcomes of THA in pediatric patients, spinal trauma classification systems, and long term outcomes after scoliosis surgery.    Your hosts are Julia Sanders from Children's Hospital Colorado, Carter Clement from Children's Hospital of New Orleans, Craig Louer from Vanderbilt, and Josh Holt from University of Iowa. This episode is sponsored by Nuvasive. Music by A. A. Alto.   References:   Akazawa et al. Health-Related Quality of Life of Patients With Adolescent Idiopathic Scoliosis at Least 40 Years After Surgery. Spine (Phila Pa 1976). 2023.   Pascual-Leone N et al. Higher Grit Scores Are Associated With Earlier Increases in Knee Flexion Following Anterior Cruciate Ligament Reconstruction With Meniscus Repair in Pediatric Patients. JPO. 2023.   Sborov KD et al. Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC. JPOSNA. 2023.   Whitmarsh-Brown MA et al. Modernizing Our Understanding of Total Hip Arthroplasty in the Pediatric and Young Adult Patient: A Single-center Experience. JPO. 2023..   Cahan et al. Opioid Represcriptions After ACL Reconstruction in Adolescents Are Associated With Subsequent Opioid Use Disorder. JPO. 2023..   O'Neill NP et al. The Reliability of the AO Spine Upper Cervical Classification System in Children: Results of a Multi-Center Study. JPO. 2023.   Wagner et al. Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction. JPO. 2023.

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs (specifically GLP1 agonists like Novo Nordisk's Saxenda and Wegovy) to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. In part 2 we took a deeper dive into the research that they used to try to support this request, and in this final installment, we will look at the research around efficacy, harm, and cost-effectiveness.First I'll offer a summary for each issue and then I'll give a breakdowns of the research that they cite.  Just a quick reminder that this request is asking the World Health Organization (WHO) to add these drugs to their list of “essential medications” globally.Before we get into the sections, I want to mention two overarching issues that are found throughout the entirety of this request and the studies that are used to support it.First, in general, a belief has been fomented (predominantly by those in the weight loss industry) that being higher-weight is so terrible then it's worth “throwing anything at the problem.” This leads to acceptance of poor, short-term, and/or incomplete data as “good enough” to foist recommendations onto higher-weight people, which means that part of weight stigma in healthcare is that higher-weight people are afforded less right to ethical, evidence-based medicine than thinner people.Second, is clinging to correlation (without any mechanism of causation) when it comes to weight, health, and health outcomes, including the abject failure to consider confounding variables. So throughout these studies “being higher-weight is associated with [health issue(s)]” stated uncritically in support of weight loss interventions. There is an utter failure to explore the idea that the reason for the outcome differences is not weight itself but, instead, exposure to weight stigma, weight cycling (which these medications actually perpetuate by their own admission,) and healthcare inequalities.  Issues with research supporting effectiveness, harms, and benefitsStudy Duration:This is the main issue. While there was one study that went up to 106 weeks, the vast majority of the studies are between 14 and 56 weeks. We know that these drugs can have significant, even life-threatening side effects (earning them the FDA's strongest warning.) 14-56 weeks is not not nearly enough time to capture the danger of long-term effects, or to capture long-term trends around weight loss/weight regain.Study PopulationMany of the studies included have small samples. Many have study populations are overwhelmingly white, which is a huge issue when making a global recommendations.Small effect and overlapMany of the studies show only a bit of weight loss (often 15lbs or less) and often there was overlap in weight lost between the treatment group and the placebo group. Even using the “ob*sity” construct that this request is based on, for many people, this amount of weight loss wouldn't even change their “class” of “ob*sity.”Failure to capture adverse eventsMuch of the research they use to support their claims of safety didn't actually capture individual adverse events or serious adverse events. Often they only captured subjects who reported leaving treatment due to side effects.Issues with research supporting cost effectivenessThe cost-effectiveness analyses they cite are based on Quality Adjusted Life Years (QALYs). This is a measurement of the effectiveness of a medical intervention to lengthen and/or improve patients' lives.The calculation for this is [Years of Life * Utility Value = #QALY]So if a treatment gives someone 3 extra years of life with a Health-Related Quality of Life (HRQL) score of 0.7, then the treatment is said to generate 2.1 [3 x 0.7] QALYs.This is a complicated and problematic concept that deserves its own post sometime in the future, but looking just at this request I think it's important to note that they are working on two main unproven assumptions:1. That being higher weight causes lower health-related quality of life and/or shorter life span (rather than any lower HRQL being related to experiences that higher-weight people have including weight stigma, weight cycling, healthcare inequalities et al.) 2. That this treatment induces weight loss and/or health benefits that increase the life span and/or health-related quality of life of those who take it.I don't believe either of these assumptions are proven by the material cited in the request to the WHO. Specifically, it's very possible that it's not living in a higher-weight body, but rather the experiences that higher-weight people are more likely to have (weight stigma, weight cycling, healthcare inequalities) that impact their HRQL.Further, the short-term efficacy data available (and Novo Nordisk's own admission about high rates of regain) fall far short of proving any assumptions about these drugs ability to actually improve or extend life. Further, the failure of the literature to adequately capture negative side effects of the drugs, both short and long-term, means that this calculation cannot be properly made.Incremental Cost-Effectiveness Ratio (ICER)ICER is how QALYs are turned into a monetary value. It is calculated by dividing the difference in total costs by the difference in the chosen measure of health outcome or effect.[(Cost of intervention A -Cost of Intervention B) / (Effectiveness of Intervention A – Effectiveness of Intervention B)]The result is a ratio of extra cost per extra unit of health effect of a more vs less expensive treatment which can then be measured in QALYs.Again, this is worthy of its own post because there are all kinds of ethical issues around things like how we value life, how we define “healthy” and the ethics of determining whether or not prolonging someone's life is “cost effective.” I'm not going to do a deep dive into that today, but I do want to note that it is a serious issue in these kinds of calculations.In this specific case, even if one was to get past the ethical issues, an accurate calculation is impossible to make on both of the measures of the equation.Cost of these drugs varies wildly between countries and sometimes within countries because, for example, Novo Nordisk is a for-profit corporation whose goal is to create as much profit as possible.  Per the WHO request letter, the monthly cost of liraglutide is $126 in Norway and $709 in the US. Semaglutide is $95 per 30 days in Turkey, but $804 per 30 days in US.When it comes to effectiveness of the treatment, again, there is virtually no long-term data. We do know that in Novo Nordisk's own studies, weight is regained rapidly and cardiometabolic benefits are lost when the drugs are discontinued and even when people stay on the drugs, weight loss levels off after about a year, at 68 weeks weight cycling begins, and at 104 weeks (when follow-up ended) weight was trending up. It's possible that these drugs are utterly ineffective over the long-term and/or that the prevalence of long-term side effects renders any treatment effects moot. We simply do not know.I do not think that this is a remotely appropriate basis from which to request that these drugs be declared globally essential by the WHO.Here are the citation breakdowns. These are not deep dives since there are enough issues with the research on a simple surface analysis.Breakdowns of evidence of comparative effectivenessEffects of liraglutide in the treatment of ob*sity: a randomised, double-blind, placebo-controlled study, Astrup et al.)This is a 20-week study funded by Novo Nordisk. It included 564 people on various doses of liraglutide and a placebo group who didn't get the drug and a group on orlistat. There were no more than 90-98 people in each group.The study explains “Participants on liraglutide lost significantly more weight than did those on placebo” by which they meant that those on the highest dose of liraglutide lose about 9.7lbs more than those on the placebo over the 20 weeks.III LEAD studiesThese are four studies that look at liraglutide in combination with other drugs for the treatment of Type 2 Diabetes that also included some information on weight changes. One was 52 weeks, the others were  26, the maximum amount of weight lost was only about 5lbs.   The first [Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with Type 2 diabetes (LEAD-1 SU), Marre et al] was a study that looked at the efficacy of adding liraglutide or rosiglitazone 4 to glimiperide in subjects with Type 2 Diabetes to test effects on blood sugar and body size.The study followed 1041 adults for 26 weeks. The study found that those on .6mg of liraglutide gained 0.7kg, those on 1.2mg gained 0.3kg, and those on 1.8mg of liraglutide lost 0.2kg, while those on placebo lost 0.1kg.The second [Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care, 2009. 32(1): p. 84-90. Nauck, M., et al.,]looked at the efficacy of adding liraglutide to metformin therapy for those with Type 2 Diabetes. They found that over the 26-week study those on liraglutide lost 1.8 ± 0.2, 2.6 ± 0.2, and 2.8 ± 0.2 kg for 0.6, 1.2, and 1.8 mg doses. Those on placebo lost 1.5 ± 0.3kg.The third [Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet, 2009. 373(9662): p. 473-81. Garber, A., et al.,] This was a study of the comparative effectiveness of Liraglutide versus glimepiride for type 2 diabetes, with small weight loss as an ancillary finding. Those in the liraglutide group lost an average of 2kg.The final study [Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD), Zinman et al.]  was a 26-week study with 533 total subjects. The goal was to study the efficacy of liraglutide when added to metformin and rosiglitazone for people with type 2 diabetes. They found that those on liraglutide lost between 0.7 and 2.3kg (1.5lbs to 5.1lbs) in 26 weeks.Meta-Analyses and Systematic Review FindingsEfficacy of Liraglutide in Non-Diabetic Ob*se Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Barboza, J.J., et al., None of the included studies were more than 56 weeks and one was only 14 weeks. One had as many as 3731 subjects, but one had only 40. Some had body weight loss as a primary outcome, but some did not. Maximum doses ranged from 1.8 to 3.0mg. The mean body weight reduction was  3.35 kg (7.4lbs) but in one study there was no difference in weight loss. The maximum difference was 6.3kg (13.9lbs)They also refer to Iqbal et al which we discussed in part 2.Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. Vilsbøll, T., et al.The included studies are between 20 and 53 weeks long, and include some of the studies they already cited individually above. Of the 25 included studies only 3 had “ob*sity” as the main inclusion criteria, the rest were Type 2 Diabetes.The mean weight loss for those on the highest dose of the drug was between 0.2kg and 7.2kg. For those in the control group it was 2.9 kg, so there was actually overlap between the treatment and placebo groups.Summary of evidence of safety and harmsThey begin with the claim “The safety profile of GLP-1 receptor agonists is also well studied”To support this they cite: Efficacy and Safety of Liraglutide 3.0 mg in Patients with Overweight and Ob*se with or without Diabetes: A Systematic Review and Meta-Analysis, Konwar, M., et al.,This included 14 total studies, many of which the authors of the WHO request had cited individually and were included in other systematic reviews and meta-analyses above. The smallest study included 19 people, the largest included 2,487. The total number of subjects was 4,142.Their conclusion was “Liraglutide in 3.0 mg subcutaneous dose demonstrated significant weight reduction with a reasonable safety profile for patients with overweight or ob*sity regardless of diabetic status compared to placebo.”Their methodology says that they omitted studies from analysis due to “short duration.” They included studies that had a minimum of 12 weeks and a maximum of 56 weeks of follow-up.While they included 14 studies, only 11 of them actually included information about adverse events.In terms of adverse effects (AEs,) they found that the pooled estimate of nine studies in nondiabetic patients and two studies in diabetic patients revealed a significant proportion of patients experiencing the adverse events in liraglutide 3.0 mg group when compared with placebo., and the pooled estimate of the eleven studies showed that liraglutide 3.0 mg had higher risk of AEs compared to placebo.When it came to “serious adverse events” they found that there was a similar risk level between the drug and placebo groups, but remember that's for only 12 to 56 weeks, and Novo Nordisk is recommending that people take these drugs for the rest of their lives. A few months to a little over a year is not enough time to capture long-term serious adverse events.The efficacy and safety of liraglutide in the ob*se, non-diabetic individuals: a systematic review and meta-analysis. Zhang, P., et al.,This included five RCTs (which were included in various of the above systemic reviews and meta-analyses) ranging in follow-up from 14 to 56 weeks.The only adverse event information captured was the number of people who withdrew from treatment due to adverse events (which they found was similar between drug and placebo) and nausea (which was experienced more by people on the drug.)So, in addition to being short in duration, this was far from a comprehensive list of side effects. They made no attempt to capture serious adverse side effects and their short-term nature would have made this difficult anyway.Association of Pharmacological Treatments for Ob*sity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. Khera, R., et al.This looked at weight loss and adverse events with a number of different weight loss drugs. Interestingly liraglutide did not show the highest amount of weight loss but was associated with the highest odds of adverse event–related treatment discontinuation. It should also be noted that high drop-out rates of 30-45% plagued all of the trials which the study authors admit means that “studies were considered to be at high risk of bias.“Given that those who drafted the WHO request are asking that these drugs be considered essential globally, it is disappointing that they included this study and didn't bother to mention this issue in their written request.This included 28 RCTs (most of which were included in other citations above) and only 3 that included liraglutide. They didn't capture individual adverse events, but only “Discontinuation of Therapy Due to Adverse Events.” They only evaluated a year of data so, again, while it is likely that these studies would have captured common adverse events had they bothered to try, there isn't long enough follow-up to have any information about serious (possibly life-threatening) long-term adverse events.Association of Glucagon-like Peptide 1 Analogs and Agonists Administered for Ob*sity with Weight Loss and Adverse Events: A Systematic Review and Network Meta-analysis. Vosoughi, K., et al.,This study included 64 RCTs with durations from 12 to 160 weeks, with a median of 26 weeks. As is common in these studies, the majority of the sample (74.9%) was white.Like those above, they only looked at treatment discontinuation from adverse events, they did not capture specific adverse events (common or serious.) Of the seven GLP-1 drugs they tested, liraglutide was tied with taspoglutide for the highest discontinuation of treatment due to adverse events.The study authors also note that “Risk of bias was high or unclear for random sequence generation (29.7%), allocation concealment (26.6%), and incomplete outcome data (26.6%).”Breakdowns for Comparative Cost-effectiveness StudiesFirst, the WHO request authors themselves admit that when it comes to cost-effectiveness, “the analyses have generally been performed only for high-income countries.” This is significant since they are asking the WHO to consider these drugs essential for the entire world.It's also important to understand that none of the data looks at a comparison of cost effectiveness for weight-neutral health interventions to these drugs. Without that information there is no way to calculate actual “cost effectiveness” since it's possible that weight-neutral health interventions would have greater benefits with less risk and dramatically lower cost.  NICE's guidance:  Liraglutide for managing overweight and ob*sity Technology appraisal guidance [TA664]Published: 09 December 2020.Do recall that NICE is involved in the current scandal with Novo Nordisk for influence peddling.These guidelines are created based on a submission of evidence by Novo Nordisk. The committee's understanding of “clinical need” was based on the testimony of a single “patient expert” who “explained that living with ob*sity is challenging and restrictive. There is stigma associated with being ob*se.”Once again we see a rush to blame body size for any “challenges” and “restrictions” of living in a higher-weight body, accompanied by the immediate decision that those bodies should be subjected to healthcare interventions that risk their lives and quality of life in order to be made (temporarily, by Novo and NICE's own admission) thinner.  There did not seem to be a patient expert to discuss the weight-neutral options.It was not immediately apparent if the patient expert was provided/paid by Novo Nordisk, but they certainly forwarded their narrative that simply living in a higher-weight body is a disease requiring treatment.It should be noted that while the trial Novo Nordisk submitted covered a wider range of people, they specifically submitted for this recommendation only the subgroup of that population who were diagnosed with “ob*sity,”  pre-diabetes, and a “high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia.”So, even if we accept this guidance as true, the WHO Essential Medicines request applies to a population much wider than this and so this fails to justify the cost-effectiveness for that population.This guidance is also based on the costs associated with obtaining the drugs through a “specialist weight management service” since an agreement is in place for Novo Nordisk to give a discount to these services.In calculating the ICER per QALY gained, the recommendations note that “Because of the uncertainties in the modelling assumptions, particularly what happens after stopping liraglutide and the calculation of long-term benefits, the committee agreed that an acceptable ICER would not be higher than £20,000 per QALY gained”Again, this recommendation is based on a trial submitted by Novo Nordisk that included 3,721 people and lasted for three years, but only 800 met the criteria for this cost-effectiveness recommendation. The trial failed to show a significant reduction in cardiovascular events. Novo's calculation of risk reduction was based on surrogate outcomes, which NICE points out “introduces uncertainty because causal inference requires direct evidence that liraglutide reduces cardiovascular events. This was not provided in the company submission because of lack of long-term evidence.”The NICE committee admits “relying on surrogates is uncertain but accepted that surrogate outcomes were the only available evidence to estimate cardiovascular benefits.”I just want to point out that another option would be to refuse to experiment on higher-weight people without appropriate evidence.These cost-effectiveness calculations are based on someone using the drug for two years, with no actual data on reduction in cardiovascular events, and with the admitted assumption that “any weight loss returned to the base weight 3 years after treatment discontinuation.” Said another way, this committee decided that it was cost effective to spend up to £20,000 per QALY for people to take a weight loss drug with significant side effects for two years, with no direct evidence of reduced cardiovascular events, and with the acknowledgment that people will be gaining all of their weight back when they stop taking it.Those who wrote the request for WHO to consider these drugs “essential” chose to characterize this as “At the chosen threshold of £20,000 per quality-adjusted life year (QALY) gained, the report concluded that liraglutide is cost-effective for the management of ob*sity.” I do not think that is an accurate characterization of the findings.The request cites “A report by the Canadian Agency for Drugs and Technologies in Health (CADTH) found that compared to standard care, the ICER for liraglutide was $196,876 per QALY gained”For the US, they cite a study that found that to achieve ICERs between $100,000 and $150,000 perQALY or evLY gained, the health-benefit price benchmark range for semaglutide was estimated as $7500 - $9800 per year, which would require a discount of 28-45% from the current US net price.They also cite “Cost-effectiveness analysis of semaglutide 2.4 mg for the treatment of adult patients with overweight and ob*sity in the United States, Kim et al.Let's take a look at their conflict of interest disclosure (emphasis mine)“Financial support for this research was provided by Novo Nordisk Inc. The study sponsor [that means Novo Nordisk] was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication.Dr Kim and Ms Ramasamy are employees of Novo Nordisk Inc. Ms Kumar and Dr Burudpakdee were employees of Novo Nordisk Inc at the time this study was conducted. Dr Sullivan received research support from Novo Nordisk Inc for this study. Drs Wang, Song, Wu, Ms Xie, and Ms Sun are employees of Analysis Group, Inc, who received consultancy fees from Novo Nordisk Inc in connection with this study.”Given that, you probably won't be shocked to learn that this concluded that Novo Nordisk's drug, semaglutide, was cost-effective. The reason I bolded the text above is that this study is based on modeling – they are taking what is, by their own admission, a “new drug” and making predictions for 30 years. Everything was simulated based on trial data (you know, those trials that we've been discussing that often have horrendous methodology…) and “other relevant literature.” The construction of the modeling and the interpretation of the results was directed by the company who stands to benefit financially from the findings, and carried out by that company's employees and consultants.  Also, and I'll just quote again here since I don't think I can improve on their text “Cost-effectiveness was examined with a willingness-to-pay (WTP) threshold of $150,000 per QALY gained” I do not think that this WTP is based on a global assessment.In their (and by their I mean Novo Nordisk's) modeling they find that semaglutide was estimated to improve QALYs by 0.138 to 0.925 and incur higher costs by $3,254 to $25,086 over the 30-year time horizon vs comparators.And, again, this is without any kind of actual long-term data. I think that the best way to characterize this information is “back of the envelope calculations” at best.To sum up, I do not think that the research they cite comes anywhere close to proving that these drugs have levels of efficacy, safety, or cost-effectiveness that warrant their addition to the WHO list of essential medicines. I believe that if the WHO grants this request I think it will be an affront to medical science, it will cheapen the concept of “essential medicines,” and it will harm untold numbers of higher-weight people all over the world.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Drs Jeffrey Swigris and Ayodeji Adegunsoye discuss fibrosing interstitial lung disease and treatment challenges for individuals with idiopathic pulmonary fibrosis. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/982422). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Idiopathic Pulmonary Fibrosis (An Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline https://pubmed.ncbi.nlm.nih.gov/35486072/ Health-Related Quality of Life and Symptoms in Patients With IPF Treated With Nintedanib: Analyses of Patient-Reported Outcomes From the INPULSIS® Trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990488/ Acute Exacerbation of Idiopathic Pulmonary Fibrosis: A Clinical Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089322/

Join me for a conversation with Dr. Lacretia Carroll, Assistant Professor in the College of Nursing at the University of Tennessee Health Science Center about the importance of health informatics. Learn more about what health and nursing informatics mean to you as a patient or as a provider. Dr. Carroll especially relates health informatics to her research on health disparities in the LGBTQ+ community.More about Dr. Carroll:Lacretia Carroll joined the faculty of the UTHSC College of Nursing in October 2019. Her research focuses on social determinants of health, health equity and disparities, and health outcomes in sexual and gender minority adolescent populations.Dr. Carroll earned her Bachelor's Degree in nursing in 2011 from the University of Alabama-Huntsville and her Master's Degree in nursing from the University of Memphis in 2013. She has clinical experience in pediatric intensive care and endocrinology and research expertise as a clinical research coordinator in pediatric allergy, immunology, and endocrinology. She received her PhD in 2018 from the University of Tennessee Health Science Center for her dissertation titled “Health-Related Quality of Life of Female Children with Congenital Adrenal Hyperplasia: A Mixed Methods Study.” Prior to assuming her faculty role, Dr. Carroll completed postdoctoral training at UTHSC.Dr. Carroll has received several small grants from organizations such as Sigma Theta Tau and the CARES Foundation. She is a member of Southern Nursing Research Society and Pediatric Endocrinology Nursing Society. Dr. Carroll has authored and co-authored peer-reviewed papers and regularly presents at scientific meetings.Follow That's Healthful and like or comment on this or any episode of this podcast.

In this podcast, Thomas John from the Department of Medical Oncology at the Peter MacCallum Cancer Centre in Melbourne, Margarita Majem from the Department of Medical Oncology at the Hospital de la Santa Creu i Sant Pau in Barcelona, Diane Legg, founder of LUNGSTRONG, and Jonathan Goldman from the David Geffen School of Medicine at the University of California in Los Angeles discuss health-related quality of life in resectable EGFR-mutant non-small cell lung cancer. This podcast is published open access in Targeted Oncology and is fully citeable. You can access the original published podcast article through the Targeted Oncology website and by using this link: https://link.springer.com/article/10.1007/s11523-022-00927-5. All conflicts of interest can be found online.   Open Access This podcast is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The material in this podcast is included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

Editor-in-Chief Dr. Sue Yom hosts Dr. Shankar Siva, Associate Professor and Radiation Oncologist from the Peter MacCallum Cancer Centre, Australia and the supervising author of "Cost-Effectiveness of Single- versus Multi-Fraction SABR for Pulmonary Oligometastases - The SAFRON II Trial"; Dr. David Sher, Professor at the University of Texas Southwestern Medical Center and the Red Journal's Methodology Section Editor who first-authored this month's OncoScan "The Cost-Effectiveness of Consolidative Radiation Therapy in Oligometastatic Disease: High-Value Proposition or Wishful Thinking?"; and Dr. Aisling Barry, Professor and Chair of Radiation Oncology at University College Cork and Cork University Hospital, Ireland, who first-authored "The Impact of Disease Progression on Health-Related Quality of Life Outcomes in Patients with Oligo-Metastatic Disease at 12-Months post Stereotactic Body Radiotherapy."

Multiple Sclerosis News Today's multimedia associate, Price Wooldridge, discusses how researchers have identified early factors that may affect the trajectory of an MS patient's long-term quality of life following diagnosis. He also reads “My MS Makes Getting Sick With a Viral Infection 10 Times Worse”, a column by Benjamin Hofmeister. =================================== Are you interested in learning more about multiple sclerosis? If so, please visit: https://multiplesclerosisnewstoday.com/ ===================================== To join in on conversations regarding multiple sclerosis, please visit: https://multiplesclerosisnewstoday.com/forums/

Drs Sumanta Pal and Brian Rini discuss front-line treatment of renal cell carcinoma. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/968736). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. Resources Bevacizumab Plus Interferon-alpha Versus Interferon-alpha Monotherapy in Patients With Metastatic Renal Cell Carcinoma: Results of Overall Survival for CALGB 90206 https://ascopubs.org/doi/10.1200/jco.2009.27.18_suppl.lba5019 An updated table of the front-line IO combination RCC studies that have shown an OS advantage https://twitter.com/brian_rini/status/1309609380585844736/photo/1 Targeting PD-1 or PD-L1 in Metastatic Kidney Cancer: Combination Therapy in the First-Line Setting https://aacrjournals.org/clincancerres/article/26/9/2087/83102/Targeting-PD-1-or-PD-L1-in-Metastatic-Kidney Conditional Survival and Long-term Efficacy With Nivolumab Plus Ipilimumab Versus Sunitinib in Patients With Advanced Renal Cell Carcinoma https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.34180 International Metastatic Renal Cell Carcinoma Database Consortium Criteria https://www.uptodate.com/contents/image?imageKey=ONC%2F116130&topicKey=ONC%2F2984&source=see_link Molecular Correlates Differentiate Response to Atezolizumab (atezo) + Bevacizumab (bev) vs Sunitinib (sun): Results From a Phase III Study (IMmotion151) in Untreated Metastatic Renal Cell Carcinoma (mRCC) https://cslide.ctimeetingtech.com/esmo2018/attendee/confcal/presentation/list?q=LBA31 Nivolumab Versus Everolimus in Patients With Advanced Renal Cell Carcinoma: Updated Results With Long-term Follow-up of the Randomized, Open-Label, Phase 3 CheckMate 025 Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415096/pdf/nihms-1732721.pdf Lenvatinib Plus Pembrolizumab or Everolimus for Advanced Renal Cell Carcinoma https://www.nejm.org/doi/10.1056/NEJMoa2035716 The Uromigos Debate: Treatment of Favorable Risk Renal Cancer https://anchor.fm/the-uromigos/episodes/Episode-67-The-Third-Uromigos-Debate---fPD1VEGF-vs-PD1CTLA4-for-front-line-renal-cancer-emjpji Health-Related Quality-of-Life Outcomes in Patients With Advanced Renal Cell Carcinoma Treated With Lenvatinib Plus Pembrolizumab or Everolimus Versus Sunitinib (CLEAR): A Randomised, Phase 3 Study https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(22)00212-1/fulltext Study of Cabozantinib in Combination With Nivolumab and Ipilimumab in Patients With Previously Untreated Advanced or Metastatic Renal Cell Carcinoma (COSMIC-313) https://clinicaltrials.gov/ct2/show/NCT03937219 A Study of Pembrolizumab (MK-3475) in Combination With Belzutifan (MK-6482) and Lenvatinib (MK-7902), or Pembrolizumab/Quavonlimab (MK-1308A) in Combination With Lenvatinib, Versus Pembrolizumab and Lenvatinib, for Treatment of Advanced Clear Cell Renal Cell Carcinoma (MK-6482-012) https://clinicaltrials.gov/ct2/show/NCT04736706 Twitter poll questions: What magnitude of benefit is required to adopt triplets? OS https://mobile.twitter.com/brian_rini/status/1508450496104783877 What magnitude of absolute PFS benefit vs doublets is required to adopt triplets? https://mobile.twitter.com/brian_rini/status/1508450910506295305 What would be the most convincing endpoint to adopt triplets? https://mobile.twitter.com/brian_rini/status/1508451622564909057 Molecular Subsets in Renal Cancer Determine Outcome to Checkpoint and Angiogenesis Blockade https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436590/ OPtimal Treatment by Invoking biologic Clusters in Renal Cell Carcinoma (OPTIC RCC) https://www.kcameetings.org/wp-content/uploads/2021/12/IKCSNA21_TIP8_Chen.pdf

In this episode, Antonia and Andrew discuss a selection of articles from the August 3, 2022 issue of JBJS, along with an added dose of entertainment and pop culture. Listen at the gym, on your commute, or whenever your case is on hold! Articles Discussed: Current Concepts Review. Current State of Platelet-Rich Plasma and Cell-Based Therapies for the Treatment of Osteoarthritis and Tendon and Ligament Injuries, by Su et al. What's Important: The Individualism Excuse and the Myth of Meritocracy in Orthopaedics, by Baird et al. Orthopaedic Forum: The Pioneering Women of Orthopaedic Surgery. A Historical Review, by Dib et al. Outcomes After Anatomic and Reverse Shoulder Arthroplasty for the Treatment of Glenohumeral Osteoarthritis. A Propensity Score-Matched Analysis, by Kirsch et al. The Influence of Surgeon Sex on Adverse Events Following Primary Total Hip Arthroplasty. A Register-Based Study of 11,993 Procedures and 200 Surgeons in Swedish Public Hospitals, by Jolbäck et al. A Prospective, Longitudinal Study of the Influence of Obesity on Total Knee Arthroplasty Revision Rate. Results from the Australian Orthopaedic Association National Joint Replacement Registry, by Wall et al. Total Hip Arthroplasty Leads to Better Results After Low-Energy Displaced Femoral Neck Fracture in Patients Aged 55 to 70 Years. A Randomized Controlled Multicenter Trial Comparing Internal Fixation and Total Hip Arthroplasty, by Bartels et al. Development and Validation of Health-Related Quality of Life Measure in Older Children and Adolescents with Early Onset Scoliosis. Early Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF), by Matsumoto et al. Exposure-Related Anxiety and Improving Patient Sat

FRONTAL FIBROSING ALOPECIA : ISOTRETINOIN VS FINASTERIDE Rakowska A, et al (starts at 9:15). Efficacy of Isotretinoin and Acitretin in Treatment of Frontal Fibrosing Alopecia: Retrospective Analysis of 54 Cases. J Drugs Dermatol. 2017. Rokni GR et al (starts at 10:43). Evaluating the combined efficacy of oral isotretinoin and topical tacrolimus versus oral finasteride and topical tacrolimus in frontal fibrosing alopecia - A randomized controlled trial. J Cosmet Dermatol. 2022 Jul 11.   FRONTAL FIBROSING ALOPECIA : EYELASH INVOLVEMENT Salas-Callo C et al (starts at 16:14). Eyelash involvement in frontal fibrosing alopecia: A prospective study. J Am Acad Dermatol 2022 Jul;87(1):232-234.   FRONTAL FIBROSING ALOPECIA : QUALITY OF LIFE David Saceda-Corralo et al (starts at 22:52). Health-Related Quality of Life in Patients With Frontal Fibrosing Alopecia. JAMA Dermatol. 2018 Apr 1;154(4):479-480. Varghae A et al (starts at 24:43). Assessment of health-related quality of life in patients with frontal fibrosing alopecia. J Cosmet Dermatol. 2022 Jun 27.   FRONTAL FIBROSING ALOPECIA : MALE FFA STUDIES OF ORAL MINOXIDIL AND FINASTERIDE/DUTASTERIDE Moussa A et al (starts at 30:00). Clinical features and treatment outcomes of frontal fibrosing alopecia in men. Int J Dermatol. 2022 Jun 21 LPP PREVALENCE STUDIES Trager MH et al (starts at 40:50). Prevalence estimates for lichen planopilaris and frontal fibrosing alopecia in a New York City health care system. J Am Acad Dermatol 2021 Apr;84(4):1166-1169 Lavian J et al (starts at 41:37). Incidence estimates for lichen planopilaris and frontal fibrosing alopecia in a New York City health care system.Dermatol Online J. 2021 Aug 15;27(8). Lim S H et al (starts at 42:29). Rapidly increasing incidence and prevalence of lichen planopilaris in an Asian population: A Korean nationwide population-based study. J Dermatol. 2022 Jun 21. Joshi TP et al (starts at 49:10). Prevalence of lichen planopilaris in the United States: A cross-sectional study of the All of Us research program. JAAD Int. 2022 Jun 13;8:69-70   CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA: QUALITY OF LIFE Akintilo et al (starts at 54:48). Health care barriers and quality of life in central centrifugal cicatricial alopecia patients. Cutis. 2018 Dec;102(6):427-432.   Maranga et al (starts at 56:49). Quality of life in patients with central centrifugal cicatricial alopecia: a preliminary study. Br J Dermatol. 2022 Jun 15.     CONCLUSION AND SUMMARY - starts at 58:46

In this episode of the Award-winning PRS Journal Club Podcast, 2022 Resident Ambassadors to the PRS Editorial Board – Saïd Azoury, Emily Long, and Ronnie Shammas- and special guest Vu T. Nguyen, MD, discuss the following articles from the April 2022 issue: “Prepectoral and Subpectoral Tissue Expander– Based Breast Reconstruction: A Propensity- Matched Analysis of 90-Day Clinical and Health-Related Quality-of-Life Outcomes” by Nelson, Shamsunder, Vorstenbosch, et al. Read the article for FREE: https://bit.ly/TissueExpanderOutcomes Special guest Vu T. Nguyen, MD is an Associate Professor of Plastic Surgery at the University of Pittsburgh and Program Director of the Pittsburgh Plastic Surgery Residency. Dr. Nguyen completed his residency training at the University of Pittsburgh followed by a Microsurgery Fellowship at the University of Pennsylvania. READ the articles discussed in this podcast as well as free related content from the archives: https://bit.ly/PRSApril22Collection 

Dr. Abbatemarco discusses the Neurology article, "Costs and Health-Related Quality of Life in Patients With NMO Spectrum Disorders and MOG-Antibody–Associated Disease". Show references: https://n.neurology.org/content/98/11/e1184

Musculoskeletal diseases consume a large amount of health and social resources and are a major cause of disability in both low- and high-income countries. In addition, patients frequently present with co-morbid chronic diseases of lifestyle. The area of musculoskeletal disease is restricted by a lack of epidemiological knowledge, particularly in low- and middleincome countries.

Bailey & Ashley discuss what it's like to miscarry in other countries. They review blogs, statistics, and superstitions that follow women around the world as they face pregnancy loss. They discovered that women suffer as one from this universal hurt. All information mentioned is linked below. New Zealand Approves Paid Leave After A Miscarriage : NPR https://resolve.org/infertility-101/what-is-infertility/fast-facts/ Reproductiveaccess.com Miscarriage - NHS (www.nhs.uk) How Culture Shapes Perceptions of Miscarriage - SAPIENS Caring for women experiencing pregnancy loss: a free e-learning resource - The Miscarriage Association How Culture Shapes Perceptions of Miscarriage - SAPIENS New Zealand becomes one of the first countries to legalize paid leave for miscarriages - The Washington Post Miscarriage - Expectant, Medical and Surgical Management (adhb.govt.nz) The Country Where Having a Miscarriage Can Land You in Prison (thewire.in) New Zealand not the first to provide paid miscarriage leave; India has a law since 1960s (republicworld.com) Estimation of pregnancy losses attributable to exposure to ambient fine particles in south Asia: an epidemiological case-control study - The Lancet Planetary Health Having a Miscarriage in China - WWAM Bam! Traditional Chinese Pregnancy Restrictions, Health-Related Quality of Life and Perceived Stress among Pregnant Women in Macao, China - Asian Nursing Research (asian-nursingresearch.com) Rising number of Swedish women suffer recurrent miscarriages (sciencenordic.com) Here In Africa, The Stigma Surrounding Baby Loss Meant My Miscarriages Were Seen As Punishment From God | HuffPost UK Parents (huffingtonpost.co.uk)

Dr. Donovan summarizes Prior Injury, Health-Related Quality of Life, Disablement, and Physical Activity in Former Women's Soccer Players by Shannon J. Cross, EdD; Diane L. Gill, PhD; Pam Kocher Brown, EdD; Erin J. Reifsteck, PhD which is featured in the January issue of the Journal of Athletic Training. Article Link: https://bit.ly/3fVZP6l

Tem gente que desperta e dá bom dia para o sol.Mas tem muita gente que acorda mal humorada e demora até mesmo para conseguir socializar.Por que isso acontece?Confira no papo entre o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.> OUÇA (57min 43s)*Naruhodo! é o podcast pra quem tem fome de aprender. Ciência, senso comum, curiosidades, desafios e muito mais. Com o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.Edição: Reginaldo Cursino.http://naruhodo.b9.com.br*PARCERIA: ALURAA Alura tem mais de 1.000 cursos de diversas áreas e é a maior plataforma de cursos online do Brasil -- e você tem acesso a todos com uma única assinatura.Aproveite o desconto de R$100 para ouvintes Naruhodo no link:https://www.alura.com.br/promocao/naruhodo *PARCERIA: ACTConheça a campanha "Viva melhor, beba menos", realizada pela OPAS, Organização Pan-Americana da Saúde, com apoio da ACT Promoção da Saúde. O podcast Naruhodo apoia essa iniciativa.Acesse: twitter.com/OPASOMSBrasil*REFERÊNCIASA marker for the end of adolescencehttps://www.sciencedirect.com/science/article/pii/S0960982204009285Morningness and eveningness personality: A survey in literature from 1995 up till 2006https://www.sciencedirect.com/science/article/abs/pii/S0191886907002516GWAS of 89,283 individuals identifies genetic variants associated with self-reporting of being a morning personhttps://www.nature.com/articles/ncomms10448Distribution and heritability of diurnal preference (chronotype) in a rural Brazilian family-based cohort, the Baependi studyhttps://www.nature.com/articles/srep09214DIURNAL PREFERENCE AND SLEEP QUALITY: SAME GENES? A STUDY OF YOUNG ADULT TWINShttps://www.tandfonline.com/doi/abs/10.3109/07420521003663801The Physiological Period Length of the Human Circadian Clock In Vivo Is Directly Proportional to Period in Human Fibroblastshttps://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0013376Molecular interrogation of hypothalamic organization reveals distinct dopamine neuronal subtypeshttps://www.nature.com/articles/nn.4462A Cryptochrome 2 mutation yields advanced sleep phase in humanshttps://elifesciences.org/articles/16695Phenotyping of PER3 variants reveals widespread effects on circadian preference, sleep regulation, and healthhttps://www.sciencedirect.com/science/article/abs/pii/S1087079217301387?casa_token=FwV3rbinBKIAAAAA:aDnC_DtGS5fX3ywDD02sahy2DHaVizxLxo9u3CsUEJFNnh9-QOG5ywZwaWnCsQzquqvAZ3Cx0frpTime for Bed: Genetic Mechanisms Mediating the Circadian Regulation of Sleephttps://www.sciencedirect.com/science/article/abs/pii/S0168952518300015?casa_token=8Uw_zcyy8dQAAAAA:KZVL7DFZq7YoX101uSgWs6frxgMa5LxezgGInYOOeoDNoqIHzAyUSfEDHJ4OlW9HA1ggaKhZ4n-kExtreme morning chronotypes are often familial and not exceedingly rare: the estimated prevalence of advanced sleep phase, familial advanced sleep phase, and advanced sleep–wake phase disorder in a sleep clinic population.https://academic.oup.com/sleep/article/42/10/zsz148/5542813?login=trueChronotype Genetic Variant in PER2 is Associated with Intrinsic Circadian Period in Humanshttps://www.nature.com/articles/s41598-019-41712-1A PERIOD3 variant causes a circadian phenotype and is associated with a seasonal mood traithttps://www.pnas.org/content/113/11/E1536.abstract?sid=9d1fba25-6642-4bb6-8048-756dbb5e2f13Sleep and Mood: Chicken or Egg?https://escholarship.org/content/qt1zj3s69s/qt1zj3s69s.pdfExposure to jet lag aggravates depression-like behaviors and age-related phenotypes in rats subject to chronic corticosteronehttps://academic.oup.com/abbs/article/51/8/834/5533128?login=trueCircadian preference and academic achievement in school-aged students: a systematic review and a longitudinal investigation of reciprocal relationshttps://www.tandfonline.com/doi/full/10.1080/07420528.2021.1926473?casa_token=8CHiH2ACoMUAAAAA%3A-kvhljaeiSNlZi7SA58yc1OzZiauLTPG1pwvk7ExalVaSPSTRD3IP95xudyvpraYH4bxSjC440KkL3IAge, the Big Five, and time-of-day preference: A mediational modelhttps://www.sciencedirect.com/science/article/abs/pii/S0191886913012592?via%3DihubLarks, owls, swifts, and woodcocks among fruit flies: differential responses of four heritable chronotypes to long and hot summer dayshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016586/Suprachiasmatic Nucleus: Cell Autonomy and Network Propertieshttps://www.annualreviews.org/doi/abs/10.1146/annurev-physiol-021909-135919Morningness–eveningness, sleep–wake variables and big five personality factorshttps://www.sciencedirect.com/science/article/abs/pii/S0191886907002516Night eating patterns and chronotypes: A correlation with binge eating behaviorshttps://www.sciencedirect.com/science/article/abs/pii/S0191886908000974Chronotype Differences in Health Behaviors and Health-Related Quality of Life: A Population-Based Study Among Aged and Older AdultsAutoMEQ - https://chronotype-self-test.info/index.php?sid=61524&newtest=YNaruhodo #5 - É possivel recuperar uma noite mal dormida dormindo mais na noite seguinte?https://www.youtube.com/watch?v=E-JN2qagigY&ab_channel=Cient%C3%ADstica%26PodcastNaruhodoNaruhodo #129 - Sono polifásico funciona segundo a ciência?https://www.youtube.com/watch?v=h6AfuI46VhQ&t=3s&ab_channel=Cient%C3%ADstica%26PodcastNaruhodoNaruhodo #245 - Por que sempre tem espaço pro doce?https://www.youtube.com/watch?v=mMRAGpdXEp8&ab_channel=Cient%C3%ADstica%26PodcastNaruhodoNaruhodo #256 - Porque roncamos?https://www.b9.com.br/shows/naruhodo/naruhodo-256-por-que-roncamos/Naruhodo #188 - Contar carneirinhos faz a gente dormir mais rápido?https://www.youtube.com/watch?v=Txu8-QTZB7IPodcasts das #Minas: PERGUNTA DE QUINTA - É PAU É PEDRA#MulheresPodcastershttps://open.spotify.com/show/7wpw0VXhWurAofD2zeJgsm*APOIE O NARUHODO!Você sabia que pode ajudar a manter o Naruhodo no ar?Ao contribuir, você pode ter acesso ao grupo fechado no Telegram, receber conteúdos exclusivos e ter vantagens especiais.Assine o apoio mensal pelo PicPay (https://picpay.me/naruhodopodcast), pelo Apoia-se (https://apoia.se/naruhodopodcast) ou ainda, para pessoas que moram fora do Brasil, pelo Patreon (https://www.patreon.com/naruhodopodcast).

Dr. Daan Kremer and Dr. Tim Knobbe summarize the results of their study "Airflow Limitation, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients," on behalf of their colleagues.

As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. Papers discussed in today's episode are listed and timestamped below.enjoy!________________________________________________________________________________________02:12 - Health-Related Quality of Life from Adolescence to Adulthood Following Extremely Preterm Birth. https://www.jpeds.com/article/S0022-3476(21)00326-7/fulltext12:45 - Low Birth Weight as an Early-Life Risk Factor for Adult Stroke Among Men. https://www.jpeds.com/article/S0022-3476(21)00632-6/fulltext19:25 - Bloodstream Infections in Preterm Neonates and Mortality-Associated Risk Factors. https://www.jpeds.com/article/S0022-3476(21)00561-8/fulltext31:01 - In‐Hospital Respiratory Viral Infections for Patients with Established BPD in the SARS‐CoV‐2 Era. https://onlinelibrary.wiley.com/doi/10.1002/ppul.2571439:07 - Neighborhood Disadvantage and Early Respiratory Outcomes in Very Preterm Infants with Bronchopulmonary Dysplasia. https://www.jpeds.com/article/S0022-3476(21)00643-0/fulltext47:57 - Family history of asthma influences outpatient respiratory outcomes in children with BPD. https://onlinelibrary.wiley.com/doi/10.1002/ppul.2560350:23 - End-of-Life Care Related Distress in the PICU and NICU: A Cross-Sectional Survey in a German Tertiary Center. https://www.frontiersin.org/articles/10.3389/fped.2021.709649/full

In this episode of the Award-winning PRS Journal Club Podcast, 2021 Resident Ambassadors to the PRS Editorial Board – Saïd Azoury, Lindsay Janes, and Ara Salibian- and special guest Andrew L. Da Lio, MD, discuss the following articles from the October 2021 issue: “A Matched Comparison of the Benefits of Breast Reduction on Health-Related Quality of Life” by Elfanagely, Othman, Rios-Diaz, et al. Read the article for FREE: https://bit.ly/BreastReductionBenefits Special Guest Andrew L. Da Lio, MD, is Clinical Professor and the Chief of the Division of Plastic and Reconstructive Surgery at the David Geffen School of Medicine at UCLA. READ the articles discussed in this podcast as well as free related content from the archives: https://bit.ly/PRSOct21Collection

Quality of life can be negatively impacted by chronic illnesses like POTS. Please join us for an honest discussion of quality of life based on the scientific literature and personal experience. Trigger warning: this episode gets heavy at times, and discusses suicide as related to poor quality of life in POTS patients. Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! Links referenced in this episode: Health-Related Quality of Life and Suicide Risk in Postural Tachycardia Syndrome CDC Healthy Days Questionnaire Standing Up to POTS page on Suicide Prevention You can read the transcript for this episode here: https://tinyurl.com/3ps5jzws Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! If you liked this episode, we hope you will help to support our production costs by donating to Standing Up to POTS at https://www.standinguptopots.org/donate Find out more about Standing Up to POTS! Check us out on our Website: www.standinguptopots.org Facebook: https://www.facebook.com/standinguptopots/ Instagram: https://www.instagram.com/standinguptopots/ Twitter: https://twitter.com/POTSActivist Pintrest: https://www.pinterest.com/TheStandingUpToPOTS/ Medical Disclaimer: The information provided here is not intended to serve as professional medical advice, diagnosis, or treatment. If you have health related issues, please contact a qualified health professional to get the personalized assessment, advice, and treatment that you need. Standing Up to POTS will not be liable for any direct, indirect, or other damages arising from the use of this podcast.

Quality of life can be negatively impacted by chronic illnesses like POTS. Please join us for an honest discussion of quality of life based on the scientific literature and personal experience. Trigger warning: this episode gets heavy at times, and discusses suicide as related to poor quality of life in POTS patients. Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! Links referenced in this episode: Health-Related Quality of Life and Suicide Risk in Postural Tachycardia Syndrome CDC Healthy Days Questionnaire Standing Up to POTS page on Suicide Prevention You can read the transcript for this episode here: https://tinyurl.com/3ps5jzws Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! If you liked this episode, we hope you will help to support our production costs by donating to Standing Up to POTS at https://www.standinguptopots.org/donate Find out more about Standing Up to POTS! Check us out on our Website: www.standinguptopots.org Facebook: https://www.facebook.com/standinguptopots/ Instagram: https://www.instagram.com/standinguptopots/ Twitter: https://twitter.com/POTSActivist Pintrest: https://www.pinterest.com/TheStandingUpToPOTS/ Medical Disclaimer: The information provided here is not intended to serve as professional medical advice, diagnosis, or treatment. If you have health related issues, please contact a qualified health professional to get the personalized assessment, advice, and treatment that you need. Standing Up to POTS will not be liable for any direct, indirect, or other damages arising from the use of this podcast.

Quality of life can be negatively impacted by chronic illnesses like POTS. Please join us for an honest discussion of quality of life based on the scientific literature and personal experience. Trigger warning: this episode gets heavy at times, and discusses suicide as related to poor quality of life in POTS patients. Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! Links referenced in this episode: Health-Related Quality of Life and Suicide Risk in Postural Tachycardia Syndrome CDC Healthy Days Questionnaire Standing Up to POTS page on Suicide Prevention You can read the transcript for this episode here: https://tinyurl.com/3ps5jzws Please click the "subscribe" button so that you don't miss an episode of The POTScast. Subscribing also helps us reach other people just like you! If you liked this episode, we hope you will help to support our production costs by donating to Standing Up to POTS at https://www.standinguptopots.org/donate Find out more about Standing Up to POTS! Check us out on our Website: www.standinguptopots.org Facebook: https://www.facebook.com/standinguptopots/ Instagram: https://www.instagram.com/standinguptopots/ Twitter: https://twitter.com/POTSActivist Pintrest: https://www.pinterest.com/TheStandingUpToPOTS/ Medical Disclaimer: The information provided here is not intended to serve as professional medical advice, diagnosis, or treatment. If you have health related issues, please contact a qualified health professional to get the personalized assessment, advice, and treatment that you need. Standing Up to POTS will not be liable for any direct, indirect, or other damages arising from the use of this podcast.

Our special guest host, Dr. Shelby Baez, summarizes the article Health-Related Quality of Life in Former National Collegiate Athletic Association Division I Collegiate Athletes Compared With Noncollegiate Athletes: A 5-Year Follow-Up by Dr. Janet Simon and colleagues. This article was featured in the recent Special Issue Celebrating Women Scholars in Athletic Training.

Dr Marwan Bukhari asks Dr Ioannis Parodis (Karolinska Institutet, Sweden) about his recent paper, which examined the impact of high BMI on health-related quality of life in patients with systemic lupus erythematosus. They discuss the main findings from the study, clinical implications, and possible future research. This paper is the Editor's Choice for March 2021.

Dr Marwan Bukhari asks Dr Ioannis Parodis (Karolinska Institutet, Sweden) about his recent paper, which examined the impact of high BMI on health-related quality of life in patients with systemic lupus erythematosus. They discuss the main findings from the study, clinical implications, and possible future research. This paper is the Editor's Choice for March 2021.

Dr Marwan Bukhari asks Dr Ioannis Parodis (Karolinska Institutet, Sweden) about his recent paper, which examined the impact of high BMI on health-related quality of life in patients with systemic lupus erythematosus. They discuss the main findings from the study, clinical implications, and possible future research. This paper is the Editor's Choice for March 2021.

Listen to Andrew Duckworth & Mike Whitehouse discuss the paper 'Effect on health-related quality of life of the X-Bolt dynamic plating system versus the sliding hip screw for the fixation of trochanteric fractures of the hip in adults: the WHiTE Four randomized clinical trial' published in the February 2021 issue of The Bone & Joint Journal.Click here to read the paper

In this special episode Jimmy and Roya focus on dry eye disease and talk about practice patterns that will help you become a dry eye expert and exam room changes to guide you to best treat the true etiology.SOURCESTFOS DEWS II Executive SummaryTFOS DEWS II Definition and Classification Reporthttp://www.tfosdewsreport.org/report-diagnostic_methodology/131_36/en/Dry Eye FoundationComparison of two questionnaires for dry eye symptom assessmentA Review of Dry Eye Questionnaires: Measuring Patient-Reported Outcomes and Health-Related Quality of LifeReliability and Validity of the Ocular Surface Disease IndexOcular surface disease index for the diagnosis of dry eye syndromeAssessment of vision-related quality of life in dry eye patientsPatients’ perception of DED and its relation with time to diagnosis and quality of life: an international and multilingual surveyDry Eye Disease: Impact on Quality of Life and VisionManagement and Therapy of Dry Eye Disease: Report of the Management and Therapy Subcommittee of the International Dry Eye Workshophttps://www.ncbi.nlm.nih.gov/books/NBK470411/ https://iovs.arvojournals.org/article.aspx?articleid=2717240 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836968/https://onlinelibrary.wiley.com/doi/full/10.1111/cxo.12849 Ocular Graft Versus Host Disease Following Allogenic Stem Cell Transplant: Review of Current Knowledge and RecommendationsTFOS DEWS II Management and Therapy ReportClick here to your free CE or CME credit: http://trynot2blink.com/freece

In this special episode Jimmy and Roya focus on dry eye disease and talk about practice patterns that will help you become a dry eye expert and exam room changes to guide you to best treat the true etiology.SOURCESTFOS DEWS II Executive SummaryTFOS DEWS II Definition and Classification Reporthttp://www.tfosdewsreport.org/report-diagnostic_methodology/131_36/en/Dry Eye FoundationComparison of two questionnaires for dry eye symptom assessmentA Review of Dry Eye Questionnaires: Measuring Patient-Reported Outcomes and Health-Related Quality of LifeReliability and Validity of the Ocular Surface Disease IndexOcular surface disease index for the diagnosis of dry eye syndromeAssessment of vision-related quality of life in dry eye patientsPatients’ perception of DED and its relation with time to diagnosis and quality of life: an international and multilingual surveyDry Eye Disease: Impact on Quality of Life and VisionManagement and Therapy of Dry Eye Disease: Report of the Management and Therapy Subcommittee of the International Dry Eye Workshophttps://www.ncbi.nlm.nih.gov/books/NBK470411/ https://iovs.arvojournals.org/article.aspx?articleid=2717240 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836968/https://onlinelibrary.wiley.com/doi/full/10.1111/cxo.12849 Ocular Graft Versus Host Disease Following Allogenic Stem Cell Transplant: Review of Current Knowledge and RecommendationsTFOS DEWS II Management and Therapy Report

Multiple Sclerosis News Today's columnist, Jenn Powell, discusses health-related quality of life in people with multiple sclerosis Plus, Multiple Sclerosis News Today's columnist and forums moderator, Ed Tobias, reports on differences between how physicians in the U.S. and Britain are treating patients during the COVID-19 pandemic. ===================================== Treatment for Relapsing MS Progression | MAYZENT® (siponimod) Read about MAYZENT, a once daily pill that can significantly slow down disability progression in people with relapsing MS. See full prescribing & safety info. http://ChangesInRMS.com ===================================== Are you interested in learning more about multiple sclerosis? If so, please visit: https://multiplesclerosisnewstoday.com/ ===================================== To join in on conversations regarding multiple sclerosis, please visit: https://multiplesclerosisnewstoday.com/forums/

Yoga blends physical, mental, and spiritual components in a way that is unique to most forms of movement. So is yoga better for health than other types of exercise? With the help of guest Alicia Kapjian-Pitt, yoga instructor and former studio manager, this episode will guide you through a brief history of yoga, explore yoga's association with health outcomes and safety profile, and discuss the issue of affordability, accessibility, and representation within both yoga and integrative medicine at large. Trust me, yoga to listen to this one.Find Alicia Kapjian-Pitt on Instagram at realaliciakp. To sign up for her email list and join her free yoga classes, email kapjianpitt.alicia@gmail.com or go to her class channel https://activv.me/yoga-with-AKP.Follow the Pass the Turmeric Instagram passtheturmeric for recipes, episode updates, and more, or email passtheturmeric@gmail.com if you have any questions or comments. You can also follow me on twitter @alexcours.During the podcast I mentioned The Broken Brain Podcast episode #90 The Science of Movement: How to Use Exercise to Defeat Depression, Anxiety, and Loneliness with Dr. Kelly McGonigal which can be found on most streaming services.Below are the studies referenced during the episode:Sharma, Manoj. “Yoga as an alternative and complementary approach for stress management: a systematic review.” Journal of evidence-based complementary & alternative medicine vol. 19,1 (2014): 59-67. doi:10.1177/2156587213503344Wolever, Ruth Q et al. “Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial.” Journal of occupational health psychology vol. 17,2 (2012): 246-258. doi:10.1037/a0027278Hendriks, Tom et al. “The Effects of Yoga on Positive Mental Health Among Healthy Adults: A Systematic Review and Meta-analysis.” Journal of Alternative and Complementary Medicine (2017): 1-13. doi: 10.1089/acm.2016.0334Dagenais, Simon et al. “A systematic review of low back pain cost of illness studies in the United States and internationally.” The spine journal : official journal of the North American Spine Society vol. 8,1 (2008): 8-20. doi:10.1016/j.spinee.2007.10.005Li, Yunxia et al. “Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis.” Medicine vol. 98,8 (2019): e14649. doi:10.1097/MD.0000000000014649Skelly AC et al. “Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review.” Comparative Effectiveness Review No. 209 (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No 18-EHC013-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2018. https://effectivehealthcare.ahrq.gov/topics/nonpharma-treatment-pain/research-2018 PMID: 30179389.Qaseem, Amir et al. “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.” Annals of internal medicine vol. 166,7 (2017): 514-530. doi:10.7326/M16-2367Patel, Neela K et al. “The Effects of Yoga on Physical Functioning and Health Related Quality of Life in Older Adults: A Systematic Review and Meta-Analysis.” The Journal of Alternative and Complementary Medicine vol. 18,10 (2012): 902-917. doi: 10.1089/acm.2011.0473Cramer, Holger et al. “The Safety of Yoga: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” American journal of epidemiology vol. 182,4 (2015): 281-93. doi:10.1093/aje/kwv071Park, Crystal L et al. “Who practices yoga? A systematic review of demographic, health-related, and psychosocial factors associated with yoga practice.” J Behav Med vol 38 (2015):460-471. dSupport the show (https://cash.app/$PasstheTurmeric)

Dr Carolyn Lam: Well, the Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, associate editor from the National Heart Centre and Duke National University of Singapore. Dr Greg Hundley: And I'm Dr Greg Hundley, associate editor from the Pauley Heart Center at VCU Health in Richmond, Virginia. Well, Carolyn, this week's feature involves the Compass trial, and we'll be talking about a comparison of low-dose rivaroxaban plus aspirin compared to aspirin alone in patients with chronic vascular disease. But before we get to that, how about if we break away and discuss a few other papers. And I'll go first this time, because this week we're going to introduce another new feature in addition to Carolyn's Quiz. Dr Carolyn Lam: Wait a minute. This was not on the script. What's going on, Greg? Dr Greg Hundley: It's on the script! Carolyn, let me get to my first paper. It's from Professor Junling Liu from Shanghai Jiao Tong University School of Medicine, and it involves branched-chain amino acid catabolism and how that may promote thrombosis risk by enhancing tropomodulin-3 propionylation in platelets. But first, we've got a new feature to add to Carolyn's Quiz. It's called Way or No Way. Dr Carolyn Lam: Just so everybody knows. This was a one-way decision to add this new component of Carolyn's Quiz, but okay, I'm all for it. Go, Greg! Dr Greg Hundley: Okay. All right. It's a fast, quick question where our listeners seek your guidance regarding an important scientific discovery from one of our published manuscripts. Are you ready? Dr Carolyn Lam: No. Dr Greg Hundley: Okay. Here's your question. Do branched-chain amino acids promote arterial thrombosis. Way or no way? Dr Carolyn Lam: Maybe? Dr Greg Hundley: Okay, Carolyn. Dr Carolyn Lam: I have a feeling you're going to tell us yes, although I wouldn't have guessed that straight away. Dr Greg Hundley: Okay. Remember that branched-chain amino acids are essential nutrients, including leucine, isoleucine, and valine, and they serve as a resource for energy production and the regulator of important nutrient and metabolic signals. In this study, the activity of human platelets from healthy subjects before and after ingestion of branched-chain amino acids were measured. PP2Cm-deficient mice were used to elucidate the impacts of BCAA catabolism on platelet activation and thrombus formation. Dr Carolyn Lam: Now okay, okay. So what did they find? Way or no way? Dr Greg Hundley: Ingestion of branched-chain amino acids significantly enhanced the activity of platelets in response to agonists and increased the risk of arterial thrombosis. The branched-chain amino acid catabolic pathway-driven propionylation of tropomodulin-3 at K255 was found to be an important mechanism underlying the branched-chain amino acid-facilitated platelet activation, and elevated levels of branched-chain amino acids and enhanced expression of positive regulators of branched-chain amino acid catabolism in platelets were found probably responsible for the high platelet activity in type 2 diabetes mellitus. Dr Carolyn Lam: Very interesting. So yes, it is possible. And what is the clinical implications? Dr Greg Hundley: Right, Carolyn. Branched-chain amino acids, or their catabolites, enhance the risk of arterial thrombosis in small animals, and perhaps future human subject studies, that restrict branched-chain amino acid intake or target branched-chain amino acid catabolism may serve as a novel strategy for anti-thrombosis therapy. Dr Carolyn Lam: Interesting. Okay, Greg. Here you go. Question for me. Have you heard of Home Time?   Dr Greg Hundley: Home Time? Yes. Home Time. It's not like time out for our kids, but we've been having a lot of Home Time in this COVID-19 with our families. Dr Carolyn Lam: All right. Touché. Touché. Home Time! Did you know it is a patient-centered outcome measure that accounts for rehospitalization mortality and post-discharge care? In the paper I want to talk about, Dr Pandey from UT Southwestern and colleagues aim to characterize risk-adjusted 30-day Home Time in patients with acute myocardial infarction as a hospital-level performance metric, and to evaluate associations with risk-standardized readmission rates. The study included almost 985,000 patients with AMI hospitalization across almost 2,400 hospitals between 2009 and 2015 derived from a hundred percent of Medicare claims data. And they found that 30-day home time for patients with AMI can be assessed as a hospital-level performance metric using Medicare claims data. It varied across hospitals, was associated with post-discharge readmission and mortality outcomes, and meaningfully reclassified hospital performance compared with the 30-day readmission and mortality metric. Dr Greg Hundley: Very nice, Carolyn. Well, I'm coming back at you again with another quiz. But first, this paper is from Kamal Khabbaz from Beth Israel Deaconess Medical Center and the Harvard Medical School, and it's going to assess whether left atrial appendage closure or exclusion during bypass surgery has impact on short-term outcomes. So, Carolyn, here's your quiz. Do you think that patients receiving CABG with atrial fibrillation should undergo ligation of their left atrial appendage? Dr Carolyn Lam: Well, I think there's definitely equipoise there. On the one hand, you're already in a surgery. Why not just ligate it? It's not like we need a left atrial appendage. And then on the other hand, I suppose it extends the surgery, it involves some risk, and we don't know if it actually prevents further events. Did I answer that right? Dr Greg Hundley: Yes. Quite the politically correct answer, I think. Now, the objective of this study was to evaluate the impact of left atrial appendage exclusion on short-term outcomes in patients with atrial fibrillation undergoing isolated coronary artery bypass graft surgery. The study analyzed 250,287 CABG patients, of whom 7% received left atrial appendage closure. Only patients with a history of atrial fibrillation were included in the analysis, and the primary outcome was 30-day readmissions following discharge. Secondary outcomes included hospital mortality and stroke. And to assess the postoperative outcomes, the team utilized multivariable logistic regression models, and they adjusted for clinical and demographic co-variables. Dr Carolyn Lam: Great. So what did they find, Greg? Dr Greg Hundley: Okay. Couple of conclusions. First, left atrial appendage exclusion was associated with a greater risk of postoperative respiratory failure, acute kidney injury, but it did not significantly change the rate of blood transfusions or the occurrence of cardiac tamponade. Second, left atrial appendage exclusion was associated with a nonsignificant reduction in stroke, no difference in in-hospital mortality, and a greater risk of 30-day readmissions. Number three, after adjusting for these co-variables, left atrial appendage ligation remained a significant predictor of this 30-day readmissions. And so, Carolyn, in this study, it looks like left atrial appendage exclusion during isolated CABG in patients with AFib is associated with a higher rate of 30-day readmissions. Dr Carolyn Lam: Thanks, Greg. Well, let me talk about what else is in this issue. First is a pair of letters, one from Kai Wu regarding the article, "Effects of Sacubitril-Valsartan Versus Valsartan in Women Compared to Men With HFpEF: Insights From PARAGON-HF" and the response from Dr John McMurry. There are also two On My Mind pieces, one entitled "COVID-19 Arrhythmic Risk and Inflammation: Mind the Gap" by Dr Lazzerini, and another entitled, "Obesity, A Risk Factor for Severe COVID-19 Infection: Multiple Potential Mechanisms" by Dr Naveed Sattar. There are two perspective pieces, "Establishment and Management of Mechanical Circulatory Support During COVID-19 Pandemic" by Dr Pham, and "The COVID-19 Pandemic: A Global Natural Experiment" by Dr Blake Thomson. There's an in-depth paper entitled "The Science Underlying COVID-19: Implications for the Cardiovascular System" by Dr Peter Liu. This is important. This one's an editor's pick, so don't forget to read this. There's an ECG challenge by Dr Praveen Gupta on "Chest Pain with ST Elevation: Looking Behind the Masquerade." In Cardiology News by Tracy Hampton, she reviews the literature and highlights three papers, one, "A Cardiovascular Disease-Linked Gut Microbial Metabolite Acts via Adrenergic Receptors" in Cell 2020; two, "Noninvasive Localization of Cardiac Arrhythmias Using Electromechanical Wave Imaging" in Science and Translational Medicine 2020; and three, "Somatic Gene Editing Ameliorates Skeletal and Cardiac Muscle Failure in Pig and Human Models of Duchenne Muscular Dystrophy", and that in Nature Medicine 2020. For the President's Page, we have a piece by Keith Churchill, who's the Executive Vice President and CEO of Yale New Haven Hospital entitled "The Compelling Need to Address Uncertainty, Anxiety, and Financial Peril for Patients". There's Highlights from Circulation Family of Journals by Sara O'Brien, including "Factors Associated With Large Improvements in Health-Related Quality of Life in Patients with Atrial Fibrillation: Results From the ORBIT-AF" from Circulation Arrhythmia and Electrophysiology. There's "Association Between Sleep Disordered Breathing and Left Ventricular Function: A Cross-Sectional Analysis of the ECHO-SOL Ancillary Study" from Circulation Cardiovascular Imaging. There's also "The Impact of a 10 Rules Protocol on COVID-19 Hospital-Related Transmission: Insights from Padua University Hospital in Italy" from Circulation Cardiovascular Interventions. There's "The Association of an AMI Readmission-Reduction Program with Mortality and Readmission" from Circulation Cardiovascular Qualities and Outcomes. And finally, "Treatment Differences in Chronic Heart Failure Patients with Reduced Ejection Fraction According to Blood Pressure" in Check HF, and that's in Circulation Heart Failure. Dr Greg Hundley: Very nice, Carolyn. Well, I've got just a few Research Letters that I reviewed. First is from Professor Puck Peltenburg, and the Research Letter involves children and adolescents from Brugada syndrome families in which only the SCN5A mutation carriers develop a type one ECG pattern induced by fever. And the second research letter is from Dr David Saadoun, and this evaluates the long-term outcome and prognosis factors associated with isolated aortitis. And then finally, Carolyn, there's a very nice piece related to the current status of cardiovascular medicine in Israel from Professor Ran Kornowski at the Rabin Medical Center. Well, Carolyn, what a packed issue we have, and how about now we get on to that feature discussion? Dr Carolyn Lam: Let's go, Greg. Dr Greg Hundley: Well, listeners, we have a wonderful feature discussion for you in this next segment. We have Professor Keith Fox from Edinburgh and our own associate editor, Professor Stefan James from Uppsala. And we're going to discuss anticoagulation and antiplatelet therapy and rivaroxaban and aspirin and results from the COMPASS trial. Keith, could you tell us what was the background information and what was the hypothesis that you wanted to test with your study? Professor Keith Fox: The hypothesis was whether the combination of a very small dose, a quarter of the dose tested here, of a NOAC alongside an antiplatelet would be superior to aspirin alone, or we also tested a half dose of the NOAC by itself. And the overall trial showed that the quarter dose of rivaroxaban plus aspirin was substantially superior to aspirin alone in preventing cardiovascular death, MI, and stroke, with its biggest impact on strokes and cardiovascular death. So that's the trial as a whole. But our specific goal here was to look at the question of net clinical benefit because clinicians are challenged by any therapy that has a balance of both potential hazard, like bleeding risk, and benefit. So what we analyzed here were the pre-specified characteristics of net clinical benefit in terms of life-threatening and major bleeding into a critical organ, plus cardiovascular death, MI, and stroke. And I asked the question, what was the net clinical benefit? Dr Greg Hundley: Net clinical benefit. Now, tell us a little bit about what population you were looking to understand net clinical benefit, and then what was the study design? Professor Keith Fox: This is the whole of the COMPASS trial without the arm that tested rivaroxaban alone, because that did not show significant benefit. So this is the remaining 18,000 patients, double-blind randomized trial. And the trial, as a whole, was stopped early on the recommendation of the DSMB because it met the criteria for benefit by four standard deviations. Now, what's unusual about this is the population of our patients and vascular risk. So these are people who in the past would just be treated with aspirin. So they're not post-MI. They are people with chronic vascular disease, either peripheral or coronary. And in the past, on top of standard secondary prevention care, they would only have got aspirin. Dr Greg Hundley: And what were the results? Professor Keith Fox: There was a 20% reduction in terms of the net clinical benefit favoring the combination of rivaroxaban and aspirin, and that net clinical benefit being the combined impact of cardiovascular death, MI, stroke, fatal bleeding, or bleeding into a critical organ. Dr Greg Hundley: And did you find the same results in, for example, older versus some of the younger patients? Or were there any other high-risk subgroups, those with impaired renal function or those with heart failure where you saw particular differences? Professor Keith Fox: Yes, Greg. This is a really important issue. If one looked at the whole trial, the number needed to treat to prevent one of these adverse events, N equals 52. But then if we looked at some of the higher-risk cohorts, which we defined prospectively ... For example, these were the risk factors like polyvascular disease, impaired renal function, ambulant heart failure, or diabetes. And if you had all four risk factors, the number needed to treat was nine. If you had three risk factors, it was 12. Two risk factors, 31. So I think there's clearly a message for clinicians to be able to identify people with a combination of these risk factors, one or more, in order to get the most benefit and the least hazard. Dr Greg Hundley: Very interesting. Any speculation on mechanism? Professor Keith Fox: Yes. One of the things that we've done in the past is we've hammered one antithrombotic pathway. Like, for example, we've used more and more potent anti-platelets or combination of anti-platelets. But perhaps one of the things that we've forgotten is the fact that the platelet activation pathway is triggered by thrombin activation and vice versa. So the concept that was new behind the whole COMPASS study was that augmentation of the antithrombotic effects by combining a very small dose of a novel anticoagulant would be beneficial. And the critical question is, would it be sufficiently beneficial without producing a lot of bleeding? So that's why we did this particular analysis. Dr Greg Hundley: So lower doses of some of these drugs. Well, Stefan, can you help us put these study results into context with what we know today about using aspirin alone, rivaroxaban, et cetera? Professor Stefan James: The reason I think this study's so important and interesting is that, first, it's a very common population that we see now in the practice, patients with a stable phase of atherosclerotic disease, both coronary and peripheral vascular. And we need to take care of these patients better. Until now, we have not had very great alternatives for these patients. Now, we've learned what Keith said, that if you combine a low dose of both anti-platelet and antithrombin, you can inhibit and reduce the risk of ischemic events. And the other important finding here is that, I think conceptually very interesting, that if you are able to reduce their number of ischemic complications or thrombotic complications, but not doing that to such an extent that bleeding increases too much, not to an extent that bleeding causes fatal events, then you can find a nice balance between safety and efficacy that can lead to substantial reductions and improvements in terms of the clinical benefit. And that's what we see here in this trial. You can see that there is a reduction of thrombotic events, ischemic events, and there is also some bleeding, but not to such an extent that it affects overall survival and the overall event rate in these patients. And particularly in patients at high risk that you pointed out, these patients have a very high event rate. Although the relative benefit is similar, the absolute benefit is quite impressive. Dr Greg Hundley: Just very exciting to me. Very low doses of some of these common drugs. What's the next study in this field, Keith? Professor Keith Fox: We've got a big gap because we know that modern dual antiplatelet therapy works really well after an acute coronary syndrome and it's highly effective. In the longer term, we know, for example, from some of the studies with ticagrelor that there are cohorts that do well for a period of time after ACS, but really we don't know the bridge between this period and the long term and what role this therapy may have after essential dual antiplatelet therapy. Dr Greg Hundley: Stefan, do you have any thoughts? Professor Stefan James: I agree with Keith. This transition period, when is patient transitioned from being an acute coronary syndrome patient to a chronic coronary syndrome patient? When does that happen? And then probably it differs between individuals and type of events, and so we need to understand more of when is this patient acutely affected and when do we need potent dual antiplatelet therapy? And when can we transition to a more stable phase in which we can inhibit thrombotic events, ischemic events, but not increased bleeding to such a degree that it affects overall survival? And so I think we need to learn a lot more about that transition period and these subgroups of patients of different risks and risks of ischemic events and bleeding events. Dr Greg Hundley: Keith, how would you go about conducting a study in that regard? Professor Keith Fox: I think really one of the very interesting questions is whether the combination of the standard of care of, for example, aspirin and ticagrelor may be better, worse, or the same than this therapy instituted at the end of the period of essential dual antiplatelet therapy. And we need to know that. Dr Greg Hundley: In closing and summing up, Keith, are there any concepts that we want to take home here? Professor Keith Fox: I think that there are two key concepts. One is the synergy between the anticoagulation system and the antiplatelet system, with the potential to use very low doses, to minimize bleeding risk, yet have the benefits. That is the first concept. The second concept is that these chronic vascular disease patients Stefan has described are at continuing risk of vascular events, especially stroke, myocardial infarction, and cardiovascular death. And these can be modified. Dr Greg Hundley: And Stefan, any thoughts from you in closing? Professor Stefan James: I think this paper and the work that Keith has described is fantastic and fascinating to think about because these populations are incredibly large, and they are not doing well. They have a high risk of events, and we tend to forget that, and so we need to both identify them and start treating them now, as we have some evidence, but we'll also need to learn more of how to identify them, how to select them appropriately, and how to identify the transition from acute events to chronic events or current chronic phase of the disease. Dr Greg Hundley: Well, listeners, I want to thank both Professor Keith Fox and our own associate editor, Professor Stefan James, for this very interesting presentation of lower doses of anticoagulant and antiplatelet therapy in patients with chronic vascular disease and really being able to reduce events and diminish bleeding. On behalf of Carolyn and myself, we want to wish you a great week and look forward to catching you next week. Take care. This program is copyright of the American Heart Association 2020.  

Health-related quality of life (HRQL) is the impact of a health condition on the individual’s ability to lead a fulfilling life. Researchers have identified determinants of HRQL in stroke survivors with aphasia to include communication, mobility, mental/emotional health, role, and social functioning. The use of patient-reported outcomes to capture HRQL in people with aphasia may better facilitate client-centered treatment approaches in this population. --- Send in a voice message: https://anchor.fm/speech-uncensored/message

Health-related quality of life (HRQL) is the impact of a health condition on the individual's ability to lead a fulfilling life. Researchers have identified determinants of HRQL in stroke survivors with aphasia to include communication, mobility, mental/emotional health, role, and social functioning. The use of patient-reported outcomes to capture HRQL in people with aphasia may better facilitate client-centered treatment approaches in this population. Visit the show notes for additional resources: https://www.speechuncensored.com/podcastepisodes/s3e23

This past year, a bill was introduced in the California State Assembly that would create more transparency among pharmaceutical companies and make more lower-cost generic drugs available to Californians by making it easier for the California Attorney General to prosecute pharmaceutical companies for so-called "pay for delay" deals.   MS Activists in California talked to our state legislators, asking them to support this bill, known as AB 824, and on January 1st, California Governor Gavin Newsom signed AB 824 into law. My guest is the author of AB 824, California Assemblymember Jim Wood. We're talking with Assemblymember Wood about what it was like to guide a bill that the pharmaceutical industry came out against through the state legislature and see it signed into law.    We'll share results of a new study that shows that undiagnosed and under-diagnosed depression is a serious problem that negatively impacts the quality of life among many older adults living with MS.   We'll tell you about a U.S. Circuit Court of Appeals ruling that leaves the fate of the Affordable Care Act in the hands of the U.S. Supreme Court -- and what that means for people living with MS.    And we'll tell you about Dr. Francisco Quintana, this year's recipient of the Barancik Prize for exceptional innovation and originality in MS research.   We have a lot to talk about! Are you ready for RealTalk MS??! ___________   Where I'm Going to Be This Month  :22 Can You Help Me Out?  2:14 Barancik Prize Awarded to Dr. Francisco Quintana   5:25 Untreated Depression Negatively Impacts Older Adults Living with MS  7:21 Judge Hands FDA a Loss on Stem Cell Clinics  10:59 Appeals Court Won't Review Affordable Care Act Decision  13:17 My Interview with California Assemblymember Jim Wood  17:20 Share This Episode  27:01 Download the RealTalk MS App  27:27 ___________ SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/127 ___________ ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.comPhone: (310) 526-2283 ___________ LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com Jon's WALK MS Fundraising Page STUDY: Under-Treated Depression Negatively Impacts Lifestyle Behaviors, Participation, and Health-Related Quality of Life Among Older People with Multiple Sclerosis Download the RealTalk MS App for iOS Download the RealTalk MS App for Android Give RealTalk MS a Rating & Review ___________ Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 127 Hosted By: Jon Strum Guests: California Assemblymember Jim Wood Tags: MS, MultipleSclerosis, MSResearch, MSActivist, MSSociety,  RealTalkMS Privacy Policy

This podcast highlights original research published in the January 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Although neck impairment has been described following surgical resection, limited studies have investigated its prevalence in nonsurgical treatment. The purpose of this study is to determine the prevalence and predictors of neck disability following head and neck cancer (HNC) treatment and to explore its association with quality of life (QOL). In conclusion, this study revealed a high prevalence of neck disability following nonsurgical treatment. While neck disability is an established sequela of surgical resection, the impact of nonsurgical treatment has gone unrecognized. Early identification and intervention to prevent progression of neck disability are crucial to optimize QOL.   Click here to read the full article.

Five articles from the December 2019 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "The Association Between Tibial Slope and Revision Anterior Cruciate Ligament Reconstruction in Patients ≤21 Years Old: A Matched Case-Control Study Including 317 Revisions", "Risk Factors Associated With a Noncontact Anterior Cruciate Ligament Injury to the Contralateral Knee After Unilateral Anterior Cruciate Ligament Injury in High School and College Female Athletes: A Prospective Study", "Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Midterm Follow-up", "The Effect of Sport-Related Concussion Injuries on Concussion Symptoms and Health-Related Quality of Life in Male and Female Adolescent Athletes: A Prospective Study", and "Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Outcomes for Quadriceps Tendon Autograft Versus Bone-Patellar Tendon-Bone and Hamstring-Tendon Autografts".   Click here to read the articles.

Death by Ignorance – Episode 12 – Just a little prickAdditional reading: https://www.amazon.com/Fantasyland-America-Haywire-500-Year-History-ebook/dp/B004J4WNJE https://www.amazon.com/Thinking-Fast-Slow-Daniel-Kahneman/dp/0374533555 Sherman KJ, Cherkin DC, Deyo RA, et al. The diagnosis and treatment of chronic back pain by acupuncturists, chiropractors, and massage therapists. Clin J Pain. 2006 Mar-Apr;22(3):227–234. Barrett, S (30 December 2007). "Be Wary of Acupuncture, Qigong, and "Chinese Medicine"". Quackwatch. http://www.dcscience.net/Ernst-2011-AcupunctAlleviatePainRiskReview.pdf Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, Littlejohn G (May 2013). "Acupuncture for treating fibromyalgia". The Cochrane Database of Systematic Reviews. 5 (5): CD007070. Seca S, Miranda D, Cardoso D, Nogueira B, Greten HJ, Cabrita A, Rodrigues MA (19 December 2018). "Effectiveness of Acupuncture on Pain, Physical Function and Health-Related Quality of Life in Patients with Rheumatoid Arthritis: A Systematic Review of Quantitative Evidence". Chinese Journal of Integrative Medicine. doi:10.1007/s11655-018-2914-x. PMID 30569405 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616356 Towler P, Molassiotis A, Brearley SG (October 2013). "What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews". Supportive Care in Cancer. 21 (10): 2913–23. doi:10.1007/s00520-013-1882-8. PMID 23868190. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466855 Barrett, Stephen. "Auriculotherapy: A Skeptical Look". Acupuncture Watch. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC558023 Cheuk DK, Wong V (May 2014). "Acupuncture for epilepsy". The Cochrane Database of Systematic Reviews. 5(5): CD005062. doi:10.1002/14651858.CD005062.pub4. PMID 24801225. https://books.google.com/books?id=E6oa37ZyTxEC&pg=PA90 Burke A, Upchurch DM, Dye C, Chyu L. Acupuncture use in the United States: findings from the National Health Interview Survey. J Altern Complement Med. 2006 Sep;12(7):639–648. Wu DZ. Acupuncture and neurophysiology. Clinical Neurology & Neurosurgery. 1990;92(1):13–25. Cheng R, Pomeranz B. Monoamineergic mechanisms of electroacupuncture analgesia. Brain Res. 1981;215:77–92. Hui KK, Liu J, Makris N, et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Human Brain Mapping. 2000;9(1):13–25. Park J, Linde K, Manheimer E, et al. The status and future of acupuncture clinical research. J Altern Complement Med. 2008 Sep;14(7):871–881. Vickers AJ. Placebo controls in randomized trials of acupuncture. Eval Health Prof. 2002 Dec;25(4):421–435. Support Death by Ignorance by donating to their Tip Jar: https://tips.pinecast.com/jar/death-by-ignoranceThis podcast is powered by Pinecast.

How'd you sleep last night? Us? Not so well, and maybe you're familiar with that pattern like a lot of Americans. In this episode we discuss sleep and mental health, and how a poor relationship with it can put us more at risk than we thought. Don't let the stress of it get to you, though. It's not gonna keep us up at night... Be well! Resources:   “Sleep and Mental Health.” Harvard Health Blog, Harvard Health Publishing, July 2009, Updated June 2019 Wanjek, Christopher. “Being a Night Owl Really Can Hurt Your Mental Health.” LiveScience, Purch, 30 Jan. 2019 Jones, Samuel E., et al. “Genome-Wide Association Analyses of Chronotype in 697,828 Individuals Provides Insights into Circadian Rhythms.” Nature News, Nature Publishing Group, 29 Jan. 2019 Strine, Tara W, and Daniel P Chapman. “Associations of Frequent Sleep Insufficiency with Health-Related Quality of Life and Health Behaviors.” NeuroImage, Academic Press, 31 July 2004

Drs. Eric Wisotzky and Erika Gosai interview Dr. Andréane Richard-Denis, a clinician-scientist working at the University of Montreal Hospital Research Centre in Quebec, Canada. They discuss a recent study she co-authored, Relationships between Specific Functional Abilities and Health-Related Quality of Life in Chronic Traumatic Spinal Cord Injury, which was published in the August 2018 issue of the American Journal of Physical Medicine & Rehabilitation. The objective of this study was to explore the relationships between specific functional abilities assessed from the 3rd version of the Spinal Cord Injury Measure (SCIM), and health-related quality of life (HRQoL) following a traumatic spinal cord injury (tSCI).

Muir Gray’s paper of the week: Hearing Aids and Health-Related Quality of Life in Adults With Hearing Loss Reference: Kitterick PT, Ferguson MA. Hearing Aids and Health-Related Quality of Life in Adults With Hearing Loss. JAMA. 2018;319(21):2225–2226. doi:10.1001/jama.2018.5567 More information here: bettervaluehealthcare.net/paper-of-the…ek-04-07-18/

This podcast covers the JBJS issue for May 2018. Featured are articles covering Sixty Years On - Ponseti Clubfoot Treatment Method Has High Satisfaction Despite Relapse Tendency; recorded commentary by Dr. Letts; Modified Scarf Osteotomy with Medial Capsule Interposition for Hallux Valgus in Rheumatoid Arthritis; Increased Lateral Femoral Condyle Ratio Is a Risk Factor for ACL Injury; recorded commentary by Dr. Voleti; Health-Related Quality of Life in Adulthood in Untreated and Treated Individuals with Scoliosis.

This podcast covers the JBJS issue for May 2018. Featured are articles covering Sixty Years On - Ponseti Clubfoot Treatment Method Has High Satisfaction Despite Relapse Tendency; recorded commentary by Dr. Letts; Modified Scarf Osteotomy with Medial Capsule Interposition for Hallux Valgus in Rheumatoid Arthritis; Increased Lateral Femoral Condyle Ratio Is a Risk Factor for ACL Injury; recorded commentary by Dr. Voleti; Health-Related Quality of Life in Adulthood in Untreated and Treated Individuals with Scoliosis.

What is Heart Rate Variability (HRV)? -Chantea Goetz Heart rate variability is the change in the time intervals between consecutive heartbeats. Variations can be due to age, gender, athletic ability, circadian rhythms, core body temperature, and metabolism. 24-hour recordings are the gold standard. To measure the autonomic, cardiovascular, & respiratory systems a short-term reading of 5 minutes a day is sufficient. HRV is a critical indicator of health, resilience, well-being, and performance. Several research studies indicate that lowered HRV values lead to increased reports of diabetes, coronary disease, anxiety, depression, asthma, and poor performance. These aliments are due to autonomic dysregulation. HRV biofeedback positively effects the cardiovascular system, respiratory system, gastrointestinal system, performance, and behavior. The benefits of using HRV biofeedback has the ability for people to become aware of their proper breathing rate, also known as resonant frequency. Proper breathing patterns can improve professional and athletic performance, improve focus and concentration, reduce anxiety and depression symptoms, improve overall health and mental well-being, while reducing risk factors for disease. HRV biofeedback training involves slowing the breathing rate to achieve the RF breathe. For most people the respiratory sinus arrhythmia (RSA) is maximized when breathing at a rate of 6 breaths per minute. In order to obtain an ideal HRV there needs to be a balance between the parasympathetic and sympathetic nervous systems. When a person is over-stressed and under-recovered there will be a decline in performance. Some ways in which to separate emotional responses from physical actions are to practice mindfulness and meditation. My Journey in BioHacking Functional Fitness -Jim Goetz ​I work with people daily in order to help them achieve their goals and improve their way of life. What good is life if it's a life that's not worth living? Everyone deserves a happy and healthy life but many lack any clue on how to achieve this.  Goals are an essential part of health and happiness. Without setting objective goals, having a plan and being accountable to this plan, success will not happen.  What biohacking is and some thoughts on this were discussed in a recent interview I gave with The Vitamin Shoppe in their publication, What is Good.  My journey is not unlike any other. However the plan I use to achieve my goals is highly researched. As goals may be and should be in different aspects of life, this article focuses on health and fitness goals.  I began working out in the fourth grade. My grammar school teacher was not the best and as a result I became very unhappy. I found enjoyment through running, push ups, and sit ups. There was a burning sensation in either my legs, chest and arms or abs that was perplexing. The more I did, the more it burned. As an eight year old, this confusing sensation led to greater experimentation, which essentially meant to do more exercises. I would do these exercises daily, timing myself to see how long I could do them until the burn began and then how long I could push through the burn until I literally could not move that body part any longer. I was utilizing the most unscientific manner to increase lactic threshold and muscular endurance and function but for an eight year old, it made sense. My life was always filled with sports. Grammar school through high school it was cross country, basketball and baseball. In college it was baseball. Like most, I only did what the coach had me do. Like most I did not realize the coach had no clue himself in how to make better athletes.  It was in undergrad when I changed majors to exercise science that I began to learn new techniques in how to improve athletic ability. Some ideas worked for me, some did not. For instance, increasing carbohydrate intake before and after working out caused a dissipation of the visual appearance of muscle. In other words, carbs for energy and replenishment caused me to gain body fat. I also noticed that by consuming high carb meals the nigh before an event, I would wake up in the morning lethargic and with stomach pangs. I would also find that during a distance event, I would eventually feel depleted of all energy and not flow through the event as planned. Training for my first Tough Mudder was also an experiment. Though I ran long distances all my life, I loathed running at this point in my life. Instead of running, I did a spin class each morning and then later on would complete two circuits of six exercises with extremely heavy weight, being able to complete no more than 1-3 reps. I would move through this as fast yet efficient as possible. In the three months leading up to the Tough Mudder, I inadvertently lost 16 lbs and gained an incredible amount of strength. For example, before I began training I could do six pull ups. By the time three months passed, I was doing twenty pull ups at a time with ease. Through these two experiences and examples, I had self discovered methods that indeed were topics of research yet had no idea about it at the time. My journey to biohacking was well on the way before I had even heard of the idea of biohacking. ​ I went through an arduous two year period without access to a gym. I became weak to the point of no longer being able to do a pull up or a full range of motion dip. I lost forty pounds and was emaciated.  Refusing to be beat, I adapted and learned  I needed to make some changes and utilize every ounce of exercise science, physiology and neurology that I knew. I found rocks, concrete, steel pipes and built some awkward equipment that I could use and train in a functional manner. Each day I would apply the lessons I knew from the text books and research journals to my personal physical development. Some say nutrition is 80% of the solution when it comes to lean muscle gain and body fat loss. I personally believe it is closer to 90% of the solution. During the two year period without access to a gym, my access to nutritious food of any sort, even food in any quantity was limited at best. I was able to find access to large amounts of peanut butter, to which I hoarded and lived off of. In January of 2017, I weighed 160 lbs. I began to hone eating a ketogenic diet that I plan on keeping a lifestyle for the rest of my life. The science appears to be there for my Genotype that my physiology thrives on this manner of eating. I combined daily undulating periodization with cross fit workout of the days, power lifting for the lower extremity, Pilates, Olympic lifting and moderate distance running. On certain days, I utilize KAATSU and ensure I train all muscles every day in some manner yet ensure I do not go past no return so that I may properly recover. There is no one size fits all formula for success. Each individual has goals. Each individuals goals are unique and important to that person. Yet 95% of people will fail in their workout routine. This is due to a lack of setting a proper goal, lack of a plan towards that goal, and most importantly accountability to execute this plan on a daily basis. The book BioHacking Your Brain for Success: Becoming a True Champion in All Aspects of Life  written by myself and Chantea Goetz discusses this in great detail. There's a reason some people are successful in all they do. Others make excuses for their failure, which really is a result of never actually putting in any effort.  The most important aspect of success is passion!!! People tell me all the time they want to lose weight. I often tell them that there's no chance they will lose the weight and keep it off. They should save their money and do something enjoyable with it. Yes, these individuals are shocked at what I say but it is true. When one gets out of bed in the morning, they need to have a true passion and meaning in why they put their feet on the ground. If there's no passion for getting up, then the odds of success at an idea are futile at best. Does anyone really have a true passion for losing 20 lbs? They have the best intentions in the world but will assuredly fail.  Take that same person who is 20 lbs overweight and sign them up for a competition and they may find that passion in training. The 20 lb weight loss will occur as a result. As Yogi Berra once said, "half of the game is ninety percent mental". I can write the greatest program in the universe for someone to succeed. If there's no passion behind it then success is not happening. One has to show up to the field to play the game. Exercise is a lot more than simply opening up a magazine and doing chest and tri's on Monday, back and bi's on Tuesday, shoulders on Wednesday, skipping legs on Thursday because let's face it, doing legs suck and with all good intention of doing something Friday, it just does not happen. Most do "abs" every day, without ever being able to see a true six pack. So many aspects of this model are flawed from the get go. First and foremost, muscles only stay anabolic for around 48 hours. This means that after a tough "chest" day, by Wednesday this muscle ceases growth. Unfortunately, the overzealous weight lifter has damaged their muscle fibers too great to be able to work it again and is left with a muscle that is catabolic. Bodybuilders can get away with this because they are taking anabolic steroids. This keeps them anabolic all day and every day. For those of us not on performance enhancing drugs, we need to stay a few steps ahead of the game and can use science (BioHack) our way to our goals. Einstein defined insanity as doing the same thing over and over again and expecting different results. So why do the majority of individuals do this single or double body part split day week after week, month after month, and think they are making progress? If someone goes to the gym with no plan, how can they see if they are progressing and progressing in the right manner? That would be like a strength and conditioning coach having a professional football team "just go lift" as opposed to having a highly specialized and detailed season long program. Perhaps progress can be optimized if they followed the rules of human physiology. Yet people do this day after day, week after week, month after month until they realize they "will never" reach their goals and eventually give up. Daily undulated periodization (DUP) has a key, which is getting in maximum workout volume, without impacting recovery, which is why the undulating and periodization aspects are critical. One trains the entire body multiple times per week and utilizes different repetition ranges, thus focusing in on more specific muscle fiber types. Training in this manner has been shown to be more effective than linear exercise programming in terms of muscular hypertrophy, strength and endurance.  Combine DUP with KAATSU (vascular occlusion moderation training) and you get extreme muscle strength and growth in a far shorter time frame than would be believed. It is believed that the restricted blood flow recruits a greater number of fast twitch muscle fibers and even converts fibers to fast twitch. This combined with the increase in chemical mediators to repair tissues has been shown to have phenomenal results. High Intensity Interval Training (HIIT) has it's place for fat burning and strength training. Some utilize it to save time in a day. Others can utilize it to have amazing physical performance results.  ​Pilates is utilized for dexterity, flexibility, and fine tuning a strong core. This can be done literally by anyone. Never let a fat person on statins tell you how to eat. Never let a skinny person tell you how to lift. And never get accurate information from the media. Open up recent text books. Read peer reviewed journals and do critical appraisals on each article you consider utilizing. In the end, set your goals to mirror your passions. Set a realistic plan to achieve them and stay accountable each day towards it. Do this and welcome into your life the success you very much deserve. My goal...pull a 500 lb deadlift and on the same day run and complete an Iron Man triathalon. What's yours? Let's get to BioHacking our way there!!!! References: Jennifer T. Fine, Graham A. Colditz, Eugenie H. Coakley, George Moseley, JoAnn E. Manson, Walter C. Willett, and Ichiro Kawachi. A Prospective Study of Weight Change and Health-Related Quality of Life in Women . JAMA 1999 282: 2136-2142. Alfred Wirth and Jutta Krause. Long-term Weight Loss With Sibutramine: A Randomized Controlled Trial. JAMA 2001 286: 1331-1339 Shinichi Amano, Arimi Fitri Mat Ludin, Rachel Clift, et al. Effectiveness of blood flow restricted exercise compared with standard exercise in patients with recurrent low back pain: study protocol for a randomized controlled trial. Trials201617:81 Zourdos, Michael C.; Jo, Edward; Khamoui, Andy V. et al. Modified Daily Undulating Periodization Model Produces Greater Performance Than a Traditional Configuration in Powerlifters. Journal of Strength & Conditioning Research: March 2016 - Volume 30 - Issue 3 - p 784–791 Nicholas J Krilanovich. Benefits of ketogenic diets. Am J Clin Nutr January 2007  vol. 85 no. 1 238-239 BioHacking the Myths of Water -Dr. Michael Brandon, DC We all know that as long as we drink 8 cups of water a day our skin will be softer and glisten, we'll have a faster metabolism, better kidney function, we'll clear out toxins from our body, perform better, and lose weight.​ Well, now it's time to state that you have been lied to. In fact, only about half of that appears to hold any truth. The other half has either never been proven, or worse, been proven incorrect but is yet repeated to everybody as health advice. So what is false tales vs true benefits? Lets do what biohackers do best and get to the science of the life requiring, ultimate biohack of H2O! Let's begin with hacking the untruths, and target the big one. There is NO proof or reason to have 8 cups of water each day. Yep, I said it. In fact, there has been multiple studies done proving this is illegitimate! In reality, there are too many variables that effect hydration requirements such as weight, gender, activity levels, what/how much you have eaten, heat, and heart or kidney pathologies just to name a few, so no one amount will work for even half of the population. The Committee at the Institute of Medicine even states that “While it might appear useful to estimate an average requirement (an EAR) for water, an EAR based on data is not possible”  There are 2 easy guidelines to account for this and the first is quite simple. If you are thirsty or active, you should drink some water. You can over do it, but it takes a lot to do so. Again, everyone is different, but typically after a gallon or so within 2-3 hours is too much for almost everybody and can cause some acute health issues. At that point you almost literally have to force water down your throat which brings us to guideline number 2; if you're drinking and it becomes physically difficult to drink water, you've probably had enough. We have a reflex that slows down our swallowing strength when we are over full of food and fluids, so as always, listen to your body, it knows best. Also, our bodies can only absorb about a quart an hour, so even if you are in heavy exercise, any more than that is going in and straight out without any benefit anyway other then depleting your body of more salt and electrolytes. The next myth to bust is that caffeine dehydrates you, so here you go, it doesn't. Well not if you're used to drinking it, and it only minimally does if you are a caffeine novice. Moderate amounts of caffeine usage (4 cups of coffee or 100mg of caffeine) showed no significant diuretic effects leading to lower hydration levels. This is not to be confused with saying that coffee and water are equal, as caffeine does lower our bodies' salt levels and does not give all the same effects as water which will be covered down the page.  ​Based on the most current research, increasing water intake alone also DOES NOT provide the following benefits as many have proclaimed; healthier and shinier skin, better kidney functions, clearing out toxins, and giving more energy. These were all thought up by one industry or another to help promotions and as far as could be found, held no scientific support. So what does drinking water help with? Still quite a bit, I mean it is necessary for a reason! Staying hydrated is great for both physical and mental performance. Muscle is 80% water, so staying fully hydrated helps prevent early muscle fatigue, cramping, and may allow for an extra rep or 2 in the gym. Also when dehydrated, our bodies release less anabolic hormones and more catabolic hormones including cortisol, so having sufficient water levels may help with exercise gains. Though these effects of dehydration effect all activities, it appears that it hampers high intensity and endurance activities like long distance running significantly more than anaerobic ones like weight lifting. ​ Being dehydrated, also can effect short term memory, focus, visual perception, and other cognitive factors. Both these and the physical decreases can occur once someone has lost as little as 2% of weight from water such as sweating. This would be about 3lbs for someone weighing initially 150lbs, and it's not uncommon for many athletes to lose 6-8% in any given workout. Drinking water can also help with weight loss, and this is 2 fold. First the simple mechanism; drinking 500ml of water (around 16 oz) before a meal helps with satiety and forces us to eat less. However, there is more to it then that. The same amount also is shown to increase metabolic rate by roughly 30%. This increase in metabolism begins in only 10 minutes and peaks after about 30-40 minutes and can last up to 3 hours. So you can burn a few extra calories a day just by staying hydrated; sounds worth-while to me.  Even if water doesn't hold up to all the “facts” that many of us have heard time and time again, it is still the item which should be consumed the most by everybody on any given day. With all the benefits mentioned, let alone the thousands of physiological reactions it helps with in the body, I say bottoms up with the bottle to good health! References: ​ Boschmann, Michael, et al. “Water Drinking Induces Thermogenesis through Osmosensitive Mechanisms | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic.”OUP Academic, Oxford University Press, 1 Aug. 2007, academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-1438.​ Killer, Sophie C., et al. “No Evidence of Dehydration with Moderate Daily Coffee Intake: A Counterbalanced Cross-Over Study in a Free-Living Population.” PLOS ONE, Public Library of Science, journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0084154.  Popkin, Barry M., et al. “Water, Hydration and Health.” Nutrition Reviews, U.S. National Library of Medicine, Aug. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2908954/.  University of Michigan. Myth of 8 Glasses of Water a Day. 24 Aug. 2015, www.med.umich.edu/1libr/Gyn/ObgynClinic/8GlassesWaterMyth.pdf.  “What Is Hyponatremia?” WebMD, WebMD, www.webmd.com/a-to-z-guides/what-is-hyponatremia#1.   biohackhumans.com   Find us: Instagram (@biohackhumans)  Facebook (@biohackhumans) Twitter (@biohackhumans) Tumblr (@biohackhumans)   Contact Us: support@biohackhumans.com

In this podcast, one of Global Spine Journal's Editors-in-Chief, Jens Chapman, interviews Sigurd Berven on his article, "Correlation Between Lumbopelvic and Sagittal Parameters and Health-Related Quality of Life in Adults With Lumbosacral Spondylolisthesis".

Does plication of the rectus have an effect for those who underwent tummy tucks for weight loss? Staalesen T, Olsén MF, Elander A. The Effect of Abdominoplasty and Outcome of Rectus Fascia Plication on Health-Related Quality of Life in Post-Bariatric Surgery Patients. Plast Reconstr Surg. 2015 Dec;136(6):750e-61e.

Since 2012, Defense and Veterans Brain Injury Center and the National Intrepid Center of Excellence at Walter Reed have been conducting a study on the effects of caregiving on the caregivers and families of service members and veterans who've sustained a traumatic brain injury. In this episode, we talk about some of what that study has learned so far and how you can take part. We also discuss an easy way you can help spread the word about TBI this Brain Injury Awareness Month. If you're interested in taking part in the "Health Related Quality of Life in Caregivers of Service Members with Military Related Traumatic Brain Injury" study, call (855) 821-1469 or email caregiver.study@dvbic.org. You can find more information about the study here: http://dvbic.dcoe.mil/caring-caregivers To download the Brain Injury Awareness Month hashtag card and take part in the #ThinkAhead social media campaign, click here: https://dvbic.dcoe.mil/aheadforthefuture/materials The TBI Family is produced by the Defense and Veterans Brain Injury Center. This podcast provides caregivers of service members and veterans with TBI with information on traumatic brain injury and highlights resources available to them. We also share caregiver stories. For information on TBI or to get the DVBIC Family Caregiver Curriculum, go to dvbic.dcoe.mil or email us at info@dvbic.org. This podcast transcript is available online via the DVBIC website: http://dvbic.dcoe.mil/files/podcast/dvbic_podcast-series_the-tbi-family_episode-6_feb-14-2017_transcript_v1.0_2017-03-28_0.pdf The views, opinions and/or findings contained in this podcast are those of the host, reporters and guests. They should not be construed as an official Department of Defense position, policy or decision unless so designated by other official documentation. All music in this podcast was used according to Creative Commons licensing. Our theme song is "I Dunno" by grapes and our credit music is "Esaelp Em Xim" by Pitx, both from CCmixter.org. Other songs used were "Hoboken" and "Sex, Death and God," both by Steve Combs from FreeAudioArchive.org. [DCoE Product Unique Identifier 3907]

We review a paper that focuses on Health-Related Quality of Life following head and neck reconstruction. The details of the paper are below. Cohen WA, Albornoz CR, Cordeiro PG, Cracchiolo J, Encarnacion E, Lee M, Cavalli M, Patel S, Pusic AL, Matros E. Health-Related Quality of Life following Reconstruction for Common Head and Neck Surgical Defects. Plast Reconstr Surg.2016 Dec;138(6):1312-1320

The PRS Journal Club and special guest moderator Dr. Rod J. Rohrich discuss the following articles from the December 2016 issue: "Do Prolonged Prophylactic Antibiotics Reduce the Incidence of Surgical-Site Infections in Immediate Prosthetic Breast Reconstruction?” by Sbitany et al. "Three-Dimensional Facial Averaging: A Tool for Understanding Facial Aging," by Lambros et al "Health-Related Quality of Life following Reconstruction for Common Head and Neck Surgical Defects," by Cohen et al.

Michael S. Weinstein, MD, FACS, FCCM, speaks with Sean Bagshaw, MD, MSc

Michael S. Weinstein, MD, FACS, FCCM, speaks with Sean Bagshaw, MD, MSc

Audible Article by Zobair Younossi, M.D., M.P.H., and Linda Henry Ph.D.

Audible Article by Zobair Younossi, M.D., M.P.H., and Linda Henry Ph.D.

MDS presents the latest research and findings from the field of Movement Disorders. Abstracts of articles from the Society Journal, Movement Disorders, are taken from the February 2014 (Vol. 29, Issue 2) issue.

Background: It is widely recognized that health-related quality of life (HRQL) is impaired in patients with Chronic Obstructive Pulmonary Disease (COPD), but there is a lack of research on longitudinal associations of COPD and HRQL. This study examined the effects of COPD in early stages of disease on HRQL over ten years in a working-age general population setting in Southern Germany while considering the influence of common comorbidities. Methods: In the population-based KORA F4 study (2006-08) 1,321 participants aged 41-61 years performed spirometry and reported information on HRQL (measured by the generic SF-12) and comorbidities. For the same participants, HRQL information was available seven years before and three years after the lung function test from the previous S4 (1999-2001) and the F4L follow-up study (2010). Using linear mixed models, the physical and mental component summary scores (PCS-12 / MCS-12) of the SF-12 were compared over time between COPD groups. Results: 7.8% of participants were classified as having COPD (according to the LLN definition and the Global Lungs Initiative), 59.4% of them in grade 1. Regression models showed a negative cross-sectional association of COPD grade 2+ with PCS-12 which persisted when comorbidities were considered. Adjusted mean PCS-12 scores for the COPD grade 2+ group were reduced (-3.5 (p = 0.008) in F4, -3.3 (p = 0.014) in S4 and -4.7 (p = 0.003) in F4L) compared to the group without airflow limitation. The size of the COPD effect in grade 2+ was similar to the effect of myocardial infarction and cancer. Over ten years, a small decline in PCS-12 was observed in all groups. This decline was larger in participants with COPD grade 2+, but insignificant. Regarding MCS-12, no significant cross-sectional or longitudinal associations with COPD were found. Conclusion: Despite small HRQL differences between COPD patients in early disease stages and controls and small changes over ten years, our results indicate that it is important to prevent subjects with airflow limitation from progression to higher grades. Awareness of HRQL impairments in early stages is important for offering early interventions in order to maintain high HRQL in COPD patients.

This podcast covers the JBJS issue for December 2013. Featured are articles covering: The Natural Progression of Synovial Fluid White Blood-Cell Counts and the Percentage of Polymorphonuclear Cells After Primary Total Knee Arthroplasty - A Multicenter Study; Efficacy and Safety of Recombinant Human Bone Morphogenetic Protein-2 Calcium Phosphate Matrix for Closed Tibial Diaphyseal Fracture - A Double-Blind, Randomized, Controlled Phase-II-III Trial; recorded commentary by Dr. Collinge; Periprosthetic Joint Infection Increases the Risk of One-Year Mortality; The Devastating Effects of Tibial Nonunion on Health-Related Quality of Life; recorded commentary by Dr. Kreder.

This podcast covers the JBJS issue for December 2013. Featured are articles covering: The Natural Progression of Synovial Fluid White Blood-Cell Counts and the Percentage of Polymorphonuclear Cells After Primary Total Knee Arthroplasty - A Multicenter Study; Efficacy and Safety of Recombinant Human Bone Morphogenetic Protein-2 Calcium Phosphate Matrix for Closed Tibial Diaphyseal Fracture - A Double-Blind, Randomized, Controlled Phase-II-III Trial; recorded commentary by Dr. Collinge; Periprosthetic Joint Infection Increases the Risk of One-Year Mortality; The Devastating Effects of Tibial Nonunion on Health-Related Quality of Life; recorded commentary by Dr. Kreder.

Background: Our retrospective follow-up study aimed to explore the degree of overall mental distress in a cohort of solid-organ transplantation (SOT) recipients after liver, heart or lung transplantation. Furthermore, we investigated how overall mental distress is linked to health-related quality of life. Methods: 123 SOT patients treated during the study period were enrolled in this investigation at a mean of 24.6 months (SD=11.6) after transplantation. Before transplantation, the Transplant Evaluation Rating Scale (TERS) was used to classify the level of adjustment in psychosocial functioning among transplantation candidates. After transplantation, recipients completed a research battery, which included the SCL-90-R, and the SF-36. Results: 39 (31.7%) transplantation recipients had clinically significant overall mental distress as measured on the Global Severity Index of the SCL-90-R. Obsessive-compulsive symptoms (92.3%), somatization symptoms (87.2%), anxiety symptoms (84.6%), depression symptoms (82.1%) and phobic anxiety symptoms (69.2%) were a frequent finding. Transplantation recipients with overall mental distress had significant lower levels of adjustment in psychosocial functioning before transaplantation than those without overall mental distress as measured in the TERS. Transplantation-related overall mental distress symptomatology was associated with maximal decrements in health-related quality of life. Conclusion: Transplantation recipients may face major transplantation-and treatment-related overall mental distress and impairments to their health-related quality of life. Further, overall mental distress is a high-risk factor in intensifying impairments to patients' overall quality of life.

Background: Solid-organ transplantations (SOT) are usually life-saving high-tech medical procedures. The transplantation itself and the intensive care unit stay could be traumatic stressors triggering posttraumatic stress symptoms (PTSS). Our retrospective follow-up study aimed to explore preoperative risk factors of PTSS in a cohort of SOT recipients, and we investigated how PTSS are associated with health-related quality of life (HRQOL) and life satisfaction. Methods: 126 SOT recipients were enrolled in this investigation. Psychiatric examination of all SOT candidates based on the Transplant Evaluation Rating Scale was carried out before SOT, and after SOT, recipients completed the PTSS-10, the SF-36 and the FLZ. Results: After the surgical intervention 19 (15.1%) SOT recipients had clinical significant PTSS. Preoperative risk factors for developing postoperative PTSS were: 1.) preexisting psychiatric morbidity, 2.) history of retransplantation, 3.) chronic benzodiazepine consumption, 4.) age, and 5.) type of transplantation. SOT-related PTSS were associated with maximal decrements in HRQOL and life satisfaction. The following HRQOL and life satisfaction domains were affected: Physical Functioning, Role Physical, Pain, General Health, Vitality, Social Functioning, Role Emotional, Mental Health, Occupation/Work and Character/Own Skills. Conclusion: SOT recipients may face a major risk of transplantation-and treatment-related PTSS and the development of impairments to HRQOL and life satisfaction.

1) Measures of health-related quality of life and 2) Topic of the month: Memory. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Ted Burns interviews Dr. David Cella about his paper on measures of health-related quality of life. Dr. Stacey Clardy is reading our e-Pearl of the week about frontotemporal dementia. In the next part of the podcast Dr. Ted Burns interviews Dr. Dean Buonomano about major categories of memory. Next week they will discuss bedside testing of memory. All participants have disclosures.Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (30% effort); and has received research support from the Myasthenia Gravis Foundation of America and Knopp Neurosciences Inc..Dr. Cella serves on the scientific advisory boards of the Moffitt Cancer Center, NCI Symptom Management and Health-Related Quality of Life (SxQOL) Steering Committee, serves as Associate Editor of The Journal of Supportive Oncology; is a consultant for Pfizer Inc, Genetech, Inc., Novartis, Bayer Schering Pharma, and GlaxoSmithKline; receives royalties from Up-to-Date annual review of Quality of life measures; receives research support from Pfizer Inc, Genetech, Inc., Novartis, Bayer Schering Pharma, GlaxoSmithKline and AVEO Pharmaceuticals, Inc.; and is funded by the NIH.Dr. Clardy serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Buonomano receives royalties from the publication of the book Brain Bugs: How the brain's flaws shape our lives.

Background: In line with patient-centered health care, it is necessary to understand patients’ perceptions of health. How stroke survivors perceive their health at different time points after stroke and which factors are associated with these feelings provide important information about relevant rehabilitation targets. Objective. This study aimed to identify the independent factors of health-related quality of life (HRQoL) from a biopsychosocial perspective using the methods of multivariate regression at 3 different time points poststroke. Methods. Included in the study were 99 patients from stroke units with diagnosed first-ever stroke. At admission and at 6 weeks, 3 months, and 1 year poststroke, HRQoL was assessed using the EuroQoL-5D Visual Analogue Scale (EQ-5D VAS). Consequences in Body Functions and Activities and Participation, and Environmental Factors were documented using 155 categories of the International Classification of Functioning, Disability and Health (ICF) Core Set for Stroke. Results. For a period of 1 year, problems with recreation and leisure, personality functions, energy and drive functions, and gait pattern functions were repeatedly associated with worse HRQoL. Whereas Body Functions and Activities and Participation explained more than three-fourths of the variances of HRQoL at 6 weeks and 3 months (R2 = 0.80-0.93), the variation at 1 year was best explained by either Body Functions or Environmental Factors (R2 = 0.51). Conclusions. The results indicate the importance of Body Functions and Activities and Participation (mainly personality functions and recreation and leisure) on HRQoL within 3 months poststroke, but increased impact of Environmental Factors on HRQoL at 1 year.

Background: Little is known as to how health-related quality of life (HRQoL) when measured by generic instruments such as EQ-5D differ across smokers, ex-smokers and never-smokers in the general population; whether the overall pattern of this difference remain consistent in each domain of HRQoL; and what implications this variation, if any, would have for economic evaluations of tobacco control interventions. Methods: Using the 2006 round of Health Survey for England data (n = 13,241), this paper aims to examine the impact of smoking status on health-related quality of life in English population. Depending upon the nature of the EQ-5D data (i.e. tariff or domains), linear or logistic regression models were fitted to control for biology, clinical conditions, socio-economic background and lifestyle factors that an individual may have regardless of their smoking status. Age-and gender-specific predicted values according to smoking status are offered as the potential `utility' values to be used in future economic evaluation models. Results: The observed difference of 0.1100 in EQ-5D scores between never-smokers (0.8839) and heavy-smokers (0.7739) reduced to 0.0516 after adjusting for biological, clinical, lifestyle and socioeconomic conditions. Heavy-smokers, when compared with never-smokers, were significantly more likely to report some/severe problems in all five domains - mobility (67%), self-care (70%), usual activity (42%), pain/discomfort (46%) and anxiety/depression (86%) -. `Utility' values by age and gender for each category of smoking are provided to be used in the future economic evaluations. Conclusion: Smoking is significantly and negatively associated with health-related quality of life in English general population and the magnitude of this association is determined by the number of cigarettes smoked. The varying degree of this association, captured through instruments such as EQ-5D, may need to be fed into the design of future economic evaluations where the intervention being evaluated affects (e. g. tobacco control) or is affected (e. g. treatment for lung cancer) by individual's (or patients') smoking status.

This podcast covers the JBJS issue for July 2010. Featured are articles covering A Prospective Randomized Study of Minimally Invasive Total Knee Arthroplasty Compared With Conventional Surgery; recorded commentary by Dr. Nelson; Relationship of Neural Axis Level of Injury to Motor Recovery and Health-Related Quality of Life in Patients with a Thoracolumbar Spinal Injury; Pathoanatomy of First-Time, Traumatic, Anterior Glenohumeral Subluxation Events; Quality and Content of Internet-Based Information for Ten Common Orthopaedic Sports Medicine Diagnoses; Combined Hip Arthroscopy and Limited Open Osteochondroplasty for Anterior Femoroacetabular Impingement.

This podcast covers the JBJS issue for July 2010. Featured are articles covering A Prospective Randomized Study of Minimally Invasive Total Knee Arthroplasty Compared With Conventional Surgery; recorded commentary by Dr. Nelson; Relationship of Neural Axis Level of Injury to Motor Recovery and Health-Related Quality of Life in Patients with a Thoracolumbar Spinal Injury; Pathoanatomy of First-Time, Traumatic, Anterior Glenohumeral Subluxation Events; Quality and Content of Internet-Based Information for Ten Common Orthopaedic Sports Medicine Diagnoses; Combined Hip Arthroscopy and Limited Open Osteochondroplasty for Anterior Femoroacetabular Impingement.

Guest: Brennan Spiegel, MD, MSHS Host: Jay Goldstein, MD In its 1948 charter constitution, the World Health Organization defined health as "a state of complete physical, mental and social well-being." Today, to measure this totality of well-being, we measure quality of life. Host Dr. Jay Goldstein discusses how quality of life measurements can be incorporated into everyday practice, with Dr. Brennan Spiegel, assistant professor of medicine in the division of digestive diseases at the David Geffen School of Medicine at UCLA. How is health-related quality of life measured objectively in clinical trials? To what degree do quality of life endpoints trump physiological endpoints?

Guest: Brennan Spiegel, MD, MSHS Host: Jay Goldstein, MD In its 1948 charter constitution, the World Health Organization defined health as "a state of complete physical, mental and social well-being." Today, to measure this totality of well-being, we measure quality of life. Host Dr. Jay Goldstein discusses how quality of life measurements can be incorporated into everyday practice, with Dr. Brennan Spiegel, assistant professor of medicine in the division of digestive diseases at the David Geffen School of Medicine at UCLA. How is health-related quality of life measured objectively in clinical trials? To what degree do quality of life endpoints trump physiological endpoints?

Guest: Melanie Calvert, PhD Host: Gary Kohn, MD Dr. Melanie Calvert, a research fellow at the University of Birmingham, PhD biochemist, and quality of life researcher speaks with host, Dr. Gary Kohn on quality of life measurement; how it's currently conducted and implemented in the medical field, and its future potential.

Guest: Melanie Calvert, PhD Host: Gary Kohn, MD Quality of life as related to patient care; how do you measure it, teach it, and use it? Join host Dr. Gary Kohn as he explores the topic with Dr. Melanie Calvert, a research fellow at the University of Birmingham and PhD biochemist who's worked with clinicians, industry, and academics researching the role quality of life plays in assessing patient outcomes and health policy decision making.

When it comes to health insurance, well, the times are changing. The nation's largest insurer now says that healthy habits could save you substantial cash. By now you should know that the Omega 3 fatty acids are great for your heart and your brain….but did you know they can also help with your pain? And yet another study, this one of women, reinforces that the more you move, the better you feel….imagine that! Dr. Cooper answers listeners' calls. Program Reference Notes:Long-Term Physical Activity Patterns and Health-Related Quality of Life in U.S. Women – http://www.ajpm-online.net/article/PIIS0749379707001031/abstract Insurance rewards healthy workers - http://www.usatoday.com/money/industries/health/2007-07-10-insurance-healthy-workers_N.htm Fighting Inflammation with Fish Oil: Q&A - http://www.clevelandclinic.org/health/health-info/docs/4200/4261.asp?index=13634

Background: Health-related quality of life (HRQL) is considered as an important outcome parameter in patients with chronic diseases. This study aimed to assess the role of disease-specific HRQL for long-term survival in patients of different diagnoses with chronic hypercapnic respiratory failure (CHRF). Methods: In a cohort of 231 stable patients (chronic obstructive pulmonary disease (COPD), n = 98; non-COPD (obesity-hypoventilation syndrome, restrictive disorders, neuromuscular disorders), n = 133) with CHRF and current home mechanical ventilation (HMV), HRQL was assessed by the disease-specific Severe Respiratory Insufficiency (SRI) questionnaire and its prognostic value was prospectively evaluated during a follow-up of 2-4 years, using univariate and multivariate regression analysis. Results: HRQL was more impaired in COPD (mean +/- SD SRI-summary score (SRI-SS) 52.5 +/- 15.6) than non-COPD patients (67.6 +/- 16.4; p < 0.001). Overall mortality during 28.9 +/- 8.8 months of follow-up was 19.1% (31.6% in COPD, 9.8% in non-COPD). To identify the overall role of SRI, we first evaluated the total study population. SRI-SS and its subdomains (except attendance symptoms and sleep), as well as body mass index (BMI), leukocyte number and spirometric indices were associated with long-term survival (p < 0.01 each). Of these, SRI-SS, leukocytes and forced expiratory volume in I s (FEV(I)) turned out to be independent predictors (p < 0.05 each). More specifically, in non-COPD patients SRI-SS and most of its subdomains, as well as leukocyte number, were related to survival (p < 0.05), whereas in patients with COPD only BMI and lung function but not SRI were predictive. Conclusion: In patients with CHRF and HMV, the disease-specific SRI was an overall predictor of long-term survival in addition to established risk factors. However, the SRI predominantly beared information regarding long-term survival in non-COPD patients, while in COPD patients objective measures of the disease state were superior. This on one hand highlights the significance of HRQL in the long-term course of patients with CHRF, on the other hand it suggests that the predictive value of HRQL depends on the underlying disease.

ABSTRACT Backgroud: The World Health Organization Disability Assessment Schedule II (WHODAS II) is a new measure of functioning and disability that is conceptually compatible with the International Classification of Functioning, Disability, and Health (ICF). In contrast to other measures of health status, the WHODAS II is based on an international classification system, it is designed to be applicable across different cultures, and it treats all disorders at parity when determining the level of functioning. Objective: The general objective of this study is to investigate whether the WHODAS II – German version – is a useful instrument for measuring functioning and disability in patients with musculoskeletal conditions, cardiovascular and general internal conditions, stroke, breast cancer and depressive disorder. Specific objectives are to assess its psychometric properties reliability (internal consistency, Cronbach's Alpha), validity (factor analysis of dimensionality, convergent validity, discriminant validity), and sensitivity to change (effect size and standardized response mean), to determine to what extent the WHODAS II correlates with a traditional generic instrument for measuring Health Related Quality of Life, the SF-36, and to define its sensitivity to change after a rehabilitative intervention in relation to that other instrument. Methods: Patients with musculoskeletal conditions, cardiovascular and general internal conditions, stroke, breast cancer and depressive disorder participated. The patients completed the questionnaires WHODAS II and SF-36. After a rehabilitation treatment the same patients completed these questionnaires again in order to assess sensitivity to change. Analyses of measurement properties were conducted. Sensitivity to change was calculated by the effect size (ES) and standardized response mean (SRM). Results: Mean score on the WHODAS II is 21.98 (SD 14.32) for musculoskeletal conditions, 18.47 (SD 15.32) for internal conditions, 38.72 (SD 24.79) for stroke, 23.84 (SD 16.61) for breast cancer, and 44.56 (SD 18.95) for depressive disorder. High reliability is obtained. For the most part, the results of the scale replication confirm the determined six domains of the questionnaire. For the domain Activities, a clear distinction between work und household activities is apparent in both musculoskeletal and internal conditions. The correlations found in comparison to the SF-36 indicated that the WHODAS II (German version) measured indeed the expected constructs. The effect sizes of the WHODAS II Total Score range from 0.163 to 0.687 depending on the subgroup; effect sizes of the SF-36 summary scores from 0.025 to 1.395, respectively. In terms of patients reporting an improvement of general health status, effect sizes are accordingly higher (0.220 to 0.915 for the WHODAS II; 0.083 to 2.023 for the SF-36). Conclusion: The WHODAS II (German version) is a useful instrument for measuring functioning and disability in patients with musculoskeletal diseases, internal diseases, stroke, breast cancer and depressive disorder. It is reliable and valid and shows similar sensitivity to change scores as the SF-36 in the accordingly subscales.