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Randomized Trial of Communication Facilitators to Reduce Family Distress and Intensity of End-of-Life Care
Communication with family of critically ill patients is often poor and associated with family distress.
To determine if an intensive care unit (ICU) communication facilitator reduces family distress and intensity of end-of-life care.
We conducted a randomized trial at two hospitals. Eligible patients had a predicted mortality greater than or equal to 30% and a surrogate decision maker. Facilitators supported communication between clinicians and families, adapted communication to family needs, and mediated conflict.
Outcomes included depression, anxiety, and post-traumatic stress disorder (PTSD) among family 3 and 6 months after ICU and resource use. We identified 488 eligible patients and randomized 168. Of 352 eligible family members, 268 participated (76%). Family follow-up at 3 and 6 months ranged from 42 to 47%. The intervention was associated with decreased depressive symptoms at 6 months (P = 0.017), but there were no significant differences in psychological symptoms at 3 months or anxiety or PTSD at 6 months. The intervention was not associated with ICU mortality (25% control vs. 21% intervention; P = 0.615) but decreased ICU costs among all patients (per patient: $75,850 control, $51,060 intervention; P = 0.042) and particularly among decedents ($98,220 control, $22,690 intervention; P = 0.028). Among decedents, the intervention reduced ICU and hospital length of stay (28.5 vs. 7.7 d and 31.8 vs. 8.0 d, respectively; P < 0.001).
Communication facilitators may be associated with decreased family depressive symptoms at 6 months, but we found no significant difference at 3 months or in anxiety or PTSD. The intervention reduced costs and length of stay, especially among decedents. This is the first study to find a reduction in intensity of end-of-life care with similar or improved family distress. Clinical trial registered with www.clinicaltrials.gov (NCT 00720200).
Journal Article
Forgotten joint score is worse when the affected leg perceived longer than shorter after total hip arthroplasty
Background
One of the causes of patient dissatisfaction after total hip arthroplasty (THA) is leg length discrepancy (LLD). Even when radiographic LLD (R-LLD) is within 5 mm, some people perceive the affected side to be longer, while others perceive it is shorter. The purpose of this study was to investigate the relationship between perceived LLD (P-LLD), R-LLD, and Forgotten Joint Score (FJS-12) after THA.
Methods
A retrospective study of 164 patients with unilateral hip disease was conducted. Based on P-LLD after THA, they were classified into three categories: perceived short (PS 21 patients), no LLD (PN 121 patients), and perceived long (PL 22 patients). On the other hand, based on R-LLD after THA, they were divided into < − 5 mm (RS 36 patients), − 5 mm ≤ x < 5 mm (RN 99 patients), and 5 mm ≥ (RL 29 patients), respectively. The proportion of P-LLD in the RN group was also evaluated. In each group, the relationship between P-LLD, R-LLD and FJS-12 was investigated.
Results
After THA, the PL group had significantly worse FJS-12 (PS: 68.3 ± 26.2, PN: 75.0 ± 20.9, PL: 47.3 ± 25.2,
P
< .0001). In the R-LLD evaluation, there was no difference in FJS-12 among the three groups (RS: 73.7 ± 21.1, RN: 70.0 ± 24.5, RL: 67.7 ± 25.4,
P
< .53). The RN group perceived leg length to be longer (RN-PL) in 12.1% of cases, and the RN-PL groups had significantly worse FJS-12 (RN-PS: 65.4 ± 24.8, RN-PN: 73.8 ± 23.1, RN-PL: 41.8 ± 27.6,
P
< .0001).
Conclusion
One year after THA, patients with longer P-LLD had worse FJS-12, even if the R-LLD was less than 5 mm.
Journal Article
Length word problems
\"This book offers readers insight into solving length word problems. Designed to support the Common Core State Standards, this title includes strategies such as using drawings, symbols, and number lines solve problems. Real-world examples and engaging text make learning meaningful to young readers\"-- Provided by publisher.
Book
Relationship between leg length discrepancy and functional scoliosis in children and adolescents
Purpose
As the relationship between leg-length discrepancy (LLD) and scoliosis has not been clearly defined, the purpose of this study was to explore the impact and severity of LLD in children and adolescents with scoliosis and the consistency between lower limb length discrepancy and pelvic height difference.
Methods
This retrospective study was conducted using prospectively collected data from 63 patients with functional scoliosis-associated LLD who received treatment at our hospital from March 2021 to July 2024. The inclusion criteria included: ①Children or adolescents with functional scoliosis complicated with LLD; ②Scoliosis classified as thoracolumbar or lumbar curve; ③A bilateral acetabular dome line parallel to the superior sacral endplate. The patients’ whole-spine posteroanterior and full lower limb radiographs were obtained to collect data on age, sex, LLD, Cobb angle, and pelvic height difference. Correlation analysis evaluated the relationship between LLD, leg-length discrepancy ratio (LLDR), Cobb angle, and the pelvic height difference. Univariate regression analysis was used to analyze the data using the SPSS software.
Results
In all cases, the convex side of the scoliosis corresponded to the shorter leg side. Female patients constituted 67% of the cohort. The patients’ mean age was 11.79 ± 3.52 years (range: 4 to 19 years). The average Cobb angle was 14.78 ± 4.99°, the average LLD was 11.22 ± 12.74 mm, and the mean pelvic height difference was 12.41 ± 10.32 mm. Significant correlations were observed when the bilateral acetabular dome line was parallel to the superior sacral endplate, and the scoliosis was thoracolumbar or lumbar, indicating associations between LLD and the Cobb angle (
R
= 0.440,
P
<0.05) and between LLDR and the Cobb angle (
R
= 0.445,
P
<0.05). Additionally, a strong positive correlation was identified between LLD and pelvic height difference (
R
= 0.874,
P
<0.05), indicating a high level of concordance between pelvic height difference and LLD.
Conclusions
In children and adolescents with functional scoliosis complicated by LLD, the Cobb angle significantly correlated with LLD. Additionally, LLDR also showed a significant correlation with the Cobb angle. A concordance was also observed between the pelvic height difference and LLD.
Clinical trial number
Not applicable.
Journal Article
Radiographic evaluation of robot-assisted versus manual total hip arthroplasty: a multicenter randomized controlled trial
BackgroundThe effectiveness of robot-assisted surgery remains contentious due to the lack of high-quality randomized controlled trials (RCTs) to elevate the level of evidence. We aimed to evaluate the postoperative radiographic outcomes of robot-assisted (RAS-THA) versus manual (M-THA) total hip arthroplasty.MethodsThis multicenter RCT was performed from March 1, 2021 to December 1, 2021. Patients were randomly assigned to routine M-THA or to RAS-THA that used the TRex-RS orthopedic joint surgical navigation system. The primary outcome was to compare the acetabular component orientation, femoral stem alignment, femoral canal fill ratio, and leg length discrepancy between RAS-THA and M-THA using postoperative radiography. Subgroup analyses of the two groups stratified by surgical approach, gender, and BMI were also conducted.ResultsSeventy-three participants were randomly allocated to the RAS-THA group, while seventy-two participants were assigned to the M-THA group. Compared to the M-THA group, the RAS-THA group exhibited less variability in the preoperative planning of the vertical center of rotation (VCOR; P < 0.001), demonstrated a significant advantage in femoral stem alignment (P = 0.004), and showed pronounced decreases in inequality and in the variability in leg length discrepancy (P < 0.001). There was no significant difference in the Lewinnek safe-zone ratio (P = 0.081) and the femoral canal fill ratio (P > 0.05) between the two groups. Further subgroup analysis also showed that the RAS-THA group had fewer horizontal center of rotation (HCOR) and leg length differences when stratified by surgical approach, gender, and overweight status.ConclusionThis RCT found that, regardless of the surgical approach, gender, or body mass index, RAS-THA can effectively improve the postoperative VCOR and significantly reduce the variability of leg length difference. RAS-THA should be considered an effective method to enhance surgical precision by achieving less variability in challenging patients with leg length discrepancies.Trial registration: ChiCTR2100044124.
Journal Article
What are light waves?
\"This engaging title introduces readers to the science of light waves. Relatable examples, accessible text, and a creative design challenge help readers discover the properties of light waves and their essential role in seeing our world\"-- Provided by publisher.
Book
