No abstract

Arthroplasty is more clinically effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip. The long-term results of total hip replacement may be better than those of bipolar hemiarthroplasty.

Our results provide empirical support for a measurement model for the QLQ-C30 yielding a single summary score. The availability of this summary score can avoid problems with potential type I errors that arise because of multiple testing when making comparisons based on the 15 outcomes generated by this questionnaire and may reduce sample size requirements for health-related quality of life studies using the QLQ-C30 questionnaire when an overall summary score is a relevant primary outcome.

Post-mastectomy pain syndrome (PMPS) is a recognised complication of breast surgery although little is known about the long-term outcome of this chronic pain condition. In 1996, Smith et al identified a prevalence rate of PMPS of 43% among 408 women in the Grampian Region, Northeast Scotland. The aim of this study was to assess long-term outcome at 7 -12 years postoperatively in this cohort of women, to describe the natural history of PMPS and impact of pain upon quality of life. Chronic pain and quality of life were assessed using the McGill Pain Questionnaire (MPQ) and Short Form-36 (SF-36). Of 175 women reporting PMPS in 1996, 138 were eligible for questionnaire follow-up in 2002. Mean time since surgery was 9 years (s.d. 1.8 years). A response rate of 82% (113 out of 138) was achieved; 59 out of 113 (52%) women reported continued PMPS and 54 out of 113 (48%) women reported their PMPS had resolved since the previous survey in 1996. Quality of life scores were significantly lower in women with persistent PMPS compared to those women whose pain had resolved. However, for women with persistent PMPS, SF-36 scores had improved over time. Risk factors for persistent PMPS included younger age and heavier weight. This study found that, of women reporting PMPS in 1996, half of those surveyed in 2002 continued to experience PMPS at a mean of 9 years after surgery.

On behalf of the Recovery Study Group. Psychological, surgical and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study, PAIN (2013), doi: http://dx.doi.org/10. 1016/j.pain.2013.09.028 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 25Two multiple logistic regression models were then developed to predict chronic pain status 26(presence or absence of chronic pain) at 4 and 9 months after controlling for other variables. 27Included variables were specified a priori by the Study Group, based upon previous (Table 3). The pattern of symptoms, in terms of location and frequency, 10was relatively stable rather than dynamic, when compared across follow-up time points. By 9 11 months postoperatively, more than half of women felt that their symptoms were unchanged, 12rather than improving over time (Table 3). Regarding symptom attribution, breast surgery 13 was reported to be the cause of symptoms for 94% women with chronic pain at 4 months 14 and 89% of women at 9 months after surgery. 16Pain intensity and character 17Most women reported chronic pain of mild intensity (Table 4) (Table 7). Decreased psychological robustness, type of axillary 5 surgery and more severe acute postoperative pain at rest increased the risk of experiencing 6 moderate to severe pain at 9 months postoperatively. Several risk factors were of borderline 7 statistical significance: younger age and having had multiple surgical procedures were 8 associated with greater pain intensity at 4 months, and chronic preoperative pain was 9 associated with greater pain intensity at 9 months postoperatively.This multicentre prospective cohort study investigated psychological, sociodemographic, and 3 surgical risk factors, adjusted for intraoperative nerve handling, on painful adverse outcomes 4 captured at multiple time points after resectional surgery for primary breast cancer. 6We found a high incidence of chronic pain, with two-thirds of women reporting pain-related 23The strengths of our study include being the first epidemiological study to investigate 27of intraoperative data collection forms; we achieved 97% complete data on nerve handling. 28 20We adjusted for other potential confounding factors, specified a priori, identified from existing 1 literature and from our own research [9-11; 30; 43; 50; 54]