Analysis and Evaluation of Subjective Quality of Life in a Group of Patients after Ischemic Stroke

Psoriasis is a chronic scaling and inflammatory skin disease that can affect patients' quality of life and daily functioning. We studied the scores of 85 patients suffering from moderate to severe plaque-type psoriasis, participating in a randomized controlled trial. We compared their scores on a generic quality-of-life instrument with data from two reference populations. We examined associations between clinical severity, as measured by the components of the Psoriasis Area and Severity Index (PASI), and the respective quality-of-life subdimensions, measured by the Medical Outcome Survey Short Form 36 (SF-36), to find out what elements of disease activity are related with impaired quality of life. Compared to the reference population, quality of life was impaired in terms of bodily pain and social functioning. There were no significant correlations between overall disease severity, as measured by PASI, and the SF-36 subdimensions. When examining the PASI components, we found significant correlations between desquamation on the upper limbs and mental health and bodily pain (r = -0.23 and r = -0.28, respectively) and between desquamation on the scalp and mental health (r = -0.29). In conclusion, we found that psoriasis patients had a lower quality of life than a reference population, without a significant relation between disease severity or disease area and quality of life. Yet psoriasis lesions located on visible body parts are significantly correlated with aspects of quality of life.

Today diabetes mellitus (DM) significantly reduces the parameters of the life quality of patients. Therefore, the life quality assessment is current and promising direction of medicine, which allows to determine a reasonable method of treatment. The aim of this study was the use of SF-36 questionnaire for determining the quality of life of patients with T2DM when applying different schemes of pharmacotherapy. The research objectives are: 1) carrying out retrospective analysis of medical histories and treatment sheets of T2DM patients in hospital environment; 2) carrying out frequency analysis of the treatment regimens used; 3) analysis of patients included in the study; 4) carrying out the survey by a nonspecific SF-36 questionnaire; 5) determination of the quality of life in T2DM patients. The research object is the quality of life in T2DM patients in hospital environment. The research methods were retrospective, frequency analysis, life quality assessment by a nonspecific SF-36 questionnaire. The pharmacoeconomic research included 2 groups of patients: the first group (25 patients) received the combination of metformin+gliclazide (43.1% of cases), the second one (56 patients) received the combination of metformin + glimepiride (16%). Patients did not significantly differ from all of the parameters analyzed, and it enabled to compare their quality of life. The life quality parameters were assessed by a nonspecific SF-36 questionnaire. When studying the life quality in patients with the metformin + gliclazide scheme the average physical health component was 24.64±0.63 and the average mental health component was 25.24±0.78; in patients with the metformin + glimepiride scheme the average physical health component was 23.89±1.1 and the average mental health component was 24.37±0.55. These results indicate that the quality of life in patients is fairly low and does not depend on the pharmacotherapeutic scheme used, obviously it is due to the severity of the T2DM course and the presence of complications. The quality of life in patients according to the physical and mental components has fairly low indicators irrespective of the pharmacotherapeutic scheme used.

Other: Links between frequency of painful symptoms, self-efficacy, and quality of life after prostate cancer treatment: Experiences of African American men

Is Video-Assisted Thoracic Surgery Lobectomy Better? Quality of Life Considerations

Primary chronic daily headaches (CDHs) have a considerable negative impact on patients. It leads to poor quality of life (QOL) and diminished ability to function in day-to-day life, in spite of this sufficient work has not been done in this area in India. The purpose of this study was to determine influence of sociodemographic variables on QOL of primary daily headache patients. A prospective study was carried out on 50 consecutive primary CDH patients attending psychiatry and neurology outpatient unit, diagnosed as per IHC 2003 criteria. They were evaluated using a specially designed proforma and QOL was evaluated using the WHOQOL-Brief (Hindi) instrument. Statistical analysis was done on SPSS version 10. Results revealed that old age patients had poor QOL in environmental domain. Female patients had poorer QOL in social relationship and environmental domains. Married patients had poorer QOL in physical, environmental domain, and their total QOL was also poor. There was a significant positive correlation with education status of patients, that is, higher educated patients had better QOL in environmental domain and negative correlation with family size, that is, more the number of family members poorer was the QOL in social relationship domain. Thus, to conclude many sociodemographic factors in the patients suffering from primary CDH have significant negative impact on QOL of patients. Among sociodemographic variables age, gender, marital status, and family size were the important factors that influence QOL of patients.

Background: Chronic kidney disease (CKD) is a disease that causes a progressive decrease in kidney function, which can end in kidney failure disease and will have an impact on decreasing quality of life. Previous research has shown that by giving vitamins B1, B6, and B12 can improve quality of life.
 Aim: To measure changes in quality of life in patients with chronic kidney disease who were given vitamins B1, B6, and B12 parenterally.
 Material and Methods: This study used quasi experimental (one group pre and post test) in 117 patients who were selected in Bethesda Hospital and Panti Rapih Hospital Yogyakarta hemodialysis unit. Patients were given vitamins B Combination injections twice a week in each hemodialysis for 4 weeks. Quality of life was measured by SF-8 questionnaire on the first day of hemodialysis before given vitamins (pre-test) and on the 30th day, after eight injection of vitamins B1, B6, and B12 (post test).
 Results: The mean age of observed patients were 51.58 ± 12.51 years. From 117 patients, 73 patients (62,4%) were male and 44 patients (37.6%) were female. The improvement in overall quality of life in patients was not significant (p= 0.055). Quality of life improvement was only significant in the male group (p = 0.016).
 Conclusion: There was no significant difference after 4-weeks-injections of vitamins B Combination to the overall quality of life in chronic kidney disease patients undergoing hemodialysis. But there was found a significant improvement in quality of life in the male patients with chronic kidney disease who had hemodialysis.
 Keywords : chronic kidney disease, quality of life, vitamins B1, B6, and B12, SF-8 questionnaire.

The importance of quality of life issues in health care practice and research is steadily growing. This growing interest fits into the definition of health as proposed by the World Health Organization (WHO) in 1948 (1). The WHO defines health as 'a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity'. The attention to health-related quality of life is reflected in the increase in the use of quality-of-life evaluation as a technique of clinical research since 1973, when only five articles listed 'quality of life' as a reference key word in the Medline data base; during the subsequent five-year periods there were 195, 273, 490, and 1252 such articles (2). Also in the field of allergy it has been recognized that allergic disease comprise more than the classical signs and symptoms being part of physical disorders such as allergic rhinitis, asthma and the atopic eczema/dermatitis syndrome (AEDS) (3). In the last decades an increasing effort has been made to understand the socioeconomic burden of atopic disease in terms of effects on health-related quality of life (HRQL) and healthcare costs. It has been acknowledged in several consensus reports that rhinitis and asthma are associated with impairments in the patients' functioning in day-to-day life at home, at work and at school 4-8). With the introduction of questionnaires designed to measure asthma- 9-11) and rhinitis-associated impairments of quality of life (12) it is clear that patients may be bothered by sleep disorders, emotional problems, impairment in activities and social functioning. Also, in general terms, patients with asthma (13) and allergic rhinitis (14) are impaired in their physical and mental functioning, including vitality and the perception of general health. From daily medical practice it can be easily understood that AEDS has a major impact on HRQL. In a way, the use of questionnaires focused on skin disease 15-17) formally confirms this association. Quality of life, QOL, has divergent meanings for different people. Also, HRQL may be considered as ill-defined. More agreement has been reached about the four domains of QOL which are considered to be important: 1) physical status and functional abilities; 2) psychological status and well-being; 3) social functioning; 4) economic and/or vocational status and factors ( 18 ). As the true quality of life value cannot be measured directly, researchers and clinicians have to resort to series of questions (items) to measure this construct indirectly. Combinations of items yield scores referring to physical, mental and social domains. An HRQL instrument must meet several criteria. It should address each component (symptom, condition) that is important to the patient. Attributes of an instrument are described in Table 1. It will be clear that the construction of quality of life questionnaires is a complex task, drawing from the fields of clinimetrics, psychometrics and clinical decision-making (2). Differences in approach, for instance item selection using factor analysis vs the impact method which select items that are most frequently perceived as important by patients -- yields different questionnaires (19). In general two types of instruments, generic and specific, have been used in allergy research. Generic questionnaires measure physical, psychological and social domains in all health conditions irrespective of the underlying disease. A frequently used generic instrument is the Medical Outcomes Survey Short Form 36 (SF-36) (20). The SF-36 was developed as part of the Medical Outcomes Study and analyzes health status using 36 questions to measure nine different health dimensions. It has been used to characterize patients with asthma. Bousquet (13) compared the FEV1 and a clinical score of asthma severity for 252 asthmatic patients. There was a significant positive correlation between all nine quality of life domains of the SF-36 and the clinical score of Aas. Eight of the nine domains also correlated with the FEV1. Also in perennial rhinitis there was a significant impairment in eight of nine QOL dimensions in patients compared with healthy subjects (14). Furthermore, the SF-36 is used to evaluate the effects of a nonsedating antihistamine on quality of life. In this study all of the nine quality of life dimensions improved significantly after one and six weeks of cetirizine treatment compared with placebo (21). Other generic instruments that have been used in allergy research are the Sickness Impact Profile (SIP) (22) and the Nottingham Health Profile (NHP) (23). The 136 items in 12 categories of the SIP describe activities of everyday living. This instrument has been used to evaluate the effect of salmeterol on asthma (24). Salmeterol led to significant improvements over salbutamol on virtually all clinical outcomes. Although all four quality of life instruments used in this study showed the same trend in favor of salmeterol, only the disease-specific Asthma Quality of Life Questionnaire (AQLQ) and the Rating Scale utilities showed significantly greater improvement on salmeterol than on salbutamol. In severe AEDS it was shown, using the SIP, that cyclosporin improves quality of life significantly (25). In particular, the SIP has been used for comparison with disease-specific instruments (24, 26-28). The NHP, the only generic instrument derived entirely from lay people, has been used to validate a disease-specific instrument for patients with dermatitis and psoriasis (29). In asthma the NHP was not able to capture clinical improvement by treatment with pulmonary steroids (30). The latter observations underline the disadvantage that the generic instruments miss depth and therefore may not be responsive enough to detect changes in general health states in spite of important changes in disease-related problems (26). The advantage of generic instruments, however, is that the burden of illness across different disorders and patient populations can be compared. In a comparison between asthma and epilepsy the major finding was that children with epilepsy had a relatively more compromised quality of life in the psychological, social, and school domains (31. In contrast, children with asthma had a more compromised quality of life in the physical domain. These findings suggested that attention simply to seizure control in the clinical setting will not address the full range of quality of life problems in children with epilepsy. Specific instruments have been designed by asking patients what kind of problems they experience from their disease. Both the frequency and the importance of impairments are measured by means of the questionnaires. These instruments have the advantage that they describe the disease-associated problems of the patients. As stated above, they seem to be more responsive to changes in HRQL than do the generic instruments. Several instruments for patients with asthma have been developed. The Asthma Quality of Life Questionnaire of Juniper is focused on symptoms, emotions, exposure to environmental stimuli, and activity limitation (32). Modifications of this questionnaire have been published recently (33, 34). When using HRQL outcome in clinical trials, the question arises whether a change in HRQL is of clinical importance. For the AQLQ, which uses a seven-point scale, the minimal important difference of quality of life score per item is considered to be very close to 0.5 (35). A change of 1.0 in the score represents a moderate change and a change in score of greater than 2.0 represents a large change in HRQL. The minimal important difference as described by Juniper is based upon patient opinions. Measures such as the standardized response mean or the effect size can be used to standardize changes. These measures are based solely upon the distribution of the observed data, in particular upon the variance (36). Recently, it has been shown that both the SF-36 and AQLQ were able to characterize a group of patients with moderate asthma very well, whereas the AQLQ domains were found to have the best discriminative properties (37. The Asthma Quality of Life Questionnaire of Marks captures breathlessness, physical restrictions, mood disturbance and concerns for health (38). St. George's Respiratory Questionnaire (11) is designed for patients with asthma and chronic obstructive pulmonary disorder COPD. It can be applied in both reversible and fixed airway obstruction. In contrast to other questionnaires, the Living with Asthma Questionnaire (10) does not include impairments experienced as a direct consequence of asthma symptomatology. Other instruments are presented in Table 2. The properties of the most frequently used questionnaire are described in Table 3. Specific instruments have been developed for children and caregivers (Table 2). In addition, questionnaires have been constructed for different age-groups of patients with rhinitis (12, 39-41). A simple practical questionnaire technique for routine clinical use, the Dermatology Life Quality Index (DLQI) has been introduced to characterize patients with skin disorders (15). This instrument has been used to compare patients with psoriasis and dermatitis (42). Also versions for children are available: the Children's Dermatology Life Quality Index (CDLQI) and the Infant's Dermatology Life Quality Index (IDLQI) (16). Other questionnaires are the Skindex (43) the Dermatology-Specific Quality of Life (DSQL) (17) and the patient-generated Dermatology Quality of Life Scales (DQOLS) (44). Recently, a questionnaire has been developed to measure HRQL in patients with allergy to insect stings. Subsequently, this instrument has been used in the evaluation of venom immunotherapy (45). It appeared that venom immunotherapy resulted in a statistically and clinically significant improvement in HRQL. Both in clinical practice and in research physicians and investigators rely on physiological and objective measures, whenever possible. However in asthma an increase in FEV1 or a decrease in PC20 histamine or methacholine may occur without any improvement experienced by the patient. Medical intervention may improve physiologic measures, whereas for instance side-effects of drugs or the cumbersome aspects of subcutaneous immunotherapy may unfavorably influence day-to-day life and compliance with treatment. It has been put forward that the classical outcome variables may only partially characterize the disease of the patient. From that point of view it has been advocated to measure HRQL along with the conventional clinical indices (46). In line with this reasoning is the weak association between classical asthma measures and the outcome of HRQL questionnaires. Comparison between de AQLQ of Marks with asthma symptoms and lung function variables revealed that a change in AQLQ score was weakly correlated with change in symptom score (r = 0.37, 95% CI 0.04–0.64) and change in BHR (r = 0.38, 95% CI 0.06–0.64). The association with change in peak flow variability was weak (r = 0.12, 95% CI 0.26–0.47) (27). Similar observations have been reported by others 47-50). An interesting study shows that the mere presence of respiratory symptoms or a (gradually) reduced lung function is insufficient reason for patients to seek medical help. Subjects are more likely to consult their general practitioner once their quality of everyday life is affected or they experience variability in lung function (51). Also, rhinitis related quality of life appears to be moderately correlated to the more classical outcome variables used in clinical trials, such as daily symptom scores and nasal hyperreactivity (52). Another argument to use quality of life instruments lies in the headstart with respect to the knowledge of their validation, reliability and responsiveness compared to the common symptom scores or visual analogue scores (VAS) scales used at clinical trials. In the field of nasal allergy, validation or standardization of symptom scores has rarely been the subject of research. In asthma, even quite recently introduced measures, such as the number of symptom-free days, merit more attention in terms of standardization and validation (53). Other reasons to assess quality of life are conceivable. Measurement of quality of life can also be useful for screening purposes or for evaluation of therapy. Quality of life may be a determinant of effectiveness or efficacy of treatment. Moreover, its assessment might be relevant to striving for optimal decision-making. As the perception of patients is clearly important in the management of disease and patient compliance (Fig. 1), measurement of this 'dimension' by HRQL questionnaires in clinical trials may be justified. The emphasis on quality of life has sometimes resulted in a routine inclusion of HRQL questionnaires in clinical trials. The inclusion of such an instrument is valuable only if the changes can be interpreted by clinicians and contributes to optimal medical decision-making. In an editorial, criticism has been directed to the routine inclusion of such instruments when the structure of the evaluation and its rationale appears ill-defined (54). A model representing the relationships between clinical aspects of therapy, HRQL and factors influencing HRQL (adapted from Cramer and Spilker (17)). Generally in clinical trials the effect of treatment or intervention on HRQL runs parallel with the effect on conventional medical outcome measures. However, in some studies differences can be found. In a study evaluating the combined effect of steroids and antihistamines no differences were demonstrated between patients treated with antihistamine and steroids vs steroids alone in terms of quality of life, whereas for some patient-rated symptoms the combination turned out to be superior (55). In a large multicenter study comparing budesonide and fluticasone it was found that both drugs were equally effective in suppressing symptoms (56), although budesonide had a better effect on general quality of life (57). This might indicate that patients perceive differences not captured by conventional symptom scores. The reverse situation, i.e. significant effects on classical outcomes (symptom scores, medication use, peak flow or FEV1) without important change in two generic and two specific HRQL measures has been described in a study on the effect of formoterol, a long-acting α2-agonist, in mild to moderate asthmatic patients (58). The latter discrepancies can be explained by a limited performance of HRQL measures in mild asthmatic patients. Alternatively, it is possible that the minor changes in symptom scores and lung function due to the intervention are not perceived by patients as relevant. Moreover, patients with a chronic condition may adapt themselves to their disease. The strength of HRQL questionnaires, that is the patient-centred approach, is also one of its weaknesses. Perceptions of quality of life experienced by persons may shift in time. It is easy to understand that a dramatic personal accident or a serious disease will not only cause deterioration in quality of life but will eventually also influence the patient's values and internal standards. For instance, in a study of quality of life after radiotherapy for laryngeal cancer, a temporary deterioration of physical functioning and symptoms was reported, mostly caused by side-effects of treatment. Despite physical deterioration, there was an improvement of emotional functioning and mood after treatment, probably as a result of psychological adaptation and coping processes (59). It is possible also that in less dramatic circumstances, disease and treatments will induce shifts in perception due to changes in the patient's values. Such subjective changes in patients' perception are known as response shift. Socioeconomic status is an additional important independent factor influencing HRQL. In a recent study with asthmatic patients it was shown that socioeconomic status attributes to HRQL. More importantly, in this study it was difficult to separate out the unique effects of socioeconomic status and race/ethnicity (60). Recently, a significant relationship between the mental health of children with asthma and family functioning has been shown (61). These findings suggest that the domains comprising the HRQL of children with asthma are related to both disease and non-disease factors. Psychological functioning influences the burden of a specific disease. A study designed to assess the effects of depressive symptoms on asthma patients' reports of functional status and health-related quality of life revealed that asthma patients with more depressive symptoms reported worse health-related quality of life than asthma patients with similar disease activity, but fewer depressive symptoms (62). Interestingly, these findings were seen not only in generic (SF-36) but also in specific (AQLQ) instruments. This means that a disease-specific instrument may be also influenced by phenomena such as fear and depression. Finally, patients may either intentionally or unconsciously mask their symptoms or trivialize their diseases. They may tend to ignore or discount those problems which they believe are unrelated to their illness. Others may tend to give socially desirable answers. Response shifts and illusory mental health (63) are not easily captured with HRQL instruments, but they will certainly influence the outcome of a clinical trial, when HRQL is chosen as the primary endpoint. In summary, one has to realize that the translation of clinical effects of treatment into perceived and reported changes in quality of life finds a place at the integration level of the patient and this is, in a way, a black box which is not easy to assess (Fig. 1). For these reasons it is strongly recommended to use HRQL outcome measures in parallel with conventional physiological outcome measures. Asthma, allergic rhinitis and AEDS often coexist. The question to what extent concomitant allergic disease affects quality of life has infrequently been addressed. In a recent study the SF-36 questionnaire from 850 subjects recruited in two French centers participating in the European Community Respiratory Health Survey was evaluated. Both asthma and allergic rhinitis were associated with impairment in quality of life. However, 78% of asthmatics also had allergic rhinitis. Subjects with allergic rhinitis but not asthma were more likely to report problems with social activities, difficulties with daily activities as a result of emotional problems, and low mental well-being than subjects with neither asthma nor rhinitis. Patients with both asthma and allergic rhinitis experienced more physical limitations than patients with allergic rhinitis alone, but no difference was found between these two groups for concepts related to social/mental health (64). In another study focusing on asthma, rhinitis and AEDS, comprising 325 subjects allergic to house dust mites, it was found that patients did show impaired quality of life compared to irrespective of the of the atopic Patients with the of asthma did out in terms of physical In addition, asthma symptoms with a visual had a major effect on social functioning, emotional functioning and disorders, in patients with AEDS, appeared to be associated with physical functioning, social functioning, mental health and general health It is not only concomitant atopic disease that has an impact on quality of life. such as and and nasal may patients with rhinitis and asthma. the SF-36 and a quality of life measure it has been shown that HRQL is impaired and that may improve quality of life for patients that is a other specific instruments such as the Index and the have been The impact of on social life in children during the four of life is not easily can be by use of a specific which measures the quality of life is a chronic disease of the respiratory which is frequently associated with respiratory compared the HRQL in patients with nasal with those of patients with perennial rhinitis and healthy It appeared that nasal impaired HRQL more than perennial allergic rhinitis The impairment of HRQL was greater when nasal was associated with asthma In addition, of nasal symptoms, and pulmonary function were after the evaluation in patients with nasal These demonstrated that nasal treatment either with nasal steroids or significantly improved both nasal symptoms and QOL without significant changes in pulmonary may a if the or is in one particular disease. A recent study the effects of on the of QOL measures an analysis of data from clinical trials with asthma, and The study suggest that conditions significantly and patients' scores on generic QOL measures and of treatment whereas their influence on disease-specific QOL scores and of treatment effect is although not These findings have significant practical for the of true treatment control of and the of QOL trials. The that atopic disease may have an effect on daily functioning has been by studies focused on school and in children with asthma may school and as as work by In a study it was shown that of children with recent symptoms of asthma, reported school absence for at one during the 12 compared with in children without respiratory absence of respiratory illness was reported for and use for respiratory problems for of the children with recent symptoms of asthma In another study reported in their activities and reported of work and school of asthma or nasal symptoms are not in patients with allergic rhinitis they may to problems during school either by direct or of sleep and allergic rhinitis may be associated with reduced to with will these problems, whereas treatment with nonsedating will only partially reverse the limitations in Recently, in a study out over in children with allergic perennial rhinitis and children with perennial rhinitis, it was shown that or the from on school on school and sleep In of the of a large it has been demonstrated that in asthma with increasing disease severity The of the effect of asthma on work the effect of work on asthma. The of asthma and of asthma is increasing It has been that of asthma can be to of asthma at work more on the of of underlying asthma than on the of possible asthma. It can be that patients with asthma may have a more severe impairment in quality of life of the between work and disease. In a study designed to address this question a statistically significant difference was seen in the scores of the AQLQ from a group of patients with asthma and a control group of subjects with asthma of The mean difference in the score was on a of limitation or of the to limitation or all the at the of the patient with asthma The difference between both groups was other more generic instruments focused on detect more showed that both asthma and rhinitis work with asthma are less likely to be at those rhinitis is a more determinant of work effectiveness In the allergic rhinitis in school days, and reduced activity per These data are derived from persons allergic rhinitis in with persons medical treatment. These data indicate that allergic rhinitis may have an important impact on and Patients are bothered by with performance and at and and may and only disease but also may influence work It has been that of treated their allergic rhinitis with antihistamines at for per Patients these antihistamines are more likely to The of include and With the antihistamines these problems have been significantly reduced studies have the for treatment of allergic rhinitis, asthma and associated In asthma in the for an A comparison of asthma in developed suggested an burden from to per of the asthma were to direct medical For the it has been that the when allergic was the primary were in The when allergic was a to other disorders such as asthma and was at The of allergic asthma and rhinitis and concerns about health care the increasing interest for only does the efficacy of treatment have to be but also its In these studies measures must be in to across patient populations and for different It is, however, difficult to the generic SF-36 or disease-specific HRQL scores into For this utilities such as the have been which measure the value that patients themselves place on their health some utilities measure the value that on health are the and Health An advantage of utilities is their to life associated with different medical can easily be into instruments are mostly A recent rhinitis specific the has been developed as a patient outcome for clinical trials and for studies comparing medical treatments for rhinitis The same group introduced an asthma specific the Asthma Index Also, disease-specific versions of the and have been developed for patients with asthma The interest in quality of life for patients with allergy that allergy is by a significant socioeconomic the introduction of HRQL outcome measures physicians were that patients cannot be by physiological measures. In a way, HRQL outcome measures of the from the with which clinicians are in their day-to-day The of these in the HRQL questionnaires it possible to include the patient in clinical trials and the in this field will improve medical decision-making and management of disease. of these outcome measures in the evaluation and management of patients be the However, HRQL questionnaires are in the of being in terms of and introduction of of instruments of QOL data is based on the that there are no measurement in the of is an technique for and which measurement into An important of is that it of whether a model fits the observed With this it has been shown that some changes in the of the SF-36 are when it is applied to evaluation of QOL for patients with or disease and with experienced criticism has been the of instruments and the to the measurement of quality of life It has been that attention has to be to better for of and of measures, these instruments will be for use in clinical practice and for use as primary in clinical trials Also, in the field of allergy the number of outcome measures is growing. For the and it will be difficult to select the of questionnaires. A a clinical is in of an disease-specific questionnaire with a whereas a at the level of health a generic instrument differences between subjects at a point in and utilities to assess of In not to patients with outcome measures research is to between In research to be focused on the selection and of a limited number of and instruments in to better understand the patient with allergy and better the of clinical trials. from the of Medical and for of the and

Objectives: Ischemic stroke (IS) is often associated with long-lasting physical deficits, linked to emotional symptoms (ES) and lowered quality of life (QoL). However, recent observations raised doubts regarding the traditional perspective of solely impairment-driven ES. In fact, anxiety and depression were also reported after transient ischemic attack (TIA) with a per definition absence of infarction and thus lacking physical deficits. This study follows the hypothesis that TIA patients might exhibit non-physical symptoms affecting individual QoL. Methods: In a prospective single-center observational study, IS patients (n = 73) were compared with TIA patients (n = 24) regarding their neurological deficit, ES and QoL, whereas the latter were evaluated by the Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 Heath Survey (SF-36). Assessments were conducted six times within a one-year follow-up period. Results: Overall, anxiety and depression decreased over time, while anxiety decreased more substantially. TIA patients showed similar levels of anxiety and depression when compared to IS patients. ES were detectable very early after the event and remained throughout the follow-up period in both groups. ES were associated with an impaired QoL including non-functional dimensions, while the strongest interrelations were observed for TIA patients, emphasizing interrelations between QoL and anxiety. Discussion: This study indicates that ES after TIA are comparable to the emotional burden after IS. ES after TIA were associated with QoL, pointing out their crucial role for individual well-being. Although confirmation in larger studies is necessary, these data underpin the need for early clinical awareness regarding non-physical symptoms in TIA patients.

Burden of pulmonary arterial hypertension in Germany

The Essential Difference in Measuring Health Status and Quality of Life in Patients with an Abdominal Aortic Aneurysm.

This study, conducted in China, aimed to investigate the association between adult attachment and quality of life in stroke patients, and to explore the underlying mechanisms. Questionnaires were administered using the Experiences in Close Relationships Inventory, Fear of Progression Questionnaire-Short Form, Stroke Stigma Scale and World Health Organization Quality of Life-BREF. The sample consisted of 242 participants, with a mean age of 60.33 years; 81 were women and 161 were men, and 92.98% had an ischaemic stroke. The results indicated that attachment avoidance was negatively associated with the quality of life in these patients. Additionally, fear of disease progression and stigma mediated the association between adult attachment and patients' quality of life. These findings contribute to a deeper understanding of the psychological factors associated with quality of life in stroke patients, offering valuable insights for developing clinical practices and intervention strategies.

Amaç: Bu çalışmada hasta güçlendirme ve yaşam kalitesi arasındaki ilişkinin ve hastaların yaşam kalitesini etkileyen faktörlerin belirlenmesi amaçlanmıştır.Yöntem: Araştırmaya bir üniversite hastanesinde 5 Şubat-25 Mayıs 2018 tarihleri arasında dâhiliye, göğüs hastalıkları, kardiyoloji ve genel cerrahi birimlerinde poliklinik başvurusu yapan kronik hastalar dâhil edilmiştir. Astım, diyabet, kronik obstrüktif akciğer hastalığı (koah), tiroid ve kalp rahatsızlığı bulunan hastaların dâhil edildiği bu çalışmada Small (2012) tarafından geliştirilen, Kaya ve Işık (2018) tarafından Türkçe geçerlilik ve güvenilirliği yapılan hasta güçlendirme ölçeği kullanılmıştır. Hastaların yaşam kalitesi ise The Euro Qol Group tarafından geliştirilmiş olan EQ-5D 5L ölçeğinin Hollanda ağırlıkları ile uygulanması ile değerlendirilmiştir. Rastgele örnekleme yöntemi kullanılmıştır ve 515 hasta araştırmaya dâhil edilmiştir. Araştırmanın verileri SPSS 23 programı ile analiz edilmiştir. Bulgular: Uygulanan hasta güçlendirme ölçeğine ilişkin ortalama skor 130,18 olarak gerçekleşmiştir. Hasta güçlendirme ile yaşam kalitesi arasında orta düzeye yakın pozitif yönlü bir ilişki bulunmuştur. Ayrıca yaş grubu ve kronik hastalık türünün hasta güçlendirme ve yaşam kalitesi skoru üzerinde değişikliğe yol açtığı belirlenmiştir.Sonuç: Bu çalışmada hasta güçlendirme ile yaşam kalitesi arasında ilişki olduğu ve hasta güçlendirmenin yaşam kalitesini artırdığı sonucuna ulaşılmıştır. Bu yüzden hastaların güçlendirilmesine yönelik uygulamalara önem verilmesi, hastanın tedavisine aktif katılımının sağlanması ve uygulanacak politikaların bu doğrultuda planlanması önerilmektedir.

Health Related Quality of Life for Stone Formers

Hu et al explored the impact of comprehensive nursing model on swallowing function and quality of life in patients with ischemic stroke. They divided 172 patients into the control group (routine care) and the research group (comprehensive care), and used standard scales to evaluate the swallowing function, neurological deficit, anxiety and depression, daily living ability, and exercise of the two groups of patients before and after care. Changes in indicators of function, quality of life, and compliance. The results showed that compared with the control group, patients in the study group achieved significant improvements in various indicators, with a lower incidence of adverse reactions and higher satisfaction with care. These data suggest that the comprehensive nursing model can significantly improve the swallowing function, quality of life and satisfaction of patients with ischemic stroke. In the future, the development of comprehensive nursing models needs to focus on technological innovation, humanized services, continuing education and training, multi-disciplinary collaboration, optimal allocation of resources, standardized practice and evaluation, etc., in order to improve nursing effects and promote the improvement of medical service quality.

Quality of life (QOL) is an important aspect of a complete outcomes evaluation, to document the effects of rehabilitation for persons with disabilities, including those with stroke. A Comparative Descriptive Study is carried out in Al-Najaf City/Al-Najaf Al-Ashraf Health Directorate / Al-Forat Center for Neurological Sciences, from Nov. 6th, 2013, to April, 10th, in order to assess the quality of life for ischemic versus hemorrhagic stroke.A non-probability (Quota sample) of 200 patients (100 ischemic stroke patients, and 100 hemorrhagic stroke patients). The data are collected using semi-constructed questionnaire, which consists of three parts (1) Patients' Demographic data. (2) Patients' clinical data. (3) Patients’ quality of life (WHOQOL). Validity of the questionnaire is determined through a five experts, who have more than 10 years of experience in nursing field. The data described statistically and analyzed through use of the descriptive and inferential statistical analysis procedures. The findings of the present study indicate that the ischemic stroke patients responses were failure at all the studied domains, except at the level of independency and environmental domain their responses were pass. While the hemorrhagic stroke patients responses were failure at all the studied domains. The study concludes that the ischemic stroke affect all the quality of life domains except the level of independence and environmental domains. While the hemorrhagic stroke affect all the quality of life domains without exceptions. While the study recommends that further studies conducted to involve a large sample size may be at a national level to obviously determine the quality of life for patients with ischemic versus hemorrhagic stroke.