Plug or Punctoplasty (POPPY) Study: Perforated Punctal Plug Versus Three-Snip Punctoplasty in the Treatment of Acquired Punctal Stenosis.

Improved Quality of Life (QOL) Outcomes in Patients With Head-and-Neck Squamous Cell Carcinoma (HNSCC) Treated With Intensity Modulated Radiation Therapy (IMRT) Compared to 3-dimensional Conformal Radiation Therapy (3D-CRT): Evidence From a Prospective Randomized Study

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Clinical and quality of life (QOL) outcomes vary depending on the patient's demographics, comorbidities, presenting symptoms, pathology, and surgical treatment used. While there have been individual predictors identified, no comprehensive method incorporates a patient's complex clinical presentation to predict a specific individual postoperative outcome. To create tool that predicts patient-specific outcomes among those undergoing cervical spine surgery. A total of 952 patients at a single tertiary care institution who underwent anterior or posterior cervical decompression/fusion between 2007 and 2013 were retrospectively reviewed. Outcomes included postoperative emergency department visit or readmission within 30 d, reoperation within 90 d for infection, and changes in QOL outcomes. Nomograms were modeled based on patient demographics and surgical variables. Bootstrap was used for internal validation. Bias-corrected c-index for emergency department visits, readmission, and reoperation were 0.63, 0.78, and 0.91, respectively. For the QOL metrics, the bias-corrected adjusted R-squared was EQ-5D (EuroQOL): 0.43, for PHQ-9 (Patient Health Questionnaire-9): 0.35, and for PDQ (Pain/Disability Questionnaire): 0.47. Variables predicting the clinical outcomes varied, but included race and median income, body mass index, comorbidities, presenting symptoms, indication for surgery, surgery type, and levels. For the QOL nomograms, the predictors included similar variables, but were significantly more affected by the preoperative QOL of the patient. These prediction models enable referring physicians and spine surgeons to provide patients with personalized expectations regarding postoperative clinical and QOL outcomes following a cervical spine surgery. After appropriate validation, use of patient-specific prediction tools, such as nomograms, has the potential to lead to superior spine surgery outcomes and more cost effective care.

In counseling patients with an unruptured intracranial aneurysm (UIA), quality of life (QoL) outcomes are important for informed decision making. We evaluated QoL outcomes in patients with and without preventive aneurysm occlusion at multiple time points during the first year after UIA diagnosis and studied predictors of QoL outcomes. We performed a prospective cohort study in patients aged ≥18 years with a newly diagnosed UIA in 2 tertiary referral centers in the Netherlands between 2017 and 2019. Patients were sent QoL questionnaires at 7 (aneurysm occlusion) or 5 (no occlusion) moments during the first year after diagnosis. We collected baseline data on patient and aneurysm characteristics, passive coping style (Utrecht Coping List), occlusion modality, and neurologic complications. We assessed health-related QoL (HRQoL) with the EuroQol 5 dimensions (EQ-5D), emotional functioning with the Hospital Anxiety and Depression Scale (HADS), and restrictions in daily activities with the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). We used a linear mixed-effects model to assess the course of QoL over time and to explore predictors of QoL outcomes. Of 153 eligible patients, 99 (65%) participated, of whom 30/99 (30%) underwent preventive occlusion. Patients undergoing occlusion reported higher baseline levels of passive coping, anxiety and depression, and restrictions than patients without occlusion. During recovery after occlusion, patients reported more restrictions compared with baseline (adjusted USER-P decrease 1 month post occlusion: -12.8 [95% CI -23.8 to -1.9]). HRQoL and emotional functioning gradually improved after occlusion (EQ-5D increase at 1 year: 8.6 [95% CI 0.1-17.0] and HADS decrease at 1 year: -5.4 [95% CI -9.4 to -1.5]). In patients without occlusion, the largest HRQoL improvement occurred directly after visiting the outpatient aneurysm clinic (EQ-5D increase: 9.2 [95% CI 5.5-12.8]). At 1 year, QoL outcomes were comparable in patients with and without occlusion. Factors associated with worse QoL outcomes were a passive coping style in all patients, complications in patients with occlusion, and higher rupture risks in patients without occlusion. After UIA diagnosis, QoL improves gradually after preventive occlusion and directly after counseling at the outpatient clinic in patients without occlusion, resulting in comparable 1-year QoL outcomes. A passive coping style is an important predictor of poor QoL outcomes in all patients with UIA.

To report the prevalence of acquired symptomatic external punctal stenosis (EPS) in a tertiary referral center in Kuwait, and to study the associated risk factors, etiologies, and management outcomes. This prospective interventional hospital-based study was performed at the Farwaniya governmental hospital in Kuwait between November 2018 and November 2019. All patients were referred to the oculoplastic clinic with symptomatic epiphora, age > 18 years, epiphora Munk score ≥ 0, tear film meniscus ≥ 2 mm, and punctum with grade ≤ 2 (smaller than normal size, but recognizable) were included. Eclusion criteria were congenital causes of epiphora, previous eyelid surgeries, and traumatic or neoplastic causes of punctal or canalicular obstruction. A total of 418 patients with symptomatic epiphora, who were referred to our oculoplastic clinic, were enrolled in our study. The prevalence of EPS was 70.3%. Eamination of the puncta revealed different shapes, including tangential, pinpoint, elevated, slit-shaped, horse shoe-shaped, and membranous puncta, with the tangential type accounting for the greatest proportion (65.3%). Bilateral punctal stenosis was observed in 206 patients (70.1%) and unilateral involvement in 88 patients (29.9%). Dilatation and syringing were performed for all puncta upon diagnosis, and repeated dilatation was performed for 225 puncta (32.7%). Placement of a Mini-Monoka tube was performed in 11 puncta (1.6%). EPS was a common cause of symptomatic epiphora in our study. Aging and female sex were identified as common risk factors. Most etiological factors of EPS were associated with a pathophysiological inflammatory mechanism. For exact estimates of its prevalence, a population-based study is necessary in future.

Besides morbidity and mortality, quality of life (QoL) is a key outcome of cancer treatments. Trials on the basis of clinical outcomes have expectations that QoL outcomes can be either tolerated or improved. Simultaneously considering QoL and clinical outcomes is challenging with lack of suitable metrics allowing incorporation of QoL as coprimary end points in clinical trial design and utilization of hierarchical hypothesis testing. We propose combining time to achieving a minimal clinically important difference (MCID) and probabilities of a MCID occurring in each QoL domain to provide QoL metrics analogous to those used for clinical end points. For QoL domains of interest, these yield QoL profiles, time to MCID, and number needed to treat. Incorporation of QoL as coprimary end points in clinical trial designs through hierarchical hypothesis testing can easily be achieved. The noninferiority designed Laparoscopic Approach to Carcinoma of the Endometrium trial, evaluating laparoscopic versus open abdominal surgery for endometrial cancer with Functional Assessment of Cancer Therapy-General QoL domains, is used to illustrate the usefulness of these metrics. This analysis revealed that laparoscopic surgery had a significant shorter time to MCID for physical and functional well-being QoL domains (physical mean: 1.5 months, 95% CI, 0.5 to 2.6; P = .002; and functional mean: 1.4 months; 95% CI, 0.4 to 2.4; P = .003) than abdominal surgery, but little difference between the two approaches for psychologic social and emotion well-being. Probability profile plots show a consistent > 2-fold higher chance of attaining a MCID for physical and functional well-being over time for laparoscopic compared with abdominal surgery. This analysis reinforces the potential value of novel MCID metrics and their usefulness in raising the profile of QoL outcomes to complement clinical end points. The methods will allow health professionals to counsel patients about QoL outcomes and clinical outcomes simultaneously.

BackgroundThere is a blooming trend in the application of robotic surgery in oral and maxillofacial care, and different studies had evaluated the quality of life (QoL) outcomes among patients who underwent robotic surgery in the oral and maxillofacial region. However, empirical evidence on the QoL outcomes from these procedures is yet to be mapped. Thus, this study was conducted to evaluate the available scientific evidence and gaps concerning the QoL outcomes of patients treated with robotic surgery in the oral and maxillofacial region.MethodsThis study adopted a scoping review design, and it was conducted and reported based on the Arksey and O’Malley, PRISMA-ScR, and AMSTAR-2 guidelines. SCOPUS, PubMed, CINAHL Complete, and APA PsycINFO were searched to retrieve relevant literature. Using Rayyan software, the retrieved literature were deduplicated, and screened based on the review’s eligibility criteria. Only the eligible articles were included in the review. From the included articles, relevant data were charted, collated, and summarized.ResultsA total of 123 literature were retrieved from the literature search. After deduplication and screening, only 18 heterogeneous original articles were included in the review. A total of 771 transoral robotic surgeries (TORSs) were reported in these articles, and the TORSs were conducted on patients with oropharyngeal carcinomas (OPC), recurrent tonsillitis, and obstructive sleep apnoea (OSA). In total, 20 different QoL instruments were used in these articles to assess patients’ QoL outcomes, and the most used instrument was the MD Anderson Dysphagia Inventory Questionnaire (MDADI). Physical functions related to swallowing, speech and salivary functions were the most assessed QoL aspects. TORS was reported to result in improved QOL in patients with OPC, OSA, and recurrent tonsillitis, most significantly within the first postoperative year. Notably, the site of the lesion, involvement of neck dissections and the characteristics of the adjuvant therapy seemed to affect the QOL outcome in patients with OPC.ConclusionCompared to the conventional treatment modalities, TORS has demonstrated better QoL, mostly in the domains related to oral functions such as swallowing and speech, among patients treated with such. This improvement was most evident within the initial post-operative year.

Introduction: The paper attempts to assess quality of life (QOL) outcomes at facet level and the factors affecting it to gain micro level understanding of the disease burden and to highlight key problematic areas faced by people living with HIV/AIDS (PLHA) in Manipur, India. Materials and Methods: A cross-sectional study with 200 PLHA (≥18 years of age) were recruited from 4 NGO centers in Imphal and Chandel using WHOQOL-HIV instrument. ANOVA and logistic regression tests were performed to compare and predict factors influencing QoL outcomes respectively. Results: In the ANOVA model, Physical and social relationships domains (<11) in Imphal, and SRPB and physical domains (<11.20) in Chandel showed poorest QOL outcomes. QOL outcome was reported poor for most facets across the six domains. Financial resources emerged as the worst affected QOL outcomes for both localities followed closely by dependence on treatment, HIV symptoms for Imphal and SRPB, concern about the future for Chandel. In the regression model, employment, clinical status, locality, gender and marital status emerged as significant predictors affecting QoL outcomes. Conclusion: Investments to improve better infrastructure, healthcare services, connectivity, and financial intervention for self-reliance and HIV/AIDS education including safer sex practices could positively affect QoL outcomes in many of the facets.

Background: Heart failure (HF) is associated with inflammation characterized by the formation of a protein complex, the inflammasome that triggers maturation of inflammatory cytokines. Inflammation in HF is associated with lower quality of life (QOL), depression, and poor outcomes. ASC, a vital component of the inflammasome, is controlled through epigenetic modification via methylation of CpG islands surrounding exon 1, and this methylation is a candidate pathway of worsening HF. The purpose of this study is to examine the relationships between ASC methylation and clinical, psychological, and QOL outcomes in HF. Methods: Stored samples from 155 HF outpatients (age 56.9±12.0 years, 64% male, 47% black, and mean LVEF 29.9±14.9) were analyzed for % methylation of seven CpG sites in the intron region preceding exon 1 of the ASC gene using pyrosequencing of bisulfite treated genomic DNA. Clinical, QOL (Kansas City Cardiomyopathy Questionnaire), and psychological (Patient Health Questionnaire [PHQ-9]) outcomes were assessed. Two-year combined clinical endpoint (death, heart transplantation, ventricular assist device implantation, or all-cause hospitalization) was analyzed. Results: Mean total ASC methylation was 5.96±0.55%. ASC methylation was inversely related to ASC mRNA (r=-.33, p&lt;0.001) and protein (r=-.464, p&lt;.001). ASC methylation had a positive linear relationship with ejection fraction (r=.81, p&lt;.001) and six-minute walk distance (r=.63, p=.005). ASC methylation had a negative linear relationship with PHQ-9 scores (r=-.65, p&lt;.001) and a positive linear relationship with QOL (r=.83, p&lt;.001). Combined clinical endpoint occurred in 71% (N=110) of participants. Higher levels of ASC methylation were associated with lower odds of clinical endpoint (odd ratio=0.43, 95% CI .187, .997, p=.049), while higher levels of ASC protein expression were associated with higher odds (OR=1.27, 95% CI 1.04,1.54, p=.016). Conclusion: Increased methylation of CpG sites in the intron region of ASC is associated with improved clinical, psychological and QOL outcomes in HF. The associated decrease in ASC expression implicates this inflammatory mediator as a possible driver of HF outcomes, and may represent a therapeutic target.

Background: Given the growing number of stroke survivors in the US, especially among women, understanding contemporary sex-specific trajectories of outcomes after stroke is crucial. Yet, such data are rare. We estimated sex-specific functional, neurological, cognitive, and quality of life outcomes at 3, 6, and 12 months post-stroke in a population-based study. Methods: First-ever ischemic strokes (IS) were ascertained between January 1, 2014 and December 31, 2019 from the Brain Attack Surveillance in Corpus Christi (BASIC) Project in South Texas. Data were collected from medical records and patient or proxy interviews (baseline, 3, 6, and 12 months after stroke). Sex-specific trajectories in functional (activities of daily living/instrumental activities of daily living score, ADL/IADL), neurological (National Institutes of Health Stroke Scale, NIHSS), cognitive (Modified Mini-Mental State Examination), and quality of life (QOL) outcomes (12-domain Stroke-specific Quality of Life scale) were estimated using multivariable-adjusted linear mixed effect models accounting for within-subject correlations. Interactions between sex and time were included to examine sex differences at each time point. Results: Among the 1,440 IS (median age 68, 48.4% women), women had significantly worse functional outcomes (0.11 points higher in ADL/IADL score) but better neurological outcomes (0.33 points lower in NIHSS score) than men at 3 months (Table 1). There were no sex differences in quality of life and cognitive outcomes. Throughout the one year following stroke, functional and neurological outcomes among both sexes improved, primarily driven by the improvement between 3 to 6 months, with small changes in the outcomes on the absolute scale (Table 2). Improvement in quality of life was only seen among women between 3 to 6 months, while worsening of cognitive outcome between 6 to 12 months was seen among both sexes. There were no significant sex differences for all outcomes at 6 or 12 months and no significant interactions between sex and time. Conclusions: Functional and neurological outcomes were at their worst at 3 months after stroke for both sexes and sex differences were small throughout the one-year poststroke, suggesting early assessment and intervention to improve these outcomes in both sex groups. The considerable worsening of cognition after 6 months post-stroke in both sexes suggests that longer-term monitoring of cognitive outcome may be needed.

Impact of Radiation-Induced Xerostomia on Quality of Life After Primary Radiotherapy Among Patients With Head and Neck Cancer

Long-term functional and quality of life outcomes in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses

To assess objective and quality of life (QOL) outcomes before and after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS) and to determine preoperative factors that predict surgical outcome in these patients. One hundred nineteen adult patients with CRS and a mean follow-up of 1.4 +/- 0.35 years were evaluated prospectively including the following patient factors: prior sinus surgery, polyps, asthma, acetylsalicylic acid intolerance (ASA), smoking, allergy, depression, and sex. Computed tomography (CT), endoscopy, and QOL assessment was performed. Predictive value of patient factors was determined based on change in endoscopy and QOL scores after ESS. Objective outcomes: preoperative CT scores were significantly worse in patients with polyps, asthma, and ASA, whereas CT score was unaffected by prior sinus surgery, smoking, allergy, depression, and sex. Patients with CRS demonstrated significant improvement on nasal endoscopy after ESS, but preoperative, postoperative, and change in scores were affected by certain patient factors. Endoscopy scores were significantly worse in patients with prior sinus surgery, polyps, asthma, and ASA, but these patients also experienced the greatest improvement in endoscopy scores. Smokers and patients with depression had the least change in endoscopy scores. QOL outcomes: patients with CRS experienced improvement in QOL after ESS. Pre- and postoperative QOL was positively affected by polyps and adversely affected by ASA, depression, and female sex, but these groups still experienced significant improvement in QOL scores. Pre- and postoperative QOL was unaffected by prior sinus surgery, asthma, smoking, and allergies, and all of these groups experienced significant improvement in QOL scores. Factors predictive of outcome: ASA and depression were predictive of worse outcome. Preoperative CT scores approached significance as being predictive of outcome. Surgical management of CRS was associated with significant improvement on objective and QOL measures; however, specific patient factors, in particular ASA and depression, predict poorer outcome. Preoperative CT may be a predictor of endoscopic and QOL outcome and deserves further study.

Findings from prior systematic reviews suggest that exercise results in meaningful improvements in many clinically relevant physiologic and quality of life (QOL) outcomes during and following cancer treatment. However, the majority of exercise-cancer studies have focused upon the benefits of aerobic exercise (AE) and knowledge of the efficacy of resistance exercise (RE) alone as a supportive care intervention for cancer patients and survivors remains limited. Consequently, the purpose of this review was to provide the first systematic evaluation of the effects of RE alone upon clinically relevant physiologic and QOL outcomes during and following cancer treatment. Literature searches were conducted to identify studies examining RE interventions in cancer patients and survivors. Data were extracted on physiologic (fitness, physical function, and body composition) and QOL (fatigue, psychological well-being, and cancer-specific and global QOL outcomes. Cohen's d effect sizes were calculated for each outcome. A total of 15 studies (6 in samples undergoing active cancer treatment and 9 in samples having completed cancer treatment) involving 1,077 participants met the inclusion criteria. Findings revealed that, on average, RE resulted in large effect-size improvements in muscular strength (d = 0.86), moderate effect-size improvements in physical function (d = 0.66), and small effect-size improvements in body composition (d = 0.28) and QOL (d = 0.25) outcomes. The effect sizes observed following RE are comparable in magnitude to the effects of exercise interventions reported in prior comprehensive reviews of the exercise-cancer literature which primarily focused upon AE. Additionally, the methodologic quality of the studies was generally strong. Taken collectively, results of this systematic review suggest that RE is a promising supportive care intervention that results in meaningful improvements in clinically relevant physiologic and QOL outcomes during and following cancer treatment.

Quality of Life (QOL) Outcomes After Three-Dimensional Conformal Radiation Therapy (3D-CRT) and Intensity Modulated Radiation Therapy (IMRT) for Localized Prostate Cancer