Better Quality Of Life Scores Research Articles

Quality of life of nursing‐home residents with dementia subject to surveillance technology versus physical restraints: an explorative study

As physical restraints should only be used in exceptional cases, there is an urgent need for alternatives to restraint use. Surveillance technology could be such an alternative. This study explored whether nursing-home residents with dementia subjected to surveillance technology had better quality of life scores for mood, behavioral and societal dimensions than residents with physical restraints. Quality of life was assessed longitudinally, with three measurements in six psychogeriatric nursing homes of residents with surveillance technology (n = 170) and residents with physical restraints (n = 22). QUALIDEM subscales were used to measure five dimensions of quality of life. Multilevel longitudinal univariate and multivariate regression techniques were used to analyze the data. Because physical restraints were almost exclusively used in residents with low activities of daily living (ADL) independency (18 of the 22), we restricted the regression analyses to residents with a Barthel Index score ≤ 5 (overall n = 53). Univariate results showed that highly ADL-dependent residents with surveillance technology had significantly more positive affect than highly ADL-dependent residents with physical restraints. However, this difference proved to be no longer significant after adjustment for the confounders: age, sex and stage of dementia. Quality of life of highly ADL-dependent nursing-home residents with dementia seems to be unrelated to the use of surveillance technology as opposed to physical restraints.

Parent perceived quality of life is age‐dependent in children with food allergy

Food allergy in children significantly affects their quality of life. Its impact can be analyzed by quality of life questionnaires. The aim of our study was to validate the French version of disease-specific questionnaires and to evaluate the quality of life in children with IgE-mediated food allergy. Two validated food allergy-specific questionnaires for quality of life, the parent's and children's forms (FAQLQ-PF and FAQLQ-CF), were translated from English to French and submitted to children with food allergy and their parents. Questionnaires were analyzed in terms of emotional impact, food anxiety, and social and food limitations. NCT 01480427. Sixty-two parents of children aged 0-12 yrs answered the FAQLQ-PF, and 32 children aged 8-12 yrs the FAQLQ-CF. Construct validity of both questionnaires was assessed by correlation between the FAQLQs and FAIM (r = 0.85 and 0.84, respectively). Both FAQLQs had good internal consistency (Cronbach's α = 0.748 and 0.67, respectively). Young children (0-3 yrs old) showed better quality of life scores than older children (FAQLQ-PF global score: p = 0.02). Worse scores were also shown among children with previous severe systemic reactions (FAQLQ-PF global score: p = 0.039), the ones with an allergic mother (FAQLQ-PF global score: p = 0.002), or allergic siblings (FAQLQ-PF emotional impact score: p = 0.034), the ones with multiple food allergy (more than 1 food) (FAQLQ-PF anxiety score: p = 0.04) and among the girls (FAQLQ-CF global score: p = 0.031). Older children, the ones with severe systemic reactions, or with mothers or siblings also affected by allergies, as well as girls, and children with multiple food allergies show worse quality of life scores.

Long-term Outcomes and Quality of Life of 186 Patients With Primary Parotid Carcinoma Treated With Surgery and Radiotherapy at the Daniel den Hoed Cancer Center

To assess the outcomes, toxicity, and quality of life (QOL) of patients with primary parotid carcinoma treated with surgery and postoperative radiotherapy at the Daniel den Hoed Cancer Center. Between 1995 and 2010, 186 patients with parotid carcinoma were treated with parotidectomy with or without neck dissection, followed by radiotherapy. Elective nodal irradiation (ENI) was applied to high-risk, node-negative disease. End points were locoregional control (LRC), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS), late toxicity, and QOL. After a median follow-up of 58 months (range, 4-172 months), the 5-year Kaplan-Meier estimates for LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%, respectively. Forty-five events were reported: 24 distant metastases (DM) and 21 locoregional failures (LRF). Event-free survival rates by histological types were 89%, 78%, 76%, 74%, and 70% for acinic cell, mucoepidermoid, adenoid cystic, adenocarcinoma, and squamous cell carcinoma, respectively. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%, respectively) than in patients with other histological types (p= 0.04) and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%, respectively) than in patients with other types (p = 0.03). None of the high-risk node-negative patients who received ENI developed regional failure. On multivariate analysis, Tstage, N stage, grade, and presence of perineural invasion and facial paralysis correlated significantly with DFS. The 5-year cumulative incidence of grade ≥2 late toxicity was 8%. QOL scores deteriorate during and shortly after treatment but returned in almost all scales to baseline scores within 6 months. Of the entire group, surgery and postoperative radiotherapy resulted in excellent outcomes with minimal side effects and preservation of good QOL scores. However, in view of the pattern of failures observed in this study, the role of adjuvant systemic or targeted therapy in patients at high risk of DM should be investigated in prospective trials.

Baseline Quality of Life Assessed with the EORTC QLQ-C30 Predicts the Treatment Outcome of Patients with Diffuse Large B-Cell Lymphoma: Results of a Prospective Cohort Study

Abstract 1595 Background:The self-reported Quality of life (QoL) assessment has been widely used as an endpoint for clinical trials along with traditional endpoints of response and survival because the QoL can provide the health-related information, and it should be considered another parameter to estimate the efficacy of treatment. However, there is growing evidence that the QoL assessment can be used as a prognostic factor in cancer patients. Thus, the prognostic value of baseline QoL was reported in several different types of cancers independent of other clinical prognostic factors. Considering the performance status of patients is an important prognostic factor in lymphoma, the assessment of QoL at diagnosis might be an informative tool for predicting treatment outcome of lymphoma. However, few data exists regarding the prognostic relevance of baseline QoL in patients with lymphoma. Thus, we evaluated the prognostic impact of baseline QoL on the outcome of patients with diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin lymphoma. Methods:The Samsung Medical Center Lymphoma Cohort Study (SMCLCS) is a prospective cohort study registering patients diagnosed with Hodgkin and non-Hodgkin lymphoma at the Samsung Medical Center (NCT00822731). All patients completed the version 3.0 of the European Organization for Research and Treatment of Cancer (EORTC) Core Questionnaire (QLQ-C30) after they provided written inform consents. Among patients registered in the SMCLCS, we analyzed the baseline QoL and clinical data of 263 patients consecutively diagnosed with DLBCL between September 2008 and February 2011. Primary CNS lymphoma was excluded, thus, all patients were treated with rituximab-CHOP. We made a prognostic model according to the scores of three items: (1) Global health status representing general health condition, (2) Functional scale representing physical function, (3) Symptom scales representing symptoms and signs. Each item was counted as one point if the score of each item was higher than 50. Thus, patients were classified as good (3 points), moderate (2 points) and poor QoL (score =0 or 1) groups. The QoL scores of patients with marginal zone B-cell lymphoma (MZL, n = 110) were used as a control. Results:The median score of Global health status was 50 (range 0–100) while the median scores of Functional and Symptom scales were 78.4 (24.1–100.0) and 79 (25.9–100.0), respectively in patients with DLBCL. These scores were significantly lower than a control group, MZL (P < 0.05). When patients were categorized into three groups, the good and moderate QoL groups accounted for 43.0% (n = 113) and 41.1% (n = 108) of patients, respectively. The proportion of poor QoL group of DLBCL was 16.0% (n = 42), and it was higher than that of MZL (2.7%). When the QoL at diagnosis was compared with other clinical factors, the poor QoL was significantly associated with poor ECOG performance status (≤ grade 2) whereas age older than 60 years was not significantly related with the poor QoL. The clinical factors representing high tumor burden such as elevated serum LDH, the number of extranodal involvement and Ann Arbor stage were significantly associated with the QoL model, thus, patients with high tumor burden showed poor QoL (P < 0.05). In consistent with this, patients with high or high-intermediate International Prognostic Index showed worse QoL scores than low or low-intermediate risk group. The frequency of treatment-related mortality was significantly higher in patients belonging to moderate and poor QoL groups than good QoL group (P < 0.05). As a result, more than 20% of the moderate or poor QoL group failed to complete the planned treatment schedule of rituximab-CHOP while only 10% of patients of the good QoL group could not finish the treatment. As a result, the overall survival of the good QoL group was significantly better than moderate and poor QoL groups (p < 0.05). This risk stratification based on the baseline QoL assessment was independently prognostic for overall survival in the multivariate analysis after controlling for International Prognostic Index. Conclusion:The baseline quality of life assessed with the EORTC QLQ-C30 is significantly associated with high tumor burden and worse overall survival of DLBCL. Thus, this prospective result suggests that the it may become a feasible prognostic factor in patients with DLBCL. Disclosures:No relevant conflicts of interest to declare.

Role of Knee Flexion in the Quality of Life of Patients Implanted With Primary TKA

Achieving complete pain relief and improving mobility are the 2 main goals after total knee arthroplasty (TKA). First is to restore patient function and second is to improve patient quality of life. Mobility after TKA and particularly range of knee flexion is related to the patient, the implant, and last but not least, the surgical management. The goal of this study was to evaluate the impact of the flexion restoration on the patient's quality of life. Between September 2000 and January 2005, 516 consecutive TKAs in 445 patients operated on in the same center were prospectively followed. The same high-flexion posterostabilized mobile- bearing implant was systematically used. Mean patient's age was 71±8 years, mean body mass index was 28±4kg/m 2 . At follow-up, an objective evaluation was performed by 2 independent observers. Objectively, the postoperative range of knee flexion was 128±4 degrees and the mean Knee Society function and knee scores were respectively 91±6 and 96±3. Higher range of flexion and Knee Society knee scores were significantly correlated with better quality of life scores (P<0.001). The results of this study showed that patient quality of life was correlated with a higher range of knee flexion.

Quality of life in the over-80-year-old medical patient following intensive care

The aim of this study was to determine the quality of life (QOL) in patients over 80 years old following intensive care who were admitted with a medical diagnosis. The older ICU population is increasing, and using QOL after critical illness rather than mortality may represent a better outcome measure. The evidence is conflicting, with some studies suggesting good QOL scores in the older patients compared with younger patients, whilst others show the opposite. This may be due to differences in study design with variations in age group studied and the follow-up period. Our study uses a novel approach to evaluate QOL using aged-matched controls.

The impact of hearing loss on the quality of life in adults

The hearing apparatus is one of the most important factors related to the development of oral communication. Thus, hearing disorders and deafness lead to severe handicap. Hearing impairment in adults cause verbal communication disorders that influence psychical, emotional and social functioning. Nowadays, there is a noticeable world tendency towards improving hard of hearing person's quality of life. Objective was to assess the association between hearing impairment and health-related quality of life. A hundred adults with billateral hearing impairment underwent hearing examination and answered the Hering Handicap Inventory for the Elderly-Screening (HHIE-S, Ventry and Weinstein), specific for hearing impairment. Almost half of all participants (44%) had a moderate hearing loss, and 36% had a mild loss. Infrequently, participants had a severe degree of hearing loss (13%) and deafness (7%). Self reported hearing handicap revealed significant emotional, social and situational dysfunctions (chi2 = 40.960; df = 1; p < 0.01). Severity of hearing loss was significantly correlated with hearing handicap (r = 0.212; p < 0.05). More often, participants revealed social and situational than emotional hearing handicap (Chi2 = 131.89; df = 100; p < 0.05). Only 12% of all participants habitually used hearing aids, and they observed a significantly better quality of life scores (chi2 = 6.23; df = 1; p < 0.05). Health-related quality of life must be estimated as a factor of great importance. Investigations should involve a more extansive population with hearing loss and a national programme should be started.

Relationships between repeated instruction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary disease

PurposeAdherence to inhalation therapy is a critical determinant of the success of chronic obstructive pulmonary disease (COPD) management. However, in practice, nonadherence to inhalation therapy is very common in COPD patients. The effects of adherence to inhalation therapy in COPD have not been fully studied, and less is known about the relationship between medication adherence and quality of life in COPD. Our aim is to assess the factors that contribute to adherence to inhalation therapy and examine their correlation with quality of life.Patients and methodsA cross-sectional analysis of 88 COPD patients was performed using a self-reported adherence questionnaire with responses on a 5-point Likert scale.ResultsOf the 88 patients who were potential participants, 55 (63%) responded with usable information. The only significant factor associated with the overall mean adherence score was receiving repeated instruction about inhalation techniques (P = 0.032). Of the 55 respondents, 22 (40.0%) were given repeated verbal instruction and/or demonstrations of inhalation technique by a respiratory physician. Significant correlations were found between the overall mean adherence score and the health-related quality of life score (St George’s Respiratory Questionnaire: total, r = −0.35, P = 0.023; symptoms, r = −0.43, P = 0.002; impacts, r = −0.35, P = 0.011). Furthermore, patients with repeated instruction showed better quality of life scores than those who did not receive instruction (total, P = 0.030; symptoms, P = 0.038; impacts, P = 0.019).ConclusionsRepeated instruction for inhalation techniques may contribute to adherence to therapeutic regimens, which relates to better health status in COPD.

Post-Traumatic Stress Disorders, Mood Disorders, and Quality of Life in Transplant Recipients With Acute Liver Failure

Objective The objective of this study was to assess post-traumatic stress disorder (PTSD), depression, anxiety, and quality of life among acute hepatitis patients undergoing liver transplantation. Method Twenty-four patients underwent transplantation due to acute liver failure. After a brief anamnestic interview to gather demographic and clinical information, each participant underwent a psychological assessment using the SF-36 Health Survey (SF-36), Impact of Events Scale–Revised (IES-R), Hospital Anxiety and Depression (HAD) Scale, as well as Beck Depression Inventory (BDI). Results The average age of the patients was 41.17 years (±17.03); the mean time after transplantation was 13.50 ± 13.80 months; 83% of the subjects were women. Anxiety symptoms were observed in 33.2% of the participants and depression in 16.7% by HAD and 45.8% by BDI. By IES-R 46.2% of patients presented high to severe levels of stress. The majority of participants (54.2%) showed good quality of life scores. A correlation analysis indicated a significant negative association between SF-36 score and other scales (from −0.514 to −0.681). Upon a comparative analysis, a significant difference between groups was only noted in SF-36 score ( P = .032). Conclusion The results led us to conclude that anxiety, depression, and PTSD were negatively associated with quality of life in this population. These symptoms also contributed directly to determine well-being among these patients.

Is lung volume reduction surgery effective in the treatment of advanced emphysema?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether lung volume reduction surgery (LVRS) might be superior to medical treatment in the management of patients with severe emphysema. Overall 497 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that LVRS produces superior patient outcomes compared to medical treatment in terms of exercise capacity, lung function, quality of life and long-term (>1 year postoperative) survival. A large proportion of the best evidence on this topic is based on analysis of the National Emphysema Treatment Trial (NETT). Seven studies compared LVRS to medical treatment alone (MTA) using data generated by the NETT trial. They found higher quality of life scores (45.3 vs. 27.5, P<0.001), improved maximum ventilation (32.8 vs. 29.6 l/min, P=0.001) and lower exacerbation rate per person-year (0.27 vs. 0.37%, P=0.0005) with LVRS than MTA. Mortality rates for LVRS were greater up to one year (P=0.01), equivalent by three years (P=0.15) and lower after four years (P=0.06) postoperative compared to MTA. Patients with upper-lobe-predominant disease and low exercise capacity (0.36 vs. 0.54, P=0.003) benefited the most from undergoing LVRS rather than MTA in terms of probability of death at five years compared to patients with non-upper-lobe disease (0.38 vs. 0.45, P=0.03) or upper-lobe-disease with high exercise capacity (0.33 vs. 0.38, P=0.32). Five studies compared LVRS to MTA using data independent from the NETT trial. They found greater six-minute walking distances (433 vs. 300 m, P<0.002), improved total lung capacity (18.8 vs. 7.9% predicted, P<0.02) and quality of life scores (47 vs. 23.2, P<0.05) with LVRS compared to MTA. Even though LVRS has a much greater cost per person over five years ($137,000 vs. $100,200, P<0.001), its improved lung function, greater exercise capacity and better quality of life scores make it a preferable treatment option to MTA, with particular indications for patients with upper-lobe-predominant disease and low exercise capacity.

Exercise Therapy for Schizophrenia

The health benefits of physical activity and exercise are well documented and these effects could help people with schizophrenia.To determine the mental health effects of exercise/physical activity programmes for people with schizophrenia or schizophrenia-like illnesses.We searched the Cochrane Schizophrenia Group Trials Register (December 2008) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We also inspected references within relevant papers.We included all randomised controlled trials comparing any intervention where physical activity or exercise was considered to be the main or active ingredient with standard care or other treatments for people with schizophrenia or schizophrenia-like illnesses.We independently inspected citations and abstracts, ordered papers, quality assessed and data extracted. For binary outcomes we calculated a fixed-effect risk ratio (RR) and its 95% confidence interval (CI). Where possible, the weighted number needed to treat/harm statistic (NNT/H) and its 95% confidence interval (CI), was also calculated. For continuous outcomes, endpoint data were preferred to change data. We synthesised non-skewed data from valid scales using a weighted mean difference (WMD).Three randomised controlled trials met the inclusion criteria. Trials assessed the effects of exercise on physical and mental health. Overall numbers leaving the trials were similar. Two trials (Beebe 2005 and Marzaloni 2008) compared exercise to standard care and both found exercise to significantly improve negative symptoms of mental state (Mental Health Inventory Depression: 1RCT, n=10, MD 17.50 CI 6.70 to 28.30, PANNS negative: 1RCT, n=10, MD -8.50 CI -11.11 to -5.89). No absolute effects were found for positive symptoms of mental state. Physical health improved significantly in the exercise group compared to those in standard care (1RCT, n=13, MD 79.50 CI 33.82 to 125.18), but no effect on peoples' weight/BMI was apparent. Duraiswamy 2007 compared exercise with yoga and found that yoga had a better outcome for mental state (PANNS total: 1RCT, n=41, MD 14.95 CI 2.60 to 27.30). The same trial also found those in the yoga group had significantly better quality of life scores (WHOQOL Physical: 1RCT, n=41, MD -9.22 CI -18.86 to 0.42). Adverse effects (AIMS total scores) were, however, similar.Results of this Cochrane review are similar to existing reviews that have examined the health benefits of exercise in this population (Faulkner 2005). Although studies included in this review are small and used various measures of physical and mental health, results indicated that regular exercise programmes are possible in this population, and that they can have healthful effects on both the physical and mental health and well-being of individuals with schizophrenia. Larger randomised studies are required before any definitive conclusions can be drawn.

Exercise therapy for schizophrenia

The health benefits of physical activity and exercise are well documented and these effects could help people with schizophrenia. To determine the mental health effects of exercise/physical activity programmes for people with schizophrenia or schizophrenia-like illnesses. We searched the Cochrane Schizophrenia Group Trials Register (December 2008) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We also inspected references within relevant papers. We included all randomised controlled trials comparing any intervention where physical activity or exercise was considered to be the main or active ingredient with standard care or other treatments for people with schizophrenia or schizophrenia-like illnesses. We independently inspected citations and abstracts, ordered papers, quality assessed and data extracted. For binary outcomes we calculated a fixed-effect risk ratio (RR) and its 95% confidence interval (CI). Where possible, the weighted number needed to treat/harm statistic (NNT/H) and its 95% confidence interval (CI), was also calculated. For continuous outcomes, endpoint data were preferred to change data. We synthesised non-skewed data from valid scales using a weighted mean difference (WMD). Three randomised controlled trials met the inclusion criteria. Trials assessed the effects of exercise on physical and mental health. Overall numbers leaving the trials were similar. Two trials (Beebe 2005 and Marzaloni 2008) compared exercise to standard care and both found exercise to significantly improve negative symptoms of mental state (Mental Health Inventory Depression: 1RCT, n=10, MD 17.50 CI 6.70 to 28.30, PANNS negative: 1RCT, n=10, MD -8.50 CI -11.11 to -5.89). No absolute effects were found for positive symptoms of mental state. Physical health improved significantly in the exercise group compared to those in standard care (1RCT, n=13, MD 79.50 CI 33.82 to 125.18), but no effect on peoples' weight/BMI was apparent. Duraiswamy 2007 compared exercise with yoga and found that yoga had a better outcome for mental state (PANNS total: 1RCT, n=41, MD 14.95 CI 2.60 to 27.30). The same trial also found those in the yoga group had significantly better quality of life scores (WHOQOL Physical: 1RCT, n=41, MD -9.22 CI -18.86 to 0.42). Adverse effects (AIMS total scores) were, however, similar. Results of this Cochrane review are similar to existing reviews that have examined the health benefits of exercise in this population (Faulkner 2005). Although studies included in this review are small and used various measures of physical and mental health, results indicated that regular exercise programmes are possible in this population, and that they can have healthful effects on both the physical and mental health and well-being of individuals with schizophrenia. Larger randomised studies are required before any definitive conclusions can be drawn.

Plasma disc decompression compared with fluoroscopy-guided transforaminal epidural steroid injections for symptomatic contained lumbar disc herniation: a prospective, randomized, controlled trial

Patients with radiculopathy, with or without back pain, often do not respond to conservative care and may be considered for epidural steroid injection therapy or a disc decompression procedure. Plasma disc decompression (PDD) using the Coblation SpineWand device is a percutaneous, minimally invasive interventional procedure. The purpose of this study was to evaluate clinical outcomes with PDD as compared with standard care using fluoroscopy-guided transforaminal epidural steroid injection (TFESI) over the course of 2 years. This was a multicenter randomized controlled clinical study. Ninety patients (18-66 years old) who had sciatica (visual analog scale score > or = 50) associated with a single-level lumbar contained disc herniation were enrolled. In all cases, their condition was refractory to initial conservative care and 1 epidural steroid injection had failed. Participants were randomly assigned to receive either PDD (46 patients) or TFESI (44 patients, up to 2 injections). The patients in the PDD Group had significantly greater reduction in leg pain scores and significantly improved Oswestry Disability Index and 36-Item Short Form Health Survey ([SF-36], physical function, bodily pain, social function, and physical components summary) scores than those in the TFESI Group. During the 2-year follow-up, 25 (56%) of the patients in the PDD Group and 11 (28%) of those in the TFESI Group remained free from having a secondary procedure following the study procedure (log-rank p = 0.02). A significantly higher percentage of patients in the PDD Group showed minimum clinically important change in scores for leg and back pain and SF-36 scores that exceeded literature-based minimum clinically important changes. Procedure-related adverse events, including injection site pain, increased leg or back pain, weakness, and lightheadedness, were observed in 5 patients in the PDD Group (7 events) and 7 in the TFESI Group (14 events). In study patients who had radicular pain associated with a contained lumbar disc herniation, those patients treated with PDD had significantly reduced pain and better quality of life scores than those treated using repeated TFESI. In addition, significantly more PDD patients than TFESI patients avoided having to undergo a secondary procedure during the 2-year study follow-up.

Comparison Study on Functional Outcomes and Perceived Quality of Life Between All-Inclusive and Fee-For-Service Continuing Care Retirement Communities

To examine the associations between 2 types of continuing care retirement communities' (CCRC) residents regarding physical function and perceived quality of life. Cross-sectional study (n=406). Eligibility criteria include age 65 years or older, residents of independent living units, and intact cognition (MMSE>or=24). All-inclusive CCRCs provide unlimited access to home health services and nursing home care as needed in return for the entry and monthly fee. Fee-for-service CCRCs offer home health and nursing home services at a full fee-for-service rate. Outcomes were functional status (ADLs and IADLs) and perceived quality of life. Multivariate regressions were used to examine the associations between residents of different types of CCRCs on selected outcomes while adjusting for covariates. The all-inclusive CCRC sample was more likely to be married (53.8% versus 33.4%; P < .001), with more years of education (17.9 versus 14.4; P < .0001), and had few physician visits in the previous year in comparison to the FFS CCRC sample. Multivariate results indicate that the FFS group had worse ADL (beta=0.95; P=.0003), IADL (beta=0.57; P=.02) function than the all-inclusive group. There was no significant difference in perceived quality of life scores between the 2 groups. Residents of both CCRCs reported equally good quality of life scores. Residents of the all-inclusive CCRC seem to have had better ADL and IADL function than the FFS CCRC residents. Prepaid home health services and nursing home care in the all-inclusive CCRC may facilitate ADL and IADL functional independence.

Osteotomy, compression and other modifications of surgical techniques for internal fixation of extracapsular hip fractures.

Many different surgical techniques have been described for the internal fixation of extracapsular hip fractures. To compare different aspects of surgical technique used in operations for internal fixation of extracapsular hip fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE, EMBASE, CINAHL, Current Controlled Trials, orthopaedic journals, conference proceedings and reference lists of articles. Date of last search was January 2008. No language restriction was applied. All randomised and quasi-randomised trials investigating operative techniques used in operations for the treatment of extracapsular hip fractures in adults. Two review authors independently selected trials, assessed trial quality and extracted data. Wherever appropriate, data were pooled. Predominantly older people with trochanteric fractures were treated in the 11 included trials.One trial (65 participants undergoing fixation with a fixed nail-plate) found no statistically significant differences between osteotomy versus anatomical reduction. Four trials, involving 465 participants undergoing fixation with a sliding hip screw (SHS), compared osteotomy versus anatomical reduction. Osteotomy was associated with an increased operative blood loss and length of surgery. There were no statistically significant differences for mortality, morbidity or measures of anatomical deformity.Two trials (138 participants) compared SHS fixation of a trochanteric hip fracture augmented with cement against a standard fixation. There were no reoperations even for the four cases of fixation failure in the cement group. The cement group had significantly better quality of life scores at six months. One trial (200 participants) comparing compression versus no compression of a trochanteric fracture in conjunction with SHS fixation found no significant differences between the two groups. One trial (120 participants) found a tendency to improved outcomes with a hydroxyapatite coated lag screw, but none reached statistical significance. One trial (19 participants) reported reduced temperatures when using a modified reaming method. Another trial (50 participants) found reduced bone marrow intravascular embolism, detected by oesophageal ultrasound, when a Gamma nail was inserted with a distal pressure venting hole in the femur. There is inadequate evidence to support the use of osteotomy for internal fixation of a trochanteric hip fracture. Similarly, there is insufficient evidence to support the use of the other techniques examined in the trials included in this review.

La mifépristone dans la prise en charge des fibromes utérins

Mifepristone, a progesterone receptor antagonist steroid, can reduce uterine fibroid tumours’ growth by several pathways. Its efficiency has been widely evaluated in symptomatic patients for more than 10 years. A significant decrease in fibroid tumours and uterine volume concomitant with better quality of life scores can be obtained with a daily administration of Mifepristone 5mg. Mifepristone can be compared with GnRH agonists in terms of efficiency. Observed adverse outcomes are hot flushes (38%), elevated hepatic enzymes (4%) and benign endometrial hyperplasia (28%). Hot flushes and endometrial hyperplasia are not observed with 5mg daily doses. Data suggest that many invasive procedures could be avoided with the routine use of Mifepristone for fibroid tumours care. However, published study periods are only three to 12 months: long lasting evaluation in larger groups of patients seems necessary before this treatment could be proposed as routine care.

Long-term adjustment of early-stage ovarian cancer survivors

The objectives of this study were to describe the quality of life (QOL), consequences of treatment, complementary therapy use, and factors correlating with psychologic state in 58 survivors of early-stage ovarian cancer since little is known about the QOL of early-stage ovarian cancer survivors. Survivors were interviewed using standardized measures to assess physical, psychologic, social, and sexual functioning; impact of cancer on socioeconomic status; and complementary therapy use. Survivors reported good physical QOL scores and few unmet needs. However, menopausal symptoms and negative impact on sexuality were reported. Less than 10% of survivors reported either an interest in sex or were sexually active. Psychologic assessment yielded a subset of 26% of patients with scores suggestive of posttraumatic stress disorder (PTSD) and 40% of survivors scored below the norm on the Mental Health Inventory-17 Survey. One third of patients required treatment for family/personal problems and took antianxiety medications. About 56% of survivors reported fear of cancer recurrence and 59% reported anxiety when their CA125 is tested. Better mental health was significantly related to less fatigue (Functional Assessment of Cancer Therapy [FACT]-fatigue, r = 0.61, P < 0.0001), less pain (European Organisation for Research and Treatment of Cancer [EORTC], r =-0.54, P < 0.0001), fewer stressful life events (Life Event Scale, r =-0.44, P > 0.001), and greater social support (MOS Social Support Survey, r = 0.41, P < 0.01). Early-stage ovarian cancer survivors had few physical complaints and unmet needs, but psychologic distress was evident in a subset of survivors; the majority of survivors reported sexual dysfunction. These results indicate the need for intervention and improved distress screening in the early-stage ovarian cancer population.

Depression, anxiety and quality of life in pediatric asthma

The study's objective was to examine depression, anxiety and quality of life according to age and asthma status in pediatric asthma in a pediatric university department. 108 patients, age: 11.75 +/- 3.10 (mean +/- SD) years (boys 11.6 +/- 2.8 years and girls 12.1 +/- 3.7 years) completed the Child Depression Inventory, the State Trait Anxiety Inventory for Children, the Pediatric Asthma Quality of Life Questionnaire, and a symptom score. Forced expiratory volume in one second was also measured. Mean forced expiratory volume in one second percent was 97.4 +/- 12.8. 23 patients (21%) had intermittent asthma, 40 patients (37%) had mild persistent, 43 patients (40%) had moderate persistent, 2 patients (2%) had severe persistent asthma. Pediatric asthma patients scored 9.36 +/- 5.57 points in the depression questionnaire. Patients showed as many depressive symptoms as the Hungarian average population, pre-adolescent boys with asthma showed even less. Children with asthma scored 31.16 +/- 4.61 points on the anxiety questionnaire; (boys 30.64 +/- 4.29, girls 32.67 +/- 5.27). Children with asthma have the same anxiety level as their healthy peers. On the quality of life questionnaire asthmatic children reached 6.18 +/- 1.00 (2.87-7.00); adolescent girls scored the worst (5.62 +/- 1.28). Adolescent asthmatic girls have the worst quality of life. Boys reach better quality of life scores as they grow older ( p = 0.02). Girls with adolescence have a tendency of decreasing quality of life, although the difference is not significant. In adolescence, asthmatic girls experience more quality of life deprivation than boys ( p = 0.013). Depression score, anxiety, or quality of life showed no difference between the intermittent and persistent asthmatic groups. Children in the symptomatic subgroup experienced poorer quality of life. Depression and anxiety were not affected by current asthma symptoms. There was no significant difference in depression, anxiety or quality of life scores according to age. The psychological status of children with asthma is fairly good. One should concentrate more on the quality of life of girls in adolescence. The good pediatric care of childhood asthmatics helps to avoid the psychological consequences of the disease.

Depressão na esquizofrenia: prevalência e relação com a qualidade de vida

This study aimed to investigate the prevalence of depression in schizophrenia and associated factors, including quality of life. A cross-sectional study was conducted with 150 outpatients. The Calgary Depression Scale for Schizophrenia measured depression, and the Quality of Life Scale-Brazil measured quality of life. Major depression was found in 56% of patients with schizophrenia. Patients with major depression had low quality of life according to both the global scale and the occupational subscale. Global quality of life was important for separating the decision-tree statistical analyses. In patients with low quality of life, three factors were associated with depression: presence of schizophrenic symptoms, number of medications, and lack of household activities. In patients with better quality of life scores, only duration of the illness was significant. The study shows a high prevalence of depression in schizophrenia, besides highlighting its repercussions on quality of life. When evaluating quality of life, the presence of depression should be taken into consideration.

Neoplastic pulmonary lymphangitis: Symptomatic treatment and quality-of-life evaluation in a prospective palliative care series

19536 Background: Neoplastic lymphangitis, or lymphangitis carcinomatosa, is a rare and distressing form of lung metastasis, for which symptom improvement is strongly necessary. Since measuring quality of life is an important step toward improving symptom management in cancer patients, and dyspnea in pulmonary lymphangitis is a complex syndrome in end-of-life care, we focused on evaluating a cohort of those individuals. Methods: 52 consecutive patients with neoplastic pulmonary lymphangitis (NPL) were prospectivelly followed in 3 services, with quality of life (QoL) evaluation also, using Medical Outcomes Study 36-item Short-Form Health Survey (SF- 36) and Saint George's Respiratory Questionnaire (SGRQ). Results: 65% (34) of patients were female; age ranged from 37 to 84 years (median: 60). Primary tumor sites were: 28 lung (54%), 18 breast (35%), 5 digestive (9%) and 1 bone cancer. Histological findings were of adenocarcinoma in most cases (71%). Karnofsky performance scale ranged from 10 to 90% (median: 60%); 52% (27) patients had other comorbidities (Charlson index ranged from 6–10; median 7); 48% (25) were previous smokers; hemoglobin levels ranged from 4.9 to 16.7 g/dL (median: 12). We also evaluated 33 patients with echocardiography, and 13 (43%) of them had signs of associated pulmonary hypertension; ejection fraction ranged from 46 to 83% (median: 69%); diastolic dysfunction was present in 22 and pericardial effusion in 10 patients. At accrual, median QoL scores were of: 32% (range: 0–84%) for SF-36 (scale with 0 worst) and 66% (range: 0–100%) for SGRQ (scale with 100% worst). Treatment is showed in a table below. Median survival was of 4 months (range: 0.2–40+ months); 22 (42%) of the patients had an unusual longer survival of more than 6 months, still showing good QoL scores. Conclusions: Despite the fact that QoL is generally poor and survival is short for patients with NPL, some patients may have longer survival time and some improvement is possible with active palliative care. [Table: see text] No significant financial relationships to disclose.