Decline In Quality Of Life Research Articles

Protocol for a randomised controlled feasibility trial of an integrated psychosexual intervention for sexual difficulties in people with Multiple Sclerosis: the PIMS trial

BackgroundMultiple Sclerosis (MS) is a long-term condition that significantly diminishes quality of life (QoL). Sexual difficulties (SDs) are common, but often overlooked symptom, affecting 50–80% of people with MS (PwMS). The emergence of SDs in MS results from the intricate interplay of disease processes, treatments, and psychosocial factors, contributing to a further decline in QoL and adverse effects on body image, relationships, and psychological well-being. Despite the limited treatment options, which mainly include medications and physiotherapy, there is promise in psychological interventions for addressing SDs in PwMS, although integrating them into routine care poses challenges. This protocol details the trial assessing the acceptability and feasibility of an eight-session, clinicians supported integrated Psychosexual Intervention for people with Multiple Sclerosis (PIMS).MethodsThis is a multicentre interventional two-arm randomized feasibility trial with a nested qualitative study to gather preliminary data about the intervention and the feasibility of conducting a full-scale trial. We aim to recruit 50 PwMS across three research sites in England’s National Health Service (NHS). Participants will be randomised to either the PIMS intervention (comprised of 8 sessions: 6 self-led and 2-facilitator led over the course of 12 weeks) or psychosexual education (one appointment with a facilitator to discuss treatment options). Feasibility will be assessed by collecting descriptive data on recruitment and retention rates and willingness to be randomised according to Consolidated Standards of Reporting Trials (CONSORT) feasibility and pilot trial guidelines. Patient reported outcomes (e.g., measures of sexual functioning and distress, psychological functioning, and quality of life) will be measured at baseline and follow up 14-weeks after randomisation. We will also use a nested qualitative study will use inductive thematic analysis to identify barriers to engagement with and delivery of the intervention, and to make appropriate modifications to PIMS.DiscussionThe PIMS intervention will be the first integrated psychosexual intervention developed for people with Multiple Sclerosis in the UK. Assessing the feasibility of PIMS is an important first step to establishing future implementation and efficacy via a definitive randomised controlled trial.Trial registrationThis trial is registered at ISRCTN: 12202900.Registration date: 28th February 2023; Retrospectively registered.IRAS identification: 305830.NIHR award reference: NIHR202006.Trial sponsorship: This trial is co-sponsored by South London and Maudsley NHS Foundation Trust and King’s College London. Contact: slam-ioppn.research@kcl.ac.uk.Protocol version: 2.0, 10th February, 2025

Psychometric evaluation of the Persian version of the Family Caregiver-Specific Quality of Life Scale (FAMQOL) among family caregivers of patients with chronic psychiatric disorders

BackgroundFamily caregivers of psychiatric patients often experience various negative psychosocial consequences, with a decline in quality of life being the most prevalent. This study was conducted with the aim of evaluating the psychometric indices of the Persian version of the Family Caregiver-Specific Quality of Life Scale (FAMQOL).MethodsThis cross-sectional study was conducted in 400 family caregivers of patients with chronic psychiatric diseases in Iran in 2024 using convenience sampling. Using a forward-backward translation procedure, the face and content validity of the FAMQOL were assessed through both qualitative and quantitative methods. After face and content validity, in order to determine construct validity, exploratory (n = 200) and confirmatory (n = 200) factor analysis was performed. To determine reliability, internal consistency (Cronbach’s alpha coefficient and Macdonald’s omega coefficient) and stability (intraclass correlation coefficient) were estimated.ResultsA total of 400 participants were evaluated, comprising 184 males (46.0%) and 216 females (54.0%). In content validity, one item was removed and during exploratory factor analysis, the remaining 15 items were loaded on four factors including social, spiritual, physical and psychological, which described 61.74% of the total variance. Confirmatory factor analysis showed that the obtained model has a good fit. All obtained factors had convergent and discriminant validity. Cronbach’s alpha (0.783 to 0.932), Macdonald’s omega (0.817 to 0.934) and intraclass correlation coefficients (0.953 to 0.971) showed acceptable internal consistency and stability of the factors of the Persian version of FAMQOL.ConclusionFindings from this study confirm that the Persian version of the FAMQOL is a valid and reliable instrument for evaluating the quality of life among family caregivers of patients with chronic psychiatric disorders. This scale holds significant potential for both research and clinical applications, facilitating the identification of caregivers’ needs and guiding the creation of targeted interventions to enhance their quality of life.

Long-Term Quality of Life Trend after Subthalamic Stimulation for Parkinson's Disease: An Updated Systematic Review and Meta-Analysis.

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a well-established treatment for Parkinson's Disease (PD). However, the long-term trajectory of Quality of Life (QoL) following STN-DBS remains underexplored. We aimed to conduct a systematic review and meta-analysis to assess QoL trends up to five years after STN-DBS. We systematically searched PubMed, Embase, and Cochrane databases from inception to August 2024 for studies involving PD patients treated with bilateral STN-DBS, evaluating QoL using the Parkinson's Disease Questionnaire (PDQ), with a minimum follow-up of 12 months post-surgery. Continuous outcomes were pooled using standardized mean differences (SMD), and statistical analyses were conducted using R version 4.3.2. Out of 4106 screened articles, 42 studies with a total of 2767 patients were included in the meta-analysis. QoL improvements were observed up to 36 months post-surgery (SMD 0.83; 95% CI 0.29 to 1.37), followed by a decline to pre-operative levels at 60 months (SMD -0.06; 95% CI -0.26 to 0.15). Subdomain analysis at 60 months revealed significant deterioration in cognitive function and communication. Meta-regression indicated that QoL improvements were independent of clinical and sociodemographic factors such as age, sex, and disease duration; however, there was a correlation with mean baseline PDQ (P = 0.01). This meta-analysis provides long-term QoL trends following STN-DBS, highlighting a further need to explore the factors driving the decline in QoL and develop strategies to mitigate this deterioration.

Enhancing Quality of Life: The Effect of Complete Decongestive Therapy on Jordanian Women With Breast Cancer After Axillary Lymph Node Dissection.

This study aimed to compare the incidence of breast cancer-related lymphedema (BCRL) between a control group and women with breast cancer who underwent complete decongestive therapy (CDT). Moreover, the quality of life (QOL) was assessed and compared between the intervention group receiving CDT and the control group. A quasi-experimental design with a purposeful sampling approach was employed for enrollment. All participants had undergone surgical interventions, specifically axillary lymph node dissection (ALND), for breast cancer at a public healthcare facility between February and July 2023. Over an 18-week period, the intervention group followed a structured CDT protocol, which included receiving skin care instructions, undergoing 30-minute manual lymphatic drainage sessions on the affected arm, wearing compression sleeves for 12 hours daily, and participating in exercise sessions three times per week. In total 180 women, 90 in the CDT group and 90 controls were recruited. The CTD intervention group experienced a notable reduction in the incidence of BCRL development and a significant improvement in QOL across the three assessment times (baseline vs week 9 and week 9 vs week 18) during the study (p<0.001). In contrast, the control group showed an increased rate of BCRL development and a significant decline in QOL when comparing the same three time points (p<0.001). Implementing CDT within the first year following ALND led to a significant reduction in the incidence of BCRL and a marked improvement in the QOL for women with who underwent surgery and ALND for breast cancer.

Effect of Foot Reflexology with Aromatic Oil to Assess Sleep Quality among Healthy Individuals: A Narrative Review

Objective: The primary objective of this literature review was to evaluate the effectiveness of foot reflexology with aromatic oil to assess Sleep quality among healthy individuals. Introduction: Sleep is a vital activity that offers relaxation, stability, stress release, and the capacity to recuperate from physical or mental exhaustion, but not getting enough sleep can lead to tiredness, sleepiness, anxiety, dizziness, instability, disorientation, focus problems and a decline in quality of life (QoL).Due to its great frequency and correlation with both mortality and morbidity, inadequate sleep has emerged as a public health problem in several nations. Methodology: A complete electronic search of published research publications was carried out utilizing databases such as Google Scholar, PubMed, and others. The search sought research that evaluated the benefits of foot reflexology with aromatic oil on sleep quality in healthy individuals. This literature review included papers that fit the requirements, such as randomized controlled trials, systematic reviews, meta-analyses, and pilot studies. Results: This review investigated the ways in which foot reflexology combined with aromatic oil affects the quality of sleep and improves physiological as well as psychological well-being of an individual. Conclusion: This study found that using foot reflexology with aromatic oil can enhance sleep quality in healthy individuals. Regular practice of foot reflexology with aromatic oil may help to alleviate sleep-related difficulties and promote overall well-being, with no recorded negative effects.

Biokinetic gait differences between Hallux valgus patients and asymptomatic subjects.

Biokinetic gait differences between Hallux valgus patients and asymptomatic subjects.

Galectin-3: Heart failure biomarker in pediatric heart defects.

Galectin-3 (Gal-3), a β-galactoside-binding lectin, has emerged as a potential diagnostic and prognostic biomarker for various diseases, including certain heart and kidney diseases, as well as cancer. Its significance is particularly notable in the context of congenital heart defects (CHD), which are the most prevalent congenital malformations, occurring in 6 to 8 out of every 1000 live births. Symptoms of heart failure (HF) in patients with congenital heart defects can manifest early in life, but in some cases, the disease progresses gradually, leading to a gradual decline in quality of life and the development of various complications. This variability underscores the need for early biomarkers to detect HF development in pediatric patients. Gal-3 plays a key role in myocardial remodeling, making it a promising candidate for advancing the diagnosis and management of HF in CHD patients. It is especially relevant in pediatric care, where early detection and intervention can significantly alter disease progression and patient outcomes. This review aims to consolidate current knowledge on the utility of Gal-3 in predicting HF among pediatric patients with CHD, highlighting its potential in changing the direction of diagnosis and treatment in this vulnerable patient population.

Perceptions of Healthcare Quality in Duchenne Muscular Dystrophy: A Patient Experience Exploratory Study.

Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle weakness, a decline in quality of life, and premature mortality. This study aims to evaluate the perceived quality of healthcare and the experience of DMD patients and their caregivers in Mexico, comparing governmental and non-profit healthcare institutions using a newly designed assessment instrument. In a cross-sectional study, data were gathered from 91 participants through an online self-administered questionnaire informed by the Donabedian model and six dimensions of healthcare quality. Analysis revealed two key mediating factors: perceived quality of healthcare and patient experience. The Mann-Whitney U test showed that non-profit organizations were perceived to provide superior quality care in both aspects (p < 0.05), notably regarding healthcare professionals' preparedness and other domains of quality. However, the patient-centered care domain indicated that the importance of quality domains may vary according to cultural and social contexts. In Mexico, the humanistic approach of healthcare professionals appeared to compensate for shortcomings in timely diagnosis and other quality domains. This emphasizes the necessity for enhanced patient education and healthcare evaluation, and it highlights that patient satisfaction does not always correlate with high-quality healthcare. The developed instrument can further aid in understanding the experiences of DMD patients across different countries and cultures.

Impact of perceived side-effects of psychotropic treatments on quality of life in patients with severe mental illness.

Psychotropic medications are critical in managing severe mental illnesses (SMI) such as schizophrenia, major depressive disorder (MDD) and bipolar disorder. However, these treatments often lead to adverse side effects that can impair patients' quality of life (QoL) and affect treatment adherence. This study aims to investigate the specific side effects of psychotropic treatments that contribute to a decline in QoL among patients with SMI, independently of treatment adherence. We conducted a cross-sectional study with 1248 patients diagnosed with SMI, recruited from a university psychiatric unit in Marseille, France. QoL was assessed using the Schizophrenia Quality of Life Scale (SQoL-18), and side effects were measured using the UKU Side Effect Rating Scale. Treatment adherence was evaluated using the Medication Adherence Rating Scale (MARS). Statistical analyses included Pearson correlations and multiple linear regression models to identify predictors of QoL. The study found that side effects, as identified by the UKU scores, could significantly predict a reduction in QoL across multiple domains, including multiple dimensions of QoL and the overall QoL index, independent of treatment adherence. Patients on antipsychotics and benzodiazepines reported higher levels of adverse side effects, which correlated with lower QoL scores. An increase in the number of psychotropic treatment classes was also associated with a significant decline in QoL (p < 0.001). Managing psychic side effects and minimising polypharmacy are critical to improving QoL in patients with SMI. Clinicians should consider these factors when developing personalised treatment strategies to enhance patient outcomes.

Determining the influence of an intervention of stress management on medical students’ levels of psychophysiological stress: the protocol of the PROMESS-Stress clinical trial

BackgroundMedical students face highly competitive stressful situations throughout their curriculum, which can lead to elevated stress levels and a major decline in quality of life, well-being, learning abilities, and health. It is crucial to assist medical students in coping with these stressful situations during their curriculum.MethodsThe PROMESS-Stress clinical trial aims to support future healthcare professionals by enhancing their abilities to manage stressful situations. The support will be provided through a 3-session stress management program. Each session will include an individual meeting between a PROMESS-Stress expert and a medical student. To reduce stress levels and enhance coping mechanisms, these sessions will focus on establishing personalized advice and goals. The present protocol is designed to assess the influence of this program on forty-five undergraduate medical students (4th and 5th-year) of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France). Assessments of psychological and physiological stress variables will be conducted before and during the intervention. At the end of the 3rd session the student’s levels of satisfaction will be assessed.The primary outcome will be changes in scores on the Perceived Stress Scale (PSS), while secondary outcomes will provide a detailed characterization of the intervention’s effects on stress coping behaviors, psychological and physiological stress variables. Exploratory outcomes will provide information regarding the student’s level of satisfaction and will determine the moderators of the program’s efficacy.Data will be analyzed according to the intention-to-treat principle and presented in accordance with the CONSORT Guidelines. Ethical approval has been obtained by the Institutional Review Board (IRB: 2023–07-04–02) and all the procedures will be performed in adherence to the Helsinki declaration. Results from this study will be presented at scientific conferences and in peer-reviewed scientific journals.DiscussionResults will provide valuable insights into the program's efficacy in reducing stress and improving coping abilities. If its efficacy is proven, PROMESS-Stress could become an integral and sustainable part of medical education, fostering a healthier and more resilient future for healthcare professionals.This manuscript follows the SPIRIT guidelines (Additional files 1 & 6).Trial registrationClinicalTrials.gov: NCT06295133; retrospectively registered.

Prospective real world data evaluation of clinical outcomes in metastatic hormone sensitive prostate cancer (MHSPC) patients treated as part of triplet therapy with darolutamide: UK multicenter RECOMMEND study.

89 Background: Darolutamide has authorisation for treatment of metastatic hormone sensitive prostate cancer (MHSPC) in combination with docetaxel chemotherapy and androgen deprivation therapy (triplet therapy) based on ARASENS trial results. The RECOMMEND study is a prospective real-world evaluation (RWE) of clinical outcomes in patients with MHSPC treated with this regimen in the UK. Methods: 318 patients were enrolled from 21 UK centres over 20 months from November 2022. Data cut-off was 14 August 2024. Disease characteristics were evaluated. Descriptive statistics have been used for patient demographics and PSA changes with treatment were analysed. Results: Patients on the study had a median age of 67 (range 38-84) years. Majority of the patients were de novo metastatic (91.2%). 68.2% have a Gleason score ≥8. 76 patients (23.9%) had next generation imaging (NGI) at diagnosis. Performance score was 0 (62.7%) or 1 (37.3%). The distribution of metastases (%) were: bone (84.9), nodal (60.4), lung (12.6) and liver (2.5). The median PSA level was 134 (range 1 to 5628) ng/mL at diagnosis. At the end of docetaxel chemotherapy median PSA was 0.35 ng/mL. PSA response see in the 226 patients who had completed 6 cycles of docetaxel chemotherapy at the data cut-off, PSA 50 was seen in 87.6% (198/226) and PSA 90 in 53.2%. PSA responses in those who only completed 4/5 cycles of docetaxel (n=14) did not significantly differ compared to those who completed all 6 cycles (PSA 50 p=0.445 and PSA 90 p-0.664). At 6 months from darolutamide initiation, quality of life (QoL) data is currently available for 173 patients, of these 88.4% reported either stable or improved QoL and 11.6% had a decline in QoL at the end of chemotherapy. Conclusions: The tolerability and efficacy profile of treatment with ADT+Darolutamide+Docetaxel in MHSPC in the RECOmMEnD study is similar to that reported in the ARASENS trial. The QoL data available for 173 patients to date reports either stable or improved QoL at 6 months for 88.4% cases. This provides important prospective RWE data, enabling patients and clinical teams to make informed choices in this setting.

Androgen suppression with abiraterone acetate, leuprolide, PARP inhibition, and stereotactic body radiotherapy (ASCLEPIuS) in high-risk and node positive prostate cancer (PCa): Phase I multicenter results.

387 Background: Level 1 evidence supports treatment of high-risk and node positive PCa using 4-9 weeks of radiotherapy (RT) combined with 18-36 months of androgen deprivation therapy (ADT) with or without abiraterone acetate plus prednisone (AAP). While effective, some cancers recur, and this prolonged treatment is associated with inconvenience and variable morbidity. We aimed to determine whether the biological synergy of stereotactic body radiotherapy (SBRT) with a 6-month combination of ADT, AAP, and the PARP inhibitor niraparib, could enable a shorter intensified, yet safe and effective, therapeutic alternative. Methods: ASCLEPIuS (NCT04194554) is a multicenter investigator-initiated phase I/II trial in high-risk or node positive, homologous recombination unselected, PCa. Patients received 6 months of ADT, AAP, niraparib and SBRT to the prostate (37.5-40 Gy) +/- pelvic lymph nodes (25 Gy). Focal prostate/nodal boosting was permitted. The phase I primary endpoint was the maximum tolerated dose (MTD) of niraparib using the time-to-event continuous reassessment method (3 dose levels: 100 mg and 200 mg held during SBRT, or 200 mg concurrent with SBRT). Dose limiting toxicities (DLT) were any persistent grade 4+ hematologic toxicity or any grade 3+ rectal/urinary toxicity at least possibly related to treatment as assessed by CTCAE v5.0. Patient reported quality of life (QOL) was assessed with the EPIC-26 short form. Linear mixed models were used to compare scores over time. Results: Accrual began in Nov. 2020 with a transition from phase I to phase II in May 2023 after enrolling 54 men. Median follow-up of the phase I cohort is 12.1 months (IQR 9.4-18.9), 80% (n=43) had Grade Group 4-5, median PSA was 17 ng/mL (range, 1-73), 15% (n=8) had cN+ disease, and 76% (n=41) received nodal RT. There were 0 DLTs to date, no grade 3+ rectal or urinary toxicities, and 5 serious adverse events at least possibly attributable to study treatment (anemia, non-rectal gastrointestinal, syncope, infection, musculoskeletal). The most common grade 3 toxicities were hypertension (n = 11, 21%) and leukopenia (n=6, 11%). Transient dose reductions or holds of AAP or niraparib occurred in 10 and 11 patients, respectively. There were no statistically significant declines in patient reported urinary QOL at 6- or 12-months post-treatment compared to baseline (all p &gt;0.15). A transient decline in bowel QOL at 6-months occurred (p&lt;0.01), which improved by 12-months (p=0.16). Conclusions: Our phase I findings support the short-term safety and tolerability of the combination of SBRT to the prostate and nodes, ADT, AAP, and niraparib at an MTD of 200 mg in men with high-risk or node positive PCa. Our trial completed phase II enrollment in May 2024, and longer-term safety, efficacy, and genomic correlations will be presented in the future. Clinical trial information: NCT04194554 .

Determinants of health-related quality of life in patients undergoing medical expulsion therapy for acute renal colic.

Patients with ureteral stones and acute renal colic significantly impaired their quality of life (QOL). However, the factors that affect quality of life during conservative management, particularly medical expulsive therapy (MET), are not well understood. This study aimed to assess the determinant of QOL. We conducted a prospective study to longitudinally assess QOL using the EuroQol-5 Dimension (EQ-5D) in patients undergoing medical expulsive therapy. Ninety-three patients were enrolled between April 2020 and December 2022, and 187 questionnaires were completed at each visit before spontaneous passage or intervention. The study found that a higher pain intensity was significantly associated with worse QOL during the primary visit (p = 0.03). At the second visit, younger age (p < 0.01), increased frequency of renal colic attacks (p < 0.01), maximum pain intensity since the last visit (p < 0.01), and shorter time from disease onset (p = 0.03) were associated with a worse QOL. Multivariate analysis showed that only the total number of renal colic attacks was associated with EQ-5D score (p = 0.047). The stone location significantly affected the cumulative incidence of renal colic attacks (p = 0.02). The mean total number of renal colic until stone passage was 3.58 in individuals with proximal stones versus 0.86 in with distal stones (p < 0.01). This study identified pain intensity and colic frequency as key factors contributing to the decline in QOL in patients with ureteral stones. Patients with proximal stones may be good candidates for early intervention to reduce colic events.

Assessing impact of postoperative outcomes and quality of life on decisional regret after resection of pancreatic ductal adenocarcinoma.

699 Background: Surgery is potentially curative for patients with localized pancreatic ductal adenocarcinoma (PDAC). Given the high rate of complications, decline in quality of life (QoL) postoperatively, and high rates of recurrence, clear preoperative communication and expectation setting is critical. This study investigates clinical outcomes that affect postoperative decisional regret (DR) in patients with PDAC. Methods: This mixed-methods study investigates the impact of clinical outcomes and QoL on the degree of DR in patients with PDAC who have undergone curative-intent resection at least 6 months prior to study recruitment. Patients completed validated surveys assessing DR and QoL by the European Organization for Research and Treatment of Cancer (EORTC). Groups are stratified by presence or absence of DR, assessed by the Decisional Regret Scale (DRS). Characteristics and survey scores were compared by chi-square, independent t-test, and median test. Narrative responses were thematically analyzed. Given significant findings, results of this interim analysis are reported below. Results: 45 patients met inclusion criteria and completed all questionnaires. 19 (42.2%) patients expressed regret about their decision to pursue curative-intent surgery, with 5 patients expressing moderate to severe regret (DRS ≥ 25). There was no significant difference in median postoperative timing of survey completion between groups (56 months in DR group vs 34 months, P=0.465). Baseline characteristics, medical treatments, and operative approaches were similar. Both groups had similar recurrence rates at time of survey completion. While 30 and 90 day readmission rates were similar, a greater proportion of the DR group had 30 day complications (42.1% vs 15.4%, P=0.045). Those expressing regret reported poorer physical functional status (mean score 79.30 ± 18.84 vs 92.31 ± 10.27, P=0.011) and greater impact on social activities (mean score 67.54 ± 33.55 vs 84.67 ± 19.19, P=0.038). Thematic analysis of narrative responses revealed that a majority of patients expressed a strong desire to have a greater focus on potential QoL changes during preoperative discussions. Conclusions: Patients expressing postoperative DR experienced more 30 day complications, and still report lasting effects on their current physical status and social activities. This emphasizes the importance of thorough preoperative counseling on surgical risks and potential changes in postoperative QoL so that patients may make the best informed decision.

Impact of race on end-of-life care among patients with esophageal cancer.

337 Background: Esophageal cancer is an aggressive malignancy with rising incidence globally. Patients with advanced esophageal cancer suffer from a heavy burden of a wide array of symptoms including dysphagia and cachexia/anorexia, necessitating the need for focused symptom management and palliative care. Studies focused on other cancer types have shown that Black patients are more likely to receive aggressive care at end-of-life (EOL) and suffer from a decline in quality of life. We sought to investigate racial differences in EOL care among patients with advanced esophageal cancer in the US. Methods: The National Inpatient Sample (NIS) was queried to identify all hospitalizations with esophageal cancer utilizing ICD-10 codes C15x from 2016 to 2020. Hospitalizations of White and Black patients with documented inpatient mortality events were then extracted. Demographic and clinical data were analyzed using chi squared tests, independent sample t-tests, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). Adjusted Odds ratios (aOR) are presented with 95% Confidence intervals (CI). Results: A total of 15,130 patients with esophageal cancer were included, of which 13,345 (88.2%) were White and 1785 (11.8%) were Black. Hospitalizations with White patients recorded higher age, more males, and higher comorbidities per CCI. Hospitalizations with Black patients had longer lengths of stay on average, higher total hospital charges, and significantly less likely to have a Do Not Resuscitate (DNR) code status (aOR 0.81, 0.74-0.9 95% CI). Rates of inpatient palliative care consultation at EOL were significantly lower among Black patients (aOR=0.53, 0.48-0.58 95% CI). Black patients were more likely to receive aggressive intervention at EOL demonstrated by rates of blood transfusion (aOR 1.9, 1.6-2.1 95% CI), mechanical ventilation (aOR 1.7, 1.5-1.8 95% CI), and vasopressor usage (aOR 1.4, 1.2-1.6 95% CI). Conclusions: We present a large retrospective analysis demonstrating significant racial disparities in EOL care amongst hospitalized patients with esophageal cancer. Black patients had longer lengths of stay, lower rates of palliative care consultation and DNR code status, and higher rates of aggressive interventions at EOL. These findings may have implications for improving health care decision making for EOL care amongst minority patients with esophageal cancer. WhiteN=13345 BlackN=1785 p-value Age (in years) 68.24±10.67 65.12±10.36 &lt;.001 CCI 9.4±3.3 8.6±3.9 &lt;.001 Mean length of stay (days) 7.5±11.3 10.4±22.8 &lt;.001 Total Cost (In thousands of dollars) 108.6±231.0 141.9±388.5 &lt;.001 Palliative Adjusted OR 60.9% 45.1% .53 (.48 - .58) &lt;.001 DNR Adjusted OR 63.8% 58.0% .81 (.74 - .90) &lt;.001 Blood transfusion Adjusted OR 13.0% 23.0% 1.9 (1.6-2.1) &lt;.001 Mechanical ventilation Adjusted OR 31.4% 45.9% 1.7 (1.5-1.8) &lt;.001 Vasopressor Adjusted OR 7.8% 10.6% 1.4 (1.2-1.6) &lt;.001

Detecting mild cognitive impairment by applying integrated random forest to finger tapping.

Early detection of dementia is essential to reduce the decline in quality of life (QoL) and the increase in medical and nursing care costs associated with dementia in an aging society. In this study, we aimed to develop a simple screening test for mild cognitive impairment (MCI), a preliminary stage of dementia, by creating an analytical method to accurately detect MCI through finger-tapping measurement. We extracted 248 characteristics from the finger-tapping waveforms of 182 MCI patients and 352 normal controls, applying five conventional classification methods along with an improved Random Forest (RF) method proposed in this study (Integrated RF). In the proposed method, the RF classification model for the MCI and normal control groups is supplementally integrated with the RF classification model for the Alzheimer's disease and normal control groups to generate a new classification model. When comparing the discrimination accuracy of each method, the proposed method achieved the highest accuracy, with an F1-score of 0.795 (recall = 0.778 and precision = 0.814). These results demonstrate the potential of finger-tapping measurement as a highly accurate screening test for MCI.

Topical review: Challenges and solutions for eye care in long-term care.

The prevalence of visual impairment among individuals living in long-term care (LTC) is substantial, yet eye care is often disregarded and inadequately addressed. This neglect contributes to a decline in quality of life for residents. Thus, understanding the challenges faced by stakeholders in providing eye care for residents might suggest opportunities to improve eye health outcomes. This study aimed to identify factors influencing access to eye care services in LTC, focusing on key stakeholders including residents, family members, aged care staff, and eye care professionals. We included studies on vision/eye care-related challenges and/or management of eye conditions for people living in LTC facilities. We performed literature searches using Cochrane Database of Systematic Reviews, PubMed, CINAHL/EBSCO, EMBASE, APA PsycINFO, and Web of Science database. The search was limited to articles in English language, published between January 2013 and September 2023. Factors influencing the vision/eye care for residents were mapped to respective stakeholders, and we visualized how they interacted within the LTC system in providing eye care. Eleven studies were included in the review. We found that the challenges to appropriate eye care in LTC are present across all stakeholder groups. These challenges include limited awareness of eye health, logistical difficulties in coordinating and managing eye care within LTC settings, and negative beliefs and attitudes toward prioritizing eye care for residents. This review highlights that barriers to eye care in LTC communities exist at multiple levels and involve a range of stakeholders. In order to improve eye care, interventions should be at the system level, considering the influence of all key stakeholders rather than employing a targeted approach.

Integration of Autogenic Exercise and Murrotal Al-Quran Improves the Quality of Life of the Elderly: A Quasy Experimental Study

The rising number of older adults in Indonesia, particularly those living with non-communicable diseases (NCDs) like diabetes mellitus (DM), presents significant challenges in enhancing their quality of life. This study investigates the impact of combining autogenic exercise with Al-Quran murottal on the quality of life among the elderly with DM. Employing a quasi-experimental design with a pre- and post-test approach, the research involved 89 elderly participants who met the inclusion criteria. These participants were divided into two groups: an intervention group, which received regular sessions of autogenic training combined with Al-Quran murottal, and a control group, which practiced self-directed internalization. The WHOQOL-OLD instrument was used to assess quality of life, with data analyzed using paired t-test and independent t-test. The findings revealed a significant improvement in the quality of life for the intervention group, as reflected by an increase in the average score from 49.42 to 74.72 (p &lt; 0.05). Conversely, the control group experienced a minor, statistically insignificant decline in quality of life. These results demonstrate that integrating physical and spiritual elements, such as autogenic exercises and Al-Quran murottal, effectively enhances the quality of life for older adults with DM, offering a holistic approach to improving their well-being.

Resilience and vulnerability of post-ostomy patients with early-onset colorectal cancer from the perspective of social-ecological theory: a qualitative study.

The incidence rate of colorectal cancer (CRC) is rising among adults under the age of 50 (early-onset colorectal cancer, EOCRC). Post-ostomy dysfunction, along with negative perceptions due to incorrect public views and a decline in quality of life, has a significant impact on these individuals, their families, and social relationships. By understanding the adaptation process of post-ostomy EOCRC(POEOCRC) patients, this study aims to provide information for developing targeted nursing interventions for this population. Based on the social-ecological theory, semi-structured, in-depth interviews were conducted with 16 POEOCRC patients in China between May 2023 and January 2024.Colaizzi's method of phenomenology was employed for data analysis. This study found two aspects of adaptation experience in POEOCRC patients. For resilience, three themes emerged:(1) Micro-Positive individual psychological experiences, (2) Meso-Positive adjustment within the family and (3) Macro-Social resource integration and utilization. In terms of vulnerability, three themes were as follows:(1) Micro-Persistent negative experiences, (2) Meso-Family crisis caused by the ostomy and (3) Macro-Urgency and fragility of social support. This study based on the social-ecological theory and highlights different dimensions of resilience and vulnerability experienced by POEOCRC patients. Early and targeted interventions to promote patients' coping skills and their ability to adapt to family and society.

Quality of life in overweight and obese children

Background. The prevalence of childhood obesity has reached concerning levels worldwide, posing a pressing and serious public health issue. The objective of this study is to examine the quality of life (QoL) in children with elevated body weight and obesity. Materials and methods. The study involved 151 children (71 girls and 80 boys) aged 12 to 17 years. The assessment included measurements of body weight, height, and calculation of body mass index, adjusted for age and sex. Based on body mass index, the children were categorised into three groups: 1 — normal weight; 2 — overweight; 3 — obese. The quality of life of participants was evaluated using the PedsQL™ 4.0 questionnaire. Results. The findings reveal a marked reduction in QoL among obese children, with the extent of QoL decline correlating with the degree of excess weight. The overall QoL score, based on the children’s self-assessment, was significantly lower in higher body weight categories: obesity — 55.96 ± 0.59 points; overweight — 78.97 ± 1.08 points; control group — 84.42 ± 1.69 points. Children in the obesity group reported the greatest reduction in the physical functioning scale, scoring an average of 54.40 ± 3.56 points. In questionnaires completed by parents, the overall QoL scores were as follows: obesity — 56.60 ± 0.77 points; overweight — 79.97 ± 1.11 points; control group — 85.22 ± 2.15 points. Parents identified the largest QoL reduction in the social functioning scale for children with obesity (54.28 ± 2.65 points). Conclusions. The study highlights a direct relationship between increased body weight and reduced QoL. Children’s self-reports indicate the most significant decline in physical functioning, while parents noted a substantial drop in social functioning of children with obesity.