Differences In Quality Of Life Research Articles

Efficacy of Traditional Acupuncture Compared to Biofeedback Therapy in Fecal Incontinence: A Randomized Controlled Trial.

Fecal incontinence has a devastating impact on quality of life and imposes a substantial socioeconomic burden. Best medical therapy including biofeedback therapy improves mild symptoms, with minimal impact on moderate to severe symptoms. Surgical management for incontinence carries a degree of morbidity resulting in low uptake and acceptability. While acupuncture is common practice in Singapore for numerous medical conditions, its role in fecal incontinence is relatively novel. In our local context, however, acupuncture is accessible, inexpensive, and potentially well-accepted as a treatment strategy. To determine the effectiveness of Traditional Chinese Medicine acupuncture, compared to biofeedback therapy in the treatment of fecal incontinence. The secondary aim is to investigate the differences in quality of life following treatment. Randomized controlled trial. Prospective, single institution study. Patients with ≥2 episodes of fecal incontinence/week, or St Mark's incontinence score of ≥5 were recruited. Patients were randomized into biofeedback therapy which included 3 sessions over 10 weeks, or 30 sessions of acupuncture over 10 weeks. Incontinence episodes, St. Mark's Score and Fecal Incontinence Quality of Life scale. Eighty-five patients were randomized into biofeedback therapy (n=46) or acupuncture (n = 39). Demographics and baseline clinical characteristics were not different (p > 0.05). Overall median incontinence episodes were reduced in both, with the acupuncture arm reporting significantly fewer at week 15 (p < 0.001). Acupuncture also improved quality of life, with improvement in lifestyle, coping, depression, and embarrassment at week 15 (p < 0.05). While the St. Mark's score was significantly reduced in both arms at week 15 (p < 0.001), the acupuncture arm's score was significantly lower (p = 0.002). Longer follow-up required. Acupuncture is clinically effective and improves quality of life in patients with fecal incontinence. See Video Abstract. Clinicaltrials.gov: NCT04276350.

Short- and long-term effects of imatinib in hospitalised COVID-19 patients: A randomised trial

ObjectivesWe studied the short- and long-term effects of imatinib in hospitalised COVID-19 patients. MethodsParticipants were randomised to receive standard of care (SoC) or SoC with imatinib. Imatinib dosage was 400mg daily until discharge (max 14 days). Primary outcomes were mortality at 30 days and 1 year. Secondary outcomes included recovery, quality of life and long COVID symptoms at 1 year. We also performed a systematic review and meta-analysis of randomised trials studying imatinib for 30-day mortality in hospitalised COVID-19 patients. ResultsWe randomised 156 patients (73 in SoC and 83 in imatinib). Among patients on imatinib, 7.2% had died at 30 days and 13.3% at 1 year and in SoC 4.1% and 8.2% (adjusted HR 1.35, 95% CI 0.47–3.90). At 1-year, self-reported recovery occurred in 79.0% in imatinib and in 88.5% in SoC (RR 0.91, 0.78-1.06). We found no convincing difference in quality of life or symptoms. Fatigue (24%) and sleep issues (20%) frequently bothered patients at one year. In the meta-analysis, imatinib was associated with a mortality risk ratio of 0.73 (0.32–1.63; low certainty evidence). ConclusionsThe evidence raises doubts regarding benefit of imatinib in reducing mortality, improving recovery and preventing long COVID symptoms in hospitalised COVID-19 patients.

Laparoscopic cholecystectomy versus conservative management for adults with uncomplicated symptomatic gallstones: the C-GALL RCT.

Gallstone disease is a common gastrointestinal disorder in industrialised societies. The prevalence of gallstones in the adult population is estimated to be approximately 10-15%, and around 80% remain asymptomatic. At present, cholecystectomy is the default option for people with symptomatic gallstone disease. To assess the clinical and cost-effectiveness of observation/conservative management compared with laparoscopic cholecystectomy for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones in secondary care. Parallel group, multicentre patient randomised superiority pragmatic trial with up to 24 months follow-up and embedded qualitative research. Within-trial cost-utility and 10-year Markov model analyses. Development of a core outcome set for uncomplicated symptomatic gallstone disease. Secondary care elective settings. Adults with symptomatic uncomplicated gallstone disease referred to a secondary care setting were considered for inclusion. Participants were randomised 1: 1 at clinic to receive either laparoscopic cholecystectomy or observation/conservative management. The primary outcome was quality of life measured by area under the curve over 18 months using the Short Form-36 bodily pain domain. Secondary outcomes included the Otago gallstones' condition-specific questionnaire, Short Form-36 domains (excluding bodily pain), area under the curve over 24 months for Short Form-36 bodily pain domain, persistent symptoms, complications and need for further treatment. No outcomes were blinded to allocation. Between August 2016 and November 2019, 434 participants were randomised (217 in each group) from 20 United Kingdom centres. By 24 months, 64 (29.5%) in the observation/conservative management group and 153 (70.5%) in the laparoscopic cholecystectomy group had received surgery, median time to surgery of 9.0 months (interquartile range, 5.6-15.0) and 4.7 months (interquartile range 2.6-7.9), respectively. At 18 months, the mean Short Form-36 norm-based bodily pain score was 49.4 (standard deviation 11.7) in the observation/conservative management group and 50.4 (standard deviation 11.6) in the laparoscopic cholecystectomy group. The mean area under the curve over 18 months was 46.8 for both groups with no difference: mean difference -0.0, 95% confidence interval (-1.7 to 1.7); p-value 0.996; n = 203 observation/conservative, n = 205 cholecystectomy. There was no evidence of differences in quality of life, complications or need for further treatment at up to 24 months follow-up. Condition-specific quality of life at 24 months favoured cholecystectomy: mean difference 9.0, 95% confidence interval (4.1 to 14.0), p < 0.001 with a similar pattern for the persistent symptoms score. Within-trial cost-utility analysis found observation/conservative management over 24 months was less costly than cholecystectomy (mean difference -£1033). A non-significant quality-adjusted life-year difference of -0.019 favouring cholecystectomy resulted in an incremental cost-effectiveness ratio of £55,235. The Markov model continued to favour observation/conservative management, but some scenarios reversed the findings due to uncertainties in longer-term quality of life. The core outcome set included 11 critically important outcomes from both patients and healthcare professionals. The results suggested that in the short term (up to 24 months) observation/conservative management may be a cost-effective use of National Health Service resources in selected patients, but subsequent surgeries in the randomised groups and differences in quality of life beyond 24 months could reverse this finding. Future research should focus on longer-term follow-up data and identification of the cohort of patients that should be routinely offered surgery. This trial is registered as ISRCTN55215960. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/71) and is published in full in Health Technology Assessment; Vol. 28, No. 26. See the NIHR Funding and Awards website for further award information.

Gender-based difference in quality of life of Migraine sufferers: A Cross-Sectional Study

Gender-based difference in quality of life of Migraine sufferers: A Cross-Sectional Study

#1562 Longitudinal changes in quality of life—a comparison between institutional hemodialysis, home-hemodialysis and peritoneal dialysis

Abstract Background and Aims Quality of life is an important factor for patients when planning for future dialysis care and for some individuals, it might be even more important than a prolonged life. Knowledge about differences between dialysis modalities is essential for patients making informed decisions. Most previous research on differences in quality of life between dialysis modalities have been cross-sectional and subjected to selection bias; few large contemporary studies have investigated the changes in quality of life between the three dialysis modalities; institutional hemodialysis (IHD), home hemodialysis (HHD) and peritoneal dialysis. The aim of the present study was to compare longitudinal changes in health-related physical and mental quality of life between patients on IHD, PD, and HHD. Method Patients on dialysis with at least two Research and Development 36 (RAND-36) questionnaires between 2017-2021 in the Swedish Renal Registry (SRR) were eligible for inclusion. Information on dialysis modality, patient characteristics and medication were obtained from the SRR and other national registries. Patients were followed for three years and remained in their designated dialysis modality in the analysis until end of the follow-up (intention-to-treat). Changes in physical (PCS) and mental (MCS) component summary score were analyzed in adjusted linear mixed models and joint models where informative censoring due to mortality and kidney transplantation was considered. Results 930 patients (IHD 714, HHD 88, PD 128), were followed for 1.8 years (IQR 1.0–2.1). Patients on HHD were younger, had lower Charlson comorbidity index (CCI) and higher serum albumin compared with IHD and PD (Table 1). At baseline, patients on IHD had a mean PCS 30.7 (95% CI 29.9–31.4) and MCS 45.6 (95% CI 44.7–46.5). The unadjusted PCS at baseline was higher in HHD patients (4.5 [95% CI 2.2–6.9]) and PD patients (2.5 [95% CI 0.5–4.5]) compared with patients on IHD but showed no difference in the adjusted models. Both unadjusted and adjusted MCS was similar at baseline. The PCS declined over time in all modalities; faster for patients on PD compared with IHD (−1.2 per year [95% CI −2.1 – −0.3]; Fig. 1). MCS decreased similarly for both PD and IHD over time, while patients on HHD had an improving MCS (1.5 per year [95% CI 0.1–2.8]) compared with patients on IHD (Fig. 2). Conclusion There are differences in the development of physical and mental quality of life over time for patients on different dialysis modalities. The dialysis modality with the overall most positive development was HHD. Offering HHD to more patients could potentially improve the quality-of-life for patients on dialysis.

Differences In Quality of Life of Nasopharyngeal Carcinoma Patients at Rsi Sultan Agung Semarang Observational Analytical Studies in Age, Gender, and Stage of Cancer

Nasopharyngeal carcinoma is a malignant tumor in the head and neck area of squamous cell type located in the nasopharynx. Nasopharyngeal carcinoma in Indonesia is the 4th most malignant cancer and is considered one of the most malignant tumors with high mortality and morbidity. This study aims to determine the difference in quality of life in nasopharyngeal carcinoma patients with characteristics (age, gender, and stage of cancer) nasopharyngeal tumors. The research method was carried out with analytical observational through a cross sectional approach. The measuring instruments used in the form of EORTC QLQ-C30 and EORTC QLQ-H&amp;N35 questionnaires were used to measure the quality of life of nasopharyngeal carcinoma patients at RSI Sultan Agung Semarang. The data were analyzed using a binary logistic regression test. The results of the study of nasopharyngeal carcinoma patients according to the characteristics at RSI Sultan Agung Semarang based on 13 respondents were dominated by male patients totaling 8 people (61.54%), aged 45 years as many as 8 people (61.54%), and cancer stages were divided into 6 people (≥46.15%) and 7 people (53.85%) in the early and advanced stages. The results of the Wald Test did not significantly differ in the quality of life of nasopharyngeal carcinoma patients at RSI Sultan Agung Semarang with each sig intention. The independent variables were age (p = 0.187), gender (p = 0.227), and cancer stage (p = 0.558). The independent variable that most affected the level of quality of life of nasopharyngeal carcinoma patients was gender with a value of Exp(B) = 5.394. The conclusion of this study is that there is no difference in quality of life in nasopharyngeal carcinoma patients with characteristics (age, gender, and stage of cancer) nasopharyngeal tumors.International Journal of Human and Health Sciences Vol. 08 No. 02 Apr’24 Page: 151-156

Evaluation of physical activity before and after respiratory rehabilitation in normal weight individuals with asthma: a feasibility study.

Individuals with asthma spend less time engaging in physical activity compared to the general population. Increasing physical activity has become a patient-centered goal for the treatment of treatable traits of individuals with asthma. There are data showing the possible effects of a pulmonary rehabilitation program on physical activity in obese individuals with asthma but not in normal-weight asthmatics. The objective of this feasibility study is to estimate the number of daily steps and time spent on activity in normal-weight individuals with asthma, measured before and after a pulmonary rehabilitation program. Normal-weight individuals with moderate to severe asthma were evaluated. The individuals measured their daily steps with an accelerometer for 5 days before and after a pulmonary rehabilitation program. The study was registered on ClinicalTrials.gov: NCT05486689. In total, 17 participants were enrolled; one dropout and data on the time in activity of two individuals are missing due to a software error during the download. Data from 16 patients were analyzed. The median number of steps/day at baseline was 5,578 (25th, 75th percentiles = 4,874, 9,685) while the median activity time was 214 min (25th, 75th percentiles = 165, 239). After the rehabilitation program, the number of daily steps increased by a median value of 472 (p-value = 0.561) and the time in activity reduced by 17 min (p-value = 0.357). We also found a significant difference in quality of life, muscle strength, and exercise capacity. The results of this study make it possible to calculate the sample size of future studies whose main outcome is daily steps in normal-weight individuals with asthma. The difficulties encountered in downloading time in activity data do not allow the same for this outcome. ClinicalTrials.gov, identifier NCT05486689.

Collaborative care approaches for people with severe mental illness.

Collaborative care for severe mental illness (SMI) is a community-based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies. To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non-collaborative care interventions) for people with diagnoses of SMI who are living in the community. We searched the Cochrane Schizophrenia Study-Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021. Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia-like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow-up. Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short-term (up to six months), medium-term (seven to 12 months) and long-term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random-effects meta-analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro. Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low- or very low-certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF-12 and the WHOQOL-BREF and the mean endpoint mental health component scores were reported at 12 months. Very low-certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI -0.26 to 0.32; 3 RCTs, 227 participants). Very low-certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI -0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low-certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low-certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years. This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher-quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care.

Investigating the Difference in Quality of Life Between Immediate and Delayed Breast Cancer Reconstruction: A Systematic Review.

Immediate and delayed breast reconstruction remains a controversial topic. Apart from the clinical outcomes that have to be considered, there is a discrepancy of opinions regarding the potential differences in quality of life. It is essential to clarify this issue, in order to contribute to the reconstruction of the decision-making process. The aim of the study was to investigate potential differences in quality of life between immediate and delayed breast reconstruction patients. A systematic review of the literature was carried out, searching for case-control studies that have comparatively examined the effects of delayed and immediate reconstruction on quality of life. A literature search was carried out using the Medline, Scopus and Web of Science databases. The quality of the studies was evaluated using the STROBE checklist for case-control studies. Three studies were found showing that immediate reconstruction led to benefits for the quality of life of patients, while one study showed the opposite. A relevant study revealed no statistically significant differences between the two groups, while another study, showed that immediate reconstruction entailed short-term benefits to quality of life. Four of the studies had debatable methodological approaches. The inconsistent study findings cannot lead to any reliable conclusions regarding differences between immediate and delayed reconstruction in quality of life. It is possible that the results vary due to the time point that the comparisons made. Future research to this direction is warranted.

Abstract PS02-04: Associations of sleep health with quality of life among women with newly diagnosed breast cancer: baseline results from the AMBER cohort study

Abstract Background High incidence, ageing, and advancements in early detection and clinical treatment have led to a growing breast cancer survivor population, particularly in developed countries. Sleep problems are common and persist in this population, affecting over 50% of breast cancer survivors. Good sleep health is characterized by sleep duration, sleep timing and sleep quality, and these three dimensions do not necessarily correlate with each other. This analysis aimed to investigate the associations of sleep health, characterized by sleep duration, sleep timing, and a range of metrics for sleep quality (latency, efficient, disturbance, medication, daytime dysfunction) with physical and mental well-being in women with newly diagnosed breast cancer. Methods Newly diagnosed breast cancer patients, with early-stage disease were recruited between 2012-2019 in Edmonton and Calgary, Canada, and completed the Pittsburg Sleep Quality Index (PSQI) to assess the habitual sleep duration and timing, as well as sleep latency, efficiency, disturbance, medication and daytime dysfunction. To measure quality of life, participants completed the SF-36 version-2 to assess their physical and mental well-being. Multivariable linear regressions were used to estimate the association of sleep characteristics with physical and mental well-being, adjusting for socio-demographic, disease, clinical and lifestyle behaviour factors. Results Among 1409 breast cancer survivors, 41% reported short or long sleep duration ( &amp;lt; 6 or ≥9 h/d), 41% reported habitual bedtimes after 11pm, 56% reported sleep efficiency being &amp;lt; 85%, 80% reported fairly good (vs. very good) sleep disturbance, 35% reported taking sleep medication in the past month, and 71% reported fairly good, fairly bad or very bad (vs. very good) daytime function. In the multivariable model, short sleep (≤6/d) was associated with worse mental well-being (-3.6, 95%CI: -4.7,-2.4) but not physical well-being (-1.5, 95%CI: -2.3,-0.7). No clinically meaningful differences in quality of life were found for sleep timing. Metrics characterizing suboptimal sleep quality were associated with poorer physical and mental well-being, with stronger associations observed for mental health well-being. Notably, only 20% and 29% women were classified as “very good” in sleep disturbance and daytime dysfunction measures, respectively. Nevertheless, even “fairly good” sleep disturbance and daytime dysfunction were associated with statistically and clinically meaningful significant poorer physical (-3, 95%CI: -3.8,-2.2) and mental (-8, 95%CI: -9,-7) well-being. Conclusion Sleep timing does not appear to affect the quality of life in a clinically meaningful manner in women newly diagnosed with breast cancer. In contrast, short sleep duration and worse sleep quality were strongly associated with poorer mental well-being in these women. Targeted interventions to improve sleep may lead to improvements in the quality of life among women with newly diagnosed breast cancer. Table 1. Association of Sleep Characteristics with SF-36 Measured Quality of Life, Physical Well-Being. Table 2. Association of Sleep Characteristics with SF-36 Measured Quality of Life, Mental Well-Being. Citation Format: Lin Yang, Qinggang Wang, Jessica McNeil, Charles Matthews, Leanne Dickau, Jeff Vallance, Margaret McNeely, S. Nicole Culos-Reed, Karen Kopciuk, Kerry Courneya, Christine Friedenreich. Associations of sleep health with quality of life among women with newly diagnosed breast cancer: baseline results from the AMBER cohort study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS02-04.

Abstract PO3-11-12: A Pragmatic Randomized Trial Comparing Morning versus Evening Dosing of Endocrine Therapy for Early Breast Cancer: Final Results (REaCT-CHRONO Study)

Abstract Background. Interventions to improve tolerability and adherence to endocrine therapy (ET) are critical to the global improvement of breast cancer (BC) survivorship. The optimal time of day to take ET in terms of quality of life, side effects and adherence is unknown. This study compared a morning dose versus an evening dose of ET in patients with early-stage BC (EBC). Methods. In this pragmatic, open-label, multicenter trial, patients with hormone receptor-positive (HR+) EBC were randomized (1:1) to receive either a morning dose (within 1 hour of the patient wake up time) or an evening dose of ET (within 1 hour of patient bedtime). The primary endpoint was endocrine toxicity/tolerability measured by the change in total Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES) score from baseline (commencement of ET) to 12 weeks. The secondary endpoints included: ET toxicity/tolerability and quality of life (FACT-ES and FACT-B) from baseline to 4, 8, 12 and 52 weeks, non-persistence or non-adherence, and patient timing preference. Results. Between June 2021 and March 2022, 245 eligible patients were randomized, 122 to morning (122/245, 49.8%) and 123 to evening (123/245, 50.2%) dosing. Mean age was 61 [standard deviation (sd) 11.9], 181 patients (73.9%) were postmenopausal, 188 (76.7%) received tamoxifen, 58 (23.7%) received an aromatase inhibitor and 22 (9%) received luteinizing hormone-releasing hormone. The mean changes in the FACT-ES score from baseline to 12 weeks following the beginning of ET were -2.0 (sd=14.3) vs -5.4 (sd=16.8) in the morning vs evening arms respectively (Wilcoxon two-sample rank sum test p-value=0.22). Also, the proportion of patients with a clinically important increase (Fisher’s exact test p-value=0.54 0.89) or decrease (p-value= 0.89) in FACT-ES Scores was not statistically different between the arms. At 52 weeks, the mean changes in the FACT-ES score from baseline were -2.5 (sd=18.8) vs -4.8 (sd=15.5) in the morning vs evening arms respectively (p-value=0.23). There was no statistical difference in FACT-ES and FACT-B scores over the 52 weeks of the study. At 12 weeks, 94.5% (69/79) vs 98.7% (78/79) were still taking the ET (p-value=0.2), whereas at 52 weeks, 92.1% (58/63) vs 85.4% (41/48) were still taking ET (p-value=0.36), in the morning vs evening arms respectively. Also, 13.7% (10/73) vs 7.6% (6/79) and 3.2% (2/62) vs 12.5% (6/48) interrupted their ET at least once, in the morning vs evening arms, at 12 and 52 weeks respectively. At week 52, 57.9% (62/107) in the morning arm vs 13.5% (14/104) in the evening arm strongly preferred an ET morning dose, whereas 7.5% (8/107) vs 42.3% (44/104) strongly preferred an ET evening dose. No significant preference changes were observed in dose timing from baseline to week 52 (p-value=0.081). Conclusions. These results suggest no significant difference in quality of life or adherence if ET is taken in the morning or in the evening. Patients should be reassured that they can take ET at their preferred time. Clinical Trial Registration: NCT04864405 Table 1. Mean changes between FACT scores at 12 weeks and 52 weeks from baseline for patients receiving ET morning vs evening dose. A positive value indicates the FACT score increased over time. FACT ES: Endocrine Subscale; FACT B: breast Citation Format: Marie-France Savard, Mohammed Ibrahim, Gregory Pond, Deanna Saunders, Lisa Vandermeer, Lesley Fallowfield, Terry Ng, Arif Awan, Sandeep Sehdev, Ana-Alicia Beltran-Bless, Mark Clemons. A Pragmatic Randomized Trial Comparing Morning versus Evening Dosing of Endocrine Therapy for Early Breast Cancer: Final Results (REaCT-CHRONO Study) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-12.

Self-care trajectories of patients with coronary heart disease: a longitudinal, observational study.

To determine if distinct trajectories of coronary heart disease (CHD) self-care behaviours could be identified, linked to differences in quality of life (QoL), and predicted based on baseline characteristics. A secondary analysis of a prospective, longitudinal, observational study. Patients with CHD answered questionnaires at study enrolment and six months later: Self-Care of Coronary Heart Disease Inventory (three subscales: maintenance, management and confidence, scored 0-100, higher score = better self-care), Hospital Anxiety and Depression Scale, 12-Item Short Form Survey, 16-Item European Health Literacy Survey Questionnaire, CHD Education Questionnaire. Latent growth mixture modelling was used to identify distinct self-care trajectories over time.On average, patients (n = 430, mean age 64.3 ± 8.9, 79% male) reported inadequate self-care (maintenance 61.6 ± 15.4, management 53.5 ± 18.5) at enrolment. Two distinct trajectories of self-care behaviours were identified: First, an "inadequate-and-worsening" (IN-WORSE) trajectory (57.2%), characterised by inadequate self-care, improvement in maintenance (4.0 ± 14.5-point improvement, p < 0.001) and worsening of management over time (6.3 ± 24.4-point worsening, p = 0.005). Second, an "inadequate-but-maintaining" (IN-MAIN) trajectory (42.8%), characterised by inadequate self-care, improvement in maintenance (5.0 ± 16.2-point improvement, p < 0.001) and stability in management over time (0.8 ± 21.9-point worsening, p = 0.713). In comparison, patients in the IN-WORSE trajectory had less favourable characteristics (including lower health literacy, knowledge, confidence) and significantly lower QoL. Not attending rehabilitation (OR 2.175; CI 1.020-4.637, p = 0.044) and older age (OR 0.959; CI 0.924-0.994, p = 0.024) predicted (IN-WORSE) trajectory inclusion. Two self-care trajectories were identified, both suboptimal. Rehabilitation predicted membership in the more favorable trajectory and some positive characteristics were identified among patients in that group. Therefore, interventions supporting these factors may benefit patients' self-care and QoL.

Role of Emotional Intelligence, in Relationship between Compassion Satisfaction, Compassion Fatigue and Quality of Life Among Nurses Working in ICU

Background: Intensive Care Unit (ICU) nurses encounter emotionally taxing situations that can affect their well-being, making the examination of factors such as emotional intelligence (EI), compassion satisfaction, and fatigue crucial in understanding their quality of life. Objective: This study aimed to explore the interplay between EI, compassion satisfaction, compassion fatigue, and quality of life among ICU nurses, and to examine the mediating role of EI in these relationships. Methods: A convenience sampling method was employed to collect data from 167 ICU nurses using a structured online questionnaire. Demographic data and measures for compassion satisfaction, fatigue, EI, and quality of life were analyzed using SPSS version 25. Path coefficients and mediation analysis were conducted using Partial Least Squares (PLS). Results: The majority of participants were below 30 years (76.2%) and female (67.9%). EI positively correlated with quality of life (path coefficient = 0.139, p = 0.007) and was a partial mediator between compassion satisfaction and quality of life. Higher compassion satisfaction was significantly associated with increased EI and quality of life (path coefficients = 0.264 and 0.628, respectively, p &lt; 0.001). Gender-based analysis revealed differences in quality of life (Males: M = 100.65, SD = 7.98; Females: M = 96.58, SD = 12.59; p = 0.035) and compassion fatigue (Males: M = 65.24, SD = 7.77; Females: M = 61.42, SD = 8.59; p = 0.007). Conclusion: Emotional intelligence is instrumental in enhancing quality of life by mediating the effects of compassion satisfaction and fatigue among ICU nurses. These insights suggest that interventions aimed at increasing EI may be beneficial for nurses facing the demanding conditions of ICU environments.

Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? – An emulated trial

BackgroundHigh rates of negative intrusive thoughts have been reported among cancer patients. Prevalent users of beta-blocker therapy have reported lower levels of cancer related intrusive thoughts than non-user. The aim of this study is to investigate if initiation of beta-blocker therapy reduces the prevalence and severity of intrusive thoughts (co-primary endpoints) and the prevalence of anxiety, depressed mood, and low quality of life (secondary endpoints) in cancer survivors.MethodsData on patient-reported outcomes from three cohort studies of Swedish patients diagnosed with colon, prostate or rectal cancer were combined with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register. Two randomized controlled trials were emulated. Trial 1 had follow-up 1 year after diagnosis, trial 2 had follow-up 2 years after diagnosis, baseline in both trials was 12 months before follow-up. Those who initiated beta-blocker therapy between baseline and follow-up was assigned Active group, those who did not was assigned Control group. All endpoints were analysed using Bayesian ordered logistic regression.ResultsTrial 1 consisted of Active group, n = 59, and Control group, n = 3936. Trial 2 consisted of Active group, n = 87, and Control group, n = 3132. The majority of participants were men, 83% in trial 1 and 94% in trial 2. The prevalence and severity of intrusive thoughts were lower in the Active group in trial 1, but no significant differences between groups were found in either trial. The prevalence of depressed mood, worse quality of life and periods of anxiety were higher in the Active group in both trials with significant differences for quality of life in trial 1 and anxiety in trial 2.ConclusionsThe emulated trials demonstrated no evidence of a protective effect of beta-blocker therapy against intrusive thoughts. The Active group had reduced quality of life and elevated anxiety compared to the Control group.Trial registrationThe three cohort studies were registered at isrctn.com/clinicaltrials.gov (ISRCTN06393679, NCT02530593 and NCT01477229).

IJCM_76A: Assessment of quality of life after normal vaginal delivery and caesarean section among mothers at a government tertiary care hospital, Bengaluru - A cross sectional study.

Background: Quality of life comprises multifaceted dimensions encompassing physical, emotional, social, and psychological aspects. Assessing quality of life is essential not only for mothers but also for their children, family members, and the community. Understanding the impact of different modes of delivery on women’s well-being is crucial for healthcare providers to offer appropriate support and interventions. Objective: To assess and compare the quality of life after normal vaginal delivery and caesarean section among mothers at a government tertiary care hospital, Bengaluru. Methodology: A cross-sectional study was conducted among mothers at a tertiary care hospital in Bengaluru. A pilot study was conducted and sample size was calculated as 200, with 100 participants in each group. Samples were selected using a simple random sampling method, and data were collected using a pre-tested, semi-structured questionnaire. The Short Form Health Survey (SF-36) was used to assess the quality of life. The collected data was entered into MS Excel and analyzed using SPSS 21.0 Results: Out of 200 participants, the mean age of the study population was 24.32 ± 5.58 years. Comparison between the vaginal and cesarean groups revealed that the vaginal birth group had higher mean scores in the physical health domain. Factors such as physical functioning, emotional well-being, socioeconomic status, and comorbidities were found to be significantly associated with modes of delivery. Conclusion: Different modes of delivery have their own unique challenges and benefits, this study illuminated distinct differences in quality of life. Normal vaginal delivery was associated with a quicker physical recuperation compared to caesarean section, while caesarean sections demanded a longer recovery period and potential physical limitations.

Strength training improves functional capacity of individuals with chronic heart failure: Randomized clinical trial

IntroductionChronic heart failure (CHF) is characterized by dyspnea, exercise intolerance and impaired quality of life. Physical exercise is a key point in the treatment of these outcomes. ObjectiveTo evaluate the effect of 24 weeks of two different training strategies on functional capacity, muscle strength and quality of life in individuals with CHF. MethodsThe following tests and evaluations were performed before and after 24 weeks of training: exercise test, one-repetition maximum test (1- RM) and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Subjects were randomized according to the modality they would perform first: aerobic training group (ATG – n=6) or strength training group (STG – n=7). ResultsThe sample consisted of 13 individuals (10 men), aged 55 ± 12 years and a left ventricular ejection fraction (LVEF) of 38.8 ± 5.3%. There was a significant increase in V'O 2peak only in STG (STG: 26.92 ± 9.81 vs 30.52 ± 8.39 mL.kg -1 .min -1 - p=0.025; ATG: 19.60 ± 7,00 vs 22.42 ± 8.54 mL.kg -1 .min -1 - p=0.119). Both groups showed significant improvements in muscle strength (STG: 45 ± 17 vs 51 ± 20 kg - p=0.001; ATG: 38 ± 19 vs 42 ± 20 kg - p=0.012). There was no significant difference in quality of life (STG: 30 ± 18 vs 24 ± 20 - p=0.109; ATG: 36 ± 16 vs 26 ± 15 - p=0.143). ConclusionThe early implementation of strength training improves functional capacity and muscle strength of individuals with CHF.

Reducing an operational access for cholecystectomy on overweight patients

The development of laparoscopic surgery, based on technological progress, and the accumulation of clinical experience makes it possible to reduce operating access, reducе the postoperative complications. Material and methods. SILS cholecystectomy were performed in 27 patients with overweight and obesity. All operations were done as planned for chronic calculousis cholecystitis. Results and discussion. We used assistive technologies for organ traction (Patent N 103722 Russian Federation) in the event of a “conflict” of instruments, which made it possible to reduce the intervention time. The mean intervention time was 55.5±6.9 minutes. In 10 patients with risk factors for the formation of trocar hernias (obesity, advanced age, functional insufficiency of the connective tissue), the access area was preventively strengthened by an implant placed over the aponeurosis. All patients were discharged in a satisfactory condition 3-4 days after surgery. Subsequently, during observation and re-examinations up to 7 years after surgery, patients did not complain about surgical intervention, felt well, and not a single case of postoperative ventral hernia was recorded. Conclusion. The advantages of cholecystectomy in overweight and obese patients using the SILS technique are obvious, associated with a reduction in the invasiveness of the operation, an excellent cosmetic result, and the achievement of a fundamentally different quality of life for patients.

Virtual Reality and Transcranial Direct Current Stimulation for Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that is particularly difficult to treat in military veterans. Noninvasive brain stimulation has significant potential as a novel treatment to reduce PTSD symptoms. To test whether active transcranial direct current stimulation (tDCS) plus virtual reality (VR) is superior to sham tDCS plus VR for warzone-related PTSD. This double-blind randomized clinical trial was conducted among US military veterans enrolled from April 2018 to May 2023 at a secondary care Department of Veterans Affairs hospital and included 1- and 3-month follow-up visits. Participants included US military veterans with chronic PTSD and warzone-related exposure, recruited via referral and advertisement. Patients in psychiatric treatment had to be on a stable regimen for at least 6 weeks to be eligible for enrollment. Data were analyzed from May to September 2023. Participants were randomly assigned to receive 2-mA anodal tDCS or sham tDCS targeted to the ventromedial prefrontal cortex, during six 25-minute sessions of standardized warzone VR exposure, delivered over 2 to 3 weeks. The co-primary outcomes were self-reported PTSD symptoms, measured via the PTSD checklist for DSM-5 (PCL-5), alongside quality of life. Other outcomes included psychophysiological arousal, clinician-assessed PTSD, depression, and social/occupational function. A total of 54 participants (mean [SD] age, 45.7 [10.5] years; 51 [94%] males) were assessed, including 26 in the active tDCS group and 28 in the sham tDCS group. Participants in the active tDCS group reported a superior reduction in self-reported PTSD symptom severity at 1 month (t = -2.27, P = .02; Cohen d = -0.82). There were no significant differences in quality of life between active and sham tDCS groups. Active tDCS significantly accelerated psychophysiological habituation to VR events between sessions compared with sham tDCS (F5,7689.8 = 4.65; P < .001). Adverse effects were consistent with the known safety profile of the corresponding interventions. These findings suggest that combined tDCS plus VR may be a promising strategy for PTSD reduction and underscore the innovative potential of these combined technologies. ClinicalTrials.gov Identifier: NCT03372460.

Investigating gender differences in quality of life and social support in patients with severe mental illnesses.

Severe mental illnesses (SMIs), including schizophrenia and bipolar disorder affect patients significantly. Gender has been identified as a key factor influencing the experience of SMIs with notable disparities in prevalence, symptoms, and treatment outcomes. Additionally, the quality of life (QoL) and social support for patients with SMIs can vary based on gender. This study examined gender differences in QoL and social support of patients with SMIs. Participants include 170 outpatients with schizophrenia and bipolar disorder at Shafa Hospital (2021). QoL and social support were assessed using World Health Organization QoL (WHOQOL-BREF) questionnaire and Medical Outcomes Study Social Support Survey (MOS-SSS), respectively. Group differences were analyzed using t-test or Mann-Whitney U test, and two-way multivariate analyses of variance explored the effect of gender and disease type. It was indicated that females with schizophrenia reported higher QoL than males, but the opposite was observed for bipolar disorder. Gender differences in social support were not significant among schizophrenia patients, nor between the two patient groups. However, women with bipolar disorder and multiple hospitalizations experienced lower social support and QoL compared to men. Additionally, more hospitalizations were associated with decreased QoL in both genders with schizophrenia. Findings suggest the need for gender- specific interventions and support policies to enhance QoL and social support in patients with SMI.

The Effect of an Exercise Program on the Quality of Life in Burn Patients

Background: Burn injuries are among the most significant causes of disability and death, having severe economic and social consequences in human societies. Objectives: This study aims to examine the effect of an exercise program on the quality of life of burn patients admitted to the burn department of Ali Ibne Abi Talib Hospital in Zahedan. Methods: In this quasi-experimental study, 30 patients with shoulder joint burns admitted to the burn department of Ali Ibne Abi Talib Hospital in Zahedan in 2021 participated. Patients meeting the inclusion criteria were selected via convenience sampling and then randomly assigned to intervention and control groups using permuted blocks. The intervention consisted of 4 individual training sessions and an exercise program. Patients in the intervention group performed exercises 3 times daily for 12 weeks, while those in the control group received only routine ward care. Data were collected using the Burn Specific Health Scale (BSHS), administered to groups 1- and 3-months post-intervention. Data analysis was conducted using SPSSv.21 software, employing the chi-square test, independent samples t-test, and repeated measures analysis of variance (ANOVA), with a significance level set at P &lt; 0.05. Results: One month post-intervention, the mean quality of life scores were 121.73 ± 7.52 in the intervention group and 122.93 ± 5.72 in the control group. After 3 months, these scores changed to 156.46 ± 9.53 in the intervention group and 122.82 ± 8.09 in the control group, indicating a significant increase in the intervention group (P = 0.001). Repeated measures ANOVA revealed no significant difference in quality of life between the 2 groups 1 month post-intervention (P = 0.37); however, a significant difference was observed at 3 months (P = 0.001). Conclusions: The study's findings suggest that exercise can improve the quality of life in patients with shoulder joint burns. Therefore, incorporating exercise and follow-up programs into the discharge plans of burn patients is recommended.