Disease Quality Of Life Questionnaire Research Articles

Effect of closed and permanent stoma on disease course, psychological well-being and working capacity in Swiss IBD cohort study patients.

Little is known about the impact of ostomy formation in inflammatory bowel disease patients on course of disease, psychological well-being, quality of life and working capacity. We analyzed patients over a follow-up of up to 16 years in the Swiss inflammatory bowel disease cohort study (SIBDCS) with prospective data collection. We compared Ulcerative colitis and Crohn's disease patients with and without ostomy as well as permanent and closed stoma formation before and after surgery, investigating disease activity, psychological wellbeing and working capacity in a case-control design. Of 3825 SIBDCS patients, 176 with ostomy were included in the study and matched with 176 patients without ostomy using propensity score, equaling 352 patients for the analysis. As expected, we observed a lower mean and maximal disease activity in patients after stoma surgery compared with control patients without stoma. Overall, psychological wellbeing in patients with stomas vs. controls as well as patients with permanent vs. closed stoma was similar in terms of disease-specific quality of life (total score of the Inflammatory Bowel Disease Quality of Life questionnaire), psychological distress (total score of the Hospital Anxiety and Depression Scale), and stress at work (effort-reward-imbalance ratio), with the exception of a higher Posttraumatic Diagnostic Scale total score in patient with vs. without stoma. Compared to IBD patients without stoma, the adverse impact on working capacity in overall stoma IBD patients appeared to be modest. However we observe a significantly higher reduction in working capacity in permanent vs. closed stoma in CD but not UC patients. As to be expected, IBD patients may benefit from closed and permanent stoma application. Stoma surgery appears to only modestly impact working capacity. Importantly, stoma surgery was not associated with adverse psychological outcomes, with comparable psychological well-being regardless of presence and type of stoma.

P9.48: A Systematic Review of the Use of Patient-Reported Outcome Measures (PROMs) in Adults Undergoing Liver Transplantation

Background: Improved survival rates of liver transplantation (LT) (~80% 5-year survival) has shifted the focus towards reducing symptom burden and improving quality of life, which can be assessed using patient-reported outcome measures (PROMs). This study systematically reviewed measurement properties of PROMs to serve as an evidence base for the selection of suitable PROMs and offer new benchmarks for value-based health-care in LT. Methods: MEDLINE, EMBASE, PubMed and COCHRANE databases were searched for relevant articles. Studies were included if they reported PROMs in LT candidates and/or recipients. Articles including patients <16 years only and clinician-assessed instruments were excluded. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to asses methodological quality of included studies and measurement properties. Results: The full-texts of 185 out of 2040 studies were reviewed. The Short-Form-36 (SF-36) (n=86 studies) and Hospital Anxiety and Depression Scale (HADS) (n=16 studies) were the most commonly reported generic instruments in this population. Only 15 studies provided original measurement properties for 24 PROMs. Both SF-36 (n=2 studies) and HADS (n=2 studies) showed high quality evidence for sufficient internal consistency (Cronbach’s alpha >7.8 and >7.3, respectively), but indeterminate reliability. The Liver Disease Quality of Life Questionnaire and its short version ((SF-)LDQOL) were the most used disease-specific PROMs reported in LT candidates (n=8 studies), and showed moderate quality evidence for sufficient internal consistency and construct validity in 2 studies. Five individual studies reported newly developed PROMs for LT recipients, often incorporating questions from existing instruments. These showed generally high quality evidence and sufficient internal consistency. Conclusion: In addition to well-established PROMs (SF-36 and HADS), we conclude that the (SF-)LDQOL is the most promising for the detection of disease-specific changes in LT candidates. However, this instrument should be evaluated further for LT recipients.

P9.04: Evaluation of Quality of Life in Adult Patients After One Year Liver Transplantation

Introduction: Liver transplantation (LT) aims not only to obtain long survival, but also to achieve an excellent quality of life (QOL). The purpose of our study is to assess several QOL aspects of recipients after 1 year of LT and to identify potential factors that might be associated with impaired QOL. Materials and Methods: Retrospective analysis including LT between 2013 to 2021. The Liver Disease Quality of Life questionnaire (LDQOL 1.0), and the consent form to participate of this study were given personally or sent by e-mail. This questionnaire includes 111 items distributed within 20 domains. Fulminant liver failure, hepatorenal transplantation and underaged patients were excluded. Significance was explored using T tests. Differences were considered statistically significant at p < 0.05. Results: This study included 89 patients out of 360 LT (56% male) who answered the survey, age range 24.8–75 years (mean: 52.5). On average, the patients had to wait 360 days before undergoing LT. Primary etiologies of liver disease were: hepatitis C virus (22.5%), alcohol (22.5%), autoimmune cirrhosis (22.5%), primary biliary cirrhosis (14.6%), NASH (6.7%), primary sclerosing cholangitis (3.3%), cryptogenic (2.2%), and others (5.6%). Thirty-one LT also presented hepatocarcinoma (HCC). The vast majority (93%) had moderate to severe liver disease, with 46% Child-Pugh B and 47% Child-Pugh C. After 1 year LT, QOL was improved resulting with a mean of 83,69%. The general well-being domain rated lowest with 69%. Higher scores (89 - 90%) were obtained on effects of liver disease, stigma of liver disease, physical limitations, emotional limitations and loneliness. There was a significant association between the Child-Pugh classification and body pain, emotional well-being, memory and stigma of liver disease (p< 0,05). Lower MELD scores (<18) showed better results after 1 year LT in energy/fatigue, emotional well-being, liver disease symptoms, effects of liver disease and hopelessness domains (p < 0,05). There was no significant difference when QOL was compared according etiology of chronic liver disease, gender, or age. Conclusion: After 1 year of LT, patients result on QOL show a significant improvement, even similar to results published on the common population, in most of the domains surveyed except for body pain, energy and emotional well-being which still need upgrade.

Comorbid Depression and Diabetes Are Associated with Impaired Health-Related Quality of Life in Chronic Kidney Disease Patients.

Given the increasing prevalence of chronic kidney disease (CKD) and its impact on health care, it is important to better understand the multiple factors influencing health-related quality of life (HRQOL), particularly since they have been shown to affect CKD outcomes. Determinants of HRQOL as measured by the validated Kidney Disease Quality of Life questionnaire (KDQOL) and the Patient Health Questionnaire depression screener (PHQ-9) were assessed in a routine CKD patient sample, the Greifswald Approach to Individualized Medicine (GANI_MED) renal cohort (N = 160), including a wide range of self-reported data, sociodemographic and laboratory measures. Compared to the general population, CKD patients had lower HRQOL indices. Dialysis was associated with (1) low levels of physical functioning, (2) increased impairments by symptoms and problems, and (3) more effects and burden of kidney disease. HRQOL is seriously affected in CKD patients. However, impairments were found irrespective of eGFR decline and albuminuria. Rather, the comorbid conditions of depression and diabetes predicted a lower HRQOL (physical component score). Further studies should address whether recognizing and treating depression may not only improve HRQOL but also promote survival and lower hospitalization rates of CKD patients.

Effect of Tiaoshen Patting Therapy Combined with Zhichan Granule on Patients with Parkinson's Disease

<bold>Objective</bold> To observe the clinical effect of Tiaoshen patting therapy combine with Zhichan granule on tremor, stiffness and postural instability on patients with Parkinson's disease. <bold>Methods</bold> A total of 228 patients with Parkinson's disease who were treated in the Shanghai Municipal Hospital of Traditional Chinese Medicine and it's medical consortium, which were randomly divided into Western medicine treatment group, traditional Chinese and Western medicine treatment group and combined treatment group,with 76 cases in each group. The Western medicine treatment group received health education about PD and Dobasazide tablets, three times a day, seven days a week, continuous treatment for 12 weeks; the traditional Chinese and Western medicine treatment group received Zhichan granule on the basis of the Western medicine treatment group, two times a day, seven days a week, continuous treatment for 12 weeks; the combined treatment group received Tiaoshen patting therapy on the basis of the traditional Chinese and Western medicine treatment group, 30 minutes a time, one time a day, three days a week, continuous treatment for 12 weeks. Before treatment, after treatment for eight weeks and after treatment for 12 weeks, Unified Parkinson Disease Rating Scale (UPDRS) and UPDRS-Ⅲ were used to evaluate PD severity and motor symptoms; Parkinson's disease non-motor symptoms questionnaire (NMS Quest) was used to evaluate the non motor symptoms of patients; 39 item Parkinson's disease quality of life questionnaire (PDQ-39) was used to evaluate the quality of life of patients; the differences of adverse reactions in the three groups were evaluated. <bold>Results</bold> Compared with before treatment, the total score of UPDRS and UPDRS-Ⅲ in the traditional Chinese and Western medicine treatment group and the combined treatment group after treatment for eight weeks decreased significantly (<italic>P</italic>&lt;0.05), and the total score of UPDRS and UPDRS-Ⅲ in the three groups after treatment for 12 weeks decreased significantly (<italic>P</italic>&lt;0.05); the scores of NMS Quest and PDQ-39 in the traditional Chinese and Western medicine treatment group after treatment for 12 weeks decreased significantly, the scores of NMS Quest and PDQ-39 in the combined treatment group after treatment for 8,12 weeks decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). Compared with the Western medicine treatment group at the same time, the total score of UPDRS and UPDRS-Ⅲ in the traditional Chinese and Western medicine treatment group and the combined treatment group after treatment for 8,12 weeks decreased significantly (<italic>P</italic>&lt;0.05), the NMS Quest score in the traditional Chinese and Western medicine treatment group after treatment for 8 weeks decreased significantly, the PDQ-39 score in the traditional Chinese and Western medicine treatment after treatment for 12 weeks decreased significantly, and the NMS Quest and PDQ-39 scores in the combined treatment group after treatment for 8,12 weeks decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). Compared with the traditional Chinese and Western medicine treatment group at the same time, the total UPDRS score, UPDRS-Ⅲ score, NMS Quest score and PDQ-39 score of the combined treatment group after treatment for 8,12 weeks decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). There was no significant difference in the incidence of adverse reactions in the three groups (<italic>P</italic>&gt;0.05). <bold>Conclusion</bold> Tiaoshen patting therapy combined with Zhizhan granule can improve the motor symptoms, non motor symptoms and quality of life of PD patients, which is safe and worthy of clinical application.

Effect of nurse-led lifestyle modification follow up program on health outcomes and quality of life among post myocardial infarction patients: a randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: None. Background India has among the world's highest burden of cardiovascular disease, potentially contributed by myocardial infarction. Despite growing trouble, there are no known post-discharge programs &amp; randomized trials reporting health status outcomes &amp; quality of life among post-myocardial infarction patients. Cardiac rehabilitation programs reduce mortality, therefore, it is crucial to understand the local burden of the disease, common challenges, public perceptions, develop timely &amp; effective interventional programs. Purpose This study aimed to evaluate the effect of a nurse-led lifestyle modification follow-up program on health outcomes &amp; quality of life among post-myocardial infarction patients. Methods A two-arm randomized controlled trial was adopted &amp; 104 post-myocardial infarction patients were recruited from August to December 2021. An equal number of participants were randomly assigned to intervention &amp; control group by random number table generator. The control group patients received routine care, while the intervention group was provided routine care along with a nurse-led lifestyle modification follow-up program(health education, educational booklet, &amp; telephone follow- up). A low-cost intervention based on information-motivation-behavioural skill model was developed. It was designed according to the needs of patients to know their risk factors, help patients establish a knowledge base, &amp; adapt to the post-illness lifestyle changes. Data were assessed &amp; compared by using the demographic datasheet, health outcomes datasheet, &amp; MacNew heart disease quality of life questionnaire. All evaluations were conducted at baseline after 12 weeks post-discharge, by face-to-face interview &amp; biophysiological measurements. Results The nurse-led lifestyle modification follow-up program was convenient for clinical application. The intervention group showed a appreciable improvement in low density lipoprotein(p=0.045), systolic blood pressure(p=0.009), diastolic blood pressure(p=0.044), body mass index(p=0.043), and NT ProBNP(p=0.007). The program effectively improved the lifestyle behaviours thereby considerably improving the quality of life in all the subscales-physical, emotional &amp; social (p&amp;lt;0.001) after 12 weeks of discharge. Conclusion In the Indian context, it is a novel &amp; extensive approach to improve access to health care and emphasizes post-discharge self-management. The greatest benefit of this program was allowing the intervention group participants to consult with us immediately. Since lifestyles vary among different individuals, we considered individuality when providing education &amp; involving them in implementation of an intervention to enhance their confidence &amp; ultimately achieve optimal health outcomes &amp; quality of life. The findings of this study are important for health care professionals caring for post-myocardial infarction patients &amp; direct incorporation of such programs into routine practice to reduce morbidity &amp; mortality.

Options in the treatment of superficial and deep venous disease in patients with Klippel-Trenaunay syndrome

ObjectiveKlippel-Trenaunay syndrome (KTS) is a congenital mixed mesenchymal malformation syndrome that includes varicose veins, capillary and venous malformations, lymphatic abnormalities, and hypertrophy of various connective tissue elements. The purpose of the present study was to describe the clinical characteristics and outcomes in a subset of patients with KTS in whom venous interventions, including iliofemoral venous stenting, were performed after failure of conservative therapy. MethodsA single-center retrospective data review of 34 patients with KTS who had undergone interventions for venous disease between January 2000 and December 2020 was performed. ResultsTheir mean age was 38.4 ± 17.5 years (range, 12-80 years). No gender predilection was found. Of the 34 patients, 61% had had all three features of the classic triad for KTS. Varicose veins were present in all 34 patients (100%), and 30% had had a history of bleeding varicosities. Most patients (79%) had CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) class ≥C4. Of the 34 patients, 30% had a history of deep vein thrombosis and/or pulmonary embolism. Factor VIII elevation was the most common thrombophilia condition (12%). The venous filling index was elevated at baseline (5.9 ± 5.1 mL/s) and did not normalize despite intervention (3.5 ± 2.3 mL/s; P = .04). The superficial venous interventions (n = 35) included endovenous laser therapy; stripping of the great saphenous vein, small saphenous vein, anterior thigh vein, or marginal vein; ultrasound-guided sclerotherapy; and stab avulsion of varicose veins. One coil embolization of a perforator vein was performed. Deep interventions (n = 19) included endovenous stenting (n = 15), popliteal vein release (n = 3), and valvuloplasty (n = 1). The venous clinical severity score had improved from 9.4 ± 4.5 to 6.2 ± 5.6 (P = .04). The visual analog scale for pain score had improved from 5.5 ± 2.7 to 2.5 ± 3.3 (P = .008). Healing of ulceration was noted in 75% of the patients. Significant improvements in the total pain (P = .04) and total psychological (P = .03) domains were noted in the 20-item chronic venous disease quality of life questionnaire. ConclusionsSuperficial and deep venous interventions are safe and effective in patients with KTS when conservative therapy has failed. Iliofemoral venous stenting is a newer option that should be considered in the treatment of chronic deep venous obstructive disease in patients with KTS in the appropriate clinical context. An aggressive perioperative deep vein thrombosis prophylaxis protocol should be in place to reduce thromboembolic complications in these patients.

Measuring quality of life in trials including patients on haemodialysis: methodological issues surrounding the use of the Kidney Disease Quality of Life Questionnaire.

Haemodialysis (HD) treatment causes a significant decrease in quality of life (QoL). When enrolled in a clinical trial, some patients are lost prior to follow-up because they die or they receive a kidney transplant. It is unclear how these patients are dealt with in the analysis of QoL data. There are questions surrounding the consistency of how QoL measures are used, reported and analysed. A systematic search of electronic databases for trials measuring QoL in HD patients using any variation of the Kidney Disease Quality of Life (KDQoL) Questionnaire was conducted. The review was conducted in Covidence version 2. Quantitative analysis was conducted in Stata version 16. We included 61 trials in the review, of which 82% reported dropouts. The methods to account for missing data due to dropouts include imputation (7%) and complete case analysis (72%). Few trials (7%) conducted a sensitivity analysis to assess the impact of missing data on the study results. Single imputation techniques were used, but are only valid under strong assumptions regarding the type and pattern of missingness. There was inconsistency in the reporting of the KDQoL, with many articles (70%) amending the validated questionnaires or reporting only statistically significant results. Missing data are not dealt with according to the missing data mechanism, which may lead to biased results. Inconsistency in the use of patient-reported outcome measures raises questions about the validity of these trials. Methodological issues in nephrology trials could be a contributing factor to why there are limited effective interventions to improve QoL in this patient group. CRD42020223869.

Suicide and Related Factors in Parkinson’s Disease

Introduction Parkinson’s disease(PD) is a progressive, neurodegenerative nervous system disease.Psychiatric symptoms are common in PD,it is important to consider the suicide risk of these patients.ObjectivesThe aim of this study is to investigate the risk of suicide in PD with a case control study and to determine the factors that may be associated.Methods126 Parkinson’s patients and 117 age,gender matched healthy controls were included.Montreal Cognitive Assessment Scale(MoCA),Suicide Probability Scale(SPS),Beck Hopelessness Scale(BHS),Apathy Rating Scale(AES) and Multidimensional Scale of Perceived Social Support(MSPSS) were completed by participants.The PD group completed Parkinson’s Disease Quality of Life Questionnaire(PDQ-39) and data on disease duration,Movement Disorders Society-Unified Parkinson’s Disease Rating Scale(MDS-UPDRS),levodopa-equivalent daily doses(LEDD) were obtained.Hamilton Anxiety Rating Scale(HAM-A) and Hamilton Depression Rating Scale(HAM-D) were administered to all participants.Results SPS total scores were significantly lower and total scores of HAM-A,HAM-D and MSPSS were found to be significantly higher in the PD group.There was no significant difference between the two groups in terms of BHS total scores.In PD group a linear relationship was found between SPS total scores and BHS,PDQ39, HAM-A and HAM-D and an inverse relationship with AES.In the regression analysis,it was concluded that a one-unit increase in BHS total scores increased the probability of suicide by 17.1%.ConclusionsIt is seen that SPS scores in patients are lower than controls and observed that SPS is correlated with hopelessness,depression,anxiety and quality of life.Although the possibility of suicide is found to be low in PD,this risk increases in patients with untreated depression and anxiety.Therefore,psychiatric evaluation may be recommended in these patients.DisclosureNo significant relationships.

Assessing quality of life in patients with autoimmune bullous diseases using the Persian version of Treatment of Autoimmune Bullous Disease Quality of Life questionnaire finds similar effects in women as men.

Background:In autoimmune bullous diseases (AIBDs), autoantibodies loosen molecular adhesions in the skin and/or mucosa and lead to blisters and erosions. Immunosuppressive drugs reduce mortality of the AIBD; therefore, patients will have to live longer with comorbidities.Objective:This study aims to determine the quality of life of AIBD patients undergoing systemic treatment while investigating the survey’s relationship with various factors.Methods:In this 2-step cross-sectional study, we initially included 53 consecutive pemphigus patients to investigate reliability and validity of the Persian version of Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL) questionnaire. Then, we conducted the study on 119 AIBD patients, currently under treatment at an AIBD clinic in Iran.Results:The mean TABQOL score for our patients was 13.87 ± 7.51. The highest TABQOL was for epidermolysis bullosa acquisita (24 ± 8.485) followed by pemphigus foliaceus (20.5 ± 14.181) and the lowest for pemphigus vulgaris (13.24 ± 6.54). There was no significant difference between patients’ TABQOL scores and their gender, history of rituximab injection, and disease severity scores. We only found a positive correlation between TABQOL and prednisolone dose.Conclusion:Treatments of AIBD considerably impact the quality of life of patients and an impairment in quality of life is correlated to higher doses of prednisolone.

Neuropsychiatric Symptoms in Parkinson's Disease Patients Are Associated with Reduced Health-Related Quality of Life and Increased Caregiver Burden.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder resulting in reduced health-related quality of life (HR-QoL) of people with PD (PwP) and their caregivers. Furthermore, there is an accumulating burden on caregivers of patients in advanced stages of the disease. In previous studies, motor- and non-motor-symptoms of PwP have been identified to contribute to reduced HR-QoL and an increased caregiver burden. This cross-sectional observational study aimed to study the influence of neuropsychiatric symptoms measured with the Scale for Evaluation of Neuropsychiatric Disorders in Parkinson’s Disease (SEND-PD) questionnaire on the HR-QoL of PwP, as well as the caregiver burden. Analyses revealed a significant association between SEND-PD subscale mood/apathy and reduced HR-QoL in PwP, measured by the Parkinson’s disease quality of life questionnaire (PDQ-8) (p < 0.001). Furthermore, mood/apathy was significantly correlated with caregiver burden (p = 0.001) in the multiple linear regression analysis. Hence, neuropsychiatric symptoms were found to have a profound impact on the HR-QoL of PwP, as well as on caregiver burden. Since neuropsychiatric symptoms were one of the main predictors for caregiver burden, physicians of PwP should treat these symptoms to stabilize caregiver burden, as well as HR-QoL in PwP and their caregivers.

Prevalence of Advanced Parkinson's Disease in Patients Treated in the Hospitals of the Spanish National Healthcare System: The PARADISE Study.

Background: Advanced Parkinson’s disease (APD) has been recently defined as a stage in which certain symptoms and complications are present, with a detrimental influence on the overall patient’s health conditions and with a poor response to conventional treatments. However, historically, the term APD has been controversial, thus consequently, APD prevalence has not been previously studied. Objectives: The main objective was to determine the prevalence of APD in patients diagnosed with idiopathic PD in hospitals of the Spanish National Healthcare System. Secondary objectives were the prevalence and incidence of PD and the clinical and sociodemographic characteristics and quality of life of patients with APD or non-APD. Methods: This was a non-interventional, cross-sectional, multicenter, national study in the hospital setting. Results: The study population included 929 patients with PD (mean age 71.8 ± 10.1 years; 53.8% male) and a mean time since diagnosis of 6.6 ± 5.4 years. At the time of diagnosis, 613 patients (66.06%) reported having had premotor symptoms. The Hoehn and Yahr stage was 1 in 15.7% of the patients, 2 in 42.8%, 3 in 30.1%, 4 in 9.9%, and 5 in 1.4%; 46.9% of the patients had comorbidities (mean age-adjusted Charlson comorbidity index 3.5 ± 1.7; median 10-year survival 77%) and the mean 8-item Parkinson’s Disease Quality of Life Questionnaire was 27.8 ± 20.5. We found an APD prevalence of 38.21% (95%CI: 35.08–41.42%), a PD prevalence of 118.4 (95%CI: 117.3–119.6), and a PD incidence of 9.4 (95%CI: 5.42–13.4) all per 100,000 population. Among the APD population, a 15.2% were receiving some form of therapy for advanced stages of the disease (deep brain stimulation, levodopa/carbidopa intestinal gel, or apomorphine subcutaneous infusion). Conclusions: The percentage of patients with APD in the hospitals of the Spanish National Healthcare System was 38.2%.

Clinical assessment of endovenous thermal ablation combined with concomitant phlebectomy for the treatment of lower limb varicose veins with or without poor glycemic control

BackgroundThis study aimed to investigate the clinical results of endovenous thermal ablation combined with stab phlebectomy for unilateral varicose veins based on diabetic management. MethodsThe study reviewed 501 patients who underwent endovenous thermal ablation combined with stab phlebectomy for unilateral varicose veins, including 337 nondiabetics (control group) and 164 diabetics. Diabetics with hemoglobin A1c ≥7% were classified as the poor glycemic control group, and hemoglobin A1c <7% as the good glycemic control group. Surgical outcomes were assessed by Venous Clinical Severity Score. The Chronic Venous disease quality of life Questionnaire was used to assess the quality of life. ResultsLower limb varicose veins can be treated successfully with endovenous thermal ablation combined with stab phlebectomy in patients with or without poor glycemic control, accompanied by a significant improvement in health status. For patients with initial varicose veins (preoperative Venous Clinical Severity Score <10), the results revealed satisfactory improvements in Venous Clinical Severity Score and quality of life among the control, poor glycemic control, and good glycemic control groups. Patients with advanced varicose veins (preoperative Venous Clinical Severity Score ≥10) also showed an obvious amelioration concerning venous symptoms and quality of life. However, the extent of improvement varied among the 3 groups. Patients subjected to advanced varicose veins with the condition of poor glycemic control exhibited a less desirable improvement in postoperative health conditions compared with the control and good glycemic control groups, especially in edema relief and ulcer healing. ConclusionEndovenous thermal ablation combined with stab phlebectomy is safe and effective in the treatment of varicose veins with or without poor glycemic control. Clinical attempts at hemoglobin A1c management may contribute to improved clinical outcomes in patients with advanced varicose veins.

Mental health in people with Parkinson\u2019s disease during the COVID-19 pandemic: potential for targeted interventions?

The COVID-19 pandemic has introduced a myriad of challenges to the social life and care of people with Parkinson’s disease (PD), which could potentially worsen mental health problems. We used baseline data of the PRIME-NL study (N = 844) to examine whether the association between COVID-19 stressors and mental health is disproportionately large in specific subgroups of people with PD and to explore effects of hypothetical reductions in COVID-19 stressors on mental health and quality of life. The mean (SD) age of the study population was 70.3 (7.8) years and 321 (38.0%) were women. The linear regression effect estimate of the association of COVID-19 stressors with mental health was most pronounced in women, highly educated people, people with advanced PD and people prone to distancing or seeking social support. Smaller effect estimates were found in people scoring high on confrontive coping or planful problem solving. The parametric G-formula method was used to calculate the effects of hypothetical interventions on COVID-19 stressors. An intervention reducing stressors with 50% in people with above median MDS-UPDRS-II decreased the Beck Depression Inventory in this group from 14.7 to 10.6, the State-Trait Anxiety Inventory from 81.6 to 73.1 and the Parkinson’s Disease Quality of Life Questionnaire from 35.0 to 24.3. Insights from this cross-sectional study help to inform tailored care interventions to subgroups of people with PD most vulnerable to the impact of COVID-19 on mental health and quality of life.

Efficacy of C-Mill gait training for improving walking adaptability in early and middle stages of Parkinson’s disease

BackgroundWalking adaptability is an obvious manifestation of Parkinson’s disease (PD). Augmented reality technologies such as interactive walkways may improve walking adaptability in patients with Parkinson’s Disease (PWP). Research questionHow effective is C-Mill gait adaptability training in the early and middle stages of PD for improving walking adaptability in motor subtypes of the disease? MethodsFifty-two patients with early- or middle-stage PD were divided into two groups according to motor subtype (postural instability/gait disorder [PIGD] and non-PIGD) and received 7 days of training (0.5 h every day, 2 h after medication) on an augmented reality treadmill with built-in visual targets and obstacles. Functional assessments were performed before and after intervention, including posture control and walking, C-gait assessment, and participant experience. The Parkinson Disease Quality of Life questionnaire was administered at 3-month follow-up. ResultsBoth the PIGD (n = 29) and non-PIGD (n = 23) groups showed improved tandem walking, obstacle avoidance, and overall score in C-gait assessment and Timed Up and Go test after C-Mill training. However, there were no differences between the two groups. The PIGD group showed improvement in visually guided stepping and Speed adaptations, whereas the non-PIGD group did not improve. The non-PIGD group reported they could complete the training with less exertion after the intervention and at the 3-month follow-up, these patients reported improvement in quality of life. SignificanceC-Mill gait adaptation training in the early and middle stages of PD improves walking adaptability in both motor subtypes. Cue strategies are the probable mechanism and may decrease fall risk after training. There was no difference between the groups in the improvements of perceived exertion and quality of life at follow-up. Although PIGD patients showed statistic improvements in visually guided stepping compared with non-PIGD patients, but the difference was not likely to be clinically meaningful. Specific effects of C-mill training for different types of PD were not observed in our study.

Health related quality of life (HRQOL) of patients with End Stage Kidney Disease (ESKD) on hemodialysis in Addis Ababa, Ethiopia: a cross-sectional study

BackgroundEnd-Stage Kidney Disease, the most severe form of chronic kidney disease, is fatal if not treated by renal replacement therapy. Thus, patients with End-Stage Kidney Disease depend on hemodialysis as a lifesaving treatment for the remainder of their lives. However, the health-related quality of life (HRQOL) of patients on hemodialysis is much more underappreciated in resource limited countries.MethodsA hospital based cross-sectional study was conducted in Addis Ababa, Ethiopia, from August 01 to October 31, 2019. All patients who were on hemodialysis in five randomly selected public and private hospitals (n = 125) were included in the study. Data were administered by trained nurses by using a standardized Kidney Disease Quality of Life questionnaire. Clinical data were extracted from the patients’ medical charts. HRQOL was categorized as low, if the overall mean score was ≤ 50, or as high, if the overall mean score was > 50. Factors associated with lower HRQOL were identified by multi-variable binary logistic regression analysis and expressed by adjusted odds ratio (aOR) and its respective 95 % confidence interval.ResultsThe mean age of the study participants (n = 125) was 50.33 years (± 15.07) and more than two-thirds (68.8 %) of the participants were males. The mean score of HRQOL was 49.08 ± 11.09, with 48.0 % (95 % CI: 42.2 − 54.5 %) of them had lower HRQOL. Unemployed patients (aOR = 2.40, 95 % CI: 1.10–5.90) and patients who had hemodialysis 2 times per week (aOR = 1.71, 95 % CI: 1.07–3.83) had lower HRQOL. Elderly patients had higher odds of having lower mean score on the burden of kidney disease (aOR = 2.07; 95 % CI 1.18–4.13) as compared to the younger patients.ConclusionsNearly half of the patients with ESKD on hemodialysis had lower overall HRQOL which is associated with their unemployment status and frequency of hemodialysis per week. Elderly patients had lower mean score of burden of kidney disease. Therefore, quality of life of patients with chronic dialysis should be given special attention during the patients’ care. Measures should be taken by the government to ensure accessibility and affordability of the hemodialysis services in the country.

Assessment of Quality of Life and Treatment Adherence in Patients under Maintenance Hemodialysis: A Cross- Sectional Study

Introduction: Chronic Kidney Disease causes sudden changes in the daily lives of patients and creates a great impact on their quality of life. Failure of adherence in Hemodialysis can lead to increased morbidity, mortality, cost, and burden on health care system.&#x0D; Objectives: This study was conducted to assess the quality of life and adherence to treatment of patients undergoing Hemodialysis.&#x0D; Methodology: A descriptive correlational study was carried out at Nobel Medical College Teaching Hospital, Biratnagar, among 96 patients who were under HD using convenience sampling technique. The data was collected through face to face interview for the period of 5 months. Quality of life and adherence to treatment were assessed using Kidney Disease Quality of Life Questionnaire (KDQOL) and End Stage Renal Disease Adherence Questionnaire (ESRD – AQ) respectively. The data was analyzed using t test, Spearman correlation statistics.&#x0D; Results In this study, the overall mean score of quality of life (QOL) of patients under HD was 48.9±13.7. More than half (54.1%) of the patients had moderate adherence to treatment while 31.2% had good adherence. Domains with the highest and lowest scores on quality of life and adherence to treatment were social domain and illness impact and adherence to HD treatment and diet restriction, respectively. There was statistically significant association between total score of quality of life and duration of HD (p≤0.05). Likewise, there was statistically significant association between adherence to treatment and marital status (p≤0.05), educational status (p≤0.05), ethnicity (p≤0.05), duration of illness (p≤0.05). Poor correlation (r= 0.273) was observed between quality of life and adherence to treatment.&#x0D; Conclusion: On average, the kidney disease component dimension of quality of life of patients under HD is higher and the overall level of adherence to treatment was moderate. Thus proper periodic counseling on illness and its long term impact, regular follow up as well as information on adherance to dietary measures are important to improve the quality of life and treatment adherance of patients under hemodialysis.

Utility of the 50% stenosis criterion for patients undergoing stenting for chronic iliofemoral venous obstruction

ObjectiveThe criterion for venous stenting in symptomatic chronic iliofemoral venous obstruction has been the arbitrary use of stenosis of ≥50%. In the present study, we evaluated the intravascular ultrasound (IVUS)-determined degree of stenosis in patients who had undergone stenting for quality of life (QOL)-impairing symptoms and assessed the utility of the 50% stenosis cutoff. MethodsA retrospective review of contemporaneously entered electronic medical record data from 480 continuous patients (480 limbs) with initial iliofemoral stents placed (2014 to 2017) for symptomatic chronic iliofemoral venous obstruction impairing their QOL was performed. The IVUS-determined normal minimal luminal areas for the common femoral vein (125 mm), external iliac vein (150 mm), and common iliac vein (200 mm) were used to group limbs as having <50% (low-grade stenosis [LGS]) or ≥50% (high-grade stenosis [HGS]) stenosis. The variables compared included the visual analog scale (VAS) for pain score, venous clinical severity score (VCSS; range, 0-27), ulcer healing, supine foot venous pressures, QOL (20-item chronic venous disease QOL questionnaire), and stent patency. A composite chronic venous insufficiency score (CCVIS) incorporating the VAS score, VCSS, and CIVIQ-20 score for predicting improvement after stenting was evaluated. ResultsOf the 480 limbs, 283 and 197 were in the LGS and HGS groups, respectively. A preponderance of women, left laterality, and post-thrombotic syndrome were noted in both groups. At baseline, although no difference was found in the VAS for pain score between groups, the LGS group had a higher VCSS than did the HGS group (P = .05). The baseline median supine foot venous pressure was 15 and 14 mm Hg in the LGS and HGS groups, respectively (P = .17). At 24 months after stenting, the mean VCSS had improved from 6.3 to 4.4 (P < .0001) and from 5.7 to 3.7 (P < .0001) in the LGS and HGS groups, respectively, without significant differences between the two groups (P = .07). A greater prevalence of ulcers was found in the LGS group (18% vs 11%; P = .04), with no differences in healing (P = .41) or recurrence rates (P = .36). The QOL scores had improved in both groups (LGS, from 58 to 37 [P < .0001]; HGS, from 61 to 35 [P < .0001]), without differences between the two groups (P > .3). No significant differences in stent patency or reinterventions rates were found. A baseline CCVIS of ≥84.5, ≥86.9, or ≥105.3 was needed for a 30-, 40-, and 50-point improvement in most limbs after stenting. ConclusionsThe degree of IVUS-determined iliofemoral venous stenosis did not appear to affect the initial clinical presentation, CEAP (clinical, etiologic, anatomic, pathophysiologic) clinical class, supine foot venous pressure, clinical improvement, QOL improvement, stent patency, or reintervention rates after stenting. Patients presenting with QOL-impairing symptoms in whom conservative treatment has failed merit consideration of correction of their obstruction even if the degree of stenosis is <50%. The use of a CCVIS might be helpful but requires further study.

Quality of Life and Health Status Among Patients Receiving Renal Replacement Therapy in Trinidad and Tobago, West Indies.

PurposeThe determinants of quality of life for patients on renal replacement therapy vary across the world. The aim of this study is to determine the quality of life of patients on renal replacement therapy in Trinidad and Tobago and predictors thereof.Patients and MethodsThis cross-sectional study took place over a 1-year period. Data were obtained from 530 out of 1383 patients meeting inclusion criteria (100 transplants, 80 peritoneal dialyses, 350 hemodialyses) using the survey instruments. Stratified random sampling with proportional allocation was used to select patients at hemodialysis centres. The Kidney Disease Quality of Life questionnaire (KDQOL-36), EuroQol and demographic questionnaires were administered via face-to-face interviews. SPSS24, STATA14 and MINITAB18 were used for descriptive and inferential data analysis.ResultsOf the 530 patients, 52.5% were male, 37.5% were in the 56–65 years age group and 51.3% were of Indo-Trinbagonian descent. Hypertension (25.5%) and type 2 diabetes mellitus (62.0%) were reported as the main causes of kidney disease in the dialysis group. In the transplant category, chronic glomerulonephritis (45%) was the main aetiology of kidney disease. The KDQOL-36 domain scores and significantly associated variables included modality of renal replacement, Charlson’s Comorbidity Index, ethnicity, income and employment status. Transplant patients had higher mean subcomponent Kidney Disease Quality of Life scores and performed better in the EuroQol than patients on dialysis. Patients on peritoneal dialysis had a better quality of life than hemodialysis patients. Among patients on hemodialysis, an arteriovenous fistula significantly impacted their quality of life.ConclusionRenal transplant recipients enjoy the best quality of life and health state among patients on renal replacement therapy in Trinidad and Tobago. Increasing patients’ access to renal transplantation or peritoneal dialysis will markedly improve health status for the number of years of renal replacement therapy.

The Parkinson’s Real-World Impact Assessment (PRISM) Study: A European Survey of the Burden of Parkinson’s Disease in Patients and their Carers

Background:A greater understanding of the everyday experiences of people with Parkinson’s disease (PD) and their carers may help improve clinical practice.Objective:The Parkinson’s Real-world Impact assesSMent (PRISM) study evaluated medication use, health-related quality of life (HRQoL) and the use of healthcare resources by people with PD and their carers.Methods:PRISM is an observational cross-sectional study, in which people with PD and their carers completed an online survey using structured questionnaires, including the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39), Non-Motor Symptoms Questionnaire (NMSQuest) and Zarit Burden Interview (ZBI).Results:Data were collected from 861 people with PD (mean age, 65.0 years; mean disease duration, 7.7 years) and 256 carers from six European countries. People with PD reported a large number of different co-morbidities, non-motor symptoms (mean NMSQuest score, 12.8), and impaired HRQoL (median PDQ-39 summary score, 29.1). Forty-five percent of people with PD reported at least one impulse control behaviour. Treatment patterns varied considerably between different European countries. Levodopa was taken in the last 12 months by 85.9% of participants, and as monotherapy by 21.8%. Carers, who were mostly female (64.8%) and the partner/spouse of the person with PD (82.1%), reported mild to moderate burden (mean ZBI total score, 26.6).Conclusions:The PRISM study sheds light on the lives of people with PD and those who care for them, re-emphasising the many challenges they face in everyday life. The study also provides insights into the current treatment of PD in Europe.