Final Health-related Quality Of Life Research Articles

Fast Track Surgery-Minimizing Side Effects of Surgery.

BSurgery leaves scars not only on the body but mind as well^ has been known for long [1]. Human civilization has progressed with paralleled evolution of technology and its application in surgical science. Surgery was once seen merely as a life-saving option. It has progressed from life to limb saving with function preservation and further to being cytoprotective or cyto-preservative [2]. Surgeons have been, used to setting the agenda for defining their own outcomes, enjoying a fiducial relationship with their patients. This therapeutic privilege and the fulcrum of social pedestal occupied by surgeons is undergoing a change in this era of Binformed consent^ [3]. The social perceptions of surgeons are suspect, given the dichotomy between the choices we make for ourselves and choices we offer to our patients [4]. In addition to Bclinical outcome^-based perspective, patient’s perceptionbased perspective is gaining currency [5, 6]. Patient reported outcomes (PROs) are driving the current march of surgical sciences [7]. The PROs are not only addressing the need for the precision and perfection in clinical outcomes but are bordering at zero tolerance for adverse events, calling at making them Bnever events^ [8, 9].Much of the PRO-related recovery can be defined as the components of postoperative recovery or postoperative convalescence. Postoperative convalescence relates to the patient-reported recovery after the surgeonexpected clinical outcome has been optimized. This is akin to the side effects of medicine alluded to by Sir Osler. It would not be an exaggeration to call the PRO-based postoperative convalescence as the Bside effects of surgery.^ It is this side effect of surgery which defines the return to normal, for the surgical patient, and determines the final health-related quality of life (HrQoL). Abdominal surgery in an index area for the surgeon. Abdominal surgery is distinct from other regions in creating an autonomic wound in addition to the somatic wound [10]. The somatic wound innervated by the thoracolumbar nerves works through the posterior column of spinal cord. The effects of this can be clinically controlled by regional blocks, preemptive analgesia, etc. Minimally, invasive surgery has minimized the somatic wound and should have neutralized the impediment to convalescence absolutely. But, the evidence has been to contrary, in a setting of level 1 designed study for colorectal operations [11]. It is therefore the importance of autonomic wound of abdominal surgery that needs to be considered. The peritoneum, a functional and metabolic omnipresent structure in abdomen, conveys sensations through the largest visceral nerve in the body, i.e., vagus, directly to brain through autonomic pathways. It has distinct nociceptors which at times are unresponsive, i.e., Bsilent nociceptors^ which respond only during an insult such as surgery. In addition to inflammatory cascade of somatic wound, this autonomic wound-mediated inflammation has a tremendous capacity for downstream amplification [12]. The complex interplay of somatic and autonomic wound-mediated inflammatory cascade has been in * Chintamani drchintamani7@gmail.com

Health-related quality of life in patients with metastatic renal cell carcinoma treated with sunitinib vs interferon-α in a phase III trial: final results and geographical analysis

Background:In a randomised phase III trial, sunitinib significantly improved efficacy over interferon-α (IFN-α) as first-line therapy for metastatic renal cell carcinoma (mRCC). We report the final health-related quality of life (HRQoL) results.Methods:Patients (n=750) received oral sunitinib 50 mg per day in 6-week cycles (4 weeks on, 2 weeks off treatment) or subcutaneous IFN-α 9 million units three times weekly. Health-related quality of life was assessed with nine end points: the Functional Assessment of Cancer Therapy–General and its four subscales, FACT–Kidney Symptom Index (FKSI-15) and its Disease-Related Symptoms subscale (FKSI-DRS), and EQ-5D questionnaire's EQ-5D Index and visual analogue scale. Data were analysed using mixed-effects model (MM), supplemented with pattern-mixture models (PMM), for the total sample and the US and European Union (EU) subgroups.Results:Patients receiving sunitinib reported better scores in the primary end point, FKSI-DRS, across all patient populations (P<0.05), and in nine, five, and six end points in the total sample, in the US and EU groups respectively (P<0.05). There were no significant differences between the US and EU groups for all end points with the exception of the FKSI item ‘I am bothered by side effects of treatment’ (P=0.02). In general, MM and PMM results were similar.Conclusion:Patients treated with sunitinib in this study had improved HRQoL, compared with patients treated with IFN-α. Treatment differences within the US cohort did not differ from those within the EU cohort.

Do antibiotics affect the quality of life of patients with upper respiratory tract illnesses?: it might depend on one’s luck

Upper respiratory tract illnesses (URTI) are known to cause measurable decline in health-related quality of life (HRQL). We studied whether antibiotics impacted patients' HRQL after obtaining medical care for URTI. Adults seeking care for URTI at a family medicine office were eligible for this study. Decisions to prescribe antibiotics were left to their physicians. Subjects completed the Quality of Well-Being questionnaire on enrolment and on days 3, 7, 14 and 28. Analysis of HRQL was undertaken using repeated measures ANOVA and ANCOVA. Seventy-three patients (mean age 35.8 years) were studied. Thirty-six of the subjects (50.7%) received prescriptions for antibiotics from their physicians at the index visit. By day 28, 78.4% of the subjects in the antibiotic group and 77.8% of the other group reported cure (p = 0.95). Receiving a prescription for an antibiotic at the initial visit did not influence subsequent HRQL reported by subjects (p = 0.98). However, when subjects receiving antibiotics were subgrouped by whether they reported an antibiotic adverse event we found significant differences in final HRQL. Subjects receiving antibiotics but not experiencing adverse events reported higher HRQL by day 28 than did subjects receiving an antibiotic but also reporting adverse events and subjects not receiving any antibiotics (p = 0.02). Providing patients experiencing URTIs with prescriptions for antibiotics does not, on average, positively impact HRQL over the following 28 days. However, the subgroup of patients who receive antibiotics and do not experience an adverse event may come out ahead.

The new questionnaire Health-Related Quality of Life for Eating Disorders showed good validity and reliability

Background and Objectives To describe the development and investigate the psychometric properties of a new instrument to measure health-related quality of life (HRQoL) for individuals with an eating disorder (ED). Methods Seven focus groups were convened and an extensive literature review was carried out to generate the items. The first draft of the questionnaire was pilot tested. Three hundred twenty-four ED patients took part in the final field study. The 12-Item Short Form Health Survey, the Eating Attitudes Test-26, and two items from the Eating Disorders Inventory-2 also were applied to examine the concurrent validity. Factor analysis, item scale correlation correcting for overlap, test–retest, Cronbach's α coefficient, known-groups validation, and the sensitivity of the questionnaire in different populations also were examined. Results The final Health-Related Quality of Life in Eating Disorders (HeRQoLED) questionnaire consisted of 50 items. Principal axis factor analysis identified eight subscales. Concurrent validity showed correlations >.40 with the criteria measures. Excellent reliability and stability were obtained. The HeRQoLED was sensitive in discriminating both between known-different groups and from the general population. Conclusion The results provide evidence of the good psychometric properties of the new HeRQoLED questionnaire, except for one domain, which had to be eliminated.