Future Quality Of Life Research Articles

Patient, caregiver, and oncologist predictions of quality of life in advanced cancer: Accuracy and associations with end-of-life care and caregiver bereavement.

Informed treatment decision-making necessitates accurate prognostication, including predictions about quality of life. We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients' future quality of life and whether these predictions are prospectively associated with end-of-life care and bereavement. We conducted secondary analyses of clinical trial data. Patients with advanced cancer (n = 156), caregivers (n = 156), and oncologists (n = 38) predicted patient quality of life 3 months into the future. Patients subsequently rated their quality of life 3 months later. Medical record data documented chemotherapy and emergency department (ED)/inpatient visits in the 30 days before death (n = 79 decedents). Caregivers self-reported on depression, anxiety, grief, purpose, and regret 7-months post-mortem. In mixed-effects models, patient, caregiver, and oncologist quality-of-life predictions at study entry were used to predict end-of-life care and caregiver outcomes, controlling for patients' quality of life at 3-month follow-up, demographic and clinical characteristics, and nesting within oncologists. Caregivers (P < 0.0001) and oncologists (P = 0.001) predicted lower quality of life than what patients actually experienced. Among decedents, 24.0% received chemotherapy and 54.5% had an ED/inpatient visit. When caregivers' predictions were more negative, patients were less likely to receive chemotherapy (P = 0.028) or have an ED/inpatient visit (P = 0.033), and caregivers reported worse depression (P = 0.002), anxiety (P = 0.019), and grief (P = 0.028) and less purpose in life (P<0.001) 7-months post-mortem. When caregivers have more negative expectations about patients' quality of life, patients receive less intensive end-of-life care, and caregivers report worse bereavement outcomes.

Abstract 7: Quality Of Life Trajectories In The Year After Large Vessel Occlusion Stroke And Their Association With 90-day Functional Outcome

Background: While research has focused on the trajectory of functional recovery after ischemic stroke, the trajectory of quality of life (QoL) has not been fully explored, nor has its relation to functional recovery. Methods: In a post hoc analysis of the IMS-III trial, we included patients with an imaging-confirmed large vessel occlusion and QoL assessed as EQ-5D at 5 study visits up to 1 year after ischemic stroke onset. We used group-based trajectory modelling (GBTM) to identify trajectories of EQ-5D index values with US-based weights and report patient demographics in each trajectory and the modified Rankin Scale (mRS) score at 90 days. Results: We included 266 patients, who had QoL measured at a mean of 4.6, 93.0, 184.3, 274.3, and 367.6 days after stroke onset. GBTM identified four trajectories with excellent fit (Figure). These QoL trajectories can be described as [1] persistent low, [2] low to medium, [3] persistent medium, and [4] medium to high. The corresponding mRS at 90 days are shown in the Figure, demonstrating a clustering of trajectories by mRS but also a diversity of trajectories. In particular, low to medium and persistent medium trajectories are represented across all mRS scores. Patient demographics are shown by trajectory in the Table, with significant differences in sex, baseline NIHSS, infarct volume, WMH burden, and diabetes. Conclusion: We demonstrate four distinct trajectories of QoL in the year after large vessel occlusion stroke, with a diversity of functional recovery and unique demographic compositions. Early recognition of a likely future QoL trajectory could suggest patient-specific rehabilitation therapies and inform prognostication and goals of care.

Biomedical students’ course preference and links with quality of life and psychological distress

Introduction: This study investigates psychological distress and quality of life (QoL) amongst first year premedical and health science students. The primary aim of this study was to investigate potential differences in QoL and psychological distress between students who sought entry into a medicine programme when compared to those opting for a non-medicine career. Methods: We examined participant responses to measures of QoL, psychological distress, and course preference (medicine or other). A structural equation model was conducted to consider the interrelationships among future course preference, gender, QoL, depression, anxiety and stress. Results: Three hundred and sixty-five students completed the online survey. An a priori conceptual model was developed and then evaluated using a structural equation model. The values obtained for RMSEA (0.027), CFI (0.999), and SRMR (0.016) indicated an excellent model fit. The overall model fit statistic, chi-square (χ2 = 7.626, df=6, p= .267), confirmed a good model fit. Students aiming to enrol in medicine generated higher psychological health and environmental QoL scores compared to their non-medicine oriented peers. In addition, physical QoL and psychological health QoL scores significantly predicted psychological distress measures. Conclusion: The study raises a potential debate regarding placing students with mixed career intentions into the same course and the potential implications this may have on teaching in interprofessional and large student groups in relation to wellbeing, pedagogy, equity, and expenditure. The findings clearly indicated that medical students are not as adversely impacted upon in terms of QoL and psychological distress compared with their non-medical peers.

The Oral Complications of COVID-19.

Background: COVID-19 is a novel coronavirus infectious disease associated with the severe acute respiratory syndrome. More and more patients are being cured due to the development of clinical guidelines for COVID-19 pneumonia diagnosis, treatment, and vaccines. However, the long-term impact of COVID-19 on patients after recovery is unclear. Currently available reports have shown that patients recovered from COVID-19 continue to experience health problems in respiratory and other organ systems. Oral problem is one of the important complications which has serious impacts on the rehabilitation and future quality of life, such as ageusia and macroglossia, but the oral complication is often being neglected. Aim of Review: From the perspective of stomatology, we summarized and elaborated in detail the types, pathogenesis of oral complications from COVID-19 patients after rehabilitation, and the reported prevention or treatment recommendations which may improve the COVID-19 patients associated oral diseases. Key Scientific Concepts of Review: 1) To understand the common oral complications and the mechanisms of the development of oral complications after the COVID-19 recovery; 2) To summary the practical strategies to prevent the oral complications and construct the rehabilitation plans for patients with oral complications.

Knowledge, Awareness and Attitude towards Prosthodontic Rehabilitation among the General Population in Bengaluru City - A Cross-Sectional Survey

Background: The prosthodontic health status and prosthodontic rehabilitation of Bengaluru city’s local population are not well documented. As prosthodontists, it is important to know how much concerned the people are towards oral health and what is their attitude, how aware are they about various available treatments and how much knowledge do they have about its importance in order to give them oral health education, create awareness and help develop the practice guidelines. Hence, the aim of the survey was to assess the knowledge, awareness and attitude of the general population in Bengaluru city towards prosthodontic rehabilitation. Material and Methods: We divided Bengaluru city (total area of about 286 sq. miles) arbitrarily into four zones, namely, North zone, South zone, East zone and West zone. A total of 2516 subjects belonging to the age group of 35 to 74 years from all the four zones were surveyed with a questionnaire which was either in English or in Kannada (local language) with sixteen closed-ended questions. The statistical analysis of the data collected through the questionnaire was done using SPSS (V-22) software. Results: The age of the subjects who participated in the survey ranged between thirty-five to seventy-four years. Among the 2516 subjects, 1283 were male subjects and 1233 were female subjects. It was found that most of the subjects (77.2%) visited the oral health care provider only when they had any dental problems. About 54.4% of the subjects who participated in the survey had not got their missing teeth replaced. About 74.9% of the subjects had restrained themselves from getting the treatment thinking that the prosthetic treatment is expensive. Conclusion: On summarizing the data obtained from the survey, it was understood that there is a strong requirement to create awareness among people about the prosthodontic rehabilitation of missing teeth. Even though there are many government programs and schemes that offer the essential dental treatments for free of cost, due to lack of awareness and knowledge regarding the same, the general public is still not approaching for the improvement of their oral health status and ignoring their dental problems thinking that the treatment is too expensive. Therefore, it is of utmost importance for the dentists to reach out to the general public, create awareness about the importance of oral health and various facilities available from the government for the dental treatments and extend the treatment hoping to improve their future quality of life through dental camps and prosthodontic outreach programs.

Religious/spiritual experiences, quality of life and satisfaction with life of hospitalized octogenarians.

to assess quality of life (QoL) and satisfaction with life (SWL) indices and verify whether the frequency of religious and spiritual experiences is associated with QoL and SWL in hospitalized octogenarians. this is a cross-sectional study, with 128 octogenarians. World Health Organization QoL instruments and Scales applied: Daily Spiritual Experience (DSES) and Satisfaction With Life (SWLS). more committed domains related to QoL and SWL: autonomy and physical capacity. The higher the score in DSES, the higher the scores in the psychological domains and past, present, and future QoL activities. The higher the score in DSES, the higher the score in the social involvement aspect. the results of this study showed that the higher frequency of religious and spiritual experiences of hospitalized elderly people was associated with better QoL and SWL. It is emphasized that religious and spiritual experiences should be explored in the hospital therapeutic context.

Human Capital vs. Quality of Life: A Sociological Appraisal

The present article sociologically analyzes how human capital and quality of life mutually affect each other. Yet, human capital is strongly possible in changing quality of life. Most countries first try to build their human capital, to be followed by a better and more prosperous quality of life. For example, South Korea and India in Asia have initially upgraded their human capital which was followed by improvement in quality of life in various sectors. In fact, in all societies, educated men and women generally have lower mortality rates; their offspring also have higher survival rates. Thus, the educational capital that leads to social capital, while affecting the current generation, also has a positive effect on future generations. Almost globally, women with higher levels of education have fewer children. They have better access to birth control tools. Such a quality of life further leads to the continuity of future quality of life. Improved quality of life leads to food per capita, accommodation per capita, services per capita, convenience per capita, and many more.

Assessing the need for a question prompt list that encourages end-of-life discussions between patients with advanced cancer and their physicians: A focus group interview study.

Early integration of palliative and cancer care improves the quality of life and is facilitated by discussions about the end of life after cessation of active cancer treatment between patients with advanced cancer and their physicians. However, both patients and physicians find end-of-life discussions challenging. The aim of this study was to assess the need for a question prompt list (QPL) that encourages end-of-life discussions between patients with advanced cancer and their physicians. Focus group interviews (FGIs) were conducted with 18 participants comprising 5 pancreatic cancer patients, 3 family caregivers, 4 bereaved family members, and 6 physicians. Three themes were discussed: question items that should be included in the QPL that encourages end-of-life discussions with patients, family caregivers, and physicians after cessation of active cancer treatment; when the QPL should be provided; and who should provide the QPL. Each interview was audio-recorded, and content analysis was performed. The following 9 categories, with 57 question items, emerged from the FGIs: (1) preparing for the end of life, (2) treatment decision-making, (3) current and future quality of life, (4) current and future symptom management, (5) information on the transition to palliative care services, (6) coping with cancer, (7) caregivers' role, (8) psychological care, and (9) continuity of cancer care. Participants felt that the physician in charge of the patient's care and other medical staff should provide the QPL early during active cancer treatment. Data were collected to develop a QPL that encourages end-of-life discussions between patients with advanced cancer and their physicians.

Prognostic Indicators in Patients with Intracerebral Hematoma in an urban clinical setting of a resource limited Country

Context and Objective: Hemorrhagic Cerebrovascular Accidents represent 10 to 15% of all strokes and are often related to the spontaneous rupture of small vessels weakened by chronic arterial hypertension or amyloid angiopathy. The aim of this work was to study the prognostic determinants of intracerebral haematomas at the neurology department of Conakry University Hospital.&#x0D; Patients and Method: This was a retrospective analytical study conducted on all patients who were hospitalized with intracerebral hematoma over the 24-month period. Only the records of patients in whom intracerebral hematoma was confirmed by brain imaging were included in this study. Logistic regression (uni-variate and multi-variate) identified prognostic determinants of intracerebral hematoma at p &lt; 0.05. The data were entered using Epi Info software version 7.1.4.0 then analysed using STATA / SE software version 11.2.&#x0D; Results: This study found 21% of cases of intracerebral hematomas during the study period, with a male predominance of 60% and a sex ratio of 1.50. The study was conducted in the presence of a male patient. Hypertension was the cause found in 89.52% of patients; followed by arteriovenous malformations in 6.67% of patients, 2.86% of cases of amyloid angiopathy and 0.95% of unknown cause. Nevertheless, we still recorded 20% of deaths during hospitalization.&#x0D; Conclusion: Previous quality of life and co-morbidities also modify the prognosis and should be taken into account in the prediction of disability and future quality of life of patients with intracerebral haematoma.

The Economic and societal burden of multiple sclerosis on lebanese society: a cost-of-illness and quality of life study protocol

ABSTRACT This protocol describes the estimation of the societal costs and quality-of-life (QOL) burden of multiple sclerosis (MS) in Lebanon. This cross-sectional, prevalence-based burden-of-illness study was carried out in a premier MS center in Lebanon. We enrolled Lebanese patients aged 18 years and older who had been diagnosed with MS more than 6 months. The study uses a bottom-up approach to estimate the cost-of-illness (COI) and QOL using a retrospective face-to-face interview questionnaire. This resource utilization questionnaire was adapted to the Lebanese context by clinical and health economics experts. The methodologies used to estimate the consumption of healthcare resources, informal care, and productivity losses are well-defined and aligned with the Lebanese healthcare system. Costs are presented overall and by MS severity levels. QOL is measured using the EuroQOL (EQ-5D-5 L) and Multiple Sclerosis International Quality of Life (MusiQoL) instrument. This protocol pioneers in informing the design of future COI and QOL studies in low – and middle-income countries (LMICs), as the methods used could be applied in similar LMICs. Furthermore, we provide recommendations and discuss the challenges of conducting a high-quality burden-of-illness study in LMICs and the steps taken to meet them, using the case of Lebanon.

Perceptions of Patients and Their Families Regarding Limitation of Therapeutic Effort in the Intensive Care Unit.

Objective: Our objective was to determine and describe the opinion and attitudes of patients and their families regarding the limitation of therapeutic effort and advanced directives in critical patients and whether end-of-life planning occurs. Religious affiliation, education level, and pre-admission quality of life were also evaluated to determine whether they may influence decisions regarding appropriate therapeutic effort. Methods: A prospective, observational and descriptive study, approved by the center’s ethical committee, was carried out with 257 participants (94 patients and 163 family members) in the intensive care unit (ICU). A questionnaire regarding the opinions of patients and relatives about situations of therapeutic appropriateness in case of poor prognosis or poor quality of life was used. The questionnaire had three sections. In the first section, sociodemographic features were investigated. In the second section, information was collected on the quality of life and functional situation before ICU admission (taking as a reference the situation one month before admission) assessed by the Karnofsky scale, Barthel index, and the PAEEC scale (Project for the Epidemiological Analysis of Critical Care Patients). The third section aimed to determine whether the family knew the patient’s opinion regarding his/her end of life. Results: Of those interviewed, 62.2% would agree to limit treatment in case of poor prognosis or poor quality of future life. In contrast, 37.7% considered that they should fight for life, even if it is irretrievable. Only 1.6% had advanced directives registered, 43.9% of the participants admitted deterioration in their quality of life before ICU admission, 18.2% with moderate-severe deterioration. Our study shows that the higher the educational level, the lower the desire to fight for life when it is irretrievable and the greater the agreement to limit treatment. Besides, those participants not affiliated with a religion were significantly less likely to fight for life, including when irretrievable, than Catholics and were more likely to agree to limit treatment. Conclusions: More than half of the participants would agree to limit treatment in the case of a poor prognosis. Our results indicate that patients do not prepare for the dying process well in advance. Religion and educational level were determining factors for the choice of procedures at the end of life, both for patients and their families.

Quality of life in individuals newly diagnosed with multiple sclerosis or clinically isolated syndrome.

Little is known about quality of life (QOL) at the time of multiple sclerosis (MS) or clinically isolated syndrome (CIS) diagnosis and how it evolves in the critical adjustment period immediately following a new diagnosis. To (1) describe QOL trajectory in the first year post-MS/CIS diagnosis and (2) examine associations of demographic and biopsychosocial factors with QOL at baseline and as it evolves over the first year post-MS/CIS diagnosis. Participants were N = 250 individuals newly diagnosed with MS or CIS. Participants completed self-report assessments of QOL, demographics, and biopsychosocial factors at 1, 2, 3, 6, 9, and 12months post-diagnosis using validated measures. At 1-month post-diagnosis, QOL M = 75.2/100 with subsequent assessments revealing consistent ratings on average. Modelling revealed a small number of variables that were predictive of QOL at baseline and/or change in QOL over time. QOL in the first year post-MS/CIS diagnosis was, on average, high and stable. A subset of modifiable factors across the biopsychosocial spectrum was associated with baseline level of QOL and change in QOL over time. The stability in QOL suggests that patients can be assessed early after diagnosis for key variables that are predictive of both current and future QOL.

An Interaction Effect of Life-Threatening Experience, Self-Efficacy, and Financial Resources on Quality of Life Among Chinese Middle-Aged and Older Women

The current study explores the interaction effect of adversities and self-efficacy at baseline on quality of life (QoL) at follow-up among middle-aged and older Chinese women. 531 women were interviewed in 2008 and 226 of them were re-interviewed a year later using Quality of Life Ladder (QoLL), General Self-Efficacy Scale (GSE), List of Threatening Experiences (LTE), Somatic Complaint Scale, and self-rated health. Respondents’ mean age at baseline was 55.7 (SD = 4.7, range: 50–78). Over a year’s time, respondents had a decline in quality of life and self-rated health (p < .001), experienced more life-threatening events (p < .05) and somatic complaints. The hierarchical multiple regression model, employed in the study, identifies three predictors of future quality of life after adding the interaction term ‘Previous LTE × Previous GSE × Previous household income’ — previous quality of life (β = .492, p < .001), previous LTE (β = -.292, p < .001), and the interaction term (β = .221, p < .05). This model explains 34.1% of the variance of future quality of life (Adjusted R2 = .341, p < .001). The findings suggests that respondents’ good self-appraisal of coping resources could moderate the impact of adversities on their future quality of life. Interventions for promoting positive psychological growth among middle-aged and older adults should cover four domains, i.e. event-related factors, environmental factors, personal factors, and cognitive and coping responses. Traditional Chinese wisdom emphasizes the importance of understanding the bad (‘Yin’—the shady side) and the good (‘Yang’—the sunny side) aspect of life events. Future research may explore the Yin Yang perspective on life-threatening experiences and its applications in cross-cultural quality of life studies in the era of globalization.

Fertility Preservation Through Oocyte Vitrification: Clinical and Laboratory Perspectives.

Preserving female fertility is crucial in a multifunctional healthcare system that takes care of patients' future quality of life. Oocyte cryopreservation is recognized by several international scientific societies as the gold standard for fertility preservation in postpubertal women, for both medical and non-medical indications. The main medical indications are oncologic diseases, gynecologic diseases such as severe endometriosis, systemic diseases compromising the ovarian reserve, and genetic conditions involving premature menopause. This paper describes the whole clinical and laboratory work-up of a fertility preservation treatment by outlining recommendations for objective and evidence-based counseling. Furthermore, it focuses on the effectiveness of the procedure and describes the most appropriate strategies to fully exploit the ovarian reserve and maximize the number of oocytes retrieved in the shortest possible time. The evaluation of the ovarian reserve, the definition of an ideal stimulation protocol, as well as oocyte retrieval, denudation, and vitrification procedures have been detailed along with approaches to maximize their efficacy, efficiency, and safety.

Quality of life of women after mastectomy with and without breast reconstruction

Introduction : Breast carcinoma is the 2nd most common cause of female death resulting from malignant neoplasms in Poland. Breast cancer occurs in younger and younger women, and often develops in professionally active persons. It is usually diagnosed at an advanced stage. A current method for the surgical removal of breast cancer involves an excision of the whole tumour with an adequate margin of healthy tissue while retaining the gland parenchyma and skin. A noticeable tendency recently observed in medicine is a complex approach to the patient, combining the treatment of the physical condition with mental considerations. Nowadays, the assessment of the quality of life of a patient is an essential element of clinical trials. The study objective is to assess the quality of life and social support for patients after breast surgery, differentiating between those who underwent breast reconstruction and those who did not. Materials and methods : Only female patients were enrolled in the study. In total, responses from 57 (100%) women were obtained. Of this group, 28 women (49%) underwent breast reconstruction. The mean age of the group was 55.09 years. The study was based on a survey prepared by the authors of this study and included socio-demographic data. The support provided by various people and organisations as experienced by the women participating in the study was also assessed. Another tool used was a questionnaire assessing the quality of life after mastectomy (EORTC QLQ-BR23) This provided the basis for an analysis of how symptoms or problems typical for patients with breast carcinoma affected quality of life. The Cantril Ladder was used to assess general life satisfaction. Results : The analysis of the results showed that more than 70% of the respondents received a substantial amount of support from their families. The patients with reconstruction assessed the level of mental support received from their family as slightly higher than the patients without reconstruction. The number of participants with breast reconstruction was 29 (50.88%), and without reconstruction was 28 (49.12%). The study showed no statistically significant differences in any aspects of the quality of life between the 2 study groups. The respondents assessed their quality of life as higher before the procedure than now. Thus, the surgery decreased their quality of life. However, the assessment of future quality of life (in 3 years’ time) is better than the assessment of the present quality of life. Conclusions : 1. Women who had undergone a mastectomy claimed that the biggest support came from their families. 2. There is no statistically significant difference between women with and without breast reconstruction regarding general quality of life or in the specific areas of the quality of life.

Effect of Game-Based Cognitive Training Programs on Cognitive Learning of Children with Intellectual Disabilities

Early detection and repeated learning training of children with intellectual disabilities are important factors that are directly related to the quality of future life of such children. However, implementation of such programs is challenging, as the subjects are still children. Therefore, motivation and interest are important for children with intellectual disabilities to carry out continuous training. In this study, Neuro-World, a game-based cognitive training program, was proposed for motivation and interest induction, and its effectiveness was compared with that of a conventional cognitive training program through analysis after both programs were implemented by professional therapists. The pre-test and post-test results of the game-based cognitive training program were statistically significant and showed superiority in the comparison with the conventional program. Therefore, the game-based cognitive training program developed in this study through digital media is expected to be effective in improving cognitive learning ability.

Physician Perceptions on Quality of Life and Resuscitation Preferences for Extremely Early Newborns.

The study aimed to explore physician views on whether extremely early newborns will have an acceptable quality of life (QOL), and if these views are associated with physician resuscitation preferences. We performed a cross-sectional survey of neonatologists and maternal fetal medicine (MFM) attendings, fellows, and residents at four U.S. medical centers exploring physician views on future QOL of extremely early newborns and physician resuscitation preferences. Mixed-effects logistic regression models examined association of perceived QOL and resuscitation preferences when adjusting for specialty, level of training, gender, and experience with ex-premature infants. A total of 254 of 544 (47%) physicians were responded. A minority of physicians had interacted with surviving extremely early newborns when they were ≥3 years old (23% of physicians in pediatrics/neonatology and 6% in obstetrics/MFM). The majority of physicians did not believe an extremely early newborn would have an acceptable QOL at the earliest gestational ages (11% at 22 and 23% at 23 weeks). The majority of physicians (73%) believed that having an extremely preterm infant would have negative effects on the family's QOL. Mixed-effects logistic regression models (odds ratio [OR], 95% confidence interval [CI]) revealed that physicians who believed infants would have an acceptable QOL were less likely to offer comfort care only at 22 (OR: 0.19, 95% CI: 0.05-0.65, p < 0.01) and 23 weeks (OR: 0.24, 95% CI: 0.07-0.78, p < 0.02). They were also more likely to offer active treatment only at 24 weeks (OR: 9.66, 95% CI: 2.56-38.87, p < 0.01) and 25 weeks (OR: 19.51, 95% CI: 3.33-126.72, p < 0.01). Physician views of extremely early newborns' future QOL correlated with self-reported resuscitation preferences. Residents and obstetric physicians reported more pessimistic views on QOL. · Views of QOL varied by specialty and level of training.. · Contact with former extremely early newborns was limited.. · QOL views were associated with preferred resuscitation practices..

The Application Systems with Industrial Revolution 5.0 In Supporting Youth Development Environment

The role of Information Communication Technology (ICT) in our life is very important and nowadays it is required to be used anywhere, through any platforms and anytime especially in relation to Youth Community of Practice (YCoP) activities in enhancing their future quality of life. Meanwhile, for social development of the youth and preparation to become a leader of tomorrow, ICT of Application System (AS) with Industrial Revolution (IR5.0) plays a big part in their journey in ensuring no one is left behind and always ready to face new issues and upcoming challenges in the future. Besides that, based on the reviews of the related papers done, there is an indication that the need of the AS is becoming increasingly important and could not be avoided in YCoP environment. Therefore, Application Systems with IR 5.0 is considered essential in assisting the youth for their activities of future development environment purposes and consequently this will ensure their quality of life can be improved and sustainable all the time.

Spondylolisthesis in young patients: postoperative functional outcomes at 22-year mean follow-up.

Previous short- and intermediate-term clinical and radiographic studies demonstrated good results in patients who underwent spine surgery for spondylolisthesis, long-term outcomes are lacking instead. Young patients are often involved in high-demanding and sport activities, therefore good/excellent functional outcomes are very important for their future quality of life. The aim of this study is to assess the long-term functional results in young patients surgically treated for developmental spondylolisthesis. Retrospective evaluation of consecutive patients who underwent lumbar surgery for spondylolisthesis. Inclusion criteria were: spondylolisthesis from grade 1 to spondyloptosis, age at surgery < 25years, follow-up > 15years. The following outcomes were assessed: VAS back, VAS leg, Oswestry disability index (ODI) score, Short Form 12 (SF-12), rate of revision surgery, postoperative recovery and sport activity. 113 patients were enrolled. Mean age at surgery was 19.8years and mean follow-up was 22.1years (16-32). 16 patients (14.2%) needed revision surgery. Functional outcomes at last follow-up were: VAS back = 1.6, VAS leg = 1.4, ODI = 9.2%, SF-12 physical component summary = 50, SF-12 mental component summary = 48.7. Significant differences were assessed in terms of ODI (p = 0.047) and SF-12 PCS (p = 0.015) between group treated with instrumented and non-instrumented techniques. Among the patients who practiced a sport, 87% returned to sport postoperatively (55% at medium-high-intensity level). This study shows good long-term functional outcomes in patients surgically treated for developmental spondylolisthesis. After surgery, there is a low incidence of back pain, the residual disability is mild and almost half of patients recover the same level of sport activity. Instrumented surgical techniques developed over the years seem to be related to high revision rate, but this does not affect long-term functional results.

Optimal treatment policies for pelvic organ prolapse in women

ABSTRACTPelvic organ prolapse (POP) is a very common gynecological disorder greatly affecting the quality of life (QoL) of females in the society. Studies have shown that approximately 40% of women in the United States have POP that requires medical intervention. In clinical practice, there are four treatment options for POP: watchful waiting, conservative treatment, reconstructive surgery, and obliterative surgery. In this study, we utilize practical data obtained through surveys and clinical literature and develop a model to help physicians and POP patients dynamically select treatment options in order to maximize a patient's expected future QoL. Results from the model are presented in the form of optimal policy tables, which can be used by physicians and patients by entering several attributes as inputs, such as the patient's age, current observed QoL defined by the severity of POP symptoms, preferences over preserving coital function, and other potential restrictive conditions. The results show significant socioeconomic incentives for potential utilization of optimal treatment policies in POP treatment. We estimate based on QoL to dollar conversions that the expected value of improved QoL for an individual POP patient is around $10,000. When aggregated over the entire POP population seeking treatment, the total annual expected value for the society is at least $675 million under medium‐level valuations of QoL. Although the optimization‐based policies imply an overall increase of about $200 million in annual POP treatment costs, the net positive gains can make this trade‐off an acceptable one.