Better Quality Of Life Scores Research Articles

Patient-Reported Chronic Pain Outcomes After Lung Transplantation.

Chronic pain after lung transplantation is a significant concern, in particular given the heterogeneity of the patient population and the challenges of achieving adequate pain control amid concerns related to complex immunosuppressant regimens and the possibility of respiratory depression. We undertook a patient-reported outcomes (PRO) survey administered via our electronic health care portal to examine the postoperative incisional pain prevalence in a cohort of lung transplant recipients at a single, high-volume center where bilateral thoracosternotomy is the preferred surgical approach. The Patient Reported Outcomes Measurement Information System (PROMIS) Global Health and Pain Intensity short forms were sent to a total of 173 lung transplant recipients who were more than 2 months postsurgery at the time of the study. A total of 64 patients responded to both PROMIS surveys (response rate 38%). In the cohort of survey respondents, we observed a chronic pain incidence of 58% after lung transplantation (median pain score 1/10) and an overall good quality of life score (median score 4/5); however, only 9.4% reported moderate-severe pain (pain score ≥5/10). Survey nonrespondents had higher rates of pretransplant opioid and psychiatric medication use compared with respondents. In this study, we demonstrated the feasibility of using an electronic PRO survey for assessing postoperative pain outcomes after lung transplantation. However, measuring pain outcomes using this type of tool highlights issues of response rate and potential selection bias. Larger studies are needed to adequately assess the risk and predictors of chronic pain after lung transplantation and its impact on quality of life.

IL-23 Inhibition as a Key Component in Psoriasis Treatment is Here to Stay

Prof Elke de Jong focussed her presentation on data from randomised clinical trials (RCT) and real-world evidence (RWE) from psoriasis patient registries. Such data is complementary with RCT having high internal validity but low external validity, and RWE having low internal validity but high external validity. She reviewed the predictors for stopping psoriasis biological treatment of high BMI and female sex and predictors for continuing treatment as concurrent psoriatic arthritis. Current unmet needs in psoriasis that demonstrate the requirement for additional treatments include patients experiencing psoriasis for roughly 20 years before being prescribed biologics, prevention of damage (e.g., psoriatic arthritis), achieving sustained effectiveness or cure, developing better patient-reported outcome measures, and better treatment of specific psoriatic areas (scalp, face, nails, and genitalia). Dr Andreas Pinter reviewed the role played by IL-23, IL-17A, and IL-22 in psoriasis, and new agents including ustekinumab blocking both IL-12 and IL-23; guselkumab, tildrakizumab, and risankizumab blocking IL-23; and brodalumab blocking IL-17A. He explored VOYAGE 1 data that showed that the IL-23 inhibitor guselkumab maintained Psoriasis Area and Severity Index (PASI) 90 response through Week 156 in >80% of patients. Furthermore, VOYAGE 2 results showed PASI 90 response was maintained in >50% of patients 6 months after guselkumab withdrawal. He demonstrated how re-treatment with guselkumab led to a high PASI 90 response in patients who lost PASI 90 response after withdrawal of treatment. Data from the VOYAGE 1 study further showed that guselkumab produced statistically significant improvements in scalp and palmar plantar scores over adalimumab, and comparable nail scores to adalimumab. Data from the UltlMMa-1 and ULtlMMa-2 studies showed that IL-23 inhibition with risankizumab produced better quality of life scores than with ustekinumab. Additionally, the ECLIPSE trial showed that IL-23 inhibition with guselkumab produced higher PASI 90 response rates than IL-17 inhibition with secukinumab at Week 48.

IL-23 Inhibition as a Key Component in Psoriasis Treatment is Here to Stay

Prof Elke de Jong focussed her presentation on data from randomised clinical trials (RCT) and real-world evidence (RWE) from psoriasis patient registries. Such data is complementary with RCT having high internal validity but low external validity, and RWE having low internal validity but high external validity. She reviewed the predictors for stopping psoriasis biological treatment of high BMI and female sex and predictors for continuing treatment as concurrent psoriatic arthritis. Current unmet needs in psoriasis that demonstrate the requirement for additional treatments include patients experiencing psoriasis for roughly 20 years before being prescribed biologics, prevention of damage (e.g., psoriatic arthritis), achieving sustained effectiveness or cure, developing better patient-reported outcome measures, and better treatment of specific psoriatic areas (scalp, face, nails, and genitalia). Dr Andreas Pinter reviewed the role played by IL-23, IL-17A, and IL-22 in psoriasis, and new agents including ustekinumab blocking both IL-12 and IL-23; guselkumab, tildrakizumab, and risankizumab blocking IL-23; and brodalumab blocking IL-17A. He explored VOYAGE 1 data that showed that the IL-23 inhibitor guselkumab maintained Psoriasis Area and Severity Index (PASI) 90 response through Week 156 in >80% of patients. Furthermore, VOYAGE 2 results showed PASI 90 response was maintained in >50% of patients 6 months after guselkumab withdrawal. He demonstrated how re-treatment with guselkumab led to a high PASI 90 response in patients who lost PASI 90 response after withdrawal of treatment. Data from the VOYAGE 1 study further showed that guselkumab produced statistically significant improvements in scalp and palmar plantar scores over adalimumab, and comparable nail scores to adalimumab. Data from the UltlMMa-1 and ULtlMMa-2 studies showed that IL-23 inhibition with risankizumab produced better quality of life scores than with ustekinumab. Additionally, the ECLIPSE trial showed that IL-23 inhibition with guselkumab produced higher PASI 90 response rates than IL-17 inhibition with secukinumab at Week 48.

Kualitas Hidup Pasien Tuberkulosis Paru dengan Stigma Diri

Tuberkulosis paru (TB) adalah penyakit kronik yang dapat memunculkan stigma diri penderitanya dan sekaligus mempengaruhi kualitas hidupnya. Sejumlah penelitian melaporkan bahwa hidup dengan TB memberikan pengaruh negatif terhadap kualitas hidup penderitanya meskipun dengan atau tanpa adanya stigma diri. Tujuan dari penelitian ini adalah untuk mengidentifikasi kualitas hidup pasien TB yang mengalami stigma diri. Merupakan penelitian deskriptif, dengan jumlah sampel sebanyak 31 orang pasien TB. Data dikumpulkan dengan menggunakan kuesioner. Peneliti melakukan skrining terlebih dahulu pada pasien TB yang mengalami stigma diri. Hasil penelitian didapatkan sebanyak 25 orang (80,64%) responden mengalami stigma diri ringan. Sebanyak 9 responden (36%) memiliki skor kualitas hidup dalam kategori baik dan sebanyak 16 responden (64%) memiliki skor kualitas hidup dalam kategori kurang baik dengan rata-rata skor kualitas hidupnya adalah 56,57. Sedangkan responden yang memiliki stigma diri sedang sebanyak 6 orang (19,36%) dengan skor kualitas hidup baik sebanyak 1 orang (16,67%) dan skor kualitas hidup kurang baik 5 orang (83,33%) dengan skor rata-rata kualitas hidup adalah 49,92. Kata kunci: kualitas hidup, stigma diri, tuberkulosis paru

Kualitas Hidup Pasien Tuberkulosis Paru yang Mengalami Stigma Diri (Quality of Life Pulmonary Tuberculosis Patients With Self Stigma))

Pulmonary tuberculosis (TB) is a chronic disease that can bring about the sufferer's self-stigma and also affect his quality of life. A number of studies report that living with TB has a negative influence on the quality of life of sufferers even with or without self-stigma. The purpose of this study was to identify the quality of life of TB patients who experienced self-stigma. This research is a descriptive study, sample were 31 pulmonary TB patients. Data was collected using a questionnaire. Data analyzed by using frequency distribution and percentage. The researcher first screened TB patients who experienced self-stigma. The results showed that 25 people (80.64%) respondents experienced mild self-stigma. A total of 9 respondents (36%) had a quality of life score in the good category and as many as 16 respondents (64%) had enough category with an average quality of life score is 56.57. While respondents who had moderate self-stigma were 6 people (19.36%) with a good quality of life score was 1 person (16.67%) and enough category quality of life score were 5 people (83.33%) with an average quality of life score is 49.92.

Patterns, outcomes and trends in hospital visits of un-operated and operated children with rheumatic heart disease in Sudan.

Rheumatic heart disease (RHD) is an important public health problem in Sudan. Clinical and echocardiographic findings from an RHD registry in Khartoum (January 2005-March 2018) are described. Operated and un-operated children were prospectively followed. The quality of life (QOL) for children who had surgery was evaluated using pediatric QOL cardiac module. A total of 818 children (51% males) were included, patients were clustered in White Nile and Kordofan area. RHD was found in 78% and acute rheumatic fever (ARF) in 22% of cases. RHD was severe in 65% and the most common lesion was mitral regurgitation (MR) in 37%. Follow-up of 107 un-operated children for a mean of 2 years revealed major complications in 38% including a mortality of 14%. Severe valve dysfunction tended to remain unchanged. There were 3 deaths in children with severe valve lesions immediately following benzathine penicillin injections. Only 19% of patients underwent surgery with an average post-operative mortality of 10.5% in the last 8 years. Of those, only 34 were reached for follow-up (23%), all were in New York Heart Association (NYHA) class 1, however adverse outcomes were observed including noncompliance with benzathine penicillin and warfarin (51% and 29% respectively) and more than mild valve dysfunction in 35%. All children who had valve surgery have a good QOL scores. In the last 3 years, the outpatient visits, admissions and mortality rates decreased by 20%, 48% and 22% respectively. RHD is clustered in certain areas and presents with severe valve lesions with a high mortality for un-operated patients. Operative mortality improved over the last years but the follow-up rates are poor and adverse outcomes are common. There is an apparent trend of decline in the number of patients with RHD seen at referral hospitals.

Health related quality of life in nigerians with complicated diabetes mellitus – a study from Enugu, South East Nigeria

BACKGROUND: Diabetes mellitus has serious consequences for patients and the presence of complications increases its morbidity and mortality including reduced quality of life. The health-related quality of life of adults with complicated diabetes in South-East Nigeria is largely unknown. AIM: This study determined the health-related quality of life among adults with complicated diabetes mellitus seen at the foremost public tertiary hospital in South East Nigeria. METHODS: Consecutive subjects with complicated diabetes, attending the dedicated out-patient clinic of the University of Nigeria Teaching Hospital were recruited over twelve weeks. Informed consent, socio-demographic and clinical data were obtained. Quality of life was determined for each patient using the validated WHOQoL-BREF instrument. Data was analyzed using the Statistical Package for Social Sciences (version 23). RESULTS: One hundred and twenty patients (54.2% females) with 42.5% aged 18-45 years were recruited. The overall mean quality of life score was reduced for all patients and especially for the very young (aged 26-35 years).The lowest quality of life score was seen in Domain 1 (physical health). Females had significantly better quality of life scores than males in social relationships domain. Presence of co-morbidities had the worst impact on quality of life across all domains. CONCLUSION: Patients with complicated diabetes mellitus in Enugu, South East Nigeria demonstrated a reduced quality of life across all domains. This was most prevalent in the very young patients. There is a need for optimal management of the condition in Nigeria.

Quality of life scores among 411 medical students

The high academic burden may hamper the quality of life of medical students. To evaluate the quality of life (QOL) for medical students attending a Chilean university. Four hundred eleven medical students aged 22 ± 2 years (51% women), studying in Santiago, Chile, answered online a validated Spanish version of the WHOQOL-BREF quality of life survey (scored from 0 to 100). Overall scores were assessed for the questionnaire domains Physical health, Psychological health, Interpersonal relationships, and Environment. The global scores were 65.1 for Physical health, 63.1 for Psychological health, 61.3 for Interpersonal relationships and 67.2 for Environment. Students in clinical practice, females, those with sedentary behaviors and consuming modafinil had lower Physical health scores. Students coming from outside Santiago, with sedentary behaviors and who consumed modafinil had poorer Psychological health scores. Students coming from outside Santiago, males and those with sedentary behaviors had Lower Interpersonal relationship scores. Environment scores were also lower among students who were sedentary or from outside Santiago. The variables that had a greater negative impact in the quality of life of these students were the transition from theoretical courses to clinical practice, being from outside Santiago, being overweight or obese and consuming modafinil. Students that were physically active had better quality of life scores.

Effect of educational nursing program on quality of life for patients with type II diabetes mellitus at Assiut University Hospital

Background: Diabetes mellitus constantly changes a patient’s life. Patient’s self care, consisting of daily insulin injections or oral anti-diabetic agents, self monitoring of blood glucose and diabetic diet has an impact on QOL. The aim of the present study was to assess quality of life for patients with type II diabetes mellitus, to develop and implement an educational nursing program for patients with type II diabetes mellitus, to evaluate the effect of applying the educational nursing program on quality of life for patients with type II diabetes mellitus pre and after two months from application of educational program.Methods: The study was conducted in the internal medicine department, internal medicine and diabetes clinic at University Hospital (Assiut–Egypt). Sixty adult patients were divided randomly equally into two groups (study group and control group) thirty for each group. The following tools were utilized for data collection: first tool “Structured patient interview questionnaire sheet”; it included two parts (socio-demographic characteristic and medical data), second tool “World Health Organization Quality of life (WHOQOL-WHO) scale”.Results: In the control group 40% of diabetic patients had good quality of life score while in the study group 100% had good quality of life after application of the educational program.Conclusions: The results of the present study concluded that: according to the control group, there was no statistically significant difference pre and post program in all domains of quality of life scale. According to the study group there was a highly significant effect of educational program on promotion of quality of life in physical, psychological, and social domains scale. Recommendations: Providing a written educational nursing program is of great importance for the patients.

Quality of life and glycemic profile of type 2 diabetes mellitus patients of Indonesian: a descriptive study

The prevalence of diabetes type 2 is increasing globally. Quality of life (QOL) in diabetic patients is the primary goal of care. Today, there is an increasing awareness suggesting that patient’sQOLand treatment satisfaction were improved after good glycemic control. This study aimed to demonstrate the quality of life and the glycemic profiles of type 2 Diabetes Mellitus patients. This study was a descriptive study of across-sectional design. A sample of 115 out-patients attending eight public health centers in Binjai City, Indonesia. Patient’s quality of life was assessedin four domains of role limitation due to physical health, psychosocial, social and environment in a four Likert point. Two glycemic profiles which are blood sugar level and glycated hemoglobin (HbA1c) were measured by Spectrophotometer Colorimeter + Full Automatic method and affinity Doronad + Modified HPLC technique, respectively. In the results, we confirmed that almost 80.0% of diabetes mellitus type 2 patients are in good QOL(score 81-100) in three QOL dimensions; Physical health, Social relationship and Environment health but not in Psychological health dimension. The blood sugar level and HbA1clevel are beyond the normal value, 267.5±103.2mg/dLand9.9±2.3%,respectively. The better controlled glycemic index, the better patient’s QOL.

Quality of life and current needs of cancer survivors enrolled in Humanitas Research Hospital's survivorship care model.

170 Background: While there are different studies investigating the quality of life (QoL) of cancer patients (pts) during active treatment, few studies report QoL of cancer survivors (CS) after at least 5 years (yrs) from achieving complete remission. We have investigated QoL and concerns about physical\psychological symptom of CS enrolled in our survivorship program from April 2015 to December 2016. Methods: We included pts > 18 yrs affected by hematologic or solid tumors after at least 5 yrs from achieving complete remission. A cross-sectional survey was carried out using validated scales: Cancer Survivors Survey of Needs subscale and a single-item measure of global QoL perception. Results: We analyzed data from 178 CS. The median age was 62 yrs (52 yrs at diagnosis), 70% were females. The most frequent histological types were breast (50%), colorectal (11%) and hematologic tumors (16%). Most pts received both chemotherapy and radiation therapy. With a median observation time of 139 months, the 10-yrs cumulative incidence of second neoplasm and cardiac adverse event was 8% and 7% respectively. 133 pts (65%) reported a good QoL (score > 3). The most frequent symptoms reported were weight changes (77%), memory\concentration deficit (65%), dental\mouth problems (61%). The most common physical\psychological symptoms were fear of relapse (83%), genetic counseling (68%), living with uncertainty (66%). A positive statistically significant association (p < 0.05) was observed between previous hormonal therapy and the following concerns (score ≥2): sleep disturbance (42% vs 35%); weight gain (31% vs 24%), osteoporosis (35% vs 18%), living with uncertainty (44% vs 38%). Female reported more fear of relapse (p 0.023) and sense of uncertainty (p 0.006) than males. 92% of pts have fully or partially adhered to the survivorship care plan. Conclusions: Most CS have a good QoL perception but we observed a high percentage of pts with a low score indicating different needs to be addressed. Pts treated with hormonal therapy are at higher risk of having both physical and psychological concerns. So far, the compliance of pts with the program was high.

An assessment of quality of life of transgender adults in an urban area of Burdwan district, West Bengal

Background: Transgender people are stigmatised in our society and are being discriminated in every aspect of life. Many of them experience abuses in various forms since childhood. Accordingly these might have adverse consequences on their life and modify their quality of life (QOL). This aspect needs to be explored. In this context the present study was conducted to assess the QOL among adult transgender people and to find its association with their socio-demographic characteristics in Burdwan municipal area of Burdwan district.Methods: A cross-sectional study was conducted during July-December 2016 among 79 adult transgender people residing in the study area. Sample size was based on 50% having satisfactory QOL with 95% CI, 10% relative error, and 10% non-response rate with finite population correction (total target reference population 96). Subjects were selected by simple random sampling and recruited for interview by time space sampling. Socio-demographic characteristics were assessed by a predesigned schedule and QOL was assessed by using a validated Bengali version of WHO-QOL BREF questionnaires.Results: 56.9% people were found to be have good QOL score as a whole. Maximum and minimum percentages of good QOL score was found in environmental domain (84.7%) and social relationship domain (45.8%). A significant positive correlation was found between education and monthly income with QOL score while negative correlation between age and QOL score. Marital status, current living status and occupation were found to have a statistically significant association with QOL score.Conclusions: The study measured QOL as well as identified some important socio-demographic variables which affected QOL among transgender people. These findings can help the government to plan conceptually to improve QOL in this special transgender group of population by some legislation, social awareness and facilities dedicated towards them.

Selective noradrenaline reuptake inhibitors for schizophrenia.

Selective noradrenaline reuptake inhibitors for schizophrenia.

Outcomes analysis of breast reduction in Brazilian women using the BREAST-Q® questionnaire: a cross-sectional controlled study

OBJECTIVE:The aim of this study was to analyse patient-reported outcomes of reduction mammoplasty among Brazilian women.METHODS:A total of 100 women were enrolled in this cross-sectional controlled study, 50 with breast hypertrophy (Hypertrophy Group) and 50 who had undergone breast reduction at least six and up to 12 months before (Mammoplasty Group). The Brazilian version of the BREAST-Q® was applied to assess patient-reported outcomes. The module reduction/mastopexy was used, and the preoperative and postoperative versions were applied to the hypertrophy and mammoplasty groups, respectively.RESULTS:The mammoplasty group presented higher scores for the subscales satisfaction with breasts, psychosocial well-being, sexual well-being and physical well-being (p=0.0001 for all of these subscales).CONCLUSION:These results suggest that patients submitted to reduction mammoplasty are satisfied with the outcomes and present better quality of life scores compared with women with breast hypertrophy.

Long-Term Outcomes and Quality of Life in Patients after Soave Pull-Through Operation for Hirschsprung's Disease: An Observational Retrospective Study.

Patients after pull-through operation for Hirschsprung's disease (HD) are at high risk of defecation disorders. This study aimed at investigating their long-term outcomes and quality of life (QoL) in comparison with controls. Patients older than 5 years operated on for HD were interviewed to complete detailed questionnaires on bowel function. Patients without neurologic impairment were enrolled in a QoL survey to compare with controls matched for sex and age and selected randomly from the general population using sampling set in a ratio of four controls to one case of HD. In total, 53 operated patients were enrolled. Mean age of the patients was 16 ± 8 years, with 68% boys. Rectosigmoid aganglionosis was the most seen form of HD in 38 (72%) cases. Open Soave was performed in 40 (75.5%) cases, and minimally invasive surgery Soave (MIS Soave) in 13 (24.5%) cases. At investigation, prevalence of fecal incontinence and constipation were 22.6 and 13.2%, respectively. Regarding QoL survey, 45 patients and 180 controls were enrolled, excluding 8 patients with neurologic impairment. Thirty-seven (82.2%) patients were classified as having a good QoL (score ≥ 9 points); whereas six had a fair QoL (5-8 points) and two had a poor QoL (< 5 points). QoL score in the cases and the controls were 10.2 ± 2.5 and 11.9 ± 0.4 points, respectively. Long aganglionosis form of HD was significantly associated with a low QoL (score < 8 points), adjusted odds ratio = 9, 95% confidence interval [1.3; 64.1] (p < 0.05). In subscales analyses, the prevalence of each dimension including fecal continence, school absenteeism, unhappiness or anxiety, food restriction, and peer rejection was significantly higher in operated patients than in controls (p <0.001). Although the QoL of patients operated on for HD in general was with good outcomes, fecal incontinence and constipation still are problematic issues and challenges in a high percentage of patients. Therefore, a long-term and multidisciplinary follow-up is essentially required for these patients.

Chemoembolization Adopting Polyethylene Glycol Drug-Eluting Embolics Loaded With Doxorubicin for the Treatment of Hepatocellular Carcinoma.

The purpose of this study is to determine the efficacy and tolerability of transarterial chemoembolization (TACE) using polyethylene glycol (PEG) drug-elutable microspheres loaded with doxorubicin for treatment of hepatocellular carcinoma (HCC). Forty-two patients with unresectable HCC, as determined by a tumor board, were assigned to undergo TACE and were treated with PEG drug-elutable embolics loaded with doxorubicin. Patients were prospectively enrolled and included 32 (76%) men and 10 (24%) women. Their median age was 65 years (range, 42-83 years). Patients were treated with 50 mg of doxorubicin loaded in 2 mL of PEG embolics (mean [± SD] diameter, 100 ± 25 µm) that were infused via a chemoembolization method. Data collected included previous cancer therapy, tumor size, number of lesions, history of TACE, tumor response (at 1, 3, and 6 months), type and intensity of adverse events, and quality of life (QOL) analysis. One month after TACE, the overall tumor response rate was 79% (50% complete response, 29% partial response, 17% stable disease, and 5% progressive disease). At 3 months, the rates were 48% for complete response, 24% for partial response, 24% for stable disease, and 3% for progressive disease. At 6 months, the rates were 43% for complete response, 19% for partial response, 29% for stable disease, and 10% for progressive disease. TACE was well tolerated by all patients, with no evidence of procedure-related complications or systemic drug-related adverse events. Fever (33%), increase in transaminase level (17%), and pain (33%) were the most frequent adverse events, and their intensity was mostly mild (grades 1 and 2). The QOL scores were 80 at 1 month, 81 at 3 months, and 82 at 6 months after TACE. These data suggest that PEG embolics are efficacious and safe for the treatment of HCC, as indicated by their good tolerability, QOL scores, and high tumor response.

Online support groups for women with breast cancer.

Online support groups for women with breast cancer.

Factors associated with adherence to disease modifying therapy in multiple sclerosis: An observational survey from a referral center in Lithuania

Aim of the studyTo investigate adherence to disease modifying therapy (DMT) in Lithuanian population of multiple sclerosis patients and factors associated to it. MethodsPatients receiving one of the following DMT's: Interferon β 1a (Rebif) 44 micrograms three times a week subdermally (s/c) or Interferon β 1a (Avonex) 30 micrograms weekly intramuscularly (i/m), or Interferon β 1b (Betaferon, Extavia) 250 micrograms once in two days s/c, or Glatiramer acetate (Copaxone) 20mg daily s/c, were presented with a questionnaire inquiring their demographic and clinical characteristics and adherence to treatment profile, as well as HAD scale and SF-36 questionnaire. Those who missed at least one dose of DMT during last three months were considered non-adherent. ResultsIn total, 207 patients were enrolled, 73 (35.3%) of them were non adherent during last three months. More patients with university education (p=0.004, χ2 =8.466 high school/vocational vs. university) as well as consuming >4 units/year of alcohol were non-adherent during last three months (p=0.005). Average score for anxiety (6.69±4.03 vs. 6.92±4.24) and depression (4.74±3.9 vs. 4.7±3.83) in HAD scale did not differ significantly between adherent and non-adherent groups. We did not find any significant difference in quality of life scores (SF-36 v.2) between the groups. No significant difference of adherence was found then comparing patients often suffering from drug side effects with those who experience rare or no side effects. In logistic regression model, patients consuming more than 4 alcohol units per year and patients with university education were more likely to miss at least one dose during last three months: 2.121 (95% CI: 1.143–3.937, p=0.017) and 2.409 (95% CI: 1.260–4.642, p=0.008) times accordingly. Patients with better quality of life scores were slightly less likely to be non adherent (OR 0.997 (95% CI: 0.994–0.999), p=0.0017). ConclusionsOne third of patients were non-adherent during last three months. Worse adherence rates were associated with higher education and higher alcohol consumption. Education, alcohol consumption and quality of life scores were found to be significant factors for predicting non-adherence. We found no associations between adherence and anxiety, depression, or drugs side effects.

Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial

SummaryBackgroundTwo commonly performed surgical interventions are available for severe (grade II–IV) haemorrhoids; traditional excisional surgery and stapled haemorrhoidopexy. Uncertainty exists as to which is most effective. The eTHoS trial was designed to establish the clinical effectiveness and cost-effectiveness of stapled haemorrhoidopexy compared with traditional excisional surgery.MethodsThe eTHoS trial was a large, open-label, multicentre, parallel-group, pragmatic randomised controlled trial done in adult participants (aged 18 years or older) referred to hospital for surgical treatment for grade II–IV haemorrhoids. Participants were randomly assigned (1:1) to receive either traditional excisional surgery or stapled haemorrhoidopexy. Randomisation was minimised according to baseline EuroQol 5 dimensions 3 level score (EQ-5D-3L), haemorrhoid grade, sex, and centre with an automated system to stapled haemorrhoidopexy or traditional excisional surgery. The primary outcome was area under the quality of life curve (AUC) measured with the EQ-5D-3L descriptive system over 24 months, assessed according to the randomised groups. The primary outcome measure was analysed using linear regression with adjustment for the minimisation variables. This trial is registered with the ISRCTN registry, number ISRCTN80061723.FindingsBetween Jan 13, 2011, and Aug 1, 2014, 777 patients were randomised (389 to receive stapled haemorrhoidopexy and 388 to receive traditional excisional surgery). Stapled haemorrhoidopexy was less painful than traditional excisional surgery in the short term and surgical complication rates were similar between groups. The EQ-5D-3L AUC score was higher in the traditional excisional surgery group than the stapled haemorrhoidopexy group over 24 months; mean difference −0·073 (95% CI −0·140 to −0·006; p=0·0342). EQ-5D-3L was higher for stapled haemorrhoidopexy in the first 6 weeks after surgery, the traditional excisional surgery group had significantly better quality of life scores than the stapled haemorrhoidopexy group. 24 (7%) of 338 participants who received stapled haemorrhoidopexy and 33 (9%) of 352 participants who received traditional excisional surgery had serious adverse events.InterpretationAs part of a tailored management plan for haemorrhoids, traditional excisional surgery should be considered over stapled haemorrhoidopexy as the surgical treatment of choice.FundingNational Institute for Health Research Health Technology Assessment programme.

An Exploratory Study to Determine the Quality of Life (QoL) and Factors Leading to Imprisonment among Women Prisoners in a Selected Women Prison

The research study titled “An exploratory study to determine the quality of life (QoL) and factors leading to imprisonment among women prisoners in a selected women prison” was based on the objectives; to determine the quality of life of women prisoners, to explore the factors leading to imprisonment, to find the association between the QoL of women prisoners and selected socio demographic and clinical variables, to find the association between the QoL and domains of quality of life of women prisoners and to find the association between the QoL of women prisoners and factors leading to imprisonment. Survey approach with an exploratory design was adopted and was conducted in a selected women prison. The conceptual framework was based on the Quality of Life model at the Centre for Health Promotion, University of Toronto. The study had primary outcome variables as quality of life and factors leading to imprisonment among women prisoners. Seventy samples were selected by purposive sampling technique. The tools used for the study were validated, pretested and the reliability also was established. The major findings of the study revealed that 43 (61.4%) participants have good quality of life. Among seventy participants 21 (30%) of them had poor QoL in psychological domain. Thirty seven (52.9%) of the participants had good QoL score in physical domain and 36 (51.4%) of them had medium QoL score in psychological domain. Majority 51 (72.9%) of the samples had good QoL score in social domain and 46 (65.7%) of them had good QoL score in environmental domain. Majority i.e. 61 (87.1%) of them had good QoL score in spiritual domain. Among the 70 participants, 10 (14.3%) of the participants had poverty as the leading reason for committing crime, followed by 8 (11.4%) having physical abuse and another 8 (11.4%) having family breakdown as the factor leading to imprisonment. Among the socio demographic variables; age of women prisoners has statistically significant association with the QoL of women prisoners (p<0.05). Among the clinical variables; Blood pressure and Lipid profile (Total serum cholesterol) have statistically significant association with quality of life (p=0.048). Physical, psychological and social domains have statistically significant association with the QoL of women prisoners (p<0.05). Factors leading to imprisonment has statistically significant association with the QoL of women prisoners (p <0.05).