Greater Improvement In Quality Research Articles

Matching-Adjusted Indirect Comparison of Risankizumab Versus Deucravacitinib in Patients with Moderate-to-Severe Plaque Psoriasis.

Despite advancements in the treatment of psoriasis (PsO), there are few head-to-head studies assessing comparative effectiveness of the newest therapies approved to treat PsO. Our objective was to assess the comparative clinical effectiveness of risankizumab and deucravacitinib in patients with moderate-to-severe PsO. This placebo-anchored matching-adjusted indirect comparison (MAIC) analysis utilized data from UltIMMa-1/2 risankizumab and POETYK PSO-1/2 deucravacitinib trials. Individual patient data from UltiMMA-1/2 were weighted via propensity score to match POETYK PSO-1/2 published summary data. Rate differences between risankizumab and deucravacitinib were assessed for Psoriasis Area and Severity Index (PASI) 75/90/100, the Static Physician Global Assessment (sPGA = 0 or 0/1), and the Dermatology Life Quality Index (DLQI) 0/1. At 16weeks, risankizumab-treated patients demonstrated statistically significantly higher rates of skin clearance and greater improvement in quality of life (QoL) compared to those treated with deucravacitinib. Across all outcomes, risankizumab demonstrated a lower number needed to treat compared to deucravacitinib. Limitations are potential bias due to unobserved/unmeasurable differences and limited generalizability of the results. This indirect comparison demonstrates that risankizumab has higher rates of skin clearance and greater improvements in QoL than deucravacitinib. This study will help inform healthcare providers in their treatment and management strategy of PsO.

Quality of Life after Deep Brain Stimulation in Parkinson's Disease: Does the Target Matter?

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is an accepted therapy for Parkinson's disease (PD) with disabling motor complications. For elderly patients with poorer cognition and postural instability, GPi has been proposed as the preferable DBS target based on expert opinion, arguing GPi-DBS may be less complicated by depression, apathy, worsened verbal fluency, and executive dysfunction, resulting in greater improvement in quality of life (QoL). However, data supporting such patient-tailored approach are lacking. The aims were to analyze whether the DBS target influences QoL in a PD cohort and a matched subgroup of frail patients with poor cognitive status and reduced postural stability, and whether other factors affect the QoL outcomes. In this retrospective study, we analyzed a single-center cohort of 138 PD patients who received bilateral STN-DBS (117) or GPi-DBS (21) using the mentioned approach for target selection. All patients underwent standardized clinical evaluations of motor- and nonmotor signs as well as QoL before and 1 year after surgery. DBS of both targets improved motor signs, dyskinesias, and pain. QoL improved without significant difference between the targets, but with a trend for greater improvement across all QoL domains in favor of the STN, even in an STN subgroup matched to the GPi group. Our results contradict the prevailing belief that GPi-DBS is superior in frail PD patients with cognitive decline and postural instability, questioning the proposed patient-tailored approach of DBS target selection. Further studies are needed for a data-driven approach.

Virtual care for paediatric asthma: A randomized controlled trial.

This work aims to investigate whether virtual care can improve clinical outcomes for children with asthma, similar to face-to-face specialty care. The study used a randomized controlled trial design, with participants allocated to either a virtual care group (n = 47) or a control group (n = 50) using simple randomization. The study was conducted from March to August 2021, and a sample of 97 children with asthma was recruited. Children in the virtual care group received online training in four modules within the first month and support through virtual meetings and phone or video calls, while the control group received standard care. The primary outcome of the study was the Asthma Control Test and Child Asthma Control Test. The virtual care group had significantly better outcomes than the control group in terms of C-ACT scores for children aged 7-11 years, fewer days under 80% of the optimum level of peak expiratory flow, lower peak expiratory flow variability, fewer rescue medication uses, and more symptom-free days. The virtual care group also had a lower number of unscheduled hospital visits and a greater improvement in quality of life compared with the control group. This study demonstrated that virtual care can improve disease management and quality of life for children with asthma.

Dietary supplementation with a wild green oat extract (Avena sativa L.) to improve wellness and wellbeing during smoking reduction or cessation: a randomized double-blind controlled study.

Smoking reduction or cessation are critical public health goals, given the well-documented risks of tobacco use to health. Reducing smoking frequency and cessation entirely are challenging due to nicotine addiction and withdrawal symptoms, which can significantly affect mental wellness and overall wellbeing. Previous research has suggested that certain dietary supplements may support smoking cessation and reduction efforts by mitigating these adverse effects. The objective of this study was to assess the effect of supplementation with 900 mg/day of Neuravena®, a green oat extract (GOE) of Avena sativa L., in enhancing wellness and wellbeing during a smoking reduction or cessation experience. This was an 8-week randomized, double-blind, placebo-controlled study, ClinicalTrials Identifier: NCT04749017 (https://classic.clinicaltrials.gov/ct2/show/NCT04749017). Participants were assigned to one of the study groups, 72 participants were assigned to GOE and 73 to placebo. The subjects were followed for 8-weeks intervention period as well as an additional 4-week follow-up period. At subsequent visits, they underwent clinical assessments including assessments of quality of life, perceived stress, depression, nicotine dependence, anxiety, cognitive performance, and specific assessments of craving intensity. GOE was associated with greater improvements in elements of the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire as compared with placebo. Similar results were obtained from the SF-36 questionnaire and a visual QoL analogue scale (VAS). Perceived stress levels showed greater decline from baseline among the GOE supplemented participants as compared to placebo. Sleep quality parameters improved with GOE supplementation and worsened in the placebo group. At the end of the intervention period, the percentage of successful reducers (defined as >20% reduction in daily cigarettes) was higher in the GOE group as compared to placebo (66.7% vs. 49.3%, p = 0.034). The improvements from baseline in QoL measures in the GOE group persisted at 4 weeks after termination of the intervention. GOE supplementation demonstrated greater improvements in quality of life measures, stress and sleep related parameters during a smoking reduction or cessation experience and the product was shown to be safe and well tolerated.

Impact of Empowerment Theory-Based Nursing Intervention on the Quality of Life and Negative Emotions of Patients Diagnosed with Brain Metastasis Post Breast Cancer Surgery.

This study explores the impact of a nursing intervention grounded in empowerment theory, focusing on behavioral change, on brain metastasis patients post-breast cancer surgery. Between June 2021 and June 2023, 102 patients diagnosed with brain metastasis after breast cancer surgery at Bao Ding No.1 Central Hospital were randomized into two groups. The control group (51 patients) received standard nursing care, while the observation group (51 patients) participated in a behavioral change nursing intervention influenced by empowerment theory. The evaluation metrics included measures of negative emotions, compliance with treatment protocols, overall quality of life, and nursing satisfaction, assessed at multiple time points during the study period. The intervention led to significant reductions in negative emotions for all patients when compared to their pre-intervention statuses, with the observation group exhibiting notably lower depression and anxiety scores at one and three months post-intervention (P < 0.05). Additionally, this group achieved higher compliance scores and demonstrated greater improvements in quality of life than the control group (P < 0.05). Nursing satisfaction was also significantly higher in the observation group, with 96.08% reporting high satisfaction compared to 80.39% in the control group (P < 0.05). Implementing a nursing intervention that emphasizes behavioral changes and leverages empowerment theory significantly enhances the quality of life, reduces negative emotions, boosts compliance with treatment, and increases nursing satisfaction among patients with brain metastasis following breast cancer surgery. This suggests that such interventions could be a valuable component of postoperative care for this patient population.

The psychological well-being index and quality of life after a cardiac rehabilitation program based on aerobic training and psychosocial support

BackgroundThis study aimed to investigate the physical and psychological benefits of an alternative cardiac rehabilitation program based on therapeutic groups during physical exercise sessions and to compare the results with those of a conventional cardiac rehabilitation program. MethodThe sample included 112 patients from the cardiac rehabilitation unit of a medical center, 91.1 % of whom were male. The control group consisted of 47 subjects, with a mean age of 57.89 ± 12.30 and the experimental group consisted of 65 subjects, with a mean age of M = 58.38 ± 9.86. Quality of life, psychological well-being, health-related quality of life, body mass index, blood pressure, abdominal circumference and resting heart rate were measured before starting and at the end of the cardiac rehabilitation program. ResultsThe experimental group improved significantly more than the control group in body mass index, systolic and diastolic blood pressure, abdominal circumference, and resting heart rate (p value < 0.005). In addition, the experimental group had significantly greater improvements in quality of life, psychological well-being, and health-related quality of life than the control group (p-value < 0.001). ConclusionsA cardiac rehabilitation program based on simultaneous aerobic training and psychosocial support improved the physical function, health-related quality of life and well-being.

Assessing the effects of prehabilitation protocols on post-operative outcomes in adult cervical deformity surgery: does early optimization lead to optimal clinical outcomes?

To investigate the effect of a prehabilitation program on peri- and post-operative outcomes in adult cervical deformity (CD) surgery. Operative CD patients ≥ 18years with complete baseline (BL) and 2-year (2Y) data were stratified by enrollment in a prehabilitation program beginning in 2019. Patients were stratified as having undergone prehabilitation (Prehab+) or not (Prehab-). Differences in pre and post-op factors were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. 115 patients were included (age: 61years, 70% female, BMI: 28kg/m2). Of these patients, 57 (49%) were classified as Prehab+. At baseline, groups were comparable in age, gender, BMI, CCI, and frailty. Surgically, Prehab+ were able to undergo longer procedures (p = 0.017) with equivalent EBL (p = 0.627), and shorter SICU stay (p < 0.001). Post-operatively, Prehab+ patients reported greater reduction in pain scores and greater improvement in quality of life metrics at both 1Y and 2Y than Prehab- patients (all p < 0.05). Prehab+ patients reported significantly less complications overall, as well as less need for reoperation (all p < 0.05). Introducing prehabilitation protocols in adult cervical deformity surgery may aid in improving patient physiological status, enabling patients to undergo longer surgeries with lessened risk of peri- and post-operative complications.

Early Oligoarticular Psoriatic Arthritis Responds to Treatment With Apremilast: Week 16 Results From FOREMOST - a Phase 4 Randomized Controlled Trial

Early Oligoarticular Psoriatic Arthritis Responds to Treatment With Apremilast: Week 16 Results From FOREMOST – a Phase 4 Randomized Controlled Trial&#x0D; Laure Gossec1, Dafna Gladman2, Laura C. Coates3, Jacob Aelion4, Jitendra Vasandani5, Jyotsna Reddy6, Rebecca Wang6, Michele Brunori6, Stephen Colgan6, Philip Mease7&#x0D; 1Sorbonne Université and Pitié Salpêtrière Hospital, Paris, France; 2Toronto Western Hospital, Toronto, ON, Canada; 3University of Oxford, Oxford, UK; 4West Tennessee Research Institute, Jackson, TN, USA; 5West Texas Clinical Research, Lubbock, TX, USA; 6Amgen Inc., Thousand Oaks, CA, USA; 7Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, WA, USA&#x0D; Introduction &amp; Objectives:&#x0D; Psoriatic arthritis (PsA) is underdiagnosed in dermatology practice, typically presenting 10 years after skin symptoms. Dermatologists may encounter early PsA since up to 30% of patients with psoriasis have PsA. Oligoarticular PsA affects ≤4 joints, is very common, and is underrepresented in clinical trials as most pivotal studies exclude patients with &lt;3 swollen and tender joints. Here, we report the efficacy and safety of apremilast vs. placebo for the treatment of early oligoarticular PsA.&#x0D; Materials &amp; Methods:&#x0D; FOREMOST (NCT03747939) is a phase 4, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Patients with PsA,based on CAPSAR criteria, duration ≤5 years, swollen joint count (SJC) &gt;1 but ≤4, and tender joint count (TJC) &gt;1 but ≤4 were randomized 2:1 to apremilast 30 mg BID (APR) or placebo for 24 weeks. The primary endpoint was the achievement of minimal disease activity (MDA)-Joints1 (mandating SJC ≤1 and TJC ≤1, and 3/5 alternate items) at week 16.&#x0D; Results:&#x0D; Of 308 patients randomized (APR: n=203; placebo: n=105), mean PsA duration was 9.9 months, mean age was 50.9 years, and 39.9% of patients were using csDMARD. MDA-Joints response was achieved in 33.9% vs. 16.0% for patients treated with APR vs. placebo (primary endpoint, P=0.0008). At week 16, a significantly greater proportion, 70.2%, of patients treated with APR achieved cDAPSA REM/LDA vs. 51.8% with placebo (P=0.0017). A greater proportion of patients achieved a good/moderate response in PASDAS score with APR (59.9%) vs. placebo (42.7%). Greater improvements from baseline in PsA Impact of Disease (PsAID)-12 score (LS mean change, −1.5 vs. −0.4; nominal P&lt;0.0001) and nail psoriasis score (visual analog scale [VAS]; LS mean change, −13.9 vs. −6.8; nominal P=0.0094) were observed with APR vs. placebo at week 16. Patients treated with APR also achieved greater improvement in quality of life measures (Patient Pain [VAS ≤15: 59.6 vs. 13.8; nominal P=0.0022], Patient Global Assessment [PtGA; VAS ≤20: 61.7 vs. 20.1; nominal P=0.0286]) when compared to placebo at week 16. No new safety signals were identified.&#x0D; Conclusion:&#x0D; FOREMOST is the first global randomized controlled trial exclusively studying early oligoarticular PsA. We report the first results of FOREMOST, the primary outcome, and show better disease control is achievable with APR, with twice the MDA-Joint response compared with placebo at 16 weeks. These findings show APR treatment of early oligoarticular PsA improves clinical and quality of life outcomes and may inform optimal management of these patients.&#x0D; Reference: 1. Coates LC, et al. J Rheumatol. 2016;43:371–5.

Effect of duration of preoperative pain on outcomes of total temporomandibular joint replacement

The purpose of the study was to determine whether the duration of preoperative pain affects outcomes of temporomandibular joint replacement (TMJR). Twenty-seven patients who underwent primary TMJR between 1 July 2020 and 31 October 2022 were retrospectively assessed for duration of preoperative pain, level of preoperative and postoperative pain on a visual analogue scale (VAS; 0, none; 10, severe), preoperative and postoperative range of motion (ROM), and net change in quality of life (much better, better, same, worse, much worse), reporting the longest available follow up for each patient. Surgical success was defined as postoperative pain of ≤4 and postoperative ROM of ≥30 mm, or net change (Δ) in ROM of ≥10 mm. Regression analyses evaluated associations between independent variables and postoperative pain and ROM. At a mean follow-up of 17.8 (SD: 6.8, range 3-32) months , pain (5.1, SD: 2.2, p < 0.001) and ROM (9.3 mm, SD: 8.0, p<0.001) significantly improved. Quality of life was much better in 16 patients, better in eight, the same in one, and worse in two. Longer duration of preoperative pain tended to be negatively associated with postoperative ROM (β = −0.27; 95% CI −0.6 to 0.0; p = 0.078) but was not associated with severity of postoperative pain. Surgical success was achieved in 23/27 patients. The successful group tended to have lower pain on VAS preoperatively (5.9, SD: 1.9) vs 7.5, SD: 1.3) and postoperatively (0.4, SD: 0.8 vs 4.8, SD: 2.6), and greater improvement in quality of life (much better: 14/23 vs 2/4). In conclusion, longer duration of preoperative pain tended to be associated with worse postoperative ROM following TMJR. Higher preoperative pain may be a predictor for unsuccessful surgery.

Evaluation of patient reported outcome measures and costs of managing osteoarthritis of the hip.

The number of hospital admissions for a hip prosthesis increased by more than 91% between 2002 and 2019 in Belgium (1), making it one of the most common interventions in hospitals. The objective of this study is to evaluate patient-report- ed outcomes and hospital costs of hip replacement six months after surgery. Both generic (EQ-5D) and specific (HOOS) PROMs of general hospital patients undergoing hip replacement surgery in 2021 were conducted. The results of these PROMs were then combined with financial and health management data. The mean difference (SD) in QALYs between the preoperative and postoperative phases is 0.20 QALYs (0.32 QALYs). The average cost (SD) of all stays is €4,792 (€1,640). Amongst the five dimensions evaluated in the EQ-5D health questionnaire, the 'pain' dimension seems to be associated with the greatest improvement in quality of life. As regards Belgium, the 26,066 arthroplasties performed in 2020 might constitute a gain of 123,000 years of life in good health. The relationship between QALYs and costs described in this study posits a ratio of €23,960 per year of life gained in good health. Given that in Belgium more than 3% of the hospital healthcare budget is devoted to hip prostheses, it would seem relevant to us to apply PROM tools to the entire patient population to assess treatment effectiveness more broadly, identify patient needs and, also, monitor the quality of care provided.

Эффективность и безопасность терапии мометазона фуроатом в сравнении с цетиризином у взрослых пациентов с сезонным аллергическим ринитом в условиях реальной клинической практики

Background: both H1-histamine blockers and intranasal corticosteroids are recommended as step 2 pharmacotherapy for allergic rhinitis (AR). Aim: to compare cetirizine and mometasone furoate (nasal spray) for AR treatment in patients requiring step 2 therapy in real-world clinical practice. Patients and Methods: this study enrolled 160 patients aged 18–75 years suffering from AR with pollen sensitization and requiring step 2 of therapy. The study was observational, open-label, comparative, and non-interventional. The patients were divided into two groups: main group (MG; n=80) who received over-the-counter medicine mometasone furoate (nasal spray) 200 μg/day regimen and comparison group (CG; n=80) who received cetirizine 10 mg/day orally for 1 month±2 days. Patients had three office visits. Each visit included a physical examination, anterior rhinoscopy, and self-assessment using the visual analog scale (VAS). Both patients and physicians completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Results: treatment efficacy was excellent (0-1 VAS score) in 52 (65%) patients in the CG and in 76 patients in the MG (95%, p&lt;0.05). Treatment efficacy was good (2-5 VAS scores) in 12 (15%) patients in the CG and in 4 (5%) patients in the MG. The study found that 5% of patients in the CG reported satisfactory results compared to 0% in the MG. Additionally, a significant difference (p&lt;0.001) in the reduction of the RQLQ score was reported among patients who experienced an improvement in quality of life by day 14 of treatment in the CG (-80.3±19.3) and MG (-113.3±34.7). The effectiveness of mometasone furoate (200 μg/day) as a monotherapy for 4 weeks was found to be superior to cetirizine treatment (10mg/day). Additionally, it was associated with a greater improvement in quality of life and better treatment tolerability due to fewer adverse events. Conclusions: mometasone furoate (nasal spray) can be recommended as a monotherapy for adults with mild to moderate AR. KEYWORDS: seasonal allergic rhinitis, mometasone furoate, cetirizine, intranasal corticosteroids, oral antihistamines. FOR CITATION: Churyukina E.V., Gamova I.V. Efficacy and safety of mometasone furoate therapy versus cetirizine in adults with seasonal allergic rhinitis in a real-world clinical setting. Russian Medical Inquiry. 2024;8(3):132–142 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-3-3.

Assessing the Scalability of a Community-Based Self-Management Intervention for Older Adults with Diabetes and other Chronic Conditions – The Aging, Community and Health Research Unit Community Partnership Program (ACHRU-CPP)

Background: A multi-pronged approach was undertaken to assess the scalability of the Aging, Community and Health Research Unit – Community Partnership Program (ACHRU-CPP), a complex, integrated 6-month self-management program for community-living older adults with diabetes and multimorbidity and their caregivers, in two Canadian provinces. The ACHRU-CPP was co-designed by patients, caregivers, home and community-care providers, and researchers, in response to a gap identified by older adults in the self-management of their diabetes and other conditions. The intervention was tested in a feasibility study and an earlier pragmatic trial found that older adults who received the ACHRU-CPP experienced greater improvements in quality of life and self-management, and greater reduction in depressive symptoms, compared to those who received usual diabetes care, at no additional cost to society. Delivered by a collaborative team of primary care providers (registered nurses, registered dietitians) and a community program coordinator, key components include home visits, group wellness sessions, team-based case conferences, caregiver support, interprofessional collaboration, and nurse-led care coordination. Scalability assessment is an integral phase of the current research program, which evaluated the effectiveness and implementation of the ACHRU-CPP in four settings in Ontario (ON) and Prince Edward Island (PEI).&#x0D; Methods: Multiple methods were used to assess scalability of the ACHRU-CPP in ON and PEI: an environmental scan, individual key informant interviews, and qualitative and quantitative data from both the foundational studies and the current trial of ACHRU-CPP implementation and effectiveness. The Intervention Scalability Assessment Tool (ISAT) guided data collection and analysis. The environmental scan was conducted with strategic input from Scalability Working Groups in ON and PEI. These groups were comprised of members of the program’s governance structure, including patient and public research partners, researchers, primary care and community service providers and administrators, and policy- and decision-makers. These partners advised on relevant research and policy documents, identified potential key informants (i.e., policy- and decision-makers at the local, provincial, and national levels), and will participate in scalability assessment workshops in ON and PEI in late 2022, to finalize the scalability assessment, and identify components of the intervention to be strengthened, and barriers to be addressed to enhance the scalability of the program, in each province.&#x0D; &#x0D; Results: To date, the results of the scalability assessment have identified areas of strength and limitations within the program, most notably issues with health human resources, mixed results regarding the effectiveness of the program, and other resource gaps.&#x0D; Conclusion: This study has evaluated the scalability of a community-based program for older adults with diabetes and multiple chronic conditions that integrates primary and community care. It also provides valuable insight on the usefulness and feasibility of the ISAT for assessing scalability, as well as strategies to engage strategic practice, policy, and public partners in the process. &#x0D; Next steps: While scale-up of the ACHRU-CPP may be merited due to the prevalence of diabetes and multimorbidity among older adults, and alignment of this program with health policy, several barriers need to be addressed before scale-up can be recommended.&#x0D;

Evaluation of a novel eating disorder prevention program for young women with type 1 diabetes: A preliminary randomized trial

ObjectiveEvaluate whether the Body Project prevention program adapted for young women with type 1 diabetes (Diabetes Body Project) reduces eating disorder (ED) risk factors and symptoms. MethodsYoung women (aged 15–30) at high-risk for EDs due to having type 1 diabetes and body image concerns (N = 55) were randomized to virtually delivered Diabetes Body Project groups or an educational control condition, completing measures at pretest, posttest, and 3-month follow-up. ResultsDiabetes Body Project versus the control participants showed significantly greater reductions in thin-ideal internalization, body dissatisfaction, diabetes distress, diabetes eating pathology, and ED symptoms by posttest, and greater reductions in diabetes eating pathology and ED symptoms, and greater improvements in quality of life by 3-month follow-up, which were medium to large effects (d’s ranged from −0.43 to −0.90). Although control participants showed a worsening of glycemic control (time in range) verses Diabetes Body Project participants, this difference was non-significant (d = 0.26). ConclusionsVirtually delivered Diabetes Body Project decreased ED risk factors and symptoms in young women with type 1 diabetes. A well powered randomized controlled trial is warranted to evaluate this intervention over longer follow-up.

Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial

ABSTRACT Depression is most often treated in primary care, where the prevailing treatment is antidepressant medication. Primary care patients with depression are less likely to be exposed to psychosocial interventions, despite evidence suggesting many of these treatments are effective. An example is acceptance and commitment therapy (ACT), a behavioral treatment for depression with a growing evidence base. A self-guided ACT intervention with a peer narrative (i.e. storytelling) format was developed with the intention of creating a treatment option for primary care patients that was more accessible than traditional psychotherapy. Titled LifeStories, the online program features videos of real individuals sharing coping skills for depression based on lived experiences and key ACT principles. A total of 93 primary care patients taking antidepressants were randomized to either continued antidepressant treatment alone or antidepressant treatment plus LifeStories for 4 weeks. There were no differences over time on depression severity and psychological inflexibility. However, LifeStories led to greater improvements in quality of life and increased patients’ interest in additional treatment compared to antidepressant medication alone.Clinical trial pre-registration: ClinicalTrials.gov (NCT04757961)

Relación entre el ejercicio físico previo a la intervención y la calidad de vida en cirugía cardiaca

Introduction and objectivesThe relationship between pre-intervention physical exercise and quality of life, risk of complications or death has not been studied. MethodsProspective cohort study. Improvement in quality of life between preoperatively and at 6 months was analyzed using the EUROQOL scale and VAS. The level of physical exercise was analyzed by METS. The improvement in quality of life was evaluated according to the previous level of exercise and we studied whether the higher the level of exercise, the greater the increase in quality of life. ResultsQuality of life improved according both scales; VAS 17.8±18.8 points (p<0.001) and EUROQOL 1.1±1.1 points (p<0.001). Patients improved their quality of life. The higher level of previous exercise did not lead to a greater improvement in quality of life, but it did reduce the event of cardiogenic shock (p=0.032), complicated postoperative (p=0.034) and the combined event combined postoperative or death (p=0.027). ConclusionsCardiac surgery improves quality of life at six months for all patients. A higher level of exercise is not related with a greater improvement in quality of life. A higher level of physical exercise is associated with less risk of postoperative complications or death.

Acupuncture and moxibustion for endometriosis: A systematic review and analysis

ObjectivesThis study aimed to examine the effect of acupuncture on symptoms and health-related quality of life in patients with endometriosis. MethodsNine biomedical databases were searched to April 2022 to identify randomized controlled trials of acupuncture and/or moxibustion used alone or as adjunct to guideline-recommended pharmacotherapy for the treatment of endometriosis. One reviewer extracted data and another verified the data. A random effects model was used to calculate mean differences. ResultsFifteen trials involving 1018 patients met the inclusion criteria, but diversity in comparisons and outcome measures prevented meta-analysis. Compared to sham acupuncture, manual acupuncture was more effective at reducing dysmenorrhea VAS pain score (mean difference [MD] − 2.40, 95 % CI [− 2.80, − 2.00]; moderate certainty evidence), pelvic pain VAS score (MD − 2.65, 95 % CI [− 3.40, − 1.90]; high certainty evidence) and dyspareunia VAS scores (MD − 2.88, [− 3.83, − 1.93]), lessened the size of ovarian cyst (MD − 3.88, 95 % CI [− 7.06, − 0.70]), and improved quality of life. Compared to conventional therapy, manual acupuncture plus conventional therapy and warm needle alone resulted in greater improvements in quality of life than conventional therapy. Among the six studies that reported safety, fewer adverse events were reported in participants who received acupuncture or moxibustion. ConclusionsLow to moderate certainty evidence from single studies showed that manual acupuncture may improve pain-related symptoms and quality of life; however, there is insufficient evidence on the overall effectiveness of acupuncture and moxibustion for endometriosis.

Analysis by sex of safety and effectiveness of transvenous phrenic nerve stimulation

PurposeLittle is known about sex differences in the treatment of central sleep apnea (CSA). Our post hoc analysis of the remedē System Pivotal Trial aimed to determine sex-specific differences in the safety and effectiveness of treating moderate to severe CSA in adults with transvenous phrenic nerve stimulation (TPNS).MethodsMen and women enrolled in the remedē System Pivotal Trial were included in this post hoc analysis of the effect of TPNS on polysomnographic measures, Epworth Sleepiness Scale, and patient global assessment for quality of life.ResultsWomen (n = 16) experienced improvement in CSA metrics that were comparable to the benefits experienced by men (n = 135), with central apneas being practically eliminated post TPNS. Women experienced improvement in sleep quality and architecture that was comparable to men post TPNS. While women had lower baseline apnea hypopnea index than men, their quality of life was worse at baseline. Additionally, women reported a 25-percentage point greater improvement in quality of life compared to men after 12 months of TPNS therapy. TPNS was found to be safe in women, with no related serious adverse events through 12 months post-implant, while men had a low rate of 10%.ConclusionAlthough women had less prevalent and less severe CSA than men, they were more likely to report reduced quality of life. Transvenous phrenic nerve stimulation may be a safe and effective tool in the treatment of moderate to severe CSA in women. Larger studies of women with CSA are needed to confirm our findings.Clinical trial registrationClinicalTrials.gov NCT01816776; March 22, 2013.

Efficacy of epirubicin plus docetaxel or paclitaxel in the treatment of breast cancer

Purpose: To determine the clinical efficacy of epirubicin plus docetaxel or paclitaxel in the management of breast cancer. &#x0D; Methods: This study was a randomized controlled trial that recruited 78 patients with breast cancer treated in The First People’s Hospital of Anqing between December 2018 and March 2021. The participants were randomized to receive either epirubicin plus docetaxel (control group) or epirubicin plus paclitaxel (study group), with 39 cases in each group. Clinical outcomes, adverse events, quality of life, and prognosis of the two groups were compared. &#x0D; Results: Epirubicin plus paclitaxel produced greater efficacy than epirubicin plus docetaxel (p &lt; 0.05). The combination also exhibited a higher safety profile versus epirubicin with docetaxel, as evidenced by lower incidences of nausea and vomiting, intestinal discomfort, muscle pain, and dyspnea reactions (p &lt; 0.05). Epirubicin with paclitaxel resulted in greater improvement in quality of life in patients than epirubicin plus docetaxel (p &lt; 0.05) as well as provided more benefits in terms of survival and recurrence control than epirubicin plus docetaxel (p &lt; 0.05). &#x0D; Conclusion: Epirubicin/paclitaxel combination alleviates clinical symptoms, reduces adverse events, enhances patient prognosis, lowers the risk of postoperative recurrence, and provides superior quality of life when compared to epirubicin/docetaxel combination in breast cancer patients. Nonetheless, large-scale and better-randomized clinical trials are required to validate the findings of this study.

Effect of Aerobic Training Versus Chair Aerobics on Body Mass Index and Quality of Life in Obese Desk Job Workers

Obesity is defined as an excess accumulation of body fat. A sedentary lifestyle is associated with an increase in BMI over time, thus leading to obesity. Physical activity has been shown to reduce stress and anxiety traits and to improve physical self- perception and mental well-being. In desk job profession, physical activity levels at work are low while sedentary behavior is high. Aerobic exercise training using treadmill has capacity to improve the intrinsic pump capacity of the myocardium. Participation in regular aerobic exercises is now considered an essential component in any long term obesity management. Chair aerobics is a form of aerobic exercise performed while sitting in a chair, which include upper and lower body movements led by an instructor while listening to music and sitting in a straight-back chair. Aim : to study the effect of aerobic versus chair aerobics on body mass index and quality of life in obese desk job workers. Method:The materials that will be used in this study are treadmill and chair with outcome measures as Obesity Related Well-Being Questionnaire (ORWELL-97) and BMI. 38 subjects will be randomly divided into 2 groups. Group 1(aerobic training) will be given aerobic training on treadmill for 30 minutes, 3 times per week for 2 months. Group 2 (chair aerobics) will be given Chair aerobics for 30 minutes 4 times per week for 2 months. Pre &amp; post intervention assessments i.e. body mass index and ORWELL- 97 Questionnaire will give the final result for the given topic. Outcome measures: Prior and after treatment both the outcome measures, Body Mass Index (BMI) and quality of life using Obesity Related Well Being Questionnaire (ORWELL-97) were measured. Result: The result of the present study demonstrates that in group 1there was greater reduction in body weight as compared to group 2 but there was greater improvement in quality of life in group 2 than in group 1. There was no significant effect statistically in BMI in both the groups. Conclusion: Study was done exclusively on desk job workers to compare the effect of aerobic training versus chair aerobics on BMI and quality of life. Aerobic training using treadmill showed greater reduction in body weight as compared to chair aerobics. Chair aerobics showed greater improvement in quality of life as compared to aerobic training using treadmill.

Minimal Clinically Important Differences in Inspiratory Muscle Function Variables after a Respiratory Muscle Training Programme in Individuals with Long-Term Post-COVID-19 Symptoms

To establish the minimal clinically important difference (MCID) for inspiratory muscle strength (MIP) and endurance (IME) in individuals with long-term post-COVID-19 symptoms, as well as to ascertain which of the variables has a greater discriminatory capacity and to compare changes between individuals classified by the MCID. Secondary analysis of randomised controlled trial of data from 42 individuals who performed an 8-week intervention of respiratory muscle training programme. A change of at least 18 cmH2O and 22.1% of that predicted for MIP and 328.5s for IME represented the MCID. All variables showed acceptable discrimination between individuals who classified as "improved" and those classified as "stable/not improved" (area under the curve ≥0.73). MIP was the variable with the best discriminative ability when expressed as a percentage of prediction (Youden index, 0.67; sensitivity, 76.9%; specificity, 89.7%). Participants classified as "improved" had significantly greater improvements in quality of life and lung function compared with the participants classified as "stable/not improved". In individuals with long-term post-COVID-19 symptoms, the inspiratory muscle function variables had an acceptable discriminative ability to assess the efficacy of a respiratory muscle training programme. MIP was the variable with the best discriminative ability, showing better overall performance when expressed as a percentage of prediction.